Total antibiotic use in a state-wide area and resistance patterns in Brazilian hospitals: an ecologic study

Background and Aim: Dissemination of multidrug-resistant (MDR) Salmonella through food chains has serious health implications, with higher rates of morbidity and mortality. Broiler meat remains a major reservoir of Salmonella contamination. The lack of proper hygiene in local broiler operations has, therefore, prompted this research into the assessment of Salmonella contamination in local shops and associated antimicrobial resistance (AMR) phenotypes. Materials and Methods: A total of 55 broiler samples including skin, meat, and swab samples from chopping and dressing sites were included in the study. The samples were collected from broiler shops in Hathazari, Bangladesh, and screened for the presence of Salmonella strains using culture-based methods. The isolates were biochemically characterized and further tested for AMR to eight common antibiotics using the disk diffusion technique. Results: Salmonella contaminations were identified in 29% (16/55) of the broiler samples. Swab samples collected from the chopping sites appeared to be contaminated in higher proportions (33%) than those collected from the dressing areas (25%). On the other hand, the skin samples (50%) were detected with a higher percentage of contamination than the meat samples (25%). All Salmonella isolates showed resistance toward at least one of the eight antibiotics used. Although none of the isolates was resistant to all antibiotics, 18.75% showed resistance to a maximum of seven antibiotics. Resistance to nalidixic acid was most prevalent (87.5%), followed by sulfamethoxazole-trimethoprim (81.25%), erythromycin (81.25%), tetracycline (75%), streptomycin (56.25%), ampicillin-clavulanic acid (50%), chloramphenicol (43.75%), and cefotaxime (18.75%). The resistance patterns of the isolates were found to be highly diverse. The most frequently observed pattern was the following: Ampicillin-clavulanic acid-sulfamethoxazole-trimethoprim-nalidixic acid-tetracycline-chloramphenicol-streptomycin-erythromycin. Conclusion: The relatively high prevalence of MDR strains in the samples underlies an urgent need for surveillance and control measures concerning hygiene and antibiotic use in local broiler operations.

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Treatment practice of acute cystitis on the basis of national prescription data

Orvosi Hetilap ◽

10.1556/oh.2014.29804 ◽

2014 ◽

Vol 155 (15) ◽

pp. 590-596 ◽

Cited By ~ 2

Author(s):

Zoltán Juhász ◽

Ria Benkő ◽

Mária Matuz ◽

Réka Viola ◽

Gyöngyvér Soós ◽

...

Keyword(s):

National Level ◽

Antibiotic Use ◽

Adherence Rate ◽

Prescription Data ◽

National Guidelines ◽

Acute Cystitis ◽

Treatment Practice ◽

Prescribing Quality ◽

Resistance Patterns ◽

Tract Infections

Introduction: Urinary tract infections are one of the common diseases in the primary health care. Aim: To analyse patterns of ambulatory antibiotic use in acute cystitis. Method: Antibiotic use data was based on national-level prescription turnovers. Patterns of antibiotic use were evaluated by prescribing quality indicators. The content of different national guidelines for treatment of acute cystitis and adherence to these guidelines were also evaluated. Results: For the treatment of acute cystitis quinolones were used predominantly. Norfloxacin (26%) and ciprofloxacin (19%) were prescribed most commonly. The use of internationally recommended agents such as sulphonamides, nitrofurans and fosfomycin shared 15%, 7% and 2%, respectively. The average adherence rate to national guidelines was 66% and certain weak points (e.g. controversial content) of the national guidelines were also identified. Conclusions: Antibiotic use in acute cystitis seems to be suboptimal in Hungary. Considering actual local antibiotic resistance patterns, a new national guideline should be worked out for acute cystitis treatment. Orv. Hetil., 2014, 155(15), 590–596.

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A between-Species Comparison of Antimicrobial Resistance in Enterobacteria in Fecal Flora

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.44.6.1479-1484.2000 ◽

2000 ◽

Vol 44 (6) ◽

pp. 1479-1484 ◽

Cited By ~ 56

Author(s):

Monica Österblad ◽

Antti Hakanen ◽

Raija Manninen ◽

Tiina Leistevuo ◽

Reijo Peltonen ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Length Of Hospital Stay ◽

Antibiotic Use ◽

University Hospital ◽

Fecal Flora ◽

E Coli ◽

Defined Daily Doses ◽

Hospital Patients ◽

Resistance Patterns ◽

Resistance Data

ABSTRACT Enterobacteria in fecal flora are often reported to be highly resistant. Escherichia coli is the main species; resistance data on other species are rare. To assess the effect of the host's environment, antimicrobial resistance was determined in fecal species of the family Enterobacteriaceae from three populations: healthy people (HP)(n = 125) with no exposure to antimicrobials for 3 months preceding sampling, university hospital patients (UP) (n = 159) from wards where the antibiotic use was 112 defined daily doses (DDD)/bed/month, and geriatric long-term patients (LTP) (n = 74) who used 1.8 DDD/bed/month. The mean length of hospital stay was 5 days for the UP and 22 months for the LTP. The isolates were identified to at least genus level, and MICs of 16 antimicrobials were determined. From the university hospital, resistance data on clinicalEnterobacteriaceae isolates were also collected. Resistance data for on average two different isolates per sample (range, 1 to 5) were analyzed: 471 E. coli isolates and 261 otherEnterobacteriaceae spp. Resistance was mainly found amongE. coli; even in HP, 18% of E. coli isolates were resistant to two or more antimicrobial groups, with MIC patterns indicative of transferable resistance. Other fecal enterobacteria were generally susceptible, with little typically transferable multiresistance. Clinical Klebsiella andEnterobacter isolates were significantly more resistant than fecal isolates. The resistance patterns at both hospitals mirrored the patterns of antibiotic use, but LTP E. coli isolates were significantly more resistant than those from UP. Conditions permitting an efficient spread may have been more important in sustaining high resistance levels in the LTP. E. coli was the main carrier of antimicrobial resistance in fecal flora; resistance in other species was rare in the absence of antimicrobial selection.

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Antibiotics on the rise: Google trends as a monitoring tool in India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20214810 ◽

2021 ◽

Author(s):

Manoj Reddy Somagutta ◽

Maria K. L. Pormento ◽

Namrata Hange ◽

Obumneme J. Iloeje ◽

Molly S. Jain ◽

...

Keyword(s):

Health Care ◽

Drug Resistance ◽

Antibiotic Use ◽

Google Trends ◽

Specific Topic ◽

Monitoring Tool ◽

Middle Income ◽

Middle Income Countries ◽

Search Terms ◽

Resistance Patterns

Coronavirus disease 2019 (COVID-19) pandemic has put enormous strains on health care and public sector resources globally, especially in low- and middle-income countries. The extensive and often inept use of antibiotics during the pandemic is suspected. Data from Google trends (GT) enables the assessment of Google users' interest in a specific topic. A strong correlation between active COVID-19 cases and GT search terms of antibiotics (r=0.90) azithromycin (r=0.96) and doxycycline (r=0.93) were noticed with p<0.05. However, hydroxychloroquine (r=0.21) was not significant. Further investigation is needed to determine GT as a possible adjunctive monitoring tool for antibiotic use and formulate drug resistance patterns in India.

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Impact of a Multimodal Antimicrobial Stewardship Program onPseudomonas aeruginosaSusceptibility and Antimicrobial Use in the Intensive Care Unit Setting

Critical Care Research and Practice ◽

10.1155/2011/416426 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Douglas Slain ◽

Arif R. Sarwari ◽

Karen O. Petros ◽

Richard L. McKnight ◽

Renee B. Sager ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antimicrobial Stewardship ◽

Antibiotic Stewardship ◽

Antibiotic Use ◽

Resistance Rate ◽

Defined Daily Doses ◽

Stewardship Program ◽

Resistance Patterns ◽

The Impact

Objective. To study the impact of our multimodal antibiotic stewardship program onPseudomonas aeruginosasusceptibility and antibiotic use in the intensive care unit (ICU) setting.Methods. Our stewardship program employed the key tenants of published antimicrobial stewardship guidelines. These included prospective audits with intervention and feedback, formulary restriction with preauthorization, educational conferences, guidelines for use, antimicrobial cycling, and de-escalation of therapy. ICU antibiotic use was measured and expressed as defined daily doses (DDD) per 1,000 patient-days.Results. Certain temporal relationships between antibiotic use and ICU resistance patterns appeared to be affected by our antibiotic stewardship program. In particular, the ICU use of intravenous ciprofloxacin and ceftazidime declined from 148 and 62.5 DDD/1,000 patient-days to 40.0 and 24.5, respectively, during 2004 to 2007. An increase in the use of these agents and resistance to these agents was witnessed during 2008–2010. Despite variability in antibiotic usage from the stewardship efforts, we were overall unable to show statistical relationships withP. aeruginosaresistance rate.Conclusion. Antibiotic resistance in the ICU setting is complex. Multimodal stewardship efforts attempt to prevent resistance, but such programs clearly have their limits.

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Multiple Antibiotic Resistance Patterns ofEscherichia coli Isolates from Swine Farms

Applied and Environmental Microbiology ◽

10.1128/aem.65.6.2770-2772.1999 ◽

1999 ◽

Vol 65 (6) ◽

pp. 2770-2772 ◽

Cited By ~ 47

Author(s):

A. G. Mathew ◽

A. M. Saxton ◽

W. G. Upchurch ◽

S. E. Chattin

Keyword(s):

Escherichia Coli ◽

Antibiotic Resistance ◽

Antibiotic Use ◽

Ofescherichia Coli ◽

Multiple Antibiotic Resistance ◽

E Coli ◽

Swine Farms ◽

Resistance Patterns ◽

Antibiotic Resistance Patterns ◽

Farm Types

ABSTRACT Antibiotic resistance of Escherichia coli from sows and pigs was determined to compare patterns between pigs of various ages and degrees of antibiotic use. Resistance patterns differed between farm types and pigs of differing ages, indicating that pig age and degree of antibiotic use affect resistance of fecal E. coli.

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Microbiologic Surveillance and Parenteral Antibiotic Use in a Critical Care Unit

Canadian Journal of Infectious Diseases ◽

10.1155/2000/672340 ◽

2000 ◽

Vol 11 (2) ◽

pp. 107-111 ◽

Cited By ~ 2

Author(s):

Sharon K Yamashita ◽

Marie Louie ◽

Andrew E Simor ◽

Anita Rachlis

Keyword(s):

Staphylococcus Aureus ◽

Critical Care ◽

Antimicrobial Therapy ◽

Critical Care Unit ◽

Bacterial Resistance ◽

Tertiary Care ◽

Antibiotic Use ◽

Parenteral Antibiotic ◽

Gram Negative ◽

Resistance Patterns

OBJECTIVE: To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU).DESIGN: Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay.SETTING: A 17-bed medical-surgical CrCU in a tertiary care teaching hospital in Metropolitan Toronto.PATIENTS: Two hundred and fifty-eight patients admitted to the CrCU between May 1995 and April 1996 who received antimicrobial therapy.RESULTS: The most frequently prescribed antibiotics were cefazolin (47%, 1098 g), gentamicin (33%,141 g) and ceftriaxone (20%, 255 g). The most common indications for antimicrobial therapy included surgical prophylaxis (34%) and pneumonia (35%). The following organisms were isolated from patients treated with antibiotics:Staphylococcus aureus(26%),Pseudomonas aeruginosa(13%), enterococci (12%),Haemophilus influenzae(11%),Escherichia coli(11%),Enterobacter cloacae(8%) and other Gram-negative bacilli (19%). Only 9% of Gram-negative bacilli were resistant to aminoglycosides, 3% were resistant to ciprofloxacin and no extended-spectrum beta-lactamases or imipenem-resistance were detected. No vancomycin-resistant enterococci and only two methicillin-resistantStaphylococcus aureusisolates were identified.CONCLUSIONS: Antibiotic use during the audit appeared appropriate for the specific clinical indications. Low levels of bacterial resistance were detected during the audit.

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Harmonized One Health Trans-Species and Community Surveillance for Tackling Antibacterial Resistance in India: Protocol for a Mixed Methods Study (Preprint)

10.2196/preprints.23241 ◽

2020 ◽

Author(s):

◽

Manoja Kumar Das ◽

Ashoka Mahapatra ◽

Basanti Pathi ◽

Rajashree Panigrahy ◽

...

Keyword(s):

Risk Factors ◽

Data Analysis ◽

Data Collection ◽

One Health ◽

Antibiotic Use ◽

Resistant Bacteria ◽

Drug Resistant ◽

Care Seeking ◽

Attitudes And Practices ◽

Resistance Patterns

BACKGROUND India has the largest burden of drug‑resistant organisms compared with other countries around the world, including multiresistant and extremely drug‑resistant tuberculosis and resistant Gram‑negative and Gram‑positive bacteria. Antibiotic resistant bacteria are found in all living hosts and in the environment and move between hosts and ecosystems. An intricate interplay of infections, exposure to antibiotics, and disinfectants at individual and community levels among humans, animals, birds, and fishes triggers evolution and spread of resistance. The <i>One Health</i> framework proposes addressing antibiotic resistance as a complex multidisciplinary problem. However, the evidence base in the Indian context is limited. OBJECTIVE This multisectoral, trans-species surveillance project aims to document the infection and resistance patterns of 7 resistant-priority bacteria and the risk factors for resistance following the One Health framework and geospatial epidemiology. METHODS This hospital- and community-based surveillance adopts a cross-sectional design with mixed methodology (quantitative, qualitative, and spatial) data collection. This study is being conducted at 6 microbiology laboratories and communities in Khurda district, Odisha, India. The laboratory surveillance collects data on bacteria isolates from different hosts and their resistance patterns. The hosts for infection surveillance include humans, animals (livestock, food chain, and pet animals), birds (poultry), and freshwater fishes (not crustaceans). For eligible patients, animals, birds and fishes, detailed data from their households or farms on health care seeking (for animals, birds and fishes, the illness, and care seeking of the caretakers), antibiotic use, disinfection practices, and neighborhood exposure to infection risks will be collected. Antibiotic prescription and use patterns at hospitals and clinics, and therapeutic and nontherapeutic antibiotic and disinfectant use in farms will also be collected. Interviews with key informants from animal breeding, agriculture, and food processing will explore the perceptions, attitudes, and practices related to antibiotic use. The data analysis will follow quantitative (descriptive and analytical), qualitative, and geospatial epidemiology principles. RESULTS The study was funded in May 2019 and approved by Institute Ethics Committees in March 2019. The data collection started in September 2019 and shall continue till March 2021. As of June 2020, data for 56 humans, 30 animals and birds, and fishes from 10 ponds have been collected. Data analysis is yet to be done. CONCLUSIONS This study will inform about the bacterial infection and resistance epidemiology among different hosts, the risk factors for infection, and resistance transmission. In addition, it will identify the potential triggers and levers for further exploration and action. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/23241

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Evaluating the Relationship Between Hospital Antibiotic Use and Antibiotic Resistance in Common Nosocomial Pathogens

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.222 ◽

2017 ◽

Vol 38 (12) ◽

pp. 1457-1463 ◽

Cited By ~ 14

Author(s):

Annie Wang ◽

Nick Daneman ◽

Charlie Tan ◽

John S. Brownstein ◽

Derek R. MacFadden

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Susceptibility ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Hospital Type ◽

Defined Daily Doses ◽

Resistance Patterns ◽

Antibiotic Resistance Patterns ◽

The Relationship ◽

Resistance Data

OBJECTIVEThe relationship between hospital antibiotic use and antibiotic resistance is poorly understood. We evaluated the association between antibiotic utilization and resistance in academic and community hospitals in Ontario, Canada.METHODSWe conducted a multicenter observational ecological study of 37 hospitals in 2014. Hospital antibiotic purchasing data were used as an indicator of antibiotic use, whereas antibiotic resistance data were extracted from hospital indexes of resistance. Multivariate regression was performed, with antibiotic susceptibility as the primary outcome, antibiotic consumption as the main predictor, and additional covariates of interest (ie, hospital type, laboratory standards, and patient days).RESULTSWith resistance data representing more than 90,000 isolates, we found the increased antibiotic consumption in defined daily doses per 1,000 patient days (DDDs/1,000 PD) was associated with decreased antibiotic susceptibility forPseudomonas aeruginosa(−0.162% per DDD/1,000 PD;P=.119). However, increased antibiotic consumption predicted increased antibiotic susceptibility significantly forEscherichia coli(0.173% per DDD/1,000 PD;P=.005),Klebsiellaspp (0.124% per DDD/1,000 PD;P=.004),Enterobacterspp (0.194% per DDD/1,000 PD;P=.003), andEnterococcusspp (0.309% per DDD/1,000 PD;P=.001), and nonsignificantly forStaphylococcus aureus(0.012% per DDD/1,000 PD;P=.878). Hospital type (P=.797) and laboratory standard (P=.394) did not significantly predict antibiotic susceptibility, while increased hospital patient days generally predicted increased organism susceptibility (0.728% per 10,000 PD;P<.001).CONCLUSIONSWe found that hospital-specific antibiotic usage was generally associated with increased, rather than decreased hospital antibiotic susceptibility. These findings may be explained by community origins for many hospital-diagnosed infections and practitioners choosing agents based on local antibiotic resistance patterns.Infect Control Hosp Epidemiol2017;38:1457–1463

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