RESUMO

Our center launched the first antimicrobial stewardship program in Peru. From 2016 to 2023, the proportion of antimicrobial prescriptions audited increased from 60% to 95%, and 65% to 95% of recommendations were accepted. Vancomycin and meropenem use dropped by 95% and 84%, respectively. The proportion of recommendations for surgical prophylaxis exceeded 90%.

RESUMO

Background and Objectives: In Peru, the presence of antimicrobial-resistant bacteria is a constant concern in hospitals and has likely increased in frequency during the pandemic. The objective of the study was to analyze the frequency of carbapenemase-producing bacteria resistant to two carbapenems (Imipenem and Meropenem), which were isolated from Peruvian patients in the intensive care unit of the Victor Lazarte Echegaray Hospital in Trujillo (Peru) during the COVID-19 pandemic. Materials and Methods: The biological samples of the patients hospitalized in the ICU were processed in the Microbiology Diagnostic Laboratory of the Víctor Lazarte Echegaray Hospital between May 2021 and March 2022. Antimicrobial sensitivity was determined with the automated system AutoScan-4, and for the identification of the type of carbapenemase, the RESISIT-3 O.K.N K-SET cassettes were used. Results: The results show that 76 cultures (76/129) had resistance to the two carbapenems (imipenem or meropenem), where the most frequent were Klebsiella pneuomoniae (31.6%), Pseudomonas aeruginosa (26.3%), and Acinetobacter baumannii (14.5%). Pseudomonas aeruginosa cultures showed at least three carbapenemase types (KPC, NDM, and OXA-48), while A. baumannii, Escherichia coli, and Burkholderia cepacia complex presented at least two carbapenemases (NDM and OXA-48). The carbapenemase NDM was detected in Enterobacter cloacae, Morganella morganii, and Proteus mirabilis, while KPC was present in all Klebsiella pneumoniae and Klebsiella oxytoca cultures. Conclusions: The samples from patients hospitalized in the Victor Lazarte Echegaray Hospital ICU showed a high prevalence of imipenem- and meropenem-resistant bacteria. These findings are relevant and concerning from the perspective of antibiotic-resistant bacteria monitoring, control, and disinfection. Thus, an appropriate antibiotic policy must be implemented.

Assuntos

RESUMO

Preventative measures, such as biosecurity and vaccinations, are essential but not sufficient to ensure high standards of health in pig production systems. Restrictive, barren housing and many widely used management practices that cause pain and stress predispose high-performance pigs reared in intensive systems to disease. In this context, antibiotics are used as part of the infrastructure that sustains health and high levels of production in pig farms. Antimicrobial resistance (AMR) is a global emergency affecting human and animal health, and the use of antibiotics (AMU) in intensive livestock farming is considered an important risk factor for the emergence and spread of resistant bacteria from animals to humans. Tackling the issue of AMR demands profound changes in AMU, e.g., reducing their use for prophylaxis and ending it for growth promotion. In support of such recommendations, we revise the link between animal welfare and AMU and argue that it is crucial to sustainably reduce AMU while ensuring that pigs can live happy lives. In support of such recommendations, we aimed to revise the link between animal welfare and AMU in pigs by analysing stress factors related to housing and management and their impact on pig welfare. In particular, we reviewed critical management practices that increase stress and, therefore, pigs' susceptibility to disease and reduce the quality of life of pigs. We also reviewed some alternatives that can be adopted in pig farms to improve animal welfare and that go beyond the reduction in stress. By minimising environmental and management stressors, pigs can become more immunocompetent and prepared to overcome pathogenic challenges. This outcome can contribute to reducing AMU and the risk of AMR while simultaneously improving the quality of life of pigs and, ultimately, maintaining the pig industry's social license.

RESUMO

PURPOSE: To describe the antimicrobial use in four tertiary care hospitals in Mexico. PATIENTS AND METHODS: Point prevalence surveys (PPSs) were conducted on medical records of hospitalized patients with prescribed antimicrobials (AMs) in four tertiary care hospitals in Mexico in 2019. Prevalence estimates and descriptive statistics were used to present the collected data on antimicrobial prescribing and microbiological studies. RESULTS: The prevalence of patients with prescribed AMs among the hospitals ranged from 47.1% to 91.3%. Antibiotics for systemic use (J01s) were the most prescribed (84.6%, [95% CI: 81.5-87.3]), mainly extended-spectrum J01s: third-generation cephalosporins 19.8% [95% CI: 16.8-23.1], and carbapenems 17.0% [95% CI: 14.2-20.2]. Antibiotic treatments were largely empirical, with no planned duration or review dates. The ceftriaxone use was excessive and prolonged. No formal reference guidelines for antimicrobial prescribing were available in the hospitals. Multidrug-resistant Escherichia coli and ESKAPE pathogens were identified in all hospitals. CONCLUSION: This study describes the extensive use of antimicrobials and broad-spectrum antibiotics for systemic use in Mexican hospitals, along with the presence of resistant pathogens to the antibiotics frequently used in the hospitals surveyed.

RESUMO

Brazil, as a major pig producer, is currently experiencing the widespread use of antimicrobials as a serious issue to be addressed. For measures to be taken in this direction, the extent of the problem must be known. The goal of this study was to evaluate the use of antimicrobials in 25 Brazilian swine herds. Antimicrobial use from birth to slaughter was correlated with biosecurity and productivity. After the first assessment (2016; M0), 13 herds implemented good practices to reduce antimicrobial use. Four years after the implementation of these measures (2020; M1), data about antimicrobial usage from these herds were collected. The results of the first assessment (M0) demonstrated a troublesome scenario: the mean value of antimicrobials used was 358.4 mg/kg of pig produced; the median of the pig's lifetime exposure to antimicrobials was 73.7%, and the median number of drugs used was seven. A positive correlation between the antimicrobials consumed and the pig's antimicrobial exposure time was detected. Nevertheless, these data did not correlate with biosecurity score or productivity. A significant difference was detected in M1, where a median 30% reduction in antimicrobials consumed was detected. There was also a 44.3% reduction of the pig's lifetime exposure to antimicrobials. The median number of drugs used was reduced from seven to five. Antimicrobial use did not always reflect the sanitary condition or the real therapeutic needs, easily leading to overuse.

RESUMO

OBJECTIVE: To describe empirical antimicrobial prescription on admission in patients with severe COVID-19, the prevalence of Hospital-Acquired Infections, and the susceptibility patterns of the causing organisms. METHODS: In this prospective cohort study in a tertiary care center in Mexico City, we included consecutive patients admitted with severe COVID-19 between March 20th and June 10th and evaluated empirical antimicrobial prescription and the occurrence of HAI. RESULTS: 794 patients with severe COVID-19 were admitted during the study period. Empiric antibiotic treatment was started in 92% of patients (731/794); the most frequent regimes were amoxicillin-clavulanate plus atypical coverage in 341 (46.6%) and ceftriaxone plus atypical coverage in 213 (29.1%). We identified 110 HAI episodes in 74/656 patients (11.3%). Ventilator-associated pneumonia (VAP) was the most frequent HAI, in 56/110 (50.9%), followed by bloodstream infections (BSI), in 32/110 (29.1%). The most frequent cause of VAP were Enterobacteriaceae in 48/69 (69.6%), followed by non-fermenter gram-negative bacilli in 18/69 (26.1%). The most frequent cause of BSI was coagulase negative staphylococci, in 14/35 (40.0%), followed by Enterobacter complex in 7/35 (20%). Death occurred in 30/74 (40.5%) patients with one or more HAI episodes and in 193/584 (33.0%) patients without any HAI episode (p < 0.05). CONCLUSION: A high frequency of empiric antibiotic treatment in patients admitted with COVID-19 was seen. VAP and BSI were the most frequent hospital-acquired infections, due to Enterobacteriaceae and coagulase negative staphylococci, respectively.

RESUMO

Although the relationship between the use of antimicrobials and the development of resistant bacteria is well established, information about the use of antimicrobials in companion animals has been poorly described, which represents a risk to public health. The aim of this study was to describe the antimicrobial prescription patterns of Chilean companion animal veterinarians. A nationally distributed survey targeted at companion animal veterinarians was designed. The survey included questions about the veterinarian's demographics, bacterial diseases treated, prescribed antimicrobials, and the use of laboratory diagnostic tools. Three hundred twenty-three responses were collected, most of the respondents were female (59.4%). The most frequently reported bacterial diseases were pyoderma (17.2%), followed by otitis and abscesses (7.4%). The antimicrobials most used corresponded with critically or highly important drugs for veterinary and human use, including ß-lactams (65.3%), quinolones (36.2%) and tetracyclines (23.2%). Only 15% of the veterinarians reported the use of laboratory diagnostic tests, although 67% declared they were aware of the official antimicrobial classification schemes. Our results describe for the first time the usage of antimicrobials by veterinarian practitioners in Chile to treat different diseases in companion animals. The data presented here provide a baseline that could help to promote the implementation of clinical guidelines and regulations in order to improve current treatments.

RESUMO

ABSTRACT Introduction: Use of antibiotic and bacterial resistance is the result of a complex interaction not completely understood. Objectives: To evaluate the impact of entire antimicrobial use (community plus hospitals) on the incidence of bloodstream infections in intensive care units adjusted by socioeconomic factors, quality of healthcare, and access to the healthcare system. Design: Ecologic study using a hierarchical spatial model. Setting: Data obtained from 309 hospitals located in the state of São Paulo, Brazil from 2008 to 2011. Participants: Intensive care units located at participant hospitals. Outcome: Hospital acquired bloodstream infection caused by MDRO in ICU patients was our primary outcome and data were retrieved from São Paulo Health State Department. Socioeconomic and healthcare indexes data were obtained from IBGE (Brazilian Foundation in charge of national decennial census) and SEADE (São Paulo Planning and Development Department). Information on antimicrobial sales were obtained from IMS Brazil. We divided antibiotics into four different groups (1-4). Results: We observed a direct association between the use of group 1 of antibiotics and the incidences of bloodstream infections caused by MRSA (1.12; 1.04-1.20), and CR-Acinetobacter sp. (1.19; 1.10-1.29). Groups 2 and 4 were directly associated to VRE (1.72; 1.13-2.39 and 2.22; 1.62-2.98, respectively). Group 2 was inversely associated to MRSA (0.87; 0.78-0.96) and CR-Acinetobacter sp. (0.79; 0.62-0.97). Group 3 was inversely associated to Pseudomonas aeruginosa (0.69; 0.45-0.98), MRSA (0.85; 0.72-0.97) and VRE (0.48; 0.21-0.84). No association was observed for third generation cephalosporin-resistant Klebsiella pneumoniae and Escherichia coli. Conclusions: The association between entire antibiotic use and resistance in ICU was poor and not consistent for all combinations of antimicrobial groups and pathogens even after adjusted by socioeconomic indexes. Selective pressure exerted at the community level seemed not to affect the incidences of MDRO infection observed in intensive care setting.

Assuntos

RESUMO

INTRODUCTION: Use of antibiotic and bacterial resistance is the result of a complex interaction not completely understood. OBJECTIVES: To evaluate the impact of entire antimicrobial use (community plus hospitals) on the incidence of bloodstream infections in intensive care units adjusted by socioeconomic factors, quality of healthcare, and access to the healthcare system. DESIGN: Ecologic study using a hierarchical spatial model. SETTING: Data obtained from 309 hospitals located in the state of São Paulo, Brazil from 2008 to 2011. PARTICIPANTS: Intensive care units located at participant hospitals. OUTCOME: Hospital acquired bloodstream infection caused by MDRO in ICU patients was our primary outcome and data were retrieved from São Paulo Health State Department. Socioeconomic and healthcare indexes data were obtained from IBGE (Brazilian Foundation in charge of national decennial census) and SEADE (São Paulo Planning and Development Department). Information on antimicrobial sales were obtained from IMS Brazil. We divided antibiotics into four different groups (1-4). RESULTS: We observed a direct association between the use of group 1 of antibiotics and the incidences of bloodstream infections caused by MRSA (1.12; 1.04-1.20), and CR-Acinetobacter sp. (1.19; 1.10-1.29). Groups 2 and 4 were directly associated to VRE (1.72; 1.13-2.39 and 2.22; 1.62-2.98, respectively). Group 2 was inversely associated to MRSA (0.87; 0.78-0.96) and CR-Acinetobacter sp. (0.79; 0.62-0.97). Group 3 was inversely associated to Pseudomonas aeruginosa (0.69; 0.45-0.98), MRSA (0.85; 0.72-0.97) and VRE (0.48; 0.21-0.84). No association was observed for third generation cephalosporin-resistant Klebsiella pneumoniae and Escherichia coli. CONCLUSIONS: The association between entire antibiotic use and resistance in ICU was poor and not consistent for all combinations of antimicrobial groups and pathogens even after adjusted by socioeconomic indexes. Selective pressure exerted at the community level seemed not to affect the incidences of MDRO infection observed in intensive care setting.

Assuntos

RESUMO

The aims of this prospective and descriptive study were to: (a) characterize treatment profile and quantify antimicrobial consumption for treatment of clinical mastitis (CM) in dairy herds of Brazil; and, (b) determine the association of antimicrobial use (AMU) for treatment of CM and herd-level descriptors, such as herd size, average milk yield, bulk milk somatic cell count (BMSCC), bulk milk total bacterial count (BMTBC), season and housing type. Data on treatment practices were obtained from 19 of 20 dairy herds selected for the study for a period of 12 months per herd. Treatment protocols were recorded in each case of CM by the farm personnel using a form that included information at the cow- and treatment-level. The frequency of antimicrobial consumption for treatment of CM was determined monthly in units of defined daily dose (DDD) and expressed as antimicrobial treatment incidence (ATI; the number of DDD per 1,000 lactating cow-days). Mixed linear regression models were used to determine the association between log-transformed ATI and herd level descriptors. The overall monthly mean ATI was 21.9 DDD per 1,000 lactating cow-days (15.4 DDD per 1,000 lactating cow-days for intramammary compounds, and 6.4 DDD per 1,000 lactating cow-days for systemically administered antimicrobials). Among intramammary drugs, aminoglycosides had the highest ATI (11.7 DDD per 1,000 lactating cow-days), followed by a treatment with a combination of tetracycline, aminoglycoside and polypeptide (10.3 DDD per 1,000 lactating cow-days). For systemically administrated antimicrobials, fluoroquinolones (6.1 DDD per 1,000 lactating cow-days), penicillin combinations (3.9 DDD per 1,000 lactating cow-days), and the combination of sulfonamide and pyrimidine (3.6 DDD per 1,000 cows per day) were the most frequently used antimicrobials. The use of combination therapy (i.e., association of intramammary and systemically administered antimicrobials) was reported for 64.3 % of treatments at the cow-level. The AMU tended to be higher in herds with highest BMSCC. In addition, a higher AMU for treatment of CM was observed during the rainy season compared to the dry season in Brazil. This seasonal effect was mostly characteristic in herds housing cows in outdoor housing systems (i.e., paddocks).

Assuntos

RESUMO

Shiga toxin-producing Escherichia coli (STEC) is a zoonotic pathogen and important cause of foodborne disease worldwide. Many animal species in backyard production systems (BPS) harbor STEC, systems characterized by low biosecurity and technification. No information is reported on STEC circulation, antimicrobial resistance (AMR) and potential drivers of antimicrobial usage in Chilean BPS, increasing the risk of maintenance and transmission of zoonotic pathogens and AMR generation. Thus, the aim of this study was to characterize phenotypic and genotypic AMR and to study the epidemiology of STEC isolated in BPS from Metropolitana region, Chile. A total of 85 BPS were sampled. Minimal inhibitory concentration and whole genome sequencing was assessed in 10 STEC strain isolated from BPS. All strains were cephalexin-resistant (100%, n = 10), and five strains were resistant to chloramphenicol (50%). The most frequent serotype was O113:H21 (40%), followed by O76:H19 (40%), O91:H14 (10%), and O130:H11 (10%). The stx1 type was detected in all isolated strains, while stx2 was only detected in two strains. The Stx subtype most frequently detected was stx1c (80%), followed by stx1a (20%), stx2b (10%), and stx2d (10%). All strains harbored chromosomal bla AmpC. Principal component analysis shows that BPS size, number of cattle, pet and horse, and elevation act as driver of antimicrobial usage. Logistic multivariable regression shows that recognition of diseases in animals (p = 0.038; OR = 9.382; 95% CI: 1.138-77.345), neighboring poultry and/or swine BPS (p = 0.006; OR = 10.564; 95% CI: 1.996-55.894), visit of Veterinary Officials (p = 0.010; OR = 76.178; 95% CI: 2.860-2029.315) and close contact between animal species in the BPS (p = 0.021; OR = 9.030; 95% CI: 1.385-58.888) increase significantly the risk of antimicrobial use in BPS. This is the first evidence of STEC strains circulating in BPS in Chile, exhibiting phenotypic AMR, representing a threat for animal and public health. Additionally, we identified factors acting as drivers for antimicrobial usage in BPS, highlighting the importance of integration of these populations into surveillance and education programs to tackle the potential development of antimicrobial resistance and therefore the risk for ecosystemic health.

RESUMO

The objective was to gather information on the status of antimicrobial surveillance in the Asia Pacific region and suggest control strategies. Twenty-one economies of the Asia Pacific region participated in this initiative. A survey was conducted on antimicrobial use and surveillance throughout the region. A workshop was carried out to create awareness about the issue and discuss the implementation of control strategies. Based on the survey results and workshop conclusions, it can be established that there is better understanding of the implications of antimicrobial resistance in the human medicine area. Only few economies take actions to control antimicrobial resistance on a veterinary/agricultural level. To confront antimicrobial resistance, it is critical to raise awareness; cooperation between all countries is needed to apply international standards, to be able to have harmonized public policies. Countries must align and improve their systems for surveillance and monitoring of antimicrobial resistance in human, animals, and the environment.

Assuntos

RESUMO

Much of healthcare in developing countries takes place in small hospitals. Little is known about the use of antimicrobials in those settings. We studied the 60-day use of parenteral antimicrobials in 48 hospitals with up to 50 beds in inner Brazil. The overall use was 242.0 defined daily doses per 100 admissions, and broad-spectrum agents accounted for 26.8%. The existence of local guidelines, educational measures and restrictive policies for antimicrobial prescriptions, as well as infection control and microbiology resources, were significantly associated with lesser use. Those findings point to possible interventions aimed at preventing antimicrobial over-use in developing countries.

Assuntos

RESUMO

Las quinolonas son antibacterianos eficaces contra gérmenes gramnegativos y especialmente útiles para eliminar infecciones de las vías urinarias u otras localizaciones, así como también para tratar a pacientes con enfermedades de transmisión sexual. Al respecto se realizó un estudio sobre el uso y abuso del ciprofloxacino, por constituir un antimicrobiano comúnmente utilizado de forma inadecuada e indiscriminada.

Quinolones are effective antibacterials against gram-negative germs. In addition, they are especially useful to eliminate infections of the urine ducts and other regions, as well as to treat patients with sexually transmitted diseases. A study about the ciprofloxacin use and overuse was carried out because it is an antimicrobial which is commonly used in an inappropriately and indiscriminately way.

RESUMO

This study describes vancomycin prescribing patterns in an average complexity hospital and compare the guidelines proposed by the Hospital Infection Control Practices Advisory Committee (HICPAC). The study was conducted in a 256-bed secondary-care hospital. Data were collected of all patients given vancomycin from March 2003 to February 2004, using a standardized chart-extraction form designed. Appropriate and inappropriate use was reviewed according to the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines on prudent vancomycin use. Out of 118 prescriptions, 95 (80.5 percent) were considered appropriate. Out of these 95 orders, 77 (81.1 percent) were administered for empiric treatment of suspected Gram-positive infections, 17 (17.9 percent) were administered for treatment of proven Gram-positive infections (76.5 percent identified as Staphyloccocus aureus-like agents) and 1 (1.0 percent) for beta-lactam allergy. The majority of the patients (96.6 percent) had recently used an antimicrobial medication (3 months). The mean pre-treatment hospitalization period was 11±10 days. Out of the 118 treatments, 67 (56.8 percent) were for nosocomial infections. The more frequent indications for vancomycin use were pneumonia (48.3 percent) and primary sepsis (18.6 percent), accounting for more than 66 percent of all treatments. No restriction policy was suggested because vancomycin use was considered adequate in the majority of the treatment cases. The broad empiric use of this antimicrobial was greater than expected in the institution and its use should be revised.

Assuntos

RESUMO

A enteropatia proliferativa suína (EPS), causada pela bactéria Lawsonia intracellularis, causa perdas econômicas importantes mundialmente, devido à diarréia e baixa taxa de crescimento de suínos na recria (forma crônica) e à morte súbita de animais de terminação e reposição (forma aguda). Programas de controle têm sido focalizados na medicação com antibióticos na ração. Essencialmente, a eficiência de um antimicrobiano pode ser testada in vitro ou in vivo. Testes in vivo podem ser desenvolvidos utilizando-se animais natural ou experimentalmente infectados. No caso de infecção experimental, o inóculo pode ser preparado com culturas puras de L. intracellularis ou com homogenado de mucosa intestinal de leitões enfermos. O uso de antimicrobianos tem-se mostrado eficiente em reduzir os sinais clínicos da EPS, resultando em melhor performance dos animais tratados em relação aos não-medicados e na redução da eliminação fecal da bactéria e da extensão e severidade das lesões macroscópicas. A maioria dos fármacos eficientes que são discutidas no texto são dos grupos dos macrolídeos, das tetraciclinas, lincosamidas e pleuromutilinas. Todos esses fármacos agem bloqueando a síntese protéica de bactérias.(AU)

Porcine proliferative enteropathy (PPE), caused by the bacterium Lawsonia intracellularis, causes serious economic losses worldwide due to diarrhea and poor growth rate medication in young growing pigs (chronic disease form) and sudden death in finisher and replacement pigs (acute hemorrhagic form). Typical control programs have focused on antibiotics. Essentially, the effectiveness of an antimicrobial can be tested in vitro or in vivo. In vivo test can be developed with natural or experimentally infected pigs. In tests that the animals are experimentally challenged, the inoculation is done with pure culture of L. intracellularis or intestinal mucosal homogenate of pig with PPE. Antimicrobial use have been shown to be effective in reducing the clinical signs of PPE and to result in better performance in treated pigs than in untreated animals. In addition, it decreases fecal shedding and the severity of gross lesions. The most efficient antimicrobial groups of drugs discussed in this manuscript are macrolides, tetracyclines, lincosamides and pleuromutilins. All of them act by blocking bacterial protein synthesis.(AU)

Assuntos

RESUMO

A enteropatia proliferativa suína (EPS), causada pela bactéria Lawsonia intracellularis, causa perdas econômicas importantes mundialmente, devido à diarréia e baixa taxa de crescimento de suínos na recria (forma crônica) e à morte súbita de animais de terminação e reposição (forma aguda). Programas de controle têm sido focalizados na medicação com antibióticos na ração. Essencialmente, a eficiência de um antimicrobiano pode ser testada in vitro ou in vivo. Testes in vivo podem ser desenvolvidos utilizando-se animais natural ou experimentalmente infectados. No caso de infecção experimental, o inóculo pode ser preparado com culturas puras de L. intracellularis ou com homogenado de mucosa intestinal de leitões enfermos. O uso de antimicrobianos tem-se mostrado eficiente em reduzir os sinais clínicos da EPS, resultando em melhor performance dos animais tratados em relação aos não-medicados e na redução da eliminação fecal da bactéria e da extensão e severidade das lesões macroscópicas. A maioria dos fármacos eficientes que são discutidas no texto são dos grupos dos macrolídeos, das tetraciclinas, lincosamidas e pleuromutilinas. Todos esses fármacos agem bloqueando a síntese protéica de bactérias.

Porcine proliferative enteropathy (PPE), caused by the bacterium Lawsonia intracellularis, causes serious economic losses worldwide due to diarrhea and poor growth rate medication in young growing pigs (chronic disease form) and sudden death in finisher and replacement pigs (acute hemorrhagic form). Typical control programs have focused on antibiotics. Essentially, the effectiveness of an antimicrobial can be tested in vitro or in vivo. In vivo test can be developed with natural or experimentally infected pigs. In tests that the animals are experimentally challenged, the inoculation is done with pure culture of L. intracellularis or intestinal mucosal homogenate of pig with PPE. Antimicrobial use have been shown to be effective in reducing the clinical signs of PPE and to result in better performance in treated pigs than in untreated animals. In addition, it decreases fecal shedding and the severity of gross lesions. The most efficient antimicrobial groups of drugs discussed in this manuscript are macrolides, tetracyclines, lincosamides and pleuromutilins. All of them act by blocking bacterial protein synthesis.

Assuntos