In the present study,we aimed to assess the development of the antimicrobial stewardship(AMS)program in China’s tertiary hospitals to identify the potential challenges for the AMS program and provide references and b...In the present study,we aimed to assess the development of the antimicrobial stewardship(AMS)program in China’s tertiary hospitals to identify the potential challenges for the AMS program and provide references and benchmarks for strategic policymaking.A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System(CARSS).The questionnaire included 5 sections regarding structure,technical support,antimicrobial use management,antimicrobial use surveillance,and education.Descriptive statistics were used for data analysis.Of the 1044 tertiary hospitals under CARSS,13.4%(140)hospitals participated in the study.Among them,99.3%(139/140)set up the AMS program.The hospital president(82.1%,115/140)and medical service department(59.3%,83/140)were responsible for AMS outcomes in most hospitals.Structured antimicrobial formulary restriction management was adopted by 99.3%(139/140)hospitals.Infectious disease department,infection control department,and microbiological laboratories were established in 87.1%(122/140),99.3%(139/140)and 100%(140/140)hospitals,respectively.Up to 85.6%(124/140)hospitals applied clinical pathways,and 33.6%(47/140)hospitals implemented hospital-specific guidelines for infectious diseases.Outpatient prescription auditing,inpatient prescription auditing,and prophylactic antimicrobial prescription auditing of aseptic operation were performed in 99.3%(139/140),98.6%(138/140)and 95.7%(134/140)hospitals,respectively.Up to 97.1%(136/140)hospitals participated in antimicrobial use surveillance network,and 99.3%(139/140)hospitals established the specialized management of carbapenem and tigecycline.Staff education and public education were provided with various ways and frequencies in 100%(140/140)and 90.0%(126/140)hospitals,respectively.AMS programs in China’s tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments.More efforts should be put to further promote and strengthen the development of hospital-specific guidelines and the establishment of a progress and outcome evaluation system.展开更多
ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hos...ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).展开更多
Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding t...Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding the knowledge, attitude, and practices of poultry farmers on AMU and AMR. Therefore, this study assessed the knowledge, attitude and practices regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Methods: This was a cross-sectional study conducted among 106 poultry farmers from November to December 2021 using a structured questionnaire. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Overall, of the 106 participants, 90.6% knew what antimicrobials were, but only 29.2% were aware of AMR. The study showed that 46.2% of the participants had low knowledge, 71.7% had negative attitudes, and 61.3% had poor practices regarding AMR. The prevalence of antibiotic use in poultry production was 83%. The most used antimicrobials were tetracycline (84%) and gentamicin (35.2%). The commonly reported reason for the use of antimicrobials was for the treatment (93.2%) and prevention (89.8%) of diseases. Further, 76.9% of the administered antimicrobials were usually done without veterinarian consultation or prescription. Conclusion: The study shows that there was high AMU in poultry farms in Kitwe. However, there was low knowledge, negative attitude, and poor practices towards AMU and AMR. Therefore, there is a need for educational and sensitisation programmes regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Alongside this, antimicrobial stewardship and surveillance systems should be strengthened in the livestock production sector. This will ensure food safety and public health.展开更多
Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivot...Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivotal roles in facilitating the prudent use of antibiotics through antimicrobial stewardship programs. Due to limited information in Benin, this study assessed the knowledge and attitudes of pharmacy staffs on antibiotic use and resistance. Materials and Methods: This cross-sectional study was conducted among 159 pharmacy staffs using a structured questionnaire from August 2018 to December 2018 in Benin. Data analysis was done by using Stata version 13.0. Results: Of the 159 participants, 54.8% knew the definition of antibiotic therapy and 66.9% knew the definition of probabilistic antibiotic therapy. The majority (88.1%) of the participants thought that the choice of antibiotics was made according to the pathology, while 60.4% thought that it depended on the pathology and the germ involved. 49.02% of dispensers in pharmacies stated that half of the patients had requested treatment without providing a prescription at the pharmacy. The top three antibiotics that were dispensed without a prescription include amoxicillin (98.1%), cloxacillin (76.7%) and metronidazole (57.2%), all from the Access group of antibiotics. Conclusion: These results underscore the need for educational and training interventions targeting specific professional groups. There is an urgent need for regulatory measures and public awareness through improved antimicrobial stewardship to limit this practice.展开更多
Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the W...Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the World Health Organization has identified Antimicrobial Stewardship as one of the strategic objectives of its global action plan on antimicrobial resistance. This survey aimed to observe antimicrobial prescribing and usage patterns in the Rivers State University Teaching Hospital with the purpose of identifying gaps to inform the specific antimicrobial stewardship interventions necessary to address our specific needs. Methodology: A point prevalence survey was conducted using the protocol and web-based automated data management system designed by the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp, Belgium, in November 2021. Results: A total of 69 adult medical and surgical patients were surveyed;27 males and 18 females. Antimicrobial prevalence was 65.2%. Third generation cephalosporins (24.4%;33.3%), fluoroquinolones (17.8%;22.2%) and imidazole derivatives (20%;36.1%) were most prescribed on the medical and surgical wards. Antimicrobial guidelines were completely unavailable, most antimicrobials (93.8%) were prescribed empirically and 64.4% of these remained empirical after 72 hours of commencement. Conclusion: Antimicrobial stewardship interventions are necessary to minimize sub-optimal antimicrobial prescribing practices in our facility. Most critical are education on appropriate use of antimicrobials, support for development of antimicrobial guidelines, diagnostic stewardship, and the drive for improved use of the laboratory to guide antimicrobial prescriptions. The antimicrobial stewardship committee and team must drive this, having the requisite support from the management and prescribers, with the primary outcomes being reduced antimicrobial prevalence and improved antimicrobial prescription patterns.展开更多
The purpose of this study was to critically evaluate the impact of an institutional blood culture notification protocol called RAIDS （rapid administration of antimicrobials by an infectious diseases specialist） on t...The purpose of this study was to critically evaluate the impact of an institutional blood culture notification protocol called RAIDS （rapid administration of antimicrobials by an infectious diseases specialist） on time to optimization of antimicrobial therapy in hospitalized patients with gram-negative bacteremia. Time to antibiotic optimization was compared in patients with gram-negative bacilli isolated from blood cultures obtained from March-May 2011 （pre-RAIDS） versus March-May 2013 （post-RAIDS）. The results show that patients in the pre-RAIDS study group had a significantly longer time to antibiotic optimization when compared to the post-RAIDS group （median （IQR）, 27.6 （10.8-75.8） h vs. 3.1 （0.8-34.3） h, p = 0.03）. The RAIDS protocol resulted in quicker time to antibiotic de-escalation （pre- vs. post-RAIDS; median （IQR）, 27.6 （10.8-134.5） h vs. 4.3 （1.4-32.6） h, p = 0.03）. There were no differences in clinical outcomes such as clinical cure, microbiological cure, and 30-day mortality between pre-RAIDS and post-RAIDS study groups. Patients in the post-RAIDS arm were more likely to receive appropriate empiric and definitive treatment. Implementation of the RAIDS protocol, which was an ASP （antimicrobial stewardship program） initiative, resulted in quicker time to antibiotic de-escalation and overall treatment optimization. RAIDS reduced the unnecessary use of broad-spectrum antimicrobial in this study population.展开更多
Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrob...Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。展开更多
Objective:To fully understand the overall system and implementation of antimicrobial stewardship(AMS)at different levels in China,an evaluation according to the integrated AMS evaluation tool developed by World Health...Objective:To fully understand the overall system and implementation of antimicrobial stewardship(AMS)at different levels in China,an evaluation according to the integrated AMS evaluation tool developed by World Health Organization(WHO)was conducted.Methods:A comprehensive search on the AMS relevant government policies,regulations,scientific research results,public and social activities was conducted,and the implementation of AMS strategies in national,subnational and hospital level were evaluated by the standards of the WHO.Results:The results shew that the system construction,technical infrastructure and actions of AMS in China at the national level is relatively satisfied,but the AMS system needs to be further strengthened at the subnational and the medical institutional level,especially the integration of multidisciplinary teams and relevant departments;the implementation of professional intervention strategies,national education and publicity,professional education and training are relatively weak.AMS implementation is mainly promoted at the national level,and AMS in primary medical institutions is almost missing.It is necessary to carry out AMS at the provincial level and medical institutions as soon as possible.The focus is to establish a professional AMS team,prepare AMS guideline,implement AMS strategy,raise public awareness and ensure the long‐term and sustainable development of AMS in the country.Conclusion:The Chinese government has established a system for AMS,and implemented a multisectoral coordinative mechanism.However,at the subnational and district levels,an AMS system and practice should be set up soon to promote the rational use of antibiotics.展开更多
Background:This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship,in addition to identifying factors influencing their perception and practices in community ...Background:This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship,in addition to identifying factors influencing their perception and practices in community pharmacy.Methods:A cross-sectional study was carried out among community pharmacists regarding antimicrobial stewardship.Convenience sampling was used to obtain the required sample from a community pharmacy in Baghdad.In total,381 participants have completed the survey.Results:The majority of the participants(85.6%)strongly agreed/agreed that“antimicrobial stewardship programs reduce the problems of antibiotic resistance”;and 85.5%of them strongly agreed/agreed that community pharmacists required adequate training on antibiotics use.In addition,high percent of community pharmacists(88.4%)strongly agreed/agreed that pharmacists have a responsibility to take a prominent role in antimicrobial stewardship programs and infection-control programs in the health system.The total score of perception was significantly influenced by older age groups,postgraduate degrees,and experience of 6–10 years(p<0.001).This study also showed that 65.4%of pharmacists always/often advise patients to continue the full course of antimicrobials,and 64.9%of them reported always/often considering clinical and safety parameters before dispensing antibiotics.The role of pharmacists was significantly influenced by the younger age group,females,higher degree in pharmacy,experience of 3–5 years,and medical complex pharmacy(p<0.001).Conclusion:Community pharmacists have a good perception toward antimicrobial stewardship programs,but their role is still limited.More efforts are needed to design better strategies for antimicrobial stewardship in community pharmacy.展开更多
High resistance rates to antimicrobials continue to be a global health threat.The incidence of multidrug-resistant(MDR)microorganisms in intensive care units(ICUs)is quite high compared to in the community and other u...High resistance rates to antimicrobials continue to be a global health threat.The incidence of multidrug-resistant(MDR)microorganisms in intensive care units(ICUs)is quite high compared to in the community and other unitsin the hospital because ICU patients are generally older,have higher numbers of co-morbidities and immunesuppressed;moreover,the typically high rates of invasive procedures performed in the ICU increase the risk ofinfection by MDR microorganisms.Antimicrobial stewardship(AMS)refers to the implementation of coordinatedinterventions to improve and track the appropriate use of antibiotics while offering the best possible antibioticprescription(according to dose,duration,and route of administration).Broad-spectrum antibiotics are frequentlypreferred in ICUs because of greater infection severity and colonization and infection by MDR microorganisms.For this reason,a number of studies on AMS in ICUs have increased in recent years.Reducing the use of broadspectrum antibiotics forms the basis of AMS.For this purpose,parameters such as establishing an AMS team,limiting the use of broad-spectrum antimicrobials,terminating treatments early,using early warning systems,pursuing infection control,and providing education and feedback are used.In this review,current AMS practicesin ICUs are discussed.展开更多
The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last ...The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades.The antimicrobial stewardship program(ASP)is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use.ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance.Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization,decreasing drug resistance and treatment failure,minimization of adverse clinical outcomes,decreasing healthcare costs and hospital length of stay,and optimization of diagnostic strategies.However,some barriers in pediatric ASP still exist.This narrative review describes core elements of ASP,the impact of implemented ASPs on pediatric healthcare,and challenges of pediatric ASP as seen by the authors.展开更多
Neonatal and pediatric sepsis remains a major global health concern,contributing significantly to morbidity and mortality among children under 5 years of age.The clinical and microbiological characteristics of sepsis ...Neonatal and pediatric sepsis remains a major global health concern,contributing significantly to morbidity and mortality among children under 5 years of age.The clinical and microbiological characteristics of sepsis differ markedly in neonates and children,necessitating tailored diagnostic and treatment approaches.This mini-review explores the evolving microbiological landscape,recent advancements in diagnostic methodologies,and challenges posed by antimicrobial resistance(AMR)in managing neonatal and pediatric sepsis.Emerging pathogens,including multidrug-resistant Gram-negative bacilli and fungal organisms,are reshaping the epidemiology of sepsis.Innovations in molecular diagnostics,including polymerase chain reaction-based platforms,next-generation sequencing,and artificial intelligence-integrated tools,are revolutionizing early pathogen detection and resistance profiling.However,implementation gaps persist,particularly in low-and middle-income countries.Therapeutic challenges are compounded by limited pediatric data on newer antimicrobials and rising AMR rates.Infection prevention strategies,especially in intensive care units,are crucial to outbreak containment.An integrated approach combining microbiological surveillance,rapid diagnostics,and antimicrobial stewardship is critical for improving sepsis outcomes.Future research should focus on context-specific implementation of diagnostic tools and optimizing treatment strategies for resource-limited settings.展开更多
BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safel...BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.展开更多
Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies...Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the AWaRe classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevalent among humans, animals, and the environment. Successfully addressing AMR calls for a collaborative, multifaceted One Health approach. Despite this, some gaps remain effectively implementing strategies currently recommended to combat AMR. As a result, it is essential to reinforce the strategies that are deployed to counter AMR across the human, animal, and environmental sectors.展开更多
Background: Antimicrobial resistance (AMR) is a growing public health concern, with far-reaching consequences for modern medicine. Zambia, like many other low- and middle-income countries, faces significant challenges...Background: Antimicrobial resistance (AMR) is a growing public health concern, with far-reaching consequences for modern medicine. Zambia, like many other low- and middle-income countries, faces significant challenges in addressing AMR. Further, high rates of resistance have been reported among various microorganisms in Zambia. This review paper aims to summarize the current situation of the burden of AMR in Zambia, including the prevalence, risk factors contributing to its emergence and spread, challenges in addressing this issue, and the required solutions to combat this growing public health threat. Additionally, the paper also outlines existing efforts to combat AMR and proposes required solutions and recommendations to address this threat to public health. Materials and Methods: This study employed a comprehensive narrative review design that included studies published from January 2000 to November 2024. The literature search was done using PubMed, Scopus, Web of Science, and Google Scholar. Results: In 2019, 1.27 million deaths were attributed to AMR of which 255,000 were from sub-Saharan Africa. Currently, the burden of AMR in Zambia is not well understood. This study found that the drug resistance index (DRI) in Zambia was 60.9%, demonstrating high resistance rates of pathogens to antimicrobials commonly used in humans and animals. The high DRI indicates the low effectiveness of antibiotics in treatment of infections. Most pathogens with high resistance to antimicrobials include Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Salmonella species, Enterococcus species, Mycobacterium tuberculosis, Acinetobacter baumannii, and Pseudomonas aeruginosa. Additionally, the study found that there was low awareness, knowledge, attitudes, and suboptimal practices regarding AMR in Zambia. The contributing factors to the emergence and spread of AMR include self-medication practices, overuse and misuse of antimicrobials in humans and animals, non-adherence to treatment guidelines, limited diagnostic capacity, substandard and falsified antimicrobials, and a lack of surveillance of AMR. There is a need to develop strategies to address the identified gaps in Zambia to successfully combat AMR. Conclusion: This study revealed high resistance of microbes to antimicrobials in Zambia. The high prevalence of AMR in Zambia indicates its burden on the country, thereby providing opportunities for further research to quantify this problem. The findings highlight the need for a One Health multi-sectoral approach to address AMR in Zambia, including strengthening surveillance and monitoring, improving antimicrobial stewardship and prescribing practices, enhancing infection prevention and control practices, increasing access to quality healthcare and diagnostic services, promoting public awareness and education, and encouraging research and development of new antimicrobial agents. The proposed solutions and recommendations can serve to strengthen the implementation of the Zambia National Action Plan (NAP) to combat AMR.展开更多
BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial st...BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship.The coronavirus disease 2019(COVID-19)pandemic has introduced additional complexities,potentially influencing these patterns.AIM To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023,with a specific focus on the impact of the COVID-19 pandemic on these trends.METHODS A retrospective analysis of microbiological data was conducted,covering the period from 2018 to 2023.The study included key bacterial pathogens such as Escherichia coli(E.coli),Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,among others.The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods.To contextualize the findings,the findings were compared with similar studies from other regions,including China,India,Romania,Saudi Arabia,the United Arab Emirates,Malaysia,and United States.RESULTS The study revealed fluctuating trends in the prevalence of bacterial isolates,with notable changes during the COVID-19 pandemic.For example,a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years,while the prevalence of E.coli showed a more variable pattern.Antibiotic resistance rates varied among the different pathogens,with a concerning rise in resistance to commonly used antibiotics,particularly among Klebsiella pneumoniae and E.coli.Additionally,the study identified an alarming increase in the prevalence of multidrug-resistant(MDR)strains,especially within Klebsiella pneumoniae and E.coli isolates.The impact of the COVID-19 pandemic on these trends was evident,with shifts in the frequency,resistance patterns,and the emergence of MDR bacteria among several key pathogens.CONCLUSION This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex,particularly in the context of the COVID-19 pandemic.The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance.Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.展开更多
BACKGROUND Antimicrobial resistance(AMR)is an escalating global health threat,disproportionately impacting low-income and middle-income countries like India.The rise of multidrug-resistant organisms(MDROs)complicates ...BACKGROUND Antimicrobial resistance(AMR)is an escalating global health threat,disproportionately impacting low-income and middle-income countries like India.The rise of multidrug-resistant organisms(MDROs)complicates treatment,increases healthcare costs,and contributes to higher morbidity and mortality.In India,factors such as antibiotic misuse,over-the-counter availability,and self-medication have exacerbated this crisis.Despite the urgency,regional data on MDRO prevalence remains limited.AIM To assess the burden and distribution of MDRO infections identified at a tertiary healthcare institute in North India.METHODS This cross-sectional study analyzed inpatient data from All India Institute of Medical Sciences(AIIMS)Rishikesh using the E-hospital database from May 2021 to February 2024,except 2022.All inpatients with culture-confirmed MDRO infections were included.Patient charts and discharge summaries were reviewed.Data analysis was performed using Jamovi software,with descriptive statistics summarizing demographics.Theχ²test was used to assess associations between MDROs and various factors.Ethical approval was obtained,and patient confidentiality was maintained.RESULTS This study included 820 participants having 1106 MDROs.The majority of patients were aged 35-64 years,with a male predominance(57.6%).Most cases were from Uttar Pradesh(49.1%)and Uttarakhand(47.6%),with Bijnor and Haridwar districts reporting the highest burden from their respective states.Klebsiella pneumoniae(K.pneumoniae)(30.6%),Acinetobacter baumannii(16.7%),and Escherichia coli(E.coli)(16.7%)were the most common MDROs.Urine was the most frequent sample type(51.0%),with K.pneumoniae as the leading pathogen.Infections varied significantly across departments(P<0.001),with General Medicine and Surgery reporting the highest burden.E.coli and Klebsiella spp.were most prevalent in these departments respectively.MDRO prevalence fluctuated over time,with significant variations by quarter(P<0.001).Following the second coronavirus disease 2019 wave,there was a rapid surge in MDROs,which stabilized after approximately three months.The overall mortality among patients harboring MDROs was 25.9%.CONCLUSION This study highlights the burden of MDROs among patients at AIIMS Rishikesh,with K.pneumoniae as the predominant pathogen.Strengthening antimicrobial stewardship and infection control measures is essential to combat rising AMR,with department-specific,and pathogen-specific stewardships.展开更多
A noteworthy public health problem,antimicrobial resistance(AMR)has been impeded in many ways by the coronavirus disease 2019(COVID-19)pandemic.This narrative review discusses the two-sided impact of COVID-19 on the m...A noteworthy public health problem,antimicrobial resistance(AMR)has been impeded in many ways by the coronavirus disease 2019(COVID-19)pandemic.This narrative review discusses the two-sided impact of COVID-19 on the magnitude of AMR.The pandemic has put tremendous strain on healthcare systems,diverting resources,personnel,and attention away from AMR diagnosis and management toward COVID-19 diagnosis and contact tracking and tracing.AMR research has been severely hampered,and surveillance and antimicrobial stewardship(AMS)programs have been de-emphasized,delayed,or halted.Antibiotics,particularly broad-spectrum,were prescribed more frequently without diagnostic confirmation of bacterial infection than before the pandemic.Nonetheless,the COVID-19 pandemic has highlighted the vulnerability of healthcare systems in controlling infectious disease threats and raised awareness of the importance of infection prevention and control.Yet,the pandemic has created opportunities to capitalize on positive effects on AMR management.The review concludes that it is now more important than ever to focus on AMR and strengthen AMS programs to ensure appropriate antibiotic use and other AMR prevention measures in healthcare.We must ensure that one of the COVID-19 legacies is increased support for AMR research,diagnostic implementation,appropriate diagnostic stewardship,and the strengthening of our health systems.The COVID-19 pandemic has demonstrated that prevention is better than cure.Countries will need to step up their efforts to combat AMR as a multidisciplinary community.We must prepare our public health systems to combat multiple threats at the same time.展开更多
BACKGROUND With the widespread use of antimicrobial drugs,bacterial resistance has become a significant problem,posing a serious threat to public health.The prevalence of clinical infection strains in hospitals and th...BACKGROUND With the widespread use of antimicrobial drugs,bacterial resistance has become a significant problem,posing a serious threat to public health.The prevalence of clinical infection strains in hospitals and their drug sensitivities are key to the appropriate use of antibiotics in clinical practice.AIM To identify prevalent bacteria and their antibiotic resistance profiles in a hospital setting,thereby guiding effective antibiotic usage by clinicians.METHODS Specimens from across the institution were collected by the microbiology laboratory.The VITEK 2 compact fully automatic analyzer was used for bacterial identification and antibiotic sensitivity testing,and the WHONET5.6 software was utilized for statistical analysis.RESULTS A total of 12062 bacterial strains of key monitoring significance were detected.Staphylococcus aureus demonstrated widespread resistance to penicillin,but none of the strains were resistant to vancomycin or linezolid.Moreover,219 strains of methicillin-resistant coagulase-negative staphylococci and 110 strains of methicillin-resistant Staphylococcus aureus were detected.Enterococcus faecalis showed moderate resistance to the third-generation quinolones ciprofloxacin and levofloxacin,but its resistance to nitrofurantoin and tetracycline was low.Enterococcus faecium displayed significantly lower resistance to third-and fourthgeneration quinolones than Enterococcus faecalis.The resistance of two key monitoring strains,Escherichia coli and Klebsiella pneumoniae,to piperacillin/tazobactam was 5%-8%.However,none of the Escherichia coli and Klebsiella pneumoniae strains were resistant to meropenem.The resistance of Acinetobacter baumannii to piperacillin/sulbactam was nearly 90%.Nonetheless,the resistance to tigecycline was low,and Pseudomonas aeruginosa demonstrated minimal resistance in the antibiotic sensitivity test,maintaining a resistance of<10%to the cephalosporin antibiotics cefotetan and cefoperazone over the last 6 years.The resistance to amikacin remained at 0.2%over the past 3 years.CONCLUSION Our hospital’s overall antibiotic resistance rate was relatively stable from 2017 to 2022.The detection rates of key monitoring strains are reported quarterly and their resistance dynamics are monitored and communicated to the entire hospital,which can guide clinical antibiotic selection.展开更多
Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “...Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely;Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.展开更多
基金China Medical Board(Grant No.17-270)National Natural Science Foundation of China(Grant No.81861138048 and 81973294)。
文摘In the present study,we aimed to assess the development of the antimicrobial stewardship(AMS)program in China’s tertiary hospitals to identify the potential challenges for the AMS program and provide references and benchmarks for strategic policymaking.A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System(CARSS).The questionnaire included 5 sections regarding structure,technical support,antimicrobial use management,antimicrobial use surveillance,and education.Descriptive statistics were used for data analysis.Of the 1044 tertiary hospitals under CARSS,13.4%(140)hospitals participated in the study.Among them,99.3%(139/140)set up the AMS program.The hospital president(82.1%,115/140)and medical service department(59.3%,83/140)were responsible for AMS outcomes in most hospitals.Structured antimicrobial formulary restriction management was adopted by 99.3%(139/140)hospitals.Infectious disease department,infection control department,and microbiological laboratories were established in 87.1%(122/140),99.3%(139/140)and 100%(140/140)hospitals,respectively.Up to 85.6%(124/140)hospitals applied clinical pathways,and 33.6%(47/140)hospitals implemented hospital-specific guidelines for infectious diseases.Outpatient prescription auditing,inpatient prescription auditing,and prophylactic antimicrobial prescription auditing of aseptic operation were performed in 99.3%(139/140),98.6%(138/140)and 95.7%(134/140)hospitals,respectively.Up to 97.1%(136/140)hospitals participated in antimicrobial use surveillance network,and 99.3%(139/140)hospitals established the specialized management of carbapenem and tigecycline.Staff education and public education were provided with various ways and frequencies in 100%(140/140)and 90.0%(126/140)hospitals,respectively.AMS programs in China’s tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments.More efforts should be put to further promote and strengthen the development of hospital-specific guidelines and the establishment of a progress and outcome evaluation system.
基金supported by the Natural Science Foundation of Hubei Province(No.2021CFB348).
文摘ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).
文摘Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding the knowledge, attitude, and practices of poultry farmers on AMU and AMR. Therefore, this study assessed the knowledge, attitude and practices regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Methods: This was a cross-sectional study conducted among 106 poultry farmers from November to December 2021 using a structured questionnaire. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Overall, of the 106 participants, 90.6% knew what antimicrobials were, but only 29.2% were aware of AMR. The study showed that 46.2% of the participants had low knowledge, 71.7% had negative attitudes, and 61.3% had poor practices regarding AMR. The prevalence of antibiotic use in poultry production was 83%. The most used antimicrobials were tetracycline (84%) and gentamicin (35.2%). The commonly reported reason for the use of antimicrobials was for the treatment (93.2%) and prevention (89.8%) of diseases. Further, 76.9% of the administered antimicrobials were usually done without veterinarian consultation or prescription. Conclusion: The study shows that there was high AMU in poultry farms in Kitwe. However, there was low knowledge, negative attitude, and poor practices towards AMU and AMR. Therefore, there is a need for educational and sensitisation programmes regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Alongside this, antimicrobial stewardship and surveillance systems should be strengthened in the livestock production sector. This will ensure food safety and public health.
文摘Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivotal roles in facilitating the prudent use of antibiotics through antimicrobial stewardship programs. Due to limited information in Benin, this study assessed the knowledge and attitudes of pharmacy staffs on antibiotic use and resistance. Materials and Methods: This cross-sectional study was conducted among 159 pharmacy staffs using a structured questionnaire from August 2018 to December 2018 in Benin. Data analysis was done by using Stata version 13.0. Results: Of the 159 participants, 54.8% knew the definition of antibiotic therapy and 66.9% knew the definition of probabilistic antibiotic therapy. The majority (88.1%) of the participants thought that the choice of antibiotics was made according to the pathology, while 60.4% thought that it depended on the pathology and the germ involved. 49.02% of dispensers in pharmacies stated that half of the patients had requested treatment without providing a prescription at the pharmacy. The top three antibiotics that were dispensed without a prescription include amoxicillin (98.1%), cloxacillin (76.7%) and metronidazole (57.2%), all from the Access group of antibiotics. Conclusion: These results underscore the need for educational and training interventions targeting specific professional groups. There is an urgent need for regulatory measures and public awareness through improved antimicrobial stewardship to limit this practice.
文摘Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the World Health Organization has identified Antimicrobial Stewardship as one of the strategic objectives of its global action plan on antimicrobial resistance. This survey aimed to observe antimicrobial prescribing and usage patterns in the Rivers State University Teaching Hospital with the purpose of identifying gaps to inform the specific antimicrobial stewardship interventions necessary to address our specific needs. Methodology: A point prevalence survey was conducted using the protocol and web-based automated data management system designed by the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp, Belgium, in November 2021. Results: A total of 69 adult medical and surgical patients were surveyed;27 males and 18 females. Antimicrobial prevalence was 65.2%. Third generation cephalosporins (24.4%;33.3%), fluoroquinolones (17.8%;22.2%) and imidazole derivatives (20%;36.1%) were most prescribed on the medical and surgical wards. Antimicrobial guidelines were completely unavailable, most antimicrobials (93.8%) were prescribed empirically and 64.4% of these remained empirical after 72 hours of commencement. Conclusion: Antimicrobial stewardship interventions are necessary to minimize sub-optimal antimicrobial prescribing practices in our facility. Most critical are education on appropriate use of antimicrobials, support for development of antimicrobial guidelines, diagnostic stewardship, and the drive for improved use of the laboratory to guide antimicrobial prescriptions. The antimicrobial stewardship committee and team must drive this, having the requisite support from the management and prescribers, with the primary outcomes being reduced antimicrobial prevalence and improved antimicrobial prescription patterns.
文摘The purpose of this study was to critically evaluate the impact of an institutional blood culture notification protocol called RAIDS （rapid administration of antimicrobials by an infectious diseases specialist） on time to optimization of antimicrobial therapy in hospitalized patients with gram-negative bacteremia. Time to antibiotic optimization was compared in patients with gram-negative bacilli isolated from blood cultures obtained from March-May 2011 （pre-RAIDS） versus March-May 2013 （post-RAIDS）. The results show that patients in the pre-RAIDS study group had a significantly longer time to antibiotic optimization when compared to the post-RAIDS group （median （IQR）, 27.6 （10.8-75.8） h vs. 3.1 （0.8-34.3） h, p = 0.03）. The RAIDS protocol resulted in quicker time to antibiotic de-escalation （pre- vs. post-RAIDS; median （IQR）, 27.6 （10.8-134.5） h vs. 4.3 （1.4-32.6） h, p = 0.03）. There were no differences in clinical outcomes such as clinical cure, microbiological cure, and 30-day mortality between pre-RAIDS and post-RAIDS study groups. Patients in the post-RAIDS arm were more likely to receive appropriate empiric and definitive treatment. Implementation of the RAIDS protocol, which was an ASP （antimicrobial stewardship program） initiative, resulted in quicker time to antibiotic de-escalation and overall treatment optimization. RAIDS reduced the unnecessary use of broad-spectrum antimicrobial in this study population.
基金the project:the Science and Technology Planning Project of Zhuhai City of China(No.20191206F060001)。
文摘Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。
基金Key Research and Development Program of Zhejiang Province,Grant/Award Number:2021C03068。
文摘Objective:To fully understand the overall system and implementation of antimicrobial stewardship(AMS)at different levels in China,an evaluation according to the integrated AMS evaluation tool developed by World Health Organization(WHO)was conducted.Methods:A comprehensive search on the AMS relevant government policies,regulations,scientific research results,public and social activities was conducted,and the implementation of AMS strategies in national,subnational and hospital level were evaluated by the standards of the WHO.Results:The results shew that the system construction,technical infrastructure and actions of AMS in China at the national level is relatively satisfied,but the AMS system needs to be further strengthened at the subnational and the medical institutional level,especially the integration of multidisciplinary teams and relevant departments;the implementation of professional intervention strategies,national education and publicity,professional education and training are relatively weak.AMS implementation is mainly promoted at the national level,and AMS in primary medical institutions is almost missing.It is necessary to carry out AMS at the provincial level and medical institutions as soon as possible.The focus is to establish a professional AMS team,prepare AMS guideline,implement AMS strategy,raise public awareness and ensure the long‐term and sustainable development of AMS in the country.Conclusion:The Chinese government has established a system for AMS,and implemented a multisectoral coordinative mechanism.However,at the subnational and district levels,an AMS system and practice should be set up soon to promote the rational use of antibiotics.
文摘Background:This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship,in addition to identifying factors influencing their perception and practices in community pharmacy.Methods:A cross-sectional study was carried out among community pharmacists regarding antimicrobial stewardship.Convenience sampling was used to obtain the required sample from a community pharmacy in Baghdad.In total,381 participants have completed the survey.Results:The majority of the participants(85.6%)strongly agreed/agreed that“antimicrobial stewardship programs reduce the problems of antibiotic resistance”;and 85.5%of them strongly agreed/agreed that community pharmacists required adequate training on antibiotics use.In addition,high percent of community pharmacists(88.4%)strongly agreed/agreed that pharmacists have a responsibility to take a prominent role in antimicrobial stewardship programs and infection-control programs in the health system.The total score of perception was significantly influenced by older age groups,postgraduate degrees,and experience of 6–10 years(p<0.001).This study also showed that 65.4%of pharmacists always/often advise patients to continue the full course of antimicrobials,and 64.9%of them reported always/often considering clinical and safety parameters before dispensing antibiotics.The role of pharmacists was significantly influenced by the younger age group,females,higher degree in pharmacy,experience of 3–5 years,and medical complex pharmacy(p<0.001).Conclusion:Community pharmacists have a good perception toward antimicrobial stewardship programs,but their role is still limited.More efforts are needed to design better strategies for antimicrobial stewardship in community pharmacy.
文摘High resistance rates to antimicrobials continue to be a global health threat.The incidence of multidrug-resistant(MDR)microorganisms in intensive care units(ICUs)is quite high compared to in the community and other unitsin the hospital because ICU patients are generally older,have higher numbers of co-morbidities and immunesuppressed;moreover,the typically high rates of invasive procedures performed in the ICU increase the risk ofinfection by MDR microorganisms.Antimicrobial stewardship(AMS)refers to the implementation of coordinatedinterventions to improve and track the appropriate use of antibiotics while offering the best possible antibioticprescription(according to dose,duration,and route of administration).Broad-spectrum antibiotics are frequentlypreferred in ICUs because of greater infection severity and colonization and infection by MDR microorganisms.For this reason,a number of studies on AMS in ICUs have increased in recent years.Reducing the use of broadspectrum antibiotics forms the basis of AMS.For this purpose,parameters such as establishing an AMS team,limiting the use of broad-spectrum antimicrobials,terminating treatments early,using early warning systems,pursuing infection control,and providing education and feedback are used.In this review,current AMS practicesin ICUs are discussed.
文摘The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades.The antimicrobial stewardship program(ASP)is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use.ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance.Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization,decreasing drug resistance and treatment failure,minimization of adverse clinical outcomes,decreasing healthcare costs and hospital length of stay,and optimization of diagnostic strategies.However,some barriers in pediatric ASP still exist.This narrative review describes core elements of ASP,the impact of implemented ASPs on pediatric healthcare,and challenges of pediatric ASP as seen by the authors.
文摘Neonatal and pediatric sepsis remains a major global health concern,contributing significantly to morbidity and mortality among children under 5 years of age.The clinical and microbiological characteristics of sepsis differ markedly in neonates and children,necessitating tailored diagnostic and treatment approaches.This mini-review explores the evolving microbiological landscape,recent advancements in diagnostic methodologies,and challenges posed by antimicrobial resistance(AMR)in managing neonatal and pediatric sepsis.Emerging pathogens,including multidrug-resistant Gram-negative bacilli and fungal organisms,are reshaping the epidemiology of sepsis.Innovations in molecular diagnostics,including polymerase chain reaction-based platforms,next-generation sequencing,and artificial intelligence-integrated tools,are revolutionizing early pathogen detection and resistance profiling.However,implementation gaps persist,particularly in low-and middle-income countries.Therapeutic challenges are compounded by limited pediatric data on newer antimicrobials and rising AMR rates.Infection prevention strategies,especially in intensive care units,are crucial to outbreak containment.An integrated approach combining microbiological surveillance,rapid diagnostics,and antimicrobial stewardship is critical for improving sepsis outcomes.Future research should focus on context-specific implementation of diagnostic tools and optimizing treatment strategies for resource-limited settings.
文摘BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.
文摘Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the AWaRe classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevalent among humans, animals, and the environment. Successfully addressing AMR calls for a collaborative, multifaceted One Health approach. Despite this, some gaps remain effectively implementing strategies currently recommended to combat AMR. As a result, it is essential to reinforce the strategies that are deployed to counter AMR across the human, animal, and environmental sectors.
文摘Background: Antimicrobial resistance (AMR) is a growing public health concern, with far-reaching consequences for modern medicine. Zambia, like many other low- and middle-income countries, faces significant challenges in addressing AMR. Further, high rates of resistance have been reported among various microorganisms in Zambia. This review paper aims to summarize the current situation of the burden of AMR in Zambia, including the prevalence, risk factors contributing to its emergence and spread, challenges in addressing this issue, and the required solutions to combat this growing public health threat. Additionally, the paper also outlines existing efforts to combat AMR and proposes required solutions and recommendations to address this threat to public health. Materials and Methods: This study employed a comprehensive narrative review design that included studies published from January 2000 to November 2024. The literature search was done using PubMed, Scopus, Web of Science, and Google Scholar. Results: In 2019, 1.27 million deaths were attributed to AMR of which 255,000 were from sub-Saharan Africa. Currently, the burden of AMR in Zambia is not well understood. This study found that the drug resistance index (DRI) in Zambia was 60.9%, demonstrating high resistance rates of pathogens to antimicrobials commonly used in humans and animals. The high DRI indicates the low effectiveness of antibiotics in treatment of infections. Most pathogens with high resistance to antimicrobials include Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Salmonella species, Enterococcus species, Mycobacterium tuberculosis, Acinetobacter baumannii, and Pseudomonas aeruginosa. Additionally, the study found that there was low awareness, knowledge, attitudes, and suboptimal practices regarding AMR in Zambia. The contributing factors to the emergence and spread of AMR include self-medication practices, overuse and misuse of antimicrobials in humans and animals, non-adherence to treatment guidelines, limited diagnostic capacity, substandard and falsified antimicrobials, and a lack of surveillance of AMR. There is a need to develop strategies to address the identified gaps in Zambia to successfully combat AMR. Conclusion: This study revealed high resistance of microbes to antimicrobials in Zambia. The high prevalence of AMR in Zambia indicates its burden on the country, thereby providing opportunities for further research to quantify this problem. The findings highlight the need for a One Health multi-sectoral approach to address AMR in Zambia, including strengthening surveillance and monitoring, improving antimicrobial stewardship and prescribing practices, enhancing infection prevention and control practices, increasing access to quality healthcare and diagnostic services, promoting public awareness and education, and encouraging research and development of new antimicrobial agents. The proposed solutions and recommendations can serve to strengthen the implementation of the Zambia National Action Plan (NAP) to combat AMR.
文摘BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship.The coronavirus disease 2019(COVID-19)pandemic has introduced additional complexities,potentially influencing these patterns.AIM To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023,with a specific focus on the impact of the COVID-19 pandemic on these trends.METHODS A retrospective analysis of microbiological data was conducted,covering the period from 2018 to 2023.The study included key bacterial pathogens such as Escherichia coli(E.coli),Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,among others.The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods.To contextualize the findings,the findings were compared with similar studies from other regions,including China,India,Romania,Saudi Arabia,the United Arab Emirates,Malaysia,and United States.RESULTS The study revealed fluctuating trends in the prevalence of bacterial isolates,with notable changes during the COVID-19 pandemic.For example,a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years,while the prevalence of E.coli showed a more variable pattern.Antibiotic resistance rates varied among the different pathogens,with a concerning rise in resistance to commonly used antibiotics,particularly among Klebsiella pneumoniae and E.coli.Additionally,the study identified an alarming increase in the prevalence of multidrug-resistant(MDR)strains,especially within Klebsiella pneumoniae and E.coli isolates.The impact of the COVID-19 pandemic on these trends was evident,with shifts in the frequency,resistance patterns,and the emergence of MDR bacteria among several key pathogens.CONCLUSION This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex,particularly in the context of the COVID-19 pandemic.The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance.Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.
文摘BACKGROUND Antimicrobial resistance(AMR)is an escalating global health threat,disproportionately impacting low-income and middle-income countries like India.The rise of multidrug-resistant organisms(MDROs)complicates treatment,increases healthcare costs,and contributes to higher morbidity and mortality.In India,factors such as antibiotic misuse,over-the-counter availability,and self-medication have exacerbated this crisis.Despite the urgency,regional data on MDRO prevalence remains limited.AIM To assess the burden and distribution of MDRO infections identified at a tertiary healthcare institute in North India.METHODS This cross-sectional study analyzed inpatient data from All India Institute of Medical Sciences(AIIMS)Rishikesh using the E-hospital database from May 2021 to February 2024,except 2022.All inpatients with culture-confirmed MDRO infections were included.Patient charts and discharge summaries were reviewed.Data analysis was performed using Jamovi software,with descriptive statistics summarizing demographics.Theχ²test was used to assess associations between MDROs and various factors.Ethical approval was obtained,and patient confidentiality was maintained.RESULTS This study included 820 participants having 1106 MDROs.The majority of patients were aged 35-64 years,with a male predominance(57.6%).Most cases were from Uttar Pradesh(49.1%)and Uttarakhand(47.6%),with Bijnor and Haridwar districts reporting the highest burden from their respective states.Klebsiella pneumoniae(K.pneumoniae)(30.6%),Acinetobacter baumannii(16.7%),and Escherichia coli(E.coli)(16.7%)were the most common MDROs.Urine was the most frequent sample type(51.0%),with K.pneumoniae as the leading pathogen.Infections varied significantly across departments(P<0.001),with General Medicine and Surgery reporting the highest burden.E.coli and Klebsiella spp.were most prevalent in these departments respectively.MDRO prevalence fluctuated over time,with significant variations by quarter(P<0.001).Following the second coronavirus disease 2019 wave,there was a rapid surge in MDROs,which stabilized after approximately three months.The overall mortality among patients harboring MDROs was 25.9%.CONCLUSION This study highlights the burden of MDROs among patients at AIIMS Rishikesh,with K.pneumoniae as the predominant pathogen.Strengthening antimicrobial stewardship and infection control measures is essential to combat rising AMR,with department-specific,and pathogen-specific stewardships.
文摘A noteworthy public health problem,antimicrobial resistance(AMR)has been impeded in many ways by the coronavirus disease 2019(COVID-19)pandemic.This narrative review discusses the two-sided impact of COVID-19 on the magnitude of AMR.The pandemic has put tremendous strain on healthcare systems,diverting resources,personnel,and attention away from AMR diagnosis and management toward COVID-19 diagnosis and contact tracking and tracing.AMR research has been severely hampered,and surveillance and antimicrobial stewardship(AMS)programs have been de-emphasized,delayed,or halted.Antibiotics,particularly broad-spectrum,were prescribed more frequently without diagnostic confirmation of bacterial infection than before the pandemic.Nonetheless,the COVID-19 pandemic has highlighted the vulnerability of healthcare systems in controlling infectious disease threats and raised awareness of the importance of infection prevention and control.Yet,the pandemic has created opportunities to capitalize on positive effects on AMR management.The review concludes that it is now more important than ever to focus on AMR and strengthen AMS programs to ensure appropriate antibiotic use and other AMR prevention measures in healthcare.We must ensure that one of the COVID-19 legacies is increased support for AMR research,diagnostic implementation,appropriate diagnostic stewardship,and the strengthening of our health systems.The COVID-19 pandemic has demonstrated that prevention is better than cure.Countries will need to step up their efforts to combat AMR as a multidisciplinary community.We must prepare our public health systems to combat multiple threats at the same time.
文摘BACKGROUND With the widespread use of antimicrobial drugs,bacterial resistance has become a significant problem,posing a serious threat to public health.The prevalence of clinical infection strains in hospitals and their drug sensitivities are key to the appropriate use of antibiotics in clinical practice.AIM To identify prevalent bacteria and their antibiotic resistance profiles in a hospital setting,thereby guiding effective antibiotic usage by clinicians.METHODS Specimens from across the institution were collected by the microbiology laboratory.The VITEK 2 compact fully automatic analyzer was used for bacterial identification and antibiotic sensitivity testing,and the WHONET5.6 software was utilized for statistical analysis.RESULTS A total of 12062 bacterial strains of key monitoring significance were detected.Staphylococcus aureus demonstrated widespread resistance to penicillin,but none of the strains were resistant to vancomycin or linezolid.Moreover,219 strains of methicillin-resistant coagulase-negative staphylococci and 110 strains of methicillin-resistant Staphylococcus aureus were detected.Enterococcus faecalis showed moderate resistance to the third-generation quinolones ciprofloxacin and levofloxacin,but its resistance to nitrofurantoin and tetracycline was low.Enterococcus faecium displayed significantly lower resistance to third-and fourthgeneration quinolones than Enterococcus faecalis.The resistance of two key monitoring strains,Escherichia coli and Klebsiella pneumoniae,to piperacillin/tazobactam was 5%-8%.However,none of the Escherichia coli and Klebsiella pneumoniae strains were resistant to meropenem.The resistance of Acinetobacter baumannii to piperacillin/sulbactam was nearly 90%.Nonetheless,the resistance to tigecycline was low,and Pseudomonas aeruginosa demonstrated minimal resistance in the antibiotic sensitivity test,maintaining a resistance of<10%to the cephalosporin antibiotics cefotetan and cefoperazone over the last 6 years.The resistance to amikacin remained at 0.2%over the past 3 years.CONCLUSION Our hospital’s overall antibiotic resistance rate was relatively stable from 2017 to 2022.The detection rates of key monitoring strains are reported quarterly and their resistance dynamics are monitored and communicated to the entire hospital,which can guide clinical antibiotic selection.
文摘Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely;Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.
