Impact of Positive Culture Reports of E. coli or MSSA on De-Escalation of Antibiotic Use in a Teaching Hospital in Pakistan and the Implications.

Background: Antibiotic de-escalation is a key element of antimicrobial stewardship programs that restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of E. coli or Methicillin sensitive Staphylococcus aureus (MSSA) on de-escalation of antibiotic therapy. Methods: This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from patient medical files, which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed using SPSS. Results: Of 256 isolated microbes, 138 (53.9%) were MSSA and 118 were E. coli (46.1%). MSSA showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). E. coli showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for E. coli were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For MSSA cases, linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of E. coli and 43% reduction in MSSA cases. Conclusion: Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad-spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns while preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment.

Reflection - an effective strategy for outcome-based learning in basic medical sciences.

OBJECTIVE: To determine the role of guided reflection for improved learning outcomes in students of basic dental sciences. METHODS: The quasi-experimental comparative educational study was conducted at the Islamic International Dental College, Islamabad, Pakistan, from May to September 2019, and comprised second-year undergraduate students in the Basic Medical Sciences curriculum for Microbiology. The subjects were arbitrarily divided into Group-1, which was exposed to guided reflection, and Group-2, which was not asked to reflect on the lectures. Post-intervention, a test of 30 multiple choice questions on the selected topics was conducted to compare the level of learning between the groups. After three weeks, the same activity was repeated with the same groups, but with different topics of lectures. Data was analysed using SPSS 21. RESULTS: Of the total 75 students, there were 28 female and 9 male students in Group-1 (Reflectors), 29 female and 9 male students in Group-2 (Non-Reflectors). Overall, there were 18 male and 57 female students. The overall 20.4±0.83 years. The difference between the groups after the first session was not significant (p>0.05). After session 2, Group-1 score was significantly better than that of Group-2 (p<0.05). CONCLUSIONS: Reflective practices on teaching sessions at the end of lectures proved to be an effective strategy to achieve outcome-based learning.