Antibiotic sensitivities of urinary tract pathogenes in Maltese patients

A survey of over 1000 bacterial isolates from Maltese patients with urinary tract infection was performed in order to investigate resistance patterns to commonly used oral antibiotics. Resistance was detected in high frequency, particularly for ampicillin, trimethoprim and sulphonamides, in samples originating from both community and hospital. A population comparison to a similar survey conducted in the UK showed local resistance rates to be twice as high.peer-reviewe

Serological diagnosis of typhoid fever : a review of the limitations of the Widal test

Typhoid fever remains an infectious disease of major importance worldwide. Even in developed countries, sporadic outbreaks continue to occur, often localised around a single origin -an asymptomatic carrier or an infected food source particularly shellfish. The severity of presentation, potential life-threatening complications as well as the serious side-effects of the antibiotics used in its treatment necessitates prompt and accurate diagnosis. The only definite diagnostic investigation remains the isolation of Salmonella typhi from samples of blood, bone marrow, faeces, bile and urine. Nevertheless serological tests are still commonly requested in the form of the Widal reaction.peer-reviewe

Addressing the challenge of antibiotic resistance in Maltese healthcare settings

Antimicrobial resistance results in substantial adverse outcomes and negatively impacts mortality, morbidity and economic expenditure. This review focuses on the costs of antibiotic resistance to both patient as well as health-care settings and highlights interventions proven to be effective in curtailing its continued escalation. These concentrate predominantly on initiatives to improve antibiotic prescribing as well as prevent the spread of multi-resistant organisms, amongst which hand hygiene is of paramount importance. With the prevalence of resistance in Malta, amongst the highest in Europe, such interventions need acceptance and implementation by all stakeholders if the current alarming situation is to be controlled and possibly improved.peer-reviewe

Consumption of antibiotics at St Luke’s Hospital : a critical factor behind the local prevalence of antimicrobial resistance?

The intensity of antibiotic use in hospital settings is recognised as possibly the most important factor for the selection of antimicrobial resistance. Hospitals are therefore being encouraged to undertake surveillance and benchmarking of antimicrobial consumption patterns with a view to identify and rectify possible evidence of overuse or misuse. Use of antibiotics at St. Luke's Hospital, Malta (SLH) was assessed retrospectively for the year 2001 as part of participation in two pan-European antibiotic surveillance networks. Total antibiotic use during the study period averaged 147 Defined Daily Doses (DDD) /100 bed days with the three most common antibiotic groups prescribed being the penicillins, cephalosporins and macrolides. Combinations of penicillin with beta-lactamase inhibitor were the predominant antimicrobials in use and their consumption was twice the median for other participating hospitals in the European ARPAC network. Differences were additionally seen for second generation cephalosporins and macrolides, where consumption was also significantly higher at SLH. These findings would explain one possible factor behind the high prevalence of resistance, particularly in Staphylococcus aureus, at SLH and suggest the need to intensify efforts for improved antibiotic stewardship programmes in hospital prescribing.peer-reviewedpeer-reviewe

Consumption of antibiotics within ambulatory care in Malta

Background: Antibiotic use is recognised as the most important driver for the development of antimicrobial resistance in community pathogens. Surveillance is therefore critical for improvement programmes. Methods: Antimicrobial distribution data for the years 2007 to 2009 were collected retrospectively by the National Antibiotic Committee from all licensed wholesale distributors (WSL) in Malta and analysed according the World Health Organization Anatomical Therapeutic Chemical classification (ATC) level 4 criteria. Results: Overall consumption increased from 18.6 defined-daily-doses/1000-inhabitant-days (DID) in 2007 to 22.7 DID in 2008 and reached 24.4 DID in 2009 - an increase of more than 30% over the three years, Penicillins with beta-lactamase inhibitor increased in volume (7.1 to 8.8 DID) but decreased in proportion (38.4% to 36.0%) between 2007 and 2009. On the other hand, second generation cephalosporins increased in both volume and proportion (2.8 to 5.4 DID; 15.0% to 22.0%). The proportion for macrolides remained stable at approximately 16% but the volume of use again increased (2.9 DID to 3.9 DID). Fluoroquinolone proportion decreased from 9.1% to 6.8%, maintaining a stable volume of use in the region of 1.7 DID. Conclusions: Antibiotic consumption in Malta has shown a consistent increasing trend over the past three years, despite a reduction in over-the-counter acquisition. Furthermore, there is evidence of a strong, and possibly unjustified, prescription of wide spectrum antibacterials. This is potentially an important driver for documented resistance in Streptococcus pneumoniae and Escherichia coli and needs to be addressed at a national level.peer-reviewe

Broad-spectrum antibiotic use in Europe : more evidence of cultural influences on prescribing behaviour

Objectives: Sociocultural factors have been hypothesized as important drivers of inappropriate antibiotic prescribing in European ambulatory care. This study sought to assess whether they can also explain the reported variation in broad-spectrum antibiotic (Br-Ab) use among EU/European Economic Area (EEA) countries. Methods: Correlation and regression analysis were performed, using the bootstrap method, between Br-Ab ratios reported from 28 EU countries by the ECDC, and national Hofstede cultural dimensions and control of corruption (CoC) scores. Results: Significant bootstrapping correlation coefficients were identified between Br-Ab ratios and the dimension of uncertainty avoidance (UAI) as well as CoC. However, following both bootstrapping multiple regression and generalized linear modelling, only UAI was retained as the sole predictor. A logarithmic model explained 58.6% of the variation in European Br-Ab variability solely using national UAI scores (P,0.001). Conclusions: Br-Ab prescribing appears to be driven by the level of UAI within the country. Any interventions aimed at reducing Br-Ab in high-consuming EU/EEA countries need to address this cultural perception to maxi-mize their chances of success.peer-reviewe

Antibiotic susceptibility patterns of local strains of Pseudomonas aeruginos

The resistance patterns of 100 local strains of Ps. aeruginosa were investigated using two different methods: (1) Broth Dilution and (2) ε-test. From the seven antibiotics tested, Ps. aeruginosa showed a 100% sensitivity to imipenem (n=30). Among the first-line agents, azlocillin, ceftazidime, and gentamicin showed the highest sensitivity rates, 87%, 93% and 92% respectively. Aztreonam and ciprofloxacin showed the presence of intermediately sensitive strains, with 61% of the isolates tested being fully sensitive to each antibiotic. Only 47% of the strains were found to be sensitive to ceftriaxone. The results obtained were similar to studies carried out abroad.peer-reviewe

Seroprevalence of Hepatitis A in Maltese adults

The objective of this study was to determine the seroprevalence of hepatitis A virus (HAV) within the adult population of Malta. Serum from blood coincidentally taken for non-acute investigations in patients aged 20 - 85 visiting St. Luke’s Hospital over a three month period in 1996 (n = 320) was retrieved and tested for anti-HAV antibodies by Enzyme Immunoassay. The results obtained from these tests showed seroprevalence levels of anti-HAV antibody. Maltese adults fall into a pattern normally associated with low to intermediate prevalence countries.peer-reviewe

A new tool for improved ambulatory care antibiotic stewardship : National Antibiotic Committee prescribing guidelines

There is clear evidence that antimicrobial resistance in local community bacterial strains is increasing with significant patient safety as well as health economic repercussions. This is particularly relevant for Staphylococcus aureus and E. coli. At the same time, surveillance of antibiotic consumption has identified a high level of ambulatory care use compared to other European countries, of which, a considerable proportion seem to be prescribed for tenuous indications. It is therefore critical to improve antibiotic stewardship in community prescribing and dispensing to address this situation. For this reason, the National Antibiotic Committee has just made available, on its website, the first set of National Antibiotic Guidelines for Ambulatory Care Prescribing - formulated on a stringent evidence base and local antimicrobial susceptibility epidemiology.peer-reviewe

Community acquired MRSA infections : a new challenge

Resistance to methicillin (the first beta-lactamase stable penicillin and precursor to flu/cloxacillin) was first seen amongst hospital isolates of Staphylococcus aureus (S. aureus) in the early sixties. Since then methicillin-resistant S. aureus (MRSA) has become widespread in hospitals and particularly intensive care units around the world . In addition, resistance to methicillin has extended to other antimicrobial groups including macrolides, quinolones and aminoglycosides such that the term MRSA is also often used as an abbreviation for multiplyresistant S. aureus. MRSA is now one of the most common causes of bacterial hospital infections, accounting for 40 - 70% of the S. aureus infections in intensive care units. This is particularly the case in the local setting where prevalence of MRSA is amongst the highest in Europepeer-reviewe