Use Of Antibiotics Research Articles

Evolving Practice Patterns of Young Retinal Specialists: A Five-Year Comparison of Treatment and Surgical Preferences

PurposeTo describe trends in demographics and practice patterns of young retina specialists over a five-year follow-up period. DesignA cross-sectional study of young retinal specialists conducted through an online social media platform to evaluate practice patterns for common conditions. MethodsAn anonymous survey was performed among U.S.-based young retinal specialists from a variety of practice environments in early stages of practice between August and September 2022. Results were compared to survey results from 2017. ResultsIn 2022, the survey population included 358 members with 101 respondents compared to 44 respondents in 2017. Most respondents preferred bevacizumab as first-line treatment for foveal-involving diabetic macular edema (DME) (60%), vein occlusions (54%), and macular degeneration (56%). Aflibercept was more popular as first-line for DME patients with poor vision (51%) compared to those with good vision (18%). For proliferative diabetic retinopathy (PDR) without macular edema, respondents prefer panretinal photocoagulation alone (43%) or in combination with anti-VEGF (48%) over anti-VEGF alone (10%). Respondents repaired rhegmatogenous retinal detachments using combined vitrectomy-buckle (20%), primary scleral buckle (10%), and pneumatic retinopexy (PR) (10%). The percentage of respondents who have used PR at least once increased significantly from 2017 to 2022. From 2017 to 2022, more respondents use masks (29.5% to 82.8%) and post-injection antibiotics (2.3% to 16.0%) when performing injections while a smaller minority use topical gel anesthesia (34.1% to 15.5%). ConclusionsSurvey results suggest more providers are more likely to observe good visual acuity in diabetic edema and use laser alone in PDR without edema. In addition, longitudinal trends show increased use of PR, masks and post-injection antibiotics, and decreased use of topical gel anesthesia.

Real-world study on disease burden and current clinical practice of hospital-acquired pneumonia in Japan

BackgroundHospital-acquired pneumonia (HAP) is a common nosocomial infection and is associated with high mortality. Despite advances in the understanding of the causes and prevention of HAP, it continues to be a frequent complication associated with hospital care. Presently, there are no large retrospective cohort studies on HAP in Japan. MethodsA retrospective cohort study was conducted using the Medical Data Vision Co. Ltd. database for the study period (1 April 2015 to 31 May 2018). The study population was defined based on ICD-10 codes for bacterial pneumonia, characteristics of hospitalization, and prescription of injection-only antibiotics. The study included patients ≥ 18 years of age with at least one episode of HAP during the identification period, where the episode was defined as hospitalization with HAP within the study identification period. ResultsA total of 2,968 patients were included in this study contributing to 2,979 HAP episodes. Patients with HAP were more likely to be male (64.9%) and older than age 65 (86.5%). The top three frequently prescribed antibiotics were sulbactam-ampicillin (39.7%; 1,183 episodes), tazobactam-piperacillin (28.4%; 846 episodes) and ceftriaxone (23.2%; 690 episodes). The mean (± SD) length of hospital stay during overall hospitalization and the HAP period were 49.9 (± 34.2) days and 11.3 ± 7.3 days respectively. The HAP patient mortality at discharge was 22.0%. ConclusionThe present study provided insights regarding the characteristics, treatment patterns of HAP patients in Japan. Further, the study provided noteworthy information regarding antibiotic usage trends in the aging Japanese population.

Analyzing Antibiotic Usage Trends in Genitourinary Infections and Procedures: Insights from the TriNetX Database

ObjectiveTo analyze antibiotic prescribing trends, particularly the decline in fluoroquinolone use for various GUI and procedures, and the growing preference for alternative treatments. MethodsThe TriNetX database was queried for antibiotic utilization rates from 2016 to 2022. We analyzed cases of cystitis, pyelonephritis, prostatitis, and other GUIs as well as periprocedure utilization for benign prostatic hyperplasia (BPH), urethral stricture disease, pelvic organ prolapse/stress urinary incontinence (POP/SUI), and overactive bladder/interstitial cystitis (OAB/IC). We determined the top four to six antibiotics prescribed within five days of diagnosis or procedure. Statistical analysis included linear regression modeling. ResultsFrom 2016-2022, fluoroquinolone use decreased in cystitis (p<0.001), pyelonephritis (p < 0.001), and prostatitis (p < 0.01). These infections were increasingly treated with beta-lactams (p<0.0001, p<0.01, p<0.01, respectively). Additionally, we found a decrease in fluoroquinolone utilization in procedures for BPH (p<0.001), urethral stricture (p<0.01), POP/SUI (p<0.001), and OAB/IC (p < 0.001). All cohorts except for OAB/IC showed a significant increase in beta-lactam use (p<0.001, p<0.01, p<0.01, respectively). ConclusionsWe noted a significant decline in fluoroquinolone use for GUI and procedures, accompanied by increased beta-lactam use, reflecting changes in prescribing practices. Judicious use is essential to promote antimicrobial stewardship and mitigate severe adverse effects.

A systematic review of factors associated with poor prognosis despite appropriate antibiotics usage for pneumonia

A systematic review of factors associated with poor prognosis despite appropriate antibiotics usage for pneumonia

Exploration of aerosolization of indoor bacterial communities in relation to antibiotic usage on swine farms

Exploration of aerosolization of indoor bacterial communities in relation to antibiotic usage on swine farms

Single dose vs prolonged antibiotic prophylaxis of fosfomycin for transrectal prostate biopsy: a single-center prospective, randomized, controlled trial

BackgroundTransrectal prostate biopsy is a commonly performed urological procedure in which antibiotic prophylaxis is recommended. Fluoroquinolone-type antibiotics are no longer acceptable in the EU. Fosfomycin-trometamol may be used, but there is no evidence regarding its ideal dose and administration time. MethodsPatients who underwent prostate biopsy between 2021 and 2023 were evaluated prospectively. 204 patients were randomized into two arms: 102 patients (Arm A) received a single dose of fosfomycin-trometamol one hour before surgery, and 102 patients (Arm B) received one additional dose of fosfomycin-trometamol 48 hours after the first dose. Urine tests and questionnaires were administered during the postoperative period and the subsequent four weeks to identify any symptoms, infectious, or other complications. ResultsThere was no statistical difference in the rate of asymptomatic bacteriuria (4.90% (5) vs 8.82% (9), p = 0.27) symptomatic UTI (0% (0) vs 1.96% (2), p = 0.50), or febrile UTI (0% (0) vs 0.98% (1), p = 1) between the groups. Only haematuria was significantly more common in Arm B (6.86% (7) vs 16.67% (17), p = 0.03), whereas other complications did not differ significantly. There was no statistical difference in hospitalization (0.98% (1) vs 2.94 (3), p = 0.62) or mortality rate (0 % (0) vs 0.98% (1), p = 1). Sub-group analysis of previous antibiotic users showed no difference in terms of complications. ConclusionThere is no significant difference in infectious complications between single dose and prolonged prophylaxis of fosfomycin-trometamol for transrectal prostate biopsy. A single dose of fosfomycin one hour before biopsy is an ideal choice with a better ecological impact compared with prolonged antibiotic prophylaxis for transrectal prostate biopsy.

Appropriateness of Empirical Antibiotic Use and Concordence with the WHO Aware Classification in Hospitalized Patients

Background: Antibiotic prescription trends analysis is essential for monitoring the sensitivity and resistance patterns of microorganisms discovered, regularly generating and updating antibiograms, and providing the context for antibiotic usage and prevalence. Specifically, consistent prescription patterns and antibiotic therapy practices with the WHO AWaRe (Access, Watch, and Reserve) classification of antibiotics and the national or WHO essential medicine list would enhance the prudent use of antibiotics, prevent the emergence and spread of antimicrobial resistance, and preserve antibiotic efficacy for future requirements. Objective: This study aimed to analyze selection of antibiotics for empirical use and definitive therapy and to evaluate rational use of antibiotics according to the WHO-AWaRe (Access, Watch, and Reserve) categories in hospitalized patients. Methodology: An observational and cross-sectional study was conducted in a 300 bedded multispecialty tertiary care hospital from October 2022 to March 2023 for a period of six months. Evaluation of demographic data based on antimicrobial susceptibility reports, pathogen characteristics, and infection site; evaluation of antibiotics administered before and after AST reports; and classification of antibiotics using WHO AWaRe metrics from the WHO essential medicines list. Descriptive statistics were applied for the data collected using Microsoft Excel. Results are expressed as total count, frequency, and percentages. Results: Antimicrobial susceptibility results from 162 patients were gathered from the laboratory. Of these 138 (85.18%) patients had positive results for Gram-negative bacteria and 24 (14.81%) for Gram-positive bacteria. The mean (SD) age of patients was 55 ± 28 years; predominantly male patients 92 (56.79%). 107 (66%) patients were hospitalized for 1-5 days. Monotherapy was given in 17 (10.5%) patients, Most of the patients were admitted into the general medicine 94 (58.02%), Bacteria were mainly isolated from urine (65 isolates, 40.1%), and a total of 36 organisms were isolated. The proportions of appropriate empirical therapy use were 84.05% for Gram-negative bacteria. A total of 706 antibiotics were prescribed out of which 334 are prescribed before AST and 372 are prescribed after AST. More prescribed empirical antibiotics were from the ‘Watch’ group (55.69%), followed by the ‘Access’ group (25.75%). ‘Reserve’ category (8.38%) and ‘not-recommended’ category (10.18%) antibiotics were also prescribed. A greater number of prescribed definitive antibiotics were from the ‘Watch’ group (48.11%). ‘Access’ group antibiotics should be preferable to the ‘Watch’ group. ‘Reserve’ antibiotics are always used as the last option when “Access” and “Watch” group antibiotics don’t work. Conclusion: The high use of empirical antibiotics especially from the ‘Watch’ category is a disturbing trend as observed in our study. . Increasing the use of ‘Access' antibiotics while limiting the use of ‘Watch' and ‘Reserve' antibiotics at the same time is the highest priority for preserving effectiveness of important antibiotics and minimizing the danger of AMR. Conducting such studies and analysis of such data periodically would pave the way for promotion of rational use of antimicrobials and help restrict the emergence of resistant strains of bacteria.

Prevalence, Risk Factors and Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Children Hospitalized with Urinary Tract Infection at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Background/Objectives: We aimed to assess the prevalence and risk factors for acquisition of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) in children admitted with urinary tract infection (UTI) at a tertiary university hospital in Saudi Arabia, as well as to investigate antibiotic resistance patterns. Methods: This retrospective cross-sectional study involved hospitalized children aged 0–14 years from January 2018 to December 2022 with urine cultures that grew E. coli or ESBL-producing E. coli. Data of the antimicrobial susceptibility for isolated bacteria were collected. Results: This study analyzed 242 urine samples obtained from 119 children with E. coli UTIs. Of these, 20.7% (n = 50) were ESBL producers. Previous antibiotic use (last 3 months), prophylactic antibiotic use, prior UTI (last 3 months), recurrent UTIs, and underlying co-morbidities (p = 0.011, &lt;0.001, 0.025, &lt;0.001, and 0.013, respectively) had a significant relationship with increased risk of ESBL E. coli UTIs. Generally, the highest resistance rates in the ESBL-producing isolates were for ampicillin and third-generation cephalosporin. Conversely, all ESBL-positive isolates were sensitive to meropenem, with variable resistance rates to other antibiotics as amikacin, nitrofurantoin, quinolones and trimethoprim/sulfamethoxazole (2%, 8%, 56% and 64%, respectively). Conclusions: There is a high prevalence of ESBL production among children hospitalized with E. coli UTIs. Addressing ESBL UTI risk factors helps to recognize high-risk cases and enhance proper antibiotic use.

Parents Perception on use of Antibiotics in Children

Objective: To determine parents’ perception on use of antibiotics in children. Study Design: Cross-sectional study. Place and Duration of Study: Department of Paediatrics, Combined Military Hospital, Kharian Pakistan, from Jul 2022 to Mar 2023. Methodology: Fifty parents aged 18-50 years were included in the study. Their parity, education levels, knowledge and attitudes on antibiotic use, including basic concepts of antibiotics, indications of antibiotic, administration of antibiotics, Antimicrobial Resistance and other side effects; parental experiences and practices around buying antibiotics without a prescription and parental experiences regarding using antibiotics to treat their children themselves were noted. Result: Sixteen respondents (32%) were male and 34(68%) were female. It was found that most parents used Cefixime 28(56%), followed by Amoxicillin, and Azithromycin. Twenty-three (46%) participants stated that antibiotics could cure infections caused by viruses. Eighty-eight percent participants knew that antibiotics should only be taken according to doctor’s prescription. Almost half of parents believed that antibiotics should be withdrawn as soon as the symptoms disappear. About 26% of parents believed that antibiotics could prevent the common cold. Thirty-six (72%) parents agreed that overuse of antibiotics exists in Pakistan. Conclusion: Poor knowledge or understanding of antibiotic usage persists among parents in Pakistan. A doctor's prescription for antibiotics may have an impact on how parents use those medicines on their children.

Prescription Practices and Usage of Antimicrobials in a Tertiary Teaching Hospital in Rwanda: A Call for Antimicrobial Stewardship

Background: Antimicrobial resistance (AMR) is a global problem that results in high morbidity and mortality, particularly in low- and middle-income countries. Inappropriate use of antimicrobials is a major driver of AMR. This study aimed to evaluate the rate and quality of antimicrobial prescription and use at the University Teaching Hospital of Kigali (CHUK), a tertiary-referral teaching hospital. Methodology: A point prevalence survey (PPS) of antimicrobial prescription was conducted using the Global PPS tool, including a healthcare-acquired infection (HAI) module. Results: On the day of the PPS, 39.3% (145/369) of inpatients were prescribed at least one antimicrobial. Out of the 259 prescribed antimicrobials, 232 (89.6%) were antibacterials, of which 151 (65.1%) belonged to the watch group of the WHO AWaRe classification. The top three antibiotics prescribed were cefotaxime (87; 37.5%), parenteral metronidazole (31; 13.4%), and meropenem (23; 9.9%). Stop or review dates for the prescribed antimicrobials were documented in 27/259 prescriptions (10.4%). Surgical prophylaxis (SP) was prescribed for longer than one day in 83.3% of 61 patients. Samples for culture were sent for 27.1% (63/232) of all the patients prescribed antibiotics. Conclusion: This PPS demonstrates multiple indicators of the poor use of antimicrobials, including the high prevalence usage of watch antibiotics and prolonged surgical prophylaxis and other poor-quality indicators. Thus, there is an urgent need for intervention to improve antimicrobial stewardship.

Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use

The global health crisis of antibacterial resistance (ABR) poses a particular threat in low-resource settings like East Africa. Interventions for ABR typically target antibiotic use, overlooking the wider set of factors which drive vulnerability and behaviours. In this cross-sectional study, we investigated the joint contribution of behavioural, environmental, socioeconomic, and demographic factors associated with higher risk of multi-drug resistant urinary tract infections (MDR UTIs) in Kenya, Tanzania, and Uganda. We sampled outpatients with UTI symptoms in healthcare facilities and linked their microbiology data with patient, household and community level data. Using bivariate statistics and Bayesian profile regression on a sample of 1610 individuals, we show that individuals with higher risk of MDR UTIs were more likely to have compound and interrelated social and environmental disadvantages: they were on average older, with lower education, had more chronic illness, lived in resource-deprived households, more likely to have contact with animals, and human or animal waste. This suggests that interventions to tackle ABR need to take account of intersectional socio-environmental disadvantage as a priority.

Recurrent late-onset neutropenia following treatment with different B cell-depleting strategies in multiple sclerosis.

As B cell-depleting therapies in multiple sclerosis (MS) have gained significant importance in the last several years, their long-term safety profile is of considerable clinical interest. Late-onset neutropenia (LON) is a rare, but potentially severe, adverse event that was first described in patients with rheumatic disorders under therapy with rituximab. Ofatumumab was approved in 2021 for the treatment of relapsing-remitting multiple sclerosis (RRMS). Neutropenia occurred in 0.2% of patients in clinical phase 3 trials, and to date, no cases of LON have been reported under ofatumumab treatment. Here, we report a case of repetitive symptomatic LON under ocrelizumab as well as ofatumumab treatment. Additionally, we review the literature on rare occurrences of LON in patients with MS, neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) undergoing B cell-depleting therapies, including rituximab, ocrelizumab, ofatumumab, inebilizumab, and ublituximab. In our case, the patient presented with repetitive symptomatic LON under ocrelizumab as well as ofatumumab treatment leading to febrile infections, subsequent use of antibiotics, and application of granulocyte-colony-stimulating factor. After repetitive episodes of LON under both B cell-depleting strategies, cladribine was subsequently initiated. A nine-month follow-up showed a normal neutrophil count and no evidence of disease activity. This case highlights the significance of symptomatic late-onset blood count changes under both ocrelizumab and ofatumumab and emphasizes the importance of continuous monitoring of the differential blood count under B cell-depleting treatment. This study was supported by the Deutsche Forschungsgemeinschaft (DFG; SFB CRC-TR-128 to F.Z., V.F., and S.B..; SFB 1080 and SFB CRC-1292 to F.Z..; and SFB/TRR 355 to S.B.) and the Hermann and Lilly Schilling Foundation (to S.B.).

ALVEOLITE COMO COMPLICAÇÃO PÓS OPERATÓRIA DE EXODONTIAS

Alveolitis is a common postoperative complication resulting from complex extractions, particularly of lower third molars, characterized by intense pain and inflammation of the dental socket. This study aims to analyze the incidence, risk factors, treatments, and preventive measures for this condition, which significantly impacts patients’ quality of life. The methodology employed was a narrative literature review, using databases such as PubMed, SciELO, and Google Scholar, with descriptors such as “alveolitis,” “surgery oral,” and “osteitis.” The results indicate that the etiology of alveolitis is multifactorial, with factors such as smoking, the use of oral contraceptives, and surgical trauma contributing to its development. Treatment varies depending on the severity of the condition, with the application of dressings, irrigation with antiseptic solutions, and, in more severe cases, the use of antibiotics. Preventive measures, such as maintaining good oral hygiene and adopting atraumatic surgical techniques, proved effective in reducing the occurrence of alveolitis.

A review of extended lactation in dairy cows managed in high-input and pasture-based farming systems

Traditionally the lactation cycle of a dairy cow is based around a 12-month calving interval, allowing for 10 months of lactation, followed by a 2-month dry period. This means that the cow has to conceive within 2–3 months after calving, when she is also at peak lactation and metabolically is in a negative energy balance. Such challenging physiological conditions make it challenging for the cow to conceive at this time and many modern high-producing cows fail to get pregnant within the constraints of a 12-month calving interval. In addition, many cows still produce at a high level at drying-off time, increasing the risk of intramammary infections. Therefore, delaying conception past peak production and, as a result, extending the lactation beyond 10 months may increasingly be necessary. Additionally, extended lactation (EL) may offer other advantages such as fewer calves being born and thus fewer ‘surplus’ calves needing to be culled at a young age, fewer health and welfare issues and improved environmental outcomes (i.e. less greenhouse-gas emission; less antibiotic usage) during the lifetime of the animal. Extending lactation is a straight forward management practice in high-input dairy systems where a consistent supply of feed supplements is readily available, but may be more challenging to implement in low(er)-input pasture-based systems. The latter are much more seasonal, with a 12-month calving interval allowing pasture growth and quality to match the cow’s nutritional demands; cows calve in spring when high-quality pasture is abundant and are dried-off during winter when pasture growth is more limited. In this review, we explored the impact of EL in both high-input systems and pasture-based systems. It covers the effects of EL on milk production, composition and processing, as well as on reproductive performance, health and welfare, and environmental and economic outcomes.

Recent updates on classification and unsolved issues of diverticular disease: a narrative review.

Recently, a paradigm shift has occurred in the classification of diverticular disease and the understanding of its pathogenesis. Diverticular disease is now defined as a variety of clinically significant conditions such as diverticulitis, diverticular bleeding, symptomatic uncomplicated diverticular disease, and segmental colitis associated with diverticulosis. Low-grade inflammation, visceral hypersensitivity, abnormal intestinal motility, and genetic factors have emerged as the key contributors to the pathogenesis of diverticular disease. Routine antibiotic use is no longer recommended for all cases of diverticulitis, and simple recurrence is not an indication for surgical treatment. Early colonoscopy with proper preparation is recommended for the treatment of diverticular bleeding, although recent studies have not shown significant efficacy in preventing recurrence. The roles of dietary fiber, nonabsorbable antibiotics, 5-aminosalicylates, and probiotics in the prevention of diverticular disease are controversial and require further investigation.

Early detection of neonatal sepsis and reduction of overall antibiotic exposure: Towards precision medicine

Infections claim the lives of over half a million newborns annually and expose survivors to the risk of lifelong disability. The challenge to clinicians is to identify newborns with invasive infections rapidly, promptly initiate antimicrobial treatment, and take measures to prevent and treat organ dysfunction. Moreover, excessive antibiotic use is a global public health problem. Despite considerable research on clinical and laboratory markers of neonatal sepsis, the effective translation into clinical practice remains limited. There is no single clinical or laboratory marker, nor any combination of markers that definitively confirms or rules out neonatal sepsis. The interpretation of these markers should take into account their diagnostic value for a given patient, along with their added value to the clinical decision-making process. The digitalization of health care systems, combined with increased computational power and advances in machine learning, offers the possibility of developing accurate predictive algorithms for early detection of neonatal sepsis.

Association Between the Duration of Diarrhea and the Length of Hospitalization Among Clostridioides difficile Patients in Northern Nigeria

The United States Centers for Disease Control and Prevention (CDC) has categorized Clostridioides difficile infection (CDI) as a significant concern in extended-care facilities, hospitals, and outpatient clinics. However, little is known about CDI in low- and middle-income countries. This study determined CDI prevalence and impact in outpatient adults presenting with diarrhea in Nigeria. Toxigenic culture and PCR were used to detect and validate C. difficile. Prior antibiotic use, medical history, and demographic data were also obtained. Descriptive and inferential statistics were used for data analysis. The patient demographics were 35.48% (22/62) for the 18–24 years age group and 32.26% (20/62) for both the 25–30 years age group and the 31+ years group, with an average age of 29.7 years. Forty-eight percent of the patients (30/62) tested positive for CDI, and the prevalence increased with age. Most patients (86.67%, 52/60) reported moderate/severe cases of diarrhea and 67.7% had no knowledge of antibiotics. The results showed that 62.30% of the cases were hospitalized with the duration of diarrhea being significantly associated (r = 0.98, p ˂ 0.001) with the length of hospitalization. These results suggest that C. difficile is common among diarrhea patients in this population and that Nigerian hospitals’ infection prevention and control measures must include this pathogen.

Timely empirical antibiotic therapy against sepsis in a rural Norwegian ambulance service: a prospective cohort study

BackgroundEarly diagnosis and antibiotic therapy in patients with sepsis reduce morbidity and mortality, thus pre-hospital management is likely to affect patient outcomes. Pre-hospital administration may increase the risk of unnecessary use of broad-spectrum antibiotics, but identification of an infectious focus enables more targeted antibiotic therapy. The aim of this study was to investigate how paramedics, with or without the assistance of general practitioners, can administer empiric intravenous antibiotic treatment against sepsis in a timely manner.MethodsCohort study of patients with suspected sepsis that received pre-hospital intravenous antibiotics and were transported to hospital. The setting was mainly rural with long average distance to hospital. Patients received targeted antibiotic treatment after an assessment based on clinical work-up supported by scoring systems. Patients were prospectively included from May 2018 to August 2022. Results are presented as median or absolute values, and chi-square tests were used to compare categorical data.ResultsWe included 328 patients. Median age was 76 years (IQR 64, 83) and 48.5% of patients were female. 30-days all-cause mortality was 10.4%. In cases where a suspected infectious focus was determined, the hospital discharge papers confirmed the pre-hospital diagnosis focus in 195 cases (79.3%). The presence of a general practitioner during the pre-hospital assessment increased the rate of correctly identified infectious focus from 72.6% to 86.1% (p = 0.009). Concordance between pre-hospital identification of a tentative focus and discharge diagnosis was highest for lower respiratory tract (p = 0.02) and urinary tract infections (p = 0.03). Antibiotic treatment was initiated 44 min (median) after arrival of ambulance, and median transportation time to hospital was 69 min. Antibiotic therapy was started 76 min (median) before arrival at hospital.ConclusionsPre-hospital identification of infectious focus in suspected sepsis was feasible, and collaboration with primary care physicians increased level of diagnostic accuracy. This allowed initiation of intravenous focus-directed antibiotics more than one hour before arrival in hospital in a rural setting. The effect of pre-hospital therapy on timing was much stronger than in previous studies from more urban areas.

Trends in Urinary Tract Infection Management in Women.

Urinary tract infections (UTIs) are a common cause of health care utilization in the United States. The coronavirus disease 2019 (COVID-19) pandemic accelerated virtual care for UTIs. This retrospective cohort study analyzes more than 1.2 million encounters for UTI based on diagnosis codes, examining temporal trends focusing on virtual compared with in-person encounters, antibiotic dispensation rates, and culture-confirmed UTIs. From 2015 to 2022, UTI encounters increased by 325.9%, with a majority occurring at virtual visits. The rate of UTI encounters per 1,000 adult female patients increased by 241.6%. Antibiotic dispensation rates increased, surpassing the rise in rate of positive urine cultures, suggesting increasing use of empiric antibiotics. Our findings underscore the importance of balancing telemedicine's accessibility with maintaining antibiotic stewardship and highlight the need for updated guidelines.

EVALUATION OF THE ROLE OF SELECTIVE DIGESTIVE TRACT DECONTAMINATION IN PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT PATIENTS

Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in critically ill patients, contributing to increased morbidity, mortality, and healthcare costs. The incidence of VAP in intensive care units (ICUs) ranges from 7% to 40%, with mortality rates potentially exceeding 50%1. Recent studies highlight that VAP affects approximately 27% of all critically ill patients, with 86% of these infections associated with mechanical ventilation. The attributable mortality of VAP varies, with some studies reporting an increase in mortality of up to 27%3. Pathogens such as Pseudomonas aeruginosa, Acinetobacter, and Stenotrophomonas maltophilia are linked to higher mortality rates4. Beyond mortality, VAP significantly extends ICU length of stay and increases healthcare costs5. The gastrointestinal tract plays a crucial role in VAP pathogenesis, as it often becomes colonized with Gram-negative bacteria during critical illness6. Interventions such as selective decontamination of the digestive tract (SDD), stress ulcer prophylaxis with sucralfate, and enteral feeding strategies are employed to reduce VAP incidence. While SDD has been shown to decrease VAP incidence and may positively impact mortality, it also poses a risk of promoting Gram-positive bacterial infections. SDD involves the use of non-absorbable antibiotics applied topically to the oropharynx and through a nasogastric tube, often supplemented with systemic antibiotics during the initial days of ICU admission. Recent guidelines and systematic reviews continue to emphasize the importance of accurate VAP diagnosis and effective antimicrobial therapy to improve patient outcomes and reduce healthcare burdens.