Transmission Of Antibiotic-resistant Organisms Research Articles

#41: Examining the Role of Rurality on the Incidence of Acute Respiratory Illnesses, Overall Antibiotic Use and Inappropriate Antibiotic Use Among Young Children in Tennessee

Abstract Background The Centers for Disease Control and Prevention (CDC) defines inappropriate antibiotic use as prescribing antibiotics not in accordance with national and local evidence-based guidelines, wrong selection of antibiotics, wrong dosing of antibiotics, or wrong duration of antibiotic use. Inappropriate antibiotic use has been associated with the development and transmission of antibiotic-resistant organisms. Acute respiratory illnesses (ARI) are the leading causes of antibiotic use among children with rates of antibiotic use in Tennessee children among the highest in the United States. The reasons for this have not been adequately assessed, particularly in children enrolled in the Tennessee Medicaid (TennCare) program, who tend to live in low-income households and rural locales and are disproportionately underrepresented in database studies conducted in large managed care organizations. We sought to examine whether the rates of ARI-related overall antibiotic use and inappropriate antibiotic use among young children enrolled in TennCare vary by the rurality of their county of residence. Methods This was a retrospective cohort study of children aged 2 months–5 years enrolled in TennCare from July 1, 2007, to June 30, 2017. We used pharmacy and healthcare claims data to calculate the incidence of ARI and ARI-related antibiotic use. Each eligible child entered into the cohort at the earliest time when selection criteria were met, and follow-up continued from cohort entry until the earliest of loss of enrollment, death, end of study, or meeting exclusion criteria. ARI was identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10) and ARI-related antibiotic use was defined as an antibiotic prescription filled within 72 hours of an ARI. ARI-related antibiotic use was classified as potentially appropriate or inappropriate using a previously published CDC classification system. The rurality of children’s county of residence was defined as either mostly urban, mostly rural, or completely rural based upon the United States Census Bureau definitions. We calculated incidence rates for ARI, ARI-related antibiotic use, and ARI-related inappropriate antibiotic use. To assess the effect of rurality of residence on these outcomes, we used multivariable mixed-effects Poisson regression. These analyses accounted for other factors including child age, gender, race, underlying comorbidities, calendar year and month, and history of antibiotic exposure. Results In total, 813,432 children met enrollment criteria and contributed a total of 2,057,272 person-years for the cohort. Overall, the rate of ARIs, antibiotic use associated with ARIs, and inappropriate antibiotic use associated with ARIs has trended down over time (Figure 1A). There were higher rates of these three outcomes in children who live in mostly rural and completely rural counties compared with those who live in mostly urban counties (Figure 1B–D). Conclusions Children who live in rural counties in Tennessee are disproportionately affected by higher rates of ARIs, antibiotic use, and inappropriate antibiotic use compared with those who live in urban counties. These findings can inform targeted stewardship interventions to reduce inappropriate antibiotic prescribing and to decrease the rates of antibiotic-resistant infections.

Prevalence, acquired antibiotic resistance and bacteriocin production of Enterococcus spp. isolated from tunisian fermented food products

In this study, a total of 100 fermented food products including dairy (Lben, Rayeb, Rigouta, and Jben) olive and vegetable products, harvested in Northwestern Tunisia, were investigated for the presence of Enterococcus spp. Our results showed high levels of contamination with Enterococcus spp., identified according to standard bacteriological, biochemical and phenotypic criteria. 143 isolates were recovered; E. faecium (46.15%) was the predominant species, followed by E. faecalis (27.27%), E. casseliflavus (12.58%), E. durans (8.39%) and E. mundtii (5.59%). None of the isolates showed acquired resistance againts clinically relevant drugs used for enterococcal infections treatment in human medicins, and no haemolytic activity was demonstrated. Furthermore, over 50% of the isolates within each species exhibited antilisterial bacteriocin production. Further data are needed to enhance understanding of bacteriocin production of enterococci in fermented food products as well as the potential risks to quality and safety, including possible transmission of antibiotic resistant organisms to human consumers.

Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives

ObjectivesMedical tourism involves patients’ intentional travel to privately obtain medical care in another country. Empirical evidence regarding health and safety risks facing medical tourists is limited. Consideration of this issue...

Antimicrobial Resistance of Enteric E. coli in Beef Cattle Treated with Antibiotics

It is crucial to the future of animal agriculture that veterinarians and livestock producers understand how to treat food animals in an intensive environment, while preventing or reducing the development of antimicrobial resistant bacteria. However, little is known about the actual development and transmission of antibiotic resistant organisms within or among groups of animals. In addition, little is known about the persistence of resistant organisms or their potential impact on the food production industry. The objective of this study was to characterize the development and dissemination of antimicrobial- resistant organisms in beef cattle treated with antibiotics.

Child-care practices: effects of social change on the epidemiology of infectious diseases and antibiotic resistance.

The increasing number of mothers of young children in the work force and the resultant escalated use of child-care facilities has had a marked effect on the epidemiology of infectious diseases in young children. Children attending child care are at high risk for respiratory and gastrointestinal tract illnesses. The high prevalence of infectious diseases in the child-care setting is accompanied by high usage of antibiotics, which in turn has resulted in spread of antibiotic-resistant organisms. The infectious disease standards of the American Public Health Association/American Academy of Pediatrics guidelines were developed to prevent and limit transmission of infectious diseases in the child-care setting. Adherence to these standards is essential but will not completely eliminate the increased risk of infectious diseases in child-care settings. New challenges need to be addressed to assure that optimal health promotion and disease prevention is practiced in child-care settings. We approach the 21st century with a vast amount of medical knowledge, molecular technology, highly effective vaccines, and powerful antimicrobial agents. However, at the same time we face many unsolved serious problems, such as preventing or controlling the emergence and spread of antibiotic-resistant organisms that adversely affect our ability to treat infectious diseases. Further research is needed concerning the relations between child care, the use of antibiotics, and transmission of antibiotic-resistant organisms in order to design and implement the most effective strategies for preventing or controlling antibiotic resistance. The potential risk for transmission of HIV in the child-care setting also needs to be recognized, and procedures to prevent transmission of blood-borne pathogens need to be followed. Monitoring compliance with national standards for child-care facilities, dissemination of information concerning infectious diseases and use of antibiotics, and development and use of new vaccines are strategies which should be used to help protect the health of children in child-care environments.