Correlation between antimicrobial consumption and antimicrobial resistance of Pseudomonas aeruginosa in a hospital setting: a 10-year study.

WHAT IS KNOWN AND OBJECTIVE: Antimicrobial resistance is one of the greatest threats to human health. One of the most important factors leading to the emergence of resistant bacteria is overuse of antibiotics. The purpose of this study was to investigate the correlation between antimicrobial usage and bacterial resistance of Pseudomonas aeruginosa (P. aeruginosa) over a 10-year period in the Clinical Center Nis, one of the biggest tertiary care hospitals in Serbia. We focused on possible relationships between the consumption of carbapenems and beta-lactam antibiotics and the rates of resistance of P. aeruginosa to carbapenems. METHODS: We recorded utilization of antibiotics expressed as defined daily doses per 100 bed days (DBD). Bacterial resistance was reported as the percentage of resistant isolates (percentage of all resistant and intermediate resistant strains) among all tested isolates. RESULTS AND DISCUSSION: A significant increasing trend in resistance was seen in imipenem (P < 0·05, Spearman ρ = 0·758) and meropenem (P < 0·05, ρ = 0·745). We found a significant correlation between aminoglycoside consumption and resistance to amikacin (P < 0·01, Pearson r = 0·837) and gentamicin (P < 0·01, Pearson r = 0·827). The correlation between the consumption of carbapenems and resistance to imipenem in P. aeruginosa shows significance (P < 0·01, Pearson r = 0·795), whereas resistance to meropenem showed a trend towards significance (P > 0·05, Pearson r = 0·607). We found a very good correlation between the use of all beta-lactam and P. aeruginosa resistance to carbapenems (P < 0·01, Pearson r = 0·847 for imipenem and P < 0·05, Pearson r = 0·668 for meropenem). WHAT IS NEW AND CONCLUSION: Our data demonstrated a significant increase in antimicrobial resistance to carbapenems, significant correlations between the consumption of antibiotics, especially carbapenems and beta-lactams, and rates of antimicrobial resistance of P. aeruginosa to imipenem and meropenem.

Monitoring of antibiotic consumption and development of resistance by enterobacteria in a tertiary care hospital.

WHAT IS KNOWN AND OBJECTIVE: Antibiotics are the most frequently used drugs in hospitalized patients, but studies have shown that the prescribed antibiotics may be inappropriate and may contribute to antibiotic resistance. We carried out a survey of antibiotic consumption and antibiotic resistance in our tertiary care university hospital, from 2005 to 2013. We focus on cephalosporins, one of the most prescribed groups of antibiotics in the tertiary health care. The objective was to identify any relationship between ceftriaxone consumption and resistance by enterobacteria. METHODS: Antibiotics consumption and antimicrobial resistance were monitored in the tertiary care university hospital from 2005 to 2013. Data on the use of antibiotics in surgical inpatients were obtained and expressed as defined daily doses per 100 bed days. Bacterial resistances were given as percentages of resistant isolates. RESULTS AND DISCUSSION: There was an increasing trend in cephalosporins consumption from 9·56 DBD (2005) to 23·32 DBD (2013), with ceftriaxone as the most frequently used cephalosporin, 3·6 DBD (2005) to 10·78 DBD (2013). E. coli and P. mirabilis resistance to ceftriaxone increased significantly from 22% in 2005 to 47% in 2013 and from 31% in 2005 to 60% in 2013, respectively. We found a significant correlation between ceftriaxone consumption and E. coli resistance (r = 0·895, P < 0·05). WHAT IS NEW AND CONCLUSION: Our study shows that cephalosporin consumption increased from 2005 to 2013, with ceftriaxone as the most prescribed antibiotic. E. coli and P. mirabilis resistance to ceftriaxone increased significantly over the study period. E. coli resistance increased with ceftriaxone consumption.

Influence of cataract maturity on aqueous humor lipid peroxidation markers and antioxidant enzymes.

PURPOSE: The impact of cataract maturity on the aqueous humor (AH) oxidant/antioxidant balance is largely controversial. This study was aimed at assessing the relationships between cataract maturity and AH lipid peroxidation markers and enzymatic antioxidants. PATIENTS AND METHODS: The concentrations of conjugated dienes (CD), lipofuscin-like fluorescent end-products (LLF), soluble proteins, as well as the activities of superoxide dismutase (SOD) and catalase (CAT) were measured in AH samples from nondiabetic patients with either immature (n=15) or mature (n=15) cataract. RESULTS: In the overall AH sample, the mean values of CD, LLF, SOD, and CAT were 0.160 ± 0.024 (OD234), 166 ± 27 RFU, 24.5 ± 7.1 U/ml, and 31.9 ± 3.9 pmol/ml, respectively. CD was positively correlated with SOD (r=0.647; P<0.001), CAT (r=-0.394; P=0.031), and LLF (r=-0.399; P=0.029). The LLF was negatively correlated with SOD (r=-0.461; P=0.010). In samples adjusted for confounding factors, differences between immature and mature cataract groups regarding SOD, CD, LLF, and total proteins were significant (P<0.05; for all variables). The multiple logistic regression analysis identified LLF (OR=4.08; P=0.038) and SOD (OR=4.99; P=0.031) as independent predictors of cataract maturity. CONCLUSIONS: These results suggest that AH lipid peroxidation markers and antioxidants may significantly depend on the cataract maturity stage.

Analysis of antibiotic utilization and bacterial resistance changes in a surgical clinic of Clinical Centre, Nis.

WHAT IS KNOWN AND OBJECTIVE: There is little published information about antibiotic utilization and resistance amongst hospital inpatients in Serbia. The purpose of this study was to analyse the variation of antibiotic utilization and the relation between antibiotic utilization and bacterial resistance. METHODS: This analysis was performed in the surgical clinic of one of the biggest Serbian tertiary hospitals, during 2005-2008. Data on the use of antibiotics in surgical inpatients were obtained and expressed as defined daily doses per 100 bed-days. Bacterial resistances were given as percentages of resistant isolates. Following the implementation of a restriction policy in 2005, the prescription of reserve antibiotics was placed under control. RESULTS AND DISCUSSION: During the investigation period the total consumption of antibiotics decreased significantly by 37·8%. Hospital aminoglycoside consumption continued to decrease from 25·1% of the total consumption in 2005 to 5·1% in 2008. During the same period there was a substantial decrease in the use of ceftriaxone (47·8%), ciprofloxacin and metronidazole. Reduction in Escherichia coli resistance to gentamicin correlated significantly with its utilization, while the resistance for all isolates decreased from 58·5% to 44·8%. WHAT IS NEW AND CONCLUSION: This analysis confirms the association between the use of antibiotics and the prevalence of resistance in a surgical clinic. Surveillance of bacterial resistance should be done periodically according to local guidelines for antibiotic therapy of surgical infections, as well as for external comparison.

Spline functions in convolutional modeling of verapamil bioavailability and bioequivalence. II: study in healthy volunteers.

The pharmacokinetics of a new verapamil retard tablet formulation have been investigated in a randomized cross-over bioequivalence study on 12 healthy subjects. The drug was given orally at a single new or standard retard tablet dose of 240mg and at a single intravenous dose of 5mg. Plasma verapamil concentrations were determined by HPLC. New retard tablets produced peak plasma verapamil concentrations of 81.34+/-5.69microg/l, time to peak plasma concentrations of 4.91+/-0.89h and an AUC (0-24h) of 1291+/-103.4h x microg/l, with a terminal phase half-life of 55.1+/-14.9h. After intravenous administration verapamil exhibited biphasic elimination kinetics with a terminal plasma half-life of 2.36+/-0.42h and systemic clearance of 34.32+/-5.81 l/h. Bioavailability of the new peroral retard formulation ranged from 19.49+/-4.41% to 67.69+/-11.70%. Absorption rates and amounts were evaluated by means of the spline-convolutional method. Input rates for the new verapamil retard formulation ranged from 0.77+/-0.20mg/h to 5.57+/-1.58mg/h. The cumulative amount of verapamil input was 39.17+/-9.71% for the new retard tablets. All pharmacokinetic parameters for the new verapamil retard tablet formulation, were in reasonable agreement with the data obtained on already registered verapamil retard formulations, indicating their bioequivalence.

[Non-traumatic subarachnoid hemorrhage of unknown origin]. / Netraumska subarahnoidna hemoragija nepoznatog uzroka.

In a series of 441 patients with signs and symptoms of spontaneous subarachnoid haemorrhage (SAH) in 62 subjects haemorrhagic aetiology could not be established. All patients were admitted during the first week of haemorrhage (most of them within 72 hours). The majority belonged to Hunt's and Hess' 1 and 2 degrees of bleeding (80.64%). Blood in subarachnoid region could not be verified by CT in 30.03% of patients. Among patients with manifested haemorrhages in 59% haemorrhage was localized in perimencephalic cisternae, and in the others a kind of SAH with characteristics of aneurysmal rupture was observed. Digital substratum angiography (DSA) of four cerebral blood vessels was performed in all patients; in 17 patients the procedure had to be repeated, but without a new pathologic substrate. The recovery of the majority of patients (91.93%) was good, and only one patient died one year after the insult. The patients with aneurysmal SAH were separately treated. In these patients the recovery was noted in 73.33% of subjects, and the rest manifested a mild invalidity. In general, patients with SAH of unknown aetiology have a better prognosis than those with aneurysmal SAH.