Better reporting of interventions : template for intervention description and replication (TIDieR) checklist and guide

Peer reviewedPublisher PD

Does Use of a Molecular Rapid Pathogen Kit Improve Outcomes in the Bacteremic and Critically Ill?

Sepsis is a pervasive condition that carries a tremendous burden of disease in the form of financial cost, morbidity, and mortality. Culturing methods slow clinicians’ ability to begin focused treatment, and increased antimicrobial resistance only intensifies the need for improved diagnostic tools. Rapid molecular diagnostic tests can shorten time to identify organisms, reduce inappropriate antibiotic treatment, and improve patient outcomes. A newly approved test has proven fast and accurate for identification and susceptibility, but has not been studied in regard to clinical outcomes. Our study will compare the effect of the Accelerate™ system versus standard identification and susceptibility tests on patient length of stay. In a randomized controlled trial, we will use the Accelerate Pheno™ system to identify microbes and drug-resistance in septic critical care patients. We expect that diagnosis using this test will result in faster, more focused therapy, which will shorten hospital stays and save lives

Incorporation of Antibiotics into Solid Lipid Nanoparticles: A Promising Approach to Reduce Antibiotic Resistance Emergence

Antimicrobial resistance is one of the biggest threats to global health as current antibiotics are becoming useless against resistant infectious pathogens. Consequently, new antimicrobial strategies are urgently required. Drug delivery systems represent a potential solution to improve current antibiotic properties and reverse resistance mechanisms. Among different drug delivery systems, solid lipid nanoparticles represent a highly interesting option as they offer many advantages for nontoxic targeted drug delivery. Several publications have demonstrated the capacity of SLNs to significantly improve antibiotic characteristics increasing treatment efficiency. In this review article, antibiotic-loaded solid lipid nanoparticle-related works are analyzed to summarize all information associated with applying these new formulations to tackle the antibiotic resistance problem. The main antimicrobial resistance mechanisms and relevant solid lipid nanoparticle characteristics are presented to later discuss the potential of these nanoparticles to improve current antibiotic treatment characteristics and overcome antimicrobial resistance mechanisms. Moreover, solid lipid nanoparticles also offer new possibilities for other antimicrobial agents that cannot be administrated as free drugs. The advantages and disadvantages of these new formulations are also discussed in this review. Finally, given the progress of the studies carried out to date, future directions are discussed.This work was supported by grants from the University of the Basque Country grant number GIU18/229 and grant number COLAB19/08) and the Industry Department of the Basque Government grant number ELKARTEK2020 KK-2020/00007)

A Review On Antibiotic Stewardship In Pediatric Primary Care

Background. Misuse of antibiotics for upper respiratory tract infections (URTIs) in pediatric primary care settings persists despite growing concern over antibiotic resistance. Interventions aimed at improving prescription use, coined Antibiotic Stewardship Programs (ASPs) often target clinicians for improved clinical decision-making. More recently, ASPs have begun educating patients to antibiotic needs, and for pediatric cases, parents who might pressure clinicians into prescribing unneeded antibiotics. While many reviews have targeted adult patients or emergency settings, few evaluate practices for pediatric populations. For this reason, we performed a review of the literature to summarize common strategies used to reduce antibiotic overprescribing for pediatric patients in the United States. Methods. We searched the PubMed and Web of Science databases as well as manually reviewed abstracts of commonly cited literature. Studies were included if they had a randomized control trial design or alternative study design specifically reporting differences in before-after antibiotic use or perceptions. One independent reviewer abstracted all data. The primary outcomes were numerous across all reviewed studies, however, consistently pertained to reductions in unnecessary prescriptions for URTIs, streamlining prescribing workflow for physicians in the pediatric primary care setting, and reductions to antibiotic resistance. Results. 11 studies met inclusion criteria with 5 studies addressing clinicians, 5 studies addressing patient parents/guardians, and 1 study addressing both clinicians and patient parents. Within the three study groupings, interventions were categorized by methodology. Clinician-focused studies included clinician-decision-support (CDS) systems, education, and both (CDS and education) categories. Patient/guardian-focused studies included ‘poster and pamphlet’ and ‘audiovisual and pamphlet’ categories. The single study targeting both clinicians and parents used education and CDS system methods. After analysis, interventions using combinations of strategies were clearly superior in affecting behavior change and reductions in antibiotic prescribing rates. Conclusions. Though ASPs have demonstrated some efficacy, few groups have established consistent findings, methods, or outcomes. Studies show impacts on behaviors leading to antibiotic over-prescription, misuse, and subsequent development of antibiotic resistance while interventions did not lead to persistent long-term effects. Inconsistent conclusions arise from high prescribing rates among pediatric subpopulations as well as difficulties quantifying qualitative health education outcomes. Moving forward, ASP interventions must incorporate integrated and multi-faceted interventions to achieve reductions in URTI-related antibiotic prescriptions and antimicrobial resistance

Exploring barriers and enablers to the implementation of feasible interventions that address antibiotic resistance in Romania

Background: Antimicrobial resistance (AMR) is a major global public threat to human and animal health and sustainable development with significant economic and societal implications. The key drivers of AMR are numerous with one key one being non-prudent use (whether misuse or overuse) of antibiotics. Non-prudent use practices are: inappropriate prescribing, self-medication and antibiotic use without prescription, non-adherence to appropriate or recommended treatment. These may result from deficient patient-doctor interactions, treatment characteristics, access to treatment, storing of antibiotics at home, limited access to healthcare, and from intentions to self-medicate. A significant number of these factors are directly associated with human behavior and occur in a community setting. The Behavior Change Wheel (BCW), which proposes the identification of capabilities, opportunities and motivations that may dictate or change a certain behavior, is a useful framework to further understand different stakeholders’ behaviors that drive antibiotic consumption (ABC) and AMR as well as related interventions. Furthermore, while antibiotics are extensively used in the community, most interventions implemented thus far are set in health facilities and are delivered or are targeting healthcare professionals. This approach misses other community spaces and engagement opportunities. Romania has the highest total ABC for systemic use in the European Union (EU). Data on public knowledge on antibiotics in this country, shows a decline in knowledge compared to previous years. All these suggests that the Romanian setting would benefit from addressing related ABC and AMR issues through community-based interventions. Furthermore, the Romanian health and social systems are confronted with challenges that parallel or will be encountered by other countries. Aim: The overall aim of the project was to construct an evidence base for developing and implementing community-based interventions to combat AMR and inform relevant policy documents, in view of combating AMR in Romania. Methods: Two studies (study I and III) relied on qualitative methodology (content analysis), using semi-structured interviews to understand pharmacists and family doctors’ perceptions on related roles as well as ABC and AMR in Romania. Study I captured data from 18 interviews with pharmacists whereas study III from 12 family doctors’ interviews. Study III represented a quantitative and qualitative synthesis of evidence on the value of community-based educational interventions to improve antibiotic use. Seventy-three papers were included, ranging from quantitative, qualitative and mixed-methods studies. Study IV used a quantitative methodology to capture perceptions of future Romanian health professionals about antibiotic use. A total of 479 participants completed the study IV survey- 233 medical students from seven faculties and 246 pharmacy students from four faculties. Key findings: Study I articulated three sub-themes that would describe pharmacists’ perceptions. The first one referred to their difficulties in ‘maintaining equilibrium between ethics, law and economy’. The second sub-theme characterized ‘antibiotic resistance problem as rooted in a low social capital environment’. This reflected the deep causes of antibiotic resistance that go beyond strictly antibiotic management. Lastly pharmacists were found to be ‘wanting to fulfil their educational role’, which is how they felt they could best contribute. The overarching theme ‘Undervalued medicines’ professionals struggling with agency related and structural barriers to meet their deontological duties’- reflects the way pharmacists perceive their current societal standing as well as how their roles are challenged by several barriers that impact their decision-making processes. Study II revealed advantages of community-based behavior change interventions in improving antibiotic use. Multifaceted interventions were found to provide the greatest benefits. Particularly, interventions that combined educational components with persuasion had a better impact across most outcomes (knowledge, attitudes, and beliefs; antibiotic adherence; antibiotic use) compared to interventions focused solely on education. The review also identified challenges in evaluating this type of research and emphasized the necessity for standardized approaches in study design and outcome measurements. While there is some emerging evidence on the cost-effectiveness of these interventions, it remains limited in scope. Study III identified the perceived factors affecting ABC and antibiotic prescribing by family doctors. Some factors pertained to the perceived behavior of family doctors or patients, others were associated with different systems, local contexts, and the COVID-19 pandemic. An overarching theme was articulated: ‘family doctors in Romania see their role differently when it comes to antibiotic resistance and perceive the lack of patient education or awareness as one of the major drivers of ABC’. All these perceived factors spanned the capability, opportunity, and motivational domains of the BCW and could be addressed through a mix of interventions. Study IV found that most students responded they felt prepared in at least 14 areas (covered by 14 questions) (out of 22 areas/questions for medical students, and 19 for pharmacy students). In terms of willingness to engage, a similar trend was observed among both medical and pharmacy students, with scores of 2 out of 4 (4 being the maximum score showing the maximum engagement willingness, considering there are 4 areas of engagement) and 3 out of 4, respectively. A significant proportion, approximately 53.5% (n=254), confirmed that they received sufficient training to ensure the appropriate use of antibiotics in their professional fields. Students who scored low on preparedness expressed a desire for additional education. Regarding their estimation on how antibiotic use will evolve in Romania, the highest number of responses from medical and pharmacy students (n=159, 33.5%), highlighted the view that the situation would worsen. Regarding the survey design, the factor structure identified through Exploratory Factor Analysis (EFA) could not be validated through Confirmatory Factor Analysis (CFA), indicating that further adjustments are required for the model and/or questionnaire. Conclusions: Promising evidence supports the benefits of community-based interventions in enhancing antibiotic use, particularly multifaceted approaches. Considering the impact of the COVID19 pandemic, policymakers should consider these interventions alongside clinical-based approaches to rebuild trust. Inclusive participation in community-based interventions fosters public ownership and utilization of community channels. Romanian healthcare professionals hold diverse perceptions of AMR. Factors influencing appropriate antibiotic use and AMR in Romania include the behaviors of pharmacists, family doctors, patients, the health system, local contexts, and the pandemic's impact. Findings also have important implications for the education and training of future Romanian healthcare professionals, necessitating further research to establish standardized methods for monitoring and evaluating progress in preparedness, engagement willingness, and teaching preferences regarding antibiotic use