Antibiotics and antibiotic resistance – analysis of awareness of students

Introduction: Antibiotics are some of the most precious achievements in medicine. Nowadays there is the danger of losing their activity due to the increase of antibiotic resistance (AR). In relation to November 18 – European Antibiotic Awareness Day, we at Medical College “Y. Philaretova” developed an educational poster, using materials of the British Society of Antimicrobial Chemotherapy. After introducing the poster, we conducted a questionnaire research among students in specialty “Medical Laboratory Technician”.Aim: The aim of the current work is to analyze the awareness of students about this problem.Materials and Methods: The questionnaire forms consisted of 11 questions of 3 to 5 multiple choice answers. They were spread for voluntary and anonymous filling out. Statistic processing by Excel and determining of relative share were applied in the analysis of results.Results: A total of 77 out of the 85 questionnaire forms were filled out, which marks an activity of 87.5%. Excellent answers were obtained for the questions concerning the causes and consequences of development of AR – relative share between 71% and 100%. Lower success rate - 43-95 %, showed the questions about mechanisms and epidemiology of AR. Unsatisfactory were the answers of the questions concerning the significance of antibiotics for the current achievements in medicine and in case of inability to limit AR – 11% and 56%, respectively.Conclusion: The students demonstrated relatively good level of knowledge about AR (apparently helped by the developed poster). Much more knowledge on antibiotics and AR is needed by future medical specialists, including for multidisciplinary training and improvement of the educational programs

Acinetobacter baumannii – a problematic microorganism with increasing antibiotic resistance

IntroductionIn the last years, the growing antibiotic resistance of Acinetobacter baumannii isolates has been registered all over the world, incl. in our country. This increases the cost of treatment, burdens health care facilities and staff, and - on an individual level - worsens the quality of life of patients, especially the risk of death. The aim of this study is to discuss up-to-date data on the problematic and increasing antibiotic resistance of Acinetobacter baumannii and their containment.Materials and MethodsInformation from the last five years is selected from scientific databases: CDC, ECDC, Elsevier, PubMed, Sciencedirect, BulSTAR, Medical Institute of Ministry of Internal Affairs.Results and DiscussionAccording to experts, emergence of carbapenem-resistant A. baumannii should be contained using complex measures: screening of risky patients, increased measures in infection control and antimicrobial stewardship. The COVID-19 pandemic over the past year has contributed to increase in resistance due to the heightened and in many cases irrational use of often broad-spectrum antibiotics. The need for laboratory testing of susceptibility/ resistance of carbapenem-resistant Acinetobacter baumannii hospital isolates to antimicrobials is frequently overlooked.ConclusionsStrict control of infections is needed to limit the increasing resistance of Acinetobacter baumannii, including through monitoring, and an early and accurate laboratory diagnosis. It is necessary to raise the level of awareness regarding antibiotic policy, both among medical professionals and among people in society as a whole, through information events and materials

ANTIMICROBIAL STEWARDSHIP - A STRATEGIC TASK IN INSTITUTIONAL AND NATIONAL HEALTHCARE

Purpose: Antimicrobial stewardship (AS) is a consensus multidisciplinary activity aimed at better care for patients and containment of Antimicrobial resistance (AR). The purpose of this article is to characterize AS process in Bulgaria at hospital and national level. Material/Methods: Analysis of national AS activities was performed. AS program of the Medical Institute – Ministry of the Interior (MI) – is presented as a model of hospital implementation. Results: In Bulgaria, the first National program for a rational antibiotic policy was developed in 2001, and National AR Surveillance system BulSTAR works since more than 15 years. Ministry of healthcare is the main regulator: hospital AS is mandatory and required for the process of hospital accreditations. At MI antibiotic policy program includes Guidelines for: - Empiric antibiotic therapy, - therapy by specialities, - Antibiotic prophylaxis in Surgery. According to the results of point prevalence survey Global PPS-2015, antibiotic use in MI was 24 %, quality indicators showed 100 % written reason for the use of antibiotics and tailoring to the microbiology result. Approaches in antimicrobials prescribing were similar to those of the other EU countries. However, the spectrum of the prescribed antibiotics was more limited and with higher usage of generic ceftriaxone. To improve the usage of antibiotics in Ambulatory care Guidelines were issued in 2016. It remains: to introduce National action plan for AS, with appropriate funding, staffing and control. Conclusions: AS activities in Bulgaria should be broaden, better controlled and supported as official Governmental policy

New Variant of CTX-M-Type Extended-Spectrum β-Lactamases, CTX-M-71, with a Gly238Cys Substitution in a Klebsiella pneumoniae Isolate from Bulgaria▿

A single Klebsiella pneumoniae strain isolated in a Bulgarian hospital was found to produce CTX-M-71, a new CTX-M variant characterized by one amino acid substitution from glycine to cysteine at position 238 in comparison to CTX-M-15. This exchange decreased the hydrolytic activity of the β-lactamase for cefotaxime, ceftazidime, and cefepime

Analysis of biofilm formation in nosocomial Stenotrophomonas maltophilia isolates collected in Bulgaria: An 11-year study (2011-2022)

The present study aimed to explore the genotypic and phenotypic characteristics of biofilm formation in Bulgarian nosocomial Stenotrophomonas maltophilia isolates (n 5 221) during the period 2011-2022, by screening for the presence of biofilm-associated genes (BAG) (spgM, rmlA and rpfF), their mutational variability, and assessment of the adherent growth on a polystyrene surface. The methodology included: PCR amplification, whole-genome sequencing (WGS) and crystal violet microtiter plate assay for biofilm quantification. The overall incidence of BAG was: spgM 98.6%, rmlA 86%, and rpfF 66.5%. The most prevalent genotype was spgM+/rmlA+/rpfF+ (56.1%), followed by spgM+/rmlA+/rpfF-(28.5%), and spgM+/rmlA-/rpfF+ (9.5%), with their significant predominance in lower respiratory tract isolates compared to those with other origin (P < 0.001). All strains examined were characterized as strong biofilm producers (OD550 from 0.224 +/- 0.049 to 2.065 +/- 0.023) with a single exception that showed a weak biofilm-forming ability (0.177 +/- 0.024). No significant differences were observed in the biofilm formation according to the isolation source, as well as among COVID-19 and non-COVID-19 isolates (1.256 +/- 0.028 vs. 1.348 +/- 0.128, respectively). Also, no correlation was found between the biofilm amounts and the corresponding genotypes. WGS showed that the rmlA accumulated a larger number of variants (0.0086 per base) compared to the other BAG, suggesting no critical role of its product to the biofilm formation. Additionally, two of the isolates were found to harbour class 1 integrons (7-kb and 2.6-kb sized, respectively) containing stil1 in their 3' conservative ends, which confers sulfonamide resistance. To the best of our knowledge, this is the first study on S. maltophilia biofilm formation in Bulgaria, which also identifies novel sequence types (ST819, ST820 and ST826). It demonstrates the complex nature of this adaptive mechanism in the multifactorial pathogenesis of biofilm-associated infections