Antibiotic stewardship program in dentistry: Challenges and opportunities.

Antimicrobial resistance (AMR) is assigned as a menace by the WHO (World Health Organization) where diseases resulting from multidrug-resistant bacteria are refractory to treatment as a result of a scarcity of new antibiotics in the queue. Antibiotic stewardship program is one of the worldwide strategies to advertise responsible use of antibiotics to halt AMR. The world has started facing a postantibiotic era without immediate and integrated action. Common infections which were treatable for decades can once again kill. The dentistry contributions towards antibiotic resistance are substantial. Approximately 10% of all common antibiotics are prescribed by dentists. Antimicrobial stewardship is a policy that can assist us in addressing the problems of antibiotic resistance. It is a framework that promotes the truly sustainable use of antimicrobials in dentistry. It refers to the approach which is multifaceted and incorporates policies, and guidelines along with surveillance, reports of prevalence and education, and audit of practice for reducing prescribing, adopted by health care organizations. The prime strategy is to improve clinical results while mitigating unintended consequences such as toxicity, pathogenic organism selection, and resistance emergence. Such issues should be centralized and the ongoing need to identify and convert "responsible usage" into context-specific and time-specific behavior. The importance of the antibiotic stewardship program, its team, and their action has become a challenge for the dental hospital but along with it, there are numerous opportunities to achieve the goal.

In-vitro Investigation of Antibiotics Efficacy Against Uropathogenic Escherichia coli Biofilms and Antibiotic Induced Biofilm Formation at Sub-Minimum Inhibitory Concentration of Ciprofloxacin.

BACKGROUND: Community-acquired urinary tract infections are associated with significant morbidity, and uropathogenic Escherichia coli (UPEC) alone causes 90% of urinary tract infections. This bacterium retains a diverse armament of virulence factors including fimbria, hemolysins, and siderophores production. In a post invasion scenario, formation of intracellular communities mimic biofilm-like characteristics and are linked to recurrent urinary tract infections. We investigated the effects of different frontline antibiotics on the formation, inhibition, and eradication of biofilms of virulent UPEC strains. MATERIALS AND METHODS: A total of 155 UPEC strains were scrutinized for various virulence factors including gelatinase, cell surface hydrophobicity, hemagglutination, and serum bactericidal activity. Biofilm formation was confirmed by three different methods: Congo red agar, test tube, and tissue culture plate method. Biofilm inhibition and eradication assays were performed according to the standard protocols. Topographical analysis of biofilms was done by scanning electronic microscopy (SEM). RESULTS: Out of 155 strains, 113 (73%) were strong biofilm formesr, while 37 (24%) produced biofilms at moderate level. Significant differences were observed between MICs of planktonic cells (MIC-p) and MICs of UPEC biofilms (MIC-b). Among tested frontline antibiotics, levofloxacin successfully inhibited biofilms at a concentration of 32 µg/mL, while trimethoprim eradicated biofilms at higher concentrations (512-1024 µg/mL). Ciprofloxacin treatment at sub-MIC level significantly enhanced biofilm formation (P<0.05). CONCLUSION: The majority of UPEC strains are strong biofilm formers and show higher tolerance towards frontline antibiotics in biofilm form. We observed significant inhibitory effects of levofloxacin (32 µg/mL) on UPEC biofilms, while treatment with sub-minimal concentrations of ciprofloxacin significantly enhanced biofilm formation. Out of all tested antibiotics, trimethoprim (512-1024 µg/mL) eradicated UPEC biofilms.

In vitro anticancer and antioxidant potential of Cestrum species.

The methanolic extract of leaves and stem of Cestrum nocturnum and Cestrum diurnum were investigated for their antioxidant and anticancer attribute through standard methods. 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay was carried out to estimate the antioxidant activity of the extracts. Whereas, anticancer potential of extracts were tested against colon cancer cell line, HCT 116 and acute myeloid leukemia (AML) cell lines, THP-1. Results showed that extracts of both plants exhibited a very strong antioxidant activity in a dose dependent manner. In addition, both extracts efficiently increased the cell death in two different cancer cell lines. Moreover, DNA fragmentation analysis further strengthens the anticancer potential of extracts of both types of plants. Current study, therefore, provide a preliminary data highlighting the antioxidant and anticancer activities of methanolic extract of leaves and stem of Cestrum nocturnum and Cestrum diurnum.

Should All Low-risk Patients Now Be Considered for TAVR? Operative Risk, Clinical, and Anatomic Considerations.

PURPOSE OF REVIEW: This article reviews the current data on TAVR in low-risk patients with severe, symptomatic aortic stenosis, highlights the results of the recently published Medtronic Low Risk Randomized Study and PARTNER 3 trials, and describes specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice in this population. RECENT FINDINGS: In low-risk patients, the Medtronic Low Risk Randomized Study demonstrated TAVR to be non-inferior to surgery with respect to the composite endpoint of death or disabling stroke while PARTNER 3 trial proved TAVR to be superior to surgery with regard to the composite endpoint of death, stroke, or rehospitalization. Recent trials demonstrate the safety and efficacy of TAVR in low-risk patients and have led to an FDA indication for the use of TAVR in these patients. However, the lack of long-term data on the rate of transcatheter valve deterioration in the younger population, higher incidence of paravalvular leak and pacemaker implantation following TAVR, along with certain intrinsic anatomic factors remain potential challenges to generalize TAVR in all low surgical risk patients. We describe specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice for low-risk patients with severe, symptomatic AS.

Population based study of serum lipid levels in Al-Kharj Health Center, Saudi Arabia.

OBJECTIVE: Previous studies have shown high prevalence of diabetes mellitus, hypertension, obesity and smoking in this community. The aim of this study is to determine the prevalence and factors associated with hyperlipidemia. METHODS: A questionnaire was administered on all patients < or =13-years of age seen by investigators between April 2002 and October 2002 in Al-Kharj Health Centre, Kingdom of Saudi Arabia. Questions were asked regarding demography; weight and height were measured and blood was collected after 14 hours fasting for lipid levels. RESULTS: Four hundred and twenty-three (56.7%) of the study population had cholesterol level <5.2 mmol/L. Three hundred and twenty-three (43.3%) had cholesterol level >5.2 mmol/L (desirable level according to National Cholesterol Education Program [NCEP]). Mean serum cholesterol level for males and females were 5.08 mmol/L and 5.19 mmol/L; 462 (59.80%) had triglycerides level <1.7 mmol/L and 311 (40.20%) had level >1.7 mmol/L (NCEP). Age <50 years, education less than high school (12 years), family history of hyperlipidemia and high triglyceride levels were strongly associated with hyperlipidemia. CONCLUSION: The study points to high prevalence of total cholesterol, triglyceride and low density lipoprotein in this population. We suggest further studies and steps to reverse these factors, which are modifiable by changes in lifestyle.