Systemic Antibacterial Agents Research Articles

Evaluation of antimicrobial purchasing by companion animal veterinary facilities in Canada, the United Kingdom, and the United States of America (2019-2021).

Measuring antimicrobial use is a core component of antimicrobial stewardship. Purchasing data may be easier to obtain than prescription data in some situations, but differences in clinic size, caseload and collection timeframes must be considered. Our objective was to evaluate purchases of systemic antibacterial agents by small animal veterinary facilities in 5 networks across 3 countries, using a mg/veterinarian full time equivalent (FTE)/week as the metric. Data were obtained from purchasing records of 2194 veterinary facilities from networks from the United States (US, n = 3: US-A, 1036 facilities; US-B, 101 facilities; US-C, 886 facilities), Canada (n = 1: 117 facilities) and the United Kingdom (UK, n = 1: 54 facilities) during 2019-2021. In total, 20 020 269 767 mg (20.02 t) of antimicrobials were purchased. Overall differences between the UK and North America were driven by significantly higher purchases of amoxicillin-clavulanic acid in the UK (P < .001), with substantially less purchasing of third generation cephalosporins in the UK (P < .0001). A significant association was found between FTE and purchasing, with decreased purchasing (mg/FTE/week) as facility FTE increased. Significant differences also were found among US regions. Facilities in the top 10% of total purchasing accounted for 23%-30% of purchases, compared to only 1.6%-3.8% for the bottom 10%. These data provide useful information about general purchasing trends, inter- and intraregional differences and differences among facility types and identify high purchasing outliers for further investigation.

The efficacy of bacteriophage/probiotic combination therapy in periodontal treatment

Relevance. Periodontal inflammations result from chronic, persistent infections triggered by dysbiosis-induced shifts within the microbial community. The high prevalence, multifactorial nature and challenging management of periodontal disease create an environment ripe for ongoing advancements in treatment modalities.Study objective: To validate, using clinical and laboratory test data, the efficacy of combined treatment involving bacteriophages and probiotics in managing chronic periodontitis.Materials and methods. A total of 100 patients aged 18 to 45 with periodontal inflammation underwent clinical laboratory examinations before receiving combination treatment. The patients were divided into two groups: Group 1 received conventional treatment based on clinical recommendations, while Group 2 received sequential treatment with a bacteriophage cocktail (targeting 81 phages against A. actinomycetemcomitans, B. licheniformis, B. fragilis, E. cloacae, E. faecalis, K. pneumonia, S. aureus, S. pyogenes, Wolinella spp. among others) followed by a probiotic containing S. Salivarius. Periodontal pocket lavages served as study material. Periodontal pathogens were isolated using real-time PCR, and proinflammatory cytokines were identified via enzyme immunoassay. Statistical analysis was conducted using STATA v.12 software.Results. Following bacteriophage/probiotic combination treatment, positive changes in study indices and a reduction in periodontopathogenic microbiota were observed. Significant decreases were noted in the levels of key periodontal pathogens: P. gingivalis (5.2-fold decrease, p &lt; 0.001), P. intermedia (3.6-fold decrease, p &lt; 0.001; T. forsythia (3.8-fold decrease, p = 0.905), T. denticola 4-fold decrease, p &lt; 0.001. Levels of IL1-β decreased by factors of 4.29 (p &lt; 0.001) and 8.59 (p = 0.02) in severity subgroups, while IL6 levels decreased by factors of 4.39 (p &lt; 0.001) and 5.94 (p = 0.0002). The lowest TNF-α levels (2.13 in mild CGP subgroup and 2.11 in moderate CGP subgroup) were observed post-treatment (p &lt; 0.001; p = 0.0005).Conclusion. The combination treatment involving the selected drugs exhibited notable therapeutic effectiveness in the management of chronic periodontitis. This approach not only avoided the necessity for systemic antibacterial agents but also facilitated prolonged remission by eradicating periodontopathogenic microbiota in patients with chronic periodontitis. The etiopathogenetic nature of this treatment represents a promising paradigm in the management of periodontal inflammation.

Evaluation of the impact of tragacanth/xanthan gum interpolymer complexation with chitosan on pharmaceutical performance of gels with secnidazole as potential periodontal treatment

Periodontitis consists a group of dental disorders that affect about 70 % of the world population. The therapy mainly relies on mechanical removing bacterial biofilm, nevertheless, local or systemic antibacterial agents play a key role in treating the acute conditions. Secnidazole is a newer derivative of commonly used metronidazole with high safety profile and broad spectrum of antimicrobial activity. The aim of the study was to evaluate the applicability of polyelectrolyte complex-based hydrogels composed of anionic tragacanth with addition of xanthan gum and cationic chitosan as carriers for buccal/intra pocket delivery of secnidazole. Prepared hydrogels with 5 % and 10 % (w/w) drug content were evaluated pharmaceutically towards inter alia physicomechanical, rheological and thermal properties, drug release kinetics, swelling behavior or antimicrobial activity. Cytotoxicity against human primary umbilical vein endothelial cells was also assessed with two independent method. Stable compositions with secnidazole were obtained, however, various miscibility of the drug with the polymers was noted. By adding chitosan, antibacterial activity and swelling performance of the gels were improved, nevertheless, drop of the mucoadhesiveness was also recorded. Hydrogels with 5 % secnidazole were selected as effective antimicrobial compositions with the highest cytocompatibility. They might be considered as promising for oromucosal application with special attention given to SEC as an alternative locally administered antimicrobial agent.

Topical antibiotic therapy for perforated otitis in the COVID-19 pandemic

The developing resistance of microorganisms to the effects of antibacterial drugs creates difficulties in the treatment of purulent diseases. This is especially reasonable in the pandemic of a new coronavirus infection (COVID-19). The aggressive effect of new strains of the virus on the mucous membrane of the nasal cavity and nasopharynx contributes to the occurrence of complications such as acute purulent otitis media and exacerbation of chronic purulent otitis, both during coronavirusinfection and in the postcovid period. Even before the start of the pandemic, antibiotic resistance was already one of the big problems in most countries of the world, this was due to the frequent unjustified appointment of systemic antibacterial agents for viral infection, as well as uncontrolled self-medication of the population with all available drugs. Due to the fear of people getting sick with COVID-19 and disagreements among doctors in treatment tactics, the use of systemic antibiotics and hormonal drugs increased already in the first months of the pandemic. In the future, the unjustifiability of this tactic was proved, but many doctors continued to prescribe several systemic antibacterial drugs to patients with uncomplicated viral infection. Under the current conditions, when there is evidence of bacterial infection, it is rational to use local antibacterial drugs, which allows you to quickly reach high concentrations in the focus of inflammation and avoid side effects of systemic antibiotics. Among the existing means in the complex therapy of perforated otitis, a special place belongs to the preparations of the group of quinoxaline derivatives, which include hydroxymethylquinoxalindioxide (Dioxidine). The advantage of the drug is its effectiveness against resistant microorganisms, as well as stimulation of marginal tissue regeneration. This property is especially important in the treatment of perforated otitis media.

Antibiotic Prescriptions in Lung Cancer and Melanoma Populations: Differences With Potential Clinical Implications in the Immunotherapy Era

IntroductionAntibiotic exposure is associated with worse clinical outcomes in patients receiving immune checkpoint inhibitors (ICI). We analyzed antibiotic prescription patterns in lung cancer and melanoma, two malignancies in which ICI are used broadly across stages. MethodsWe performed a retrospective cohort study of adults in the U.S. Veterans Affairs (VA) medical system diagnosed with lung cancer or melanoma from 2003 to 2016. We defined antibiotic exposure as receipt of a prescription for a systemic antibacterial agent between 6 months before and 6 months after cancer diagnosis. Demographics, clinical variables, prescriptions, and diagnostic codes were abstracted from the VA Corporate Data Warehouse. Antibiotic exposure was compared using t tests, Chi-square, and multivariate analyses. ResultsA total of 310,321 patients (280,068 lung cancer, 30,253 melanoma) were included in the analysis. Antibiotic exposure was more common among patients with lung cancer (42% vs. 24% for melanoma; P < .001). Among antibiotic-exposed patients, those with lung cancer were more likely to receive prescriptions for multiple antibiotics (47% vs. 30% for melanoma; P < .001). In multivariate analyses, antibiotic exposure was associated with lung cancer diagnosis (HR 1.50; 95% CI, 1.46-1.55), comorbidity score (HR 1.08; 95% CI, 1.08-1.09), non-white race (HR 1.11; 95% CI, 1.06-1.17), and female gender (HR 1.31; 95% CI, 1.24-1.37). ConclusionAmong cancer patients, antibiotics are prescribed frequently. Antibiotic exposure is more common in certain cancer types and patient populations. Given the negative effect antibiotic exposure has on immunotherapy outcomes, these observations may have clinical and healthy policy implications.

Application of Dimethyl Sulfoxide as a Therapeutic Agent and Drug Vehicle for Eye Diseases.

Dimethyl sulfoxide (DMSO) is an amphipathic molecule widely used as a solvent for water-insoluble substances, cryopreserving, and cell-biological therapies. It has known properties as an inducer of cellular differentiation, a free radical scavenger, and a radioprotectant. In addition, DMSO is used for its various therapeutic and pharmaceutical properties, such as anti-inflammatory, local and systemic analgesic, antibacterial, antifungal, antiviral, and membrane penetration enhancement agents. DMSO treatment can be given orally, intravenously, or topically for a wide range of indications. The administration of DMSO exhibits favorable outcomes in human eye diseases with low to none observed ocular or systemic ocular toxicity. Nevertheless, DMSO is an essential and nonpatentable potential therapeutic agent that remains underexplored and ignored by pharmaceutical developers and ophthalmologists. This current review takes data from experimental and clinical studies that have been published to substantiate the potential therapeutic efficacy of DMSO and stimulate the research of its application in clinical ophthalmology. Given that DMSO is inexpensive, safe, and easily formulated into therapeutic medicinal products and conventional ophthalmological drugs, this compound should be further explored and studied in the treatment of a variety of acute and chronic ocular disorders.

Molecular docking analysis on the interaction between bovine serum albumin and three commercial fluoroquinolones: Ciprofloxacin, enrofloxacin and pefloxacin

Fluoroquinolones are a family of broad spectrum, systemic antibacterial agents that have been used as therapy for infections in the respiratory and alimentary tract in animals. The pharmacodynamic of this class is widely described, predominantly to the commercial drugs ciprofloxacin (CIP), enrofloxacin (ENR), and pefloxacin (PEF). Bovine serum albumin (BSA) is the main endogenous carrier in the bovine bloodstream, being responsible for the biodistribution of different classes of molecules and drugs, including fluoroquinolones. The molecular features and interaction between BSA and fluoroquinolones are not fully described, thus, the present work enlightens the intimacy of the interaction of BSA with CIP, ENR, PEF through structural modeling and molecular docking calculation approaches. The role of key amino acid residues was assessed, indicating that the main protein binding pocket is composed by Trp-212 residue playing an important stabilization for the three fluoroquinolones through both hydrogen bonding and van der Waals forces, where reside the individual structural differences observed among the three fluoroquinolones and BSA. There is a descriptive protagonism of carboxyl group on the ENR interaction which traps the molecule and avoids the deep communication in the protein binding pocket, as well as the ligands CIP and PEF showed an interface amino acid residue interaction profile higher than 70%.

Infantile Eosinophilic Pustular Folliculitis: A Case Report

Infantile eosinophilic pustular folliculitis (I-EPF) is a rare disease characterized by pruritic vesicles and sterile pustules on the erythematous surface of the scalp and facial localization, usually seen in the neonatal period. It is essential to show the presence of dense eosinophils in the diagnosis of pustules. Histopathological examination of the hair follicles by eosinophils infiltration is determined. Here we reported a 5-month-old baby boy with infantile eosinophilic pustular folliculitis.

Severity and Management of patients with Snake and Scorpion Envenomation Admitted to an Intensive Care Unit in Southeastern Turkey: A retrospective study

Background: Snake and scorpion envenomation is a common public health problem in many regions of the world. Life-threatening emergencies may occur in patients with snake and scorpion envenomation; therefore, these patients may be required intensive care unit (ICU) follow-up. Our objective was to present the demographic and clinical characteristics, treatment modalities and short term outcomes of patients with snake and scorpion envenomation who followed up in our tertiary hospital ICU. Methods: Patient records were retrospectively searched and snake or scorpion envenomation patients with ICU stay were identified with relevant keywords and ICD-10 codes between January 2010 and September 2019. All cases with ICU stay were included for study analysis, regardless of patient age. Scorpion and snake envenomation managed in outpatient clinic were excluded from our data. Poisoning severity score (PSS) system was used to present signs and symptoms and PSS was calculated. Primary and critical care treatment modalities were identified and analyzed. Results: Forty patients (25 with snake bites [62.5%] and 15 with scorpion sting [37.5%]) were included in this retrospective study. Local and systemic effects have been reported in 33 (82.5%) and in 27 patients (67.5%), respectively. Majority of patients suffered from pain or disturbances in sensory neural, hematological, cardiovascular or metabolic systems. Median PSS was 2 (0-4) and median length of stay in ICU was 2 days (1-12). Mortality rate was 2.5%. Antivenom immunoglobulins (n=32, %80.0), systemic antibacterial agents (n=24, 60%), and paracetamol (n=21, 52.5%) were the most common systemically administered treatments. Surgical interventions were performed in 4 patients (10%) Conclusions: We reported that snake and scorpion envenomation were mostly admitted to the ICU with local and/or systemic symptoms for advanced monitoring and observation. Although life treating emergencies and mortality was uncommon in our study, we think that these patients should be closely followed up in ICU.

Пандемия COVID-19: новый виток нарастания антибиотикорезистентности

In this article, we analyzed the problems associated with increasing antibiotic resistance, irrational use of antibiotics, and inadequate demand for them during the COVID-19 pandemic. Objective. Using the method of digital epidemiology, we analyzed the dynamics of the frequency of a specific request for antibiotics in pharmacies and hospitals. We used open data from Yandex (Wordstat.Yandex) and Google (Google Trends) collected on weekly basis for the Russian Federation. Results. The World Health Organization reports a growing problem of antibiotic misuse by some individuals and healthcare institutions during the COVID-19 pandemic. Extensive irrational use of antibiotics causes the development of antibiotic resistance by many microorganisms, including those circulating in hospitals (for example, ESKAPE group). Moreover, COVID-19 has led to an exponential increase in the use of biocides worldwide, potentially resulting in additional indirect pressure promoting the selection of antibiotic-resistant strains. The pandemic in Russia was marked by a significant increase in antibiotic sales in pharmacies (including systemic antibacterial agents) and purchases by healthcare institutions. Conclusion. Our findings demonstrate that the rapid spread of COVID-19 was associated with extensive consumption of antibiotics, which resulted in growing antibacterial resistance (number of circulating drug-resistant strains) and posed a threat to the national security. The COVID-19 necessitates the discovery of new effective treatments for this infection, as well as rational use of antimicrobial drugs. The implementation of surveillance of antibiotic consumption will help to identify changing trends in their use, combine efforts to solve problems related to antibiotics and drug resistance, and to ensure rational use of antimicrobials. Key words: antibiotics, antibiotic resistance, pandemic, COVID-19, digital epidemiology

Variability in Antimicrobial Use Among Hospitals Participating in the Canadian Nosocomial Infection Surveillance Program

Background: The association between antimicrobial use (AMU) and emergence of antimicrobial resistance is well documented. The Canadian Nosocomial Infection Surveillance Program (CNISP) has conducted sentinel surveillance of AMU at participating Canadian hospitals since 2009 resulting in the largest pan-Canadian hospital database of dispensed antimicrobials. Objectives: Describe interhospital variability of AMU across Canada. Methods: Hospitals submit annual AMU data based on patient days (PD). Antimicrobials were measured in defined daily doses (DDD) for adults using the WHO Anatomical Therapeutic Chemical (ATC) system. The AMU data among pediatric patients have been available since 2017 using days of therapy (DOT). Surveillance includes systemic antibacterial agents (J01 ATC codes), oral metronidazole, and oral vancomycin. AMU was assessed using quintiles, interquartile ranges (IQR), and relative IQRs (upper- and lower-quartile values divided by the median). Results: Between 2009 and 2018, 20–26 hospitals participated in adult surveillance each year (35 teaching hospitals and 3 nonteaching hospitals participated in ≥1 year). Over this period, overall AMU decreased by 13% at participating adult hospitals from 645 to 560 DDD per 1,000 PD. AMU varied substantially between hospitals, but this variability decreased over time (Fig. 1). In 2009, the IQRs for overall AMU spanned 309 DDD per 1,000 PD, and in 2018 it spanned only 103 DDD per 1,000 PD. This decrease in variability was due to large decreases in use among hospitals with high use in 2009–2010. Among hospitals in the highest use quintile in 2009–2010, AMU decreased, on average, 44 DDD per 1,000 PD each year. Among hospitals in the lowest use quintile in 2009–2010, AMU increased, on average, 6 DDD per 1,000 PD each year. In 2018, antibiotics with the largest absolute IQR variability were cefazolin (61–113 DDD per 1,000 PD), piperacillin-tazobactam (32–64 DDD per 1,000 PD), and vancomycin (24–49 DDD per 1,000 PD). Among antibiotics with ≥1 DDD per 1,000 PD, antibiotics with the largest relative IQR variability were tobramycin (0.3–6 DDD per 1,000 PD), cefadroxil (0.08–9 DDD per 1,000 PD), and linezolid (0.2–3 DDD per 1,000 PD). In 2018, the IQR for overall pediatric AMU (n = 7 teaching hospitals) was 426–581 DOT per 1,000 PD. Antibiotics with the largest IQRs were vancomycin (0.6–58 DOT per 1,000 PD), cefazolin (33–88 DOT per 1,000 PD), and tobramycin (3–57 DOT per 1,000 PD). Among antibiotics with ≥1 DOT per 1,000 PD in 2018, antibiotics with the largest relative IQRs were tobramycin (3–57 DOT per 1,000 PD), cefuroxime (1–6 DOT per 1,000 PD), and amoxicillin (8–42 DOT per 1,000 PD). Conclusions: There is wide variation in overall antibiotic use across hospitals. Variation between AMU at adult hospitals has decreased between 2009 and 2018; in 2018, antibiotics with the largest IQRs were cefazolin and piperacillin-tazobactam. Benchmarking AMU is crucial for informing antimicrobial stewardship efforts.Funding: CNISP is funded by the Public Health Agency of Canada.Disclosures: Allison McGeer reports funds to her institution from Pfizer and Merck for projects for which she is the principal investigator. She also reports consulting fees from Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.

Impact of penicillin allergy records on antibiotic costs and length of hospital stay: a single-centre observational retrospective cohort

Patients with a penicillin allergy record are usually prescribed non-penicillin antibiotics and have worse health outcomes. This study explored the impact of penicillin allergy records on antibiotic treatment costs and patient length of stay. Patients prescribed a systemic antibacterial agent between April 2016 and March 2018 in a 750-bed English hospital were included in this study. The following data were extracted for each patient: age, sex, comorbidities, infection treated, antibiotic usage (defined daily dose), hospital length of stay and penicillin allergy status. Multi-variable log-linear modelling was used to determine associations between patients labelled as penicillin allergic and total antibiotic costs and length of stay. Using the above models, the potential reductions in total cost and hospital bed-days of 'delabelling' patients with a penicillin allergy record were estimated. Penicillin allergy records were present in 14.3% of hospital admissions and were associated with an increase in non-penicillin antibiotic prescribing, a 28.4% increase in antibiotic costs and 5.5% longer length of hospital stay compared with patients without a penicillin allergy record. Patients with a penicillin allergy record accounted for an excess antibiotic spend of £10,637 (2.61% of annual antibiotic drug spend) and 3522 excess bed-days (3.87% of annual bed-days). Delabelling 50% of patients with a self-reported penicillin allergy record would save an estimated £5501 in antibiotic costs and £503,932 through reduced excess bed-days. Delabelling patients with a self-reported allergy record has potential to reduce antibiotic costs, but its biggest cost impact is via a reduction in excess bed-days.

Phospholipid-Dependent Functions of a Macrocyclic Analogue of the Ion-Channel-Forming Antibiotic Gramicidin A.

An ion-channel-forming natural peptide, gramicidin A (1), exhibits potent antimicrobial activity against Gram-positive bacteria, although medical applications are limited to topical use due to its mammalian cytotoxicity. We recently reported that the artificial macrocyclic analogue 2 provides a promising starting point for developing new ion-channel-based systemic antibacterial agents because of its low mammalian cytotoxicity compared to that of the parent 1. To dissect the molecular factors involved in the species selectivity of 2, we evaluated the ion transport activities, phospholipid affinities, and conformational properties of 1 and 2 using various compositions of phospholipids. A combination of lipid dot blot assays and circular dichroism (CD) analysis with H+/Na+ exchange assays revealed that the higher H+/Na+ exchange activity of 2 than that of 1 in liposomes containing 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphatidylcholine (POPC) or 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-(1'-rac-glycerol) (POPG) is attributable to its higher affinity towards the phospholipids than that of 1. Notably, we also discovered that 2 showed weaker H+/Na+ exchange activity in liposomes containing 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphatidylethanolamine (POPE). CD analysis of 2 in liposomes indicated that the weak H+/Na+ exchange activity is induced by disturbance of the ion-conducting β6.3-helical conformation in the POPE-containing lipid bilayer. These results suggest that the POPE-induced attenuation of the ion-conducting activity of 2 contributes to the alleviation of undesirable mammalian cytotoxicity of 2 compared to that of 1.

1007. A novel approach to evaluate antibiotic utilization across the spectrum of inpatient and ambulatory care and implications for prioritization of antibiotic stewardship efforts

BackgroundAntibiotic overuse remains a significant problem in inpatient and outpatient settings. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated healthcare system in order to prioritize antibiotic stewardship efforts.MethodsWe conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly-selected days between October 1, 2017 and September 30, 2018. Inpatients and perioperative patients were recorded as having received an antibiotic if they were administered ≥1 dose of a systemic antibacterial agent. Outpatients were recorded as having received an antibiotic if they were prescribed ≥1 systemic antibacterial agent.ResultsOn the study days, 10.9% (95% CI 10.6–11.3%) of patients received an antibiotic. Of all antibiotics administered or prescribed, 54.1% were from ambulatory care (95% CI 52.6–55.7%), 38.0% were from the hospital, (95% CI 36.6–39.5%), and 7.8% (95% CI 7.1–7.8%) were perioperative. The emergency department/urgent care centers, adult outpatient clinics, and adult noncritical care inpatient wards accounted for 26.4% (95% CI: 25.0–27.7%), 23.8% (95% CI: 22.6–25.2), and 23.9% (95% CI 22.7–25.3) of antibiotic use, respectively. Only 9.2% (95% CI: 8.3–10.1%) of all antibiotics were administered in critical care units. Antibiotics with a broad spectrum of Gram-negative activity accounted for 30.4% (95% CI: 29.0–31.9%) of all antibiotics prescribed. Infections of the respiratory tract were the leading indication for antibiotic use.ConclusionIn an integrated healthcare system, nearly three-quarters of antibiotic use occurred in the emergency department/urgent care centers, adult outpatient clinics, and adult noncritical care inpatient wards. Antibiotics with a broad spectrum of Gram-negative activity accounted for a large portion of antibiotic use. Analysis of antibiotic utilization across the spectrum of inpatient and ambulatory care is useful to prioritize antibiotic stewardship efforts.Disclosures All authors: No reported disclosures.

1012. Characterization of Antibiotic Superutilizers in the Inpatient Setting

BackgroundInappropriate use of antibiotics is a major public health concern that contributes to increased antibiotic resistance, adverse effects, and healthcare costs. Little is known about the highest utilizers, or superutilizers, who may be appropriate targets for antibiotic stewardship efforts. The purpose of this study was to characterize superutilizers at an academic hospital.MethodsAll adult patients who were admitted to the Hospital of the University of Pennsylvania and received at least one day of antibiotics between July 1, 2017 and June 30, 2018 were identified. All inpatient administrations for systemic antibacterial agents were identified. Antibiotics given in procedural areas and the emergency department were excluded, as were any antifungals and antivirals. Usage was reported as days of therapy (DOT). We compared the demographics and DOT among the superutilizers (defined as the top 1% of patients) to different groupings of the rest of the population.ResultsOverall, 13,559 patients (and 183,082 DOT) were included in the analysis, including 136 superutilizers. The superutilizers received 15% of the total antibacterial DOT and a median of 56 DOT during the 12-month period. (table)ConclusionInpatient antibiotic use is unevenly distributed across the population. Higher meropenem and sulfamethoxazole/trimethoprim DOT suggest that treatment of multidrug-resistant organisms and opportunistic infection prophylaxis are more common in the superutilizer group. Additional study is needed to determine whether antimicrobial stewardship efforts could impact antibiotic use in the superutilizer population. Disclosures All authors: No reported disclosures.

The Infectious Diseases Society of America's 10 × '20 Initiative (10 New Systemic Antibacterial Agents US Food and Drug Administration Approved by 2020): Is 20 × '20 a Possibility?

Infections caused by antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae, have increased in frequency, resulting in significant patient morbidity and mortality. The Infectious Diseases Society of America continues to propose legislative, regulatory, and funding solutions to address this escalating crisis. This report updates the status of development and approval of systemic antibiotics in the United States as of late 2018. We performed a review of the published literature and on-line clinical trials registry at www.clinicaltrials.gov to identify new systemically acting orally and/or intravenously administered antibiotic drug candidates in the development pipeline, as well as agents approved by the US Food and Drug Administration since 2012. Since our 2013 pipeline status report, the number of new antibiotics annually approved for marketing in the United States has reversed its previous decline, likely influenced by new financial incentives and increased regulatory flexibility. Although our survey demonstrates progress in development of new antibacterial drugs that target infections caused by resistant bacterial pathogens, the majority of recently approved agents have been modifications of existing chemical classes of antibiotics, rather than new chemical classes. Furthermore, larger pharmaceutical companies continue to abandon the field, and smaller companies face financial difficulties as a consequence. Unfortunately, if 20 × '20 is achieved due to efforts embarked upon in decades past, it could mark the apex of antibiotic drug development for years to come. Without increased regulatory, governmental, industry, and scientific support and collaboration, durable solutions to the clinical, regulatory, and economic problems posed by bacterial multidrug resistance will not be found.

Non-pharmacological treatment modalities for atopic dermatitis

Non-pharmacological measures to improve the management of atopic dermatitis (AD) are as important as pharmacotherapy for true healing of the skin. Skin dryness (which contributes to inflammation, loss of suppleness (leading to fissuring), impaired barrier function, and increased adherence of Staphylococcus aureus organisms) can be overcome by the use of emollients. Ointments and creams provide better barrier function than lotions. Bathing is an important part of the management of AD. Regular, once-daily bathing in warm (not hot) water to hydrate the skin and debride crusts is important. Scented soaps should be avoided and replaced with a moisturising cleanser. After bathing, patients should pat the skin dry and apply emollients immediately. Routine use of topical or systemic antibacterial or antifungal agents is not recommended for AD, but during flares such agents may be invaluable. There is no specific diet for the treatment of AD. Elimination diets are not routine treatment and are potentially harmful. Food elimination should be reserved for those children who have been proven to be allergic to the specific food.

Antibacterial use in the Faroe Islands, Iceland, and Denmark 1999–2011

The Faroe Islands, Iceland, and Denmark are neighbouring Nordic countries with great ethnic, cultural, and political similarities and are relatively homogeneous. Important information about prescribing practices can be obtained by comparing the antibacterial use in these countries. The objective was to describe, compare, and analyse the use of systemic antibacterial agents in these countries during the y 1999-2011. Data were obtained from the Faroe Islands, Iceland, and Denmark on systemic antibacterial use and expressed in defined daily dosages (DDD). Prescription data were also obtained for specific age groups. The total antibacterial use for the y 1999-2011 varied markedly between the 3 countries, with a mean use of 21.8 DDD/1000 inhabitants/day (DID) in Iceland, 17.7 in the Faroe Islands, and 16.3 in Denmark. The total use remained fairly constant over the years in the Faroe Islands and Iceland, whereas in Denmark it increased gradually from 13.5 DID in 1999 to 19.5 DID in 2011. The higher use in Iceland can be explained by much higher consumption of tetracyclines. There was also considerable variation in the use of individual penicillins and macrolides between the countries. Despite the great ethnic and cultural similarities of these 3 countries, we found marked differences in total antibacterial use and important differences in the use of individual antibacterials.

New Cephalosporin Shows Promise in Drug-Resistant Pneumonia

New Cephalosporin Shows Promise in Drug-Resistant Pneumonia

Irrigating methicillin‐resistant Staphylococcus aureus‐colonised and ‐infected chronic wounds – why use tap water?

International Wound JournalVolume 12, Issue 5 p. 605-605 LETTER TO THE EDITOROpen Access Irrigating methicillin-resistant Staphylococcus aureus-colonised and -infected chronic wounds – why use tap water? Basavraj S Nagoba PhD, Corresponding Author Basavraj S Nagoba PhD Department of Microbiology MIMSR Medical College Latur, Indiadr_bsnagoba@yahoo.com; bsnagoba@gmail.comSearch for more papers by this authorSohan P Selkar MPhT, Sohan P Selkar MPhT Department of Physiotherapy MIP College of Physiotherapy Latur, IndiaSearch for more papers by this authorJitendra B Mule MSc, Jitendra B Mule MSc Sunrich Aqua (Packaged Drinking Water Plant) Maharashtra Industrial Development Corporation Latur, IndiaSearch for more papers by this author Basavraj S Nagoba PhD, Corresponding Author Basavraj S Nagoba PhD Department of Microbiology MIMSR Medical College Latur, Indiadr_bsnagoba@yahoo.com; bsnagoba@gmail.comSearch for more papers by this authorSohan P Selkar MPhT, Sohan P Selkar MPhT Department of Physiotherapy MIP College of Physiotherapy Latur, IndiaSearch for more papers by this authorJitendra B Mule MSc, Jitendra B Mule MSc Sunrich Aqua (Packaged Drinking Water Plant) Maharashtra Industrial Development Corporation Latur, IndiaSearch for more papers by this author First published: 19 September 2013 https://doi.org/10.1111/iwj.12150Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Dear Editors, We read with great interest a letter entitled, ‘Irrigating methicillin-resistant Staphylococcus aureus-colonised and -infected chronic wounds with tap water’, by Li et al. 1. In this study, the use of tap water, which was 2°C higher than individual body temperature, has been suggested to irrigate chronic wounds infected with methicillin-resistant Staphylococcus aureus (MRSA) for 5 minutes, twice a day. A significant improvement in the condition of the chronic wound after 2 weeks of irrigation with tap water has been reported, showing two impressive clinical photographs before and after warm tap water irrigation. It is not clear whether tap water irrigation was the only treatment modality used for the treatment of wound or some other local or systemic antibacterial agent was also used to eliminate MRSA from the wound site. We do agree that daily wound irrigation with requisite pressure can decontaminate wound and eliminate bacterial colonies, preventing subsequent liberation of multiple toxins that may incite an ongoing inflammatory response that retards the process of wound healing; however, complete elimination of most noxious and most difficult bacteria such as MRSA from chronic wound site by using tap water irrigation alone appears to be difficult. Another important issue is why use tap water? Although use of tap water is a very economical option because of its wide availability, it is comparatively better than normal saline in reducing infection rates 2 and is also superior to antibacterial solutions in removing debris and bacteria present at wound site, thereby creating a better healing environment, when an irrigation pressure of greater than 8 psi is used 3. It is risky to use tap water because it may contain potentially pathogenic bacterial flora that may lead to further addition of infectious material to the already infected wound. Hence, tap water that is 2°C higher than individual body temperature is not always a better option for wound irrigation. Instead of tap water, bacteria-free boiled water, distilled water or packed mineral water would be a better option for irrigation of chronic wounds. Hence, irrigation with boiled water, distilled water or packed mineral water that has a pressure of about 45 psi would be a superior alternative to detach bacteria and debris from the wound, thus serving the purpose of irrigation and simultaneously not adding any potentially pathogenic microbial flora to the wound. Basavraj S Nagoba, PhD1, Sohan P Selkar, MPhT2 & Jitendra B Mule, MSc3 1Department of Microbiology MIMSR Medical College Latur, India dr_bsnagoba@yahoo.com; bsnagoba@gmail.com 2Department of Physiotherapy MIP College of Physiotherapy Latur, India 3Sunrich Aqua (Packaged Drinking Water Plant) Maharashtra Industrial Development Corporation Latur, India References 1Li TS, Choong MY, Wu SF, Chen KJ. Irrigating methicillin-resistant Staphylococcus aureus—colonized and infected chronic wounds. Int Wound J 2013; 10: 359. Wiley Online LibraryPubMedWeb of Science®Google Scholar 2Bansal BC, Wiebe RA, Perkins SD, Abramo TJ. Tap water for irrigation of lacerations. Am J Emerg Med 2002; 20: 469– 72. CrossrefPubMedWeb of Science®Google Scholar 3Stone S, Carter W. Wound preparation. In: JE Tintinalli, G Kelen, J Stapczynski, editors. Emergency medicine: a comprehensive study guide, 5th edn. New York: McGraw-Hill, 2000: 284– 7. 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