Browsing by Subject "Antibiotic resistance"
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- ItemOpen AccessThe anti-Pseudomonas aeruginosa antibody Panobacumab is efficacious on acute pneumonia in neutropenic mice and has additive effects with meropenem(Public Library of Science, 2013) Secher, Thomas; Fas, Stefanie; Fauconnier, Louis; Mathieu, Marieke; Rutschi, Oliver; Ryffel, Bernhard; Rudolf, MichaelPseudomonas aeruginosa ( P. aeruginosa ) infections are associated with considerable morbidity and mortality in immunocompromised patients due to antibiotic resistance. Therefore, we investigated the efficacy of the anti- P. aeruginosa serotype O11 lipopolysaccharide monoclonal antibody Panobacumab in a clinically relevant murine model of neutropenia induced by cyclophosphamide and in combination with meropenem in susceptible and meropenem resistant P. aeruginosa induced pneumonia. We observed that P. aeruginosa induced pneumonia was dramatically increased in neutropenic mice compared to immunocompetent mice. First, Panobacumab significantly reduced lung inflammation and enhanced bacterial clearance from the lung of neutropenic host. Secondly, combination of Panobacumab and meropenem had an additive effect. Third, Panobacumab retained activity on a meropenem resistant P. aeruginosa strain. In conclusion, the present data established that Panobacumab contributes to the clearance of P. aeruginosa in neutropenic hosts as well as in combination with antibiotics in immunocompetent hosts. This suggests beneficial effects of co-treatment even in immunocompromised individuals, suffering most of the morbidity and mortality of P. aeruginosa infections.
- ItemOpen AccessAntibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates(Public Library of Science, 2013) Boyles, Tom H; Whitelaw, Andrew; Bamford, Colleen; Moodley, Mischka; Bonorchis, Kim; Morris, Vida; Rawoot, Naazneen; Naicker, Vanishree; Lusakiewicz, Irena; Black, JohnBACKGROUND: Antibiotic consumption is a major driver of bacterial resistance. To address the increasing burden of multi-drug resistant bacterial infections, antibiotic stewardship programmes are promoted worldwide to rationalize antibiotic prescribing and conserve remaining antibiotics. Few studies have been reported from developing countries and none from Africa that report on an intervention based approach with outcomes that include morbidity and mortality. METHODS: An antibiotic prescription chart and weekly antibiotic stewardship ward round was introduced into two medical wards of an academic teaching hospital in South Africa between January-December 2012. Electronic pharmacy records were used to collect the volume and cost of antibiotics used, the patient database was analysed to determine inpatient mortality and 30-day re-admission rates, and laboratory records to determine use of infection-related tests. Outcomes were compared to a control period, January-December 2011. RESULTS: During the intervention period, 475.8 defined daily doses were prescribed per 1000 inpatient days compared to 592.0 defined daily doses/1000 inpatient days during the control period. This represents a 19.6% decrease in volume with a cost reduction of 35% of the pharmacy's antibiotic budget. There was a concomitant increase in laboratory tests driven by requests for procalcitonin. There was no difference in inpatient mortality or 30-day readmission rate during the control and intervention periods. CONCLUSIONS: Introduction of antibiotic stewardship ward rounds and a dedicated prescription chart in a developing country setting can achieve reduction in antibiotic consumption without harm to patients. Increased laboratory costs should be anticipated when introducing an antibiotic stewardship program.
- ItemOpen AccessBacterial disease and antimicrobial susceptibility patterns in HIV-infected, hospitalized children: a retrospective cohort study(Public Library of Science, 2008) Jaspan, Heather B; Huang, Lyen C; Cotton, Mark F; Whitelaw, Andrew; Myer, LandonBACKGROUND: Serious bacterial infections are a major source of morbidity and mortality in HIV-infected children. The spectrum of disease is wide, and responsible organisms vary according to setting. The use of antibiotic prophylaxis and the emergence of multi-drug resistant bacteria necessitate examination of responsible organisms and their antibiotic susceptibility. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cohort study of all HIV-positive pediatric admissions at an urban public sector hospital in Cape Town between January 2002 and June 2006 was conducted. Children between the ages of one month and nine years with laboratory confirmed HIV status, serious bacterial infection, and a hospital length of stay of 5 days or more, were eligible for inclusion. Organisms isolated from blood, urine, and cerebral spinal fluid cultures and their antimicrobial susceptibility were examined, and compared according to timing of isolation to distinguish nosocomial versus community-acquired. One hundred and forty-one children were identified (median age 1.2 years), 39% of whom were on antiretrovirals started before or during this hospitalization. Bacterial infections involved all organ systems, however pneumonia was most common (67%). S. pneumoniae and S. aureus were the most common gram positive and K. pneumoniae was the most common gram negative organism. K pneumoniae isolates were resistant to many first and second line antibiotics, and were all considered nosocomial. All S. aureus isolates were methicillin resistant, some of which were community-acquired. Conclusions/Significance Bacterial infections are an important source of co-morbidity in HIV-infected children in resource-limited settings. Clinicians should have a low threshold to initiate antibiotics in children requiring hospitalization. Broad-spectrum antibiotics should be used judiciously. Clinicians caring for HIV-infected children should be cognizant of the most common organisms affecting such children, and of their local antimicrobial susceptibilities, when treating empirically for serious bacterial infections.
- ItemOpen AccessColonisation with pathogenic drug-resistant bacteria and Clostridioides difficile among residents of residential care facilities in Cape Town, South Africa: a cross-sectional prevalence study(2019-11-19) September, Jason; Geffen, Leon; Manning, Kathryn; Naicker, Preneshni; Faro, Cheryl; Mendelson, Marc; Wasserman, SeanAbstract Background Residential care facilities (RCFs) act as reservoirs for multidrug-resistant organisms (MDRO). There are scarce data on colonisation with MDROs in Africa. We aimed to determine the prevalence of MDROs and C. difficile and risk factors for carriage amongst residents of RCFs in Cape Town, South Africa. Methods We performed a cross-sectional surveillance study at three RCFs. Chromogenic agar was used to screen skin swabs for methicillin-resistant S. aureus (MRSA) and stool samples for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). Antigen testing and PCR was used to detect Clostridiodes difficile. Risk factors for colonisation were determined with logistic regression. Results One hundred fifty-four residents were enrolled, providing 119 stool samples and 152 sets of skin swabs. Twenty-seven (22.7%) stool samples were positive for ESBL-E, and 13 (8.6%) residents had at least one skin swab positive for MRSA. Two (1.6%) stool samples tested positive for C. difficile. Poor functional status (OR 1.3 (95% CI, 1.0–1.6)) and incontinence (OR 2.9 (95% CI, 1.2–6.9)) were significant predictors for ESBL-E colonisation. MRSA colonization appeared higher in frail care areas (8/58 v 5/94, p = 0.07). Conclusions There was a relatively high prevalence of colonisation with MDROs, particularly ESBL-E, but low C. difficile carriage, with implications for antibiotic prescribing and infection control practice.
- ItemOpen AccessIt is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey(2022-03-17) Sartelli, Massimo; Labricciosa, Francesco M; Coccolini, Federico; Coimbra, Raul; Abu-Zidan, Fikri M; Ansaloni, Luca; Al-Hasan, Majdi N; Ansari, Shamshul; Barie, Philip S; Caínzos, Miguel A; Ceresoli, Marco; Chiarugi, Massimo; Claridge, Jeffrey A; Cicuttin, Enrico; Dellinger, Evan P; Fry, Donald E; Guirao, Xavier; Hardcastle, Timothy C; Hecker, Andreas; Leppäniemi, Ari K; Litvin, Andrey; Marwah, Sanjay; Maseda, Emilio; Mazuski, John E; Memish, Ziad A; Kirkpatrick, Andrew W; Pagani, Leonardo; Podda, Mauro; Rasa, Huseyin K; Sakakushev, Boris E; Sawyer, Robert G; Tumietto, Fabio; Xiao, Yonghong; Aboubreeg, Wedad F; Adamou, Harissou; Akhmeteli, Lali; Akin, Emrah; Alberio, Maria G; Alconchel, Felipe; Magagi, Ibrahim A; Araúz, Ana B; Argenio, Giulio; Atanasov, Boyko C; Atici, Semra D; Awad, Selmy S; Baili, Efstratia; Bains, Lovenish; Bala, Miklosh; Baraket, Oussama; Baral, Suman; Belskii, Vladislav A; Benboubker, Moussa; Ben-Ishay, Offir; Bordoni, Pierpaolo; Boumédiène, Abdalia; Brisinda, Giuseppe; Cavazzuti, Laura; Chandy, Sujith J; Chiarello, Maria M; Cillara, Nicola; Clarizia, Guglielmo; Cocuz, Maria-Elena; Cocuz, Iuliu G; Conti, Luigi; Coppola, Raffaella; Cui, Yunfeng; Czepiel, Jacek; D’Acapito, Fabrizio; Damaskos, Dimitrios; Das, Koray; De Simone, Belinda; Delibegovic, Samir; Demetrashvili, Zaza; Detanac, Dzemail S; Dhingra, Sameer; Di Bella, Stefano; Dimitrov, Evgeni N; Dogjani, Agron; D’Oria, Mario; Dumitru, Irina M; Elmangory, Mutasim M; Enciu, Octavian; Fantoni, Massimo; Filipescu, Daniela; Fleres, Francesco; Foghetti, Domitilla; Fransvea, Pietro; Gachabayov, Mahir; Galeiras, Rita; Gattuso, Gianni; Ghannam, Wagih M; Ghisetti, Valeria; Giraudo, Giorgio; Gonfa, Kebebe B; Gonullu, Emre; Hamad, Yousif T E Y; Hecker, Matthias; Isik, Arda; Ismail, Nizar; Ismail, Azzain; Jain, Sumita A; Kanj, Souha S; Kapoor, Garima; Karaiskos, Ilias; Kavalakat, Alfie J; Kenig, Jakub; Khamis, Faryal; Khokha, Vladimir; Kiguba, Ronald; Kim, Jae I; Kobe, Yoshiro; Kok, Kenneth Y Y; Kovacevic, Bojan M; Kryvoruchko, Igor A; Kuriyama, Akira; Landaluce-Olavarria, Aitor; Lasithiotakis, Konstantinos; Lohsiriwat, Varut; Lostoridis, Eftychios; Luppi, Davide; Vega, Gustavo M M; Maegele, Marc; Marinis, Athanasios; Martines, Gennaro; Martínez-Pérez, Aleix; Massalou, Damien; Mesina, Cristian; Metan, Gökhan; Miranda-Novales, María G; Mishra, Shyam K; Mohamed, Mohaned I H; Mohamedahmed, Ali Y Y; Mora-Guzmán, Ismael; Mulita, Francesk; Musina, Ana-Maria; Navsaria, Pradeep H; Negoi, Ionut; Nita, Gabriela E; O’Connor, Donal B; Ordoñez, Carlos A; Pantalone, Desiré; Panyko, Arpád; Papadopoulos, Aristeidis; Pararas, Nikolaos; Pata, Francesco; Patel, Tapan; Pellino, Gianluca; Perra, Teresa; Perrone, Gennaro; Pesce, Antonio; Pintar, Tadeja; Popivanov, Georgi I; Porcu, Alberto; Quiodettis, Martha A; Rahim, Razrim; Mitul, Ashrarur R; Reichert, Martin; Rems, Miran; Campbell, Glendee Y R; Rocha-Pereira, Nuno; Rodrigues, Gabriel; Villamil, Gustavo E R; Rossi, Stefano; Sall, Ibrahima; Kafil, Hossein S; Sasia, Diego; Seni, Jeremiah; Seretis, Charalampos; Serradilla-Martín, Mario; Shelat, Vishal G; Siribumrungwong, Boonying; Slavchev, Mihail; Solaini, Leonardo; Tan, Boun K; Tarasconi, Antonio; Tartaglia, Dario; Toma, Elena A; Tomadze, Gia; Toro, Adriana; Tovani-Palone, Marcos R; van Goor, Harry; Vasilescu, Alin; Vereczkei, Andras; Veroux, Massimiliano; Weckmann, Sergio A; Widmer, Lukas W; Yahya, AliIbrahim; Zachariah, Sanoop K; Zakaria, Andee D; Zubareva, Nadezhda; Zuidema, Wietse P; Di Carlo, Isidoro; Cortese, Francesco; Baiocchi, Gian L; Maier, Ronald V; Catena, FaustoBackground The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants’ perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.
- ItemOpen AccessPrevalence and antimicrobial resistance profiles of respiratory microbial flora in African children with HIV-associated chronic lung disease(2021-02-25) Abotsi, Regina E; Nicol, Mark P; McHugh, Grace; Simms, Victoria; Rehman, Andrea M; Barthus, Charmaine; Mbhele, Slindile; Moyo, Brewster W; Ngwira, Lucky G; Mujuru, Hilda; Makamure, Beauty; Mayini, Justin; Odland, Jon Ø; Ferrand, Rashida A; Dube, Felix SBackground HIV-associated chronic lung disease (CLD) is common among children living with HIV (CLWH) in sub-Saharan Africa, including those on antiretroviral therapy (ART). However, the pathogenesis of CLD and its possible association with microbial determinants remain poorly understood. We investigated the prevalence, and antibiotic susceptibility of Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) among CLWH (established on ART) who had CLD (CLD+), or not (CLD-) in Zimbabwe and Malawi. Methods Nasopharyngeal swabs (NP) and sputa were collected from CLD+ CLWH (defined as forced-expiratory volume per second z-score < − 1 without reversibility post-bronchodilation with salbutamol), at enrolment as part of a randomised, placebo-controlled trial of azithromycin (BREATHE trial - NCT02426112 ), and from age- and sex-matched CLD- CLWH. Samples were cultured, and antibiotic susceptibility testing was conducted using disk diffusion. Risk factors for bacterial carriage were identified using questionnaires and analysed using multivariate logistic regression. Results A total of 410 participants (336 CLD+, 74 CLD-) were enrolled (median age, 15 years [IQR = 13–18]). SP and MC carriage in NP were higher in CLD+ than in CLD- children: 46% (154/336) vs. 26% (19/74), p = 0.008; and 14% (49/336) vs. 3% (2/74), p = 0.012, respectively. SP isolates from the NP of CLD+ children were more likely to be non-susceptible to penicillin than those from CLD- children (36% [53/144] vs 11% [2/18], p = 0.036). Methicillin-resistant SA was uncommon [4% (7/195)]. In multivariate analysis, key factors associated with NP bacterial carriage included having CLD (SP: adjusted odds ratio (aOR) 2 [95% CI 1.1–3.9]), younger age (SP: aOR 3.2 [1.8–5.8]), viral load suppression (SP: aOR 0.6 [0.4–1.0], SA: 0.5 [0.3–0.9]), stunting (SP: aOR 1.6 [1.1–2.6]) and male sex (SA: aOR 1.7 [1.0–2.9]). Sputum bacterial carriage was similar in both groups (50%) and was associated with Zimbabwean site (SP: aOR 3.1 [1.4–7.3], SA: 2.1 [1.1–4.2]), being on ART for a longer period (SP: aOR 0.3 [0.1–0.8]), and hot compared to rainy season (SP: aOR 2.3 [1.2–4.4]). Conclusions CLD+ CLWH were more likely to be colonised by MC and SP, including penicillin-non-susceptible SP strains, than CLD- CLWH. The role of these bacteria in CLD pathogenesis, including the risk of acute exacerbations, should be further studied.
- ItemOpen AccessTertiary hospitals physician’s knowledge and perceptions towards antibiotic use and antibiotic resistance in Cameroon(2021-10-29) Domche Ngongang, Sandra C.; Basera, Wisdom; Mendelson, MarcBackground Infections due to resistant bacteria are associated with severe illness, increased risk for complications, hospital admissions, and higher mortality. Inappropriate use of antibiotics, which contributes to increased antibiotic resistance (ABR), is common in healthcare settings across the globe. In Cameroon, antibiotics have been reported as high as 45–70% of prescriptions. We sought to investigate the knowledge, attitudes, and perceptions regarding appropriate antibiotic use and ABR of medical doctors practicing in tertiary hospitals in Yaoundé, Cameroon. Methods We conducted a cross-sectional survey using a 54-item self-administered questionnaire sent via email to medical doctors working in the four major tertiary hospitals of Yaoundé. The questionnaire recorded socio-demographics, perceptions on antibiotic use and ABR, sources and usefulness of education on ABR, and clinical scenarios to appraise knowledge. Results A total of 98/206 (48%) doctors responded. Years of experience ranged between 1 and 17 years. Most participants agreed that ABR is a problem nationwide (93%) and antibiotics are overused (96%), but only one third (32%) thought that ABR was a problem in their wards. Most respondents (65%) were confident that they use antibiotics appropriately. We found a mean knowledge score of 56% (± 14), with prescribers not influenced by patient-exerted pressure for antibiotic prescribing scoring better compared to those influenced by patients (67% vs 53%, p = 0.01). Overall, most participants (99%) expressed interest for further education on both appropriate antibiotic use and ABR. Conclusion Confidence of prescribers in their ability to appropriately use antibiotics conflicts with the low level of knowledge on antibiotic use in this group of doctors. Moreover, the opinion of the majority, that ABR is not a problem in their own backyard is in keeping with similar studies in other countries and is of significant concern. Introduction of formal antibiotic stewardship programmes in Cameroon may be a useful intervention.