Use Of Antibiotics Research Articles

Case report: Relaps of Streptococcus suis infection in patient with Meningoencephalitis at Prof. Ngoerah Hospital, Bali

Background: S. suis is a facultative anaerobic Gram-positive bacterium that causes human infection. It is a primary health problem in the swine industry. Ceftriaxone is a therapeutic option for meningitis besides Ampicillin. Recently, the incidence of resistance to ceftriaxone was reported. The recurrence of S. suis in this patient is thought to be caused by ceftriaxone resistance due to inadequate initial therapy. Case Presentation: A 43-year-old male patient came to the ER with headaches in the head and neck. The patient had a history of meningitis due to S. suis twice before. While in the ER, the patient was given ceftriaxone while awaiting culture results. Blood cultures showed S. suis infection using VITEK 2 COMPACT (Biomeriuex®) and ceftriaxone resistance. The patient was successfully managed with Ampicillin following these culture results, leading to good outcomes. Discussion: S. suis is a gram-positive bacterial pathogen in pigs that can cause severe human infection, including meningitis, septicemia, endocarditis and deafness the most common complications. The patient experienced three relapses due to S. suis. On the third visit, blood culture results identified ceftriaxone-resistant S. suis. The patient's recurrent relapses could be attributed to several factors, including inadequate antibiotic administration, antibiotic resistance, weak immune system, contact with the source of infection and environmental variables, highlighting the complexity and challenges in treating S. suis infection. Conclusion: The use of antibiotics in relapse cases has the potential to cause antibiotic resistance, so it’s necessary to make guidelines for antibiotic therapy in S. suis infection to prevent recurrent infections.

Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

BACKGROUND Current surgical procedures for anorectal abscesses, including incision and drainage alone or combined concurrent fistulotomy, remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula. AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures. METHODS In this retrospective study, 525 patients with anorectal abscesses treated by incision and drainage alone, at a tertiary general hospital from August 2012 to July 2022, were included. A new classification for anorectal abscesses based on their propensity to develop into fistulas, considering 18 other potential risk factors, was established. These factors, from electronic medical records, were screened for significance using the χ ² test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses. RESULTS One year post-follow-up, the overall recurrence rate was 39%:81.0% and 23.5% for fistula-prone and non-fistula-prone abscesses, respectively. Univariate χ ² analysis showed significant differences in recurrence rates based on anatomical classifications and pus culture results (P < 0.05). Fistula-prone abscess, ≥ 7 days between symptom onset and surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were risk factors for recurrence, while diabetes mellitus was protective (P < 0.05). Moreover, fistula-prone abscess [odds ratio (OR) = 7.651, 95%CI: 4.049–14.458, P < 0.001], ≥ 7 days from symptom onset to surgery (OR = 2.137, 95%CI: 1.090–4.190, P = 0.027), chronic diarrhea (OR = 2.508, 95%CI: 1.216–5.173, P = 0.013), and local anesthesia (OR = 2.308, 95%CI: 1.313–4.059, P = 0.004) were independent risk factors for postoperative anorectal abscess recurrence using multivariate logistic regression. Body mass index ≥ 28 (OR = 2.935, 95%CI: 1.203–7.165, P = 0.018) was an independent risk factor for postoperative recurrence of non-fistula-prone abscess. CONCLUSION The choice of surgical procedure for treating anorectal abscesses should follow this new classification. Prompt and thorough incision and drainage can significantly reduce postoperative recurrence.

Associations of Clinical Characteristics With Sudden Cardiac Arrest in People With Type 2 Diabetes With and Without Cardiovascular Disease: A Longitudinal Case-Control Study Using Routine Primary Care Data

OBJECTIVE To assess longitudinal associations with sudden cardiac arrest (SCA) of clinical characteristics recorded in primary care in people with type 2 diabetes (T2D), both with and without cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS We performed a case-control study, with SCA case subjects with T2D from the Amsterdam Resuscitation Studies (ARREST) registry of out-of-hospital resuscitation attempts in the Dutch Noord-Holland region (2010–2020) and up to five matched (age, sex, T2D, general practitioner [GP] practice) non-SCA control subjects. We collected relevant clinical measurements, medication use, and medical history from GPs’ electronic health care records. We analyzed the associations of clinical characteristics and medication use with SCA in the total sample and in subgroups with or without CVD using multivariable time-dependent Cox regression (hazard ratios, 95% confidence intervals). RESULTS We included 689 SCA case subjects and 3,230 non-SCA control subjects. In multivariable models, low fasting glucose (<4.5 mmol/mol: 1.91 [1.00–3.64]), antihypertensive (1.80 [1.39–2.33]), glucose lowering (oral only: 1.32 [1.06–1.63]; insulin only: 2.31 [1.71–3.12]; oral and insulin: 1.64 [1.21–2.22]), heart failure (1.91 [1.55–2.35]), and QTc-prolonging prokinetic (1.78 [1.27–2.50]), antibiotic (1.35 [1.05–1.73]), and antipsychotic (2.10 [1.42–3.09]) medication were associated with SCA in the total sample. In subgroup effect modification analyses, QTc-prolonging antibiotic (1.82 [1.26–2.63]) and antipsychotic (3.10 [2.09–4.59]) medication use were associated with SCA only in those without CVD. CONCLUSIONS In people with T2D, low fasting glucose and QTc-prolonging prokinetic, antibiotic, or antipsychotic medication use and a history of heart failure are associated with SCA risk. Subgroup analyses indicate antibiotic and antipsychotic medication use increases SCA risk specifically in those without CVD.

Ciprofloxacin Concentrations in Food Could Select for Quinolone Resistance in Klebsiella pneumoniae: An In Vivo Study in Galleria mellonella

Background: The use of antimicrobials to treat food animals leaves antimicrobial residues in foodstuffs. The World Health Organization (WHO) defines the acceptable daily intakes (ADIs) of these residues as the dose of these antimicrobials that is safe for an average human to consume on a daily basis. We hypothesized that the lowest dose of ciprofloxacin classified as safe by the WHO could select for ciprofloxacin-resistant strains of Klebsiella pneumoniae in a Galleria mellonella model. Objectives: We aimed to evaluate if the consumption of peri-ADI doses of ciprofloxacin could select for ciprofloxacin-resistant (Ser464Phe, GyrB, ciprofloxacin MIC of 4 µg/mL) compared to -susceptible (isogenic, ciprofloxacin MIC of 0.047 µg/mL) strains of K. pneumoniae in a Galleria mellonella model. Results: A significant increase was seen in the proportion of resistance for the 1× ADI and 1/10th ADI concentrations on day 2 compared to the positive control. Methods: A model of K. pneumoniae infection in G. mellonella larvae was used for the experiment. The larvae were inoculated with K. pneumoniae followed by 10× ADI, 1× ADI, 1/10th ADI, 1/100th ADI, and 1/1000th ADI doses of ciprofloxacin. The isolation of K. pneumoniae colonies was then performed on selective agar plates with and without ciprofloxacin (1 µg/mL). The proportion of colonies with ciprofloxacin resistance was then calculated for each group at 24 and 48 h. Conclusions: We found that, at 48 h, there was an enrichment of K. pneumoniae colonies with ciprofloxacin resistance in the larvae receiving 1× ADI and 1/10th ADI concentrations of ciprofloxacin. These results suggest that the ciprofloxacin MSCselect for K. pneumoniae in this model is 1/10th of the acceptable daily concentration (ADI) dose of ciprofloxacin, which is equivalent to 0.239 ng/µL.

Global trends in antibiotic consumption during 2016–2023 and future projections through 2030

Antibiotic resistance is a global public health threat. Many factors contribute to this issue, with human antibiotic consumption being significant among them. Analyzing trends and patterns in consumption can aid in developing policies to mitigate the burden of antimicrobial resistance and global disparities in access to antibiotics. Using pharmaceutical sales data licensed from IQVIA, we estimate national-level trends in antibiotic consumption in 67 countries during 2016–2023 and analyze the effects of economic growth and the COVID-19 pandemic. Finally, we estimate global human consumption and project growth through 2030 assuming current trends. We find that estimated antibiotic consumption in reported countries increased 16.3% from 29.5 to 34.3 billion defined daily doses (DDDs) from 2016 to 2023, reflecting a 10.6% increase in the consumption rate from 13.7 to 15.2 DDDs per 1,000 inhabitants per day. Increases were most pronounced in upper-middle- and lower-middle-income countries. While the COVID-19 pandemic significantly reduced consumption globally, this was most pronounced in high-income countries, and in these countries, reductions in antibiotic use in 2020 were sharper, and lasted longer, than in other countries. By 2030, we project that, without reductions in rapidly developing nations, such as investments to improve infrastructure, particularly water and sanitation, along with improved access to vaccination, global antibiotic consumption will increase by 52.3% from an estimated 49.3 billion in 2023 to 75.1 billion DDDs.

Exploring Physicians' Perspectives on Antibiotic Stewardship Implementation: A Qualitative Investigation in Al-Nasiriyah Hospitals

Background: The overuse and inappropriate use of antibiotics cause antimicrobial resistance (AMR). The antibiotic stewardship program (ASP) plays a crucial role in improving prescribing antibiotics. Although the Iraqi Ministry of Health has issued ASP legislation, its full implementation in clinical practice remains incomplete. Objectives: To explore physicians' perspectives regarding the current and potential implementation of ASP in Al-Nasiriya hospitals. Methods: A qualitative study was conducted in Al-Nasiriyah public hospitals from December 17, 2023, to January 21, 2024, using face-to-face interviews. Physicians who prescribe antibiotics, work in Al-Nasiriyah public hospitals, and consent to participate in the study were recruited using purposeful and snowball sampling, and the size of the sample was specified by saturation. The interviews' audio was transcribed verbatim and analyzed thematically. Results: Nine public hospitals in Al-Nasiriyah were included in the study. One hospital was excluded because the ASP was activated after data collection began. Sixteen physicians in different specialties were recruited, 15 males and one female. Thematic analysis revealed two major themes: challenges in antibiotic prescribing practices (3 subthemes: antibiotic selection, review, and practice, antibiotic mismanagement, and antibiotic resistance) and antibiotic stewardship implementation (4 subthemes: ASP knowledge and components, perceived benefits and importance, implementation challenges and barriers, and ASP enablers). Conclusions: There were many challenges in antibiotic prescribing practice, including antibiotic mismanagement and AMR. The participants acknowledged the importance of the ASP, but they mentioned many barriers to its application.

A latent class analysis of knowledge and attitudes toward antibiotic use in Vietnam: the challenge of reducing antibiotic resistance

A latent class analysis of knowledge and attitudes toward antibiotic use in Vietnam: the challenge of reducing antibiotic resistance

Implementing oral antibiotics for bone and joint infections: Lessons learned and opportunities for improvement

Abstract Background Although intravenous antibiotics have historically been the standard of care for bone and joint infections, clinical trial data has highlighted the safety and efficacy of oral antibiotics. Despite this, intravenous antibiotics are still commonly used and evaluations of institutional guidelines advancing oral antibiotic use are limited. Methods In April 2023, we implemented a new institutional guideline to preferentially treat patients with bone and joint infections with oral antibiotics. The post-guideline cohort was compared with a historical pre-guideline cohort via retrospective chart review. The primary outcome was the proportion of patients discharged exclusively on oral antibiotics. Secondary outcomes included 90-day treatment failure, length of stay, and adverse effects. Results One hundred and eighty-six patients (53 pre-guideline and 133 post-guideline) were included in the analysis. Patients in the post-guideline cohort were more likely to be discharged exclusively on oral antibiotics (25% vs. 70%, p<0.01), with no difference in 90-day treatment failure (8% vs. 9%, p=0.75). Patients in the post-guideline cohort had a shorter length of stay than pre-guideline (median days: 8 vs. 7, p=0.04) and trended towards fewer PICC-related adverse events (6% vs. 1% p=0.07). Conclusion An institutional guideline was effective in increasing the proportion of patients with bone and joint infections discharged on oral antibiotics. We observed similar clinical outcomes after implementing the guidelines while reducing length of hospital stay.

Antibiotics as adjunct to non-surgical periodontal therapy in diabetic patients.

A comprehensive literature search was performed via MEDLINE/PubMed, Scopus, and Web of Science, including all relevant publications accessed on March 2023 and subsequently updated up to July 2024. Additionally, grey literature was searched, and there was no restriction on publication data and languages. All randomized clinical trials comparing topical/systemic antibiotics as an adjunct to scaling and root planning (SRP) with SRP alone for the treatment of diabetic patients with periodontitis were included. Literature reviews, case reports and series, preclinical studies or studies lacking periodontal data were excluded. Clinical attachment level was considered as the primary outcome. Bleeding on probing, pocket depth, and gingival index were the secondary outcomes. The risk of bias was evaluated using the Cochrane Collaboration Tool, and for each domain, bias risk was judged as low, unclear and high risk of bias. Selection, removing duplicates, screening, extracting data, and assessing the quality of studies were done by two investigators and findings were tabulated. Meta-analysis was conducted, generating forest plots to compare different treatment modalities, time periods, and antibiotic types. Key periodontal parameters such as probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BoP) were analysed. Upon screening and further evaluation of 690 articles, 43 were considered for full-text eligibility. Finally, 30 studies were included in the systematic review, and 27 were included in meta-analysis. Out of 30 randomized clinical trials, 9 studies focused on topical and antibiotics, and 21 involved systemic administration of antibiotics. Five of the nine studies focussing on topical administration of antibiotics, were classified as having a low risk of bias and four as having a high risk of bias. Out of 21 studies on systemic antibiotics, eight were classified as having a low risk of bias, two were undefined, and eleven showed a high risk of bias. Authors concluded that adjunctive use of antibiotics could lead to improvement in periodontal clinical parameters CONCLUSION: The findings showed that the adjunctive use of antibiotics led to slight improvements in clinical outcomes. However, keeping in mind antibiotic resistance, and side effects of antibiotics, their use should be approached cautiously and only when necessary.

Isolation and Identification of Pathogenic Bacteria from Urinary Tract Infection in Patients Attending Rwanda Military Hospital

Background: About 150 million people worldwide are diagnosed with urinary tract infection every year and more than half of women will get at least one in their lifetimes. Overuse and misuse of antibiotics have contributed to the growing problem of resistance amongst uropathogenic bacteria making it hard to treat UTIs. There is an increasing prevalence of antibiotic resistance and that’s why area-specific monitoring studies to document the microorganisms causing UTIs and their antimicrobial susceptibility is mandatory for helping the selection of an effective empirical treatment. Aim: The present study aimed to determine bacteria causing UTIs and their antibiotic susceptibility patterns among patients attending Rwanda military hospital. Methodology: The study was a cross-sectional study and a total number of 118 patient’s urine samples were tested in microbiology Lab. Results: Most frequently isolated bacteria to cause UTIs in this study was E. coli (59%) followed by Klebsiella pneumonia (16%), S. aureus (6%), Citrobacter freundii (5%), Proteus spp. (3%), S. Saprophyticus (3%), Streptococcus spp. (3%), Pseudomonas aeruginosa (2%), Klebsiella oxytosa (2%) and Acinetobacter baumanii (2%). Meropem, imipem, gentamicin and cefotaxime were the most effective antibiotics in susceptibility testing. Thus, ciprofloxacin, sulfamethoxazole and norfloxacin were mostly developed resistance to isolated bacteria. Conclusion: The study recommended that the ministry of health in Rwanda should establish the commission or government body which will be in charge of controlling use of antibiotics properly and fighting against drugs resistance in Rwanda. Keywords: Pathogenic bacteria, Urinary tract infections, E.coli, Antibiotics

STUDY OF PREVALENCE OF MULTI-DRUG RESISTANT ACINETOBACTER SPECIES IN VENTILATOR-ASSOCIATED PNEUMONIAE CASES IN A TERTIARY CARE HOSPITAL, VISAKHAPATNAM

Objective: Acinetobacter sps are important oppurtunistic pathogens with their significance in colonising and persistent biofilm production capabilities. The aim of the present study was to assess the prevalence of multidrug-resistant Acinetobacter sps in ventilator-associated pneumoniae cases in a tertiary care hospital Visakhapatnam. Methods: A prospective study was conducted on 328 endotracheal aspirate samples received in Clinical Laboratory, Department of Microbiology for a period of 1 y, from June 2023 to June 2024, in mechanical ventilated cases, admitted in intensive care units, in a tertiary care hospital, Visakhapatnam. Results: Out of 328 samples received, 42 (12.8%) were Acinetobacter isolates with resistance to Aminoglycosides (66.7%), Cephalosporins (57.1%), Quinolones (52.4%), Carbapenems (42.9%). Biofilm production was identified in 31 isolates (73.8%) by Congo Red Agar method in this study. Conclusion: The potential ability of Acinetobacter sps to form biofilms and antibiotic selective pressure leading to emergence of resistant clones is directly proportional to the injudicious use of antibiotics. There is a strict need of antibiotic stewardship measures in intensive care units to restrict development of pan-resistant strains.

Antimicrobial Resistance in Lactococcus spp. Isolated from Native Brazilian Fish Species: A Growing Challenge for Aquaculture

Lactococcus spp. has emerged as a pathogen that is affecting global aquaculture, with L. garvieae, L. petauri, and L. formosensis causing piscine lactococcosis. While antimicrobials are commonly used to treat diseases in aquaculture, reports of antimicrobial resistance in fish isolates are increasing. However, little is known about the susceptibility patterns of Lactococcus spp. strains isolated from native fish species in Brazil. This study aimed to assess the antimicrobial susceptibility of these strains and establish a provisional epidemiological cutoff value for L. garvieae using the normalized resistance interpretation approach. A total of 47 isolates were tested: 17 L. garvieae, 24 L. petauri, and 6 L. formosensis. The isolates were classified as wild-type (WT) or non-wild-type (NWT) based on inhibition zone diameters. Isolates classified as NWT for three or more antimicrobial classes were considered multidrug-resistant, and the multiple antibiotic resistance (MAR) index was calculated. The results revealed heterogeneity in antimicrobial resistance profiles, with higher resistance to trimethoprim/sulfamethoxazole and norfloxacin. Resistance to other antimicrobials, including florfenicol and oxytetracycline (approved for use in Brazil), varied according to the bacterial species. Lactococcus petauri (87.5%) and L. formosensis (66.7%) showed the highest multidrug resistance, compared to L. garvieae (11.7%), along with higher MAR index values. These findings suggest that multidrug-resistant strains could pose future challenges in the production of native species, underscoring the need for ongoing monitoring of antimicrobial resistance and responsible use of antimicrobials in aquaculture.

Determinants of Cervical Cancer Screening Among Rural Women in Zimbabwe.

To identify the determinants of cervical cancer (CC) screening among underserved rural women in Zimbabwe. Community-based cross-sectional survey. 840 rural women (25-65 years). A structured, pretested questionnaire was used to collect data on sociodemographic characteristics and factors influencing screening. The outcome was defined as self-reported ever screening for CC. Multivariable logistic regression was used to examine the association between CC screening and independent variables. Of the 840 women included, 33% had a history of screening. Women 25-45 years (adjusted odds ratio (aOR): 0.43; 95% CI: 0.30-0.61) and without medical insurance (aOR: 0.66; 95% CI: 0.45-0.97) had reduced odds of CC screening. Conversely, women who had seen or heard messages on CC screening (aOR: 1.48; 95% CI: 1.03-2.13), were living with HIV (aOR: 1.87; 95% CI: 1.22-2.87) reported recent antibiotic use (aOR: 4.50; 95% CI: 1.47-13.79) and had malaria in the last 6 months (aOR: 2.45; 95% CI: 1.02-5.86) had increased odds of CC screening. There is a need for intensified efforts to improve CC screening uptake, particularly in underserved rural areas with suboptimal screening rates and high CC burden. Strategies should include widespread tailored awareness messaging targeting younger women, women living with HIV, and women without medical insurance.

A case of penicillin-resistant group B Streptococcus isolated from a patient in the UK.

In England, group B streptococci (GBS; Streptococcus agalactiae) are considered universally susceptible to penicillin. Reports from Africa, Asia, North America and a few European countries have described GBS isolates with penicillin MICs above the epidemiological cut-off (0.125 mg/L). Our aim was to characterize a penicillin-resistant GBS (PRGBS) isolate recovered in 2016 from a patient treated with long-term antimicrobials in the UK. Antibiotic susceptibility of a referred isolate from a discharging sinus overlying a chronic prosthetic joint infection was determined using gradient strip testing for seven antibiotics. Illumina short read sequencing was carried out using a HiSeq 2500 platform to determine MLST, capsular type, to detect mutations in the pbp genes, and to compare the isolate with contemporaneous GBS isolates circulating in the UK. The GBS isolate belonged to capsular type Ia and MLST 144. We observed resistance to penicillin (MIC = 1 mg/L) and tetracycline (32 mg/L) with susceptibility to linezolid (1 mg/L), erythromycin (0.064 mg/L), clindamycin (0.064 mg/L), teicoplanin (0.064 mg/L) and vancomycin (0.25 mg/L). Deduced amino acid sequences revealed substitutions and non-synonymous changes in PBP2x and PBP2b. Genomic analysis of contemporaneous cases (n = 34) from across the UK identified single nucleotide polymorphism (SNP) variation ranged from 153-6596 SNPs. We confirm the first identification of a PRGBS isolate amongst referrals to the UK's national reference laboratory. Substitutions in pbp1a, pbp2a, pbp2x and pbp2b were identified that likely developed in the face of long-term beta-lactam antibiotic use.

Using digital health technologies to optimise antimicrobial use globally.

Digital health technology (DHT) describes tools and devices that generate or process health data. The application of DHTs could improve the diagnosis, treatment, and surveillance of bacterial infection and the prevention of antimicrobial resistance (AMR). DHTs to optimise antimicrobial use are rapidly being developed. To support the global adoption of DHTs and the opportunities offered to optimise antimicrobial use consensus is needed on what data are required to support antimicrobial decision making. This Series paper will explore bacterial AMR in humans and the need to optimise antimicrobial use in response to this global threat. It will also describe state-of-the-art DHTs to optimise antimicrobial prescribing in high-income and low-income and middle-income countries, and consider what fundamental data are ideally required for and from such technologies to support optimised antimicrobial use.

Reevaluating antibiotic prophylaxis: insights from a network meta-analysis on dry socket and surgical site infections.

Three databases (MEDLINE, Cochrane Library, and Scopus) were searched in December 2021 for 16 Randomised Clinical Trials (RCTs). Three reviewers reviewed the articles on oral antibiotic prophylaxis (ABP) for the prevention of surgical site infection (SSI) and dry socket (DS) after lower third molar (L3M) extraction using the PICO framework. From 1999 to 2021, RCTs involving healthy patients undergoing L3M extraction with ABP, placebo, or no therapy were included. Adverse effects (AEs) associated with antibiotic usage, along with the main outcomes (DS and SSI), were also documented. Three independent investigators selected articles based on pre-established inclusion criteria, with any disagreements resolved by consensus or additional researchers. PRISMA guidelines were followed, involving initial title and abstract screening, followed by full-text evaluation. Exclusion reasons were documented, and the most recent report was included when multiple reports on the same patients were found, with no language restrictions applied. Two investigators evaluated studies quality and quality of evidence respectively using the Cochrane Collaboration tool and GRADEpro GDT. They independently extracted data, focusing on the type of extraction and the number of extracted L3M. They also detailed the use of antibiotics, including dosage, dosage regimen, timing, and duration. Among 16 articles, 15 used a parallel arm design, while one used a crossover design. The antibiotics studied included Amoxicillin+Clavulanic acid (7 articles), Amoxicillin (6), Metronidazole (2), Azithromycin (1), and Clindamycin (2), all compared with no treatment or placebo. A pairwise meta-analysis was used to combine studies with equivalent treatment (direct estimation), and a network meta-analysis compared outcome variables across different treatments (indirect comparison). Two included articles had a low risk of bias and the level of evidence was low according to GRADE. Pooled results supported the use of antibiotics to reduce DS and SSI following L3M extraction with a number needed to treat 25 and 18, respectively. Despite the fact that ABP reduces the risk of DS and SSI, it is recommended to consider systemic conditions and individual patient risk factors before prescribing antibiotics, due to global health threat.

Threshold Modeling for Antibiotic Stewardship in Oman.

Antimicrobial stewardship supports rational antibiotic use. However, balancing access to antibiotic treatment while controlling resistance is challenging. This research used a threshold logistic modelling approach to identify targets for antibiotic usage associated with carbapenem-resistant Acinetobacter baumannii (CRAb), carbapenem-resistant Klebsiella pneumonia (CRKP), and extended-spectrum β-lactamases- producing Escherichia coli (ESBL-producing E. coli) incidence in hospitals. This study utilises an ecological population-level design. Monthly pathogen cases and antibiotic use were retrospectively determined for inpatients between January 2015 and December 2023. The hospital pharmacy and microbiology information systems were used to obtain this data. Thresholds were identified by applying nonlinear modelling and logistic regression. Incidence rates of 0.199, 0.175, and 0.146 cases/100 occupied bed-days (OBD) for CRAb, CRKP, and ESBL-producing E. coli, respectively, were determined as the cutoff values for high (critical) incidence rates. Thresholds for aminoglycosides (0.59 defined daily dose (DDD)/100 OBD), carbapenems (6.31 DDD/100 OBD), piperacillin-tazobactam (3.71 DDD/100 OBD), third-generation cephalosporins (3.71 DDD/100 OBD), and fluoroquinolones (1.91 DDD/100 OBD), were identified. Exceeding these thresholds would accelerate the gram-negative pathogens' incidence rate above the critical incidence levels. Employing the threshold logistic approach enabled near real-time performance monitoring feedback, risk scores and alert signals for when the incidence of the selected pathogens are entering critical levels. Threshold logistic models can help inform and implement effective antimicrobial stewardship interventions to manage resistance within hospital settings.

Clinical Profile and Outcomes of All Admitted COVID-19 Positive Patients with Primary Lung Cancer in a Tertiary Government COVID-19 Referral Center: A Retrospective Cohort Study

Background. COVID-19 infection poses a continuing challenge especially to those already with prior lung disease. To analyze such patients’ profile is essential in today’s health care management. Objective. The study aimed to compare the outcomes of COVID-19 confirmed patients with and without primary lung cancer in terms of hospital stay, recovery, and mortality. Methods. The study employed a retrospective cohort design. Chart review of all adult COVID-19 patients in Philippine General Hospital from January 2021 to June 2021 was done. A matched cohort study was conducted between COVID-19 patients with and without primary lung cancer. Results. Among the 953 COVID-19 patients, there were 14 patients with primary lung cancer. In terms of length of hospital stay, patients with primary lung cancer had shorter days from 1.32 to 15.1 days compared to 2.28 to 18.36 days in patients without primary lung cancer (p-value 0.271). Furthermore, they had 64% recovery rate compared to 78% in those without primary lung cancer (p-value 0.118). In terms of overall mortality rate, primary lung cancer patients had 36% rate as compared to 22% in the non-lung cancer group (p-value 0.119). Diabetes mellitus, mild to severe COVID, Remdesivir, and antibiotic use were associated with longer hospital stay while oxygen support via nasal cannula and invasive ventilation led to shorter hospital stay. Age above 50 years, chronic liver disease, other malignancy, shortness of breath, oxygen support via face mask, high flow nasal cannula, invasive ventilation, antibiotic use, hemoperfusion and nebulization showed a decrease chance of recovery while on contrary, Remdesivir showed an increase chance of recovery. An increase mortality rate was seen among age above 50 years, chronic liver disease, other malignancy, shortness of breath, oxygen support via facemask, high flow nasal cannula, invasive ventilation, antibiotics, hemoperfusion, and nebulization, in contrast to a decrease in Remdesivir therapy. Conclusions. Among all admitted COVID-19 patients, primary lung cancer patients were associated with shorter hospital stay (8.21+6.89days), lower rate of recovery (64%), and higher mortality rate (36%) as compared to those without primary lung cancer. However, based on the computed p-values for each outcome, these differences are not statistically significant.

An in-depth analysis of antimicrobial prescription quality in 10 non-university hospitals, in southwest Germany, 2021.

BackgroundNon-university hospitals are the major provider of inpatient care in Germany, serving 89% of acute care hospital beds. Although surveillance data on antimicrobial use in hospitals are widely available, data on prescription quality are rare.AimWe aimed to provide an in-depth analysis of antimicrobial prescribing patterns and quality in southwest German non-university hospitals.MethodsDuring 2021, we performed three point prevalence surveys (PPS) in 10 non-university hospitals, representing ca 10% of hospital beds in the federal state of Baden-Württemberg (11 million inhabitants). Demographic and clinical information were collected. We assessed the overall performance of 14 validated process quality indicators (QI) covering infection diagnostics, antimicrobial therapy and documentation.ResultsOf 8,560 patients analysed, 2,861 (33%) received at least one antimicrobial. Most (2,789, 80%) antimicrobial prescriptions were for therapeutic indications. Most frequently prescribed agents were beta-lactam/beta-lactamase inhibitors (1,120, 40%) in therapeutic and cefuroxime (269, 37%) in prophylactic indications. According to the World Health Organization's Access, Watch, Reserve classification, the Access-to-Watch ratio was 0.73. Overall adherence to QIs was low and varied substantially (27-93%), with documentation, possible streamlining and switching to oral therapy exhibiting the lowest fulfilment rates (<50%).ConclusionThe results indicate a need to improve antimicrobial prescribing quality in non-university hospitals. The high prevalence of antimicrobial use in our setting underlines the demand for sustainable antimicrobial stewardship programmes in this sector. Our QI-based PPS approach can be used to identify key targets for future antimicrobial stewardship interventions. The results indicate a need for further legislation on antimicrobial stewardship.

Effectiveness analysis of a pharmacist-led intervention for orthopedic perioperative use of antibiotics: a retrospective cohort study

BackgroundFollowing the Chinese guidelines’ recommendation to completely cancel routine cephalosporin skin tests, the choice of cephalosporin as surgical prophylactic medication was affected. This was due to the limited cognition of the predictive value of cephalosporin skin test or the desire to avoid medical disputes. The aim of this retrospective study was to evaluate whether the pharmacist-led perioperative antibiotic prophylaxis model could improve clinicians’ medical behavior in choosing cephalosporin antibiotics for surgical prophylaxis.MethodsFrom July 2021 to May 2022, a retrospective analysis was conducted on the selection of surgical preventive medication, skin test, postoperative infection and adverse drug reactions in foot and ankle surgery. The study was divided into three period: the rountine cephalosporin skin test period (Period I: Skin Test), the period when the routine cephalosporin skin test was cancelled but the pharmacist did not intervene (Period II: Cancel Skin Test), and the period when the pharmacist-led perioperative antibiotic prophylaxis was implemented after the cancellation of the cephalosporin skin test (Period III: Pharmacist Intervention).ResultsA total of 1,583 patients were enrolled in this study. There was no significant difference in the utilization rate of cefuroxime between the routine skin test stage and the skin test cancelled stage [74.92% (Period I) vs. 74.54% (Period II), P &amp;gt; 0.05]. However, in the pharmacist intervention stage, the usage rate of cefuroxime significantly increased compared to the initial stage when the skin test was cancelled [87.07% (Period III) vs. 74.54% (Period II), P &amp;lt; 0.05]. The use of cephalosporins also increased in patients with self-reported beta-lactam allergies between these stages [41.94% (Period III) vs. 3.22% (Period II), P &amp;lt; 0.05)]. There was no significant difference in the incidence of postoperative infection and adverse drug reactions among the three periods.ConclusionThe pharmacist-led perioperative antibiotic prophylaxis model can significantly improve the medical behavior of clinicians in choosing cephalosporin antibiotics as surgical prophylactic medication and optimize the perioperative medication plan.