Impact of antimicrobial stewardship program on clinical outcomes in multidrug-resistant Gram-negative bacterial infections at a tertiary care hospital from South India

Background: Increasing bacterial resistance to antimicrobial agents is resulting in high morbidity and mortality. Antimicrobial stewardship (AMS) programs aim at rationale use of antimicrobial agents in clinical settings by development and implementation of antibiotic policy. As the patterns of antimicrobial resistance vary with organism and time, there is a need for periodic surveillance. Aims and Objectives: The aim of the study was to study the impact of AMS program on appropriate use of antimicrobial agents and clinical outcomes in patients with multidrug-resistant Gram-negative bacterial (MDR GNB) infections. Materials and Methods: This is a prospective observational study that included patients diagnosed with multidrug-resistance Gram-negative bacterial infections during June to July 2019. Identification of multidrug-resistant organisms was performed as per clinical and laboratory standards institute guidelines 2016. Information on the use of empirical antibiotic and other antimicrobial agents after culture and sensitivity report were collected and assessed for appropriateness. All the patients were followed up till discharge. Results: From 170 patients, there were 211 specimens sent for culture and sensitivity and 249 pathogens were isolated. The most frequent pathogen isolated was Escherichia coli (42.6%) followed by Klebsiella spp. (22.9%). Isolates were most resistant to cefazolin (86.7%) and ceftriaxone (83.9%), and most sensitive to polymyxin B (100%) and tigecycline (97.2%). All patients were administered antimicrobial agents as per antibiotic policy of the institute and 154 (90.6%) patients have recovered from illness with a mean length of hospital stay of 19.4 ± 6.6 days. Conclusion: Adherence to antimicrobial policy helps in improved outcomes in patients with MDR GNB infections. Hence, the need to implement AMS program in all hospitals.

Uso irracional de medicamentos na pandemia do Covid-19: revisão integrativa / Irrational use of medicines in the Covid-19 pandemic: integrative review / Uso irracional de medicamentos en la pandemia de Covid-19: revisión integradora

Os medicamentos são uma importante fonte tática de ação em saúde, quando usados para prevenção, alívio, diagnóstico ou cura de algumas enfermidades. Entretanto, apesar dos benefícios de tratar diversas doenças, os medicamentos podem trazer consigo riscos, como efeitos colaterais graves à saúde do usuário, além de possibilitar a resistência microbiana. O consumo excessivo de medicamentos sem prescrição é considerado um grande problema na saúde pública e vem sendo acentuado desde o período pandêmico da COVID-19 disso, partindo do princípio de que os fármacos podem desencadear reações adversas e apresentar danos à saúde, o objetivo deste artigo é discutir o uso irracional de medicamentos e destacar os medicamentos mais utilizados pela população na pandemia da COVID-19. Trata-se de um estudo de revisão integrativa da literatura. Foi realizado um levantamento bibliográfico de 12 artigos científicos do ano de 2020 a 2022. Destaca- se que o uso indevido de medicamentos consiste em uma prática corriqueira na sociedade e a automedicação durante o período da pandemia apresentou-se como um risco à população. Os medicamentos mais citados na pesquisa foram a azitromicina e a ivermectina.

Medications are an important tactical source of health action, when used for prevention, relief, diagnosis or cure of some diseases. However, despite the benefits of treating various diseases, medications can bring with them risks, such as serious side effects to the user's health, as well as enabling microbial resistance. The excessive consumption of non-prescription drugs is considered a major problem in public health and has been accentuated since the pandemic period of COVID-19 of this, assuming that drugs can trigger adverse reactions and present damage to health, the aim of this article is to discuss the irrational use of medicines and highlight the most commonly used drugs by the population in the pandemic of COVID-19. This is an integrative literature review study. A literature survey of 12 scientific articles from the year 2020 to 2022 was conducted. It is noteworthy that the misuse of medicines is a common practice in society and self-medication during the pandemic period presented itself as a risk to the population. The most cited drugs in the survey were azithromycin and ivermectin.

Los medicamentos son una importante fuente táctica de acción sanitaria, cuando se utilizan para prevenir, aliviar, diagnosticar o curar algunas enfermedades. Sin embargo, a pesar de los beneficios en el tratamiento de diversas enfermedades, los medicamentos pueden traer consigo riesgos, como graves efectos secundarios para la salud del usuario, además de posibilitar la resistencia microbiana. El consumo excesivo de medicamentos de venta libre es considerado un gran problema de salud pública y se ha acentuado desde el período de la pandemia de COVID-19 de esto, asumiendo que los medicamentos pueden desencadenar reacciones adversas y presentar daños a la salud, el objetivo de este artículo es discutir el uso irracional de medicamentos y destacar los fármacos más utilizados por la población en la pandemia de COVID-19. Se trata de un estudio de revisión bibliográfica integradora. Se realizó un estudio bibliográfico de 12 artículos científicos del año 2020 al 2022. Se destaca que el uso indebido de medicamentos es una práctica común en la sociedad y la automedicación durante el período pandémico se presentó como un riesgo para la población. Los medicamentos más citados en la encuesta fueron la azitromicina y la ivermectina.

Multi-centre survey and analysis of individual therapy of antimicrobial agents in children / 中国药房

OBJECTIVE To investigate the development of individual therapy of antimicrobial agents in pediatric patients. METHODS A questionnaire survey was conducted to investigate the individual therapy of antimicrobial agents in 30 children’s hospitals and pediatric departments of general hospitals in China. The survey data was analyzed statistically by Microsoft Excel 2007 and SPSS 26.0 software. RESULTS In this survey， 75 questionnaires were collected， and 53 of them were valid with an effective rate of 70.7%. The results showed that 86.7% （26/30） of the hospitals carried out individual therapy of antimicrobial agents in different forms. Clinical needs primarily contributed to the individual therapy in these hospitals， while the insufficient personnel and equipment were the biggest obstacles for individual therapy. The proportions of hospitals， who implemented evidence- based pharmacy， therapeutic drug monitoring （TDM）， model-informed precision dosing （MIPD） and antimicrobial-related genetic tests were 70.0%， 80.0%， 30.0% and 33.3%， respectively. Various detection methods of TDM were carried out in various hospitals， and the antimicrobial agents which needed TDM focused on vancomycin and voriconazole. Moreover， nearly half of pharmacists did not know much about MIPD. CONCLUSIONS At present， TDM is the main way to develop individual therapy of antimicrobial agents in various hospitals， but its monitoring coverage and testing standards need to be improved. MIPD and antimicrobial-related gene tests still need to be further promoted in clinical practice.

A study on prescription pattern and safety profile of antimicrobial agents in medicine department of tertiary care hospital

Background: Antimicrobial agents (AMAs) are an integral part of management of diseases in the department of general medicine, and a wide range of antimicrobials are used for prevention, prophylaxis, or treatment of various infectious diseases. Systematic studies regarding the pattern of AMAs use may help in improving the quality of patient care by evidence-based practices and also in formulating effective antimicrobial usage guidelines. Aim and Objectives: The objectives of this study were as follows: (i) To analyze the prescribing trends of Antimicrobials in Medicine wards of a Tertiary Care Hospital; (ii) to assess safety profile of AMAs; and (iii) to analyze extraneous factors influencing AMAs prescription. Materials and Methods: The prospective analysis of Antimicrobial prescriptions of Medicine wards for the period of July 2018–August 2019. The class of AMAs, formulation, dose, route of administration, frequency, and duration of administration and their safety was assessed using the WHO indicators. Results: The most frequently used AMAs were third generation cephalosporin (Ceftriaxone) and it was frequently combined with metronidazole. The choice of initial AMAs was empirical, which was later changed depending on the clinical response. The AMAs were effective in preventing or controlling infections and well tolerated without any serious adverse reactions or drug interactions. Conclusions: The rational use of AMAs is necessary to control worldwide emergence of antibacterial resistance, side effects, and to reduce the cost of treatment.

Drug utilization pattern in ENT outpatient department in tertiary care teaching hospital in Southern Rajasthan

Background: Drug utilization study is one of the most potent tool to promote rational drug use in medical, social, and economic scenario. Very less or no study has been done in Southern Rajasthan, hence this study shows valuable insights in Drug Utilization pattern. Aim and Objectives: To evaluate the drug utilization pattern in ear, nose and throat (ENT) outpatient department (OPD) in M.B. government hospital, Udaipur, Rajasthan. Materials and Methods: A prospective observational study was done in ENT OPD for a period of 9 months. Total 445 prescriptions were taken into consideration. All patients of the age group 18 years and above were included in the study. Results: Of total 445 cases, maximum number of patients (7.19%) suffered from bilateral chronic suppurative otitis media and minimum (2.02%) from eustachian tube block. A total number of drugs prescribed were 60. Maximum utilized drug was ibuprofen and minimum was Acyclovir. Mean number of drugs prescribed were 2.615. Maximum drugs were given by oral route and minimum as gargles. Total prescribed drugs were 1164. Most common prescribed drug group was NSAIDS (23.19%). Total cost of therapy was 58,584, cost per patient was122.6. Prescribed daily dose/defined daily dose ratio was calculated for antibiotics. Conclusion: Study shows rational drug prescribing. Account of Alternative medicine was taken in consideration, isolation of microorganisms prior drug prescribing was not done.

Use of information technology to improve patient compliance: A pilot study

Background: Compliance with treatment is the key link between treatment and outcome in medical care, non-compliance leads to failure of treatment. Noncompliance with antimicrobial agents (AMAs) is the important reason for Resistance to antimicrobials. Forgetting to take medicine is one of the important causes of non-compliance. Aim and Objectives: Hence, the present study was planned to evaluate the compliance for antimicrobial treatment in patients receiving a short course of antimicrobials, with or without reminding them to take medicine using a smartphone app. Materials and Methods: Prospective interventional study was planned in a tertiary care hospital after permission from the ethics committee. The present pilot work of the study was carried out on 30 patients receiving AMAs. Patients receiving a short course of chemotherapy were enrolled and stratified based on the frequency of administration of antimicrobials. They were then allocated alternately in control (15) and study (15) groups. After explaining the prescription to all, “Pill Reminder” app was downloaded on smartphones of participants in the study group. All were contacted to enquire about compliance at the end of the treatment period. Results: Baseline characteristics of participants in both groups were comparable. URTI, UTI Tinea cruris, Tinea capitis were the disorders for which they received AMAs. The frequency of administration was once/twice/thrice a day. Duration was 3–14 days in both groups. At the end of the study, 53.3% of patients in control group and 100% of patients in intervention group were compliant to the treatment. Conclusion: The use of the reminder app significantly improved patient’s compliance with medications. Further studies are required to validate these results.

Evaluation of efficacy of subgingival administration of 1% chlorhexidine gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis - A clinical and microbiological study

Aim: The aim of the present study was to evaluate the clinical and microbiological effects of subgingival administration of 1% chlorhexidine gel (Chlorhexamed® 1% gel) in patients with chronic periodontitis. Settings and Design: The study was done in a parallel?arm design with a total of 30 patients with 60 sites suffering from chronic periodontitis. The patients were divided into control and experimental groups. Materials and Methods: The clinical parameters recorded were plaque index, gingival index, modified sulcular bleeding index, probing pocket depth and relative attachment level at baseline, 1 month and 3 month. Microbiological colony?forming units were assessed for Porphyromonas gingivalis, Fusobacterium nucleatum and Tannerella forsythia at baseline, 1 week, 1 month and 3 months. The control group received scaling and root planing (SRP) after baseline evaluation; however, the experimental group received the application of Chlorhexamed® gel within 48 hours after SRP. Then, the values obtained were subjected to statistical analysis. Results: Both groups showed significant improvement from the baseline to 3 months in all clinical and microbiological parameters. The experimental group showed better improvement in all parameters. Conclusion: The use of Chlorhexamed® gel has proven to be an efficacious adjunct with SRP in the treatment of chronic periodontitis.

Analysis of pattern of antimicrobial usage in children of age 1 to 12 years with respiratory tract infections admitted in pediatric intensive care unit in a tertiary care hospital

Background: Children are more prone to suffer from recurrent infections of respiratory tract due to their immature developed airway, lungs, and immunity, which makes lower respiratory tract infections as one of the most commonly encountered diseases in PICU and one of the leading causes of death among children below 5 years of age. Antimicrobials are one of the commonly prescribed drugs for respiratory tract infections which act as double edged sword as it has saved many lives from dreadful infections and also its injudicious use can give rise to antimicrobial resistance that can endanger many patients’ lives. Aim and Objectives: The aim of the study was to analyze the pattern of antimicrobial drugs used in in-patients admitted to pediatric intensive care unit with respiratory tract infections and to identify the factors to decide the selection of antibiotics. Materials and Methods: The present study was conducted in Pediatrics along with Pharmacology Department of VIMS, Bellary. After obtaining approval from the institutional ethics committee, the study was conducted. Patients were enrolled in the study after obtaining written informed consent from the patient’s informants. Children of age group 1?12 years, suffering from infections of respiratory tract admitted in PICU who were treated with antibiotics were analyzed in our study. Based on the clinical presentation, the diagnosis of RTI was done by treating pediatrician. Results: In our institute, children of under 5 age group, that is, 2?5 years, about 40% of patients were hospitalized in PICU. Male patient’s preponderance was present about 57.5%. Common most respiratory infection seen was bronchopneumonia (46.5%), followed by lower respiratory tract infection (20.5%) and lobar pneumonia (14.5%). All of these patients were involved with other associated conditions, namely, febrile convulsions, severe anemia, and respiratory distress. Conclusion: Prescribing pattern in pediatric intensive care unit showed the preference of using two antibiotics to treat respiratory tract infections. Ceftriaxone and combination of amoxicillin + clavulanic acid were preferred as first-line antibiotics. Amikacin and vancomycin were used as secondline drugs. Piperacillin, tazobactam, and vancomycin were the next line antimicrobial agents. These drugs were given to patients by parenteral routes such as IV and IM.

Efecto bioconservante del propóleo y su aplicación en la conservación de matrices cárnicas / Bioconservative Effect of Propolis and its Application in the Conservation of Meat Matrices

Resumen: Antecedentes: los conservantes de origen sintético, como nitratos y nitritos, empleados en la industria alimentaria para la conservación de matrices cárnicas, han reportado efectos desfavorables a largo plazo en la salud de los consumidores recurrentes. Objetivo: conocer las características fisicoquímicas y antimicrobianas del propóleo como potencial bioconservante en matrices cárnicas de alto consumo. Materiales y métodos: se desarrolló una revisión bibliográfica de literatura acorde a la pregunta problema planteada por el grupo de investigación, y se llevó a cabo una búsqueda en las bases de datos Scopus, NCBI, SciELO, ScienceDirect y Google Scholar de artículos de revisión, artículos científicos, libros y trabajos de grado. Resultados: el propóleo es un compuesto natural con una variedad amplia de elementos útiles para la conservación de matrices cárnicas, por sus propiedades antimicrobianas y antioxidantes. Conclusiones: el propóleo presenta propiedades antimicrobianas y antioxidantes útiles en el campo de la industria alimentaria, por lo que se considera una de las alternativas más viables para la conservación de productos cárnicos y la disminución del uso de conservantes sintéticos en producción cárnica. No obstante, es fundamental el desarrollo de más investigaciones que permitan evaluar el comportamiento de los compuestos activos del propóleo en las diversas matrices cárnicas

Abstract: Background: Preservatives of synthetic origin, such as nitrates and nitrites, used in the food industry for the preservation of meat matrices, have reported long-term unfavorable effects on the health of recurrent consumers. Objective: To know the physicochemical and antimicrobial characteristics of propolis as a potential biopreservative in high consumption meat matrices. Materials and Methods: A bibliographic review of literature was developed according to the problem question posed by the research group, carrying out a search in the Scopus, NCBI, SciELO, ScienceDirect and Google Scholar databases of review articles, scientific articles, books and works degree. Results: Propolis is a natural compound with a wide variety of useful elements for the conservation of meat matrices, due to its antimicrobial and antioxidant properties. Conclusions: Propolis has useful antimicrobial and antioxidant properties in the field of the food industry, being considered one of the most viable alternatives for the preservation of meat products and the reduction of the use of synthetic preservatives in meat production. However, it is essential to develop more research to evaluate the behavior of the active compounds of propolis in the various meat matrices

Knowledge, attitude and practice towards antibiotic use: An interventional study among medical and dental undergraduates

Background: Adequate importance should be given to antimicrobial chemotherapy and the antibiotics resistance issues during undergraduate training. For successful and sustained intervention, knowledge, attitudes, and practices (KAP) of antimicrobials should be done. So accordingly, this study was planned. Aim and Objective: The aim of the study was to compare KAP of antibiotic use among the 2nd year medical and dental students before and after intervention. Materials and Methods: Questionnaire-based study was done in medical and dental undergraduate students. After taking consent, responses were collected before and after intervention. Each correct response was given a score of 1 and responses were graded as satisfactory and unsatisfactory. Data collected was statistically analyzed using Microsoft Excel 2010 and results were expressed in percentage. Paired t-test was used to analyze pre and post-interventional data. Results: Significant rise in mean knowledge, attitude, practice, and overall scores after intervention in medical and dental students were observed. Satisfactory responses were significantly reduced from 73% to 63% in medical students. Casual attitude towards self-use and irregular use of antimicrobial agents (AMA) was observed which may lead to antibiotic resistance. Significant improvement in overall satisfactory responses was also observed after intervention. Conclusion: Medical and dental students showed improved knowledge about AMA use and antimicrobial resistance (AMR) after pharmacology teaching. However, predominant low scores of attitude and perception indicate the need for further educational interventions such as small group exercises, prescription audits, frequent discussion on rational pharmacotherapy, skillful communication with the patient about prescription. To reduce AMR, students should be trained about AMA use and its adherence by patients as well.

Polymeric Material With Controlled Release of Antimicrobial Agents for Medical Application

@#Introduction: Nowadays the use of synthetic polymers has become an integral part of modern medicine. Poly(2-hydroxyethyl methacrylate) has attracted special attention for therapeutic use. The objective of this study was to develop novel polymeric material based on poly(2-hydroxyethyl methacrylate) by addition of water as pore-forming agent and antimicrobial components, which would differ from similar materials by controlled release of active substances. Methods: The antimicrobial release kinetics study materials were immersed into distilled water followed by sampling and measuring their concentration. Concentration of chlorhexidine bigluconate and metronidazole was determined using spectrophotometric method and decamethoxine by photocolorimetric method based on reaction with eosin. The swelling rate was determined by gravimetric method. Results: Conventional dressing materials, after being soaked with antiseptic solutions, have demonstrated limited abilities in releasing active substances. Gauze pads were found to release antimicrobials during a short period of time reaching 50–80 % for decamethoxine containing samples and almost 100 % for those with metronidazole and chlorhexidine bigluconate at 2 h of observation. No study active substances were released from activated charcoal dressings. Similar results were obtained with porcine xenografts. Unlike the above mentioned dressing materials, modified polymer matrix based on poly(2-hydroxyethyl methacrylate) showed the controlled release of antimicrobial substances into water medium. Study material containing 3.0 % of decamethoxine and 76.3 % of water demonstrated optimal efficiency in the rate and duration of release, exerting high physical and mechanical properties. Conclusion: The synthesized polymers are similar to conventional dressings in antimicrobial release kinetics, but in some characteristics they are better for practical application.

Chemical composition, antioxidant, antimicrobial activity, toxicity, genetic analysis and popular use of Eugenia luschnathiana (O. Berg) Klotzsch ex B. D. Jacks: a literature review / Composición química, actividad antioxidante, antimicrobiana, toxicidad, análisis genético y uso popular de Eugenia luschnathiana (O. Berg) Klotzsch ex B. D Jack: una revisión de la literatura

This review describes the geographical distribution, botanical data, popular use, chemical composition, pharmacological activities and genetic aspects related to Eugenia luschnathiana, a native Brazilian plant popularly known as "bay pitomba". E. luschnathiana leaves are characterized morphologically by the presence of a petiole, an attenuated base, acuminated apex, elliptical shape, and parallel venation. The major chemical compounds found in E. luschnathiana are sesquiterpenes. Literature reports showed that E. luschnathiana extracts have antioxidant properties and antimicrobial activity against Gram-negative and Gram-positive bacteria. The extractsfrom the leaf, fruit and stem, and a concentrated residual solution of its essential oil, displayed negligible toxicity. Lastly, a cytogenetic analysis indicated that some markers can be used for the study of genetic diversity, population structure, and genetic improvements. The information available on E. luschnathiana supports the hypothesis that this plant may be a source of compounds with promising pharmacological activity.

Esta revisión describe la distribución geográfica, datos botánicos, uso popular, composición química, actividad farmacológica y el análisis genético de Eugenia luschnathiana, una planta originaria del Brasil conocida popularmente como "pitomba da baía". Las hojas de E. luschnathiana se caracterizan por la presencia de pecíolo, base atenuada, ápice acuminado, forma elíptica y venación paralela. Su composición química presenta mayormente sesquiterpenos. Los informes en la literatura muestran que los extractos de E. luschnathiana presentan propiedades antioxidantes y actividad antimicrobiana contra las bacterias Gram-negativas y Gram-positivas. Los extractos de la hoja, fruto y tallo, y una solución residual concentrada del aceite esencial, presentaron baja toxicidad. Por último, un análisis citogenético indicó que algunos marcadores pueden utilizarse para estudios de diversidad genética, estructura poblacional y mejoramiento genético. Las informaciones disponibles acerca de E. luschnathiana proponen la hipótesis de que esta planta puede ser una fuente de compuestos con actividad farmacológica prometedora.

First report of the aac(6)-Ib-cr gene in Providencia stuartii isolates in Brazil

Abstract INTRODUCTION: The aac(6')-Ib-cr and bla KPC genes are spreading among Enterobacteriaceae species, including Providencia stuartii, in some countries of world. METHODS: These genes were investigated in 28 P. stuartii isolates from a public hospital in Recife, Pernambuco, Brazil, by PCR and sequencing. RESULTS: The aac(6')-Ib-cr gene was detected in 16 resistant isolates, and the bla KPC gene was seen in 14. CONCLUSIONS: The presence of these genes in P. stuartii multi- and extensively drug-resistant isolates indicates that the resistance arsenal of this species is increasing, thus limiting the therapeutic options.

Treatment and pharmaceutical care of one patient with Chlamydia psittaci pneumonia complicated by drug-induced liver injury / 药学实践杂志

Objective To explore the role of clinical pharmacists in rational drug use through the pharmacy care of an elderly pneumonia patient with Chlamydia psittaci infection and drug-induced liver injury. Methods The clinical pharmacists participated in the treatment of one patient with Chlamydia psittaci pneumonia and drug-induced liver injury. Based on the results of second-generation gene sequencing, the characteristics of the pathogen were learned by literature search. The clinical pharmacists monitored the patient’s liver and kidney function, provided a new medication treatment plan to Doctors, and performed patient education during the treatment. Results The initial empirical anti-infective treatment with teicoplanin and imipenem-cilastatin was not effective. After the diagnosis of Chlamydia psittaci and Candida albicans infection, the combination of doxycycline with azithromycin and fluconazole was administered. Drug-induced liver injury was found with this treatment. The clinical pharmacist proposed to switch to doxycycline and clarithromycin with co-administration of magnesium isoglycyrrhizinate and polyene phosphatidylcholine to protect the liver. With this new regime, patient's liver function was improved and the infection was under control. Conclusion Individualized pharmaceutical cares provided by clinical pharmacists helped the safe, rational and effective use of medications.

Intervenciones farmacéuticas y desenlaces clínicos en un programa de gerenciamiento de antimicrobianos / Pharmaceutical interventions and clinical outcomes in an antimicrobial stewardship program

Resumen Introducción: La participación del farmacéutico en el programa de gerenciamiento de antimicrobianos (PGAn) se ha asociado con mejores resultados. Objetivos: Describir las intervenciones farmacéuticas y desenlaces clínicos de un PGAn centrado en antimicrobianos de amplio espectro, en pacientes hospitalizados en una institución de alta complejidad. Método: Estudio observacional, prospectivo, en pacientes ingresados a una clínica de alta complejidad entre agosto de 2016 y septiembre de 2017. En el entorno de un PGAn, un farmacéutico con entrenamiento en enfermedades infecciosas evaluó e intervino la antibioticoterapia, en conjunto con el médico infectólogo, quien realizó la modificación de la antibioticoterapia pertinente. Adicionalmente, se documentó el desenlace clínico. Resultados: Se incluyeron 258 pacientes. El 16,1% de los antimicrobianos se valoró como no indicado. Se realizaron 126 intervenciones farmacéuticas con 82,5% de aceptación. El desenlace principal fue la curación clínica y/o microbiológica de la patología infecciosa. Conclusión: El problema asociado al antimicrobiano con mayor frecuencia en la población de estudio fue el espectro antimicrobiano con respecto a la sensibilidad del microorganismo. Siendo consecuentes, el de-escalamiento fue la intervención farmacéutica con mayor prevalencia. Se alcanzó un porcentaje de aceptación similar a otros estudios, de las intervenciones realizadas por el farmacéutico en el entorno del PGAn. La curación clínica y/o microbiológica fue la principal causa de egreso hospitalario.

Abstract Background: The pharmacist's participation in the antimicrobial stewardship program (AMSP) has been associated with better outcomes. Aims: To describe the pharmaceutical interventions and clinical outcomes of a PGA focused on broad-spectrum antibiotics in hospitalized patients in a tertiary healthcare setting. Method: Prospective observational study in patients admitted to a tertiary healthcare setting between August-2016 and September-2017. In the context of a AMSP, a pharmacist training in infectious diseases evaluated and intervened antibiotic therapy, with the infectious disease specialist, who performed relevant modification of the antibiotic therapy. In addition, the clinical outcome was evaluated and documented. Results: 258 patients were included. 16.1% of antibiotics were assessed as not indicated. A total of 126 pharmaceutical interventions were performed with 82.5% acceptance. The main outcome was the clinical and/or microbiological cure of infection. Conclusion: The problem associated with the antibiotic most frequently in the study population was the antimicrobial spectrum. Being consistent, de-escalation was the pharmaceutical intervention with the highest prevalence. A high percentage of acceptance of the interventions performed by the pharmacist in the environment of the PGAn was considered. Clinical and/or microbiological cure was the main cause of hospital discharge.

A Molecular Docking Study against COVID-19 Protease with a Pomegranate Phyto-Constituents 'Urolithin' and Other Repurposing Drugs: From a Supplement to Ailment

Aim:We conducted an in silico study on Urolithin and different antimicrobial agents targeting virus protease and peptidase.Methodology: The dockingstudy was completed by using docking tools. Drug compounds and COVID-19 receptor molecules were prepared, docking was performed and interaction was visualized through Discovery Studio visualizer.Results: Urolithin A has interacted against peptidase (PDBID:2GTB) with binding energy -6.93kcal/mol and against protease (PDBID:6LU7) with the binding energy -5.46 kcal/mol,while Urolithin Bhasinteracted to peptidase (PDBID:2GTB) with binding energy -6.74kcal/moland with protease it interacted with a binding energy -4.67 kcal/mol. The antimicrobial agent Ofloxacin was found to interactagainst protease(PDBID:6LU7) with a binding energy -6.84 kcal/mol and against protease(PDB:6LU7) with a binding energy -8.00 kcal/mol. Conclusion: The most common interacting amino acids of target enzymes of the virus with studied drugs were His41, His164, Met165, Glu166, Gln189. From the docking studies, it is observed that Ofloxacin and Urolithin have the potential to inhibit the virus protease as well as peptidase significantly and these could prevent the entry of the virus to the inside of the host cell. Thus, further antiviral research on these antimicrobial agents and Urolithin could be helpful to control the COVID-19 disease

Incidence of Septicemia in Children Attending University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Introduction: Septicemia is an invasive infection where chemical substances released into the bloodstream causes morbidity and mortality in neonates. The developing countries carries major burden of the problem and Nigeria is not exceptional.Objective: The study was carried out to determine age/sex-related prevalence, causative agents and antimicrobial sensitivity pattern of neonatal septicemia in children at University of Port Harcourt Teaching Hospital, Nigeria.Methods: This retrospective study was carried out in the pediatric department for a period of twelve months. Blood culture test using thioglycollate broth and tryptone soya broth for isolation of microorganisms was adopted. Antimicrobial sensitivity pattern was done with disc diffusion method. The data was analyzed using descriptive statistics and Chi square for significance.Results:A total of 598 children were examined, of which 394(67.9%) children showed negative blood cultures, while 204(34.1%) children had positive bacterial cultures and 2 children (0.3%) were positive for Candida albicans. Overall, Klebsiellaspp. was the most common pathogen, accounting for (37.8%) of the total isolates, which is followed by Staphylococcus aureus(28.4%), Escherichia coli(11.8%), unclassified Coliforms (8.3%), Pseudomonasspp. (4.9%), Proteusspp. (3.4%), Enterococcusspp. (2.9%) and coagulase-negative Staphylococcus(CONS) (2.5%) respectively. Early onset neonatal sepsis (EONNS) had Klebsiella spp as the most prevalent causative agent while Staphylococcus aureus was prevalent among the late onset neonatal sepsis (LONNS). Klebsiella spp. was susceptible to spafloxacin(87.0%) followed by ofloxacin (82.0%), amoxycillin-clavulanic acid (79.0%) and ceftazidime (65.0%) among the Gram negative organisms. In the category of Gram positive organisms, Staphylococcus aureus was highly sensitive to ofloxacin (81.0%) followed by spafloxacin (79.0%) and amoxicillin-clavulanic acid (71.0%). Conclusion: The study showed Klebsiellaspp. and Staphylococcus aureus were the prevalent bacterial organisms of septicemia in children in University of Port Harcourt Teaching Hospital. Early diagnosis with use of appropriate antimicrobial treatment will effect intervention for management of the children

A prospective study of antimicrobial utilization in post-operative care unit of a teaching hospital in South India

Background: Surgical site infections, a common cause of morbidity and mortality in hospitalized patients can be prevented using an antimicrobial agent (AMA) as prophylaxis. Inappropriate use of AMA leads to antimicrobial resistance.Methods: A prospective study was conducted on 208 patients in Owaisi Hospital and Research Centre (OHRC) for a period of 6 months on post-surgical patients admitted in the postoperative care unit. Included in the study were post-operative patients aged 18 years and above, who were willing to participate in the study. Data related to demography of the patients and the AMAs used in these patients was collected and analysed.Results: Majority of the patients belonged to the age group 50 to 59 years (32%) followed by 40 to 49 age group (23%). Male patients (54%) were more than females. Common route of administration was intravenous (89%) and the most common dosing frequency was thrice a day (54%). Most AMAs were used in combinations. Metronidazole (62%) was the most commonly prescribed AMA, followed by ceftriaxone (55%).Conclusions: Cephalosporins were the preferred antimicrobials for surgical prophylaxis of aerobic infections prescribed in 74% of cases, while metronidazole was used as the primary antimicrobial agent to prevent anaerobic infections. AMA utilization needs to be continuously evaluated in post-operative units of the surgery departments in order to promote rational prescribing to decrease morbidity, cost of therapy and to contain the problem of developing AMA resistance in the region.

Aleitamento natural e artificial: relações com a ocorrência de bactérias cariogênicas e saúde do bebê / Natural and artificial breastfeeding: relationships with the occurrence of cariogenic bacteria and baby's health

A Organização Mundial de Saúde recomenda o aleitamento materno exclusivo durante os primeiros 6 meses de vida do bebê, e sabe-se que hábitos alimentares inadequados estão associados a várias doenças, como cárie dentária e obesidade. A cárie dentária está relacionada a microrganismos como Streptococcus mutans que, por sua vez, facilitam a colonização por Candida. O objetivo nesta pesquisa foi analisar a ocorrência de S. mutans, Candida, uso de antibiótico, internação hospitalar e hábitos alimentares da criança e relacionar esses aspectos com a modalidade de aleitamento, no binômio mãe-filho, bem como com o índice de higiene bucal. Trata-se de um recorte de um estudo longitudinal, com 42 pares de mães e crianças aos 30 meses de vida. O exame clínico, para averiguação de presença de cárie e Índice de Higiene Oral Simplificado (IHOS), foi realizado nos pares em visitas domiciliares, além de aplicação de questionário sobre hábitos alimentares, uso de antibiótico e internação da criança, e coleta de saliva de mãe e filho, para análise de cultura de S. mutans e Candida. Como principais resultados, verificou-se que 64,28% das mães interromperam o aleitamento materno antes dos 06 meses de idade do bebê, 100,00% de bebês apresentaram S. mutans, 51,28% apresentaram Candida, 57,14% dos bebês foram submetidos à antibioticoterapia, 21,42% foram internados, 73,80% tinham hábitos alimentares inadequados, 71,43% fizeram uso de aleitamento artificial e 100,00% apresentaram (IHOS) baixo, e 11,90% das crianças apresentaram lesão de cárie. Portanto, com base nos resultados obtidos e respeitando-se os limites do estudo, concluiu-se que não houve relação da variável desmame precoce com a presença de S. mutans e Candida, uso de antibióticos e a internação hospitalar da criança, porém, houve a associação de presença de cárie com as variáveis desmame precoce-hábito alimentar (p=0,046) e uso de mamadeira-aleitamento artificial (p=0,018)(AU)

The World Health Organization recommends exclusive breastfeeding during the first 6 months of the baby's life, and inadequate eating habits are associated with several diseases, such as tooth decay and obesity. Dental caries is related to microorganisms such as Streptococcus mutans that facilitate colonization by Candida. The objective of this research was to analyze the occurrence of S. mutans, Candida, use of antibiotics, hospitalization and children's eating habits and to relate these aspects with the type of breastfeeding, in the mother-child binomial, as well as with the oral hygiene index. This is an excerpt from a longitudinal study, with 42 pairs of mothers and children at 30 months of age. The clinical examination, to check for the presence of caries and Simplified Oral Hygiene Index (IHOS), was carried out in pairs in home visits, in addition to the application of a questionnaire on eating habits, use of antibiotics and hospitalization of the child, and collection of saliva from mother and son, for culture analysis of S. mutans and Candida. As main results, it was found that 64.28% of mothers stopped breastfeeding before the baby was 6 months old, 100.00% of babies had S. mutans, 51.28% had Candida, 57.14% babies were submitted to antibiotic therapy, 21.42% were hospitalized, 73.80% had inadequate eating habits, 71.43% used artificial breastfeeding and 100.00% had low (IHOS), and 11.90% of the children had caries injury. Therefore, based on the results obtained and respecting the limits of the study, it was concluded that there was no relationship between the variable early weaning with the presence of S. mutans and Candida, use of antibiotics and the child's hospitalization, however, there was the association of the presence of caries with the variables early weaning-eating habits (p = 0.046) and use of bottle-feeding (p = 0.018)(AU)

Pseudomonas aeruginosa in the ICU: prevalence, resistance profile, and antimicrobial consumption

Abstract INTRODUCTION: Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance. METHODS: Data were obtained from ICUs between 2010 and 2013. RESULTS: P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B. CONCLUSIONS: Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial- and multi-drug resistance.