Delineating the origins of the multidrug-resistant pathogens in ornamental fish farms by multilocus sequence typing and identification of a novel multidrug-resistant plasmid.

To evaluate the overuse of antibiotics and to identify the origin of pathogens in the ornamental fish industry, we conducted a field investigation of three representative fish farms in Liaoning province, China. Drug-resistant pathogens in the fishponds and groundwater were isolated and subtyped by multilocus sequence typing (MLST). In total, 33 pathogenic strains, including Aeromonas veronii and five other pathogens, were isolated from diseased fish and from groundwater. MLST revealed that A. veronii obtained from diseased fish in three fish farms can be subtyped into four sequence types, which were also identified in the corresponding groundwater. All of the isolates obtained from diseased fish showed resistance to at least four antibiotics. Notably, Citrobacter freundii JY-17 exhibited resistance to the majority of the antibiotics and was a carrier of a megaplasmid with 15 drug resistance genes. PCR assays targeting ß-lactam, kanamycin, macrolide, phenicol, sulfonamide, and trimethoprim resistance genes in the pathogens from the diseased fish and groundwater were also conducted. The results revealed strong correlations between antibiotic treatment and increased antimicrobial resistance in fish pathogens. The results suggested that groundwater is the origin of the pathogens in ornamental fish. Antibiotic treatment of ornamental fish promoted the emergence of resistant pathogens.

Antibiotic prescription patterns for acute upper respiratory tract infections in an outpatient population with health insurance in Syria - a retrospective cross-sectional study.

Background: Antibacterial resistance is an ongoing global issue, threatening the lives of millions and affecting the quality of health systems, resulting in high costs to the worldwide economy. Syria is one of many countries with a high rate of antibiotic prescription or consumption, even before the war. Methods: A retrospective cross-sectional study was conducted to assess the pattern of antibiotic prescribing with regard to acute upper respiratory tract infection (AURTI) cases throughout the year 2019; data were collected from GlobeMed Syria (now Modern Healthcare Claims Management Company) following ethical approval. Results: The study comprised 14 913 cases, of which 13 382 (90%) had received an antibiotic prescription. All age groups showed high prescribing rates, with the 46-55 years age group having the highest (95.0%). Acute tonsillitis had the most significant percentage of antibiotics prescribed (98.7%). Cephalosporins were the most commonly prescribed antibiotic class. Family physicians were more inclined to prescribe antibiotics than those in other specialism groups. Conclusion: Syria has a high rate of prescribing antibiotics for AURTIs, which may contribute to the evolution of resistant bacteria. The rate is higher than those reported in other Arab countries. Physicians need to commit to following the official guidelines, taking the appropriate prescribing of antibiotics more seriously, and should take more care in distinguishing viral origins of AURTIs.

COVID-19 Vaccination Outcomes and Antibiotic Crisis and Overuse During the COVID-19 Pandemic in Bosnia and Herzegovina.

Background: COVID-19 has different presentations from mild flu like symptoms such as anosmia, dysgeusia, fever, sore throat, cough, dyspnea, headache, abdominal pain and diarrhoea to severe COVID-19 with the development of acute respiratory syndrome (ARDS), septic shock, metabolic acidosis, coagulation dysfunction, multiorgan failure or even death. Objective: The aim of this research project was to present and highlight the outcomes of the vaccination against COVID-19 and the widespread use of antibiotics during the initial admission and treatment of COVID-19 patients in out of hospital settings. Methods: This observational cross-sectional study was conducted between September 1st and September 24th 2021, during the fourth wave of COVID-19 outbreak in Bosnia and Herzegovina, among the patients admitted to the primary health care COVID-19 centre of Canton Sarajevo in Bosnia and Herzegovina. Results: Patients were mostly female 213 (53.3%), with a mean age of 48.8±18.6, with hypertension 129 (32.3%) or diabetes mellitus 35 (8.7%) as comorbidities and being COVID-19 unvaccinated 236 (59.0%) COVID-19 unvaccinated patients expressed more fever (X 2=9.93, p<0.05), had typical COVID-19 chest X ray presentation (X 2=6.08, p<0.05) and abnormal lung auscultation sounds (X 2=5.43, p<0.05). Out of all patients, 312 (78.0%) have received antibiotics and 3 (0.75%) antivirotics such as favipiravir as therapy for the treatment of COVID-19. The mean duration of the antibiotic regime was 10.2 ± 7.5 days with a minimum of 3 days and maximum of 62 days. The minimum CRP value when antibiotics were prescribed was 0.1 (ref. value <5mg/l). The most prescribed antibiotic was doxycycline 172 (43.0%), followed by ceftriaxone 139 (34.7%) and azithromycin 108 (27.0%). Conclusion: Our study showed that vaccination acts protective for the development of severe COVID-19 forms, as well as that antibiotics were overused among COVID-19 infected. The outcome of such malpractice could lead to antimicrobial resistance which will be seen in further years. Governmental agencies should advise physicians to change these trends.

Prospective study on the overuse of blood test-guided antibiotics on patients with acute diarrhea in primary hospitals of China.

BACKGROUND: Overuse with antibiotics in the treatment of infectious diseases has become a central focus of public health over the years. The aim of this study was to provide an up-to-date evaluation of the blood test-guided antibiotic use on patients with acute diarrhea in primary hospitals of China. MATERIALS AND METHODS: A cross-sectional survey was conducted on 330 patients with acute diarrhea in Shanghai, People's Republic of China, from March 2013 to February 2016. These patients were treated with or without antibiotics based on the results of their blood tests, including examinations of C-reactive protein (CRP), white blood cells (WBC), and the percentage of neutrophils (Neu%). The infection types, which included bacterial, viral, and combination diarrhea, were determined by microbiological culture methods. Antibiotics used in non-bacterial diarrhea patients were considered misused and overused. RESULTS: There were significant overall differences in the clinical characteristics and blood tests between patients with diarrhea with a bacterial infection and patients with other types of infections. The patients were divided into four grading groups (0-3) according to the number of the positive results from three blood testes (CRP, WBC, and Neu%). The misuse rates of antibiotics in each group (0-3) were 81.3%, 71.1%, 72.4%, and 64.9%, respectively. CONCLUSION: In this prospective study, the current diagnostic criteria (CRP, WBC, and Neu%) based on blood tests are not reliable in diagnosing bacterial diarrhea or guiding antibiotics use. To limit antibiotic overuse, a rapid and accurate differentiation of bacterial diarrhea from other types of diarrhea is pivotal.

Antibiotics Use and Misuse in Children: A Knowledge, Attitude and Practice Survey of Parents in India.

INTRODUCTION: Antibiotic resistance is a topic of global concern these days. Irrational, excessive use of antibiotics by the general public is one of the key factors responsible for this. AIM: Through this study, we aim to analyse the knowledge, attitude and practices of antibiotics use among parents of children presenting to a tertiary care hospital in India. Also, correlate it with the gender, education level and previous use of antibiotics by the parents. MATERIALS AND METHODS: A cross sectional study was conducted at a tertiary care hospital in Navi Mumbai, India from September to November 2014 and a total of 1000 parents were interviewed using a questionnaire designed by the authors. Descriptive statistics were used for the analysis of data. RESULTS: A total of 872 parents were included in the study. Around one in every four (28%) parents correctly identified that antibiotics are used against bacterial infections while only 15.5% parents knew the meaning of the term antibiotic resistance. Majority of the respondents appreciated that unnecessary use of antibiotics could harm the child (73.6%). It was noteworthy that 85.2% parents stated that they don't use leftover antibiotics from the previous prescription for the next time without doctor's consult. Males, parents with higher level of formal education and use of antibiotics previously were found to have more knowledge regarding antibiotics and lesser misconceptions (p<0.05). CONCLUSION: Overall, in this study it was found that misconceptions exist about the use and indications of antibiotics. Lack of knowledge regarding antibiotic resistance was prevalent. But participants were aware of the risks associated with use of excessive antibiotics. More interaction with paediatricians and involvement of mass media may help to improve the antibiotics knowledge and practices among parents and consequently, control the problem of antibiotic resistance.

Assessing the overuse of antibiotics in children with URTIs in Saudi Arabia: development of the parental perception on antibiotics scale (PAPA scale).

BACKGROUND: Antibiotic overuse is influenced by several factors that can only be measured using a valid and reliable psychosocial measurement instrument. This study aims to establish translation and early stage validation of an instrument recently developed by this research team to measure factors influencing the overuse of antibiotics in children with upper respiratory tract infections in Saudi Arabia. METHOD: The content evaluation panel was composed of area experts approached using the Delphi Technique. Experts were provided with the questionnaires iteratively, on a three-round basis until consensus on the relevance of items was reached independently. Translation was achieved by adapting Brislin's model of translation. RESULTS: After going through the iterative process with the experts, consensus was reached to 58 items (including demographics). Experts also pointed out some issues related to ambiguity and redundancy in some items. A final Arabic version was produced from the translation process. CONCLUSION: This study produced preliminary validation of the developed instrument from the experts' contributions. Then, the instrument was translated from English to Arabic. The instrument will undergo further validation steps in the future, such as construct validity.

Effects of antibiotic use on cytokine balance in neonatal rats in early life / 中华实用儿科临床杂志

Objective To identify the dynamic influence of antibiotics use on T helper cell(Th) 1/Th2 cytokine balance in neonatal rats in their early life.Methods Twenty-four newborn SD rats were randomly divided into 3 groups including 2dCef group,7dCef group and a control group (n =8).SD rats at 2 or 7 days of age were injected Cefotaxime sodium intraperitoneally for 3 consecutive days.The control group was injected the same amount of phosphate buffer saline.Serum and bronchoaveolar lavage fluid (BALF) samples were collected on 35 days old and diffe-rential cell count in BALF was done.Enzyme linked immunosorbent was used to detect the concentration of interleukin(IL)-12,interferon-γ(IFN-γ),IL-4 and IL-5 in serum and BALF,and real-time quantitative PCR was used to detect mRNA expression of those cytokines in lung tissues.Results The number of total cells,neutrophils,and lymphocytes in Cefotaxime treated on 2nd day after birth were significantly higher than those in the controls and 7th day group (F =93.78,15.84,7.36,all P ＜0.05).For Thl cytokines detection:the IL-12 secretion in BALF and serum and INF -γsecretion in BALF of the 2 antibiotic groups were lower than those in control group (F =26.53,12.95,47.18,all P ＜ 0.05),the decrease in 2dCef group were more obviously than 7dCef group [(127.72 ± 12.35) ng/L vs (198.15 ± 18.93) ng/L,(105.91±13.61) ng/Lvs (133.63 ±13.82) ng/L,(147.23 ±24.10) ng/Lvs (178.52±12.46) ng/L,all P ＜0.05].The mRNA expression of IL-12 in antibiotic groups were lower than those in control group (F =33.60,P ＜0.05),and the decrease in 2dCef group was more obvious than that in 7 dCef group (0.073 ± 0.023 vs 0.093 ± 0.028,P ＜0.05).For the Th2 cytokines:the IL-4 secretion concentration and mRNA expression in the 2 antibiotic groups were higher than those in the control group (BALF,serum and lung) (F =64.26,13.79,11.54,all P ＜ 0.05),the increase in 2dCef group was more obvious than that in 7dCef group[(103.65 ± 7.68) ng/L vs (82.04 ± 8.77) ng/L,(87.81 ± 4.72) ng/L vs (69.69 ± 7.79) ng/L,(0.067 ± 0.036) ng/L vs (0.051 ± 0.055),all P ＜ 0.05];however,no significant differences of IL-5 either mRNA or cytokine secretion being detected among these 3 groups (F =0.50,0.75,0.08,all P ＞ 0.05).Conclusions Antibiotic use during early time of neonate rats alters postnatal immune cells distribution in the lung and promotes the shift in cytokine balance towards a Th2 profile,and the earlier the antibiotic use,the more serious the impact.