Restrictive use of antibiotics in organic animal farming – a potential for safer, high quality products with less antibiotic resistant bacteria

Spread of antibiotic resistance along the food-chain is a major food safety concern due to the risk of treatment failure of human foodborne infections. Recent reports suggest that the restrictions on use of antibiotics in organic animal farming promote lower levels of antibiotic resistance in organic animal products as compared to conventional products. This is, however, scarcely documented in the EU, particularly for swine. Thus, the organic pig production is probably characterized by significant lower levels of antibiotic resistance and providing the documentation of this very important quality parameter of organic pigs holds the opportunity of exploiting this essential advantage of organic pork in marketing. Therefore, in SafeOrganic it will be documented whether the organic pigs in different European countries does show lower levels of antibiotic resistant bacteria compared to the conventional pigs. Furthermore, there seems to be a widespread routine of slaughtering conventional and organic animals at the same slaughter lines without special hygiene barriers to avoid cross-contamination. An important part of the project is therefore to investigate to which degree antibiotic resistant bacteria from conventional raised animals is transferred to organic meat during processing. Accordingly, SafeOrganic will assess and suggest management options, which can minimize the contact and hence risk of cross-contamination between the organic and the conventional meat products during slaughter. Information on the antibiotic use at farm level is normally not available, which hampers the authority control of imprudent use of antibiotics. Therefore, SafeOrganic will investigate if bacterial antibiotic resistance patterns and genotypes can be used as markers for the consumption of antibiotics in organic animal production. The results obtained in the project will be communicated to end-users enabling the slaughter industry to reduce spread of antibiotic resistant bacteria, and organic animal farmers to market pork meat with very low levels of antibiotic resistant bacteria implying an improved food safety quality compared to pork from conventional farming systems

Microbial diversity in individuals and their household contacts following typical antibiotic courses.

BackgroundAntibiotics are a mainstay of treatment for bacterial infections worldwide, yet the effects of typical antibiotic prescriptions on human indigenous microbiota have not been thoroughly evaluated. We examined the effects of the two most commonly prescribed antibiotics (amoxicillin and azithromycin) in the USA to discern whether short-term antibiotic courses may have prolonged effects on human microbiota.ResultsWe sampled the feces, saliva, and skin specimens from a cohort of unrelated, cohabitating individuals over 6 months. An individual in each household was given an antibiotic, and the other a placebo to discern antibiotic impacts on microbiota, as well as determine whether antibiotic use might reshape the microbiota of each household. We observed household-specific patterns of microbiota on each body surface, which persevered despite antibiotic perturbations. While the gut microbiota within an individual became more dissimilar over time, there was no evidence that the use of antibiotics accelerated this process when compared to household members. There was a significant change in microbiota diversity in the gut and mouth in response to antibiotics, but analogous patterns were not observed on the skin. Those who received 7 days of amoxicillin generally had greater reductions in diversity compared to those who received 3 days, in contrast to those who received azithromycin.ConclusionsAs few as 3 days of treatment with the most commonly prescribed antibiotics can result in sustained reductions in microbiota diversity, which could have implications for the maintenance of human health and resilience to disease

Empirical treatment of bacterial keratitis: an international survey of corneal specialists.

Background/aimsNew antibiotic agents and changing susceptibility patterns may have changed the empirical treatment of bacterial keratitis. Our objective in this study was to survey cornea specialists' practice patterns in the initial treatment of bacterial ulcers.MethodsThis study consisted of a short online survey emailed to members of the Cornea Society listserv for an international sample of cornea specialists. Data collection began July 2014 and ended October 2014.ResultsA total of 1009 surveys were emailed, and we received 140 (14%) responses. The majority of US clinicians surveyed (n=83, 80%) chose fortified antibiotics empirically, with 55% (n=57) selecting fortified vancomycin and 16% (n=17) using fluoroquinolone alone. International respondents were twice as likely to use fluoroquinolone monotherapy (31%, n=11, p=0.07) and less likely to use fortified vancomycin (33%, n=12, p=0.03). Forty-five per cent (n=46) of US respondents reported that their initial antibiotic choice covered methicillin-resistant Staphylococcus aureus, compared with 22% (n=8) of international respondents (p<0.01). Overall, respondents who were concerned about availability of antibiotics and toxicity were 20.86 (p<0.001) and 7.48 (p<0.001) times more likely to choose fluoroquinolone monotherapy, respectively. If respondents' primary considerations were broad spectrum coverage or antibiotic resistance they had 7.10 (p<0.001) and 12.51 (p<0.001) times the odds of using fortified vancomycin, respectively.ConclusionPractice patterns for the initial treatment of bacterial keratitis vary with clinicians in the USA being more likely to use fortified antibiotics versus fluoroquinolone monotherapy and more concerned with resistant organisms than their international peers

Patterns of medication use and factors associated with antibiotic use among adult fever patients at Singapore primary care clinics.

BACKGROUND: Antimicrobial resistance is a public health problem of global importance. In Singapore, much focus has been given to antibiotic usage patterns in hospital settings. Data on antibiotic use in primary care is lacking. We describe antibiotic usage patterns and assess factors contributing to antibiotic usage among adults presenting with acute febrile illness (AFI) in primary care settings in Singapore. METHODS: We analyzed data from the Early Dengue infection and outcome study. Adults with AFI presenting at 5 Singapore polyclinics were included. We used multivariable logistic regression to assess demographic, clinical and laboratory factors associated with antibiotic usage among adults with AFI. RESULTS: Between December 2007 and February 2013, 1884 adult AFI patients were enrolled. Overall, 16% of adult AFI patients reported antibiotic use. We observed a rise in the use of over-the-counter medications in late 2009 and a decrease in antibiotic use during 2010, possibly related to the outbreak of pandemic influenza A H1N1 virus. After adjusting for age, gender, polyclinic and year of enrolment, the following factors were associated with higher odds of antibiotic use: living in landed property (compared to public housing) (OR = 1.73; 95% CI: 1.06-2.80); body mass index (BMI) <18.5 (OR = 1.87; 95% CI: 1.19-2.93); elevated white blood cell (WBC) count (OR = 1.98; 95% CI: 1.42-2.78); and persistence of initial symptoms at 2-3 days follow-up with OR (95% CI) for categories of 1, 2, 3, and ≥4 persisting symptoms being 2.00 (1.38-2.92), 2.67 (1.80-3.97), 4.26 (2.73-6.64), and 2.79 (1.84-4.24) respectively. CONCLUSIONS: Our study provides insights on antibiotic usage among adult patients presenting to primary care clinics with febrile illness, and suggests that high socio-economic status, and risk factors of a severe illness, that is, low BMI and persistence of initial symptoms, are associated with higher antibiotic use. Further work to understand trends of antibiotic usage in both private and public primary care clinics, and factors that influence patient expectation and physician prescribing of antibiotics is important

Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries

Background The 2017 WHO Model List of Essential Medicines for Children (EMLc) groups antibiotics as Access, Watch, or Reserve, based on recommendations of their use as first-choice and second-choice empirical treatment for the most common infections. This grouping provides an opportunity to review country-level antibiotic consumption and a potential for stewardship. Therefore, we aimed to review 2015 levels of oral antibiotic consumption by young children globally. Methods We analysed wholesale antibiotic sales in 70 middle-income and high-income countries in 2015. We identified oral antibiotic formulations appropriate for use in young children (defined as child-appropriate formulations [CAFs]) using wholesale data from the IQVIA-Multinational Integrated Data Analysis System database, and we estimated 2015 antibiotic consumption in reference to the 2017 WHO EMLc Access, Watch, Reserve (AWaRe) antibiotic groups. We used three metrics for assessment of intra-country patterns: access percentage, defined as the number of CAF standard units of Access antibiotics divided by the total number of CAF standard units; amoxicillin index, defined as the number of amoxicillin CAF standard units divided by the total number of CAF standard units; and access-to-watch index, defined as the ratio of Access-to-Watch CAF standard units. Findings The overall median volume of CAF antibiotic standard units sold in 2015 per country was 74·5 million (IQR 12·4–210·7 million). The median access percentage among the 70 countries was 76·3% (IQR 62·6–84·2). The amoxicillin index was low (median 30·7%, IQR 14·3–47·3). The median access-to-watch index was 6·0 (IQR 3·1–9·8). CAF antibiotic consumption patterns were highly variable between the 70 countries, without a clear difference between high-income and middle-income countries. Interpretation Antibiotics in the Access group have a key role in treating young children globally. A simple combination of metrics based on the AWaRe groups can be informative on individual countries' patterns of antibiotic consumption and stewardship opportunities. These metrics could support countries in the development of programmes to improve access to core Access antibiotics, particularly amoxicillin. Funding Global Antibiotic R&D Partnership (German Federal Ministry of Health, Médecins Sans Frontières, Netherlands Ministry of Health, Welfare and Sport, and UK Department for International Development)

Antibiotic susceptibility, heteroresistance, and updated treatment strategies in helicobacter pylori infection

In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in Helicobacter pylori (Hp) eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach) is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in Hp eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in Hp infection presented in the guidelines of the Toronto Consensus Group (2016) are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently approved in Japan, is also considered to be a promising solution for Hp eradication, even for clarithromycin-resistant strains. Furthermore, there is growing interest in finding new therapeutic strategies, such as the development of vaccines or the use of natural resources, including probiotics, plants, or nutraceuticals.In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in Helicobacter pylori (Hp) eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach) is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in Hp eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in Hp infection presented in the guidelines of the Toronto Consensus Group (2016) are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently approved in Japan, is also considered to be a promising solution for Hp eradication, even for clarithromycin-resistant strains. Furthermore, there is growing interest in finding new therapeutic strategies, such as the development of vaccines or the use of natural resources, including probiotics, plants, or nutraceuticals

Antibiotic prescribing patterns at a referral hospital in Kenya : a point prevalence survey

Background: Antibiotics are important in prevention and treatment of infections and the reduction in associated morbidity and mortality. Inappropriate use can lead to antimicrobial resistance, rendering them ineffective. Studies have shown variations in antibiotic prescribing patterns across different patient populations within the same hospital. Objectives: Our study aimed at establishing the prevalence and patterns of antibiotic use in a referral hospital in Kenya, with the aim of using the data for quality improvement. Methods: A point prevalence survey was conducted at a referral hospital in Kenya in April 2017. All patients who received antibiotics were recruited from all departments. Descriptive and inferential data analysis was done to establish the patterns of antibiotic use and the associations between variables. Ethical approval was obtained from the Kenyatta National Hospital/ University of Nairobi Research and Ethics Committee. Results: A hundred and seventy nine patients were enrolled in the study. The prevalence of antibiotic prescribing was 54.7%. The highest prevalence of antibiotic prescribing was found in critical care unit and isolation ward, both at 100%. Obstetrics and gynecology department had the least prevalence at 20.8%. Penicillins (46.9%) followed by cephalosporins (44.7%) were the most prescribed antibiotic classes. A larger proportion of antibiotic prescribing was for treatment (75.4%) as compared to prophylaxis (29.0%). Majority (76.9%, n=52) of the patients on surgical prophylaxis were on prolonged duration (>1 day). Empiric prescribing accounted for 82.6% of the total antibiotic encounters while targeted treatment was recorded in 17.4%. Conclusions: The study identified several areas for potential improvement in antibiotic prescribing such as the high prevalence of inpatient antibiotic use, prolonged duration of antibiotic use in surgical prophylaxis, extensive prescribing of broad spectrum agents such as ceftriaxone and the low prevalence of targeted antibiotic prescribing

Antibiotic Susceptibility of Salmonella, Shigella and Vibrio Isolated From Diarrhea Patients in Jakarta, Indonesia

Background: The rapid increase of antibiotic resistance among enteric pathogens in developing countries has become a great concern. In Indonesia, Salmonella, Shigella, and Vibro are still an important public health problem. Objectives: The purpose of this study was to determine the antibiotic resistance patterns of several diarrhea-causing enteric bacteria that are frequently found in Indonesia, particularly Salmonella, Shigella and Vibrio. Methods: A cross-sectional study was conducted , among 150 rectal swabs collected from patients with diarrhea, the enteric pathogens isolated comprised Shigella (11.4%), Salmonella (6.6%) and Vibrio(2.7%). Results: Antibiotic susceptibility test on Shigella species to several antibiotics such as ampicillin, chloramphenicol, tetracycline and, trimethoprim-sulfamethoxazole showed a considerably high resistance rate (25%-100%), whereas ceftriaxone, ciprofloxacin, norfloxacin and nalidixic acid were apparently still effective (resistance rate 0%). Non-typhoid Salmonella had similar resistance patterns as those of Shigella, particularly to ampicillin, tetracycline, chloramphenicol and trimethoprim- sulfamethoxazole However, for S. typhi it was found that all antibiotics were still effective. Vibrio was resistant to ampicillin (resistance rate 100%), whereas the other antibiotics were still effective. Conclusion: It may be concluded that for each of the enteric pathogens the antibiotic resistance pattern should be determined. Use of antibiotics should be based on the antibiotic susceptibility tests