Total Antibiotic Research Articles

Impact of the COVID-19 Pandemic on Inpatient Antibiotic Consumption in Switzerland.

The aim of this study was to analyze inpatient antibiotic consumption during the first 16 months of the COVID-19 pandemic in Switzerland. The entire period (January 2018–June 2021) was divided into the prepandemic period, the first and second waves, and the intermediate period. In the first year of the pandemic, total overall inpatient antibiotic consumption measured in defined daily doses (DDD) per 100 bed-days remained stable (+1.7%), with a slight increase in ICUs of +4.2%. The increase in consumption of broad-spectrum antibiotics was +12.3% overall and 17.3% in ICUs. The segmented regression model of monthly data revealed an increase in overall antibiotic consumption during the first wave but not during the second wave. In the correlation analysis performed in a subset of the data, a significant positive association was found between broad-spectrum antibiotic consumption and an increasing number of hospitalized COVID-19 patients (p = 0.018). Restricting this dataset to ICUs, we found significant positive correlations between the number of hospitalized COVID-19 patients and total antibiotic consumption (p = 0.007) and broad-spectrum antibiotic consumption (p < 0.001). In conclusion, inpatient antibiotic use during the different periods of the COVID-19 pandemic varied greatly and was predominantly notable for broad-spectrum antibiotics.

Temporal trend of antibiotic use among primary school children in Shanghai, 2017-2020

To investigate the temporal trend of antibiotic use among children in Shanghai from 2017 to 2020. The stratified cluster sampling method was used to establish a dynamic cohort of healthy children based on primary schools in Changning District, Shanghai. In the cohort, there were 282 children from 2017, 287 children from 2018, 294 from 2019 and 301 from 2020. A total of 700 children aged 7-11 years were included in the study. The basic information and antibiotic use of children were investigated by questionnaire every year, and their height and weight were measured at the same time. Chi-square test was used to analyze the difference of antibiotic use rate in each year and generalized estimation equation was used to analyze the temporal trend of antibiotic use. The results showed that the use rates of all antibiotics, cephalosporins, azithromycin and other antibiotics (including penicillin, lincomycin, quinolones, etc.) of children between 2017 and 2020 were 15.6%, 10.5%, 2.7%, and 2.4%, respectively. In 2017, 2018, 2019, and 2020, there were significant differences for the use rates of total antibiotics and other antibiotics in children (P=0.033, P=0.040), and there were no significant differences for the use rates of cephalosporins and azithromycin (P=0.274, P=0.455). After adjusting for children's basic characteristics, the generalized estimation equation showed that the annual use rate of all antibiotics, cephalosporins, and other antibiotics decreased over time.

Sewerage surveillance tracking characteristics of human antibiotic emission in sewage

Antibiotics discharging are causing the concerns of public health and sustainable production. Further policies on antibiotic production and antibiotic sales are difficult to make when lacking of sewage surveillance. In this study, the dynamic occurrence of 24 typical antibiotics in urban sewerage was investigated throughout a whole year. It was found that 17 of 42 samples had a total antibiotic concentration of more than 1000 ng/L. Sulfonamides, lincosamides, macrolides and tetracyclines were the four most common antibiotic categories in sewerage system, with the average concentration of 1246 ng/L, 2418 ng/L, 1734 ng/L and 1140 ng/L, respectively. The concentration of β-lactams was relatively low in the raw sewage (with the median value of 11 ng/L) and exhibited a tendency of attenuation in sewerage due to its degradability. The total concentration of antibiotics in sewage in different quarters were positively correlated with the dosage of antibiotics prescribed by local hospitals (R = 0.88, p < 0.01). The antibiotics profiles were also determined by the local regional discharge, specific seasons and weather features. Antibiotics consumption significantly affects the level of antibiotic residues in sewage, indicating that sewage surveillance can provide rough information on antibiotic usage. These findings can lead to new ways to understand the actual antibiotic usage in humans, and guide the antibiotic production and usage based on sewage surveillance.

P02 Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: a single-centre retrospective cohort study

BackgroundDefining the gold standard for appropriate antibiotic prescribing is challenging due to the subjective nature of evaluating quality in prescribing. In 2017 the UK Government Scientific Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection (APRHAI) used the Delphi process to define appropriate antibiotic prescribing, and developed an audit tool that supports patient-level assessment of antibiotic appropriateness in NHS hospitals.ObjectivesTo quantify excess antibiotic use in a 750-bed acute hospital in the south-west of England (bottom 20th centile on PHE Fingertips for total antibiotic prescribing), and to determine where in the prescribing process the opportunity to safely reduce antibiotic use is: (A) initiation, (B) the pre-72 h review, or (C) course length optimization.MethodsThe EPMA system was used to identify patients discharged from medical specialties in August 2020 who had received at least one dose of antibiotic. Patients were grouped by discharging medical specialty, as follows: acute medicine, elder care, renal, endocrine, gastroenterology, respiratory and cardiology. Medical notes for 25% of discharges from each specialty were requested and audited against the APRHAI audit tool. A junior doctor completed the audit form for each patient with the case then discussed by two infection specialists until consensus was reached. Excess days of antibiotic therapy (DOTs) were calculated for each of the three timepoints (A–C).ResultsIn total, 184 of 647 (28%) patients discharged from medical specialties were audited: 85 female, 99 male, median age 69 years (IQR 60–82), total DOTs 1658 of which 403 (24%) were excess. Excess DOTs by timepoint: A (initiation) 112 (28%), B (pre-72 h review) 184 (46%), C (course length) 107 (27%). Ninety-four of 187 (50%) of patients recorded zero excess DOTs.ConclusionsWe did not identify any excess DOTs in half of all patients initiated on antibiotics. However, in the other half we identified a significant proportion of excess DOTs with most excess DOTs at the pre-72 h review.

Evaluating and Comparing the Impact of an Enhanced Antimicrobial Stewardship Programme in a District Specialist Hospital: A Two-Year Retrospective Study

Antimicrobial stewardship (AMS) programme is established to optimise use of antibiotics and to contain antibiotic resistance. This single centre, cross sectional retrospective study aimed to evaluate and compare the impact of an enhanced AMS programme in 2019 with data obtained in 2018 before its implementation. Types of interventions made by the AMS team, acceptance rate of AMS recommendations, antibiotic usage (DDD/1000 patients-days) and expenditure (antibiotic usage cost, RM) of 14 antibiotics under national surveillance were reviewed. Our study demonstrated non-significant reduction in total antibiotic usage (mean 188.25 versus 183.94; p = 0.523). Nonetheless, significant decline in prescribing of cefoperazone either alone or in combination with sulbactam, ciprofloxacin and meropenem was observed. There was a significant reduction in total usage cost (mean RM80,070.39 versus RM70,858.81; 95% confidence interval (CI):1519.48, 16903.69; p = 0.022) contributed in part by decreased third generation cephalosporins, meropenem and ciprofloxacin prescriptions. During enhanced AMS period, total AMS cases (45 versus 358), frequency of rounds (12 versus 37) and ward pharmacist-initiated AMS interventions were increased. The most common intervention and recommendation encountered were inappropriate choice and de-escalation of antibiotic, respectively. There was an improvement in overall acceptance rate in 2019 (67% versus 78%; p = 0.081). In conclusion, the enhanced programme resulted in decreased overall antibiotic prescription and expenditure, besides greater acceptance of AMS recommendations.

Prescriptions patterns and appropriateness of usage of antibiotics in small and medium- sized hospitals in Korea

Background: Although small- and medium-sized hospitals comprise most healthcare providers in South Korea, data on antibiotic usage is limited in these facilities. We evaluated the pattern of antibiotic usage and its appropriateness in hospitals with &lt;400 beds in South Korea. Methods: A multicenter retrospective study was conducted in 10 hospitals (6 long-term care hospitals, 3 acute-care hospitals, and 1 orthopedic hospital), with &lt;400 beds in South Korea. We analyzed patterns of antibiotic prescription and their appropriateness in the participating hospitals. Data on the monthly antibiotic prescriptions and patient days for hospitalized patients were collected using electronic databases from each hospital. To avoid the effect of the COVID-19 pandemic, data were collected from January to December 2019. For the evaluation of the appropriateness of the prescription, 25 patients under antibiotic therapy were randomly selected at each hospital over 2 separate periods. Due to the heterogeneity of their characteristics, the orthopedics hospital was excluded from the analysis. The collected data were reviewed, and the appropriateness of antibiotic prescriptions was evaluated by 5 specialists in infectious diseases (adult and pediatric). Data from 2 hospitals were assigned to each specialist. The appropriateness of antibiotic prescriptions was evaluated from 3 aspects: route of administration, dose, and class. If the 3 aspects were ‘optimal,’ the prescription was considered ‘optimal.’ If only the route was ‘optimal,’ and the dose and/or class was ‘suboptimal,’ but not ‘inappropriate,’ it was considered ‘suboptimal.’ If even 1 aspect was ‘inappropriate,’ it was classified as ‘inappropriate.’ Results: The most commonly prescribed antibiotics in long-term care hospitals was fluoroquinolone, followed by β-lactam/β-lactamase inhibitor (antipseudomonal). In acute-care hospitals, these were third-generation cephalosporin, followed by first-generation cephalosporin and second-generation cephalosporin. The major antibiotics that were prescribed in the orthopedics hospital was first-generation cephalosporin. Only 2.3% of the antibiotics were administered inappropriately. In comparison, 15.3% of patients were prescribed an inappropriate dose. The proportion of inappropriate antibiotic prescriptions was 30.6% of the total antibiotic prescriptions. Conclusions: The antibiotic usage patterns vary between small- and medium-sized hospitals in South Korea. The proportion of inappropriate prescriptions exceeded 30% of the total antibiotic prescriptions.Funding: NoneDisclosures: None

Hospital-level variation in the utilization of antipseudomonal antibiotics: A nationwide cross-sectional study at the VHA

Background: Avoiding unnecessary antipseudomonal coverage is 1 of the most common targets for antibiotic stewardship programs (ASPs), but little is known about the magnitude of facility-level variation in antipseudomonal agent utilization. We aimed to describe the variability in the use of antipseudomonal agents across inpatient settings within a nationwide integrated healthcare system. Method: We analyzed the data from a retrospective cohort of patients who were admitted to acute-care hospitals within the VHA system in 2019. We defined antipseudomonal agents as systemic antibiotics with activity against wild-type Pseudomonas aeruginosa, and we evaluated overall and antipseudomonal antibiotic use among 129 hospitals, according to the agents described in the NHSN Antimicrobial Usage and Resistance Module. We calculated each hospital’s overall and antipseudomonal days of therapy (DOT) per 1,000 days present and the proportion of antipseudomonal agent usage among all antibiotics based on DOT at each hospital. Hospital-level variation was assessed by comparing the proportion of total antibiotic consumption accounted for by antipseudomonal agents. Associations between antipseudomonal proportions and overall antibiotic consumption were also assessed. Results: Among 129 VHA hospitals, the median DOT per 1,000 days present for all antibiotics was 434.4 (IQR, 371.9–487.1), and the median antipseudomonal DOT per 1,000 days present was 127.7 (IQR, 99.8–159.6). The median proportion of total antibiotic consumption accounted for by antipseudomonal agents was 30.0% (range, 14.9%–40.7%; IQR, 26.4%–34.4%) (Fig. 1). We detected only a weak correlation between overall antibiotic consumption and antipseudomonal proportion (Pearson correlation coefficient, 0.396), which suggests that hospitals with higher total antibiotic consumption were not necessarily using more antipseudomonal agents. In a stratified analysis, there was more prominent hospital-level variability in surgical specialties than medical specialties (Fig. 2). Conclusions: We detected high hospital-level variability in the consumption and proportion of antipseudomonal antibiotics among an integrated healthcare system. Although it is plausible that these variabilities originated from case-mix differences among hospitals, including differing rates of P. aeruginosa infections, it may also highlight opportunities for reducing antipseudomonal antibiotic utilization, especially among surgical specialties. Further studies are needed to evaluate the contribution of modifiable patient- and facility-level factors to this variability.Funding: NoneDisclosures: None

Antimicrobial Properties of Distichochlamys citrea M.F. Newman Rhizome n‐Hexane Extract against Streptococcus pyogenes: Experimental Evidences and Computational Screening

AbstractDistichochlamys citrea, an endemic plant species found only in Vietnam, traditionally known effective for internal inflammation and infection, thus considered as a promising natural antibiotic source. A variety of experimental‐computational methodologies were utilised. Gas chromatography‐mass spectrometry reveals twenty‐one bioactive components (C1‐C21) is found in the n‐hexan extract. Bioassays indicate its total antibiotic activity of high significance against Streptococcus pyogenes (IZD 14±2.0 mm; MIC value of 156.25 μg.mL−1). Docking simulation predicts C17 (DS −12.9 kcal.mol−1; RMSD 1.34 Å)&gt;C14 (DS −12.3 kcal.mol−1; RMSD 1.58 Å)&gt;C16 (DS −12.0 kcal.mol−1; RMSD 1.30 Å) as the most effective inhibitors towards S‐ribosylhomocysteine lyase structure (UniProtKB: P0C0C7). Quantitative structure‐activity relationships suggest all the compounds are predicted with high biocompatibility in reference for oral drug development, and specifiy C1‐C21 especially safe for use in vertebrates. The results preliminarily confirm the significant antibiotic activity of Distichochlamys citrea and encourage further in‐depth experiments in order to harness its pharmacological potentiality.

Impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection

ObjectiveTo investigate the impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection (HA-CDI). MethodsRetrospective study conducted in the Hospital Universitario de Valme (HUV) and the Hospital General Universitario de Alicante (HGUA) in Spain between January 2019 and February 2021. The study period was divided into non-COVID19 period (2019 and months from 2020 to 2021 with ≤30 hospitalized COVID19 patients) and COVID19 period (months from 2020 to 2021 with >30 COVID19 patients). HA-CDI incidence rates (IR) were calculated as the number of new CDI cases per 10.000 occupied bed-days (OBD) and antimicrobial consumption by means of the defined daily dose (DDD) per 1000 OBD. ResultsDuring the COVID19 period, HA-CDI IR in the HUV was 2.6 per 10.000 OBD, which was lower than what was observed during the non-COVID19 period (4.1 per 10.000 OBD; p = 0.1). In the HGUA, HA-CDI IR during COVID19 period was 3.9 per 10.000 OBD, which was not significantly different to the IR observed during the non-COVID19 period (3.7 per 10.000 OBD; p = 0.8). There was a slight increase in the total antibiotic consumption during COVID19 period in both hospitals, with significant increases of certain high-risk antibiotics as cephalosporins. ConclsusionsHA-CDI incidence has not increased during the COVID19 pandemic in two tertiary centers in Spain, in spite of a slightly higher antibiotic consumption during the COVID19 period in both hospitals. These findings suggest that, in the presence of strict infection control measures, hospital antibiotic consumption might have a lower impact than expected on HA-CDI.

Antibiotic Use before, during, and after Seeking Care for Acute Febrile Illness at a Hospital Outpatient Department: A Cross-Sectional Study from Rural India.

Antibiotic resistance is a naturally occurring phenomenon, but the misuse and overuse of antibiotics is accelerating the process. This study aimed to quantify and compare antibiotic use before, during, and after seeking outpatient care for acute febrile illness in Ujjain, India. Data were collected through interviews with patients/patient attendants. The prevalence and choice of antibiotics is described by the WHO AWaRe categories and Anatomical Therapeutic Chemical classes, comparing between age groups. Units of measurement include courses, encounters, and Defined Daily Doses (DDDs). The antibiotic prescription during the outpatient visit was also described in relation to the patients’ presumptive diagnosis. Of 1000 included patients, 31.1% (n = 311) received one antibiotic course, 8.1% (n = 81) two, 1.3% (n = 13) three, 0.4% (n = 4) four, 0.1% (n = 1) five, and the remaining 59.0% (n = 590) received no antibiotics. The leading contributors to the total antibiotic volume in the DDDs were macrolides (30.3%), combinations of penicillins, including β-lactamase inhibitors (18.8%), tetracyclines (14.8%), fluoroquinolones (14.6%), and third-generation cephalosporins (13.7%). ‘Watch’ antibiotics accounted for 72.3%, 52.7%, and 64.0% of encounters before, during, and after the outpatient visit, respectively. Acute viral illness accounted for almost half of the total DDDs at the outpatient visit (642.1/1425.3, 45.1%), for which the macrolide antibiotic azithromycin was the most frequently prescribed antibiotic (261.3/642.1, 40.7%).

Export and risk from antibiotic remobilization from surrounding water to lake in the extreme 2020 Yangtze River basin flooding

Global climate change increased the frequency of extreme rainfall events, leading to higher flood risk. In addition to the personal and property losses, another important consequence of a flood disaster was release and exposure risks from emerging contaminants, which was usually overlooked. The remobilization and fate of the antibiotics induced by floods remain unclear. We captured antibiotic concentrations around the Chaohu Lake after an unprecedented flood with a range of 5.0–317 ng/L. Higher concentrations in polder waters than their receiving rivers were attributed to the antibiotic release from soil particles and the sharp increase of water: soil ratio by flood storage. Source apportionment analysis of antibiotics implied that diffuse pollution by manure application and aquaculture activity was the predominant sources. Commonalities of spatial variations of antibiotics in polders were related to the condition of waterlogging and pollution source. The total antibiotic storage for all submerged polders was estimated at 27.9 kg. The concentrations and risks from pumping floodwater detained by polders into the lake were much higher than that from discharging flood directly into the lake. The retention-reaction-remobilization process would pose unexpectedly high risks for the lake. This study provided a new sight for constructing ecological wetland flood storage areas.

Rethinking the “Pan-Culture”: Clinical Impact of Respiratory Culturing in Patients With Low Pretest Probability of Ventilator-Associated Pneumonia

BackgroundRespiratory cultures are often obtained as part of a “pan-culture” in mechanically ventilated patients in response to new fevers or leukocytosis, despite an absence of clinical or radiographic evidence suggestive of pneumonia.MethodsThis was a propensity score–stratified cohort study of hospitalized mechanically ventilated adult patients between 2014 and 2019, with a new abnormal temperature or serum white blood cell count (NATW), but without radiographic evidence of pneumonia, change in ventilator requirements, or documentation of purulent secretions. Two patient groups were compared: those with respiratory cultures performed within 36 hours after NATW and those without respiratory cultures performed. The co-primary outcomes were the proportion of patients receiving >2 days of total antibiotic therapy and >2 days of broad-spectrum antibiotic therapy within 1 week after NATW.ResultsOf 534 included patients, 113 (21.2%) had respiratory cultures obtained and 421 (78.8%) did not. Patients with respiratory cultures performed were significantly more likely to receive antibiotics for >2 days within 1 week after NATW than those without respiratory cultures performed (total antibiotic: adjusted odds ratio [OR], 2.57; 95% CI, 1.39–4.75; broad-spectrum antibiotic: adjusted OR, 2.47, 95% CI, 1.46–4.20).ConclusionsPerformance of respiratory cultures for fever/leukocytosis in mechanically ventilated patients without increasing ventilator requirements, secretion burden, or radiographic evidence of pneumonia was associated with increased antibiotic use within 1 week after incident abnormal temperature and/or white blood cell count. Diagnostic stewardship interventions targeting performance of unnecessary respiratory cultures in mechanically ventilated patients may reduce antibiotic overuse within intensive care units.

Early Switch From Intravenous to Oral Antibiotics in Skin and Soft Tissue Infections: An Algorithm-Based Prospective Multicenter Pilot Trial.

BackgroundIn hospitalized patients with skin and soft tissue infections (SSTIs), intravenous (IV) empiric antibiotic treatment is initiated. The best time point for switching from IV to oral treatment is unknown. We used an algorithm-based decision tree for the switch from IV to oral antibiotics within 48 hours and aimed to investigate the treatment outcome of this concept.MethodsIn a nonrandomized trial, we prospectively enrolled 128 patients hospitalized with SSTI from July 2019 to May 2021 at 3 institutions. Clinical and biochemical response data during the first week and at follow-up after 30 days were analyzed. Patients fulfilling criteria for the switch from IV to oral antibiotics were assigned to the intervention group. The primary outcome was a composite definition consisting of the proportion of patients with clinical failure or death of any cause.ResultsNinety-seven (75.8%) patients were assigned to the intervention group. All of them showed signs of clinical improvement (ie, absence of fever or reduction of pain) within 48 hours of IV treatment, irrespective of erythema finding or biochemical response. The median total antibiotic treatment duration was 11 (interquartile range [IQR], 9–13) days in the invention group and 15 (IQR, 11–24) days in the nonintervention group (P < .001). The median duration of hospitalization was 5 (IQR, 4–6) days in the intervention group and 8 (IQR, 6–12) days in the nonintervention group (P < .001). There were 5 (5.2%) failures in the intervention group and 1 (3.2%) in the nonintervention group after a median follow-up of 37 days.ConclusionsIn this pilot trial, the proposed decision algorithm for early switch from IV to oral antibiotics for SSTI treatment was successful in 95% of cases. Clinical Trials Registration. ISRCTN15245496

A shortened course of Amoxicillin/Clavulanate is the preferred antibiotic treatment after surgery for perforated appendicitis in children

Background/purposeDespite evidence supporting short course outpatient antibiotic treatment following appendectomy for perforated appendicitis, evidence of real-world implementation and consensus for antibiotic choice is lacking. We therefore aimed to compare outpatient antibiotic treatment regimens in a national cohort. MethodsWe identified children who underwent surgery for perforated appendicitis between 2010 and 2018 using the PearlDiver database and compared 45-day disease-specific readmission between children who received shortened (5–8 days) versus prolonged (10–14 day) total antibiotic courses (inpatient intravenous and/or oral) completed with outpatient Amoxicillin/Clavulanate versus Ciprofloxacin/Metronidazole, and compared antibiotic type (5–14 days) to each other. Results4916 children were identified, 2001 (90.0%) treated with Amoxicillin/Clavulanate (5–14 days), 381 (19.0%) with shortened (5–8 days), 1464 (73.2%) with prolonged (10–14 days) courses. 222 (10.0%) were treated with Ciprofloxacin/Metronidazole, 44 (19.8%) with shortened, 174 (78.4%) with prolonged courses. Freedom from readmission was not different between prolonged and shortened course whether they received Amoxicillin/Clavulanate (adjusted hazard ratio [AHR] 1.54, 95%CI 0.95–2.5) or Ciprofloxacin/Metronidazole (AHR 3.49, 95%CI 0.45–27.3). Antibiotic type did not affect readmission rate (Amoxicillin/Clavulanate versus Ciprofloxacin/Metronidazole, AHR 1.21, 95%CI 0.71–2.05). ConclusionProlonged antibiotic regimens are routinely prescribed despite evidence suggesting shorter courses and antibiotic choice are not associated with greater treatment failure. As it is better tolerated, we recommend a shortened course of Amoxicillin/Clavulanate for oral management of perforated appendicitis. Study designRetrospective. Level of evidenceLevel III.

Determination of 42 antibiotic residues in seven categories in water using large volume direct injection by ultra high performance liquid chromatography-triple quadrupole mass spectrometry

抗生素作为新型有机污染物在自然水体中被频繁检出,检出种类多且含量水平低,为了实现更加快速、全面、准确的高通量分析,研究开发了一种利用大体积直接进样测定水中7大类(磺胺类、林可酰胺类、喹诺酮类、大环内酯类、四环素类、头孢类及氯霉素类)42种抗生素的超高效液相色谱-三重四极杆质谱法。水样经0.22 μm滤膜过滤,加入Na2EDTA并调节pH值至6.0~8.0,加入内标混匀后,采用Phenomenex Kinetex C18柱(50 mm×30 mm, 2.6 μm),以0.1%(v/v)甲酸水溶液-乙腈作为流动相进行梯度洗脱,质谱智能化分时间段-多反应选择离子监测(Schedule-MRM)模式进行检测。42种抗生素在相关线性范围内线性良好(r=0.9949~0.9995),回收率为80.1%~125%,相对标准偏差为0.8%~12.2%,方法检出限为0.015~3.561 ng/L。将该方法应用于10份水源水和5份末梢水的检测,结果显示在42种抗生素中,12种抗生素有检出,包括磺胺类、大环内酯类、林可酰胺类和氯霉素类,其在水源水中的检出率达100%;林可霉素和氯霉素是检出质量浓度最高的两种抗生素,它们的质量浓度范围分别为3.83~13.8和24.8~33.6 ng/L。该方法从检出限和回收率两方面与标准方法和文献报道进行了比较,检出限及回收率均满足要求。该方法与传统前处理方法相比具有简单、快速、绿色、精密度高、准确度高、消耗样品量小的优点,能用于地表水、地下水、末梢水等较为洁净水体中42种痕量水平的抗生素测定。

Drug Utilization Study in Outpatient Department of Ophthalmology in Tertiary Care Hospital

Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use.&#x0D; Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH).&#x0D; Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation.&#x0D; Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%).&#x0D; Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs.

The impact of the length of total and intravenous systemic antibiotic therapy for the remission of diabetic foot infections

ObjectiveWe investigated the impact of the total length of systemic antibiotic therapy (ABT) and its initial intravenous (IV) part on clinical failure (CF) and microbiological failure (MF) in diabetic foot infections (DFIs). MethodsIn this single-center, retrospective, unmatched case-control study, we included DFI episodes treated with a combined surgical-antibiotic approach. ResultsWe included 721 DFI episodes, 537 with osteomyelitis (DFO). CF occurred in 191 (26.5%) and MF in 42 (5.8%) episodes. Multivariate Cox regression analysis showed that a short ABT of 8–21 days (hazard ratio [HR] 0.4; 95% CI 0.2–0.7) was inversely associated with CF. This was also applicable for IV ABT with relatively short durations of 2–7 days (HR 0.5; 95% CI 0.3–0.8) or 8–14 days (HR 0.6; 95% CI 0.4–0.9). We failed to detect a minimal threshold of total or IV ABT predictive for CF or MF. ConclusionsCompared with total ABT of more than 84 days and IV therapy of more than 14 days, shorter total and IV ABT yielded no enhanced risk of CF or MF. Considering the “bias by indication” that is inherent to retrospective DFI studies, the best study design concerning the duration of ABT would be a stratified, prospective randomized trial, which is currently under way in our medical center.

Evaluation of Antibiotic Duration after Surgical Debridement of Necrotizing Soft Tissue Infection.

Background: Necrotizing soft tissue infection (NSTI) is known to be a medical emergency with high morbidity and mortality. Guidelines do not specify the optimal duration of antibiotic agents after completion of surgical debridements of NSTI, which has created variable practice. It was hypothesized that patients with NSTI who receive 48 hours or less of post-operative antibiotic agents after final debridement have similar rates of subsequent intervention or infection recurrence, suggesting that a shorter duration of antibiotic agents may treat NSTI adequately after final surgical debridement. Patients and Methods: This was a retrospective study including adults with NSTI identified through International Classification of Diseases, Ninth Revision (ICD-9), International Classification of Diseases, Tenth Revision (ICD-10), and Current Procedural Terminology (CPT) codes admitted to one academic institution between January 1, 2010 and July 31, 2020. Demographics, surgical practices, antibiotic practices, and clinical outcomes including inpatient mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, total antibiotic days, necrotizing infection clinical composite end point (NICCE) success, and infection recurrence were compared based on the duration of antibiotic agents after final debridement. Results: Three hundred twenty-two patients with NSTI were included and baseline characteristics and clinical severity markers were well balanced between the two groups. In 71 patients (22%) who received less than 48 hours of antibiotic agents after final debridement there was no difference in recurrence (1.4% vs. 3.6%; p = 0.697), mortality (1.4% vs. 4.4%; p = 0.476), or ICU LOS (1 vs. 2 days; p = 0.300], but they did have a shorter hospital LOS (7 vs. 10 days; p = 0.011). Conclusions: Shorter duration of antibiotic therapy after final surgical debridement of NSTI may be appropriate in patients without another indication for antibiotic agents.

Contamination Characteristics and Ecological Risk Assessment of Antibiotics in the Third Drain of Ningxia

Solid-phase extraction and ultra-high performance liquid chromatography-electrostatic field orbit hydrazine mass spectrometry were used to detect and analyze the contamination of nine antibiotics including sulfonamides, tetracyclines, macrolides, quinolones, and lincomycin in the third drain of Ningxia. Correlations between the antibiotic concentration and water quality indexes were explored, and the ecological risks were evaluated. The results showed that seven antibiotics were detected in the third drain and its confluent stream, with the total concentrations of 14.91-153.48 ng·L-1 and ND-39.37 ng·L-1, respectively. The detection ratios of clarithromycin, levofloxacin, ciprofloxacin, and lincomycin were 100% in the third drain. The highest-concentration antibiotic was levofloxacin (0.84-94.12 ng·L-1), followed by lincomycin (11.15-48.13 ng·L-1). Based on the spatial distribution analysis, after flowing through Pingluo County, total antibiotic concentrations in the third drain increased significantly and showed an increasing trend. The maximum concentration appeared in the Huinong section and showed a decreasing trend downstream. The total concentration of antibiotics before flowing into the Yellow River was 20.26 ng·L-1. Correlation analysis showed that levofloxacin was significantly positively correlated with NH4+-N and TN (P<0.01), erythromycin was significantly correlated with TN, and clarithromycin was significantly correlated with both NH4+-N and TN (P<0.05), which indicated that water quality index was closely related to antibiotic concentration. The results of the ecological risk assessment showed that levofloxacin and clarithromycin in the third drain posed certain ecological risks.

236 E-Prescribing and Smart Antimicrobial Stewardship in Upper Limb Infections

Abstract Aim Upper limb infections secondary to traumatic wounds, animal bites and other causes are a common reason for admission to the plastic surgery service for intravenous antibiotics. This audit investigated the compliance of treatment of upper limb infections with trust guidance. The guidance stipulated an antibiotic treatment duration of five to seven days total and microbiology advice suggested that in cases requiring multiple washouts, this should start from the date of the last surgical washout where pus was present. Method There was retrospective sampling for four months using inpatient lists to include patients admitted for intravenous antibiotics for upper limb infections. Notes were requested by the secretaries and data was collected using patient notes, discharge summaries and electronic drug charts. Results The analysis included twenty-seven suitable patients. All patients had the correct antibiotics prescribed according to guidance, however only 22% of patients had five to seven days total of antibiotics either from the start of therapy or from the date of last infected washout in those who underwent surgical treatment. 14/27 patients had more than seven days total antibiotics. 13/27 patients were discharged with an additional seven days of oral antibiotics regardless of the total duration. Conclusions These infections are significantly over-treated with antibiotics, which has serious potential consequences for antimicrobial resistance. The findings of the audit prompted new trust guidelines to be produced and prescribing guidance was sent to the junior doctors to calculate the total antibiotic duration when preparing discharge summaries. There is a plan for re-audit in a few months’ time.