BackgroundInfectious diseases are one of the most frequent reasons for consultation in the Emergency Department (ED), as well as one of the main causes of mortality and admission in the hospital. ...According to recent studies, antimicrobials are the second most common type of medication prescribed in the ED, so it is important to optimise their use.PurposeTo describe and to analyse the prescription of antimicrobials prescribed empirically in the ED of a third-level hospital and to analyse if microbiological samples are collected in order to establish a targeted treatment.Material and methodsCross-sectional study of all antimicrobial prescriptions of patients waiting in the ED for admission to hospital from February 2018 to March 2018.The following variables were collected: age, sex, type of infection and microbiological samples (yes/no). It was analysed if the patient after admission maintained the same empirical antimicrobial treatment and if it was correct according to the microbial sensibility data from the sample studied. Data were collected from electronic health records and electronic prescription systems.ResultsNinety-three patients were included, 68 male and 25 female (mean 70 years, SD 13.5 years). The main clinical infections treated were: non-pneumonic lower respiratory tract (41%), urinary tract (18%) intrabdominal (12%), pneumonia (7.5%), chronic obstructive pulmonary disease exacerbation (7.5%) and other type of infections (14%).After admission, 34% of the patients maintained empirical antimicrobial treatment, 51% treatments were changed to another antimicrobial agent and 15% of patients were discharged from the hospital.Microbiological samples were collected before treatment in 48% of patients. According to the laboratory sample results, the empirical antimicrobial was correct in 63% of patients.ConclusionLess than 50% of patient samples were collected before treatment and more than 35% of the empirically prescribed treatments were inadequate according to the laboratory sample results.In order to prescribe suitable antimicrobial treatments, it is important to take microbiological samples in advance to establish a targeted treatment that could be optimised by developing a multidisciplinary group (program for optimising the use of antimicrobials (PROA)) in the ED.References and/or acknowledgementsNo conflict of interest.
BackgroundThe correct use of antimicrobial treatment is necessary to ensure their effectiveness, the control of resistance and to avoid the occurrence of adverse reactions.PurposeTo analyse the ...pharmaceutical interventions (PI) in antimicrobial treatment and quantify the degree of their acceptance.Material and methodsDescriptive and retrospective study in a 150 bed-hospital was made. PI on antimicrobial treatments were analysed over a period of 16 months (December 2016 – March 2018). The collected data were: age, antimicrobial treatment, type of PI and degree of acceptance of the PI. The reasons for PI were classified into: inadequate dosage, dose adjustment due to renal insufficiency, drug change after antibiogram, therapeutic duplicity, suspension of treatment due to inadequate duration and change of route of administration. The degree of acceptance of the PI was detected based on the medical prescription modifications according to the recommendations. The pharmaceutical recommendations were made through the daily evolutions in the patient’s history in the Ticares computer program.ResultsTwo-hundred and forty-four PI were carried out in 132 patients (1.84 PI per patient). The average age of the patients was 79 years (53% women). The PI, according to classification were: 160 (65.6%) PI due to changes in the antimicrobial administration route (92 were accepted, 57.5%); 70 (28.7%) PI due to suspension of treatment due to inadequate duration (44 were accepted, 62.90%); seven (2.9%) PI for dose adjustment due to renal failure (three were accepted, 42.9%); three (1.2%) PI due to therapeutic duplicity (100% accepted); three (1.2%) PI due to inadequate posology (two were accepted, 66.7%); and one (0.4%) PI due to antimicrobial change after antibiogram (the patient was discharged and it could not be confirmed if there was a change in the prescription). Regarding the degree of acceptance, 144 (59%) IP were accepted and 60 (37,29%) IP were not accepted.ConclusionMore than half of the pharmaceutical interventions resulted in a change in the medical prescription according to the recommendation. The pharmaceutical validation adds safety to the hospitalisation process and represents an improvement in the quality of care.References and/or acknowledgementsNo conflict of interest.
Zinc oxide nanoparticles (ZnO NPs) are one of the most widely used nanoparticulate materials due to their antimicrobial properties, but their main mechanism of action (MOA) has not been fully ...elucidated. This study characterized ZnO NPs by using X-ray diffraction, FT-IR spectroscopy and scanning electron microscopy. Antimicrobial activity of ZnO NPs against the clinically relevant bacteria Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and the Gram-positive model Bacillus subtilis was evaluated by performing resazurin microtiter assay (REMA) after exposure to the ZnO NPs at concentrations ranging from 0.2 to 1.4 mM. Sensitivity was observed at 0.6 mM for the Gram-negative and 1.0 mM for the Gram-positive cells. Fluorescence microscopy was used to examine the interference of ZnO NPs on the membrane and the cell division apparatus of B. subtilis (amy::pspac-ftsZ-gfpmut1) expressing FtsZ-GFP. The results showed that ZnO NPs did not interfere with the assembly of the divisional Z-ring. However, 70% of the cells exhibited damage in the cytoplasmic membrane after 15 min of exposure to the ZnO NPs. Electrostatic forces, production of Zn
ions and the generation of reactive oxygen species were described as possible pathways of the bactericidal action of ZnO. Therefore, understanding the bactericidal MOA of ZnO NPs can potentially help in the construction of predictive models to fight bacterial resistance.
Summary Background Unnecessary antibiotic prescribing contributes to antimicrobial resistance. In this trial, we aimed to reduce unnecessary prescriptions of antibiotics by general practitioners ...(GPs) in England. Methods In this randomised, 2 × 2 factorial trial, publicly available databases were used to identify GP practices whose prescribing rate for antibiotics was in the top 20% for their National Health Service (NHS) Local Area Team. Eligible practices were randomly assigned (1:1) into two groups by computer-generated allocation sequence, stratified by NHS Local Area Team. Participants, but not investigators, were blinded to group assignment. On Sept 29, 2014, every GP in the feedback intervention group was sent a letter from England's Chief Medical Officer and a leaflet on antibiotics for use with patients. The letter stated that the practice was prescribing antibiotics at a higher rate than 80% of practices in its NHS Local Area Team. GPs in the control group received no communication. The sample was re-randomised into two groups, and in December, 2014, GP practices were either sent patient-focused information that promoted reduced use of antibiotics or received no communication. The primary outcome measure was the rate of antibiotic items dispensed per 1000 weighted population, controlling for past prescribing. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN32349954, and has been completed. Findings Between Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio IRR 0·967 95% CI 0·957–0·977; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 95% CI 133·77–136·22 in the patient-focused intervention group and 133·98 133·06–134·90 in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105). Interpretation Social norm feedback from a high-profile messenger can substantially reduce antibiotic prescribing at low cost and at national scale; this outcome makes it a worthwhile addition to antimicrobial stewardship programmes. Funding Public Health England.
One major concern associated with food safety is related to residual effects of antibiotics that are widely used to treat animals and result in antimicrobial resistance. Among different groups of ...antibiotic, the use of quinolones in livestock is of major concern due to the significance of these antimicrobial drugs for the treatment of a range of infectious diseases in humans. Therefore, it is desirable to develop reliable methods for the rapid, sensitive, and on-site detection of quinolone residue levels in animal-derived foods to ensure food safety. Sensors and biosensors are promising future platforms for rapid and on-site monitoring of antibiotic residues. In this review, we focus on recent advancements and modern approaches in quinolone sensors and biosensors.
Detection of quinolone residues in animal-derived foods is vital to ensure public health and avoid antimicrobial resistance.
Electrochemical and optical sensors and biosensors are powerful analytical tools for real-time analysis of various samples.
Immunochromatographic strip-based optical assays are useful for the rapid and on-site detection of quinolones.
Electrochemical sensors with high sensitivity and selectivity have the potential for miniaturization and fabrication of portable devices, which are preferred in diagnostic fields, such as food quality control.
Integration of nanomaterials in sensors and biosensors results in assays with higher sensitivity and rapid response.
Unnecessary and inappropriate use of antibiotics in human healthcare is a major driver for the development and spread of antimicrobial resistance; many countries are implementing measures to limit ...the overuse and misuse of antibiotics e.g. through the establishment of antimicrobial use reduction targets. We performed a review of antimicrobial use reduction goals in human medicine in Transatlantic Taskforce on Antimicrobial Resistance partner countries. On 31 March 2017, the European Centre for Disease Prevention and Control sent a questionnaire to National Focal Points for Antimicrobial Consumption and the National Focal Points for Antimicrobial Resistance in 28 European Union countries, Iceland and Norway. The same questionnaire was sent to the TATFAR implementers in Canada and the United States. Thirty of 32 countries replied. Only nine countries indicated that they have established targets to reduce antimicrobial use in humans. Twenty-one countries replied that no target had been established. However, 17 of these 21 countries indicated that work to establish such targets is currently underway, often in the context of developing a national action plan against antimicrobial resistance. The reported targets varied greatly between countries and can be a useful resource for countries willing to engage in the reduction of antibiotic use in humans.
Display omitted
The control of bacterial infections is of particular importance in the field of tissue engineering. Recently, much attention has been addressed toward the use of mesoporous bioactive ...glasses (MBGs) for antibacterial strategies, primarily because of their capability of acting as carriers for the local release of antimicrobial agents. The incorporation of antibacterial metallic ions including silver (Ag+), zinc (Zn2+), copper (Cu+ and Cu2+), cerium (Ce3+ and Ce4+), and gallium (Ga3+) cations into the MBG structure and their controlled release is proposed as one of the most attractive strategies for inhibiting bacterial growth and reproduction. Moreover, the possibility of loading and delivering various antibacterial biomolecules (e.g., antibiotics) through the porous structure of MBGs makes them as ideal candidates for antibacterial applications. In this review, we aim to present a comprehensive evaluation of MBG potential regarding antibacterial activities. For this purpose, different types of antibacterial ion-doped and drug-loaded MBGs are introduced and discussed in the light of existing knowledge, along with the significant challenges ahead.
Prevention and treatment of infections is one of the today’s greatest challenges in medical sciences, also considering the well-known issues related to increased bacterial resistance to antibiotics. The advent of mesoporous glasses led to the birth of a new class of multifunctional biomaterials acting as bioactive platforms for the local release of organic or inorganic agents eliciting an antimicrobial effect. This reviews summarizes the state of the art of MBGs in this field, highlighting the latest evolutions and the specific role played by metallic antimicrobial ions that can be incorporated in the glass composition and then properly released. Perspective for tissue engineering applications are also discussed to provide an up-to-date contribution that is useful to both experienced scientists and early-stage researchers.
Pharmaceutical and personal care products (PPCPs) are considered as emerging contaminants (ECs) in the environment due to their known or suspected adverse ecological effects and human health risks. ...Wastewater, compost, and manure application release PPCPs into the agricultural soil systems. Since the plants can take up such ECs, they are considered as a primary window of human exposure to the PPCPs via the route of consumption of contaminated plants. This may lead to deleterious human health effects. However, as PPCPs are of various kinds, differential uptake and bioaccumulation in the plant have recently received research interest. Therefore, the present article reviewed the occurrence of PPCPs as antibiotics, anti-inflammatory drugs, hormones, cytostatic drugs, contrast media, β-blockers, blood lipid regulators, antiepileptic drugs, antimicrobials, ultra-violet filters, preservatives, insect repellents, and synthetic musks in the environment by assembling the literature. Moreover, plant uptake and translocation under the realistic and greenhouse condition, and the factors influencing the uptake and translocation through the plants are explicitly demonstrated in this review. Also, the human risk connected with the consumption of the contaminated plants and the research gap areas were investigated with future perspectives.
Mast cells (MCs), which are granulated tissue-resident cells of hematopoietic lineage, contribute to vascular homeostasis, innate/adaptive immunity, and wound healing. However, MCs are best known for ...their roles in allergic and inflammatory diseases, such as anaphylaxis, food allergy, rhinitis, itch, urticaria, atopic dermatitis, and asthma. In addition to the high-affinity IgE receptor (FcεRI), MCs express numerous G protein–coupled receptors (GPCRs), which are the largest group of membrane receptor proteins and the most common targets of drug therapy. Antimicrobial host defense peptides, neuropeptides, major basic protein, eosinophil peroxidase, and many US Food and Drug Administration–approved peptidergic drugs activate human MCs through a novel GPCR known as Mas-related G protein–coupled receptor X2 (MRGPRX2; formerly known as MrgX2). Unique features of MRGPRX2 that distinguish it from other GPCRs include their presence both on the plasma membrane and intracellular sites and their selective expression in MCs. In this article we review the possible roles of MRGPRX2 on host defense, drug-induced anaphylactoid reactions, neurogenic inflammation, pain, itch, and chronic inflammatory diseases, such as urticaria and asthma. We propose that host defense peptides that kill microbes directly and activate MCs through MRGPRX2 could serve as novel GPCR targets to modulate host defense against microbial infection. Furthermore, mAbs or small-molecule inhibitors of MRGPRX2 could be developed for the treatment of MC-dependent allergic and inflammatory disorders.
PDF
