Perception, Attitude, and Confidence of Physicians About Antimicrobial Resistance and Antimicrobial Prescribing Among COVID-19 Patients: A Cross-Sectional Study From Punjab, Pakistan

Background: Patients with coronavirus disease 2019 (COVID-19) could experience multiple coinfections, and judicial antimicrobials, including antibiotics, is paramount to treat these coinfections. This study evaluated physicians’ perception, attitude, and confidence about antimicrobial resistance (AMR) and antimicrobial prescribing in patients with COVID-19.Methods: A self-administered and validated online questionnaire comprised of six sections was disseminated among physicians working in public sector hospitals in Punjab, Pakistan, using the convenience sampling method from April to May 2021. The study also assessed the validity and reliability of the study questionnaire using exploratory factor analysis and Cronbach’s alpha. In addition, the descriptive and inferential statistics present survey results.Results: A total of 387 physicians participated in this study. The study showed that the questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0.77). Most physicians (n = 221, 57.1%) believed that AMR is a considerable problem in Pakistan. Less than a quarter of respondents (n = 91, 23.5%) consulted with local antibiotic resistance data to prescribe antibiotics in COVID-19 patients. However, the respondents were confident to select a suitable antibiotic (n = 229, 59.2%). More than three-quarters of the respondents believed that advice from a senior colleague (n = 336, 86.8%), infectious disease (ID) physician (n = 315, 81.4%), and implementing antimicrobial stewardship programs (ASPs) could facilitate appropriate prescribing of antibiotics in COVID-19 patients. Multivariate logistic regression revealed that physicians with more than 10 years of experience had higher odds of consulting local guidelines for antibiotic therapy (OR, 4.71 95% CI: 1.62–13.73, p = 0.004) than physicians with less than 5 years of experience. Similar trends were found for consulting national guidelines and local resistance data to select an empiric antibiotic therapy.Conclusion: AMR-related awareness was optimal among physicians. Only a few physicians looked up local antibiotic resistance data before prescribing antibiotics to COVID-19 patients empirically. The significant approaches advised by physicians to reduce AMR risk among COVID-19 patients were the implementation of ASPs combined with advice from ID physicians.

Causes and Management of Acute Pyelonephritis

Acute pyelonephritis is a bacterial infection that causes kidney inflammation. Pyelonephritis is a kidney infection that develops as a result of an ascending urinary tract infection that travels from the bladder to the kidneys. Acute pyelonephritis affects over 250,000 people each year, resulting in more than 100,000 hospitalizations. Infection with Escherichia coli is the most prevalent cause. Fever, vomiting, abdomen or loin discomfort, and fatigue are all symptoms of acute pyelonephritis, however Fever is the most clinically useful symptom. Escherichia coli is the causative agent in more than 80% of instances of acute pyelonephritis. Staphylococcus saprophyticus, and enterococci are among the other etiologic factors. While Infections caused by Klebsiella, Enterobacter, Clostridium, or Candida are more common in diabetic patients. Acute pyelonephritis can be treated as an outpatient or as an inpatient procedure. Outpatient treatment is available for healthy, young, non-pregnant women with uncomplicated pyelonephritis. The choice of first-line oral antibiotics depends on local antibiotic resistance characteristics, although trimethoprim alone or in combination with sulphamethoxazole, cephalexin, or amoxicillin-clavulanic acid. In this article we will be looking the causes and management of acute pyelonephritis.

Bactibilia-effect on postoperative course and outcome in patients with bilio-pancreatic diseases

Background: Bactibilia is detrimental to the outcomes of biliary tract surgery. The present study was undertaken to determine the microbial flora of bile and their significance to post-operative infectious complications and morbidity.Methods: A retrospective study of patients with biliopancreatic diseases who underwent surgery from Jan 2017 to March 2020 in a tertiary care hospital were analyzed. The samples were assessed for bile microbiological flora, and a search for their possible link with post-operative infectious complications and morbidity was carried out.Results: A total of 90 bile samples were assessed. The mean age of the study group was 51.8 SD-13.6 years with male predominance. Bactibilia was found in 39 cases (43.3%), mostly in patients with malignant diseases, older than 50 years and females. Escherichia coli was the most common organism. Post-operative infectious complications were seen in twenty cases, thirteen of them in bactibilia-associated patients, showing statistical significance. Statistical significance was found between the presence of pre-operative biliary stent and bactibilia and between diabetes mellitus and bactibilia. Nine out of 24 patients with comorbidities had post-operative infectious complications. No significant relationship was found between pre-operative jaundice and comorbidities with bactibilia. Conclusions: The present study showed a statistically significant relationship between the presence of pre-operative biliary stent and bactibilia and also the incidence of post-operative infectious complications and bactibilia. Microbiological analysis of bile is a valuable tool in prognosticating the post-operative complications, thereby guiding us to provide adequate therapy and helps to establish local antibiotic guidelines.

Local antibiotic therapy for endoprosthesis site infection (Literature review)

Endoprosthetics of joints has firmly taken its place in a number of orthopedic interventions in the treatment of diseases of the musculoskeletal system. Unfortu-nately, with an increase in the number of operations, the number of complications that develop at various stages of treatment does not decrease. Deep infections in the area of the endoprosthesis (paraprosthetic infection) are especially difficult in treatment, since only 20% of patients, and mainly in early forms of complications, manage to save the implant. The incidence of infectious complications at the stationary stage in specialized endoprosthetics centers does not exceed 1% during primary operations, but their number, as a rule, multiplies several years after the intervention. The most common treatment option for paraprosthetic infection is staged revision arthroplasty. The authors of the review conduct a comparative analysis of the effectiveness of one- and two-stage treatment options. The latter is based on the use of bone cement spacers impregnated with antibiotics.

Unilateral Hypermature Cataract and Uveitis in Dwarf Campbell’s Hamster (Phodopus campbelli)

Background: In the ophthalmological examination of a 1.5-year-old male dwarf Campbell hamster, who was examined with complaints of photophobia, pain, weakness and whitening of the eye color, hypermature cataract and chronic uveitis were observed in the left eye. Methods: Local antibiotic therapy was administered to the patient for the first ten days in order to eliminate a possible microbial agent. In addition, local NSAI drugs were applied to reduce pain and inflammation. Then, peros Prednol (methylprednisolone) was administered at a dose of 0.5 mg/kg for the first ten days and 1 mg/kg for the next ten days in order to suppress the inflammation associated with uveitis. The patient’s body weight and intraocular pressure were measured before the treatment. During the treatment, intraocular pressure values were checked every day. During this period, the patient was fed ad libitum at normal room temperature, in his own cage. Result: As a result of the treatment applied to the patient, who was followed up for more than a month, symptoms such as pain, photophobia and blepharospasm disappeared and the patient’s eating and drinking status improved compared to the past. However, increasing dose of Prednol did not have the expected effect on intraocular pressure values. Due to the very small size of the hamster eye in the treatment of hypermature cataracts, lens removal cannot be performed as easily as in other species.

Comparison of the Postoperative Effects of Local Antibiotic versus Systemic Antibiotic with the Use of Platelet-Rich Fibrin on Impacted Mandibular Third Molar Surgery: A Randomized Split-Mouth Study

The surgery of the impacted mandibular third molar is the most frequent procedure in dentistry. The prescription of systemic antibiotics after the third molar extraction is widespread among dentists, but this is still argumentative. This study is aimed at evaluating the postoperative effects of local antibiotic mixed with platelet-rich fibrin (PRF) and a postoperative systemic antibiotic prescribed for mandibular third molar surgery. The study included 75 patients divided into a control and 4 test groups ( n = 15 ). In the control group, only PRF was placed into the extracted socket, and no antibiotic was prescribed. In the first and third groups, PRF was applied to the socket; penicillin and clindamycin were prescribed as oral medications, respectively. In the second and fourth groups, only PRF combined with penicillin and clindamycin was applied into the socket, respectively. The outcome variables were pain, swelling, analgesic intake, and trismus. These variables were also assessed based on the first, second, third, and seventh days following the operation. Unpaired Student’s t -test and Mann–Whitney U test were used for analysis. There were significant differences in the total VAS pain scores between the control and group 3 ( p < 0.05 ), groups 1 and 2 ( p < 0.01 ), and group 4 ( p < 0.001 ) in ascending order. For analgesic intake, there was no significant difference for group 1 ( p > 0.05 ). However, there were statistical differences between the control group and groups 2 and 3 ( p < 0.01 ) and group 4 ( p < 0.001 ). Trismus and swelling did not differ among the groups ( p > 0.05 ). This study showed that the effects of local and systemic antibiotics with the use of PRF reduced postoperative outcomes. Moreover, local antibiotics with PRF may be a viable method to avoid the possible side effects of systemic antibiotics.

Pythium insidiosum keratitis reported in China, raising the alertness to this fungus-like infection: a case series

Background The objective of this study is to report typical clinical and laboratory characteristics of three cases of keratitis caused by Pythium insidiosum in China. Case presentation Three Chinese patients of Han nationality diagnosed with Pythium keratitis from 2017 to 2019 were included. One 45-year-old female and one 55-year-old male were exposed to river water, and one 51-year-old female was burned by ash in the eyes. All of them are of Han ethnicity. Upon slit-lamp examination, subepithelial and superficial stromal opacities were observed in a reticular pattern. After conventional treatment with antifungal agents, the clinical status worsened and therapeutic penetrating keratoplasty was performed. Unfortunately, enucleation was performed to remove all infected tissue and relieve pain. Pythium insidiosum was identified in culture and confirmed by internal transcribed spacer ribosomal RNA gene sequencing analysis. Following the systemic and local antibiotic regimens, the patients were cured ultimately and no regression of infection was observed. Conclusions It is significant for ophthalmologists and microbiologist to be alert to this eye-threatening infection, especially in patients who are resistant to antifungal treatments and with water-related exposure.

Antibiotic-Coated Nail in Open Tibial Fracture: A Retrospective Case Series

Implant-associated infections still represent one of the main problems in treatment of open fracture. The role of systemic antibiotic prophylaxis is now agreed and accepted; however, recent literature seems to underline the importance of local antibiotic therapy at the fracture site, and antibiotic nails have been shown to play a role in the treatment of open fractures in terms of fracture healing and lower risk of infection. We retrospectively analyzed our results, from January 2016 to March 2020, with the use of coated nails in the treatment of open tibial fractures, evaluating the rates of infection and fracture healing as primary outcomes and the rate of reoperations, time from trauma to nailing and hospital stay as secondary outcomes. Thirty-eight patients treated with coated nail (ETN ProtectTM, Synthes) were included in the study. Minimum follow-up was of 18 months. Thirty-four of 38 patients achieved bone union and 2 patients underwent septic non-union. In our series, no systemic toxicity or local hypersensitivity to antibiotics were recorded. From this study, use of antibiotic-coated nails appears to be a valid and safe option for treatment of open tibial fractures and prevention of implant-related infections, particularly in tibial fractures with severe soft tissue exposure and impairment.

Recurrent bacterial vaginosis: possible ways of correction

Research objective: to increase the effectiveness of bacterial vaginosis (BV) treatment in women of reproductive age.Materials and methods. The study involved 64 women of reproductive age with BV. After a course of local antibiotic therapy participants were divided into 2 groups: patients of group I were not prescribed local remedies to restore the vaginal microflora, patients of group II were prescribed vaginal prebiotic suppositories Folial № 10. No additional drugs were used in subgroups IA and IIA, while oral probiotic Maxibalance was prescribed in subgroups IB and IIB. The effectiveness of BV treatment was evaluated at the first, third and sixth months of the observation period according to the results of clinical examination and vaginal pH evaluation by litmus strips.Results. The course of BV in subgroup IA was characterized by prevailing number of relapses and their early appearance. 1 case of BV recurrence was found among patients of subgroup IA at the 1st month of follow-up, 6 and 8 BV episodes were found at 3 and 6 months of follow-up respectively. Sequential treatment with antibiotics and oral probiotics (subgroup IIB) was associated with the onset of 3 BV relapses on 4–5 months from baseline. Local prebiotic (subgroup IIA) after the vaginal sanation was associated with BV reoccurrence in only one patient at the end of the study. No relapses of BV were detected in subgroup IIB during the study.Conclusions. Permanent imbalance of vaginal normocenosis creates optimal conditions for chronic and recurrent diseases of dysbiosis nature, especially BV. Despite the sensitivity of the anaerobic flora to the recommended antibacterial medications, their use as monotherapy in BV treatment is often insufficient. The results of the study demonstrate a significant anti-relapse efficiency of consecutive treatment by antibacterial drugs and a complex of probiotic + prebiotic. This effect is probably based on the restoration of vaginal immunity and metabolism by stable colonization of the vaginal mucosa with live lactobacilli of eubiotic origin.