Use Of Antimicrobial Medications Research Articles

Efficacy of Clindamycin in Preventing Abortion and Vertical Transmission of Toxoplasma gondii (PRU Strain) Infection in Pregnant BALB/c Mice

Background: Toxoplasma gondii transmission can occur during pregnancy if the mother contracts the infection for the first time. Treatment strategies include the use of antimicrobial medications and providing supportive care. Spiramycin is commonly used to treat toxoplasmosis in pregnant women and to hinder the disease's transmission. However, its ability to treat the fetus is questionable due to its limited capacity to cross the placental barrier. Additionally, economic constraints and sanctions may impede access to this medication. Objectives: Consequently, in search of an effective treatment, for the first time in Iran, the effectiveness of clindamycin in preventing abortion and vertical transmission of the PRU strain of T. gondii infection in pregnant mice was evaluated. Methods: On the twelfth day of gestation, pregnant mice were exposed to T. gondii and subsequently received treatment with either clindamycin or spiramycin. This resulted in the establishment of four distinct groups: A normal control group, an infected group without treatment, an infected group treated with clindamycin, and another infected group treated with spiramycin. Following these interventions, a series of parasitological evaluations (including microscopic examination and real-time PCR), histopathological evaluations, and immunological assessments were conducted. Results: The findings showed a significant reduction in the number of cysts in the eye and brain (ranging from 77.32% to 90.72%) among the groups treated with clindamycin and spiramycin compared to the control group. Furthermore, treatment with clindamycin, like treatment with spiramycin, was able to suppress inflammatory changes, prevent cell death, and reduce vascular cuffs in the brain, as well as decrease bleeding, placental thrombosis, and the accumulation of inflammatory cells in the placenta. Clindamycin was also effective in diminishing retinal folds, tiny retinal bleeds, and cell vacuolation in eye tissues. Immunologically, treatment in both the spiramycin and clindamycin groups resulted in a decrease in the level of the cytokine TNF-α, indicating an increase in the cellular immune response. In addition, increased levels of IL-10 in the treated infected groups could contribute to the reduction of TNF-α production. Conclusions: Typically, spiramycin is the first choice for treating congenital toxoplasmosis, but clindamycin can be a useful substitute or additional treatment when resistance to primary medications occurs, when there is intolerance, or when access to the main drugs is restricted.

Evaluation of hematological changes and immune response biomarkers as a prognostic factor in critical patients with COVID-19.

COVID-19 disease has been a challenge for health systems worldwide due to its high transmissibility, morbidity, and mortality. Severe COVID-19 is associated with an imbalance in the immune response, resulting in a cytokine storm and a hyperinflammation state. While hematological parameters correlate with prognosis in COVID patients, their predictive value has not been evaluated specifically among those severely ill. Therefore, we aim to evaluate the role of hematological and immune response biomarkers as a prognostic factor in critically ill patients with COVID-19 admitted to the intensive care unit. From May 2020 to July 2021, a retrospective cohort study was conducted in a reference hospital in Manaus, which belongs to the Brazilian public health system. This study was carried out as single-center research. Clinical and laboratory parameters were analyzed to evaluate the association with mortality. We also evaluated the role of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein-to-lymphocyte ratio (CLR). We gathered information from medical records, as well as from prescriptions and forms authorizing the use of antimicrobial medications. During the study period, 177 patients were included, with a mean age of 62.58 ± 14.39 years. The overall mortality rate was 61.6%. Age, mechanical ventilation (MV) requirement, leukocytosis, neutrophilia, high c-reactive protein level, NLR, and CLR showed a statistically significant association with mortality in the univariate analysis. In the multivariate logistic regression analysis, only MV (OR 35.687, 95% CI: 11.084-114.898, p< 0.001) and NLR (OR 1.026, 95% CI: 1.003-1.050, p = 0.028) remained statistically associated with the outcome of death (AUC = 0.8096). While the need for mechanical ventilation is a parameter observed throughout the hospital stay, the initial NLR can be a primary risk stratification tool to establish priorities and timely clinical intervention in patients with severe COVID-19 admitted to the ICU.

Advances in Antimicrobial Coatings for Preventing Infections of Head-Related Implantable Medical Devices

During surgery and after, pathogens can contaminate indwelling and implanted medical devices, resulting in serious infections. Microbial colonization, infection, and later biofilm formation are major complications associated with the use of implants and represent major risk factors in implant failure. Despite the fact that aseptic surgery and the use of antimicrobial medications can lower the risk of infection, systemic antibiotic use can result in a loss of efficacy, increased tissue toxicity, and the development of drug-resistant diseases. This work explores the advancements in antimicrobial coatings for head-related implantable medical devices, addressing the critical issue of infection prevention. It emphasizes the significance of these coatings in reducing biofilm formation and microbial colonization and highlights various techniques and materials used in creating effective antimicrobial surfaces. Moreover, this article presents a comprehensive overview of the current strategies and future directions in antimicrobial coating research, aiming to improve patient outcomes by preventing head-related implant-associated infections.

Acinetobacter baumannii: A multidrug-resistant pathogen, has emerged in Saudi Arabia.

A significant opportunistic pathogen, Acinetobacter baumannii (A. baumannii) has evolved mechanisms of resistance to a wide variety of antimicrobials, including carbapenems. In this article, we assessed the prevalence, risk factors, antimicrobial sensitivity, and resistance mechanisms among A. baumannii in several locations in Saudi Arabia. Hospital-acquired infections caused by A. baumannii were prevalent in the country due to a variety of reasons, such as the high number of critically ill patients, the frequency of gastrointestinal colonization, and the widespread use of antimicrobial medications. There has been an increase in the frequency of A. baumannii strains that are resistant to several antimicrobials, including carbapenems. Hospitals are a breeding ground for multidrug-resistant A. baumannii due to the widespread use of broad-spectrum antibiotics, the potential for patient-to-patient transmission of the bacteria, the high risk of infection during invasive intensive care unit procedures, and the high frequency with which diabetic and cancer patients in hospitals undergo invasive diagnostic and therapeutic procedures. Combinations of colistin and tigecycline with carbapenems or other antibiotics remain the best treatment option and are relatively safe to treat patients with multidrug resistance (MDR) A. baumannii infections, despite the rising incidence of resistance to these drugs observed in many hospitals. The prevalence of multidrug-resistant A. baumannii in Saudi hospitals calls for in-depth research into the underlying molecular mechanisms of multidrug resistance. In addition, a better understanding of A. baumannii resistance patterns and the establishment of a treatment protocol to reduce the infection burden in Saudi Arabia could benefit from the implementation of a local antibiogram database in tandem with a national antimicrobial stewardship and infection prevention program.

Green Synthesis of Zinc Oxide Nanoparticles Using Cymbopogon citratus Extract and Its Antibacterial Activity.

Excessive use of antimicrobial medications including antibiotics has led to the emerging menace of antimicrobial resistance, which, as per the World Health Organization (WHO), is among the top ten public health threats facing humanity, globally. This necessitates that innovative technologies be sought that can aid in the elimination of pathogens and hamper the spread of infections. Zinc oxide (ZnO) has multifunctionality owing to its extraordinary physico-chemical properties and functionality in a range of applications. In this research, ZnO nanoparticles (NPs) were synthesized from zinc nitrate hexahydrate, by a green synthesis approach using Cymbopogon citratus extract followed by characterization of the NPs. The obtained X-ray diffraction peaks of ZnO NPs matched with the standard JCPDS card (no. 89-510). The particles had a size of 20-24 nm, a wurtzite structure with a high crystallinity, and hexagonal rod-like shape. UV-Vis spectroscopy revealed absorption peaks between 369 and 374 nm of ZnO NPs synthesized from C. citratus extract confirming the formation of ZnO. Fourier transform infrared confirmed the ZnO NPs as strong absorption bands were observed in the range of 381-403 cm-1 corresponding to Zn-O bond stretching. Negative values of the highest occupied molecular orbital-lowest unoccupied molecular orbital for ZnO NPs indicated the good potential to form a stable ligand-protein complex. Docking results indicated favorable binding interaction between ZnO and DNA gyrase subunit b with a binding energy of -2.93 kcal/mol. ZnO NPs at various concentrations inhibited the growth of Escherichia coli and Staphylococcus aureus. Minimum inhibitory concentration values of ZnO NPs against E. coli and S. aureus were found to be 92.07 ± 0.13 and 88.13 ± 0.35 μg/mL, respectively, at a concentration of 2 mg/mL. AO/EB staining and fluorescence microscopy revealed the ability of ZnO NPs to kill E. coli and S. aureus cells. Through the findings of this study, it has been shown that C. citratus extract can be used in a green synthesis approach to generate ZnO NPs, which can be employed as alternatives to antibiotics and a tool to eliminate drug-resistant microbes in the future.

Combined use of antimicrobial medication and physical therapeutic factors in periodontitis

Metronidazole-based preparations are widespread in periodontal practice among those with antibacterial action. However, recently, reports are increasing about the resistance of pathogenic microorganisms to metronidazole. The treatment of this problem is facilitated by the combined effect of metronidazole and physical therapeutic factors, which can ensure the delivery of the antimicrobial agent to periodontal tissues and its deposition. The efficacy of Metrogil Dent gel ultraphonophoresis with low-frequency ultrasound and Metrogil electrophoresis in the treatment of periodontitis has been proven. However, no information is available in the literature about the comparative effectiveness of ultraphonophoresis and electrophoresis of metronidazole-based preparations in the complex treatment of periodontitis, which is of scientific and practical interest.

Preoperative antibiotic prophylaxis in a single tertiary hospital in Slovenia—the role of education in recommendation compliance

Purpose: The aim of the present study was to evaluate the impact of an educational intervention package on perioperative antimicrobial prophylaxis (PAP) prescription practice in three elective procedures—total hip arthroplasty (THA), caesarean section (CS), and radical prostatectomy (RP)—in a single tertiary care hospital in Slovenia.&#x0D; Methods: An interventional study was performed to evaluate the impact of an educational intervention package on PAP compliance. PAP prescription practices for three elective types of surgery (THA, CS, and RP) were observed. Thirty operative reports for each type of surgical procedure were evaluated according to indication, timing of preoperative prophylaxis administration, antibiotic selection and dosage, and total prophylaxis duration. This was followed by an educational intervention package that included a discussion with department leaders led by an infectious disease specialist and an educational seminar and discussion for surgeons, supplemented by PAP recommendations provided as pocket reminders. Then, the compliance with PAP recommendations for the same types of procedures performed in the post-interventional period (3–6 months after the intervention) was evaluated again.&#x0D; Results: Complete pre-interventional compliance with local guidelines was observed in 67%, 70%, and 3.3% of THA, CS, and RP cases, respectively. A major deviation from PAP recommendations was observed in the timing of preoperative PAP administration before surgery and in the total PAP duration A deviation from recommendations for RP, which is a major surgical procedure, was observed as a longer postoperative PAP duration compared to the intraoperative course. In the post-interventional period, an improvement in total compliance with PAP recommendations was observed in 80.0%, 90.0%, and 50.0% of THR, CS, and RP procedures, respectively.&#x0D; Conclusion: Our study revealed an improvement in adherence to PAP recommendations after an educational intervention package for selected procedures at the University Medical Centre Maribor. This simple intervention can have an important impact on patient care quality by reducing antimicrobial medication use, resistance development, and treatment cost.

Impact of COVID-19 pandemic on anti-microbial resistance and secondary microbial infections

Corona Virus Disease-2019 (COVID-19) has become one of the most serious diseases in the history of mankind. It has captured the entire world and solutions are yet to be discovered to fight this global crisis. The outcomes of COVID-19 are influenced by a variety of pre-existing factors. The secondary microbial infections are one of the prominent ones that are major contributors for Antimicrobial Resistance (AMR) as they warrant the use of antimicrobial medications. The present review aimed at exploring the potential relationship between AMR under such circumstances and COVID-19 related outcomes. The published literature across the globe has delineated that the impact of COVID-19 may have worsened by a great degree due to the presence of secondary infections majorly bacterial ones. The consequences of COVID-19 have been fatal and a significant proportion can be a major attributor to AMR, either directly or indirectly. Although, there is a dearth of studies that can establish a very strong and direct relationship between AMR and negative COVID-19 outcomes so in-depth research on this topic is required to further explain this relationship in detail.

Bedside Nurses: Champions of Antimicrobial Stewardship.

Microbial organisms include bacteria, viruses, fungi, and parasites. Antimicrobial medications are currently overused or misused, which has resulted in multidrug resistance. Hospitalized patients in the intensive care unit have the highest risk for infections leading to poor outcomes and require successful treatment options. Inappropriate prescription of antimicrobials places patients and the community at risk for more resistant infections in the future. To prevent misapplication of these important medications, interdisciplinary antimicrobial stewardship programs promote appropriate and safe antimicrobial medication use. Members of these programs are called to be good stewards of antimicrobial medications, incorporating the scope of practice and knowledge of each specialty and the evidence from the literature to develop strategies and protocols for safe and effective antimicrobial medication use. Nurse involvement in antimicrobial stewardship programs is inadequate, limiting the programs' potential. Support for increased direct-care nurse participation in antimicrobial stewardship programs is key to improve program targets and patient outcomes. This article calls for increased nursing awareness of the importance of antimicrobial stewardship programs in clinical practice and greater direct-care nurse involvement in these programs.

Antimicrobial Stewardship: Laboratory to Clinical Microbiology: A Road Map

Antimicrobial stewardship refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics and decreasing unnecessary costs. While clinical microbiologists with clinical pharmacists are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture, and guidance in the pre analytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems.&#x0D; Bangladesh J Med Microbiol 2019; 13 (2): 25-29

Management of Pediatric Community-acquired Bacterial Pneumonia.

1. Amanda I. Messinger, MD* 2. Oren Kupfer, MD* 3. Amanda Hurst, PharmD† 4. Sarah Parker, MD‡ 1. Divisions of *Pulmonary Medicine and 2. ‡Infectious Diseases, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO 3. †Department of Pharmacy, Children’s Hospital Colorado, Aurora, CO * Abbreviations: CAP: : community-acquired pneumonia CT: : computed tomography IV: : intravenous MIC: : minimum inhibitory concentration MRSA: : methicillin-resistant Staphylococcus aureus PCR: : polymerase chain reaction VATS: : video-assisted thorascopic surgery Management of pediatric community-acquired pneumonia should focus on judicious use of antimicrobial medications, bacterial diagnostics, and surgical drainage when complicated by large effusion and empyema. Treatment in adherence to national guidelines produces favorable outcomes. After completing this article, readers should be able to: 1. Reinforce rational antibiotic use for bacterial community-acquired pneumonia (CAP) in outpatient and inpatient settings. 2. Review and update techniques for microbial diagnosis of CAP. 3. Review medical and surgical management of complicated pneumonia. 4. Present specific considerations for CAP in patients with neuromuscular disease. Community-acquired pneumonia (CAP) is the most common cause of death in children worldwide, accounting for 15% of deaths in children younger than 5 years of age. (1) Nearly 1 in 500 children will be hospitalized for CAP, which creates a substantial economic burden. CAP is thus important to diagnose and appropriately treat. While viral causes of CAP are most common, differentiating viral versus bacterial etiologies can be difficult. This leads to excessive use of antimicrobial medications or susceptibility to feeling a pressure to prescribe. (2) Overall, in the United States, 11.4 million antimicrobial prescriptions for pediatric respiratory tract infections per year are avoidable. (3) Furthermore, broad-spectrum but less effective antimicrobial agents are often prescribed when pharmacokinetically favorable narrow-spectrum agents are available. (4) Arguably, the untoward effects of overtreatment of CAP in those in whom treatment is unwarranted compounds the morbidity of this disease process. Because of mounting knowledge of antimicrobial side effects, resistance, and microbiome effects, practitioners must adhere to the principles of judicious use when treating CAP. In this regard, CAP, its epidemiology, various etiologic origins, clinical presentations, and general diagnosis and treatment were …

Plasma Soluble Urokinase-Type Plasminogen Activator Receptor Is Not Associated with Neurological Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage.

Aneurysmal subarachnoid hemorrhage (aSAH) is a common cause of death or long-term disability. Despite advances in neurocritical care, there is still only a very limited ability to monitor the development of secondary brain injury or to predict neurological outcome after aSAH. Soluble urokinase-type plasminogen activator receptor (suPAR) has shown potential as a prognostic and as an inflammatory biomarker in a wide range of critical illnesses since it displays an association with overall immune system activation. This is the first time that suPAR has been evaluated as a prognostic biomarker in aSAH. In this prospective population-based study, plasma suPAR levels were measured in aSAH patients (n = 47) for up to 5 days. suPAR was measured at 0, 12, and 24 h after patient admission to the intensive care unit (ICU) and daily thereafter until he/she was transferred from the ICU. The patients' neurological outcome was evaluated with the modified Rankin Scale (mRS) at 6 months after aSAH. suPAR levels (n = 47) during the first 24 h after aSAH were comparable in groups with a favorable (mRS 0-2) or an unfavorable (mRS 3-6) outcome. suPAR levels during the first 24 h were not associated with the findings in the primary brain CT, with acute hydrocephalus, or with antimicrobial medication use during 5-days' follow-up. suPAR levels were associated with generally accepted inflammatory biomarkers (C-reactive protein, leukocyte count). Plasma suPAR level was not associated with either neurological outcome or selected clinical conditions. While suPAR is a promising biomarker for prognostication in several conditions requiring intensive care, it did not reveal any value as a prognostic biomarker after aSAH.

Increased use of antimicrobial medication in bulimia nervosa and binge-eating disorder prior to the eating disorder treatment.

We examined the use of antimicrobial medication as a proxy for infections in large patient cohort treated for binge-eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN) over the five-year period preceding eating disorder treatment. Patients (N = 1592) at the Eating Disorder Unit of Helsinki University Central Hospital between 2000 and 2010 were compared with matched general population controls (N = 6368). The study population was linked to the prescription data of antibacterial, antifungal and antiviral medication from the Register on Reimbursed Prescription Medicine. Data were analyzed using regression models. Individuals with BN and BED had received more often antimicrobial medication prescriptions compared to their controls (OR: 1.7, 95% CI: 1.3-2.1; OR: 2.6, 95% CI: 1.4-4.6, respectively), while no significant difference emerged in AN (OR: 0.9, 95% CI: 0.7-1.0, p = 0.10). Of the main drug categories, the respective pattern was seen in antibacterial and antifungal medication, while increased use for antivirals appeared only in BN (OR: 1.6, 95% CI: 1.1-2.3). Measured with the mean number of prescriptions or mean Defined Daily Doses per individual, patients with BN, BED and males with AN had also higher total antimicrobial medication use. Indicating increased infections, we found elevated use of antimicrobial medication in BN, BED and in males with AN. Infections may be consequence of hyperglycemia, weight gain, or dysregulation of intestinal microbiota associated with core eating disorder behaviors. Or the other way round; changes in intestinal microbiota due to infections, inflammation, or antibacterial medications might contribute to eating disorders in multiple ways. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:542-552).

Antibiotic stewardship - Rational use of antibiotics and antifungal agents

Antibiotics remain the single biggest weapon that we have in our fight against infections. Sepsis continues to be one of the biggest problems faced by the critically ill children. They are either admitted to the ICU with a new infection or later in their course of illness, acquile an infection termed as nosocomial infection or a hospital acquired infection. There are not veiy many new antibiotics that are available to fight the bacterial infection. At the same time the microbes are rapidly developing resistance against antibiotics of all classes, seemingly winning this war against infections. Antibiotics are one class of dings that have the potential to affect the health of not only the patient but also of the entire society over a period of time. The rise of multidrug resistant organisms is a global phenomenon. It is imperative that we cherish and protect the dings with the goal of preserving them for generations to come. We may be able to do this by exercising Antibiotic stewardship. This refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics and decreasing unnecessary costs. Antimicrobial stewardship is the responsibility of all physicians. We can each make a difference by exercising discipline in the management of patients. It is imperative that we tiy to protect the environment of appropriate handling of waste. Hand hygiene, appropriate isolation practices, terminal cleaning are all essential practices to reduce the spread of resistance organism. Selecting the right antimicrobial looks at various aspects of the patient and the drug pharmacokinetics and pharmacodynamics. This article will examine this concept and antibiotic stewardship in general, that makes the difference between success and failure in the treatment of infections and spread of multidrug reistance.

Enhancing US-Japan cooperation to combat antimicrobial resistance.

The Global Health Security Agenda (GHSA) is aimed at preventing, detecting, and responding to infectious disease threats. To move toward these goals, the United States has committed to partner with at least 30 countries around the world. One of the objectives of the GHSA includes "[p]reventing the emergence and spread of antimicrobial drug resistant organisms." Antimicrobial resistance (AMR) has become a growing global health security problem, with inappropriate use of antimicrobial medications in humans and animals and a lack of new antimicrobial medications contributing to this problem. While AMR is a growing global concern, working on it regionally can make this multifaceted problem more manageable. The United States and Japan, both world leaders in the life sciences, are close allies that have established cooperative programs in medical research and global health that can be used to work on combating AMR and advance the GHSA. Although the United States and Japan have cooperated on health issues in the past, their cooperation on the growing problem of AMR has been limited. Their existing networks, cooperative programs, and close relationships can and should be used to work on combating this expanding problem.

EFFECTIVENESS OF THE TARGET ANTIBIOTIC ADMINISTRATION IN THE TREATMENT OF THE SEVERE CHRONIC PERIODONTITIS PART I – MICROBIOLOGICAL EVALUATION

INTRODUCTION: The microbial etiology of inflammatory periodontal diseases provides the rationale for the use of antimicrobial medication in periodontal therapy. Scaling and root planning (SRP) is generally the first treatment employed for periodontitis. Antibiotics may be prescribed for periodontal patients who do not respond to conventional mechanical therapy, for patients with acute periodontal infections associated with systemic manifestations, for prophylaxis in medically compromised patients, and as an adjunct to surgical and non-surgical periodontal therapy. AIM: The objects of the study are: 1. To determine the value of the microbiological diagnosis with culturing method in the treatment planning of the periodontal diseases. 2. To evaluate the importance of the susceptibility testing for the target antimicrobial treatment of periodontitis. 3. To evaluate the effectiveness of the adjunctive target antimicrobial administration in periodontitis cases. MATERIALS AND METHODS: A total of 17 patients with aggressive or severe chronic periodontitis were included in this study. All patients must have at least 15 teeth and 4 periodontal sites with PD>4mm in different quadrants of the dentition. Microbiological samples were taken from the periodontal pockets using paper points. The samples were taken from tree categories periodontal sites with PD 3-5mm, 5-7mm and >7mm. All samples were analyzed with culture method. Selected colonies from the patients from the test groups were tested for antimicrobial susceptibility. A standardized oral hygiene motivation program was applied to all patients. The Full Mouth Treatment approach was selected for therapy of the patients. Amoxicillin 500mg and Metronidazole 250mg tid for 10 days were administrated on the control group. The patients from the test group received antimicrobial treatment according to the results from the susceptibility analysis. Clinical, radiograph and microbiological evaluations are done again after 3 months. RESULTS: The results from the microbiological analysis are presented in schemes. CONCLUSION: The indiscriminate use of antimicrobials could be influencing the appearance of resistant strains associated with periodontal diseases in the population. That’s why the use of antibiotics must be based on susceptibility testing, instead of a unique protocol of adjunctive antimicrobial regimen.

Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their ventilator-associated pneumonia (VAP) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Occurrence of VAP in acute care facilities.a. VAP is one of the most common infections acquired by adults and children in intensive care units (ICUs).i. In early studies, it was reported that 10%-20% of patients undergoing ventilation developed VAP. More-recent publications report rates of VAP that range from 1 to 4 cases per 1,000 ventilator-days, but rates may exceed 10 cases per 1,000 ventilator-days in some neonatal and surgical patient populations. The results of recent quality improvement initiatives, however, suggest that many cases of VAP might be prevented by careful attention to the process of care.2. Outcomes associated with VAPa. VAP is a cause of significant patient morbidity and mortality, increased utilization of healthcare resources, and excess cost.i. The mortality attributable to VAP may exceed 10%.ii. Patients with VAP require prolonged periods of mechanical ventilation, extended hospitalizations, excess use of antimicrobial medications, and increased direct medical costs.

Evaluation of an Antimicrobial Stewardship Program at a Pediatric Teaching Hospital

Thirty to 50% of hospitalized patients receive antimicrobial therapy. Previous data suggest that inappropriate use results in higher mortality rates, longer lengths of stay, and increased medical costs. Antimicrobial Stewardship Programs (ASPs) reduce the improper use of antimicrobials and improve patient safety. Despite increased awareness about the benefits of these programs, few pediatric ASPs exist and fewer comprehensive studies evaluate their effects. A prospective observational study was conducted to describe the use and impact of a pediatric ASP. Data were collected on the clinician's request for targeted antibiotics and the interventions made by the ASP. Retrospective chart review was performed to assess outcomes and compliance on empiric antimicrobial therapy decisions and recommendations to discontinue antimicrobial therapy. During the 4-month study period, calls were placed to the ASP for 652 patients. Forty-five percent of those calls required an intervention by the ASP. These interventions included: (1) Targeting the known or suspected pathogens (20%); (2) Consultation (43%); (3) Optimize antimicrobial treatment (33%); and (4) Stop antimicrobial treatment (4%). Three of the 84 (3.5%) patients recommended to receive alternative therapy developed an infection not covered by the ASP recommendations or the antimicrobial initially requested by the clinician. Our data demonstrate that an ASP improves the appropriate use of antimicrobial medications in hospitalized children. In addition, the ASP plays an integral role in providing guidance to clinicians and ensures that the appropriate antimicrobial agents are used.

Acute Otitis Media in Children

Children attending day care centers (DCCs) frequently carry antibacterial-resistant organisms in their nasopharynx, leading to acute otitis media (AOM) that may be refractory to antibacterial treatment. The development and spread of resistant organisms are facilitated in DCCs as a result of the following: (i) large numbers of children; (ii) frequent close person-to-person contact; and (iii) a wide use of antimicrobial medications. Intensive antimicrobial usage provides the selection pressure that favors the emergence of resistant organisms, while DCCs provide an ideal environment for transmission of these organisms. The American Academy of Pediatrics and American Academy of Family Physicians' guidelines recommend high-dose amoxicillin/clavulanic acid (rather than amoxicillin alone) as the first therapeutic choice in the treatment of AOM in children attending DCCs. The introduction of the 7-valent pneumococcal conjugated vaccine (PCV7) had a major role in decreasing the number of episodes of Streptococccus pneumoniae AOM secondary to the serotypes included in the vaccine. It also had a major role in reducing the nasopharyngeal carriage of vaccine-type S. pneumoniae (and in particular of antibacterial-resistant organisms), preventing, in this way, its spread to contacts in the community. However, the recent observation of increased rates of antibacterial-resistant non-vaccine serotype S. pneumoniae may erode the success of PCV7.

Genital infections in women undergoing therapeutic abortion

We studied the prevalence of genital infections and the frequency of infectious complications in 170 women who requested an abortion in Antwerp, Belgium, where termination of pregnancy is still illegal. Chlamydia were isolated in 12% of these women, compared to a 0.6% isolation rate for N. gonorrhoeae. After the abortion 5.5% developed PID and 3% endometritis. There was a strong correlation between an infection with C. trachomatis before abortion and the appearance of infectious complications after the aspiration curettage. No such relationship was found with any other micro-organism. Depending on the prevalence of C. trachomatis in a given population, screening followed by selective treatment or prophylactic use of antimicrobial medication for all women is indicated to prevent post-abortum infections.