scholarly journals Evaluation of the impact of antimicrobial use protocols in PRRS virus infected swine on phenotypic antimicrobial resistance patterns

2021 ◽  
Author(s):  
Carissa A. Odland ◽  
Roy Edler ◽  
Noelle R. Noyes ◽  
Scott A. Dee ◽  
Joel Nerem ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Longitudinal Studies ◽  
Bacterial Infections ◽  
Population Level ◽  
Control Group ◽  
Antimicrobial Use ◽  
Treatment Groups ◽  
Resistance Patterns ◽  
The Impact ◽  
Over Time

A longitudinal study was conducted to assess the impact of different antimicrobial exposures of nursery-phase pigs on patterns of phenotypic antimicrobial resistance in fecal indicator organisms throughout the growing phase. Based on practical approaches used to treat moderate to severe PRRSV-associated secondary bacterial infections, two antimicrobial protocols of differing intensity of exposure [44.1 and 181.5 animal-treatment days per 1000 animal days at risk (ATD)] were compared with a control group with minimal antimicrobial exposure (2.1 ATD). Litter-matched pigs (n = 108) with no prior antimicrobial exposure were assigned randomly to the treatment groups. Pen fecal samples were collected nine times during the wean-to-finish period and cultured for Escherichia coli and Enterococcus spp. Antimicrobial susceptibility testing was conducted using NARMS gram-negative and gram-positive antibiotic panels. Despite up to 65-fold difference in ATD, few and modest differences were observed between groups and over time. Resistant patterns at marketing overall remained similar to those observed at weaning, prior to any antimicrobial exposures. Those differences observed could not readily be reconciled with the patterns of antimicrobial exposure. Resistance of E. coli to streptomycin was higher in the group exposed to 44.1 ATD, but no aminoglycosides were used. In all instances where resistance differed between time points, the higher resistance occurred early in the trial prior to any antimicrobial exposures. These minimal impacts on AMR despite substantially different antimicrobial exposures point to the lack of understanding of the drivers of AMR at the population level and the likely importance of factors other than antimicrobial exposure. IMPORTANCE Despite a recognized need for more longitudinal studies to assess the effects of antimicrobial use on resistance in food animals, they remain sparse in the literature, and most longitudinal studies of pigs have been observational. The current experimental study had the advantages of greater control of potential confounding, precise measurement of antimicrobial exposures which varied markedly between groups and tracking of pigs until market age. Overall, resistance patterns were remarkably stable between the treatment groups over time, and the differences observed could not be readily reconciled with the antimicrobial exposures, indicating the likely importance of other determinants of AMR at the population level.

Wastewater Surveillance of Antimicrobial Resistance in Human Populations: A Systematic Review

2020 ◽  
Author(s):  
Kevin Chau ◽  
Leanne Barker ◽  
Natalie Sims ◽  
Barbara Kasprzyk-Hordern ◽  
Eric Budgell ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Longitudinal Studies ◽  
Study Design ◽  
Meta Analysis ◽  
Population Level ◽  
Human Populations ◽  
Grab Sampling ◽  
Culture Independent ◽  
Methodological Approaches ◽  
The Impact

Wastewater-based surveillance of antimicrobial resistance (AMR) may facilitate convenient monitoring of population-level AMR prevalence without the healthcare-associated bias and data collection restrictions inherent to clinically oriented systems. However, differences in study design and methodology likely contribute to differences in outcomes and interpretation, limiting reproducibility, reliability and meta-analysis. We therefore systematically reviewed studies using wastewater for AMR surveillance in human populations to identify optimal practices to detect wastewater-human AMR correlations. We evaluated 7,063 records and 174 full-text methods in a two-stage screen; 20 studies were included. Risk of bias assessment divided studies into high-risk (n=3), low-risk (n=3) and unclear-risk (n=14). Most studies detected wastewater-human AMR correlations (n=15) but only six studies identified statistically significant associations, most via culture-independent approaches (n=5). Genomic approaches also facilitated higher-resolution AMR monitoring whereas culture-based studies primarily undertook observational comparisons of specific organisms and phenotypic AMR profiles. Studies identifying wastewater-human AMR correlations were consistently associated with sampling wastewater influent irrespective of other methodological approaches. For longitudinal studies, a timeframe of >=6 months was similarly associated. Most influent studies identifying wastewater-human AMR correlations used composite (n=5) or flow-proportional wastewater sampling methods (n=4); however, grab sampling was commonest overall (n=6) and generally appeared similarly effective.Wastewater-based surveillance of AMR in human populations appears relatively robust, with most included studies reporting a correlation despite high diversity in study design and methodology. Our review supports sampling of wastewater influent using composite sampling (at a minimum) as a standard. Impacts of other methodological approaches are less clear; however, a minimum timeframe of six months for longitudinal studies, and increased sampling coverage for culture-independent studies to enable adequate biostatistical analyses appear sensible. As this relatively new field grows, more studies with clear wastewater-based population-level AMR surveillance aims are needed to better determine the impact of confounding features and validate comprehensive “best practice” protocols.

scholarly journals Effects of In-Feed Chlortetracycline Prophylaxis in Beef Cattle on Animal Health and Antimicrobial-Resistant Escherichia coli

2016 ◽  
Vol 82 (24) ◽  
pp. 7197-7204 ◽  
Author(s):  
Getahun E. Agga ◽  
John W. Schmidt ◽  
Terrance M. Arthur
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Human Health ◽  
Bacterial Infections ◽  
Animal Health ◽  
Agricultural Practices ◽  
Control Group ◽  
Content Type ◽  
E Coli ◽  
The Impact

ABSTRACTConcerns have been raised that in-feed chlortetracycline (CTC) may increase antimicrobial resistance (AMR), specifically tetracycline-resistant (TETr)Escherichia coliand third-generation cephalosporin-resistant (3GCr)E. coli. We evaluated the impact of a 5-day in-feed CTC prophylaxis on animal health, TETrE. coli, and 3GCrE. coli. A control group of cattle (n= 150) received no CTC, while a CTC group (n= 150) received in-feed CTC (10 mg/lb of body weight/day) from the 5th to the 9th day after feedlot arrival. Over 25% (38/150) of the animals in the control group developed illnesses requiring therapeutic treatment with antimicrobials critically important to human medicine. Only two animals (1.3%) in the CTC group required such treatments. Fecal swab and pen surface occurrences of genericE. coli(isolated on media that did not contain antimicrobials of interest and were not isolated based on any specific resistance), TETrE. coli, and 3GCrE. coliwere determined on five sampling occasions: arrival at the feedlot, 5 days posttreatment (5 dpt), 27 dpt, 75 dpt, and 117 dpt. On 5 dpt, TETrE. coliconcentrations were higher for the CTC group than the control group (P< 0.01). On 27 dpt, 75 dpt, and 117 dpt, TETrE. coliconcentrations did not differ between groups. 3GCrE. colioccurrences did not differ between control and CTC groups on any sampling occasion. For both groups, generic, TETr, and 3GCrE. colioccurrences were highest on 75 dpt and 117 dpt, suggesting that factors other than in-feed CTC contributed more significantly to antimicrobial-resistantE. colioccurrence.IMPORTANCEThe occurrence of human bacterial infections resistant to antimicrobial therapy has been increasing. It has been postulated that antimicrobial resistance was inevitable, but the life span of the antimicrobial era has been prematurely compromised due to the misuse of antimicrobials in clinical and agricultural practices. Direct evidence relating the use of antimicrobials in livestock production to diminished human health outcomes due to antimicrobial resistance is lacking, and the U.S. Food and Drug Administration has taken an approach to maximize therapeutic efficacy and minimize the selection of resistant microorganisms through judicious use of antimicrobials. This study demonstrated that prophylactic in-feed treatment of chlortetracycline administered for 5 days to calves entering feedlots is judicious, as this therapy reduced animal morbidity, reduced the use of antimicrobials more critical to human health, and had no long-term impact on the occurrence of antimicrobial-resistantE. coli.

scholarly journals 152. Applying A Difference-in-Difference Analysis to Assess Effect of Antimicrobial Stewardship Strategies on Changes in Antimicrobial Use

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S86-S86
Author(s):  
Ann F Chou ◽  
Yue Zhang ◽  
Makoto M Jones ◽  
Christopher J Graber ◽  
Matthew B Goetz ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Pharmacist ◽  
Antibiotic Use ◽  
Feedback Mechanism ◽  
Health Care Facilities ◽  
Antimicrobial Use ◽  
Time Points ◽  
The Difference ◽  
The Impact ◽  
Over Time

Abstract Background About 30–50% of inpatient antimicrobial therapy is sub-optimal. Health care facilities have utilized various antimicrobial stewardship (AS) strategies to optimize appropriate antimicrobial use, improve health outcomes, and promote patient safety. However, little evidence exists to assess relationships between AS strategies and antimicrobial use. This study examined the impact of changes in AS strategies on antimicrobial use over time. Methods This study used data from the Veterans Affairs (VA) Healthcare Analysis & Informatics Group (HAIG) AS survey, administered at 130 VA facilities in 2012 and 2015, and antimicrobial utilization from VA Corporate Data Warehouse. Four AS strategies were examined: having an AS team, feedback mechanism on antimicrobial use, infectious diseases (ID) attending physicians, and clinical pharmacist on wards. Change in AS strategies were computed by taking the difference in the presence of a given strategy in a facility between 2012–2015. The outcome was the difference between antimicrobial use per 1000 patient days in 2012–2013 and 2015–2016. Employing multiple regression analysis, changes in antimicrobial use was estimated as a function of changes in AS strategies, controlling for ID human resources in and organizational complexity. Results Of the 4 strategies, only change in availability of AS teams had an impact on antimicrobial use. Compared to facilities with no AS teams at both time points, antibiotic use decreased by 63.9 uses per 1000 patient days in facilities that did not have a AS team in 2012 but implemented one in 2015 (p=0.0183). Facilities that had an AS team at both time points decreased use by 62.2 per 1000 patient days (p=0.0324). Conclusion The findings showed that AS teams reduced inpatient antibiotic use over time. While changes in having feedback on antimicrobial use and clinical pharmacist on wards showed reduced antimicrobial use between 2012–2015, the differences were not statistically significant. These strategies may already be a part of a comprehensive AS program and employed by AS teams. In further development of stewardship programs within healthcare organizations, the association between AS teams and antibiotic use should inform program design and implementation. Disclosures All Authors: No reported disclosures

scholarly journals Emerging Options for the Diagnosis of Bacterial Infections and the Characterization of Antimicrobial Resistance

2021 ◽  
Vol 22 (1) ◽  
pp. 456
Author(s):  
Simone Rentschler ◽  
Lars Kaiser ◽  
Hans-Peter Deigner
Keyword(s):  
Antimicrobial Resistance ◽  
Bacterial Infections ◽  
Point Of Care ◽  
Rapid Identification ◽  
Adequate Treatment ◽  
Resistance Patterns ◽  
Detection And Diagnosis ◽  
Patient Prognosis ◽  
Point Of Care Detection

Precise and rapid identification and characterization of pathogens and antimicrobial resistance patterns are critical for the adequate treatment of infections, which represent an increasing problem in intensive care medicine. The current situation remains far from satisfactory in terms of turnaround times and overall efficacy. Application of an ineffective antimicrobial agent or the unnecessary use of broad-spectrum antibiotics worsens the patient prognosis and further accelerates the generation of resistant mutants. Here, we provide an overview that includes an evaluation and comparison of existing tools used to diagnose bacterial infections, together with a consideration of the underlying molecular principles and technologies. Special emphasis is placed on emerging developments that may lead to significant improvements in point of care detection and diagnosis of multi-resistant pathogens, and new directions that may be used to guide antibiotic therapy.

scholarly journals The Importance of Studying Health Behavior in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 827-827
Author(s):  
Jaime Hughes ◽  
Susan Hughes ◽  
Mina Raj ◽  
Janet Bettger
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Behavior Change ◽  
Chronic Conditions ◽  
Population Level ◽  
Multiple Chronic Conditions ◽  
Prior Work ◽  
Time Changes ◽  
The Impact ◽  
Over Time

Abstract Behavior change is an inherent aspect of routine geriatric care. However, most research and clinical programs emphasis how to initiate behavior change with less emphasis placed on skills and strategies to maintain behaviors over time, including after an intervention has concluded. This presentation will provide an introduction to the symposium, including a review of prior work and our rationale for studying the critical yet overlooked construct of maintenance in older adults. Several key considerations in our work include the impact of multiple chronic conditions, declines in cognitive and functional capacity over time, changes in environmental context and/or social support, and sustainability of community and population-level programs and services.

scholarly journals Pediatric Antimicrobial Susceptibility Trends across the United States

2013 ◽  
Vol 34 (12) ◽  
pp. 1244-1251 ◽  
Author(s):  
Pranita D. Tamma ◽  
Gwen L. Robinson ◽  
Jeffrey S. Gerber ◽  
Jason G. Newland ◽  
Chloe M. DeLisle ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
The United States ◽  
Methicillin Resistant ◽  
Resistance Patterns ◽  
Gram Negative Organisms ◽  
Pediatric Healthcare ◽  
Regional Comparisons ◽  
Susceptibility Patterns ◽  
Over Time

Objective.Antimicrobial susceptibility patterns across US pediatric healthcare institutions are unknown. A national pooled pediatric antibiogram (1) identifies nationwide trends in antimicrobial resistance, (2) allows across-hospital benchmarking, and (3) provides guidance for empirical antimicrobial regimens for institutions unable to generate pediatric antibiograms.Methods.In January 2012, a request for submission of pediatric antibiograms between 2005 and 2011 was sent to 233 US hospitals. A summary antibiogram was compiled from participating institutions to generate proportions of antimicrobial susceptibility. Temporal and regional comparisons were evaluated using χ² tests and logistic regression, respectively.Results.Of 200 institutions (85%) responding to our survey, 78 (39%) reported generating pediatric antibiograms, and 55 (71%) submitted antibiograms. Carbapenems had the highest activity against the majority of gram-negative organisms tested, but no antibiotic had more than 90% activity against Pseudomonas aeruginosa. Approximately 50% of all Staphylococcus aureus isolates were methicillin resistant. Western hospitals had significantly lower proportions of S. aureus that were methicillin resistant compared with all other regions tested. Overall, 21% of S. aureus isolates had resistance to clindamycin. Among Enterococcus faecium isolates, the prevalence of susceptibility to ampicillin (25%) and vancomycin (45%) was low but improved over time (P < .01), and 8% of E. faecium isolates were resistant to linezolid. Southern hospitals reported significantly higher prevalence of E. faecium with susceptibilities to ampicillin, vancomycin, and linezolid compared with the other 3 regions (P < .01).Conclusions.A pooled, pediatric antibiogram can identify nationwide antimicrobial resistance patterns for common pathogens and might serve as a useful tool for benchmarking resistance and informing national prescribing guidelines for children.

scholarly journals Do EFL Learners Enhance Their knowledge of Their Home Cultures as a Result of comparing them with other Cultures Through Project-Based Learning?

2021 ◽  
Vol 04 (08) ◽  
Author(s):  
Akharraz Mohamad ◽  
Keyword(s):  
Language Learners ◽  
Cultural Awareness ◽  
Cultural Practices ◽  
Project Based Learning ◽  
Control Group ◽  
Cultural Products ◽  
Treatment Groups ◽  
Foreign Language Learners ◽  
The Impact ◽  
Experimental Group

The existing research studies have revealed that project-based learning (PjBL) has significantly helped foreign language learners enhance their cultural understanding as a result of completing their projects (e.g., Bouchouk, 2017; Hsu, 2014; Kim, 2019; Liu et al., 2006; Ngo, 2014). While these studies have congruently proved the utility of PjBL in enhancing students’ cultural awareness, none of them has measured the effect of PjBL together with a comparative and contrastive approach on students’ understanding of their home cultures. Hence, the purpose of this study is to investigate the impact of comparing students’ home cultures with the English cultures through PjBL on students’ understanding of their own cultures in terms of cultural products, cultural practices, and cultural perspectives. Two similar intact groups were randomly assigned to control and treatment groups. The two groups were pretested, administered two different treatments for 24 weeks, and post-tested to assess their differences. The independent sample t-tests results exhibited that the experimental group substantially deepened their understanding of their home cultures as a result of comparing them with the English cultures through PjBL. The study also revealed that while the control group significantly improved their cultural products, those in the experimental group greatly enhanced their knowledge of cultural practices and perspectives.

scholarly journals Salmonella Typhimurium in livestock in Great Britain – trends observed over a 32-year period

2018 ◽  
Vol 146 (4) ◽  
pp. 409-422 ◽  
Author(s):  
D. Mueller-Doblies ◽  
K. C. R. Speed ◽  
S. Kidd ◽  
R. H. Davies
Keyword(s):  
Retrospective Study ◽  
Great Britain ◽  
Antimicrobial Resistance ◽  
Phage Type ◽  
Livestock Species ◽  
Phage Types ◽  
Specific Phage ◽  
Resistance Patterns ◽  
Over Time

AbstractIn this retrospective study, we describe and analyse Salmonella data from four livestock species in Great Britain between 1983 and 2014, focusing on Salmonella Typhimurium. A total of 96 044 Salmonella isolates were obtained during the study period. S. Typhimurium was the predominant serovar isolated from cattle and pigs and represented 40.7% (18 455/45 336) and 58.3% (4495/7709) of isolates from these species respectively, while it only accounted for 6.7% (2114/31 492) of chicken isolates and 8.1% (926/11 507) of turkey isolates. Over the study period, DT104 was the most common phage type in all four species; however, DT104 peaked in occurrence between 1995 and 1999, but is currently rare.Monophasic strains of S. Typhimurium represented less than 3% of all Salmonella isolates in cattle and chickens in 2014, but accounted for 10.4% of all turkey isolates and 39.0% of all pig isolates in the same year.Salmonella isolates were tested for their in vitro susceptibility to 16 antimicrobials. Antimicrobial resistance of S. Typhimurium isolates is largely influenced by the dominance of specific phage types at a certain time, which are commonly associated with particular resistance patterns. Changes in resistance patterns over time were analysed and compared between species.

113 Effects of Sleep on Intrusive Symptoms and Emotion Reactivity in a Laboratory-Based Film Analogue Study

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A46-A46
Author(s):  
Anna Marie Nguyen ◽  
Rebecca Campbell ◽  
Abigail Vance ◽  
Ellen Leen-Feldner
Keyword(s):  
Sleep Deprivation ◽  
Control Group ◽  
Significant Interaction Effect ◽  
Emotion Reactivity ◽  
Negative Valence ◽  
Significant Difference ◽  
Regulation Strategies ◽  
Acute Sleep Deprivation ◽  
The Impact ◽  
Over Time

Abstract Introduction Recent literature highlights the need to focus on the impact of intrusive symptoms as a possible risk factor for the development and maintenance of PTSD. Cognitive and sleep models also contribute to the further understanding of intrusive symptoms. Further emotion work emphasizes that disgust is an emotion closely associated with the emergence of posttraumatic stress symptomology following traumatic events. Methods This study utilized a film eliciting disgust to examine the effects of acute sleep deprivation on the intensity of intrusive symptoms and emotion reactivity. Forty-nine college students were randomly assigned to sleep as usual or an acute sleep deprivation after watching a disturbing film. It was hypothesized that, relative to the control group, participants who were acutely sleep deprived would report higher frequency of intrusive symptoms and higher negative valence. Results Findings were partially consistent with hypotheses. There were no group or interaction effects on intrusive symptoms, although participants across both groups reported significant decreases in negative valence and intrusive symptoms across the study (F(1, 47) = 10.30, p &lt; 0.01). There was a significant interaction effect between sleep group and self-reported negative valence, where individuals in the sleep deprived group reported significantly higher valence than individuals in the control group, despite significant decreases in negative valence over time (F(1, 48) = 7.869, p &lt; 0.01). Conclusion Possible mechanisms that may contribute to the significant difference in valence may be due to higher order emotion regulation strategies that are compromised due to sleep loss. However, the significant decreases in negative valence and intrusive symptoms over time may be due to methodological factors or the type of sleep manipulation. Further work can address these challenges by using a larger sample size or examining the effects of chronic, partial sleep deprivation. Support (if any):

scholarly journals Physicians' Perspective on Prescribing Patterns and Knowledge on Antimicrobial Use and Resistance in Penang, Malaysia: A Qualitative Study

2020 ◽  
Vol 8 ◽  
Author(s):  
Ali Akhtar ◽  
Amer Hayat Khan ◽  
Hadzliana Zainal ◽  
Mohamed Azmi Ahmad Hassali ◽  
Irfhan Ali ◽  
...  
Keyword(s):  
Health Care ◽  
Antimicrobial Resistance ◽  
Qualitative Study ◽  
Health Care System ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
Antimicrobial Use ◽  
Prescribing Practices ◽  
The Impact ◽  
Care System

Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system.Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis.Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance.Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.

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