JAC-Antimicrobial Resistance最新文献

Background: Acute otitis media (AOM) is a leading cause of healthcare visits, antibiotic prescription and complications in children aged under 5 years. Following the introduction of pneumococcal conjugate vaccines (PCVs), non-typeable Haemophilus influenzae (NTHi) has become the most common causative agent for AOM, followed by Streptococcus pneumoniae and Moraxella catarrhalis. PCVs are not yet included in the National Immunization Program in Vietnam.

Objectives: To determine the frequency and characteristics of the pathogens related to AOM in Vietnam in children ≤5 years old.

Methods: This was a cross-sectional study performed at the Vietnam National Children's Hospital from October 2021 to December 2023 in children ≤5 years old diagnosed with acute suppurative otitis media. Clinical features of the children were described. Pathogens of interest were identified by culture or real-time PCR (rtPCR). The antibiotic susceptibility profiles of H. influenzae and S. pneumoniae isolates were determined.

Results: In total, 482 children ≤5 years old were included, of which 70.8% were ≤2 years old and 61% had an history of AOM. The most frequent bacteria isolated were H. influenzae (52.1%, 99.6% of which were NTHi) and S. pneumoniae (41.1%). Most S. pneumoniae isolates were resistant to azithromycin, clarithromycin and cefuroxime. Most H. influenzae isolates were resistant to amoxicillin, cefixime, cefuroxime, azithromycin and clarithromycin.

Conclusions: The pathogens most frequently associated with AOM in this study were in line with previous findings. Many isolates were resistant to commonly given oral antibiotics. These results can inform decision-making on AOM prevention and treatment strategies in Vietnam.

Objective: To audit the prescribing of antibiotics at a tertiary-level public hospital, in preparation for the implementation of an antimicrobial stewardship programme.

Methods: A retrospective audit of antibiotic prescriptions for the period April 2020 to June 2020 was conducted to ascertain appropriate antibiotic prescribing based on a set of process measures, which included whether cultures were taken before the initiation of empirical antibiotics, the duration of antibiotic therapy, de-escalation to a narrower spectrum antibiotic, the concurrent use of four or more antibiotics, documented indication for antibiotic use, and parenteral to oral conversion. Statistics were calculated using Stata (Version 17).

Results: A total of 380 patient medical charts were reviewed. It was noted that there were no standalone antibiotic charts, and antibiotics were prescribed alongside other medication in one prescription record. There was non-compliance to one or more of the process measures in two-thirds of antibiotic prescriptions audited. Excessive duration of therapy was evident in 3.16% (12) prescriptions. There were 18 (4.74%) instances in which de-escalation to a narrower spectrum antibiotic based on susceptibility results did not occur. Only a small proportion of patients were switched from parenteral to oral antibiotics (n = 12, 3.16%). Some of the additional findings included redundant antibiotic coverage (n = 137, 36.05%) and prescription of an antibiotic that did not align with the susceptibility results (n = 98, 25.79%).

Conclusions: Inappropriate antibiotic prescribing did occur in some cases. The results from this pre-implementation study highlight the importance of introducing antimicrobial stewardship interventions with process and outcome measures.

Objective: To monitor the gut colonization by multidrug resistant (MDR) bacteria in residents of a single long-term care facility (LTCF) in relation to their clinical evolution, antibiotic consumption and mortality risk.

Methods: In a total of 187 voluntarily enrolled residents, five rectal swabs samples were recovered over 1 year. Selective media were used to isolate MDR bacteria. Clinical data related to infections, antibiotic consumption and mortality were recovered. Mortality risk among residents who were MDR colonized and non-colonized was compared by Kaplan-Meier curves.

Results: Globally, 25% of residents have gut colonization by ESBL-producing Escherichia coli with a lack of other pathogens such as Acinetobacter baumannii or Clostridioides difficile. Monitoring of ESBL-producing E. coli colonization for 1 year allowed to us to establish three categories among residents: 48.6% never colonized, 15.5% had a persistent colonization, and the remaining 35.8% presented intermittent colonization. The rates of mortality, infections and antibiotic exposure were comparable among ESBL-producing E. coli colonized and non-colonized residents, except for the intermittent colonization group in which a higher and statistically significant mortality rate was observed. As expected, urinary and respiratory tract infections were the most prevalent infectious pathologies in the LTCF, with amoxicillin/clavulanate and fluoroquinolones being the most prescribed antibiotics. A high percentage of ESBL-producing E. coli (28%), and fluoroquinolone resistance were detected in clinical samples.

Conclusions: The monitoring of gut colonization by MDR microorganisms in a single LTCF for 1 year demonstrated the predominance of ESBL-producing E. coli. Almost half of the residents were resistant to its colonization, whereas in 15.5% of them gut colonization was stable. Incidence of infectious episodes and antibiotic exposure were comparable between colonized and non-colonized subjects, but the group with the highest risk of mortality was that with intermittent colonization by ESBL-producing E. coli.

Background: The drivers of antimicrobial resistance (AMR) likely vary substantially by different demographics. However, few complete, open, national detailed data exist on how antibiotic use (ABU) varies by both age and sex. Here, we aimed to describe the variation in ABU and consider how these age- and sex-specific patterns influence targets and methods for AMR control.

Methods: Prescriptions of all antibiotics from general practices in England for 2015-23 disaggregated by 5 year age bands and sex were analysed at the national and Integrated Care Board (ICB) level. A descriptive analysis of the relative rates of ABU by age and sex was conducted, followed by an evaluation of comparison metrics of prescription levels between regions. ABU by age and sex were compared with global AWaRe targets, and ABU by age-group was correlated against influenza vaccination introduction, to evaluate the impact of such vaccines on ABU.

Results: From a total of 249 578 795 prescriptions (across 9 years), 63% were given to women and the most prescribed were amoxicillin, nitrofurantoin and flucloxacillin sodium. Prescriptions per 100 000 population varied substantially across sex, age, geographical region, season, year, COVID-19 pandemic period and drug. Most antibiotics were prescribed more to women across most age bands (84% of antibiotics had more prescriptions to females across 50% of age bands). We show how this variation requires a more nuanced approach to comparing ABU across geographies and highlight that AWaRe targets are not met uniformly [prescribing in men aged 11-20 does not fulfil the Access, Watch and Reserve (AWaRe) 80% Access target]. We also show the impact on ABU of time-sensitive interruptions (38% of antibiotics showed a seasonal pattern in the absence of disruptions), including differential age-targeted influenza vaccination, COVID-19 restrictions and a shortage of amoxicillin due to a group A Streptococcus outbreak. However, we found few open data to link age- and sex-specific ABU to relevant AMR.

Conclusions: These detailed differences in ABU across England suggest that there should be large variation in AMR burden by age and sex. Linkage of this ABU data with similarly detailed open-access AMR data is now needed for better intervention design.

Background and objectives: The antimicrobial nitroxoline is used in treating uncomplicated urinary tract infections (UTIs) in some European countries. In vitro antimicrobial data on uropathogens from China are lacking. To investigate the activity of nitroxoline in vitro against uropathogens isolated from Chinese patients.

Methods: MICs of nitroxoline were determined using broth microdilution of 229 bacterial isolates of 10 species including Acinetobacter baumannii derived from urinary sample. The EUCAST susceptibility breakpoint for Escherichia coli (16 mg/L) was applied for all isolates. The MBC for A. baumannii (n = 34) was determined, with the MBC defined as the nitroxoline concentration at which a 99.9% reduction in the initial inoculum was observed. Time-kill curves of the two isolates of A. baumannii were tested over a 24 h period.

Results: Except for Pseudomonas aeruginosa, most isolates were susceptible to nitroxoline. The MIC50/90 values of nitroxoline for E. coli, Klebsiella pneumoniae and Proteus mirabilis were 4/8, 8/32 and 8/16 mg/L, respectively. Among the Gram-negative isolates, nitroxoline demonstrated a better inhibitory effect against A. baumannii with an MIC50/90 value of 2/2 mg/L. The MBC of A. baumannii was equal to the MIC or one dilution higher. The time-kill curves of A. baumannii displayed concentration-dependent killing.

Conclusions: Nitroxoline showed excellent in vitro activity against uropathogens isolated from China and may be a good option for uncomplicated UTIs caused by A. baumannii, which are more challenging and have few clinical options. Further in vivo efficacy studies are needed.

Background: Antimicrobial resistance (AMR) poses a significant threat to both human and animal health. Educational resources aimed at pet owners raise awareness of AMR and promote antimicrobial stewardship (AMS).

Objectives: To review available AMS educational resources for pet owners conveying key messages and fostering responsible antibiotic use.

Methods: A review was conducted on various educational materials targeted at pet owners. Key features assessed included content type, target audience, accessibility, engagement level and clarity of key AMS messages.

Results: A total of 16 resources targeting pet owners were identified. While many resources effectively communicated the risks of AMR and the importance of responsible antibiotic use, gaps in measurement of long-term behavioural change were noted. Resources often catered to engaged pet owners, potentially neglecting marginalized populations who may benefit from AMS education. Practical guidance on actions like proper disposal of unused medications was limited, although initiatives like the Antibiotic Amnesty campaign showed promise in promoting responsible practices.

Conclusions: Educational resources for pet owners on AMS show promise in enhancing awareness and promoting responsible antibiotic use. However, improvements in clarity, engagement strategies and addressing specific concerns of pet owners are necessary for greater impact. Further research is needed to assess long-term behavioural changes amongst pet owners in antibiotic use following exposure to these resources.

Introduction: Antimicrobial resistance (AMR) is an emerging global threat, with notable impact evident in low- and middle-income countries. Indiscriminate antibiotic prescribing is recognized as the key factor responsible for the continued spread of AMR.

Objectives: To comprehensively map published data of evidence of AMR in healthcare settings in South Africa, encompassing the exploration of antibiotic prescribing practices and the implementation of antimicrobial stewardship initiatives.

Methods: The scoping review methodology was based on the guidelines outlined by Arksey and O'Malley. The protocol for this scoping review has been registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/PWMFB). The search strategy was documented using the protocol outlined within the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). Databases used were Science Direct, Scopus, PubMed, Wiley, Directory of Open Access Journals; and health organizations such as the WHO. In addition, the Google search engine was used to search for grey matter. The search was restricted to peer-reviewed articles in English on human studies for the period 2019-24.

Results: The search yielded a total of 529 articles from electronic databases and search engines. Twenty-nine articles were accepted for inclusion following the application of the study protocol. The majority of the articles were primary research papers.

Conclusions: The findings reveal that South Africa has measures in place to combat AMR; however, inconsistencies were found between the private and public health sectors, in addition to the lack of adherence to guidelines and limitations in AMR education among healthcare workers and students.

Background: The ability of microorganisms to resist antimicrobial medicines is called antimicrobial resistance (AMR). AMR awareness among the general public may be increased via a variety of approaches including the use of social media campaigns, traditional media, influencer outreach storytelling, community theatre, interactive games and quizzes and art and music. This analysis aims to evaluate YouTube videos to educate the general public about AMR.

Methods: A content analysis was performed on the AMR educational videos that were retrieved from YouTube using the following keyword phrases: 'what is antimicrobial resistance', 'causes of antimicrobial resistance' and 'prevention of antimicrobial resistance'.

Results: A total of 74 AMR educational videos were identified and analysed based on predefined selection criteria. Subsequently, three online videos that met the inclusion criteria were selected and analysed.

Conclusions: The analysed AMR educational videos were easily accessible and comprehensible, and serve as valuable resources for promoting AMR awareness and education among the general population.