Use Of Antibiotics For Infections Research Articles

Incision and drainage as mainstay therapy in antibioma: A case report

Antibioma is a chronic sterile, tough fibrous abscess formed commonly due to prolonged and inappropriate use of antibiotics for infections, without facilitating proper drainage of the pus. It is a localized swelling which is painless, smooth, non-tender and firm on palpation. It is only after the abscess has been incised, the body defence mechanism and antibiotic can eradicate the infection by releasing pressure, increasing blood circulation and oxygen to the anaerobic environment. Here, a rare case of antibioma in the neck of an 8 year old male child who had undergone extraction of an offending tooth to eradicate the infection. However, inadequate drainage of the abscess and lack of proper postoperative follow-up led to persistence of residual infection.

Effectiveness of a Glyceryl Trinitrate (GTN) Patch in Preventing Amputation, Improving Pain Control and Reducing the Size of Tissue Loss for a Patient With Critical Limb-Threatening Ischaemia (CLTI).

Background Foot ulcer is a common complication of poorly controlled diabetes and peripheral vascular disease (PVD). The current standard of treatment for diabetic foot ulcers includes the management of underlying risk factors, wound debridement, use of antibiotics for infection, off-loading with cast, and revascularisation surgery. The glyceryl trinitrate (GTN) patch is currently off-licence in treating PVD or diabetic foot ulcers. This study aims to evaluate the effectiveness of the GTN patch in preventing amputation, improving pain control, and reducing the size of tissue loss (ulcer/gangrene) or localised ischaemic area. Method This is a pilot study of 30 patients who were started on the GTN patchfrom February 2020 to October 2021. Inclusion criteria were patients who have critical limb-threatening ischaemia (CLTI) and with no viable options or are at high risk for revascularisation, both endovascular and open surgery. Patients who were on a GTN patch for less than six weeks at the time of data collection or had unclear outcomes were excluded. The outcomes were retrospectively collected on prevention of amputation, improvement in pain control, and reduction in tissue loss (the size of ulcer/gangrene) or localised ischaemic area with the use of a GTN patch. The binomial test was used to compare the observed outcome of the GTN patch and the expected outcome, which was assumed to be 50% in this study. Results Ninety-three per cent (93%) of the patients who had GTN patches successfully avoided amputation (p<0.0001). Eighty-four per cent (84%) of patients reported better pain control (p=0.0022) and improvement in the size of ulcer/gangrene/localised ischaemic areas (p=0.0005). Conclusion The GTN patch is effective in preventing amputation, improving pain control, and reducing the size of ulcer/gangrene/localised ischaemic areas in patients who have end-stage CLTI and no viable options or who are at high risk for revascularisation surgery.

The Effect of Vitamin K2 Supplementation on PIVKA-II Levels in Patients with Severe Motor and Intellectual Disabilities Undergoing Long-Term Tube Feeding.

Nutritional support is essential for patients with severe motor and intellectual disabilities (SMID) to ensure the smooth provision of medical care. These patients often require long-term tube feeding with enteral formulas, potentially leading to deficiencies in vitamins and trace elements. Additionally, frequent antibiotic use for infections often disrupts gut microbiota, inhibiting vitamin K2 production by intestinal bacteria. We assessed the serum protein induced by vitamin K absence or antagonists-II (PIVKA-II) and undercarboxylated osteocalcin (ucOC) levels to assess the vitamin K status in 20 patients with SMID (median age: 44.1 years, 11 men and 9 women) undergoing long-term tube feeding for durations ranging from 3 to 31 years. Thirteen (65%) and nine (45%) patients had elevated PIVKA-II (<40 mAU/mL) and serum ucOC levels (reference value < 4.50 ng/mL), respectively. Dietary vitamin K1 intake did not differ between patients with and without elevated PIVKA-II levels. Vitamin K2 supplementation for 3 months decreased serum PIVKA-II levels near those within the reference range. Approximately half of the patients with SMID on tube feeding had subclinical vitamin K deficiency. Further studies are needed to ascertain if long-term vitamin K2 supplementation effectively prevents vitamin K deficiency-induced hypercoagulation, osteoporosis, and vascular calcification in patients with SMID.

What initiates chemical intolerance? Findings from a large population-based survey of U.S. adults

BackgroundWorldwide observations point to a two-stage theory of disease called Toxicant-Induced Loss of Tolerance (TILT): Stage I, Initiation by an acute high-level or repeated lower-level chemical exposures, followed by Stage II, Triggering of multisystem symptoms by previously tolerated, structurally diverse chemical inhalants, foods/food additives and drugs. Until recently, there was no known biological mechanism that could explain these observations. In 2021, we published a plausible and researchable two-stage biomechanism for TILT involving mast cells: Stage I, Initiation via mast cell sensitization; Stage II, Triggering of mast cell degranulation by previously tolerated exposures, resulting in the release of thousands of mediators, including histamine and a host of inflammatory molecules. The objective of this study was to identify common TILT initiators.MethodsA randomized, population-based sample of 10,981 U.S. adults responded to a survey which included items concerning medical diagnoses, personal exposures, antibiotic use, and several possible initiators of Chemical Intolerance (CI). CI was assessed using the internationally validated Quick Environmental Exposure and Sensitivity Inventory (QEESI). Participants identified as chemically intolerant were asked to recall when their intolerances began and what they felt had initiated their condition.ResultsTwenty percent met QEESI criteria for TILT, approximately half of whom identified one or more initiating exposures. Initiators in order of frequency were mold (15.6%), pesticides (11.5%), remodeling/new construction (10.7%), medical/surgical procedures (11.3%), fires/combustion products (6.4%), and implants (1.6%). Protracted antibiotic use for infections involving the prostate, skin, tonsils, gastrointestinal tract, and sinuses were strongly associated with TILT/CI (OR > 2).DiscussionParticipants identified two broad classes of TILT initiators: 1) fossil fuel-derived toxicants (i.e., from coal, oil, natural gas), their combustion products, and/or synthetic organic chemical derivatives, e.g., pesticides, implants, drugs/antibiotics, volatile organic compounds (VOCs); and 2) biogenic toxicants, e.g., particles and VOCs from mold or algal blooms. One in four primary care patients suffers from Medically Unexplained Symptoms (MUS). Doctors in primary care, neurology, psychiatry, psychology, occupational medicine, and allergy/immunology would be well-advised to include TILT in their differential diagnosis of patients with so-called MUS. Because 20% of U.S. adults meet QEESI criteria for CI, the role of contemporary exposures in initiating and exacerbating these conditions via mast cells needs our immediate attention. There is a concomitant need for policies and practices that reduce initiating exposures as well as ubiquitous and often unavoidable triggers such as fragranced personal care, cleaning, and laundry products in multi-occupant housing, workplaces, medical settings, schools, places of worship, and all public buildings—literally anywhere air is shared. Fossil fuels are assaulting humans and other animal species both from within via mast cell sensitization, and from without via climate change.

Prescribers' Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan.

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.

Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis.

Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988-2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran's Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

A Spectrum of Causative Organisms of Healthcare-associated Infections in a Tertiary Care Hospital of West Bengal: An Observational Study

ABSTRACT Background Nosocomial infections are the foremost reasons for morbidity and mortality among hospitalized patients. Rampant use of antibiotics in infections has led to the emergence of multiresistant bacteria worldwide. Periodical review of sensitivity profiles is of utmost importance for optimal patient benefit. Aims and objectives To explore the spectrum of organisms responsible for intensive care unit (ICU) and inpatient hospital-acquired sepsis and evaluate the pattern of antibiotic sensitivity of the organisms. Materials and methods Samples were collected from all consecutive patients getting fever and satisfying the criteria for a nosocomial infection indoor as well as ICU, irrespective of etiology. They included sputum, blood, urine, and wound swabs. All samples were sent for a routine examination as well as a culture and sensitivity test. Descriptive statistical methods were used with the help of SPSS version 21. Results The most frequent organisms for nosocomial infections in the ICU were Enterobacteriaceae (45%), Acinetobacter (13.7%), and Staphylococcus aureus (12.3%). In the general wards, the most common isolates were Enterobacteriaceae (59.9%), S. aureus (14.5%), Enterococcus (9.8%), and Pseudomonas (9.3%). There was a high percentage of extended-spectrum beta-lactamase among the Enterobacteriacae, methicillin-resistant S. aureus, and borderline oxacillin-resistant S. aureus among S. aureus and metallo-ß-lactamase among the Acinetobacter and Pseudomonas. These indicate resistance to most beta-lactams, cephalosporins, and at times to carbapenems. There was also coresistance to fluoroquinolones and aminoglycosides. Conclusion An antibiotic policy should be improvised for each healthcare facility on the basis of that point of time. How to cite this article Ghosh S, Mukhopadhyay M, Namhata A, et al. A Spectrum of Causative Organisms of Healthcare-Associated Infections in a Tertiary Care Hospital of West Bengal: An Observational Study. Bengal Physician Journal 2020;7(1):2–7.

Teacher and Student Views on the Feasibility of Peer to Peer Education as a Model to Educate 16-18 Year Olds on Prudent Antibiotic Use-A Qualitative Study.

Peer education (PE) has been used successfully to improve young peoples’ health-related behaviour. This paper describes a qualitative evaluation of the feasibility of university healthcare students delivering PE, covering self-care and antibiotic use for infections, to biology students in three UK schools (16–18 years), who then educated their peers. Twenty peer educators (PEds) participated in focus groups and two teachers took part in interviews to discuss PE feasibility. Data were analysed inductively. All participants reported that teaching students about antibiotic resistance was important. PE was used by PEds to gain communication skills and experience for their CV. PEds confidence increased with practice and group delivery. Interactive activities and real-life illness scenarios facilitated enjoyment. Barriers to PE were competing school priorities, no antibiotic content in the non-biology curriculum, controlling disruptive behaviour, and evaluation consent and questionnaire completion. Participation increased PEds’ awareness of appropriate antibiotic use. This qualitative study supports the feasibility of delivering PE in schools. Maximising interactive and illness scenario content, greater training and support for PEds, and inclusion of infection self-care and antibiotics in the national curriculum for all 16–18-year olds could help facilitate greater antibiotic education in schools. Simplifying consent and data collection procedures would facilitate future evaluations.

Antibiotic treatment of infections in burn patients - a systematic review

Due to the loss of the natural skin barrier function with reduced immune competence as a result of a plasma loss and the numerous intensive care interventions, burn patients are particularly at risk for infection. systematic review METHODS: A systematic review of German and English literature between 1990 and 2018 analyzes the epidemiological and diagnostic aspects as well as the therapeutic use of antibiotics in infections of burn patients in clinical trials. A total number of 53 randomized controlled clinical trials met the inclusion criteria. Various types / forms of application of antibiotic prophylaxis in burn wounds were investigated: topically, systemically (generally), systemically (perioperatively), nonabsorbable antibiotics (= selective intestinal decontamination), locally (inhaled) and all forms of administration versus control. Early postburn prophylaxis was studied in low-severity patients (six studies) and severe burn patients (seven studies). Antimicrobial prophylaxis has shown no effectiveness in the prevention of toxic shock syndrome in low grade burns, but can be useful in patients with severe burns in need for mechanical ventilation. Perioperative prophylaxis has been studied in ten studies. The benefit of long-term systemic antibiotic prophylaxis in the majority of burn patients is not evident. Mild infections in stable clinical conditions should be closely monitored, while in severe infections, international sepsis guidelines and the Tarragona principle are recommended.

Suspicious drug hypersensitivity reactions in pediatric patients: a retrospective single-center study

Drug hypersensitivity reactions (DHRs) are important clinical problems in childhood. There have been only a limited number of studies conducted in Turkey on this subject. This study was performed to obtain knowledge about DHRs in pediatric patients. Therefore, this study assesses the properties of hypersensitivity reactions, culprit drugs, patient risk factors, and common errors related to the management of these reactions. The study was conducted as a retrospective cross-sectional study by an assessment of data from 96 patients with DHRs evaluated in our department between December 2009 and August 2011. Information was obtained on prevalence of the DHRs, type and properties of the reactions, culprit drugs, patient characteristics, and the management of the reactions. The total prevalence of DHRs was 0.47%. The prevalence of DHRs was 0.38 and 0.50% in inpatients and outpatients, respectively, while the prevalence of DHRs requiring hospitalization of outpatients was 0.1%. The drugs most commonly causing hypersensitivity reactions were β-lactam antibiotics (80.3%). The skin was the most common system involved in DHRs, and maculopapular rashes were the most common type of skin involvement (40.5%). Anaphylaxis was the most common severe DHR. Of the five patients with identified anaphylaxis, only two received epinephrine. β-Lactam antibiotics were the most common causative agent in this study. Therefore, the rationale use of antibiotics for infections commonly encountered in childhood is important. Physicians’ levels of knowledge about the recognition of anaphylaxis and the management of severe reactions should be increased. It is important to evaluate patients who have a history of previous DHRs and/or asthma in order to prevent future DHRs. It is necessary to educate doctors about the administration of epinephrine as the most important part of the treatment of anaphylaxis.

Collaboration with an infection control team for patients with infection after spine surgery

The risk of infection, including surgical site infection (SSI), after spine surgery has increased due to aging and more immunocompromised hosts. An infection control team (ICT) is responsible for management of health care-associated infections at our institution. The study subjects were 40 patients (18 men and 22 women with an average age of 54 years) referred to the ICT after spine surgery since 2010. Pathogenic bacteria and treatment in these cases were reviewed. Collaboration with the ICT involved guidance on use of antibiotics for infection in 30 patients (16 SSI and 14 non-SSI) and a search for the infection focus for fever of unknown origin in 10 patients (7 patients were found to have urinary tract infections and 2 patients were found to have pneumonia). The detection rate of causative bacteria in ICT consultation was 88% (35 out of 40 patients). SSI patients with instrumentation involved had a significantly higher rate of methicillin-resistant Staphylococcus aureus infection compared with those without instrumentation (42% vs 13%; P < .05). All cases of SSI with instrumentation involved were cured by ICT support without removal of instrumentation. Early assistance from the ICT was important for prevention of worsening of methicillin-resistant S aureus infection. Collaboration with the ICT was helpful for detection of pathogenic bacteria and allowed appropriate use of antibiotics at an early stage.

Integrating a Rapid Diagnostic Test and Antimicrobial Stewardship: Optimizing Discharge Antibiotics in Skin and Soft Tissue Infections.

A rapid test to detect methicillin resistance in Staphylococcus aureus through the penicillin-binding protein 2a antigen was introduced for pediatric patients hospitalized for purulent skin and soft tissue infections. Integration of this test with physician education and stewardship guidance improved targeted antibiotic use for infections caused by methicillin-susceptible S. aureus (44%-80%, P < 0.001), including when final culture results were not available.

Complementary or alternative? The use of homeopathic products and antibiotics amongst pre-school children.

BackgroundAny intervention to reduce the inappropriate use of antibiotics for infections in children has the potential to reduce the selective pressure on antimicrobial resistance and minimise the medicalisation of self-limiting illness. Little is known about whether homeopathic products might be used by some families as an alternative to antibiotics or the characteristics of such families. We used the Avon Longitudinal Study of Parents and Children (ALSPAC) observational dataset to explore the hypothesis that the use of homeopathic products is associated with reduced antibiotic use in pre-school children and to identify characteristics of the families of pre-school children given homeopathic products.MethodsQuestionnaires data were completed by the parents of 9723 children while aged between 3–4.5 years in Bristol UK. Univariable and multivariable analyses were used to explore the relationships between antibiotic and homeopathic product use.ResultsSix percent of children had received one or more homeopathic products and 62% one or more antibiotics between the ages of 3 and 4.5 years. After adjustment for factors associated with antibiotic use, there was no association between homeopathic product and antibiotic use (adjusted OR = 1.02, 95% CI 0.84, 1.24). Factors independently associated with child homeopathic product use were: higher maternal education, maternal use of homeopathic products, maternal lack of confidence in doctors, mothers reporting that they were less likely to see doctor when the child was ill, children being given vitamins, watching less television and suffering from wheeze and food allergies.ConclusionIn this observational study, the use of homeopathic products was not associated with decreased antibiotic consumption, suggesting the use of homeopathic product complements rather than competes with the use of antibiotics in pre-school children. The characteristics of mothers giving homeopathic products to their children are similar to those associated with adult self-administration.

Neonatal Surgery

This edition gives the reader an update concerning the modern care of newborns. Advancements in neonatal and perinatal medicine have led to the survival of many babies who formerly would have had dismal prognoses. This is particularly true of low-birth-weight, premature infants. The timing of a new edition, therefore, is appropriate. This edition has omitted the cumbersome chapters from the previous edition related to the organization, structure, and staff requirements of a surgical intensive care unit for newborns. The authors have added new and important chapters concerning fluid and electrolyte management, nutrition support, and prenatal diagnosis; sections describing diagnostic imaging techniques for the neonate and management of the very-low-birth weight infant, and an update on the appropriate use of antibiotics for infections in the newborn. The book is somewhat unusual in that it limits its scope to conditions that mainly affect newborns, unlike most other pediatric surgical textbooks. Updated information

PEDIATRIC SURGERY—A FIVE-YEAR (1949-1954) REVIEW

SURVEYS of pediatric wards throughout the country show the steady growth in the percentage of patients classed as surgical as opposed to those treated medically. In many centers, the surgical patients outnumber the medical ones. Obviously much of this shift is due to the use of antibiotics for infection, with more home care now possible for diseases previously requiring hospital care. Fathered by Dr. William E. Ladd, whose career was so admirably reviewed by Dr. Thomas H. Lanman recently, the growth of the sub-specialty of pediatric surgery has been rapid. Increasing numbers of surgeons are devoting their entire time to the care of children. As the problems of children are dealt with more uniformly and the results of treatment of the varied embryological mishaps improve, there are increasing reports in the literature of value for those centering their attentions on these problems. Editorial comment has been made from various centers as to the proper training for a pediatric surgeon, and the place of this specialty in the ever growing list of sub-specialties. Two contributions to the field in text form have been presented. Ladd and Gross first emphasized abdominal surgery of infants and children. In 1953, Gross presented the compilation of the experiences at the Boston Children's Hospital in a very complete form covering the cases at that hospital and referring to the work of many others. In 1948, Coe edited a group of papers on various aspects of the surgery of infants and children, as presented before the meeting of the American Academy of Pediatrics.