Total Antibiotic Research Articles

Predictors of antimicrobial use in intensive care unit patients

Background: Identification of predictors of antibiotic use can inform targeted antimicrobial stewardship initiatives and can account for sources of bias in before-and-after interventional stewardship studies. To date, no study has identified clinical predictors of antimicrobial use within intensive care units (ICUs), where antimicrobial resistance is most prevalent and problematic. Methods: As part of an ongoing prospective, single-arm, pilot feasibility trial of an ICU diagnostic stewardship intervention, we performed a nested retrospective cohort study to explore associations between patient clinical variables and ICUs antimicrobial use and resistance rates (AURs). We included all patients hospitalized in 3 ICUs (surgical, medical, and cardiac) from 2017 to 2021 at Michigan Medicine, a large, tertiary-care, academic medical center. Data were extracted from the electronic medical record using a structured query. Admission-level data were captured, including patient demographics, medical comorbidities, International Classification of Disease, Tenth Revision (ICD-10) admission diagnoses, as well as calendar day-level data including vital signs, clinical and microbiologic laboratory data, measures of acute severity of illness, ventilator–supplemental oxygen metrics, and procedural interventions using current procedural terminology (CPT) codes. ICU AURs were defined as total antibiotic days of therapy per patient per 100 ICU days. Associations between clinical variables and ICU AURs were calculated as rate ratios (RRs). Multiple imputation using fully conditional specification was performed to create 25 imputation data sets. Negative binomial regression models were constructed for each data set using backward selection. Variables retained in >50% of models were included in a final multivariate model. Results: In total, 15,177 ICU patient admissions were captured. Age, sex assigned at birth, and race did not independently associate with ICU AURs. Comorbidities, medical interventions, admission diagnoses, and laboratory data that independently associated with ICU-AURs are shown in Table 1. The clinical variables most strongly associated with increased ICU-AURs were pneumonia (RR, 1.55; 95% CI, 1.451.64), bacteremia (RR, 1.35; 95% CI, 1.25– 1.46), intraabdominal infection (RR, 1.35; 95% CI, 1.18–1.55), SOFA score (RR, 1.27; 95% CI, 1.14–1.42), abnormal WBC (RR, 1.26; 95% CI, 1.20–1.32), and immunocompromised status (RR, 1.20; 95% CI, 1.10–1.31). Clinical variables most strongly associated with decreased ICU-AURs were cardiac ICU (RR, 0.56; 95% CI, 0.52–0.60), COVID-19 (RR, 0.62; 95% CI, 0.56–0.70), and receipt of an invasive nonsurgical procedure (RR, 0.90; 95% CI, 0.82–0.98). Conclusions: In this single-center retrospective cohort study, several clinical variables were independently associated with ICU-AURs. These results may be used to identify patient subgroups for potentially high-yield ICU-based stewardship interventions and to account for sources of bias in before-and-after studies of ICU-based stewardship interventions.Disclosures: None

Antimicrobial Stewardship in a Psychiatric Hospital: Opportunities for Improvement

Background: Western State Hospital (WSH) is an 800-bed, state-owned psychiatric hospital in Washington State which services individuals in 20 counties. WSH provides services and inpatient treatment to patients referred via behavioral health providers and/or the civil court system. Because many patients are admitted with serious, long-term illness, WSH also provides primary care and addresses infectious syndromes encountered in admitted patients. In January 2016, WSH officially began their antimicrobial stewardship program (ASP). In 2017 WSH joined the UW Center for Stewardship in Medicine (UW-CSiM) to grow and optimize their ASP. Methods: The lead pharmacist at WSH participated in weekly hour-long education and tele-mentoring sessions through the UW-CSiM program. Educational materials were adapted from UW-CSiM didactics and delivered to providers during regular meetings and grand rounds. Daily pharmacist led prospective audit with feedback was conducted. Antibiotic use data were collected and measured by days of therapy (DOT) per 1000-patient days from pharmacy dispensing records from 2015 to 2022. Results: From 1/1/15 to 12/31/22, there was a consistent trend of decreasing antibiotic consumption annually. In particular, antibiotic use decreased by over 65% ranging from 35-43 DOT per 1000 patient-days in 2015 to 9-11 DOT per 1000 patient-days in 2022 (Figure 1). This translates to approximately 1000 antibiotic days of therapy in 2015 and 200 days of antibiotic therapy in 2022. As of 2022, the two most common antibiotics used were cephalexin and sulfamethoxazole/trimethoprim Conclusion: Although treating infections is not a principal focus of a psychiatric hospital, patients receiving care in inpatient psychiatric facilities do experience common infections and receive antibiotics during their stay. At WSH, initiation of an antimicrobial stewardship program was associated with sustained decrease in total antibiotic DOT over 7 years. These data highlight the impact of tele-education and tele-mentoring in infectious diseases and antimicrobial stewardship as a path to build a successful antimicrobial stewardship even without formal infectious diseases training. Our single center experience at a large psychiatric hospital demonstrates the use of antimicrobials in these facilities and the opportunity for a large impact of an antimicrobial stewardship program in inpatient psychiatric facilities.Disclosures: None.

Reducing the rate of guideline-discordant therapy for inpatients with community-acquired pneumonia

Background: Despite guidelines recommending shorter durations of therapy and empiric coverage of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) only for patients with certain risk factors, optimizing therapy for community-acquired pneumonia (CAP) remains a challenge for antimicrobial stewardship (AMS) teams. We investigated the impact of a multimodal AMS initiative on the rate of guideline-discordant empiric antibiotic selection and total duration of therapy for CAP. Methods: A quality improvement initiative was implemented at 9 community hospitals in 2022 to optimize CAP therapy. Education was provided to pharmacists and providers. Alerts were implemented within the electronic medical record to prompt the AMS team to review fluoroquinolones, antipseudomonal β-lactams, and anti-MRSA agents ordered for CAP. Clinical pharmacists reviewed antibiotic orders for CAP at hospital discharge and encouraged providers to prescribe a total antibiotic duration of 5–7 days. For the preintervention period (July– September 2021) and the postintervention period (July to September 2022), a random sample of 320 patients with an antibiotic order for CAP were evaluated retrospectively via chart review. Patients treated for an indication other than CAP were excluded. The primary outcome was the proportion of patients with a total duration of therapy >7 days. Secondary outcomes included average duration of therapy, rate of guideline-discordant empiric therapy, and type of guideline discordance. Results: In total, 317 patients were included. The proportion of patients with a total duration of therapy >7 days decreased from 29% to 14% (P < .01). Average duration of therapy and guideline-discordant empiric therapy also decreased significantly (Table 1). Conclusions: This multifaceted AMS initiative was associated with decreased guideline-discordant empiric therapy and decreased total duration of therapy for CAP.Disclosures: None

Effects of antibiotics on the endophyte and phyllosphere bacterial communities of lotus from above and below surface water in a typical shallow lake

Antibiotics are ubiquitous pollutants that are widely found in aquatic ecosystems, where the bacterial community of aquatic plants is influenced by antibiotics. However, differences between endophyte and phyllosphere bacteria of Lotus from above and below surface water remains unclear. Lotus samples from above and below the surface water were collected to investigate the differences in endophyte and phyllosphere bacteria and dominant environmental factors in regions with low (L-) and high (H-) total antibiotic levels. There were significant differences in Shannon diversity between endophyte and phyllosphere bacteria except between the below-surface water phyllosphere bacteria and below-surface water endophytes in both L-antibiotic and H-antibiotic regions, with higher values for phyllosphere bacteria. The dominant phylum in all phyllosphere samples was Proteobacteria (76.1%–92.5%), while Cyanobacteria (47.8%–81.1%) was dominant in all endophyte samples. The dominant source of above-surface water endophytes was below-surface water endophytes (83.68–91.25%), below-surface water phyllosphere bacteria (48.43–55.91%) for above-surface water phyllosphere bacteria, and above-surface water endophytes (53.83–61.80%) for below-surface water endophytes, while the dominant contributor to the below-surface water phyllosphere bacteria was also below-surface water endophytes (52.96–61.00%) in two regions, indicating that antibiotic stress changed the sink‒source relationship between endophytes and phyllosphere bacteria. The physical-chemical properties of surface water and sediments could be responsible for the variations in the above- and below-surface water endophytes and phyllosphere bacteria in both regions. It is suggested that antibiotics may have a substantial effect on endophyte and phyllosphere bacterial community.

수의사 처방제 전·후 가축에 대한 항생제 판매량

A veterinarian prescription system (VPS) was implemented in 2013 to reduce the use of antibiotics in food-producing animals in South Korea. To understand effects of VPS on sales of antibiotics for food-producing animals, this study compared average sales of antibiotics for seven years before (2006-2012) and after (2014-2020) implementing VPS using population correction unit (PCU). As a result, average sales (242 mg/PCU) after implementing VPS decreased by 36% compared to those (380 mg/PCU) before implementing it. In addition, average sales of HP-CIAs after implementing VPS decreased by 14% from 51.4 mg/PCU to 44.2 mg/PCU compared to those before implementing it. Although average sales of total antibiotics and HP-CIAs for food-producing animals decreased after implementing VPS compared to those before implementing it, they were still higher than those in Europe. Therefore, it is necessary to strengthen VPS continuously to reduce the use of antibiotics for food-producing animals in the future.

The impact of the COVID-19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland.

To evaluate the impact of the COVID-19 pandemic on the patterns of antimicrobial use and the incidence of pathogens in primary and secondary healthcare settings in Northern Ireland. Data were collected on antibiotic use and Gram-positive and Gram-negative pathogens from primary and secondary healthcare settings in Northern Ireland for the period before (January 2015-March 2020) and during (April 2020-December 2021) the pandemic. Time series intervention analysis methods were utilized. In the hospital setting, the mean total hospital antibiotic consumption during the pandemic was 1864.5 defined daily doses (DDDs) per 1000 occupied-bed days (OBD), showing no significant change from pre-pandemic (P = .7365). During the pandemic, the use of second-generation cephalosporins, third-generation cephalosporins, co-amoxiclav and levofloxacin increased, there was a decrease in the percentage use of the hospital Access group (P = .0083) and an increase in the percentage use of Watch group (P = .0040), and the number of hospital Klebsiella oxytoca and methicillin-susceptible Staphylococcus aureus cases increased. In primary care, the mean total antibiotic consumption during the COVID-19 pandemic was 20.53 DDDs per 1000 inhabitants per day (DID), compared to 25.56 DID before the COVID-19 pandemic (P = .0071). During the pandemic, there was a decrease in the use of several antibiotic classes, an increase in the percentage use of the Reserve group (P = .0032) and an increase in the number of community-onset Pseudomonas aeruginosa cases. This study provides details of both changes in antibiotic consumption and the prevalence of infections in hospitals and primary care before and during the COVID-19 pandemic that emphasize the importance of antimicrobial stewardship in pandemic situations.

Combined effects of microplastics and chlortetracycline on the intestinal barrier, gut microbiota, and antibiotic resistome of Muscovy ducks (Cairina moschata)

Antibiotics and microplastics (MPs) have become critical concerns worldwide because of their increasing amount and ecological risks to ecosystems. However, how MPs exposure affects the bioaccumulation and risks of antibiotics in waterfowls remains poorly understood. In this study, Muscovy ducks were exposed to single and combined contamination with polystyrene MPs and chlortetracycline (CTC) for 56 days, and the effects of MPs on CTC bioaccumulation and their risks in duck intestines were investigated. MPs exposure reduced the bioaccumulation of CTC in the intestine and liver of ducks and increased their fecal CTC excretion. MPs exposure caused severe oxidative stress, inflammatory response, and intestinal barrier damages. Microbiome analysis showed that MPs exposure induced microbiota dysbiosis by increasing the abundance of Streptococcus and Helicobacter, the increase of which may exacerbate intestinal damages. Co-exposure to MPs and CTC alleviated the intestinal damage by regulating the gut microbiome. Metagenomic sequencing revealed that the combined exposure to MPs and CTC increased the abundance of Prevotella, Faecalibacterium, and Megamonas and incidence of total antibiotic resistance genes (ARGs), especially tetracycline ARGs subtypes in the gut microbiota. The results obtained herein provide new insights into the potential risks of polystyrene MPs and antibiotics in waterfowls living in aquatic environments.

Occurrence and risk levels of antibiotic pollution in the coastal waters of eastern China.

In order to preliminarily explore the distribution of antibiotic pollution in the coastal waters of eastern China, the concentrations of 13 antibiotics in 5 representative coastal rivers in Jiangsu and 21 sampling sites in the coastal waters of Jiangsu were analyzed. The total antibiotic concentrations in the 5 rivers ranged from 33.14 to 417.78 ng L-1, and the total antibiotic concentrations in the 21 sampling sites ranged from 0.90 to 86.33 ng L-1. Macrolides exhibited the highest total concentration and the maximum detection frequency in both coastal rivers and the coastal waters. The concentrations of antibiotics in a sampling site decreased as the distance of the sampling site from the coastline increased, indicating that river inputs are important sources of antibiotic pollution in the coastal waters of Jiangsu. The detection frequencies of roxithromycin, lincomycin, azithromycin, and sulfamethoxazole in the rivers and sampling sites were above 70%. Correlation analysis showed that the concentrations of antibiotics were positively correlated with the levels of chemical oxygen demand, total phosphorus, and total nitrogen. Risk assessments revealed that roxithromycin and ofloxacin posed medium ecological and resistance risks, respectively, to the most sensitive aquatic organisms in the coastal waters of Jiangsu. The results of this study highlight the significance of monitoring and controlling the concentrations of antibiotic contaminants in the coastal waters of Jiangsu.

Epidemiology and clinical features ofStreptococcus pyogenesbloodstream infectionsin childrenin Madrid, Spain.

Studies have shown increased invasive Group A Streptococcus (GAS) disease, including bloodstream infections (GAS-BSI). However, the epidemiological data of GAS-BSI are limited in children. We aimed to describe GAS-BSI in children in Madrid, over 13years (2005-2017). Multicenter retrospective cohort study from 16 hospitals from Madrid, Spain. Epidemiology, symptomatology, laboratory, treatment, and outcome of GAS-BSI in children ≤ 16years were analyzed. 109 cases of GAS-BSI were included, with incidence rate of 4.3 episodes/100,000 children attended at the emergency department/year. We compared incidence between two periods (P1:2005-June 2011 vs P2:July 2011-2017) and observed a non-significant increase along the study period (annual percentage change: + 6.0% [95%CI:-2.7, + 15.4]; p = 0.163).Median age was 24.1months (IQR:14.0-53.7), peaking during the first four years of life (89/109 cases;81.6%). Primary BSI (46.8%), skin and soft tissue (21.1%), and osteoarticular infections (18.3%) were the most common syndromes. We compared children with primary BSI with those with a known source and observed that the former had shorter hospital stay (7vs.13days; p = 0.003) and received intravenous antibiotics less frequently (72.5%vs.94.8%; p = 0.001) and for shorter duration of total antibiotic therapy (10vs.21days; p = 0.001). 22% of cases required PICU admission. Factors associated with severity were respiratory distress, pneumonia, thrombocytopenia, and surgery, but in multivariate analysis, only respiratory distress remained significant (adjusted OR:9.23 [95%CI:2.16-29.41]). Two children (1.8%) died. Conclusion: We observed an increasing, although non-significant, trend of GAS-BSI incidence within the study. Younger children were more frequently involved, and primary BSI was the most common and less severe syndrome. PICU admission was frequent, being respiratory distress the main risk factor. What is known: • In recent decades, several reports have shown a worldwide increase in the incidence of invasive Group A streptococcal disease (GAS), including bloodstream infection (BSI). Recently, there have been a few reports showing an increase in severity as well. • There needs to be more information on the epidemiology in children since most studies predominantly include adults. What is new: • This study, carried out in children with GAS-BSI in Madrid, shows that GAS-BSI affects mostly younger children, with a broad spectrum of manifestations, needing PICU admission frequently. Respiratory distress was the leading risk factor for severity, whereas primary BSI seemed to be less severe. • We observed an increasing, although non-significant, trend of GAS-BSI incidence in recent years (2005-2017).

Impact of total parenteral nutrition and antibiotics on hepatic and intestinal homeostasis in pediatric murine model

Parenteral nutrition (PN) prevents starvation and supports metabolic requirements intravenously when patients are unable to feed enterally. Adult rodents and piglets have been used in PN research for decades, while almost no research has used adolescent mice. Clinically, human neonates are frequently provided PN in intensive care settings along with exposure to antibiotics (ABX) to minimize infection during care. Since PN bypasses the intestine, intravenous alimentation impacts metabolism and may alter organ growth and programming during critical early life developmental windows. Utilizing our newly established adolescent murine PN model, we first administered ABX or controlled drinking water to time pregnant dams to disrupt maternal microbiome. Resulting pups (post-natal day 9, n=6-8/group) were then randomized to PN or sham surgery controls for 72 hours with or without prior ABX exposure. ABX or PN decreased liver and brain organ weights, intestinal length, and mucosal architecture compared with controls. PN significantly elevated hepatic proinflammatory cytokine expression, neutrophils, macrophages, and bacterial colony forming units, which was blocked by ABX. However, PN+ABX uniquely elevated metabolic regulatory genes, FXR, CYP27A1, SPEBP1, and FASN, resulting in accumulation of hepatocyte lipid vesicles and altered circulating bile acid pools. Within the gut, PN elevated the relative abundance of Akkermansia, Coprococcus and decreased Lactobacillus compared with enteral controls, while ABX enriched Enterobacteriaceae and Adlercrutzia. We conclude that even brief PN feeding elevates hepatic inflammatory stress in an early life model. While concurrent ABX exposure protects against PN associated inflammatory responses, the dual therapy modulates bile acid and lipid metabolism, which may contribute to the progressive hepatic dysfunction observed in human neonates unable to wean from PN. This study serves as the first demonstration of PN and ABX exposures upon hepatic metabolism and inflammation in an early life murine model. Institutional Start Up Funding This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Inborn Error of Immunity Presenting with Salmonella Pericarditis and Pericardial Effusion

Salmonella infections typically occur in disorders of innate immunity with impairment in phagocyte function and/or impaired signaling in the IL-12/interferon (IFN)-gamma axis. Pericarditis/pericardial effusion has previously been reported as a rare complication of Salmonella infection.An 8-year-old, previously healthy, fully immunized Hispanic female presented with 4 days of fever and 5 days of pain in her chest, abdomen, and left shoulder. Her medical and family history was unremarkable. Chest radiograph revealed cardiomegaly, and a transthoracic echocardiogram identified a large pericardial effusion. Labs showed leukocytosis (15 K/uL), neutrophilia (ANC 12.77 K/uL), elevated CRP (287 mg/dL), and elevated BNP (607 pg/mL). Exam showed mild distress, gallop on cardiac auscultation, diminished left breath sounds, cool extremities, and 1+ peripheral pulses. She underwent pericardiocentesis, and the fluid culture was positive for Salmonella alachua. She was treated with IV ceftriaxone for 8 days, then transitioned to trimethoprim/sulfamethoxazole (TMP/SMX) to complete a 30-day total antibiotic course.Inpatient immunologic evaluation revealed T cell lymphopenia (TCL) with decreased naïve CD4+ and CD8+ T cells. Increased CD4+ and CD8+ effector memory T cells (Tem) were also observed, along with increased CD8+ TEMRA, and certain subsets of CD4+/CD8+ central memory T cells lacking CD62L. HIV testing and neutrophil oxidative burst were negative. Given her significant T cell lymphopenia, TMP/SMX prophylaxis was continued after the treatment course, and fluconazole prophylaxis was initiated due to endemic coccidiomycosis.A targeted 429-gene panel for inborn errors of immunity revealed a heterozygous missense variant of uncertain significance in PIK3CD, = c.1013G>A, p.Arg338Gln. This variant is not in gnomAD for Hispanics and is present in 0.0009% of non-Finnish Europeans. Gain-of-function (GoF) PIK3CD mutations cause a combined immunodeficiency, with increased risk of infection from encapsulated organisms, such as salmonella. However, the patient’s immunophenotype is not consistent with GoF PIK3CD mutation. She had normal transitional B cells, lack of increased senescent T cells, and absence of lymphoproliferation.TCL is likely an immunologic risk factor for Salmonella pericarditis with pericardial effusion. Though the PI3CKD variant does not appear to be pathogenic, additional functional testing for this variant is in progress.

Occurrence and Distribution of Antibiotics in a Tropical Mariculture Area of Hainan, China: Implications for Risk Assessment and Management.

With the rapid global demand for mariculture products in recent years, the use of antibiotics has increased intensively in the mariculture area. Current research on antibiotic residues in mariculture environments is limited, and less information is available on the presence of antibiotics in tropical waters, limiting a comprehensive understanding of their environmental presence and risk. Therefore, this study investigated the environmental occurrence and distribution of 50 antibiotics in the near-shore aquaculture waters of Fengjia Bay. A total of 21 antibiotics were detected in 12 sampling sites, including 11 quinolones, 5 sulfonamides, 4 tetracyclines, and 1 chloramphenicol; the quinolones pyrimethamine (PIP), delafloxacin (DAN), flurofloxacin (FLE), ciprofloxacin (CIP), norfloxacin (NOR), pefloxacin (PEF), enrofloxacin (ENO), and minocycline (MNO) of the tetracycline class were detected in all sampling points. The total antibiotic residue concentrations in the study area ranged from 153.6 to 1550.8 ng/L, the tetracycline antibiotics were detected in the range of 10 to 1344.7 ng/L, and the chloramphenicol antibiotics were detected in the range of 0 to 106.9 ng/L. The detected concentrations of quinolones ranged from 81.3 to 136.1 ng/L, and the residual concentrations of sulfonamide antibiotics ranged from 0 to 313.7 ng/L. The correlation analysis with environmental factors revealed that pH, temperature, conductivity, salinity, NH3--N, and total phosphorus had a strong correlation with antibiotics. Based on PCA analysis, the main sources of antibiotic pollution in the area were determined to be the discharge of farming wastewater and domestic sewage. The ecological risk assessment indicated that the residual antibiotics in the water environment of the near-shore waters of Fengjiawan had certain risks to the ecosystem. Among them, CIP, NOR, sulfamethoxazole (TMP), ofloxacin (OFL), enrofloxacin (ENO), sulfamethoxazole (SMX), and FLE showed medium to high risk. Therefore, it is recommended to regulate the use of these antibiotics and the discharge and treatment of culturing wastewater, and measures should be taken to reduce the environmental pollution caused by antibiotics and to monitor the long-term ecological risk of antibiotics in the region. Overall, our results provide an important reference for understanding the distribution and ecological risk of antibiotics in Fengjiawan.

Spatial Distribution and Risk Assessment of Antibiotics in 15 Pharmaceutical Plants in the Pearl River Delta.

Pharmaceutical plants are an essential source of antibiotics emitted into the aqueous environment. The monitoring of target antibiotics in pharmaceutical plants through various regions is vital to optimize contaminant release. The occurrence, distribution, removal, and ecological risk of 30 kinds of selected antibiotics in 15 pharmaceutical plants in the Pearl River Delta (PRD) were investigated in this study. Lincomycin (LIN) showed the highest concentration (up to 56,258.3 ng/L) in the pharmaceutical plant influents from Zhongshan city. Norfloxacin (NFX) showed a higher detection frequency than other antibiotics. In addition, the spatial distribution of antibiotics in pharmaceutical plants showed significant differences, with higher concentrations of total antibiotics found in pharmaceutical plant influents in Shenzhen City than those of different regions in PRD. The treatment processes adopted by pharmaceutical plants were commonly ineffective in removing antibiotics, with only 26.7% of antibiotics being effectively removed (average removal greater than 70%), while 55.6% of antibiotics had removal rates of below 60%. The anaerobic/anoxic/oxic (AAO)-membrane bioreactor (MBR) combined process exhibited better treatment performance than the single treatment process. Sulfamethoxazole (SMX), ofloxacin (OFL), erythromycin-H2O (ETM-H2O), sulfadiazine (SDZ), sulfamethazine (SMZ), norfloxacin (NFX), and ciprofloxacin (CIP) in pharmaceutical plant effluents posed high or moderate ecological risk and deserve particular attention.

Restrictive Use of Empirical Antibiotics Is Associated with Improved Short Term Outcomes in Very Low Birth Weight Infants: A Single Center, Retrospective Cohort Study from China.

Antibiotics are essential for treating neonatal sepsis, but abuse or inappropriate use of antibiotics have harmful adverse effects. The inappropriate use of antibiotics has led to the significant increase in bacterial antimicrobial resistance in the neonatal intensive care unit (NICU). The aim of this study was to retrospectively analyze the changes in antibiotic usages in a NICU after the implementation of an antibiotic stewardship program and to determine the impact of this implementation on the short-term clinical outcomes of very low birth weight (VLBW) infants. The antibiotic stewardship program was initiated in the NICU in early 2015. For analysis, all eligible VLBW infants born from 1 January 2014 to 31 December 2016 were enrolled, and we classified the year 2014 as pre-stewardship, 2015 as during stewardship, and 2016 as post-stewardship. A total of 249 VLBW infants, including 96 cases in the 2014 group, 77 cases in the 2015 group, and 76 cases in the 2016 group, were included for final analysis. Empirical antibiotics were used in over 90% of VLBW infants in all three groups during their NICU stay. Over the 3-year period, the duration of an initial antibiotic course was significantly reduced. The proportion of patients receiving an initial antibiotic course for ≤3 days gradually increased (2.1% vs. 9.1% vs. 38.2%, p < 0.001), while the proportion of babies treated with an initial antibiotic course >7 days significantly decreased (95.8% vs. 79.2% vs. 39.5%, p < 0.001). The total days of antibiotic usage during the entire NICU stay also showed a significant reduction (27.0 vs. 21.0 vs. 10.0, p < 0.001). After adjusting for confounders, the reduction in antibiotic usage was associated with decreased odds of having an adverse composite short-term outcome (aOR = 5.148, 95% CI: 1.598 to 16.583, p = 0.006). To assess the continuity of antibiotic stewardship in the NICU, data from 2021 were also analyzed and compared to 2016. The median duration of an initial antibiotic course further decreased from 5.0 days in 2016 to 4.0 days in 2021 (p < 0.001). The proportion of an initial antibiotic course in which antibiotics were used for ≤3 days increased (38.2% vs. 56.7%, p = 0.022). Total antibiotic usage days during the entire NICU stay also decreased from 10.0 days in 2016 to 7.0 days in 2021 (p = 0.010). The finding of this study strongly suggests that restricting antibiotic use in VLBW infants is beneficial and can be achieved safely and effectively in China.

The impacts of the national centralized drug procurement policy on the use of policy-related antibiotic agents: the case of Shaanxi province, China

ABSTRACT Objectives The purpose of NCDP policy was to reduce the price of drugs. However, it is unclear that a reduction in the price of a single antibiotic will lead to an increase in other alternatives, which is crucial for antibiotic management. The aim of this study was to evaluate the impact of policy on the consumption of policy-related antibiotic. Methods Quasi-experimental interrupted time series methods were used to assess the effects of the policy. Results After the implementation of the policy, the consumption of the winning products increased rapidly, with a significant difference in growth (β 2 = 88.03). For nonwinning products, the level of purchase volume decreased (β 2 =-22.83) in the intervention group, and after adding the comparison group, this number fell further in statistical significance (β 2 =-114.53). Among all the nonwinning products, the level of purchase volume (β 2 =-73.59) and expenditures (β 2 =-346.71) of the generic drugs that passed the conformance evaluation decreased significantly after the policy in the difference model. The purchase volume of J01DC, J01DD and total antibiotics significantly increased in control group compared with the intervention. Conclusion The implementation of the volume-based procurement policy promoted the use of winning products and decreased the usage of its alternative watch antibiotics.

Riverine antibiotic occurrence and potential ecological risks in a low-urbanized and rural basin of the middle Yangtze River: Socioeconomic, land use, and seasonal effects

This study firstly investigated the effects of season, land use, and socioeconomic on the spatiotemporal changes of riverine antibiotic concentrations in a low urbanized and rural watershed. In the dry and wet seasons, water samples were collected and analyzed for 15 antibiotics. The results indicated that 14 antibiotics, excluding leucomycin, were detected. Monsoon led to significantly lower total antibiotic concentrations in the wet season (22.0ngL−1) than in the dry season (51.2ngL−1). Total antibiotic concentrations were dominated by amoxicillin (below limit of detection (<LOD)-34.7ngL−1)), erythromycin-H2O (<LOD-14.7ngL−1), roxithromycin (<LOD-27.9ngL−1), and trimethoprim (<LOD-6.34ngL−1). The total antibiotic concentrations were usually higher in the downstream areas of urban land than in the river reaches of forest land and agricultural land. At county or city scales, total antibiotic concentrations in the dry season were significantly correlated with the rural population, public budget, husbandry product and output, effluent volume, fishery product and output, and hospital number, which generally depend on land use in the basin. Amoxicillin poses a high ecological risk to aquatic algae, whereas erythromycin-H2O, ofloxacin, and norfloxacin pose medium ecological risks. However, trimethoprim poses a medium ecological risk to mollusks. These results provide improved insights into the characteristics of antibiotic occurrence and ecological risks in the waters of low-urbanized and rural areas in China and can be extrapolated worldwide.

Effect of instant surgery compared with traditional management on paediatric complicated acute appendicitis post-surgery wound: A meta-analysis.

A meta-analysis study to assess the influence of instant surgery (IS) compared with conservative therapy (CT) on paediatric complicated acute appendicitis (CAA) post-surgery wounds. A comprehensive literature examination until January 2023 was implemented, and 2098 linked studies were appraised. The picked studies contained 66 674 subjects with paediatric CAA post-surgery wounds in the picked studies' baseline; 64 643 of them were using IS, and 2031 were using CT. The odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of the IS compared with the CT on paediatric CAA post-surgery wounds using the dichotomous and continuous styles and a fixed or random model. The IS had a significantly higher wound infection (OR, 4.97; 95% CI, 2.35-10.54, P< .001) with moderate heterogeneity (I2 = 57%) compared with the CT in a paediatric CAA post-surgery wound. However, no significant difference was found between IS and CT in total antibiotic duration (MD, -5.34; 95% CI,-12.67 to -1.98, P= .15) with high heterogeneity (I2 = 95%) in paediatric CAA post-surgery wounds. The IS had a significantly higher wound infection; however, no significant difference was found in total antibiotic duration compared with the CT in paediatric CAA post-surgery wounds. Although precautions should be taken when commerce with the consequences because most of the studies picked for this meta-analysis had low sample sizes.

Evaluation the Rationality of Clinical Outcomes of Antibiotic Use and Patterns of Bacterial Resistance to Antibiotics in Children with Pneumonia

Pneumonia is a respiratory infection that attacks the lungs in the lung parenchyma tissue or alveoli. Pneumonia is one of the leading causes of death in children worldwide. Rational use of antibiotics can reduce the risk of antibiotic resistance. This study used observational analytics with a retrospective cohort design. The research subjects were pediatric patients with a diagnosis of pneumonia who were hospitalized at Dr. Sardjito Yogyakarta period 1 January – 31 December 2020. The rationality of the use of antibiotics was evaluated using the Gyssens method. The clinical outcome observed was the patient's condition improving or not improving after 3 to 5 days of antibiotic administration. Chi-Square test to see the relationship of antibiotic rationality to clinical outcomes and multiple logistic regression analysis to analyze the relationship of confounding variables to clinical outcomes. From 141 patients, 211 antibiotic regimens were obtained, with details of 186 empiric antibiotics and 25 definitive antibiotics. The rational use of antibiotics in empirical and definitive antibiotics was 140 regimens (75.27%) and 22 regimens (88%). Total irrational antibiotics (category I-VI) from empirical and definitive antibiotics were 24.73% and 12%, respectively. There is a significant relationship between the rationality of antibiotics with clinical outcomes both empirical and definitive antibiotics (p&lt;0.05). Meanwhile, for confounding variables, there was no significant relationship to the clinical outcome (p&gt;0.05). The most common bacteria were Klebsiella pneumoniae and Acinetobacter baumanii. Klebsiella pneumoniae was the most resistant to ampicillin, ampicillin sulbactam and ceftriaxone antibiotics and Acinetobacter baumanii was the most resistant ampicillin.

Effect of microbiology comment nudging on antibiotic use in asymptomatic bacteriuria: A before-and-after quasi-experimental study.

To describe the effect of a microbiology comment nudge on antibiotic use for asymptomatic bacteriuria (ASB). Single-center, before-and-after, quasi-experimental study. Community-based, public, not-for-profit teaching hospital in the southeastern United States. Adult inpatients with a positive urine culture and the absence of urinary tract infection signs and symptoms. Implementation of a microbiology comment nudge on urine cultures. In total, 204 patients were included in the study. Antibiotics were less likely to be continued beyond 72 hours in the postimplementation group: 57 (55%) of 104 versus 38 (38%) of 100 (P = .016). They were less likely to have antibiotics continued beyond 48 hours: 60 (58%) of 104 versus 43 (43%) of 100 (P = .036). They were also less likely to have antibiotics prescribed at discharge 35 (34%) of 104 versus 20 (20%) of 100 (P = .028). In addition, they had fewer total antibiotic days of therapy: 4 (IQR, 1-6) versus 1 (IQR, 0-6) (P = .022). Microbiology comment nudging may contribute to less antibiotic utilization in patients with ASB.

Prescription of antibiotics by general practitioners for patients with a diagnosis of SARS- CoV-2 infection: Analysis of an electronic French health record

ObjectiveTo define the factors associated with overprescription of antibiotics by general practitioners (GPs) for patients diagnosed with COVID-19 during the first wave of the pandemic. MethodsAnonymised electronic prescribing records of 1370 GPs were analysed. Diagnosis and prescriptions were retrieved. The initiation rate by GP for 2020 was compared with 2017–2019. Prescribing habits of GPs who initiated antibiotics for > 10% of COVID-19 patients were compared with those who did not. Regional differences in prescribing habits of GPs who had consulted at least one COVID-19 patient were also analysed. ResultsFor the March–April 2020 period, GPs who initiated antibiotics for > 10% of COVID-19 patients had more consultations than those who did not. They also more frequently prescribed antibiotics for non-COVID-19 patients consulting with rhinitis and broad-spectrum antibiotics for treating cystitis. Finally, GPs in the Île-de-France region saw more COVID-19 patients and more frequently initiated antibiotics. General practitioners in southern France had a higher but non-significant ratio of azithromycin initiation rate over total antibiotic initiation rate. ConclusionThis study identified a subset of GPs with overprescribing profiles for COVID-19 and other viral infections; they also tended to prescribe broad-spectrum antibiotics for a long duration. There were also regional differences concerning antibiotic initiation rates and the ratio of azithromycin prescribed. It will be necessary to evaluate the evolution of prescribing practices during subsequent waves.