Use Of 3rd Generation Cephalosporins Research Articles

Risk factors and economic burden for community-acquired multidrug-resistant organism-associated urinary tract infections: A retrospective analysis.

The spread of multidrug-resistant organisms (MDROs) has resulted in a corresponding increase in the incidence of urinary tract infections (UTIs). The risk factors and hospitalization burden for community-acquired MDRO-associated UTIs are discussed herein. This retrospective study included 278 patients with community-based MDRO-associated UTIs from January 2020 to January 2022. The MDRO (n = 139) and non-MDRO groups (n = 139) were separated based on drug susceptibility results. Community-based MDRO-associated UTIs mainly occurred in the elderly and frail patients with a history of invasive urinary tract procedures. The MDRO group imposed a greater economic burden compared to the non-MDRO group. Independent risk factors for community-based MDRO-associated UTIs were as follows: white blood cell (WBC) count > 10.0 × 109/L (OR = 2.316, 95% CI = 1.316-3.252; P = .018); ≥3 kinds of urinary tract obstructive diseases (OR = 1.720, 95% CI = 1.004-2.947; P = .048); use of 3rd generation cephalosporins (OR = 2.316, 95% CI = 1.316-4.076; P = .004); and a history of invasive urologic procedures (OR = 2.652, 95% CI = 1.567-4.487; P < .001). Days of hospitalization, antibiotic use, and bladder catheter use were significantly greater in the MDRO group than the non-MDRO group (P < .05).

88. Effect of an MDR Enterobacterales Screening Tool on Antibiotic Prescribing for Abdominal Infections Caused by Mixed Bacteria

Abstract Background Background: Choosing antibiotics for infections caused by mixed Enterobacterales is challenging. Our microbiology lab implemented a multi-drug resistance (MDR) screen for cultures with mixed gram-negative to direct clinicians to use 3rd generation cephalosporins for screen neg. pathogens, and to use broader beta-lactams for screen-pos. pathogens. Here we report the effect of MDR screen on final antibiotic choice. Methods Methods: We retrospectively reviewed cases with abdominal infections caused by mixed bacteria at UNC Medical Center between August and November 2020. Cultures with non-Enterobacteraeles gram negatives were excluded. MDR screen was done by plating mixed Enterobacterales on HardyCHROM™ ESBL agar. Screen-pos. cases were updated “MDR Enterobacterales present” and pathogens were identified with full susceptibilities. Screen-neg. cases were labeled “MDR Enterobacterales not present”. Definitely covering antibiotics were defined by the use of 3rd generation cephalosporins for screen neg. cases, or based on susceptibilities in case of screen pos. organisms or concomitant bacteremia. Possibly covering antibiotics included regimens whose susceptibility could not be predicted based on the screen (e.g., amox/clav or quinolone+metronidazole). Results Results: 51 cases were identified. Median age was 51 years (range 10 to 87). 54.9% were female and 45.1% male. Infections included intra-abdominal abscesses (n =35), perirectal or scrotal abscesses (10), abdominal wound infections (4), perineal necrotizing fasciitis (1), and cholecystitis (1). Sample types were abscess fluid (43), wound purulence (4) or tissue (3). MDR screen was pos. in 7.8%. Antibiotics were adjusted in 17.6% as a result of the screen report. 31.5% of final antibiotics definitely covered the isolated bacteria, 56.9% possibly covered, and 5.9% did not have an active antibiotic. Among screen pos. cases, final antibiotics definitely covered in 75% and possibly in 25%. Conclusion Conclusions: The MDR Enterobacterales screening tool for abdominal infections had limited impact on final antibiotic choice, but was useful when positive. Further directions include assessment of provider understanding of the MDR screen results and investigation of utility of screen in other infection types. Disclosures All Authors: No reported disclosures

Antibiotic prescription analysis of inpatients in a tertiary care teaching hospital

Background: Antibiotics are one among the commonly prescribed drugs. Patterns of antibiotic resistance widely follows local patterns of antibiotic prescribing and usage. Periodic surveillance of antibiotic prescriptions at regional level are essential to understand and combat antimicrobial resistance. To study the prescribing pattern of antibiotics among inpatients of various specialties in a tertiary care teaching hospital. Method: A prospective observational study of prescribing pattern of antibiotics was conducted among inpatients of various specialties in a tertiary care teaching hospital. Antibiotic prescribing data was collected using a semi structured proforma. The data obtained was analyzed and the conclusions were drawn using descriptive analysis.Results: A total of 1161 prescriptions were collected. 3211 antibiotics were prescribed. Mean average duration of treatment with antibiotics per patient was 11.8 days. Use of 3rd generation cephalosporins, imipenem, piperacillin and vancomycin observed. 75% of antibiotics were prescribed for prophylactic use. Antibiotics prescribed for therapeutic indication were supported by clinical, radiological and other investigations like culture and sensitivity reports.Conclusions: The present study highlights the use of antibiotics for long duration among admitted patients. Implementation of antimicrobial stewardship program with adherence to standard treatment guidelines is essential to combat antimicrobial resistance.

Antimicrobial prescriptions in cats in Switzerland before and after the introduction of an online antimicrobial stewardship tool

BackgroundAntimicrobial stewardship activities are essential to improve prudent antimicrobial use. The aim of the present study was to evaluate changes in antimicrobial prescriptions in cats after the introduction of prudent use guidelines promoted by an online antimicrobial stewardship tool (AntibioticScout.ch) in Switzerland. Data from 792 cats presented to two university hospitals and 14 private practices in 2018 were included and compared to 776 cases from 2016. Cats were diagnosed with acute upper respiratory tract disease (aURTD), feline lower urinary tract disease (FLUTD) and abscesses. Clinical history, diagnostic work-up and antimicrobial prescriptions (class, dosage, duration) were assessed. Type and proportions [95% confidence intervals] of antimicrobial prescriptions were compared between the two evaluation periods and a mixed effects logistic regression model was applied to evaluate compliance with Swiss prudent use guidelines.ResultsFrom 2016 to 2018, the proportion of antimicrobial prescription in all included cases decreased from 75.0% [71.8–78.0] to 66.7% [63.3–69.9]; this decrease was most pronounced for treatments at university hospitals (67.1% [59.5–74.0] to 49.3% [40.9–57.8]) and for cats with FLUTD (60.1% [54.6–65.4] to 48.8% [43.2–54.4]). Use of 3rd generation cephalosporins in private practices declined from 30.7% [26.5–35.1] to 22.1% [18.4–26.2], while overall use of non-potentiated aminopenicillins increased from 19.6% [16.4–23.0] to 27.8% [24.1–31.9]. In cases where antimicrobial therapy was indicated, compliance with guidelines did not increase (33.3% [26.6–40.6] to 33.5% [27.2–40.2]), neither at universities nor in private practices. On the other hand, antimicrobial treatment was more often withheld in cases with no indication for antimicrobial therapy (35.6% [30.1–41.4] to 54.0% [47.6–60.4]); this was found for private practices (26.7% [20.8–33.4] to 46.0% [38.4–53.7]) and for aURTD cases (35.0% [26.5–44.2] to 55.4% [44.7–65.8]).ConclusionsOverall proportions of antimicrobial prescription, unjustified antimicrobial therapy and, in private practices, use of 3rd generation cephalosporins decreased from 2016 to 2018 for the investigated feline diseases. However, overall compliance with Swiss prudent use guidelines was still low, implying that further efforts are required to foster prudent antimicrobial use in cats.

Clostridioides difficile associated peritonitis in peritoneal dialysis patients \u2013 a case series based review of an under-recognized entity with therapeutic challenges

BackgroundInitial presentation of peritoneal dialysis associated infectious peritonitis can be clinically indistinguishable from Clostridioides difficile infection (CDI) and both may demonstrate a cloudy dialysate. Empiric treatment of the former entails use of 3rd-generation cephalosporins, which could worsen CDI. We present a logical management approach of this clinical scenario providing examples of two cases with CDI associated peritonitis of varying severity where the initial picture was concerning for peritonitis and treatment for CDI resulted in successful cure.Case presentationA 73-year-old male with ESRD managed with PD presented with fever, abdominal pain, leukocytosis and significant diarrhea. Cell count of the peritoneal dialysis effluent revealed 1050 WBCs/mm3 with 71% neutrophils. C. difficile PCR on the stool was positive. Patient was started on intra-peritoneal (IP) cefepime and vancomycin for treatment of the peritonitis and intravenous (IV) metronidazole and oral vancomycin for treatment of the C. difficile colitis but worsened. PD fluid culture showed no growth. He responded well to IV tigecycline, oral vancomycin and vancomycin enemas. Similarly, a 55-year-old male with ESRD with PD developed acute diarrhea and on the third day noted a cloudy effluent from his dialysis catheter. PD fluid analysis showed 1450 WBCs/mm3 with 49% neutrophils. IP cefepime and vancomycin were initiated. CT of the abdomen showed rectosigmoid colitis. C. difficile PCR on the stool was positive. IP cefepime and vancomycin were promptly discontinued. Treatment with oral vancomycin 125 mg every six hours and IV Tigecycline was initiated. PD fluid culture produced no growth. PD catheter was retained.ConclusionsIn patients presenting with diarrhea with risk factors for CDI, traditional empiric treatment of PD peritonitis may need to be reexamined as they could have detrimental effects on CDI course and patient outcomes.

Seasonal Occurrence and Carbapenem Susceptibility of Bovine Acinetobacter baumannii in Germany.

Acinetobacter baumannii is one of the leading causes of nosocomial infections in humans. To investigate its prevalence, distribution of sequence types (STs), and antimicrobial resistance in cattle, we sampled 422 cattle, including 280 dairy cows, 59 beef cattle, and 83 calves over a 14-month period. Metadata, such as the previous use of antimicrobial agents and feeding, were collected to identify putative determining factors. Bacterial isolates were identified via MALDI-TOF/MS and PCR, antimicrobial susceptibility was evaluated via VITEK2 and antibiotic gradient tests, resistance genes were identified by PCR. Overall, 15.6% of the cattle harbored A. baumannii, predominantly in the nose (60.3% of the A. baumannii isolates). It was more frequent in dairy cows (21.1%) than in beef cattle (6.8%) and calves (2.4%). A seasonal occurrence was shown with a peak between May and August. The rate of occurrence of A. baumannii was correlated with a history of use of 3rd generation cephalosporins in the last 6 months prior to sampling Multilocus sequence typing (Pasteur scheme) revealed 83 STs among 126 unique isolates. Nine of the bovine STs have previously been implicated in human infections. Besides known intrinsic resistance of the species, the isolates did not show additional resistance to the antimicrobial substances tested, including carbapenems. Our data suggest that cattle are not a reservoir for nosocomial A. baumannii but carry a highly diverse population of this species. Nevertheless, some STs seem to be able to colonize both cattle and humans.

Impact of an infectious diseases specialist-led antimicrobial stewardship programmes on antibiotic use and antimicrobial resistance in a large Korean hospital

The aim of this study was to evaluate the impact of an infectious diseases specialist (IDS)-led antimicrobial stewardship programmes (ASPs) in a large Korean hospital. An interrupted time series analysis assessing the trends in antibiotic use and antimicrobial resistance rate of major pathogens between September 2015 and August 2017 was performed in an 859-bed university-affiliated hospital in Korea. The restrictive measure for designated antibiotics led by an IDS reduced carbapenems usage by −4.57 days of therapy (DOT)/1,000 patient-days per month in general wards (GWs) (95% confidence interval [CI], −6.69 to −2.46; P < 0.001), and by −41.50 DOT/1,000 patient-days per month in intensive care units (ICUs) (95% CI, −57.91 to −25.10; P < 0.001). Similarly, glycopeptides usage decreased by −2.61 DOT/1,000 patient-days per month in GWs (95% CI, −4.43 to −0.79; P = 0.007), and −27.41 DOT/1,000 patient-days per month in ICUs (95% CI, −47.03 to −7.79; P = 0.009). Use of 3rd generation cephalosporins, beta-lactam/beta-lactamase inhibitors, and fluoroquinolones in GWs showed change comparable with that of carbapenems or glycopeptides use. Furthermore, trends of antimicrobial resistance rate of Staphylococcus aureus to gentamicin in GWs, Staphylococcus aureus to ciprofloxacin and oxacillin in ICUs, and Pseudomonas aeruginosa to imipenem in ICUs decreased in slope in the intervention period. The in-hospital mortality rate per 1,000 patient-days among ICU patients remained stable between the pre-intervention and intervention periods. In conclusion, an IDS-led ASPs could enact a meaningful reduction in antibiotic use, and a decrease in antibiotic resistance rate, without changing mortality rates in a large Korean hospital.

Microbiological quality and antimicrobial resistance characterization of Salmonella spp. in fresh milk value chains in Ghana

Consumer perception of poor hygiene of fresh milk products is a major barrier to promotion of milk consumption as an intervention to alleviate the burden of malnutrition in Ghana. Fresh milk is retailed raw, boiled, or processed into unfermented cheese and spontaneously fermented products in unlicensed outlets. In this study, we have determined microbiological quality of informally retailed fresh milk products and characterized the genomic diversity and antimicrobial resistance (AMR) patterns of non-typhoidal Salmonella (NTS) in implicated products.A total of 159 common dairy products were purchased from five traditional milk markets in Accra. Samples were analysed for concentrations of aerobic bacteria, total and fecal coliforms, Escherichia coli, staphylococci, lactic acid bacteria and yeast and moulds. The presence of Salmonella, E. coli O157:H7, Listeria monocytogenes and Staphylococcus aureus were determined. AMR of Salmonella against 18 antibiotics was experimentally determined. Genome sequencing of 19 Salmonella isolates allowed determination of serovars, antigenic profiles, prediction of AMR genes in silico and inference of phylogenetic relatedness between strains.Raw and heat-treated milk did not differ significantly in overall bacterial quality (P = 0.851). E. coli O157:H7 and Staphylococcus aureus were present in 34.3% and 12.9% of dairy products respectively. Multidrug resistant (MDR) Salmonella enterica serovars Muenster and Legon were identified in 11.8% and 5.9% of unfermented cheese samples respectively. Pan genome analysis revealed a total of 3712 core genes. All Salmonella strains were resistant to Trimethoprim/Sulfamethoxazole, Cefoxitin, Cefuroxime Axetil and Cefuroxime. Resistance to Chloramphenicol (18%) and Ciprofloxacin (100%), which are first line antibiotics used in treatment of NTS bacteremia in Ghana, was evident. AMR was attributed to presence and/or mutations in the following genes: golS, sdiA for cephalosporins, aac(6′)-Iy, ant(9) for aminoglycosides, mdtK, gyrA, gyrB, parC, parE for quinolones and cat1, cat4 for phenicols. Phylogenetic analysis based on accessory genes clustered S. Legon strains separately from the S. Muenster strains. These strains were from different markets suggesting local circulation of related strains.Our study justifies consumer resistance to consumption of unripened soft cheese without further lethal heat treatment, and provides evidence that supports the Ghana Health Service recommendation for use of 3rd generation cephalosporins for the treatment of MDR NTS infections.

Use of 3rd generation cephalosporins in different age groups in tertiary health care centers of Karachi

Prescription writing is the key part in healthcare provision. The caution use of antibiotics is very important as their resistance can be life threatening. Our study aims to find out the current prescribing practice of the antibiotics, specially the use of cephalosporins for Pediatric in tertiary health care centres situated in Karachi. Cross sectional, random sampling method was used to collect data of patients from different hospitals &amp; health cares in the city of Karachi from September to November 2013. Antibiotics are most commonly prescribed drugs. On the other hand Antibiotics are available and sold throughout the whole city without the prescription of a registered medical practitioner, which is one of the causes for overuse of antibiotics resulting in becoming the bacteria &amp; other microbes resistant to antibiotics. Our result shows that altogether 50 patients, 13 males and 14 females (54 %), were using third generation cephalosporins.

L’e-learning interactif comme outil de développement professionnel continu : évaluation de la participation à un programme de formation au bon usage des antibiotiques dans un service d’urgences

To assess the participation in an interactive e-learning, promoting a decreased use of 3rd generation cephalosporins and fluoroquinolones for lower respiratory tract infections, in the emergency department. Methods: The e-learning consisted of a 16-min slide show, one-page take-home messages, 10 optional and interactive multiple choice tests on the theory of antibacterial therapy, and 20 interactive multiple choice tests based on clinical vignettes. The training was available for physicians of the emergency department for 14 weeks. The participation in the e-learning was defined by the response to every multiple choice test based on clinical vignettes. The participation rate of emergency physicians was satisfactory. The impact of this e-learning on clinical skills has to be demonstrated.

Screening and Identification of Extended Spectrum β-lactamase (ESBL) Pathogens in Urine Sample of UTI Patient?s

Extended Spectrum β-Lactamases (ESBL) exhibit most important resistant mechanism challenging broad spectrum of antibiotics, ESBL’s hamper current treatment strategies limiting therapeutic options. Hence, it is important to screen those organisms using standard techniques to fix the spread and outcome consequences. Aim and objective of our perspective cohort study was to isolate and to identify the resistant ESBL pathogens consecutive ESBL positive strains were recovered by Disc Diffusion Test (DDT) and 90% of the isolates were E. coli and Klebsiella pneumoniae. Further, antibiotic susceptibility assay against third line cephalosporins like cefotaxime (30 g), cefotaxime/clavulanic acid (30 μg/10 μg), ceftazidime (30 μg), ceftazidime/clavulanic acid (30 μg/10 μg), ampicillin (30 μg) and amikacin (30 μg) were tested by CLSI guidelines from NCCLS (National Committee for Clinical Laboratory Standards). Minimum Inhibitory Concentration (MIC) was determined against E-test ESBL strips containing cefotaxime (CT), cefotoxime/clavulanate (CTL), ceftazidime (TZ), ceftazidime/Clavulanate (TZL). E. coli (ATCC 25922) was used as negative control and (ATCC 700603) as a positive control strain. Controls were satisfactory in comparison to standard chart. Our study results unveil a very high spread of such super bugs in health centers. The empiric use of 3rd generation cephalosporins should be curtailed, as it is associated with increased risk of ESBL production. The necessity for continued antimicrobial resistance surveillance to prevent higher degree of resistance is justified in the light of our findings

Antimicrobial Use and Resistance Among Gram-negative Bacilli in an Italian Intensive Care Unit (ICU)

Gram-negative bacilli antimicrobial resistance remains a significant problem for patients in the intensive care unit (ICU). We performed a retrospective analysis of microbiological data and antibiotic consumption over a 4-year period (2000-2003) in an Italian ICU.Pseudomonas aeruginosa and Klebsiella pneumoniae represented approximately 40% of all isolates. The most significant trend in antimicrobial use was an increase in use of 3rd generation cephalosporins, imipenem, and ciprofloxacin. A significant trend toward an increase in resistance rates to piperacillin, 3rd generation cephalosporins and ciprofloxacin was observed for K. pneumoniae and a positive correlation between resistance and drug-usage was evident for K. pneumoniae and piperacillin, cefotaxime, ceftazidime, cefepime, and ciprofloxacin, but not for piperacillin/tazobactam. No statistically significant correlations were evidenced for P. aeruginosa. Trends in resistances were studied also for Serratia spp and Proteus spp. Isolation rates of extended-spectrum beta-lactamase (ESBL)-producing strains in pathogens studied were high, especially for K. pneumoniae (72%, 160/222) and Proteus spp (41%, 18/43).In conclusion, the study showed high resistance among Gram-negative organisms isolated in the ICU and significant ESBL production. A significant correlation between antibiotic consumption and increasing resistance was evident for K. pneumoniae.