Antibiotic utilization patterns for different wound types among surgical patients : findings and implications

Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post operatively. However, there are concerns with the extent of extend prophylaxis post-operatively especially among low- and middle-income countries (LMICs). This increases antimicrobial re-sistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study among 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. Identi-fied varables included post-op prophylactic antimicrobials given to all patients in all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures and among these, the use of third generation cephalosporins was common. The duration of post-operative prophylaxis was 3-4 days, appreciably longer than guideline suggestions, with most patients prescribed antimicrobials up to discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration post-operatively need to be addressed. This includes appropriate interventions, including antimicrobial stewardship pro-grams, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and reduce AM

Point prevalence survey of antimicrobial use during the COVID-19 pandemic among different hospitals in Pakistan : findings and implications

The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis

Using culture sensitivity reports to optimize antimicrobial therapy : findings and implications of antimicrobial stewardship activity in a hospital in Pakistan

Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. Objective: Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. Methods: A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient’s medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization’s Defined Daily Dose methodology. Results: A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus) (125) (25.1%) and the most common Gram-negative pathogen was Escherichia coli (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the Acinetobacter baumannii isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. Conclusions: Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics

γ Aminobutyric Acid (GABA): A Key Player in Alleviating Abiotic Stress Resistance in Horticultural Crops: Current Insights and Future Directions

Gamma-aminobutyric acid (GABA) is a non-protein amino acid known for its role in the nervous system of animals. However, research has also revealed its presence and function in plants recently. In plants, GABA is a signal molecule involved in multiple physiological processes, including stress response, growth, and development. This review aims to present a thorough summary of the current knowledge regarding the role of GABA in plants. We begin by discussing the biosynthesis and transport of GABA in plants, followed by a detailed examination of its signaling mechanisms. Additionally, we explore GABA's potential roles in various plant physiological processes, such as abiotic stress response, and its potential application in horticultural plants. Finally, we highlight current challenges and future directions for research in this area. Overall, this review offers a comprehensive understanding of the significance of GABA in plants and its potential implications for plant physiology and crop improvement

Impact of positive culture reports of E. coli or MSSA on de-escalation of antibiotic use in a teaching hospital in Pakistan and the implications

BACKGROUND: Antibiotic de-escalation is a key element of antimicrobial stewardship programs to restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of E. coli or Methicillin sensitive Staphylococcus aureus (MSSA) on de-escalation of antibiotic therapy. METHOD: This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from the patient medical files which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed by using SPSS. RESULTS: Of 256 isolated microbes, 138 (53.9%) were MSSA and 118 were E. coli (46.1%). MSSA showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). Whereas E. coli showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for E. coli were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For MSSA cases, the was linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of E.coli and 43% reduction in MSSA cases. CONCLUSION: Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns with preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment