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The spread of antimicrobial resistance (AMR) is a global challenge. Close and continuous surveillance for quick detection of AMR can be difficult, especially in remote places. This narrative review focuses on the contributions of pharmacovigilance (PV) as an auxiliary tool for identifying and monitoring the ineffectiveness, resistance, and inappropriate use of antibiotics (ABs). The terms "drug ineffective", "therapeutic failure", "drug resistance", "pathogen resistance", and "multidrug resistance" were found in PV databases and dictionaries, denoting ineffectiveness. These terms cover a range of problems that should be better investigated because they are useful in warning about possible causes of AMR. "Medication errors", especially those related to dose and indication, and "Off-label use" are highlighted in the literature, suggesting inappropriate use of ABs. Hence, the included studies show that the terms of interest related to AMR and use are not only present but frequent in PV surveillance programs. This review illustrates the feasibility of using PV as a complementary tool for antimicrobial stewardship activities, especially in scenarios where other resources are scarce.

RESUMO

OBJECTIVE: To compare dispensed oral antibiotic prescription rates (DAPRs) after implementation of pneumococcal conjugate vaccine (PCV) in high antibiotic-prescribing clinics (HPC) with low antibiotic-prescribing clinics (LPC) in 2 distinct ethnic groups of children (Jewish and Bedouin children) <5 years of age. METHODS: Clinics with ≥50 insured children, active both pre-PCV (2005-2009) and post-PCV (2010-2018) implementation, were included. HPC and LPC were defined by DAPRs above or below the median in each age and ethnic group. Monthly dispensed antibiotic prescription rate (DAPR) trends (adjusted for age and ethnicity) were calculated using interrupted time series. Mean yearly incidence rate-ratios (late PCV13 vs pre-PCV) were calculated. RESULTS: Bedouin HPC had the highest pre-PCV overall-DAPR per 1000 child-years ± SD (2520.4 ± 121.2), followed by Jewish HPC (1885.5 ± 47.6), Bedouin LPC (1314.8 ± 81.6), and Jewish LPC (996.0 ± 19.6). Shortly after PCV implementation, all DAPRs and amoxicillin/amoxicillin-clavulanate DAPRs declined in all groups except Jewish LPC, stabilizing within 4-5 years post-PCV. The rates and magnitudes of declines were directly proportional to the pre-PCV DAPR magnitudes, achieving near-complete closure of the pre-PCV DAPR gaps between the 4 groups (rates during late-PCV13 ranging from 1649.4 ± 23.5 [Bedouin HPC] to 1200.3 ± 72.4 [Jewish LPC]). CONCLUSIONS: PCVs are a powerful tool in reducing outpatient antibiotic consumption among young children, especially in HPC, resulting in partial closure of DAPR gap between HPC and LPC. The higher impact on HPC suggests that PCV-associated declines of respiratory disease may strongly contribute to a judicious antibiotic approach in clinics with high antibiotic consumption.

Assuntos

Infecções Pneumocócicas , Streptococcus pneumoniae , Criança , Humanos , Lactente , Pré-Escolar , Vacinas Pneumocócicas/uso terapêutico , Antibacterianos/uso terapêutico , Vacinas Conjugadas , Combinação Amoxicilina e Clavulanato de Potássio , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle

RESUMO

BACKGROUND: High rates of antibiotic use (AU) among inpatients with coronavirus disease 2019 (COVID-19) despite low rates of bacterial coinfection and secondary infection have been reported. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in South America. METHODS: We conducted an ecologic evaluation of AU in inpatient adult acute care wards in 2 HCFs each in Argentina, Brazil, and Chile. The AU rates for intravenous antibiotics were calculated as the defined daily dose per 1000 patient-days, using pharmacy dispensing records and hospitalization data from March 2018-February 2020 (prepandemic) and March 2020-February 2021 (pandemic). Differences in median AU were compared between the prepandemic and pandemic periods, using the Wilcoxon rank sum test to determine significance. Interrupted time series analysis was used to analyze changes in AU during the COVID-19 pandemic. RESULTS: Compared with the prepandemic period, the median difference in AU rates for all antibiotics combined increased in 4 of 6 HCFs (percentage change, 6.7%-35.1%; P < .05). In the interrupted time series models, 5 of 6 HCFs had significant increases in use of all antibiotics combined immediately at the onset of the pandemic (immediate effect estimate range, 15.4-268), but only 1 of these 5 HCFs experienced a sustained increase over time (change in slope, +8.13; P < .01). The effect of the pandemic onset varied by antibiotic group and HCF. CONCLUSIONS: Substantial increases in AU were observed at the beginning of the COVID-19 pandemic, suggesting the need to maintain or strengthen antibiotic stewardship activities as part of pandemic or emergency HCF responses.

Assuntos

Antibacterianos , COVID-19 , Humanos , Adulto , Antibacterianos/uso terapêutico , COVID-19/epidemiologia , Pacientes Internados , Pandemias , Chile/epidemiologia , Argentina/epidemiologia , Brasil

RESUMO

BACKGROUND: In the collaborative efforts to control bacterial antimicrobial resistance (AMR), the challenge for many low- and middle-income countries currently lies in the adequate design and successful implementation and operation of different strategies aimed at improving antibiotic use during hospital care. This study aims to provide data on these different strategies in three hospitals with different levels of complexity and geographic locations in Colombia. METHODS: This before-and-after study describes and analyzes the development and implementation of clinical practice guidelines (CPGs), continuing education courses, quick consultation tools, and antimicrobial stewardship programs (ASPs) with the use of telemedicine. This includes measuring indicators in the ASP framework such as adherence to CPGs and antibiotic consumption. RESULTS: We used five CPGs developed in the Colombian context. We designed and developed a Massive Open Online Course (MOOC) and a mobile application (app) as strategies for dissemination and implementation. The ASP was designed and implemented according to each institution's level of complexity. In the three hospitals, a progressive increase in adherence to the antibiotic recommendations proposed in the CPGs was observed, and there was a lower use of antibiotics with the ASPs, both in the general wards and ICUs. CONCLUSIONS: We concluded that in medium-complexity hospitals located in small rural cities, successful development of ASPs is possible when they are well-planned, implemented, and supported by the organization. It is necessary that Colombia and other Latin American countries continue activities that reduce AMR by designing, implementing, and improving these interventions throughout the national territory.

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BACKGROUND: Pediatric Antimicrobial Stewardship Programs (ASP) consider DOT a fundamental measure to quantify the impact of ASP. Novel strategies have been described, but no endemic channels (EC) have been reported to compare antibiotic use within historical patterns. This report describes the process of constructing an EC and analyzing its interpretation. METHODS: This was a descriptive study of the construction, implementation, and analysis of EC. The median and quartile method, as well as the geometric mean (GM) and confidence interval (CI) methods using DOT for the last 4 years were used. ECs have also been elaborated on in critical services (PICU). RESULTS: GM and CI method seem to be more sensitive in identifying changes in antimicrobial use. Ceftriaxone increased its use starting in December 2021, reaching the warning zone in March 2022 in relation to increased cases of bacterial and complicated pneumonia. Piperacillin-tazobactam showed an important increase in PICU during the first 8 months of 2021, reaching the alert zone until August 2021; thereafter, its use decreased, and this variation was related to a modification in the presentation of complicated appendicitis during the COVID 19 pandemic restrictions. The use of ampicillin-sulbactam has increased since January 2022 because of a change in local guidelines regarding its use in appendicitis and peritonitis. The changes identified in each EC allowed ASP to take different conducts. CONCLUSION: EC allowed us to construct a new tool to measure ASP impact, internal comparison of antibiotic use facilitated taking timely interventions. EC could be useful for all pediatric and adult ASP.

Assuntos

Gestão de Antimicrobianos , Apendicite , COVID-19 , Criança , Humanos , Gestão de Antimicrobianos/métodos , Estudos Retrospectivos , Antibacterianos/uso terapêutico

RESUMO

INTRODUCTION: This article analyzes experiences of antibiotic use and bacterial infections among Primary Health Care users of the Brazilian Unified Health System (SUS) and the possible implications for antimicrobial resistance (AMR). The aim is to map aspects that shape users' lay knowledge regarding antibiotics use and AMR. METHODS: This is an exploratory study, which consists primarily of individual in-depth interviews with 19 respondents. Recurrent interview topics were coded and analysed according to thematic content analysis. RESULTS: Our findings show users' lived experiences constitute three dimensions related to users' previous antibiotic use: (1) lay knowledge about medicines; (2) previous bacterial infections and (3) communication during the consultation. Lay knowledge encompasses the users' understanding of how antibiotics work in comparison to other drugs and experimentations they make with medication. Users' narratives about bacterial infections are divided into situations of urinary tract infections and antibiotic treatments for other conditions. Communication during the consultation is mainly characterized by a lack of shared knowledge and trust in the doctor-patient relationship. DISCUSSION: Users bring together knowledge learned from their own experiences to create the rationale, which shapes how they understand antibiotic use, bacterial infections and medical advice. These experiences are interwoven with information received from healthcare professionals (HPs) on these topics, creating a scenario that goes beyond professional information about antibiotic use. Users have knowledge about medication, antibiotics use and bacterial infection but do not have room to share it with HP, allowing lived experiences to take precedence over professional information. CONCLUSION: Users ascribe symbolic meanings to antibiotics creating a lay knowledge frame, even if this knowledge is not scientifically correct. The personal experiences of bacterial infections and their treatment are also an important source of knowledge about antibiotic use and AMR among users. Users demand from their HPs both trust and willingness to listen to their health narratives and experiences. By considering lay knowledge as part of the assessment of a user's health condition, rather than dismissing it as erroneous and therefore unworthy of attention, HPs may enhance the compliance of users. PATIENT OR PUBLIC CONTRIBUTION: Patients or community members did not participate in the design stage of the study. Primary Care patients were invited to participate as respondents of in-depth interviews, which were carried out by the first author at a Primary Care Unit (PCU) in the suburb of Campo Limpo, Southern region of São Paulo, Brazil. Patients were interviewed after reading and signing a Free and Informed Consent Form, holding with them a copy of the Form. Among the final activities of the project, a feedback session at the same PCU is planned to report on the results of the study. All respondents will have the opportunity to contribute further information regarding their antibiotic use and exchange knowledge and experiences on antimicrobial resistance.

Assuntos

Antibacterianos , Infecções Bacterianas , Humanos , Antibacterianos/uso terapêutico , Brasil , Relações Médico-Paciente , Pesquisa Qualitativa , Infecções Bacterianas/tratamento farmacológico

RESUMO

The composition and diversity of the gut microbiota are essential for the health and development of the immune system of infants. However, there is limited information on factors that influence the gut microbiota of very preterm infants. In this study, we analyzed factors that affect the gut microbiota of very preterm infants. The stool samples from 64 very preterm infants with a gestational age less than 32 weeks were collected for 16S rRNA gene sequencing. The infants were divided according to the delivery mode, antibiotic use during pregnancy, and feeding methods. The abundance of Proteobacteria was high in both cesarean (92.7%) and spontaneous (55.5%) delivery groups and then shifted to Firmicutes after the first week of birth. In addition, Proteobacteria was also the dominant phylum of infant gut microbiome for mothers with antibiotic use, with more than 50% after the first week of birth. In comparison, the dominant phylum for mothers without antibiotic use was Firmicutes. Proteobacteria level was also high in breastfeeding and mixed-feeding groups, consisting of more than 90% of the community. By contrast, Proteobacteria was the dominant phylum at the first week of birth but then shifted to Firmicutes for the formula-fed group. The alterations of gut microbiota in infants can affect their health condition during growth. This study confirmed that the different feeding types, delivery modes, and use of antibiotics during pregnancy can significantly affect the composition of the gut microbiota of very preterm infants.

RESUMO

Intensive pig production systems are a source of stress, which is linked to reduced animal welfare and increased antimicrobial use. As the gatekeepers of the welfare of the animals under their care, farmers are seen as the stakeholder responsible for improving animal welfare. The aim of this study was to explore the knowledge and attitudes of pig farmers towards pig welfare and the impact of such attitudes on farmers' selection of management strategies on the farm. We conducted in-depth semi-structured interviews with 44 pig farmers in one of the main pig producing regions of Brazil. Interviews covered knowledge and attitudes towards pig sentience and behaviour and welfare-related issues commonly observed in intensive pig farms (belly-nosing, fights, tail-biting, diarrhoea and castration without pain control) and farmers' conception and attitudes towards pig welfare. We identified many management and animal-based indicators of poor welfare, such as the use of painful and stressful management practices and use of environments that limit the expression of natural behaviours. However, most farmers were satisfied with animal welfare standards at their farms. Farmers' perceptions are aligned with their understanding of animal welfare. Although they identified all the dimensions that impact the welfare of a pig on a farm (affect, biological functioning and naturalness), their social reality, industry demands and available advice pushed them to perceive their range of action limited to biological and environmental aspects of the animals that do not necessarily benefit affective state. This precluded farmers from making associations between good health and the animal's ability to express a full behavioural repertoire, as well as from viewing abnormal behaviours as problems. The negative consequences for the welfare of the animals were commonly alleviated by routines that relied on constant use of medication, including high dependence on antibiotics. Expressions of estrangement from the production chain were common voices among the participants. This suggests that farmers may not be sufficiently informed or engaged in responding to consumers' expectations and commitments made by companies, which can pose a severe economic risk for farmers. The findings of this study indicate that economic, technical and social factors restrict farmers' autonomy and their ability to perform their role as stewards of animal welfare. (Re)connecting different human, animal and environmental interests may be a step to changing this scenario.

Assuntos

Bem-Estar do Animal , Fazendeiros , Criação de Animais Domésticos , Animais , Antibacterianos , Brasil , Fazendas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Suínos

RESUMO

Objectives: Education and awareness-raising are global health policy tools to modify public behavior towards antibiotic resistance. Considering the high frequency of antibiotic use and self-medication in Egypt, together with the lack of an awareness agenda, our objectives were to assess the knowledge and practices related to antibiotic use and resistance among patients attending dental clinics, and to evaluate the changes in knowledge following a specially designed one-on-one educational session. Material and Methods: A convenience sample of 310 dental patients participated in this study. A modified questionnaire was used to assess knowledge and practices related to antibiotic use and resistance. Second-year dental students were trained to administer the questionnaire and to use the educational materials they designed to raise awareness. Following the education session, patients completed another similar questionnaire to assess the changes in their knowledge. Results: Increasing awareness of antibiotic resistance can be an effective way to address the antibiotic resistance crisis. More than half of the participants (55.6%) did not know whether antibiotics treat diseases caused by bacterial or viral infections. The majority of participants (85.5%) had taken antibiotics during the last year, and (50.5%) of them had taken the same antibiotic more than once. Higher educational levels of the participants were significantly associated with a higher level of knowledge. Statistically significant increase in the percentages of correct answers to all questions were observed after the educational sessions. Conclusion: The one-on-one educational session is an effective approach to address the antibiotic resistance crisis (AU)

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Objetivos: Educação e conscientização são ferramentas de política de saúde global para modificar o comportamento do público em relação à resistência aos antibióticos. Considerando a alta frequência de uso de antibióticos e automedicação no Egito, juntamente com a falta de uma agenda de conscientização, nossos objetivos foram avaliar o conhecimento e as práticas relacionadas ao uso de antibióticos e resistência entre pacientes atendidos em clínicas odontológicas, e avaliar as mudanças em conhecimento após uma sessão educacional especialmente projetada para este assunto. Material e Métodos: Uma amostra de 310 pacientes odontológicos participou deste estudo. Um questionário modificado foi usado para avaliar o conhecimento e as práticas relacionadas ao uso e resistência a antibióticos. Os alunos do segundo ano do curso de odontologia foram treinados para aplicar o questionário e usar os materiais educacionais que elaboraram para aumentar a conscientização. Após a sessão educacional, os pacientes responderam a outro questionário semelhante para avaliar as mudanças em seus conhecimentos. Resultados: Aumentar a conscientização sobre a resistência aos antibióticos pode ser uma forma eficaz de lidar com a crise de resistência aos antibióticos. Mais da metade dos participantes (55,6%) não sabia se os antibióticos tratam doenças causadas por infecções bacterianas ou virais. A maioria dos participantes (85,5%) havia tomado antibiótico no último ano e (50,5%) deles havia tomado o mesmo antibiótico mais de uma vez. O maior nível de escolaridade dos participantes foi significativamente associado a um maior nível de conhecimento. Aumentos estatisticamente significativos nas porcentagens de respostas corretas para todas as questões foram observados após a sessão educacional. Conclusão: A sessão educacional individual é uma abordagem eficaz para lidar com a crise de resistência aos antibióticos. (AU)

Assuntos

Humanos , Masculino , Feminino , Resistência Microbiana a Medicamentos , Conhecimento , Antibacterianos

RESUMO

The aim of this study was to assess the effect of the adoption of a set of good practices of handling on dairy calves welfare. Data were retrieved from the records of a commercial farm, considering three periods: Conventional handling (CH, 12 mo.), transitional period (TP, 4 mo.), and good practices handling (GPH, 12 mo.). During CH calves were kept in individual pens, milk-fed in open pails and subjected to abrupt weaning; while during TP and GPH they were kept in groups, milk-fed in nipple-pails, brushed for 5 min. once a day, and subjected to progressive weaning. TP was assumed as a training period necessary for GPH implementation. The percentages of calves treated with antibiotics and numbers of deaths per month were used as indicators of calves welfare. Statistical analysis was performed using a logistic regression model to compare the number of deaths per month between CH and the other periods. Chi-square test was used to compare the percentage of animals treatedwith antibiotics per month. Results showed that CH had a higher risk of calf's death then TP and GPH, as well as a higher percentage of animals treated with antibiotics. In conclusion, the adoption of good practices of handling improved dairy calves welfare.

Assuntos

Feminino , Animais , Bovinos , Antibacterianos/biossíntese , Bem-Estar do Animal , Bovinos/crescimento & desenvolvimento , Estimulação Física

RESUMO

The aim of this study was to assess the effect of the adoption of a set of good practices of handling on dairy calves welfare. Data were retrieved from the records of a commercial farm, considering three periods: Conventional handling (CH, 12 mo.), transitional period (TP, 4 mo.), and good practices handling (GPH, 12 mo.). During CH calves were kept in individual pens, milk-fed in open pails and subjected to abrupt weaning; while during TP and GPH they were kept in groups, milk-fed in nipple-pails, brushed for 5 min. once a day, and subjected to progressive weaning. TP was assumed as a training period necessary for GPH implementation. The percentages of calves treated with antibiotics and numbers of deaths per month were used as indicators of calves welfare. Statistical analysis was performed using a logistic regression model to compare the number of deaths per month between CH and the other periods. Chi-square test was used to compare the percentage of animals treatedwith antibiotics per month. Results showed that CH had a higher risk of calf's death then TP and GPH, as well as a higher percentage of animals treated with antibiotics. In conclusion, the adoption of good practices of handling improved dairy calves welfare.(AU)

Assuntos

Animais , Feminino , Bovinos , Bovinos/crescimento & desenvolvimento , Bem-Estar do Animal , Antibacterianos/biossíntese , Estimulação Física

RESUMO

BACKGROUND: Inappropriate prescriptions of antibiotics lead to ineffective and unsafe treatments and worsening of diseases. Medical students may have deficiencies in their prescription skills and they may need further training in the use of antibiotics for their practice. Medical skills in prescribing antibiotics can be improved through continuous medical education. The aim of this study was to assess the current levels of knowledge, attitudes, and practices (KAP) in antibiotic prescription in upper respiratory tract infections (URTI) among postgraduate family medicine students in Ecuador. METHODS: A cross-sectional study with an on-line survey, based on micro-curricular contents, to evaluate KAPs regarding antibiotic prescription in URTI among postgraduate family medicine students in 5 provinces of Ecuador. RESULTS: Two hundred and seventy-three physicians responded (94.1%). Most physicians treated between 1 and 5 URTI cases per day. The odds for inadequate knowledge and inappropriate practices in URTI among postgraduate family medicine students were 8.74 (95%CI, 4.94-15.46, P < .001) and 5.99, (IC95%, 2.66-13.50, P < .001) in physicians who were students of the first half of the study program. CONCLUSION: The knowledge in URTI was limited among physicians. Nonetheless, they expressed a positive attitude toward not using antibiotics in URTI. A postgraduate program can significantly improve the knowledge and practices related to antibiotic prescriptions in URTI.

Assuntos

Antibacterianos , Medicina de Família e Comunidade , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Antibacterianos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Masculino , Padrões de Prática Médica , Estudantes

RESUMO

A total of 2,184 pigs (DNA 600 × PIC L42) were used to evaluate the effects of weaning age and antibiotic (AB) use on pig performance from weaning to marketing in a commercial production system. Experimental treatments were arranged in a 3 × 2 factorial with main effects of weaning age (18.5, 21.5, or 24.5 d of age) and with the use of ABs or an antibiotic-free (NAE) program. At birth, pigs were ear tagged, and the date of birth and sex recorded. Pigs were weaned from a 4,000-sow farm over four consecutive weeks. Four weaning batches (one per week) of 546 pigs were used. Each weaning batch had one-third of pigs of each weaning age. Pigs were placed in pens by weaning age and then randomly assigned to an AB or NAE program. There were 14 replicate pens per treatment and 26 pigs per pen (13 barrows and 13 gilts). Pigs allocated to the AB program were fed a diet containing 441 mg/kg chlortetracycline (CTC) from day 8 to 21 postweaning. They were also administered 22 mg/kg of body weight (BW) of CTC via drinking water for five consecutive days after a porcine respiratory and reproductive syndrome outbreak during week 7 after weaning. In the first 42 d postweaning, increasing weaning age improved (linear, P < 0.001) BW at day 42, average daily gain (ADG), and average daily feed intake (ADFI). From weaning to 197 d of age, increasing weaning age increased (linear, P < 0.001) ADG and ADFI. Pigs on the AB program had greater (P = 0.031) ADG and ADFI compared with NAE pigs. An interaction (linear, P = 0.005) was observed for feed efficiency (G:F). When ABs were provided, increasing weaning age did not result in any change in G:F; however, in the NAE program, increasing weaning age increased G:F. Pigs on the AB program had lower (P < 0.001) total losses (mortality and removals) than those on the NAE program. Increasing weaning age marginally (linear, P = 0.097) decreased total losses. Increasing weaning age decreased (quadratic, P < 0.001) the number of pigs treated with an injectable AB but the AB program did not (P = 0.238). The weight sold (at 197 d of age) per pig weaned was increased (linear, P = 0.050) by increasing weaning age and by using AB in feed and water (P = 0.019). In summary, increasing weaning age linearly improved most of the pig performance criteria and relatively the short-term use of ABs reduced mortality and removals with both factors contributing to increased weight sold per pig weaned.

Assuntos

Ração Animal , Antibacterianos , Ração Animal/análise , Animais , Dieta , Ingestão de Alimentos , Feminino , Distribuição Aleatória , Suínos , Desmame

RESUMO

OBJECTIVE: To test whether updated clinical practice guidelines for managing upper respiratory tract infections released in France in November 2011 were associated with changes in national outpatient pediatric antibiotic use. STUDY DESIGN: We performed an interrupted time-series analysis using national antibiotic dispensation data in French children from January 2009 to December 2017 (IQVIA Suivi de la Dispensation Médicale database). We described the overall evolution of antibiotic prescription rates and modeled the changes in the proportion of amoxicillin and the proportion of broad-spectrum antibiotics following the guidelines in 2 age groups (0-5 and 6-14 years old). RESULTS: We analyzed 123 million pediatric antibiotic prescriptions. The most commonly prescribed individual antibiotic agent was amoxicillin (37.7%). Over the study period, the annual antibiotic prescription rate decreased by 33.1% (from 1387 to 928 per 1000 pediatric inhabitants per year), consistently across age groups and major antibiotic agents except for amoxicillin (+14.4%). After the release of the guidelines, we observed a gradual increase in the proportion of amoxicillin (relative change 5 years postintervention of +64.3% [95% CI 51.6-80.1] and +28.4% [21.1-36.2] for children 0-5 and 6-14 years, respectively) concomitantly with a gradual decrease in the proportion of broad-spectrum antibiotics (relative change 5 years postintervention of -26.1% [-29.3, -23.7] and -19.8% [-22.1, -16.0] for children 0-5 and 6-14 years old, respectively). CONCLUSIONS: The 2011 guidelines for upper respiratory tract infections preceded changes in outpatient pediatric antibiotic use at the national level, with a replacement of broad-spectrum antibiotics by amoxicillin.

Assuntos

Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Infecções Respiratórias/tratamento farmacológico , Adolescente , Gestão de Antimicrobianos , Criança , Pré-Escolar , França/epidemiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Análise de Séries Temporais Interrompida , Infecções Respiratórias/epidemiologia

RESUMO

BACKGROUND: Many gaps in the burden of resistant pathogens exist in endemic areas of low- and middle-income economies, especially those endemic for carbapenem resistance. The aim of this study is to evaluate risk factors for carbapenem-resistance, to estimate the association between carbapenem-resistance and all-cause 30-day mortality and to examine whether mortality is mediated by inappropriate therapy. METHODS: A case-control and a cohort study were conducted in one tertiary-care hospital in Medellín, Colombia from 2014 to 2015. Phenotypic and genotypic characterization of isolates was performed. In the case-control study, cases were defined as patients infected with carbapenem-resistant K. pneumoniae (CRKP) and controls as patients infected with carbapenem-susceptible K. pneumoniae (CSKP). A risk factor analysis was conducted using logistic regression models. In the cohort study, the exposed group was defined as patients infected with CRKP and the non-exposed group as patients infected with CSKP. A survival analysis using an accelerated failure time model with a lognormal distribution was performed to estimate the association between carbapenem resistance and all-cause 30-day-mortality and to examine whether mortality is mediated by inappropriate therapy. RESULTS: A total of 338 patients were enrolled; 49 were infected with CRKP and 289 with CSKP. Among CRKP isolates CG258 (n = 29), ST25 (n = 5) and ST307 (n = 4) were detected. Of importance, every day of meropenem (OR 1.18, 95%CI 1.10-1.28) and cefepime (OR 1.22, 95%CI 1.03-1.49) use increase the risk of carbapenem resistance. Additional risk factors were previous use of ciprofloxacin (OR 2.37, 95%CI 1.00-5.35) and urinary catheter (OR 2.60, 95%CI 1.25-5.37). Furthermore, a significant lower survival time was estimated for patients infected with CRKP compared to CSKP (Relative Times 0.44, 95%CI 0.24-0.82). The strength of association was reduced when appropriate therapy was included in the model (RT = 0.81 95%CI 0.48-1.37). CONCLUSION: Short antibiotic courses had the potential to reduce the selection and transmission of CRKP. A high burden in mortality occurred in patients infected with CRKP in a KPC endemic setting and CRKP leads to increased mortality via inappropriate antibiotic treatment. Furthermore, dissemination of recognized hypervirulent clones could add to the list of challenges for antibiotic resistance control.

Assuntos

Antibacterianos/uso terapêutico , Enterobacteriáceas Resistentes a Carbapenêmicos , Doenças Endêmicas , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/mortalidade , Klebsiella pneumoniae/genética , Meropeném/uso terapêutico , Idoso , Antibacterianos/efeitos adversos , Estudos de Casos e Controles , Cefepima/efeitos adversos , Cefepima/uso terapêutico , Ciprofloxacina/efeitos adversos , Ciprofloxacina/uso terapêutico , Colômbia , Farmacorresistência Bacteriana Múltipla , Feminino , Genótipo , Humanos , Estimativa de Kaplan-Meier , Klebsiella pneumoniae/isolamento & purificação , Modelos Logísticos , Masculino , Meropeném/efeitos adversos , Pessoa de Meia-Idade , Fenótipo , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Cateteres Urinários/efeitos adversos

RESUMO

Resumen Antecedentes: Los antimicrobianos (ATM) son uno de los medicamentos más utilizados en recién nacidos (RN) hospitalizados. El uso indiscriminado de ATM trae consecuencias negativas como son el predominio de bacterias resistentes a los ATM usualmente utilizados y asociaciones individuales a morbilidad relevante como son la displasia broncopulmonar, enterocolitis necrosante, sepsis tardía y/o muerte. Objetivo: Registrar y evaluar las tendencias del uso de ATM a lo largo del tiempo en RN hospitalizados en el Servicio de Neonatología (SRN) del Complejo Asistencial Dr. Sótero del Río, con el fin de objetivar los cambios en la práctica habitual de la indicación de ATM. Un objetivo secundario fue evaluar el impacto de estas conductas sobre la resistencia antimicrobiana. Métodos: Estudio de cohorte, prospectivo, observacional, unicéntrico, en todos los pacientes hospitalizados entre enero de 2011 y diciembre de 2014. Se registró el peso al nacer, días de hospitalización, indicación y días de uso de ATM para cada paciente. El uso de ATM fue cuantificado por medio de distintas tasas: días de indicación de un o más ATM para el consumo global (TUA), sumatoria total de días de uso (STUA) como para los ATM más frecuentemente utilizados. Cada tasa calculada por 100 días hospitalizados. Además, se registró la susceptibilidad antimicrobiana de las bacterias más frecuentemente aisladas en nuestro servicio: Staphylococcus coagulasa negativa (SCN) y bacilos gramnegativos (BGNs). Resultados: El 34,7% de los pacientes hospitalizados recibió algún tipo de antimicrobiano, correspondiendo 32,3% a antibacterianos. El ATM más utilizado fue ampicilina (20,2% del total) y luego cefadroxilo (11,6%). El TUA no cambió entre 2011 y 2014. La STUA disminuyó en 10,7% entre 2011 y 2014 (p < 0,05). En el análisis por rangos de peso, en el grupo < 750 g disminuyó la tendencia de uso de vancomicina (descenso de uso en 9,9%) y un aumento de 18,8% para metronidazol. Por otra parte, hubo un aumento en el uso del régimen de piperacilina/tazobactam en el grupo > 1.500 g. Al evaluar la susceptibilidad antimicrobiana, hubo una disminución de la susceptibilidad a cloxacilina en SCN entre 2011 y 2014 desde 27 a 10,3%, respectivamente. Para BGN hubo una disminución desde 76,9 a 40,5% en la susceptibilidad a cefalosporinas de tercera generación, principalmente debido a Klebsiella pneumoniae que pasó a ser el BGN predominante, con un aumento de 6,7 a 50% en los años 2011 y 2014, respectivamente. Para Klebsiella pneumoniae la susceptibilidad a cefalosporinas de tercera generación descendió desde 77 a 22%. Por último, amikacina mostró una actividad sobre 85% en todos los BGNs entre 2011 y 2014. Conclusiones: Es recomendable planificar y mantener un registro continuo del consumo de ATM tanto como terapia y profilaxis, idealmente llevar el TUA, el STUA y siendo categorizado por tipo de ATM y rango de peso de los RN. En forma concomitante, es de considerable importancia analizar y evaluar la susceptibilidad de microorganismos. Es esencial que un equipo interdisciplinario prepare este registro, y que continuamente proporcione retroalimentación a los profesionales que mantienen el funcionamiento de las unidades de cuidados neonatales.

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Background: Antibiotics (ATB) are drugs widely used in hospitalized newborns. The indiscriminate use of ATBs promote the rise of resistant bacteria to the most commonly indicated antimicrobials. In addition, ATB prescription presents associations to morbidity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, late sepsis and even death. All of the above leads to an increase in health care costs. Aim: To record and to evaluate trends of antibiotic use over time in hospitalized NB in the Neonatology Unit at Dr. Sótero del Río Hospital, in order to objectify the changes in the usual practice of the ATM indication. A secondary objective was to assess its impact on antimicrobial resistance. Methods: Cohort, observational, prospective unicenter study which included all hospitalized patients between January 2011 and December 2014. Birth weight, hospitalization days, ATB indication and days of ATB use were recorded for each patient. The use of ATB was quantified by means of different rates; days of indication of one or more ATBs for global consumption (RUA), total sum of days of use (TSUA) and for the most frequently used ATBs. Each calculated rate for 100 days hospitalized. In addition, the antimicrobial susceptibility of the most frequently isolated bacteria in our service: coagulase-negative Staphylococcus (SCN) and Gram-negative bacilli (BGN) were recorded continuously. Results: The 34.7% of the hospitalized patients received some type of antimicrobial agent. ATBs were 32.3% of medicines used. The most widely used was ampicillin (with 20.2% of the total) and cefadroxyl (with 11.6%). The RUA did not change during the study time, but STUA decreased by 10.7% between 2011 and 2014 with p < 0.05. When subgroup analyzes were divided by weight ranges, in the < 750 g group, the use of vancomycin decreased in use by 9.9% and an increase of 18.8% for metronidazole was observed. On the other hand, there was an increase in the use of the piperacillin-tazobactam regimen in the range > 1,500 g. When evaluating antimicrobial susceptibility, there was a decrease in susceptibility for oxacillin in SCN between 2011 and 2014 from 27% to 10.3% respectively. In addition, for Gram negative there was a decrease from 76.9% to 40.5% in susceptibility to third generation cephalosporins, mainly due to Klebsiella pneumoniae, which became the predominantly isolated BGN with an increase of 6.7% to 50% between 2011 and 2014, respectively. For K. pneumoniae the loss of susceptibility to third generation cephalosporins decreased from 77% to 22%. Finally, amikacin showed an activity over 85% in all BGNs between 2011 and 2014. Conclusions: It is advisable to plan and to maintain a continuous record of ATB consumption, as well as therapy and prophylaxis, being categorized by ATB type and range of newborn weight. It is of considerable importance to analyze and to evaluate the susceptibility of microorganisms. It is essential that an interdisciplinary team prepare this recording, and to continuously provide feedback to professionals who maintain the functioning of neonatal care units.

Assuntos

Humanos , Masculino , Feminino , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Farmacorresistência Bacteriana , Programas de Monitoramento de Prescrição de Medicamentos , Gestão de Antimicrobianos/métodos , Antibacterianos/uso terapêutico , Fatores de Tempo , Testes de Sensibilidade Microbiana , Chile , Estudos Prospectivos , Fatores de Risco , Estatísticas não Paramétricas , Uso Indevido de Medicamentos sob Prescrição

RESUMO

Infections are the leading cause of morbidity and mortality among burn-injury patients. Even in the absence of documented infection, antibiotics are often given to burn-injury patients at the beginning of treatment, an empirical measure in response to signs and symptoms of infection. The choice of antimicrobial therapy for these patients should be based on technical criteria, based on laboratory findings, at the risk of further increasing antimicrobial resistance levels.

Assuntos

Anti-Infecciosos/uso terapêutico , Queimaduras/complicações , Uso de Medicamentos , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem

RESUMO

The use of antibiotics in livestock can pose a public health threat, especially if antibiotic residues remain in the food product. Understanding how often and why farmers sell products with antibiotic residues is critical to improving the quality of these products. To understand how often milk with antibiotic residues is sold on small farms in a major dairy-producing region of Peru and identify factors associated with selling milk with antibiotic residues, we tested milk samples for antibiotic residues from every provider on three routes of commercial milk companies and from bulk tanks of farmers currently treating cows with antibiotics. We also asked farmers if they sold milk from treated cows and examined factors associated with the tendency to do so. The prevalence of milk contamination with antibiotic residues on commercial routes was low (0-4.2%); however, 33/36 farmers treating their animals with antibiotics sold milk that tested positive for antibiotic residues. The self-reported sale of milk from treated cows had a sensitivity, specificity, and positive and negative predictive values of 75.8%, 100%, 100% and 27.2%, respectively (with testing of milk for residues as the gold standard). Finally, 69/156 randomly selected farmers reported selling milk from treated cows, and farmers' knowledge of antibiotics and the milk purchaser were significantly associated with a farmer's tendency to report doing so. Educating farmers on the risks associated with antibiotics and enforcement of penalties for selling contaminated milk by milk companies are needed to improve milk quality.

Assuntos

Antibacterianos/análise , Indústria de Laticínios , Resíduos de Drogas/análise , Contaminação de Alimentos/análise , Leite/química , Adulto , Animais , Antibacterianos/toxicidade , Indústria de Laticínios/métodos , Indústria de Laticínios/normas , Coleta de Dados , Países em Desenvolvimento , Resíduos de Drogas/toxicidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Leite/toxicidade , Peru , População Rural

RESUMO

Antibiotics are commonly used in animal agriculture; they can improve animal health and productivity, but their use may also represent a public health threat. Very little is known about antibiotic use on small farms in lower/middle income countries. To understand antibiotic use on these farms and promote the judicious use of these drugs, pharmacoepidemiologic data are necessary. However, acquiring such data can be difficult, as farmers are often illiterate (and therefore cannot participate in written surveys or keep treatment records), antibiotics can be obtained over-the-counter (in which case no prescriptions are generated) and monitoring and surveillance systems for drug use are often non-existent. The goal of this study was to compare two methods of acquiring pharmacoepidemiologic data pertaining to antibiotics that are well-adapted to farms in lower-middle income countries: self-report and the collection of discarded drug packaging. A convenience sample of 20 farmers in Cajamarca, Peru, participated in the study. Farmers placed discarded antibiotic packaging in bins for six months. At the end of the six-month period, farmers were interviewed and asked to recall the antibiotic usage that occurred on their farm over the past month and past six months; these self-reported data were quantitatively and qualitatively compared to the bin contents collected in the last month and previous six months. We found that the agreement between the bins and self-report was relatively poor for both the quantity and types of antibiotics used. The bins appeared to perform better than self-report when bottles and mLs of antibiotics were measured, while self-report appeared to perform better for intra-mammary infusions. The bins also appeared to perform better when data pertaining to an extended time period (six months) were collected. The results of this study will provide guidance to investigators seeking to collect pharmacoepidemiologic data in similar environments.

Assuntos

Criação de Animais Domésticos , Antibacterianos/administração & dosagem , Bovinos , Indústria de Laticínios , Coleta de Dados/métodos , Uso de Medicamentos , Animais , Peru/epidemiologia , População Rural , Fatores Socioeconômicos

RESUMO

Very little is known about the use of antibiotics on small dairy farms in lower/middle-income countries. The use of these drugs can have profound impacts on animal health, farmer income and public health. A survey of 156 farmers was conducted in Cajamarca, a major dairy-producing center in the highlands of Peru characterized by small farms (<15 cows) to assess patterns and determinants of antibiotic use and farmers' knowledge of antibiotics. The reported incidence of disease on these farms was relatively low (0.571 episodes of disease per cow-year), but more than 83% of the reported episodes were treated with antibiotics. The most commonly used antibiotics were oxytetracycline, penicillin and trimethoprim-sulfamethoxazole drugs; antiparasitic drugs were also used to treat what were likely bacterial infections. An increased incidence of treated disease was significantly associated with smaller farm size, lower farmer income, the previous use of the Californian Mastitis test on the farm and antibiotic knowledge. Farmers' knowledge of antibiotics was assessed with a series of questions on antibiotics, resulting in a "knowledge score". Increased knowledge was significantly associated with the use of antibiotics for preventative reasons, the purchase of antibiotics from feed-stores, the experience of complications in animals after having administered antibiotics, the number of workers on the farm and the educational level of the farmer. Overall, antibiotics appeared to be used infrequently, most likely because therapeutic interventions were sought only when the animal had reached an advanced stage of clinical disease. Few farmers were able to define an antibiotic, but many farmers understood that the use of antibiotics carried inherent risks to their animals and potentially to the consumers of dairy products from treated animals. The results of this study are useful for understanding the patterns of antibiotic use and associated management, demographic and knowledge factors of farmers on small dairy farms in rural Peru.

Assuntos

Antibacterianos/administração & dosagem , Bovinos , Agricultura , Animais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Análise de Regressão , População Rural , Fatores Socioeconômicos , Inquéritos e Questionários