Total Antibiotic Research Articles

Quantification of antibiotic usage against Streptococcus suis in weaner pigs in The Netherlands between 2017-2021

Streptococcus suis is an important pig pathogen that can cause severe disease in the post-weaning period. As there are no commercial vaccines available in the Netherlands, antibiotic treatment is often necessary to control disease. S. suis is regarded as one of the major causes of antibiotic prescription in weaned pigs, but scientific studies supporting this claim with quantitative data are lacking. The aim of this study was to obtain insight in, and to quantify usage of, antibiotics against S. suis in weaner pigs at sow farms in the Netherlands. Three sources of data were used, including 1) total antibiotic usage in weaner pigs in the Netherlands, as yearly reported by the Netherlands Veterinary Medicines Institute (SDa), and estimates from 2) pig veterinarians and 3) pig farmers on the relative amount of antibiotics prescribed against S. suis, via questionnaires. Information from the SDa on the total amount of antibiotic usage was combined with the estimates of the veterinarians to estimate the antibiotic usage against S. suis in weaner pigs. Our study shows that ~90% of the total amount of amoxicillin (AMOX) and ampicillin (AMPI) prescribed in weaner pigs is used for treatment of disease caused by S. suis (S. suis disease). Of all orally prescribed antibiotics against S. suis, AMOX comprises 85% of the total absolute usage expressed by the mean defined daily dosage per animal farm (3.2 – 5.4 mean DDDAF). Furthermore, veterinarians reported that at farms with structural S. suis disease problems second choice antibiotics (AMOX, AMPI) are more often prescribed than at farms with incidental S. suis disease. All together, we estimated that S. suis disease accounts for about 1/3rd of the total antibiotic usage in weaner pigs. This study is the first to quantify antibiotic usage against S. suis in weaner pigs and shows that S. suis is a hotspot of antibiotic usage. This underlines the severity and relevance of S. suis disease and the need for alternative control measures.

Occurrence, fate, and ecological risk of PAEs, PFASs, antibiotics in industrial, urban and rural WWTPs in Shaanxi Province, China

The wastewater treatment plants (WWTPs) were considered as a hub of transit from human activities as a source to the aquatic ecosystems as a sink of emerging contaminants (ECs). This study investigated the fate of phthalate esters (PAEs), per- and polyfluoroalkyl substances (PFASs) and antibiotics in the influent and effluent of WWTPs in industrial, urban and rural in Shaanxi province (China). The first most abundant monomer of these three types of ECs were the same in industrial, urban and rural WWTPs. The composition of PAEs in the influent of urban and rural WWTPs were quite different from that of industrial WWTPs. The removal efficiency of PAEs and PFASs in urban WWTPs were higher than those in rural and industrial WWTPs. The annual mass load of PFASs in rural WWTPs was lower than that in industrial and urban WWTPs. The risk quotient (RQ) of PAEs was high, with most of them exceeding 1. While the RQ of PFASs was low, exceeding 0.1 only in some industrial WWTPs. The frequency of high risk of total antibiotics in urban and rural WWTPs was higher than that in industrial WWTPs. This study provided field survey data and guidance to strengthen the management of ECs in the region.

Antibiotics Residues in Inland and Transitional Sediments

This study assesses the concentrations of a range of antibiotics in riverine and transitional sediments in Ireland. A selection of 12 macrolide, fluoroquinolone, sulphonamide, and diaminopyrimidine antibiotics were quantified in 80 grab surficial sediment samples from around Ireland, selected to investigate areas of potentially higher pollution risk (agriculture, aquaculture, industrial emissions, and wastewater emission points) as well as isolated areas where there are no known pollution sources. Several of the macrolides and sulphonamides/trimethoprim were generally detected more frequently above limits of quantification (LoQ). Fluoroquinolones, while frequently detected above limits of detection (LoD), concentrations were mostly below method LOQs. The most prevalent antibiotic detected was clarithromycin, found at the highest mean concentration (6.65 ng/g) and detected in ∼90 % of samples. Comparing levels of quantified antibiotics to levels reported internationally, Ireland is at the lower end for all quantified antibiotics. This is with the notable exception of clarithromycin, which is higher than levels found in comparable studies in Italy, Spain, France, and Argentina. Higher levels of total antibiotics (49.3 ± 24.7 ng/g) were found to be present immediately adjacent to wastewater emission points while moderate degrees of contamination (9.0 ± 9.7 ng/g) were also linked to wastewater, aquaculture, or agricultural pressures. Based on risk quotients calculated from available sediment PNECs taken from the NORMAN ecotoxicology database, clarithromycin was also the only compound to be present at concentrations indicative of a “moderate” degree of environmental risk, with most of the remaining falling below this threshold. Ciprofloxacin was ostensibly found to be of a “high” degree of environmental risk; however, this is based on only a single sample quantified above the LoQ. Overall, antibiotic sediment concentrations suggest a low ecotoxicological risk for most of the target antibiotics, although clarithromycin, ciprofloxacin, and sulfamethoxazole warrant further monitoring in sediments. A final notable finding is the differences in partitioning behaviour of antibiotics between water and sediment: clarithromycin is more likely to be detected in sediment while sulfamethoxazole partitions more to water. Such partitioning behaviour should therefore be taken into consideration for any subsequent monitoring programmes.

Impact of a two step antimicrobial stewardship program in a paediatric haematology and oncology unit

Objective: To describe the implementation of a multi-step antimicrobial stewardship program in a haemato-oncology and stem cell transplantation program unit. Methods: Pre-post quasi-experimental study with two interrupted time-series analyses, conducted between 01/01/2019 and 31/12/2022 in the Paediatric Haemato-Oncology Unit of the Padua Paediatric Hospital. The interventions were: (1) 02/2020: dissemination of febrile neutropenia clinical pathways, (2) April 2021: provision of the clinical pathways via a customized App (Firstline.org) and implementation of a twice-a-week prospective audit and feedback. The main outcome was antibiotic consumption measured by days of administered therapy (DOTs)/1000 patients’ days for all antibiotics and most used molecules. Results: The first intervention (clinical pathways) resulted in a decrease in the overall antibiotic use by the haemato-oncology unit, with an abrupt reduction of 3-gen cephalosporins in favor of piperacillin-tazobactam, as indicated by the clinical pathways. Meropenem and glycopeptide use did not vary. The second intervention (antimicrobial stewardship) further decreased total antibiotic consumption, and a significant decline in meropenem, amikacin, and glycopeptides was achieved. Conclusions: Multi-step stewardship based on guidelines dissemination, multidisciplinary team intervention and collaboration (“handshake” stewardship) was highly effective in optimizing guidelines adherence and reducing overprescriptions in a fragile patient cohort.

Long-term Effectiveness of Financial Incentives for Not Prescribing Unnecessary Antibiotics to Children with Acute Respiratory and Gastrointestinal Infections: A Japan's Nationwide Quasi-Experimental Study.

To address antibiotic overuse, the Japanese government implemented a novel financial incentive policy in 2018. The policy enables eligible healthcare facilities to claim 800 JPY (≈5.7 USD) per case wherein a rationale to not prescribe antibiotics is offered to children aged <3 years with acute upper respiratory tract infections or gastroenteritis. Although the short-term effect of this policy was observed in our previous study, its long-term effects have not been evaluated nationwide. We conducted a quasi-experimental study using a staggered difference-in-differences design with propensity score matching. Data from 165,113 children born between April 2017 and March 2019 were extracted from two nationwide administrative databases. The study tracked these children until May 2022, comparing those exposed to the policy with those who were not. The introduction of financial incentives led to a 44.9% reduction (95%CI, 41.1% to 47.7%) in total antibiotic prescriptions within the first month and 19.5% reduction (95%CI, 8.7% to 29.1%) over 48 months. Broad-spectrum antibiotic use also decreased by 24.4% (95%CI, 14.0% to 33.6%) over the same period. The policy did not result in increased hospitalizations, after-hours visits, or healthcare costs, but was associated with a slight increase in the number of office visits. A dose-response relationship was observed, with reductions in antibiotic use leveling off after approximately five incentives. Financial incentives effectively reduced antibiotic prescriptions in children without adverse health outcomes, demonstrating sustained benefits over four years. This antimicrobial stewardship intervention offers a scalable model for other countries aiming to curb antibiotic overuse and combat antimicrobial resistance.

EGS SO28 - Management of oesophageal diverticulitis in a 71-year-old female: Case report and review of management approaches

Abstract Background Oesophageal diverticulitis is a rare condition with fewer than ten reports in the literature. We present a case of oesophageal diverticulitis in a 71-year-old female with a history of COPD, TIA, and known oesophageal diverticulum. She was managed conservatively with NBM, total parenteral nutrition and intravenous antibiotics requiring a 16-day inpatient stay. The rarity of this condition poses challenges in its diagnosis and management, necessitating a thorough understanding of both conservative and surgical interventions. This case highlights the complexity involved in treating oesophageal diverticulitis, especially in patients with significant comorbidities. Method Patient presented with a 6-day history of upper abdominal pain and sepsis (elevated inflammatory markers; CRP 320, WCC 11.1, temperature 38.0, pulse 104). Abdomen was soft with upper abdominal tenderness. Imaging was consistent with diverticulitis of a 5.9cm lower oesophageal diverticulum without perforation. Initial management included making the patient nil by mouth, total parenteral nutrition, and intravenous antibiotics (vancomycin and metronidazole). The patient’s condition was closely monitored with serial blood tests and clinical assessments. Opinion was sought from a tertiary upper GI centre. Discharge was planned once the patient safely transitioned to oral diet and was apyrexial for 48 hours. Results Inflammatory markers improved over five days (CRP from 320 to 51, WCC from 11.1 to 9). She remained intermittently pyrexial until day 8 of admission. Clinical improvement allowed transition from intravenous to oral therapy, and she was discharged on day 16 with double dose oral PPI therapy. Patient has been followed up by tertiary upper GI services with plans for consideration of surgical resection of the oesophageal diverticulum. The patient’s successful discharge without surgical intervention during the acute phase underscores the effectiveness of a conservative management approach initially, with a plan for definitive surgical treatment in a stable outpatient setting. Conclusion Oesophageal diverticulitis, though rare, requires a nuanced approach to management, especially in patients with significant comorbidities. This case demonstrates the importance of an awareness of thorough history taking and review of previous examinations to prevent delayed diagnosis of a rare pathology not demonstrated on a CT abdomen and pelvis. This approach highlights the importance of individualised treatment plans and the potential for conservative management to provide stabilisation, followed by elective surgical management. The paucity of cases of oesophageal diverticulitis has prevented development of evidence based guidelines, underscoring the importance of seeking advice from tertiary centers when managing rare presentations.

Occurrence, spatiotemporal distribution, and health risk of antibiotics in the Wuhan section of the Yangtze River, China.

The occurrence, spatiotemporal changes, and health hazard of antibiotics in source water and finished water in the Wuhan section of the Yangtze River are not well understood. In this study, 43 source water and finished water samples were collected from 11 water plants in Wuhan in August 2021 and May 2022. Fifty-one antibiotics from eight categories were measured. A total of 41 antibiotics were detected in the source water samples, and 24 in the finished water samples. The total antibiotic concentration in source water ranged from 1.68 to 437.18 ng/L, which is significantly higher than that in finished water (2.04-87.25 ng/L). Sulfonamides and lincosamides were predominant, accounting for nearly 80% of the total antibiotic concentration. Lincomycin constituted nearly 30% of the total antibiotic concentration in the source water. In August 2021, the average total antibiotic concentration in source water was 107.12 ng/L, higher than in May 2022 (63.13 ng/L). Spatially, the total antibiotic concentrations in samples collected from the Han River, a tributary of the Yangtze River, were higher than those in the main stream of the Yangtze River. Ecological risk assessment indicated that the hazard posed by most antibiotics were negligible. Lincomycin potentially posed a high health hazard, and clarithromycin and roxithromycin posed a moderate hazard to infants.

Ecological Risk and Microbial Diversity Characteristics of Antibiotics in Farm and Surrounding Environmental Media

Farm manure is one of the largest sources of antibiotics in environmental media. At present, there are limited studies on antibiotic residues and microbial diversity in different environmental media. The residual characteristics of five typical veterinary antibiotics （sulfadiazine, SDZ； doxycycline, DOX； oxytetracycline, OTC； tetracycline, TC； and chlortetracycline, CTC） in different environmental media and their effects on environmental microbial diversity were preliminarily discussed by taking an ecological farm and a seven-year long-term experimental field in Bishan District of Chongqing as the research object. The results showed that the content of oxytetracycline in chicken manure was the highest （17.75-18.80 μg·kg-1）, the content of doxycycline in soil was the highest （2.00-2.55 μg·kg-1）, and the concentration of chlortetracycline in water was the highest （13.77-21.10 μg·L-1）. During the sampling time, the total antibiotics in soil and chicken manure changed little. The five antibiotics in the water had high ecological risks. The five antibiotics significantly affected the microbial diversity in the environmental media. The dominant bacteria in the soil were Proteobacteria and Actinobacteria, and the dominant bacteria in water were Proteobacteria and Bacteroidetes.

Removal of Pharmaceutically Active Compounds from Hospital Wastewater with Ozonation

Hospital wastewater includes many pharmaceutically active compounds (PhACs). Since this resulted in both PhACs distribution to the environment and antibiotic resistance development of microorganisms, on-site treatment of hospital wastewater has gained importance. In this study, the removal of 21 PhACs consisting of 12 parent compounds and 9 main metabolites from hospital wastewater was researched by ozonation. In this context, commonly used analgesics (paracetamol, diclofenac, ibuprofen, and naproxen, 4'-hydroxydiclofenac, 5-hydroxydiclofenac, 1-hydroxyibuprofen, 2-hydroxyibuprofen, carboxyibuprofen, (S)-O-desmethyl naproxen) and antibiotics (ciprofloxacin, sulfamethoxazole, trimethoprim, erythromycin, metronidazole, clarithromycin, azithromycin, clindamycin, N-acetyl-sulfamethoxazole, sulfamethoxazole-β-D-glucuronide, clindamycin sulfoxide) were selected. PhAC analyses were conducted with HPLC/MS-MS. The ozonation dose was between 0.05-5.0 mg O3/mg COD. In real hospital wastewater, many of the selected PhACs were detected and total analgesic and antibiotic were determined as 22.9 and 40.6 µg/L, respectively. The results showed that detected PhACs were completely removed at 1.5 mg O3/mg COD. Additionally, COD removal was determined as 48% in this ozone dose. The result of the study shows that pre-oxidation of hospital wastewater is an effective method in terms of on-site pretreatment of PhACs.

Spatial-temporal Distribution and Ecological Risk of Antibiotics in the Soils of a Typical Agricultural Watershed in the Three Gorges Reservoir Area

In order to understand the spatial-temporal distribution and ecological risk of antibiotics in the soil of an agricultural watershed in the Three Gorges Reservoir area, the topsoil samples were collected at 26 sites in the Wangjiagou small watershed, Fuling District, Chongqing in spring, summer, autumn, and winter of 2022, and 21 antibiotics with five classes were determined using solid phase extraction and ultra-performance liquid chromatography-tandem mass spectrometry. The content levels and spatial-temporal distribution of antibiotics were analyzed, the correlations between antibiotic contents and soil physicochemical factors were discussed, and the potential ecological risk of antibiotics in the soil was evaluated using the risk quotient method. The results showed that the detection rates of 21 antibiotics were 0-100% with the range of ND-219.5 μg·kg-1, and those of tetracyclines （TCs）, quinolones （FQs）, and chloramphenicols （CAPs） reached 100% in all four seasons. The total antibiotic content ranged from 14.35 to 504.1 μg·kg-1 with the average value of 149.7 μg·kg-1, and the average contents of the five classes of antibiotics showed a decreasing trend of TCs （77.95 μg·kg-1）, FQs （34.96 μg·kg-1）, CAPs （28.14 μg·kg-1）, sulfonamides （SAs, 7.15 μg·kg-1）, and macrolides （MLs, 1.48 μg·kg-1）. The antibiotic contents of soils during autumn and winter were significantly higher than those in summer （P &lt; 0.05） and showed an overall variation trend of first decreasing and then increasing with the season and a distribution situation of "low in the west and high in the east." The sites with high antibiotic contents were mainly concentrated in vegetable fields, residential areas, and dry lands. In spring soils, the contents of tylosin （TYL） （P &lt; 0.01）, tetracycline （TC） （P &lt; 0.01）, doxycycline （DXC）, and sulfamethodiazine （SMR） （P &lt; 0.05） were significantly negatively correlated with soil pH. In summer soils, total phosphorus （TP） had significantly positive effects on the contents of sulfamethoxazole （SFZ） and TC （P &lt; 0.05） and had extremely significant positive effects on sulfamethoxazole （SMX）, SMR, and ofloxacin （OFL） （P &lt; 0.01）. Total nitrogen （TN） had significantly positive effects on the contents of SMX （P &lt; 0.01） and SMR （P &lt; 0.05）, and soil organic matter （SOM） had significantly positive effects on the contents of TC and enrofloxacin （ENR） （P &lt; 0.05）. However, ciprofloxacin （CIP） （P &lt; 0.001）, sulfampyridine （SPD）, norfloxacin （NOR）, and TYL contents （P &lt; 0.05） were significantly negatively correlated with soil pH. In autumn soils, TN significantly negatively affected CIP content （P &lt; 0.05）； the contents of sulfadiazine （SDZ）, TC, and DXC were negatively affected by soil pH （P &lt; 0.05）； and cation exchange capacity （CEC） significantly positively affected the contents of TC and SFZ （P &lt; 0.05）. In winter soils, TP had a significantly positive effect on TYL content, and TN had a significantly positive effect on SFZ content （P &lt; 0.05） and an extremely positive effect on sulfamethoxine （SMM） （P &lt; 0.001）. Chlorotetracycline （CTC） （P &lt; 0.01）, CIP （P &lt; 0.01）, thiamphenicol （TAP） （P &lt; 0.001）, chloramphenicol （CAP） （P &lt; 0.001）, oxytetracycline （OTC） （P &lt; 0.001）, and sulfadimidine （SM2） （P &lt; 0.05） were significantly negatively correlated with soil pH, and CEC had a significantly negative effect on SDZ content （P &lt; 0.05）. The soils in the Wangjiagou agricultural small watershed were mainly threatened by SMX, SDZ, TC, DXC, erythromycin, NOR, OFL, CIP, and ENR, and their ecological risks should not be ignored.

Antibiotic prescribing in health and justice settings (HJS)-surveillance and opportunities for quality improvement

Abstract Introduction Improving surveillance of antibiotic prescribing and reducing health inequalities in antimicrobial resistance (AMR) are priorities in the new 5 year AMR national action plan (2024-2029)1. People in contact with the justice system are one of the inclusion groups in the CORE20plus5, a national NHE England approach to support reduction of health inequalities.2 Aim This project aimed to collate and analyse all antibiotic prescribing data from English prisons in order to identify opportunities for quality improvement. Method This project analysed antibiotic prescribing data from September 2022 to current date for the first time in HJS from the IT system used in all prisons in England. No ethical approval is required as surveillance is of anonymised data only. Data was broken down by age band (18 and under, 19-49, 50 and over), category of prison, region, ICB, individual prison and antibiotic type. The dashboard allows benchmarking across sites and comparison with primary care, as prisoners in HJS are considered to have similar infections to primary care patients. Results The majority of prescribing is in male prisoners, reflecting the male/female population split. The most frequently prescribed antibiotics are those used for: skin and soft tissue (including acne), respiratory tract, dental and urinary tract infections. A number of focus areas for quality improvement have been identified, including: Broad spectrum antibiotics (Cephalosporins, Co-amoxiclav and Quinolones), target of &amp;lt;10% total antibiotic prescribing in primary care, in HJS, currently 11%. Appropriate quinolone prescribing is a target in all settings due to recent MHRA alert3. Acne prescribing represents a significant proportion of antibiotic prescribing in HJS. Lymecycline 12%, whereas in primary care &amp;lt;3%. Duration of Antibiotic Courses: In primary care there is a medicines optimisation opportunity ambition to achieve 75% prescribing amoxicillin 500mg as 5 day duration. In HJS only 27% is for 5 days. When prescribing 100mg doxycycline for respiratory infections, NICE guidance recommends a 5 day course, but in HJS only 3% is prescribed as a 5 day course. For UTI in female prisons, nitrofurantoin 100mg MR is most commonly prescribed, NICE guidance for UTI in women is for 3 days; 47% in HJS are for 3 days, but 35% are 7 day courses. Discussion and Conclusion This dashboard provides insight into antibiotic prescribing data allowing opportunities for quality improvement opportunities to be identified and antimicrobial stewardship interventions to be evaluated. This work will progress to tackle the focus areas identified. Next steps are to work with antibiotic champions from HJS to co-produce intervention plans, share patient safety messages, trial available resources, rollout interventions and monitor impact via the dashboard. Limitations Indications are not available from the data but extrapolated from the antibiotic prescribed. The dashboard is currently an excel spreadsheet in NHSE. It will be moved to a platform that enables access by individual prisons.

WHO/INRUD prescribing indicators with a focus on antibiotics utilization patterns at outpatient department of Adigrat general hospital, Tigrai, Ethiopia: a retrospective cross-sectional study

BackgroundThe World Health Organization (WHO) defines rational use of drug as a state in which medications are received by patients appropriately according to their clinical needs and individual requirement, for adequate period and at the right cost. More than 50% of all medicines are prescribed, dispensed, or sold inappropriately worldwide. This study aimed to evaluate the prescribing patterns in Adigrat general hospital, Tigrai, Ethiopia.MethodsA retrospective cross-sectional study was done to evaluate prescription patterns. A systematic random sampling technique was used to select 600 prescriptions and the prescriptions were reviewed using WHO/International Network of Rational Use of Drugs prescribing indicators. Data was collected from prescriptions dispensed from 01 March 2023 to 30 March 2024 at outpatient pharmacy of Adigrat general hospital. Data was analyzed using SPSS version 21 and a p-value < 0.05 was declared statistically significant.ResultsA total of 1088 medicines were prescribed in 600 prescription encounters, giving an average number of 1.8 (± 0.83) medicines per encounter. The percentage of medicines prescribed by generic name was 91.5% while 98.7% of the medicines were prescribed from essential medicine list (EML). Besides, the percentages of encounters containing at least one antibiotic and one injection were 44.5% and 7.2%, respectively. A total of 340 antibiotics were prescribed in 267 encounters. Penicillins (34.4%), macrolides (23.8%) and fluoroquinolones (17.1%) were the most prevalent antibiotics classes. The “Access” and “Watch” groups covered 54.4% and 45.6% of the total antibiotics prescribed, respectively. Being under 18 years old [Adjusted Odds Ratio (AOR): 9.830, CI: 4.062–23.786], being prescribed with three medicines (AOR: 3.247, CI: 1.571–6.708) and certain diagnosis like diseases of the respiratory system (AOR: 3.750, CI: 2.136–6.584) were significantly associated with antibiotic prescribing.ConclusionThis study showed deviations of prescribing patterns from WHO standards. The percentage of prescriptions with antibiotic was far from WHO optimal value. The use of antibiotics from “Access” group was below WHO standard. The percentage of medicines prescribed by generic name and the percentage of encounters with injection also deviated from WHO standard. Antibiotics prescribing showed significantly association with age, number of medicines and certain diseases.

Rapid laboratory diagnosis of urinary tract infection, with or without antibiotic decision support-a small pilot study investigating accuracy and clinical impact.

The study evaluated the accuracy and clinical impact of rapid diagnostics (RD) with or without antibiotic decision support (ADS) for hospitalized patients with urinary tract infections. A two-centre prospective intervention was conducted with 230 patients divided into three groups: RD-only (n = 59), RD plus ADS (n = 56) and a control group (n = 115). Mean laboratory turnaround time for RD was 10 h and 50 min. Of 115 microorganisms, 108 were correctly identified. The error rate for rapid susceptibility determination was 0.85%. Total antibiotic consumption, measured in defined daily doses (DDD), was lower in the intervention groups compared to the control group (ADS: 10.3 DDD, p = 0.01; RD: 10.9 DDD, p = 0.06; control: 13.0 DDD). No significant differences were observed in the use of broad-spectrum antibiotics (p = 0.816). Adherence to antibiotic guidelines was significantly better in the ADS group compared to the control group (p = 0.015) (RD vs control; p = 0.261). The ADS group also received fewer doses of ineffective antibiotics (ADS: 1.8 doses, p = 0.012; RD: 2.4 doses, p = 0.195; control: 3.4 doses). Length of hospital and ICU stays or 30-day readmission rates did not differ across groups. No in-hospital mortality was observed in any group.

Impact of a multifaceted antibiotic stewardship programme in a paediatric acute care unit over 8 years.

Antibiotics are the most prescribed drugs for children worldwide, but overuse and misuse have led to an increase in antibiotic resistance. Antimicrobial stewardship programmes (ASPs) have proven feasible in reducing inappropriate antimicrobial use. The study aimed at evaluating the impact and sustainability of an ASP with multiple interventions over 8 years. This quasi-experimental study was conducted between 2014 and 2022 in the paediatric acute care unit of Padua University Hospital. Demographic and clinical data were retrieved from the electronic clinical records. Daily prescriptions were collected and analysed based on the AWaRe classification and using days of therapy (DOT) out of 1000 patient days (DOT/1000PDs). The primary outcome was to assess the change in overall antibiotic consumption and of access and watch antibiotics, stratifying patients with and without comorbidities. Trends in antibiotic consumption (DOTs/1000PD) were assessed using joinpoint regression analysis. A total of 3118 children were included. Total antibiotic consumption remained stable and low in patients without comorbidities, ∼300 DOT/1000PDs, whereas a statistically significant constant reduction was observed in children with comorbidities, from almost 500 DOT/1000PPDs to <400 DOT/1000PDs. Access consumption increased in both groups of patients, whereas watch consumption constantly decreased, although statistically significant only in children with comorbidities. Implementing a multistep ASP has proven feasible and sustainable in improving antibiotic prescriptions for previously healthy and fragile children. All the implemented interventions were low cost, and with efficient use of resources, ensuring an ASP that was effective, practical, and easily replicable and implementable in various healthcare settings.

Selective Digestive Decontamination: A Comprehensive Approach to Reducing Nosocomial Infections and Antimicrobial Resistance in the ICU.

Background/Objective: Multidrug-resistant (MDR) bacteria pose a significant threat to global health, especially in intensive care units (ICUs), where high antibiotic consumption drives antimicrobial resistance. Selective digestive decontamination (SDD) is a strategy designed to prevent nosocomial infections and colonization by MDR pathogens. This study aimed to evaluate the impact of implementing an SDD protocol on antibiotic consumption and colonization by carbapenemase-producing Enterobacterale (CPE) in a specific ICU setting. Methods: This quasi-experimental study was conducted in the ICU of a university hospital from June 2021 to June 2023. Patients were divided into two groups: pre-intervention (before SDD) and post-intervention (after SDD implementation). Data on antibiotic consumption (expressed as defined daily doses (DDDs) per 100 stays), nosocomial infections, colonization rates, and the incidence of MDR bacteria were collected. A statistical analysis was conducted to compare the pre- and post-intervention groups. Results: A total of 3266 patients were included, with 1532 in the pre-intervention group and 1734 in the post-intervention group. The implementation of the SDD protocol resulted in a significant reduction in total antibiotic consumption (p = 0.028), with notable decreases in carbapenem use (p < 0.01) and colonization by CPE (p = 0.0099). The incidence of nosocomial infections also decreased in the post-SDD group, although this reduction was not statistically significant. Conclusions: The implementation of the SDD protocol in this ICU setting significantly reduced antibiotic consumption and colonization by CPE. These findings suggest that SDD may be a valuable tool in managing antimicrobial resistance in critical care settings, without contributing to the development of MDR bacteria.

Factors prolonging antibiotic duration and impact of early surgery in thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation.

A standard 6-12-week course of antibiotics is recommended for pyogenic spondylitis. Recent evidence supports early minimally invasive posterior fixation surgery; however, its effect on antibiotic treatment duration is unclear. This study aims to identify factors associated with prolonged antibiotic treatment in thoracolumbar pyogenic spondylitis patients resistant to conservative treatment and assess whether early surgery can reduce treatment duration. We retrospectively reviewed 74 patients with thoracolumbar pyogenic spondylitis undergoing minimally invasive posterior fixation at nine facilities. Patients were grouped based on antibiotic duration (≥ 6 or < 6 weeks) and timing of surgery (≤ 3 weeks or > 3 weeks of starting antibiotics). Univariable and multivariable logistic regression analyses were used to identify factors associated with prolonged antibiotic treatment and study the outcomes of patients undergoing early surgery. Forty-nine patients (66%) required prolonged antibiotic treatment. The presence of an iliopsoas abscess (p = 0.0006) and elevated C-reactive protein (CRP) levels (≥ 10mg/dL, p = 0.015) were independently associated with prolonged antibiotic treatment. Early surgery significantly reduced total antibiotic duration (5.3 weeks vs. 9.9 weeks, p < 0.0001) without increasing the incidence of postoperative infection recurrences and unplanned additional surgeries. Despite factors associated with prolonged antibiotic treatment, early surgery consistently shortened the treatment duration compared to late surgery. Early surgery (within three weeks) with minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis is associated with reduced antibiotic duration and overall treatment duration regardless of the presence of prolonging factors like iliopsoas abscess and elevated CRP levels.

Understanding the interaction between soil ORP and enzyme activity: How does wetland type affect constructed wetland performance for the advanced treatment of swine wastewater?

Constructed wetlands (CWs) are widely used for the advanced treatment of swine wastewater. Wetland type is the most critical parameter for engineering applications; therefore, the performance of horizontal/vertical subsurface flow CWs (HSFCWs and VSFCWs) was explored over one year of operation. The effects of five antibiotics (40 μg/L each), copper (Cu, 1.0 mg/L), and their combination on CW performance and soil oxidation–reduction potential (ORP) and enzyme activity were investigated. The annual removal efficiencies of HSFCWs and VSFCWs for total organic carbon (TOC), nitrogen, and phosphorus were 72.03 %–84.49 % and 87.15 %–90.72 %, for antibiotics were 91.35 %–99.52 % and 87.33 %–99.57 %, and for Cu were 97.37 %–97.44 % and 95.52 %–96.85 %, respectively. The CWs removed antibiotics through substrate adsorption, plant absorption, and biodegradation. Total antibiotic residues in HSFCW and VSFCW soils ranged from 6.29 to 17.31 and 24.57 to 589.07 μg/kg, respectively, and enrofloxacin and roxithromycin posed medium and high risks in VSFCW non-rhizosphere soil. The amount of residual antibiotics in Phragmites australis parts was in the order of fibrous roots > rhizomes > aboveground. ORP and enzyme activities were greater in rhizosphere soil than in non-rhizosphere soil and greater in the VSFCWs than in the HSFCWs. CW performance and soil enzyme activities decreased under the stress of antibiotics and coexistence of antibiotics and Cu. These findings advance our knowledge of CW design, elucidate the unique advantages of CWs, and offer efficient operation strategies for swine wastewater advanced treatment, helping researchers recognize the adverse effects of antibiotics on CWs.

Comparative evaluation of early treatment with ceftolozane/tazobactam versus ceftazidime/avibactam for non-COVID-19 patients with pneumonia due to multidrug-resistant Pseudomonas aeruginosa.

Ceftolozane/tazobactam and ceftazidime/avibactam are commonly used in patients with MDR-Pseudomonas aeruginosa (PSA) pneumonia (PNA). This study compared outcomes between non-COVID-19 hospitalized patients with MDR-PSA PNA who received ceftolozane/tazobactam or ceftazidime/avibactam. The study included non-COVID-19 adult hospitalized patients with MDR-PSA PNA in the PINC AI Healthcare Database (2016-22) who received ceftolozane/tazobactam or ceftazidime/avibactam within 3 days of index culture for ≥2 days. Outcomes were mortality, recurrent MDR-PSA PNA, discharge destination, post-index culture day length of stay (LOS) and costs (in US dollars, USD), and hospital readmission. The final sample included 197 patients (117 ceftolozane/tazobactam, 80 ceftazidime/avibactam). No significant differences were observed in mortality and post-index culture LOS and costs between groups. In the multivariable analyses, patients who received ceftolozane/tazobactam versus ceftazidime/avibactam had lower recurrent MDR-PSA PNA (7.9% versus 18.0%, P = 0.03) and 60 day PNA-related readmissions (11.1% versus 28.5%, P = 0.03) and were more likely to be discharged home (25.8% versus 9.8%, P = 0.03). Compared with ceftazidime/avibactam patients, ceftolozane/tazobactam patients had lower adjusted median total antibiotic costs (5052 USD versus 8099 USD, P = 0.003) and lower adjusted median comparator (ceftolozane/tazobactam or ceftazidime/avibactam) antibiotic costs (3938 USD versus 6441 USD, P = 0.005). In the desirability of outcome ranking (DOOR) analysis, a ceftolozane/tazobactam-treated patient was more likely to have a more favourable outcome than a ceftazidime/avibactam-treated patient [DOOR probability: 59.6% (95% CI: 52.5%-66.8%)]. Early treatment with ceftolozane/tazobactam may offer some clinical and cost benefits over ceftazidime/avibactam in patients with MDR-PSA PNA. Further large-scale studies are necessary to comprehensively understand the outcomes associated with these treatments for MDR-PSA PNA.

Developing a framework for identifying risk factors and estimating direct economic disease burden attributable to healthcare-associated infections: a case study of a Chinese Tuberculosis hospital

Healthcare-associated infections (HAIs) represent a major global health burden, which necessitate effective frameworks to identify potential risk factors and estimate the corresponding direct economic disease burden. In this article, we proposed a framework designed to address these needs through a case study conducted in a Tuberculosis (TB) hospital in Hubei Province, China, using data from 2018 to 2019. A comprehensive multistep procedure was developed, including ethical application, participant inclusion, risk factor identification, and direct economic disease burden estimation. In the case study, ethical approval was obtained, and patient data were anonymized to ensure privacy. All TB hospitalized patients over the study period were included and classified into groups with and without HAIs after screening the inclusion and exclusion criteria. Key risk factors, including gender, age, and invasive procedure were identified through univariate and multivariate analyses. Then, propensity score matching was employed to select the balanced groups with similar characteristics. Comparisons of medical expenditures (total medical expenditure, medicine expenditure, and antibiotics expenditure) and hospitalization days between the balanced groups were calculated as the additional direct economic disease burden measures caused by HAIs. This framework can serve as a tool for not only hospital management and policy-making, but also implementation of targeted infection prevention and control measures. Moreover, it has the potential to be applied in various healthcare settings at local, regional, national, and international levels to identify high-risk areas, optimize resource allocation, and improve hospital management and governance, as well as inter-organizational learning. Challenges to implement the framework are also raised, such as data quality, regulatory compliance, considerations on unique nature of communicable diseases and other diseases, and training need for professionals.

A retrospective propensity-score-matched cohort study of the impact of procalcitonin testing on antibiotic use in hospitalized patients during the first wave of COVID-19.

Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK. Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic. Secondary: to measure differences in length of hospital/ICU stay, mortality, total days of antibiotic prescribing and resistant bacterial infections between these groups. Multi-centre, retrospective, observational, cohort study using patient-level clinical data from acute hospital Trusts/Health Boards in England/Wales. Inclusion: patients ≥16 years, admitted to participating Trusts/Health Boards and with a confirmed positive COVID-19 test between 1 February 2020 and 30 June 2020. Data from 5960 patients were analysed: 1548 (26.0%) had a baseline PCT test and 4412 (74.0%) did not. Using propensity-score matching, baseline PCT testing was associated with an average reduction in early antibiotic prescribing of 0.43 days [95% confidence interval (CI): 0.22-0.64 days, P < 0.001) and of 0.72 days (95% CI: 0.06-1.38 days, P = 0.03] in total antibiotic prescribing. Baseline PCT testing was not associated with increased mortality or hospital/ICU length of stay or with the rate of antimicrobial-resistant secondary bacterial infections. Baseline PCT testing appears to have been an effective antimicrobial stewardship tool early in the pandemic: it reduced antibiotic prescribing without evidence of harm. Our study highlights the need for embedded, rapid evaluations of infection diagnostics in the National Health Service so that even in challenging circumstances, introduction into clinical practice is supported by evidence for clinical utility. ISRCTN66682918.