Can we prevent antimicrobial resistance by using antimicrobials better?

Since their development over 60 years ago, antimicrobials have become an integral part of healthcare practice worldwide. Recently, this has been put in jeopardy by the emergence of widespread antimicrobial resistance, which is one of the major problems facing modern medicine. In the past, the development of new antimicrobials kept us one step ahead of the problem of resistance, but only three new classes of antimicrobials have reached the market in the last thirty years. A time is therefore approaching when we may not have effective treatment against bacterial infections, particularly for those that are caused by Gram-negative organisms. An important strategy to reduce the development of antimicrobial resistance is to use antimicrobials more appropriately, in ways that will prevent resistance. This involves a consideration of the pharmacokinetic and pharmacodynamics properties of antimicrobials, the possible use of combinations, and more appropriate choice of antimicrobials, which may include rapid diagnostic testing and antimicrobial cycling. Examples given in this review include Mycobacterium tuberculosis, Gram-negative and Gram-positive organisms. We shall summarise the current evidence for these strategies and outline areas for future development

Anti-microbial Use in Animals: How to Assess the Trade-offs

Antimicrobials are widely used in preventive and curative medicine in animals. Benefits from curative use are clear – it allows sick animals to be healthy with a gain in human welfare. The case for preventive use of antimicrobials is less clear cut with debates on the value of antimicrobials as growth promoters in the intensive livestock industries. The possible benefits from the use of antimicrobials need to be balanced against their cost and the increased risk of emergence of resistance due to their use in animals. The study examines the importance of animals in society and how the role and management of animals is changing including the use of antimicrobials. It proposes an economic framework to assess the trade-offs of anti-microbial use and examines the current level of data collection and analysis of these trade-offs. An exploratory review identifies a number of weaknesses. Rarely are we consistent in the frameworks applied to the economic assessment anti-microbial use in animals, which may well be due to gaps in data or the prejudices of the analysts. There is a need for more careful data collection that would allow information on (i) which species and production systems antimicrobials are used in, (ii) what active substance of antimicrobials and the application method and (iii) what dosage rates. The species need to include companion animals as well as the farmed animals as it is still not known how important direct versus indirect spread of resistance to humans is. In addition, research is needed on pricing antimicrobials used in animals to ensure that prices reflect production and marketing costs, the fixed costs of anti-microbial development and the externalities of resistance emergence. Overall, much work is needed to provide greater guidance to policy, and such work should be informed by rigorous data collection and analysis systems

Review on bibliography related to antimicrobials

In this report, a bibliographic research has been done in the field of antimicrobials.In this report, a bibliographic research has been done in the field of antimicrobials. Not all antimicrobials have been included, but those that are being subject of matter in the group GBMI in Terrassa, and others of interest. It includes chitosan and other biopolymers. The effect of nanoparticles is of great interest, and in this sense, the effect of Ag nanoparticles and antibiotic nanoparticles (nanobiotics) has been revised. The report focuses on new publications and the antimicrobial effect of peptides has been considered. In particular, the influence of antimicrobials on membranes has deserved much attention and its study using the Langmuir technique, which is of great utility on biomimetic studies. The building up of antimicrobials systems with new techniques (bottom-up approach), as the Layer-by-Layer technique, can also be found in between the bibliography. It has also been considered the antibiofilm effect, and the new ideas on quorem sensing and quorum quenching.Preprin

Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017

Antimicrobial agents used to treat infections are life-saving. Overuse may result in more frequent adverse effects and emergence of multidrug-resistant microorganisms. In 2016-17, we performed the second point-prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals. We included 1,209 hospitals and 310,755 patients in 28 of 31 European Union/European Economic Area (EU/EEA) countries. The weighted prevalence of antimicrobial use in the EU/EEA was 30.5% (95% CI: 29.2-31.9%). The most common indication for prescribing antimicrobials was treatment of a community-acquired infection, followed by treatment of HAI and surgical prophylaxis. Over half (54.2%) of antimicrobials for surgical prophylaxis were prescribed for more than 1 day. The most common infections treated by antimicrobials were respiratory tract infections and the most commonly prescribed antimicrobial agents were penicillins with beta-lactamase inhibitors. There was wide variation of patients on antimicrobials, in the selection of antimicrobial agents and in antimicrobial stewardship resources and activities across the participating countries. The results of the PPS provide detailed information on antimicrobial use in European acute care hospitals, enable comparisons between countries and hospitals, and highlight key areas for national and European action that will support efforts towards prudent use of antimicrobials

Antimicrobial susceptibility pattern and multidrug resistance ındex in Pseudomonas aeruginosa among clinical isolates in Denizli, Turkey

Background: Pseudomonas aeruginosa is an important hospital infection agent causing morbidity and mortality with the ability to gain resistance to many antimicrobials. The objective of this study was to determine the sensitivity profiles of nosocomial P. aeruginosa isolates in Denizli, Turkey. Methods: A total 120 P. aeruginosa strains which were isolated from specimens sent to the microbiology laboratory between January 2015 and December 2015 were investigated. Antimicrobial resistance was determined by agar disc diffusion method using Mueller-Hinton agar according to Clinical and Laboratory Standards Institute recommendations. Results: With respect to sensitivity pattern, the most sensitive antimicrobials were Amikacin, colistin, tobramisin, netilmicin and gentamicin and the resistance rates were detected as 97%, 96%, 92%, 90%, 83%, respectively over 120 P. aeruginosa strains. The sensitivity rates for the other antimicrobials were 56% for Piperacilin and 54% for Tazobactam. P. aeruginosa strains 62 (52%) isolates showed multiple antimicrobial resistance to 13 antimicrobials Conclusion: To prevent the spread of the resistant bacteria, it is critically important to have strict antimicrobial policies while surveillance programmes for multidrug resistant organisms and infection control procedures need to be implemented. In the meantime, it is desirable that the antimicrobial susceptibility pattern of bacterial pathogens like P. aeruginosa in specialized clinical units to be continuously monitored and the results readily made available to clinicians so as to minimize the development of resistance. © 2018, National Institute for Medical Research. All rights reserved

Antimicrobial Susceptibility Patterns in Urinary Tract Infections in Dogs (2010-2013).

BackgroundUrinary tract infections (UTIs) are common in dogs. The responsible bacterial populations have evolved with increasing resistance to many antimicrobials.ObjectiveTo characterize the antimicrobial susceptibility patterns of canine urinary tract isolates over a 51-month period.AnimalsOne thousand six hundred and thirty-six bacterial isolates from 1,028 dogs.MethodsAerobic bacterial isolate growth and susceptibility data from urine cultures of dogs were identified, retrospectively. Medical records were reviewed to obtain signalment, comorbidities, and antimicrobial use in the previous 30 days. The UTIs were further categorized as uncomplicated, complicated, or pyelonephritis.ResultsCommon bacterial isolates identified were Escherichia coli (52.5%), Staphylococcus spp. (13.6%), and Enterococcus spp. (13.3%). In vitro susceptibility among all isolates varied for commonly prescribed antimicrobials (amoxicillin [59%], amoxicillin/clavulanic acid [76%], cephalexin [66%], enrofloxacin [74%] and trimethoprim-sulfamethoxazole [86%]). For all antimicrobials tested (except aminoglycosides), in vitro susceptibility was higher in uncomplicated versus complicated infections (P < .05). Uncomplicated infection isolate susceptibility rates remained ≤90% for PO administered antimicrobials. Administration of amoxicillin, doxycycline, and enrofloxacin, but not amoxicillin/clavulanic acid in the previous 30 days was associated with resistance to that antimicrobial. Multidrug resistant isolates of E. coli and Staphylococcus spp. were more common in dogs with complicated than uncomplicated UTIs (36% versus 21%, P < .0001).Conclusions and clinical importanceIn vitro susceptibility was highly variable and no PO administered antimicrobial had >90% efficacy among isolates tested. Multidrug resistance was frequent among isolates tested suggesting that routine culture and susceptibility testing is indicated. Previously prescribed antimicrobials may affect empirical choices made pending susceptibility testing

Antimicrobial Susceptibilities of Aerobic Isolates from Respiratory Samples of Young New Zealand Horses

3rd Annual IEEE Energy Conversion Congress and Exposition, ECCE 2011, Phoenix, AZ, 17-22 September 2011This paper presents a method of mitigating the transient overshoots of DC-DC converters operating with large load disturbances. The method involves a small auxiliary power circuit with a complementary control scheme that provides a smooth absorption and release of excess energy from and to the main DC-DC converter in the events of large load changes. This control mechanism interactively mitigates the large transient overshoots which would otherwise appear at the converter output. Since the control scheme involves an adjustable-energy-storage feature, the proposed solution is effective for any level of step-load change within a pre-specified range.Department of Electronic and Information EngineeringRefereed conference pape