scholarly journals Persistence of first-line antibiotic-resistant typhoid fever among Pakistani children: a growing concern for regional antimicrobial stewardship

2022 ◽  
Vol 2 ◽  
pp. e1301
Author(s):  
Saima Mohsin ◽  
Andrew W. Taylor-Robinson
Keyword(s):  
Typhoid Fever ◽  
Antimicrobial Stewardship ◽  
First Line ◽  
Antibiotic Resistant

Modern aspects of epidemiology and prevention of typhoid infection (review)

2021 ◽  
pp. 16-26
Author(s):  
Alla Nikolaevna Kaira ◽  
Vyacheslav Fedorovich Lavrov ◽  
Oksana Anatolievna Svitich
Keyword(s):  
Typhoid Fever ◽  
Natural Disasters ◽  
Risk Groups ◽  
Poverty Line ◽  
Epidemiological Surveillance ◽  
Prevention Measures ◽  
Labor Migrants ◽  
Antibiotic Resistant ◽  
The World ◽  
Resistant Strains

Typhoid fever is still an urgent infection, especially in countries where the majority of the population lives below the poverty line, with limited resources, and without the ability to comply with basic hygiene rules. About 11 million cases of typhoid fever are registered worldwide every year, and about 400 people die from this infection every day. The global development of international relations activates migration processes, tourism, and provides rapid movement of significant masses of people around the world, which makes the risk of widespread typhoid infection quite real. In recent years, due to the emergence of antibiotic-resistant strains of S. typhi, treatment of typhoid fever has become less effective. Natural disasters in the form of earthquakes and floods, man-made disasters, as well as military conflicts that occur in different parts of the world, are fertile «soil» for the emergence and spread of typhoid infection, which actualizes the implementation of appropriate prevention measures, including immunoprophylaxis of the disease. Despite the obvious success in the fight against typhoid fever, which consists in a significant reduction in cases of typhoid infection in the world, this dangerous infectious disease still remains an urgent problem, both for health authorities and the population of many countries. Children and young people are still ill, and there is a real risk of infection spreading to any country. Natural disasters pose a real threat of typhoid outbreaks and epidemics. Mass appearance of antibiotic-resistant strains of S. typhi significantly complicates the treatment of patients, dictates the need for constant monitoring of the pathogen’s resistance to antibiotics and the introduction of typhoid immunoprophylaxis for epidemic indications among professional risk groups, labor migrants, and tourists traveling to countries with typhoid-affected countries. There is also a need for reliable epidemiological surveillance of this infection, carried out on an ongoing basis.

scholarly journals Tractable targets for meropenem-sparing antimicrobial stewardship interventions

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Clark D Russell ◽  
Ian F Laurenson ◽  
Morgan H Evans ◽  
Claire L Mackintosh
Keyword(s):  
Clinical Practice ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Real Life ◽  
Lessons Learned ◽  
Source Control ◽  
First Line ◽  
Escalation Therapy ◽  
Clinical Records

Abstract Background As meropenem is a restricted antimicrobial, lessons learned from its real-life usage will be applicable to antimicrobial stewardship (AMS) more generally. Objectives To retrospectively evaluate meropenem usage at our institution to identify targets for AMS interventions. Methods Patients receiving meropenem documented with an ‘alert antimicrobial’ form at two tertiary care UK hospitals were identified retrospectively. Clinical records and microbiology results were reviewed. Results A total of 107 adult inpatients receiving meropenem were identified. This was first-line in 47% and escalation therapy in 53%. Source control was required in 28% of cases after escalation, for predictable reasons. Those ultimately requiring source control had received more prior antimicrobial agents than those who did not (P = 0.03). Meropenem was rationalized in 24% of cases (after median 4 days). Positive microbiology enabled rationalization (OR 12.3, 95% CI 2.7–55.5, P = 0.001) but rates of appropriate sampling varied. In cases with positive microbiology where meropenem was not rationalized, continuation was retrospectively considered clinically and microbiologically necessary in 8/40 cases (0/17 empirical first-line usage). Rationalization was more likely when meropenem susceptibility was not released on the microbiology report (OR 5.2, 95% CI 1.3–20.2, P = 0.02). Input from an infection specialist was associated with a reduced duration of meropenem therapy (P < 0.0001). Early review by an infection specialist has the potential to further facilitate rationalization. Conclusions In real-life clinical practice, core aspects of infection management remain tractable targets for AMS interventions: microbiological sampling, source control and infection specialist input. Further targets include supporting rationalization to less familiar carbapenem-sparing antimicrobials, restricting first-line meropenem usage and selectively reporting meropenem susceptibility.

scholarly journals Pediatric Antimicrobial Stewardship Programs

2017 ◽  
Vol 22 (1) ◽  
pp. 77-80 ◽  
Author(s):  
Kristen Nichols ◽  
Sylvia Stoffella ◽  
Rachel Meyers ◽  
Jennifer Girotto ◽  
Keyword(s):  
Antimicrobial Stewardship ◽  
Bacterial Infections ◽  
Pediatric Patients ◽  
Task Force ◽  
Position Statement ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Frequent Use ◽  
Increased Risk

The frequent use of antimicrobials in pediatric patients has led to a significant increase in multidrug-resistant bacterial infections among children. Antimicrobial stewardship programs have been created in many hospitals in an effort to curtail and optimize the use of antibiotics. Pediatric-focused programs are necessary because of the differences in antimicrobial need and use among this patient population, unique considerations and dosing, vulnerability for resistance due to a lifetime of antibiotic exposure, and the increased risk of adverse events. This paper serves as a position statement of the Pediatric Pharmacy Advocacy Group (PPAG) who supports the implementation of antimicrobial stewardship programs for all pediatric patients. PPAG also believes that a pediatric pharmacy specialist should be included as part of that program and that services be covered by managed care organizations and government insurance entities. PPAG also recommends that states create legislation similar to that in existence in California and Missouri and that a federal Task Force for Combating Antibiotic-Resistant Bacteria be permanently established. PPAG also supports post-doctoral pharmacy training programs in antibiotic stewardship.

An Early CT-Diagnosis Based Treatment Strategy for Invasive Fungal Infection in Allogeneic Transplant Recipients Using Caspofungin First Line: An Effective Strategy with Low Mortality.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1149-1149
Author(s):  
Fiona L Dignan ◽  
Stephen O Evans ◽  
Mark E Ethell ◽  
Bronwen E. Shaw ◽  
Unell BG Riley ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Antifungal Treatment ◽  
Ct Diagnosis ◽  
Allogeneic Transplant ◽  
First Line ◽  
Antibiotic Resistant ◽  
Once Daily ◽  
Transplant Patients ◽  
Serum Testing

Abstract Empirical antifungal therapy is the standard treatment in allogeneic transplant patients who have persistent febrile neutropenia. This approach can be associated with increased cost, toxicity and breakthrough infections. There are limited reports to date of strategies for the early diagnosis of invasive fungal infection (IFI). These include either invasive investigations or serum testing. (Oshima K et al, J Antimicrobial Chemother2007 Aug; 60(2): 350–5, Maertens J et al, Clin Infect Dis2005; 41:1242–50). To our knowledge, there are no reports to date of treatment strategies based only on high resolution computerised tomography (HRCT) scans. We used a CT-diagnosis based treatment strategy for early invasive aspergillosis in 99 consecutive patients undergoing allogeneic transplantation over a two year time period. A retrospective review of the electronic patient record, notes and drug charts was undertaken in all patients receiving an allogeneic transplant in our unit from 1st January 2006 to 31st December 2007. The study protocol was approved by the Royal Marsden Hospital audit committee. Patients received primary antifungal prophylaxis with itraconazole or secondary prophylaxis with voriconazole from day + 1. Patients had a HRCT scan performed if they had antibiotic resistant fever for &gt; 72 hours. Parenteral antifungal treatment with caspofungin was commenced in patients with a positive HRCT result. Cavitation, air crescent sign and halo sign were classified as major changes. Nodules and new infiltrates including consolidation and effusions were classified as minor changes. Serum testing was not used due to the possibility of false positive results with tazobactampiperacillin antimicrobials and low sensitivity in patients receiving mould active azoles as prophylaxis. Neutropenic fever developed in 89/99 patients (90%). Fifty-four percent (53/99) of patients developed antibiotic resistant fever for &gt; 72 hours and would have received parenteral antifungal treatment if an empiric strategy had been used. The HRCT-based strategy reduced the use of parenteral antifungal treatment to 17% of patients (17/99). Four of these patients had engrafted (absolute neutrophil count &gt;0.5x109 cells/L for 3 days) at time of commencing caspofungin following a period of persistent neutropenic fever. Fifteen patients had a positive HRCT scan and 2 were treated empirically until a HRCT could be performed. The remaining 36/53 patients (68%) did not receive antifungal treatment although they would have met criteria for standard empirical therapy. Our nonempiric strategy reduced the use of parenteral antifungal treatment from 54% to 17% of allogeneic transplant patients. These findings represent a 68% reduction in use of parenteral antifungal agents Caspofungin (70mg once daily IV on day 1 and 50mg once daily IV thereafter) was given for a median of 13 days (3–34 days) and 11 patients responded to treatment. Six patients required second line antifungal therapy. Only one patient died from IFI after 100 days of follow-up. No patients had to stop caspofungin due to toxicity. Three of the 36 patients who did not receive initial antifungal treatment went on to receive empiric caspofungin within 100 days. One of these 3 patients died of enterococcal septicaemia. The other 2 patients recovered. None of this group had probable or proven IFI. During the extended follow-up period of 3–27 months (median 13 months) only 3/99 patients (3%) died of IFI. These results suggest that this non-empiric strategy of parenteral antifungal treatment based on HRCT scanning is feasible and may help to reduce toxicity, cost and breakthrough infections associated with the use of antifungal agents. Caspofungin may be a useful first line agent in this setting. A randomised controlled trial is warranted to further evaluate these results.

scholarly journals Antibiotic Prescribing in New York State Medicare Part B Beneficiaries Diagnosed With Cystitis Between 2016 and 2017

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Joyce Y Yu ◽  
Valerie A McKenna ◽  
Ghinwa K Dumyati ◽  
Teresa J Lubowski ◽  
Joseph J Carreno
Keyword(s):  
New York ◽  
Antimicrobial Stewardship ◽  
New York State ◽  
Outpatient Setting ◽  
Medicare Part ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
First Line ◽  
York State ◽  
Medicare Part B

Abstract Background Statewide tracking and reporting is an outpatient antimicrobial stewardship tool that may be useful for many stakeholders. However, to date, these evaluations have been limited. This study aimed to track and report outpatient antibiotic prescribing in Medicare Part B enrollees diagnosed with cystitis in the outpatient setting. Methods This was a retrospective, cohort study of Medicare Part B enrollees in New York State. Inclusion criteria include outpatient visit in 2016 or 2017, cystitis diagnosis code, and oral antibiotic prescription ≤3 days after diagnosis of cystitis. Antibiotics were categorized as first-line, oral β-lactams, fluoroquinolones, or other per Infectious Diseases Society of America acute uncomplicated cystitis guidelines. Data were stratified by sex. Annual prescriptions proportions were compared using χ 2 test or Fisher’s exact test as appropriate. Results A total of 50 658 prescriptions were included. For females’ prescriptions, first line increased (41.5% vs 43.8%, P &lt; .0001), oral β-lactams increased (17.8% vs 20.5%, P &lt; .0001), fluoroquinolones decreased (34.1% vs 29.1%, P &lt; .0001), and other increased (6.5% vs 6.6%, P = .76) in 2017. For males’ prescriptions, first line increased (25.2% vs 26.7%, P = .11), oral β-lactams increased (23.1% vs 26.2%, P = .0003), fluoroquinolones decreased (44.0% vs 39.3%, P &lt; .0001), and other remained unchanged (7.8% vs 7.8%, P = .92) in 2017. Conclusions Guideline concordant therapy prescribing for cystitis increased among Medicare Part B beneficiaries in New York State between 2016 and 2017. However, there was still a high prevalence of fluoroquinolone prescribing. These data highlight the need for additional outpatient antimicrobial stewardship efforts in New York State.

scholarly journals Antimicrobial Resistance in Salmonella Typhi Isolated From a Referral Hospital of Kathmandu, Nepal

2021 ◽  
Vol 14 ◽  
pp. 117863612110563
Author(s):  
Saroj Khadka ◽  
Basudha Shrestha ◽  
Anil Pokhrel ◽  
Sachin Khadka ◽  
Rajesh Dhoj Joshi ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Antibiotic Susceptibility ◽  
Large Scale ◽  
Salmonella Typhi ◽  
Diffusion Method ◽  
Dilution Method ◽  
Agar Dilution Method ◽  
First Line ◽  
Disk Diffusion Method

Purpose: The morbidity and mortality due to typhoid fever can be significantly reduced with the use of effective antibiotics. At present, fluoroquinolones, third generation cephalosporins, and azithromycin are widely used to treat typhoid fever. However, changing antibiotic susceptibility among Salmonella Typhi and Salmonella Paratyphi poses a particular challenge to the therapeutic management of enteric fever. The objective of this study was to assess the antibiotic susceptibility pattern of Salmonella Typhi isolates. Patients and Methods: A total of 706 blood specimens were collected from febrile patients attending the outpatient department of Kathmandu Model Hospital during June to September, 2018. The antibiotic susceptibility testing for 11 different antibiotics (nalidixic acid, ciprofloxacin, ofloxacin, levofloxacin, cefixime, ceftriaxone, cefotaxime, azithromycin, cotrimoxazole, chloramphenicol, and amoxicillin) was performed by disk diffusion method. Furthermore, minimum inhibitory concentration (MIC) values of ciprofloxacin, ofloxacin, and azithromycin were determined by agar dilution method. Mutation at gyrA ser83 associated with reduced susceptibility to fluoroquinolones was determined by PCR-RFLP. Results: Out of 706 blood samples, 6.94% (n = 49) were culture positive for Salmonella enterica (S. Typhi, n = 46). It was revealed that 97.8% S. Typhi isolates were susceptible to conventional first-line antibiotics (ampicillin, chloramphenicol, and cotrimoxazole), 97.3% to cephalosporins and 95.7% to azithromycin. S. Typhi were either resistant or intermediately susceptible to fluoroquinolones: 97.8% to ciprofloxacin, 91.3% to ofloxacin, and 89.1% to levofloxacin. The MIC of ciprofloxacin, ofloxacin, and azithromycin for S. Typhi ranged from 0.008 to 32, 0.03 to 16, and 2 to 8 μg/mL, respectively. Out of 46 S. Typhi isolates, 44 (95.65%) had gyrA ser83 mutation. Conclusion: Fluoroquinolones have poor activity against Salmonella Typhi. The trends of increasing azithromycin MIC value among S. Typhi might limit its use for the treatment of typhoid fever. Effectiveness of conventional first-line antibiotics in vitro suggests considering their clinical use after large-scale studies.

Change in Antibiotic Use in Secondary and Tertiary Hospitals Nationwide After a National Antimicrobial Stewardship Campaign Was Launched in China, 2011–2016: An Observational Study

2020 ◽  
Vol 221 (Supplement_2) ◽  
pp. S148-S155 ◽  
Author(s):  
Yonghong Xiao ◽  
Ping Shen ◽  
Beiwen Zheng ◽  
Kai Zhou ◽  
Qixia Luo ◽  
...  
Keyword(s):  
Observational Study ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Resistant Bacteria ◽  
Total Drug ◽  
Antibiotic Resistant ◽  
Drug Procurement ◽  
Carbapenem Resistant ◽  
Tertiary Hospitals

Abstract Background An antimicrobial stewardship campaign was launched in 2011 by the Ministry of Health. This study aimed to assess the achievements and trends in the clinical use of antibiotics in secondary and tertiary hospitals following this campaign in China. Methods This observational study analyzed nationwide hospital antibiotic procurement and consumption data and antibiotic-resistance surveillance data based on claims filed in 2010–2016. Results After a 6-year national campaign, the proportion of outpatients and surgical patients who received antibiotic treatment decreased from 19.5% to 8.5% and from 97.9% to 38.3%, respectively. The intensity of antibiotic use among inpatients decreased from 85.3±29.8 defined daily dosage (DDD) per 100 patient days to 48.5±8.0 DDD per 100 patient days. Moreover, the antibiotic procurement expenditure among hospitals declined from 22.3% of total drug procurement costs in 2010 to 12.1% in 2016, although total drug procurement costs doubled during that time. The incidence of methicillin-resistant Staphylococcus aureus isolates also dropped (from 54.4% in 2010 to 34.4% in 2016), as did the proportion of carbapenem-resistant Pseudomonas aeruginosa isolates (from 30.8% to 22.3%). Conclusions The 6-year campaign successfully reduced antibiotic consumption and irrational drug use in Chinese hospitals which was associated with declines in the prevalence of common antibiotic-resistant bacteria.

Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia

2014 ◽  
Vol 69 (3) ◽  
pp. 216-225 ◽  
Author(s):  
Katherine K. Perez ◽  
Randall J. Olsen ◽  
William L. Musick ◽  
Patricia L. Cernoch ◽  
James R. Davis ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Rapid Diagnostics ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Gram Negative Bacteremia

Prevalence of Multi-Drug Resistant Salmonella typhi among Clinically Diagnosed Typhoid Fever Patients in Lagos, Nigeria

2000 ◽  
Vol 55 (5-6) ◽  
pp. 489-493 ◽  
Author(s):  
Kabir’ O. Akinyemi ◽  
Akintoye O. Coker ◽  
Daniel K. Olukoya ◽  
Akeeb O. Oyefolu ◽  
Eriwu P. Amorighoye ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Nalidixic Acid ◽  
Susceptibility Testing ◽  
Salmonella Typhi ◽  
Drug Resistant ◽  
First Line ◽  
Isolation Rate ◽  
Total Blood ◽  
Health Institutions ◽  
Group 1

A total of 635 clinically diagnosed typhoid fever patients were bled from three different health institutions in the metropolis of Lagos, Nigeria over a period of 15 months, May 1997 to July 1998. Out of the total blood cultured, 101 (15.9% ) isolates of Salmonella species were isolated of which 68 (67.3% ) were S. typhi, 17 (16.8% ) and 16 (15.8% ) were S. paratyphi A and S. arizonae respectively. The overall isolation rate of S. typhi among patients is 10.7% , with most isolates 45.9% found among the severely-ill young adults, age group 1 6 -30 years. All isolates were subjected to anti-microbial susceptibility testing using 12 different antibiotics: chloramphenicol, ampicillin, cotrimoxazole, gentamicin, colistin sulfate, nalidixic acid, nitrofurantoin, cefotaxime, tetracycline, streptomycin, ofloxacin and ciprofloxacin. All the S. typhi and S. paratyphi A isolates showed resistance to two or more of the 10 of 12 antibiotics tested particularly the 3-first-line antibiotics commonly used (chloramphenicol, ampicillin and cotrim oxazole) in the treatment of typhoid fever in Nigeria. No isolate showed resistance to ofloxacin and ciprofloxacin, however, nalidixic acid and gentamicin showed a moderate and appreciable inhibition to most of our isolates.

scholarly journals The Use of Ceftriaxone Compared to Chloramphenicol in Typhoid Fever Treatment: an Evidence Based Case Report

2017 ◽  
Vol 6 (3) ◽  
pp. 74
Author(s):  
Jeffry Adijaya Susatyo
Keyword(s):  
Typhoid Fever ◽  
Rural Areas ◽  
Bacterial Resistance ◽  
Low Cost ◽  
Salmonella Typhi ◽  
Evidence Based ◽  
Line Treatment ◽  
First Line ◽  
Screening Process ◽  
First Line Treatment

Typhoid fever is a disease caused by the gram-negative bacterium Salmonella typhi. Since its introduction in 1949, chloramphenicol for decades become a first-line treatment of typhoid fever. Until now, chloramphenicol is still the first line treatment of typhoid fever in rural areas in Indonesia, especially due to its low cost. However, in addition to the problem of bacterial resistance, chloramphenicol is known to cause side effect such as bone marrow suppression. Right now many other antibiotics are used as regimens for treatment of typhoid fever, one of which is ceftriaxone. This report is created to answer the clinical question whether ceftriaxone is more effective compared to chloramphenicol as first-line treatment of typhoid fever. Structured search was performed on PubMed, EBSCO, and ScienceDirect and after a screening process and appraisal using criteria from Center of Evidence Based Medicine at Oxford University, three articles were selected. Two of the three articles demonstrate higher effectiveness of chloramphenicol in term of defervescence rate (P = 0.35 and P > 0.05). On the other hand, the third article shows higher effectiveness of ceftriaxone in term of defervescence rate (P = 0.0001). The conclusion drawn is that ceftriaxone showed better effectiveness in the treatment of typhoid fever compared to chloramphenicol.

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