Therapeutic Use Of Antibiotics Research Articles

Preanalytical Stability of 13 Antibiotics in Biological Samples: A Crucial Factor for Therapeutic Drug Monitoring

The stability of antibiotic preanalytical samples is a critical factor in therapeutic drug monitoring (TDM), a practice of undoubted importance for the proper therapeutic use of antibiotics, especially in complex management patients, such as pediatrics. This review aims to analyze the data in the literature regarding the preanalytical stability of some of the antibiotics for which TDM is most frequently requested. The literature regarding the preanalytical stability of amikacin, ampicillin, cefepime, ceftazidime, ciprofloxacin, daptomycin, gentamicin, levofloxacin, linezolid, meropenem, piperacillin, teicoplanin, and vancomycin in plasma, serum, whole blood, and dried blood/plasma spot samples was analyzed. Various storage temperatures (room temperature, 4 °C, −20 °C, and −80 °C) and various storage times (from 1 h up to 12 months) as well as subjecting to multiple freeze–thaw cycles were considered. The collected data showed that the non-beta-lactam antibiotics analyzed were generally stable under the normal storage conditions used in analytical laboratories. Beta-lactam antibiotics have more pronounced instability, particularly meropenem, piperacillin, cefepime, and ceftazidime. For this class of antibiotics, we suggest that storage at room temperature should be limited to a maximum of 4 h, storage at 2–8 °C should be limited to a maximum of 24 h, and storage at −20 °C should be limited to a maximum of 7 days; while, for longer storage, freezing at −80 °C is suggested.

Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort

BackgroundPregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection and country income, among hospitalized women with suspected or confirmed pregnancy-related infections.MethodsWe used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women.ResultsWe found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries.ConclusionsDifferences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.

Gut Distribution, Impact Factor, and Action Mechanism of Bacteriocin-Producing Beneficial Microbes as Promising Antimicrobial Agents in Gastrointestinal Infection.

Gastrointestinal (GI) infection by intestinal pathogens poses great threats to human health, and the therapeutic use of antibiotics has reached a bottleneck due to drug resistance. The developments of antimicrobial peptides produced by beneficial bacteria have drawn attention by virtue of effective, safe, and not prone to developing resistance. Though bacteriocin as antimicrobial agent in gut infection has been intensively investigated and reviewed, reviews on that of bacteriocin-producing beneficial microbes are very rare. It is important to explicitly state the prospect of bacteriocin-producing microbes in prevention of gastrointestinal infection towards their application in host. This review discusses the potential of gut as an appropriate resource for mining targeted bacteriocin-producing microbes. Then, host-related factors affecting the bacteriocin production and activity of bacteriocin-producing microbes in the gut are summarized. Accordingly, the multiple mechanisms (direct inhibition and indirect inhibition) behind the preventive effects of bacteriocin-producing microbes on gut infection are discussed. Finally, we propose several targeted strategies for the manipulation of bacteriocin-producing beneficial microbes to improve their performance in antimicrobial outcomes. We anticipate an upcoming emergence of developments and applications of bacteriocin-producing beneficial microbes as antimicrobial agent in gut infection induced by pathogenic bacteria.

Effects of a Training Course for Andalusian Podiatrists on Antibiotic Management in Ingrown Toenail Infections: A Pilot Study.

The use of antibiotics (ABs) for the prevention and management of infections has been widespread for decades and, at this time, AB resistance is a global health crisis. The available evidence highlights the need to reduce the prophylactic and therapeutic use of ABs to avoid associated risks. A preliminary study with a total sample of 56 Andalusian (Spain) podiatrists was surveyed. The purpose of this study was to identify whether there were changes in prescription habits from a situation before a subsequent training course on AB indications for the management of infections associated with ingrown toenails. An ad hoc questionnaire of 15 items related to therapeutic and prophylactic prescriptions of ABs was developed for this purpose, and the evaluation was carried out before and after the training course. The responses obtained before and after training were compared. The training activity led to improvements in the prescription habits of the participants, producing significant changes in the prescription pattern of the professionals in 10 of the 15 items. The results of this preliminary study show that the podiatrists surveyed improved the rational use of systemic AB therapy in ingrown toenails infections.

Hematological changes in Florida pompano (Trachinotus carolinus) supplemented with β-glucan and Pediococcus acidilactici synbiotic.

Florida pompano (Trachinotus carolinus) are a species of growing interest for commercial aquaculture. Effective health monitoring is crucial to the successful growout of the species, and prophylactic and therapeutic use of chemicals and antibiotics has been the traditional strategy for promoting stock health. However, concerns about antimicrobial resistance, chemical residues in seafood products and the environment, and resultant immunosuppression have prompted the industry to identify alternative management strategies, including supplementation with prebiotics, probiotics, and combinations of both (synbiotics). The objectives of this study are to determine and compare hematological, plasma biochemical, and plasma protein electrophoresis data of synbiotic-supplemented (β-glucan and Pediococcus acidilactici) and non-supplemented Florida pompano. Reference intervals for blood analytes are provided for both groups and for subgroups (females, males, large, and small fish) where statistically significant results exist. There are no differences between the hematological and plasma biochemistry analytes between the supplemented and control groups, except for blood urea nitrogen and carbon dioxide, indicating a possible effect of synbiotic supplementation on gill function and osmoregulation. Sex-related and size-related differences are observed within each of the control and supplemented groups; however, biometric measurements do not strongly correlate with blood analytes. These data represent baseline hematological and plasma biochemical data in the Florida pompano and indicate the safety of synbiotic supplementation in this commercially important species. This study serves to further the commercialization of Florida pompano by providing blood analyte reference intervals for health monitoring in the aquaculture setting.

To Treat or Not to Treat: Public Attitudes on the Therapeutic Use of Antibiotics in the Dairy Industry-A Qualitative Study.

This paper describes the views of 779 U.S. residents on questions related to therapeutic antibiotic use in dairy cattle. An online survey was conducted with qualitative (open-ended) questions. Respondents were offered one of three scenarios with varying degrees of information describing a farmer with a sick cow that would benefit from antibiotic therapy. The text replies to the open-ended questions were analyzed by grouping responses with similar comments and identifying patterns or themes. Content analysis showed that many of the participants in this study provided farmers with the social license to treat sick cows with antibiotics; however, some participants commented on the social license not necessarily extending to antibiotic use for growth promotion or prophylactic use. Our findings are not generalizable, but may provide some insight that should be considered when developing policies and practices regarding the use of antibiotics on dairy farms that may promote improved alignment with societal values.

Azithromycin to Prevent Sepsis of Death in Women Planning a Vaginal Birth

ABSTRACT A high proportion of peripartum maternal deaths are caused by infection and sepsis, and this proportion continues to rise. In addition, neonatal sepsis is the third most common cause of neonatal death; the 2 conditions are connected in that maternal infection causes an increased risk of neonatal sepsis. Recent studies have shown azithromycin to be effective in reducing instances of maternal infection after an unplanned cesarean delivery, but its effectiveness for infections related to vaginal delivery has not yet been examined. This study, A-PLUS (Azithromycin Prevention in Labor Use Study), was designed to investigate the effectiveness of azithromycin in women planning a vaginal delivery. This study was conducted as a multicountry, double-blind, placebo-controlled, randomized trial over 8 sites in 7 countries. Primary outcomes included maternal sepsis or death within 6 weeks of delivery, as well as stillbirth, neonatal death, or sepsis within 4 weeks of delivery. Secondary maternal outcomes included related components, such as specific infections of chorioamnionitis, endometritis, perineal wound infection, abdominal or pelvic abscess, mastitis or breast abscess, pneumonia, or pyelonephritis, as well as therapeutic use of antibiotics, duration of hospital stay, readmission, admission to a special care unit, and unscheduled health care visits. Secondary outcomes relating to neonates included similar components, specific infection, the duration of hospital stay, readmission, admission to a special care unit, unscheduled health care visits, and safety outcomes (adverse events related to medication). Final analysis included 29,278 women, with 14,590 women (and 14,687 neonates or stillbirths) in the azithromycin group and 14,688 women (and 14,782 neonates or stillbirths) in the placebo group. Maternal sepsis or death was observed in 227 patients in the azithromycin group and 344 patients in the placebo group (adjusted relative risk, 0.67; 95% confidence interval [CI], 0.56–0.79; P < 0.001). Sepsis was the case in 219 in the azithromycin group and 339 in the placebo group (relative risk, 0.65; 95% CI, 0.55–0.77), and death from sepsis was rare. For neonates, stillbirth, death, or sepsis was observed in 1540 in the azithromycin group and 1526 in the placebo group (relative risk, 1.02; 95% CI, 0.95–1.09), with sepsis accounting for 1433 and 1407 cases in the azithromycin and placebo groups, respectively. Both the outcomes of stillbirth and neonatal death were relatively uncommon. Maternal adverse effects experienced from the medication were not significantly different between groups, and the azithromycin group had noticeably reduced risk of endometritis, wound infections, and several others when compared with the placebo group. These results indicate that azithromycin is consistently effective in lowering the risk of infection and sepsis in mothers and infants during vaginal delivery. The number treated to prevent 1 case of maternal death or sepsis was 125; this is consistent with previous research in individuals undergoing cesarean delivery. Although azithromycin was effective at preventing maternal infection and sepsis, there were no significant effects on neonatal outcomes. This is consistent with most previous research; reasons for discrepancies could be inclusion of different types of infections and differences in antibiotic treatment between countries. Further research could improve the generalizability of these findings by focusing on factors that influence the effectiveness of azithromycin and that impact its clinical use.

Evaluation of Implementation and Effectiveness of China's Antibiotic Stewardship in the First Affiliated Hospital of Sun Yat-sen University.

Antibiotic stewardship has been prioritized by governments and health care organizations in recent years as antibiotic resistance is markedly increasing. A tertiary hospital in Guangzhou, China was chosen as a study example to undertake an implementation and effectiveness evaluation of China's antibiotic stewardship to improve and promote antimicrobial stewardship nationwide. The general surgery department of the study hospital was utilized to examine surgical site infection, and samples from across the hospital were used to identify bloodstream infection. Data was analyzed using descriptive analysis, the Mann-Kendall trend test, logit model and panel data model, and t-tests. In terms of prophylactic and therapeutic antibiotic rational use, respectively, we evaluated implementation conditions, the correlation between implementation and corresponding disease progress, and the cost-effectiveness of China's antibiotic stewardship. For perioperative prophylactic antibiotic use, antibiotic stewardship was found to have been well-implemented, cost-effective, and reduced the incidence of surgical site infection. However, concerning therapeutic use and antibiotic-resistant bacterial infection prophylaxis, the complexity of influencing factors and the contradiction between stewardship implementation and clinical demand needs to be further evaluated.

Perioperative therapeutic antibiotics are beneficial to prevent exacerbation of limb-associated infection after bypass surgery in patients with critical limb-threatening ischemia and foot infection score of ≥1.

Postoperative limb infection is associated with a poor prognosis and a low amputation-free survival rate after surgical revascularization in patients with critical limb-threatening ischemia. The Global Vascular Guidelines 2019 recommend antibiotic therapy for patients with deep space foot infection or wet gangrene; however, no study is cited as evidence for this recommendation. The present study was performed to offer new evidence supporting the use of perioperative therapeutic antibiotics in patients with critical limb-threatening ischemia (CLTI) undergoing surgical revascularization. This single-center retrospective study was performed in Kyushu University Hospital and involved patients with CLTI who underwent surgical revascularization from 2003 to 2021. Ampicillin/sulbactam and cefazolin were defined as preventive antibiotics, and other types were defined as therapeutic antibiotics. Postoperative limb-associated infection was defined as an increased foot infection (fI) score in the Wound, Ischemia, and foot Infection (WIfI) classification system after surgical revascularization. The association between perioperative antibiotic therapy and postoperative limb-associated infection was assessed. Among 286 limbs of 263 patients with CLTI, 27 (9%) limbs developed postoperative limb-associated infection after surgical revascularization. The fI scores were significantly higher in the patients with than without postoperative limb-associated infection (1.0 ± 0.2 vs 0.4 ± 0.1, respectively; p = 0.0033), indicating that an fI score of ≥1 was a risk factor for postoperative limb-associated infection. Perioperative therapeutic antibiotics significantly reduced the incidence of postoperative limb-associated infection compared with preventive antibiotics (0.0% vs. 44.8%, respectively; p = 0.0028) in the patients with CLTI who had an fI score of ≥1 after bypass surgery, although perioperative therapeutic antibiotics were not effective for patients with an fI score of 0. Perioperative therapeutic antibiotics for patients with an fI score of ≥1 are beneficial for reducing the incidence of postoperative limb-associated infection after surgical revascularization.

Profilaktička i terapijska primena antibiotika u kolorektalnoj hirurgiji

Complications in colorectal surgery carry a high risk of morbidity and mortality, prolong hospitalization time and increase treatment costs, and the largest number of postoperative complications is related to surgical site infection (SSI). Antibiotic prophylaxis started in the fifties of the last century and changed with each new antibiotic. The following were used in order: aminoglycosides (1943), macrolides (1952), polymyxins (1958), and cephalosporins (1965). With the discovery of metronidazole in 1970, the prophylactic spectrum was extended to include anaerobic bacteria, which are an indispensable part of the flora in this anatomical region. Due to the nature of the gastrointestinal tract, it was believed that oral antibiotic prophylaxis and mechanical bowel preparation (MBP) could achieve intestinal sterilization and thus ensure a safe surgical intervention. However, studies have shown that MBP did not have an overall beneficial effect on postoperative complications and caused significant patient discomfort, so it was almost abandoned. Today, it is known that about 16% of surgical infections are caused by multiresistant bacteria, and only oral antibiotic prophylaxis is not sufficient to prevent these infections. Namely, in the race between bacterial resistance and the development of new antibiotics, antibiotics are increasingly lagging, and the treatment of complications remains a nightmare for surgeons. For this reason, the prevention of SSI in colorectal surgery is a challenge for 21st-century medicine. In modern surgery, both open and laparoscopic, the first and second generations of intravenous cephalosporins are most often used for prophylactic purposes, as antibiotics of a sufficiently broad spectrum, with favorable pharmacokinetics and rare side effects. New research indicates that in colorectal surgery, the combination of standard intravenous prophylaxis with the addition of an oral antimicrobial the day before surgery is superior when it comes to SSI prevention. However, there are still no clear recommendations on the regimen and type of antibiotics and they should be given in institutional guides and protocols, taking into account the bacterial spectrum in the local environment, as well as resistance, and the availability of appropriate drugs. Therapeutic use of antibiotics is reserved for acute conditions in colorectal surgery and its complications. For therapeutic purposes, more potent antibiotics are used against the expected pathogens, usually a combination of several antibiotics, such as third or fourth-generation cephalosporins, metronidazole, fluoroquinolones, or piperacillin/tazobactam and others. When it comes to the therapeutic use of antibiotics in colorectal surgery, research indicates that the most important thing is to recognize the infection in time and immediately start treatment, correct the therapy according to the causative agent, and also to stop the administration of antibiotics in time, to avoid unwanted complications and already advanced bacterial resistance.

Factors’ analysis associated with adverse outcome of the treatment of patients with invasive candidiasis

Introduction/Objective. Invasive candidiasis (IC) is the most common invasive fungal infection in humans. It manifests as candidemia, and can affect internal organs and lead to sepsis and septic shock. A good knowledge of the factors that lead to the morbidity and mortality of these patients is necessary. We aimed to investigate the factors associated with the unfavorable outcome of patients with IC treated at our institution. Methods. The research was conducted at the Military Medical Academy in Belgrade, Serbia. The retrospective cohort study included 145 patients of both sexes, aged over 18, with a proven diagnosis of IC. Demographics, comorbidities, use of therapeutic procedures, antibiotics, antifungal treatment and outcome were compared between deceased and surviving patients with IC. The results were analyzed using Student?s t-test, Mann?Whitney U test, multivariate statistical analysis. Results. The results showed that the predictors of death were diabetes mellitus (adjusted OR 6.886; CI: 2.608?18.178; p = 0.000) and chemotherapy (adjusted OR 6.826; 95% CI: 2.037?22.866; p = 0.002), which increase the risk of death seven times compared to the basal risk and mechanical ventilation, which increases the risk of death about three times (adjusted OR: 3.056; 95% CI: 1.132?8.253; p = 0.012). Conclusion. Optimal treatment is necessary in terms of early detection and identification of the causative agent of IC. In susceptible patients, such as immunocompromised patients, appropriate treatment should be initiated as soon as possible.

THE USE OF ENVIRONMENTALLY-SAFE POLUMS IN AQUACULTURE

Introduction. In the conditions of anthropogenic pollution of water, environment-safe drugs and implementing of immunomodulatory drugs are becoming increasingly common. Schemes of their use in fisheries are being developed. The article presents and analyzes the potential use of biologically active additives (BAA), namely probiotics, prebiotics and yeasts, both domestically and internationally produced, in terms of their effect on the fish body.
 Materials and methods of research. Search for literature data on the use of biologically active substances in fish farming, namely probiotics, prebiotics and yeast.
 Research results. Considering the negative impact of prophylactic and therapeutic use of antibiotics in aquaculture, the use of dietary immunostimulants has been proposed as an alternative to antimicrobial drugs. In this sense, functional dietary supplements, including pre-, probiotics and yeasts, are receiving increasing attention as an environmental strategy to improve fish health.
 Probiotics are the objects of comprehensive scientific research and an important product on the world market. The use of probiotics as biocontrol agents in aquaculture is increasing. The benefits of such additives include increased nutritional value, inhibition of pathogens and enhanced immune response by increasing white blood cells and phagocytosis. They improve the quality of the growing environment, protect fish from biological hazards, and modulate physiological processes that ultimately contribute to the health and welfare of fish in aquaculture. Probiotics also enhance growth performance and feed utilization in aquatic animals by increasing the activity of digestive enzymes.
 The beneficial effects of prebiotics are due to by-products resulting from the fermentation of intestinal commensal bacteria. Among the many health benefits attributed to prebiotics is the modulation of the immune system. They directly enhance the innate immune response, including activation of phagocytosis, neutrophils, alternative complement system, and increased lysozyme activity.
 Another environmentally friendly product that has been proposed as a dietary supplement is yeasts. Research on yeast products in fish diets has focused on their role in nutritional and functional supplements that contribute to the immune responses and gut health of fish.
 Conclusions. Various studies of pro- and prebiotics in fish have shown the following results: effects on growth, gut microbiota, resistance to pathogenic bacteria and parameters of innate immunity such as alternative complement activity (ACH50), lysozyme activity, natural hemagglutination activity, respiratory burst, superoxide dismutase activity and phagocytic activity.All the above studies demonstrate that the addition of nutritional supplements to feed, such as immunostimulants, is an alternative method for the prevention and control of various diseases in aquaculture.

Antibiotic use in gastrointestinal surgery patients at a Vietnamese national hospital

BackgroundInvasive gastrointestinal surgery may be performed as an open or endoscopic procedure, such as laparoscopic semi-colon surgery, laparoscopic appendectomy, laparoscopic gastrectomy, and anal surgery, among other such operations. Regardless of the approach, the operative procedure interferes with the patient’s gastrointestinal tract, necessitating the rational use of prophylactic antibiotics to improve treatment outcomes and minimize postoperative infections.ObjectiveTo investigate the prophylactic and postoperative antibiotic usage in patients who underwent invasive gastrointestinal surgery, and to identify factors associated with postoperative infection.DesignThis descriptive, cross-sectional study included 112 patients who underwent invasive gastrointestinal surgery at the Department of Gastroenterology, Thong Nhat Hospital. We conducted a cross-sectional study in all inpatients aged 18 years and older, who underwent invasive gastrointestinal surgery between January 2020 and December 2020. We recorded patient characteristics, the administration and appropriateness of antibiotics, as well as treatment outcomes. The appropriateness of prophylactic and postoperative antibiotic usage was assessed based on 2015 Vietnamese national guideline for antibiotic use. Multivariable logistic regression analysis was used to determine the factors associated with postoperative infection.ResultsPatients’ mean age was 59.7 ± 17.2 years. Most surgeries (89.3%) were clean-contaminated procedures. The rates of appropriate types of antibiotics selected, doses, and overall rates of appropriateness of antibiotic prophylaxis were 68.0%, 76.4% and 54.7%, respectively. Of the patients investigated, 34.8% had at least one sign of postoperative infection; the overall appropriate rate of postoperative antibiotic was 38.5%. Old age was associated with postoperative infection and longer length of hospitalization.ConclusionImplementation of the guidelines recommended for the prophylactic and therapeutic use of antibiotics is essential to improve treatment outcomes.

ASSESSMENT OF RATIONAL USE OF ANTIMICROBIAL IN ORTHOPAEDIC PROCEDURE

Background: From a clinical perspective, proper use of antimicrobial experts is essential. Current anti-microbial drugs play a vital role in both the prevention and treatment of irresistible illnesses, making them one of the most important agents for therapeutic evaluation. Without a doubt, there is a problem with their abuse globally, with underdeveloped countries experiencing it to a greater extent.Objective: evaluation of the therapeutic and preventive use of antibiotics in patients who have had orthopaedic surgery.Methodology: On 150 clinical records of orthopaedic patients who underwent medical procedure, an immediate and observational review was done.Result: This study included information from 150 people, including 80 men and 70 women who had orthopaedic surgery. Cephalosporins (73.36%) and cefuroxime (62.62%) were found to be the antimicrobial classes most frequently utilised for prophylaxis and therapy, respectively. Nearly 50% of prophylactic cases were found to be unsuitable, whilst approximately 70% of antibiotic treatments failed to adhere to recommendations.Conclusion: This study includes the maximum number of patients from total hip replacement surgery and open reduction internal fixation (ORIF), respectively. The study's findings showed that some surgical prophylaxis during orthopedic operations was somewhat improper.

Assessing farm biosecurity and farmers' knowledge and practices concerning antibiotics and antibiotic resistance in poultry and pig farms in Southern Togo.

Background and Aim:Several factors contribute to the unusual incidence of antibiotic resistance, which is now a primary public health concern. However, failure in managing preventive and therapeutic antibiotic use on farms is one of the most crucial factors. Therefore, this study aimed to evaluate the biosecurity of farms, farmers’ competence, and practices related to antibiotics and their resistance in poultry and pig rearing in Togo.Materials and Methods:Through a cross-sectional survey, 121 commercial poultry farmers and 97 commercial pig farmers were questioned to evaluate the biosecurity of farms and farmers’ competence and practices related to antibiotics and antibiotic resistance. Descriptive analyses, including the evaluation of proportions, were carried out. In addition, results from qualitative factors were evaluated in a defined grid and totaled up to assess cleanliness measures, awareness, and behavior regarding antibiotics and their resistance.Results:The results demonstrated that most farmers working on poultry farms had a university education, while most working on pig farms had secondary education. Most poultry (69%) and pig (44%) farms were of small sizes (<1000 animals in poultry and <10 animals in pig farming). The footbaths were used in just 51% of poultry farms and 4% of pig farms, respectively, with 37% and 82% of poultry and pig farms having inadequate levels of hygiene. In poultry farms, respiratory issues and periodic decline in egg-laying were the main problems. Simultaneously, skin disorders (scabies) and plagues (African swine fever) were the primary health constraints in pig farming. Tetracycline is the most commonly used antibiotic by farmers. However, in poultry and pig farms, 21% and 67% of farmers were unaware of antibiotics. In addition, 39% and 57% were unaware of antibiotic resistance. Poultry and pig farmers’ competence were substantially linked to their education level. Poultry farmers demonstrated better practices, including procuring antibiotics based on veterinary prescriptions (63%) and they knew where antibiotics should be bought (90%). Nevertheless, 43% of farmers asserted unpleasant activities – no application for laboratory testing (93%) and use of antibiotics for prevention (82%). In pig farming, most farmers (69%) reported inadequate incidents of the use of antibiotics.Conclusion:This study identified a crucial non-compliance with biosecurity measures and good practices toward antibiotic use on many farms. Therefore, training of farmers is mandatory for safe livestock products.

Does restricting therapeutic antibiotics use influence efficiency of pig farms? Evidence from Denmark’s Yellow Card Initiative

Abstract In the light of increasing awareness of public health risks from livestock-sourced antimicrobial resistance, antimicrobial use in animal agriculture is facing increased regulations around the world. The most recent and sophisticated addition is the Danish Yellow Card Initiative, which imposes quantity restriction on therapeutic antibiotic use. Using a panel $m$-order conditional efficiency analysis, this article provides one of the first empirical estimates of the association between the Danish Yellow Card Initiative and the economic efficiency of pig farms. The research design enables us to establish associations rather than causal relationships but the results suggest a small reduction (0.15 percentage points for the average farm) in revenue efficiency and a small reduction (0.03 percentage points) in cost efficiency in the short run after imposing restrictions to antibiotic use.

Chicken liver is a potential reservoir of bacteriophages and phage-derived particles containing antibiotic resistance genes.

SummaryPoultry meat production is one of the most important agri‐food industries in the world. The selective pressure exerted by widespread prophylactic or therapeutic use of antibiotics in intensive chicken farming favours the development of drug resistance in bacterial populations. Chicken liver, closely connected with the intestinal tract, has been directly involved in food‐borne infections and found to be contaminated with pathogenic bacteria, including Campylobacter and Salmonella. In this study, 74 chicken livers, divided into sterile and non‐sterile groups, were analysed, not only for microbial indicators but also for the presence of phages and phage particles containing antibiotic resistance genes (ARGs). Both bacteria and phages were detected in liver tissues, including those dissected under sterile conditions. The phages were able to infect Escherichia coli and showed a Siphovirus morphology. The chicken livers contained from 103 to 106 phage particles per g, which carried a range of ARGs (bla TEM, bla CTx‐M‐1, sul1, qnrA, armA and tetW) detected by qPCR. The presence of phages in chicken liver, mostly infecting E. coli, was confirmed by metagenomic analysis, although this technique was not sufficiently sensitive to identify ARGs. In addition, ARG‐carrying phages were detected in chicken faeces by qPCR in a previous study of the group. Comparison of the viromes of faeces and liver showed a strong coincidence of species, which suggests that the phages found in the liver originate in faeces. These findings suggests that phages, like bacteria, can translocate from the gut to the liver, which may therefore constitute a potential reservoir of antibiotic resistance genes.

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

The Impact of a Multifaceted Pharmacist-Led Antimicrobial Stewardship Program on Antibiotic Use: Evidence From a Quasi-Experimental Study in the Department of Vascular and Interventional Radiology in a Chinese Tertiary Hospital

Objective: The objective of the study was to assess the impact of multifaceted clinical pharmacist-led antimicrobial stewardship (AMS) program on the rational use of antibiotics for patients who receive vascular and interventional radiology therapies. Methods: A quasi-experimental retrospective intervention design with a comparison group was applied to the practice of antibiotic use in the department of vascular and interventional radiology in a Chinese tertiary hospital. We used difference-in-differences (DID) analysis to compare outcomes before and after the AMS intervention between the intervention group and control group, to determine whether intervention would lead to changes in irrationality of antibiotic prescribing, antibiotic utilization, cost of antibiotics, and length of hospital stay. Results: The DID results showed that the intervention group was associated with a reduction in the average consumption of antibiotics (p = 0.017) and cost of antibiotics (p = 0.006) and cost per defined daily dose (DDD) (p = 0.000). There were no significant differences in the mean change of total costs and length of stay between the two groups (p > 0.05). The average inappropriate score of perioperative antimicrobial prophylaxis in the intervention group declined by 0.23, while it decreased by 0.02 in the control group [0.21 (95% CI, −0.271 to −0.143); p = 0.000]. The average inappropriate score of non-surgical antimicrobial prophylaxis in the intervention group declined by 0.14, while it increased by 0.02 in the control group [0.16 (95% CI, −0.288 to −0.035); p = 0.010]. The average inappropriate score of the therapeutic use of antibiotics in the intervention group declined by 0.07, while it decreased by 0.01 in the control group [0.06 (95% CI, −0.115 to −0.022); p = 0.003]. Conclusions: This study provides evidence that implementation of AMS interventions was associated with a marked reduction of antibiotic use, cost of antibiotics, and irrationality of antibiotic prescribing in China.

Effects of antibiotic treatment on antimicrobial resistance in pig microbiomes: a longitudinal study

Abstract The United Kingdom has prohibited the prophylactic use of antibiotics in agriculture but they are still critical for disease control. It is thus vital to understand the effects of antibiotic treatment on antimicrobial resistance (AMR) spread. Hi-C metagenomic sequencing can help identify AMR genes in animal microbiomes and assign plasmid-based genes to their bacterial hosts. Leveraging Hi-C, we sequence antibiotically-treated pig microbiomes through time to identify dynamic trends in AMR gene prevalence. Fecal samples were collected at time points prior to and following antibiotic treatment in 6 farms across England when pigs presented with illness. Control samples were collected from 2 of these farms at multiple time points without treatment. Samples were processed using a bioinformatic pipeline that outputs assemblies with information on taxonomic classification and presence/absence of an AMR allele. 115 AMR alleles across 11 antibiotic classes were included. The bacterial species in highest abundance/farm belonged to order Bacteroidales (45.9-53.1%). Tetracycline resistance alleles showed the highest prevalence/farm (28.4-52.8%). No significant association between bacterial species abundance and time point, and AMR allele prevalence and time point was found in all farms (χ2 p&amp;gt;.05). The distribution of the number of AMR alleles/assembly was significantly higher between the first and last time point in 4/6 treated farms and 1/2 control farms (Wilcoxan rank sum p &amp;lt;.01). A higher difference in the proportion of assemblies with greater than 6 AMR alleles between the first and last time point was observed in 1 treated farm (.17 95% CI .013-.21) compared to its control (.03 95% CI .023-.033). Slight acquisition of AMR alleles was observed but we see minimal temporal fluctuations in bacterial species abundance and AMR allele prevalence overall implying that the microbiome is fairly robust to antibiotic treatment. This encourages its responsible use for disease control. Key messages Ensuring that the responsible use of antibiotics does not drastically affect AMR mobilization is key to preserving the efficacy of therapeutics in agriculture. While acquisition of resistance genes over time is seen it cannot conclusively be tied to treatment; Minimal microbiome perturbation post treatment implies that therapeutic antibiotic use is warranted.