1
|
Hilal MG, Han B, Yu Q, Feng T, Su W, Li X, Li H. Insight into the dynamics of drinking water resistome in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 322:121185. [PMID: 36736566 DOI: 10.1016/j.envpol.2023.121185] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/12/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Antibiotic resistance (AR) is a serious environmental hazard of the current age. Antibiotic resistance genes (ARGs) are the fundamental entities that spread AR in the environment. ARGs are likely to be transferred from the non-pathogenic to pathogenic microbes that might ultimately be responsible for the AR in humans and other organisms. Drinking water (DW) is the primary interaction route between ARGs and humans. Being the highest producer and consumer of antibiotics China poses a potential threat to developing superbugs and ARGs dissemination. Herein, we comprehensively seek to review the ARGs from dominant DW sources in China. Furthermore, the origin and influencing factors of the ARGs to the DW in China have been evaluated. Commonly used methods, both classical and modern, are being compiled. In addition, the risk posed and mitigation strategies of DW ARGs in China have been outlined. Overall, we believe this review would contribute to the assessment of ARGs in DW of China and their dissemination to humans and other animals and ultimately help the policymakers and scientists in the field to counteract this problem on an emergency basis.
Collapse
Affiliation(s)
- Mian Gul Hilal
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, China; MOE, Key Laboratory of Cell Activities and Stress Adaptations, School of Life Science, Lanzhou University, Lanzhou, 730000, Gansu, PR China
| | - Binghua Han
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Qiaoling Yu
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Tianshu Feng
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Wanghong Su
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Xiangkai Li
- MOE, Key Laboratory of Cell Activities and Stress Adaptations, School of Life Science, Lanzhou University, Lanzhou, 730000, Gansu, PR China
| | - Huan Li
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, China.
| |
Collapse
|
2
|
Muacevic A, Adler JR. Antibiotic Antibiogram in Patients With Complicated Urinary Tract Infections in Nephrology Unit of South Waziristan. Cureus 2022; 14:e29803. [PMID: 36337803 PMCID: PMC9619388 DOI: 10.7759/cureus.29803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To evaluate the antibiotic antibiogram in patients with complicated urinary tract infections (cUTIs) presenting to a Nephrology unit of South Waziristan. Methods A cross-sectional study was conducted at the Department of Nephrology, Sholam, South Waziristan. The study included all patients who presented with cUTIs and the symptoms included urinary urgency, hematuria, dysuria, suprapubic discomfort, and increased frequency. Those patients with clinical manifestations but are on antibiotics within the past five days were excluded. Results A total of 158 patients were included in the study with 113 (71.5%) females and 45 (28.5%) males. A total of 95 (60%) cases had gram-negative microbes, 47 (30%) had gram-positive cocci, and 16 (10%) had candida infection. In our study, the highly prevalent uropathogenic gram-positive bacteria showed the highest sensitivity to Linezolid, Rifampicin, and Vancomycin. Methicillin-resistant staph aureus was detected in 25% of isolates. All isolates of candida were sensitive to fluconazole. Gram-negative bacteria were highly resistant to ceftazidime, cefepime, ceftriaxone, and ciprofloxacin. Conclusion The development of bacterial resistance against multiple antibiotics is a global crisis that restricts the drug of choice for the treatment of cUTIs. In our study, we showed that overall, E.coli (gram negative) and S. Aureus (gram-positive) showed variable resistance to many antibiotics including ceftazidime, cefepime, piperacillin-tazobactam, ceftriaxone, and clindamycin.
Collapse
|
3
|
Zhang S, Wen J, Wang Y, Wang M, Jia R, Chen S, Liu M, Zhu D, Zhao X, Wu Y, Yang Q, Huang J, Ou X, Mao S, Gao Q, Sun D, Tian B, Cheng A. Dissemination and prevalence of plasmid-mediated high-level tigecycline resistance gene tet (X4). Front Microbiol 2022; 13:969769. [PMID: 36246244 PMCID: PMC9557194 DOI: 10.3389/fmicb.2022.969769] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Abstract
With the large-scale use of antibiotics, antibiotic resistant bacteria (ARB) continue to rise, and antibiotic resistance genes (ARGs) are regarded as emerging environmental pollutants. The new tetracycline-class antibiotic, tigecycline is the last resort for treating multidrug-resistant (MDR) bacteria. Plasmid-mediated horizontal transfer enables the sharing of genetic information among different bacteria. The tigecycline resistance gene tet(X) threatens the efficacy of tigecycline, and the adjacent ISCR2 or IS26 are often detected upstream and downstream of the tet(X) gene, which may play a crucial driving role in the transmission of the tet(X) gene. Since the first discovery of the plasmid-mediated high-level tigecycline resistance gene tet(X4) in China in 2019, the tet(X) genes, especially tet(X4), have been reported within various reservoirs worldwide, such as ducks, geese, migratory birds, chickens, pigs, cattle, aquatic animals, agricultural field, meat, and humans. Further, our current researches also mentioned viruses as novel environmental reservoirs of antibiotic resistance, which will probably become a focus of studying the transmission of ARGs. Overall, this article mainly aims to discuss the current status of plasmid-mediated transmission of different tet(X) genes, in particular tet(X4), as environmental pollutants, which will risk to public health for the "One Health" concept.
Collapse
Affiliation(s)
- Shaqiu Zhang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Jinfeng Wen
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Yuwei Wang
- Mianyang Academy of Agricultural Sciences, Mianyang, China
| | - Mingshu Wang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Renyong Jia
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Shun Chen
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Mafeng Liu
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Dekang Zhu
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Xinxin Zhao
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Ying Wu
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Qiao Yang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Juan Huang
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Xumin Ou
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Sai Mao
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Qun Gao
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Di Sun
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Bin Tian
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| | - Anchun Cheng
- Avian Disease Research Center, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Institute of Preventive Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Sichuan Agricultural University, Chengdu, China
| |
Collapse
|
4
|
Li F, Huang K, Chang H, Liang Y, Zhao J, Yang S, Liu F. A Polydopamine Coated Nanoscale FeS Theranostic Platform for the Elimination of Drug-resistant Bacteria via Photothermal-enhanced Fenton Reaction. Acta Biomater 2022; 150:380-390. [DOI: 10.1016/j.actbio.2022.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 12/12/2022]
|
5
|
Zhang P, He Q, Song D, Wang Y, Liu X, Ding G, Xing W. Association of Helicobacter pylori Infection With Carotid Atherosclerosis in a Northern Chinese Population: A Cross-Sectional Study. Front Cardiovasc Med 2022; 8:795795. [PMID: 35174222 PMCID: PMC8841728 DOI: 10.3389/fcvm.2021.795795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Numerous studies have shown that Helicobacter pylori (HP) infection may be involved in the development of carotid atherosclerosis (CAS), but this conclusion is still controversial. The aim of this study was to explore whether there is a positive association between HP infection and CAS occurrence. We collected data on demographic characteristics, lifestyle, and disease history of the participants by questionnaire. We obtained clinical anthropometric data and blood samples of the participants from clinical examinations and laboratory work. The 13C urea breath test (13C-UBT) was performed to assess the HP infection status, and carotid ultrasonography was used to diagnose the CAS and plaque types. Univariate analysis and multivariate logistic regression were used to identify the relationship between HP infection and CAS. A total of 1,424 participants were recruited for this study. A total of 740 HP-positive individuals and 684 HP-negative individuals were identified, and 345 participants were diagnosed with CAS. The prevalence of CAS was higher in the HP-positive group (26.4%) than in the HP-negative group (21.7%) (P < 0.05). A significantly higher prevalence of carotid intima-media thickening, carotid plaque, and carotid stenosis was identified in the HP-positive group than in the HP-negative group (P < 0.05). There was no significant difference in the detection rate of unstable plaques between the HP-positive and HP-negative groups (P > 0.05). In multivariate models adjusted for covariates, HP infection showed a positive association with CAS, independent of other risk factors (ORs range: 1.283–1.333, P < 0.05). HP infection independently accounted for approximately 5% of the CAS risk in the absence of other cardiovascular risk factors. A positive association between HP infection and CAS was demonstrated in this study. HP infection might be an independent risk factor for CAS. Although the effect of HP infection on CAS observed in our study was less than that of traditional risk factors, we believe that this is an indispensable advance in the etiological study of CAS. These results imply that the microbial population might play an essential role in CAS, which provides a new perspective for the primary prevention of CAS.
Collapse
|
6
|
Yin J, Li H, Sun Q. Analysis of Antibiotic Consumption by AWaRe Classification in Shandong Province, China, 2012-2019: A Panel Data Analysis. Front Pharmacol 2021; 12:790817. [PMID: 34880766 PMCID: PMC8645977 DOI: 10.3389/fphar.2021.790817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: This study aims to examine the changes in trends and patterns of clinical consumption of antibiotics in Shandong, China based on Access, Watch, and Reserve (AWaRe) Classification after 10-years national antibiotic stewardship. Methods: Antibiotic consumption data of all health care institutions for the period of 2012-2019 were obtained from the Drug Centralized Bidding Procurement System of Shandong. Shandong is a province that has the second-largest population in China. Five of the 16 cities in Shandong were high-income areas (HIAs) and the other 11 cities were grouped into upper-middle-income areas (UMIAs). The main outcome measures were the antibiotic consumption rates (DDD per 1,000 inhabitants per day, DID) and the proportions of different groups of antibiotics. Results: The overall antibiotic consumption rate increased from 12.859-15.802 DID between 2012 and 2014, then continuously decreased to 9.771 DID in 2019. The consumption rate of access, watch, and reserve antibiotics have reduced since 2014 with a compound annual growth rate of -10.1, -9.0, and -8.1%, respectively. During 2012-2019, the access group proportion reduced from 50.0 to 44.9%, while the proportion of the watch group increased from 42 to 45.2%. The antibiotic consumption rate increased from 2012 to 2019 (from 7.38 to 9.12 DID) in the HIAs but sharply decreased in the UMIAs from 2014 to 2019 (from 17.94 to 10.05 DID). The watch antibiotics had the highest proportion of consumption in the HIAs (55.3% in 2019), while the access group had the highest proportion of consumption in the UMIA (49.5% in 2019). Conclusion: The antibiotic stewardship policies launched in the last 10 years have contributed to reducing the clinical antibiotic consumption in Shandong. These policies have different effects on areas with different economic levels. The pattern of antibiotic consumption is still inappropriate in China as the watch group of antibiotics was consumed the most.
Collapse
Affiliation(s)
- Jia Yin
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Hongyu Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Qiang Sun
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| |
Collapse
|
7
|
Lin Y, Liu X, Liu Z, Xu Y. Visible-Light-Driven Photocatalysis-Enhanced Nanozyme of TiO 2 Nanotubes@MoS 2 Nanoflowers for Efficient Wound Healing Infected with Multidrug-Resistant Bacteria. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2103348. [PMID: 34418285 DOI: 10.1002/smll.202103348] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Indexed: 06/13/2023]
Abstract
To enhance the catalytic activity of the nanozymes for efficient wound healing infected with multidrug-resistant bacteria, photo-based motivations have been suggested, but attention is mainly focused on the external stimulus of near-infrared light, while the inexhaustible visible one is promising but lack of study. Herein, an efficient visible light-stimulated peroxidase-like nanozyme system, TiO2 nanotubes coated with MoS2 nanoflowers (TiO2 NTs@MoS2 ), is discovered for efficient bacterial treatment. Based on the synergetic effects between the two components, the bandgap of the TiO2 NTs can be narrowed from 3.2 to 2.97 eV due to the MoS2 loading, which extended the light response of TiO2 to visible-light range and enhanced the photocatalytic activity accordingly. Meanwhile, the peroxidase-like activity of MoS2 can be significantly enhanced due to the combination with TiO2 NTs in return. Especially, the peroxidase-like activity of the TiO2 NTs@MoS2 nanocomposite can be further improved under the sunlight irradiation, rendering much more hydroxyl radical (•OH) generation. Accordingly, the as-obtained TiO2 NTs@MoS2 shows an outstanding antibacterial effect against drug-resistance extended spectrum β-lactamases producing Escherichia coli and methicillin-resistant Staphylococcus aureus under the visible light. In vivo wound healing test further confirms the high antimicrobial efficiency and good biocompatibility of the synergistic antimicrobial system.
Collapse
Affiliation(s)
- Yu Lin
- Institute of Biomedical Engineering, College of Life Sciences, Qingdao University, Qingdao, 266071, China
| | - Xiangyong Liu
- Institute of Biomedical Engineering, College of Life Sciences, Qingdao University, Qingdao, 266071, China
| | - Zengxu Liu
- Institute of Biomedical Engineering, College of Life Sciences, Qingdao University, Qingdao, 266071, China
| | - Yuanhong Xu
- Institute of Biomedical Engineering, College of Life Sciences, Qingdao University, Qingdao, 266071, China
- Department of Urology, Key Laboratory of Urinary System Diseases, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| |
Collapse
|
8
|
Yao X, Hu H, Wang S, Zhao W, Song M, Zhou Q. Synthesis, Antimicrobial Activity, and Molecular Docking Studies of Aminoguanidine Derivatives Containing an Acylhydrazone Moiety. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 20:536-545. [PMID: 34567180 PMCID: PMC8457745 DOI: 10.22037/ijpr.2020.113711.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A series of aminoguanidine derivatives containing an acylhydrazone moiety was designed based on combination principles to find new antibacterial agents with wide spectra and high activities. The synthesized compounds were characterized by spectral methods and screened for their antibacterial activity. The results showed that several compounds provided great antimicrobial activities against Gram-positive bacteria (including the multidrug-resistant clinical isolates). Especially, this series of compounds presented high potency against Staphylococcus aureus, among which the derivative 3f was the most promising one with a MIC value of 4 μg/mL. Compound 3d, with a tertiary butyl group, was found to have the broad spectrum inhibitory capacity, which is effective to eight strains and showed the most potent inhibitory activity against B. subtilis CMCC 63501 with a MIC value of 4 μg/mL. What’s more, compound 3d also presented high activities against four multidrug-resistant strains, which were comparable or potent to oxacillin and penicillin. Molecular docking studies revealed that H-bond interaction with amino acid residue THR81 and alkyl hydrophobic interaction with residue ALA246 of FabH were crucial for their binding force and in-vitro antimicrobial activities.
Collapse
Affiliation(s)
- Xiaodong Yao
- Jiangxi Institute of Biological Products Inc, Ji'an , 343009, Jiangxi, China
| | - Hongmei Hu
- Medical College, Jinggangshan University, Ji'an , 343009, Jiangxi, China
| | - Shiben Wang
- School of Pharmacy, Liaocheng University, LiaoCheng, 252059, Shandong, China
| | - Wenhao Zhao
- Medical College, Jinggangshan University, Ji'an , 343009, Jiangxi, China
| | - Mingxia Song
- Medical College, Jinggangshan University, Ji'an , 343009, Jiangxi, China.,Research Center of Chinese Medicinal Resources and Functional Molecules of Jinggangshan University, Ji'an , 343009, China
| | - Qiugui Zhou
- Medical College, Jinggangshan University, Ji'an , 343009, Jiangxi, China.,Research Center of Chinese Medicinal Resources and Functional Molecules of Jinggangshan University, Ji'an , 343009, China
| |
Collapse
|
9
|
Mermer A. The Importance of Rhodanine Scaffold in Medicinal Chemistry: A Comprehensive Overview. Mini Rev Med Chem 2021; 21:738-789. [PMID: 33334286 DOI: 10.2174/1389557521666201217144954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Abstract
After the clinical use of epalrestat that contains a rhodanine ring, in type II diabetes mellitus and diabetic complications, rhodanin-based compounds have become an important class of heterocyclic in the field of medicinal chemistry. Various modifications to the rhodanine ring have led to a broad spectrum of biological activity of these compounds. Synthesis of rhodanine derivatives, depended on advenced throughput scanning hits, frequently causes potent and selective modulators of targeted enzymes or receptors, which apply their pharmacological activities through different mechanisms of action. Rhodanine-based compounds will likely stay a privileged scaffold in drug discovery because of different probability of chemical modifications of the rhodanine ring. We have, therefore reviewed their biological activities and structure activity relationship.
Collapse
Affiliation(s)
- Arif Mermer
- Department of Biotechnology, Hamidiye Health Science Institute, University of Health Sciences Turkey, 34668, İstanbul, Turkey
| |
Collapse
|
10
|
Risk factors for antibiotic resistance development in healthcare settings in China: a systematic review. Epidemiol Infect 2021; 149:e141. [PMID: 34078502 PMCID: PMC8220497 DOI: 10.1017/s0950268821001254] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Antibiotic resistance (ABR) threatens the effectiveness of infectious disease treatments and contributes to increasing global morbidity and mortality. In this study, we systematically reviewed the identified risk factors for ABR among people in the healthcare system of mainland China. Five databases were systematically searched to identify relevant articles published in either English and Chinese between 1 January 2003 and 30 June 2019. A total of 176 facility-based references were reviewed for this study, ranging across 31 provinces in mainland China and reporting information from over 50 000 patients. Four major ABR risk factor domains were identified: (1) sociodemographic factors (includes migrant status, low income and urban residence), (2) patient clinical information (includes disease status and certain laboratory results), (3) admission to healthcare settings (includes length of hospitalisation and performance of invasive procedures) and (4) drug exposure (includes current or prior antibiotic therapy). ABR constitutes an ongoing major public health challenge in China. The healthcare sector-associated risk factors was the most important aspect identified in this review and need to be addressed. Primary health care system and ABR surveillance networks need to be further strengthened to prevent and control the communicable diseases, over-prescription and overuse of antibiotics.
Collapse
|
11
|
Shen Z, Xu W, Yu J, Chen L, Zhang J, Sheng S, Dong X, Bian H. Synthesis and in vitro antibacterial activity of new aminothiazole-oximepiperidone cephalosporins. Bioorg Med Chem Lett 2021; 40:127928. [PMID: 33705899 DOI: 10.1016/j.bmcl.2021.127928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
Four new aminothiazole-oximepiperidone cephalosporins (10a-10d) were synthesized, with their in vitro antibacterial activities against hospital isolated Gram-negative bacteria assessed. The results showed that compounds 10a-10d effectively inhibit a variety of Gram-negative bacteria. Compound 10a was the most potent compound, with comparable activity as ceftazidime. The combination of compound 10a and Avibactam was very active against almost all bacteria tested, which including multidrug resistant K. pneumoniae and A. baumannii. Compared to Avycaz, this combination is more potent against ESBL producing K. pneumoniae. Thus, the combination of 10a and Avibactam is of interest for further studies.
Collapse
Affiliation(s)
- Zhengwu Shen
- School of Medicine, Shanghai Jiao Tong University, 280 South Chongqing Road, Shanghai 200025, PR China; School of Pharmacy, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, PR China.
| | - Wei Xu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, PR China
| | - Jingfeng Yu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, PR China
| | - Lixia Chen
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, PR China
| | - Jinghua Zhang
- School of Medicine, Shanghai Jiao Tong University, 280 South Chongqing Road, Shanghai 200025, PR China
| | - Sihan Sheng
- School of Medicine, Shanghai Jiao Tong University, 280 South Chongqing Road, Shanghai 200025, PR China
| | - Xun Dong
- Yunnan Baiyao Group Co., Ltd., 3686 Yunnan Baiyao Street, Kunming 650200, PR China.
| | - Hongzhu Bian
- Yunnan Baiyao Group Co., Ltd., 3686 Yunnan Baiyao Street, Kunming 650200, PR China
| |
Collapse
|
12
|
Wu JH, Li X, Chen GP, Fu MY, Ye F. Changing trends of deep neck infections in southern China: A review of 127 cases. Sci Prog 2021; 104:368504211028367. [PMID: 34191640 PMCID: PMC10358622 DOI: 10.1177/00368504211028367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study aimed to review our experience with the clinical characteristics and management of deep neck infections (DNIs) and determine the changing trends of their characteristics over time in southern China. Patients diagnosed with a DNI between January 2009 and December 2018 were screened retrospectively for their demographic characteristics, etiology of infection, site of infection, microbiology, treatment, and complications. In total, 127 patients were included: 41 (32.3%) were treated between 2009 and 2013 (group A), and 86 (67.7%) were treated between 2014 and 2018 (group B). The most common site of infection in group A was the parapharyngeal space (15 patients, 36.6%), while that in group B involved multiple spaces (36 patients, 41.9%). The leucocyte count (×109 cells/L) was 13.23 ± 4.19 in group A and 16.04 ± 4.33 in group B (p < 0.001). Streptococcus viridans was the most common bacteria in both groups. The mean hospital stay was 21.46 ± 33.09 days in group A and 10.44 ± 6.19 days in group B. The rate of diabetes mellitus (DM) in group A was lower than that in group B (8/41 and 33/86, respectively; p = 0.034). Airway obstruction was the most common complication in both groups. DNIs are more likely to show multi-space involvement, affect more DM patients, and be associated with higher leucocyte counts over time. We infer that the duration from morbidity to admission and that from admission to operation play roles in the successful management of DNIs, possibly causing fewer complications, lower mortality rates, and shorter hospital stays. DM patients require increased attention.
Collapse
Affiliation(s)
- Jian-Hui Wu
- Min-Yi Fu, The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong 528400, P.R. China.
| | | | - Guo-Ping Chen
- The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, P.R. China
| | - Min-Yi Fu
- The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, P.R. China
| | - Fei Ye
- The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, P.R. China
| |
Collapse
|
13
|
Yang J, Wang H, Roberts DJ, Du HN, Yu XF, Zhu NZ, Meng XZ. Persistence of antibiotic resistance genes from river water to tap water in the Yangtze River Delta. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 742:140592. [PMID: 32629269 DOI: 10.1016/j.scitotenv.2020.140592] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/09/2020] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Abstract
Antibiotic resistance genes (ARGs) raise public concern as emerging contaminants. The abundance and variation of 11 ARGs, intI1 and 16S rRNA gene were deciphered using quantitative PCR (qPCR) in two drinking water treatment systems that include river, wetland, drinking water treatment plants (DWTPs) and tap water from the Yangtze River Delta. The influencing factors for ARG abundance in river water were also explored. All investigated genes were detected in river water and there was no significant difference between the two systems, with sulfonamide ARGs occupying the highest abundance. Temperature had a significant effect on the ARG distribution based on permutational multivariate analysis of variance (PERMANOVA). Further Spearman analysis demonstrated that temperature was strongly correlated with the abundance of sul1, sul2, tetA and tetC, and these genes were significantly correlated with environmental factors (including temperature, total organic carbon (TOC) and dissolved oxygen (DO)). Considering the frequency and abundance of ARGs, as well as their correlation with other genes, sul1, sul2, tetA and tetC could be used as indicators of ARGs in river water. No significant reduction was noted for the absolute abundance of ARGs from river water to wetland water. Principle coordinates analysis (PCoA) combined with PERMANOVA revealed that drinking water treatment was responsible for reducing 16S rRNA gene and ARG abundance resulting in 3-log reductions. However, it should be noted that after transportation of distribution pipeline, both 16S rRNA gene and ARGs still detected in tap water, which indicated persistence of ARGs and will require further research.
Collapse
Affiliation(s)
- Juan Yang
- State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China; Jiaxing-Tongji Environmental Research Institute, 1994 Linggongtang Road, Jiaxing 314051, Zhejiang Province, China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China
| | - Hong Wang
- State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China.
| | - Dustin James Roberts
- State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China; Jiaxing-Tongji Environmental Research Institute, 1994 Linggongtang Road, Jiaxing 314051, Zhejiang Province, China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China
| | - Hao-Nan Du
- State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China; Jiaxing-Tongji Environmental Research Institute, 1994 Linggongtang Road, Jiaxing 314051, Zhejiang Province, China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China
| | - Xin-Feng Yu
- Zhejiang Jiayuan Environmental Group Co. Ltd, 231 South Huancheng Road, Jiaxing 314000, Zhejiang Province, China
| | - Ning-Zheng Zhu
- State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China; Jiaxing-Tongji Environmental Research Institute, 1994 Linggongtang Road, Jiaxing 314051, Zhejiang Province, China
| | - Xiang-Zhou Meng
- State Key Laboratory of Pollution Control and Resources Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China; Jiaxing-Tongji Environmental Research Institute, 1994 Linggongtang Road, Jiaxing 314051, Zhejiang Province, China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China
| |
Collapse
|
14
|
Lan Y, Sun W, Chen Y, Miao J, Li G, Qiu X, Song X, Zhao X, Zhu Z, Fan Y, Zhu S. Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections. Front Neurol 2020; 11:574280. [PMID: 33224089 PMCID: PMC7667237 DOI: 10.3389/fneur.2020.574280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022] Open
Abstract
Stroke has been a leading cause of mortality in China. Stroke-associated infections (SAI) are common complications, occurring in 5–65% of stroke patients. Faced with SAI, clinicians often are placed in a considerable dilemma. On the one hand, preventive overuse of antibiotics will lead to the emergence of drug-resistant bacteria. On the other hand, treatment delay of the infection will likely result in a poor outcome. Therefore, it is necessary to determine the early predictors of post-stroke infection to screen patients with high infection risk for early clinical intervention, thereby promoting and improving survival rates. We assessed 257 patients with acute ischemic stroke from a consecutive retrospective cohort. Data of these patients were obtained from three hospitals (TongJi Hospital and its two branches) between August 2018 and June 2019. Of these patients, 59 (23.0%) developed SAI. SAI was defined according to the modified Centers for Disease Control and Prevention criteria. There were 38 patients (64.4%) who developed pneumonia, 11 with urinary tract infections (18.6%), and 10 with other infections (16.9%). We found that a higher neutrophil-to-lymphocyte ratio (adjusted odds ratio [aOR] = 1.16; 95% confidence interval [CI], 1.01–1.33; P = 0.034), National Institutes of Health Stroke Scale score (aOR = 1.18; CI, 1.09–1.27; p < 0.001), and dysphagia (aOR = 2.95; CI, 1.40–6.22; P = 0.004) were risk factors for SAI. Of note, hypertriglyceridemia (aOR = 0.35; CI, 0.13–0.90; P = 0.029) was a protective factor, lowering the risk of SAI. To this end, a reliable nomogram was constructed for the prediction of SAI in our study (mean C-index value ± standard deviation = 0.821 ± 0.03). It has the potential to be widely used and may help identify patients at high risk for SAI and make timely clinical decisions. Given our study was based on relatively small dataset, the results should be interpreted with care and external validation in independent datasets is very necessary.
Collapse
Affiliation(s)
- Yan Lan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhe Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuxi Chen
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States
| | - Jinfeng Miao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuli Qiu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Song
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yebin Fan
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
15
|
The Effects of County Public Hospital Reform on the Consumption and Costs of Antibiotics: Evidence from a Quasinatural Experiment in Jiangsu, China. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9262170. [PMID: 33145360 PMCID: PMC7599416 DOI: 10.1155/2020/9262170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/22/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022]
Abstract
Background Overuse of antibiotics is a major driver for rapid spread of antimicrobial resistance worldwide, particularly common in China. The close linkage between hospital revenue and sales of drugs has become the key incentive for overprescription of antibiotics. Since 2009, the Chinese government implemented a series of measures to cut off the link, including removing the markup of drugs, increasing financial subsidies, and adjusting charges for medical service. Objective To evaluate the impacts of county public hospital reform on the consumption and costs of procured antibiotics in Jiangsu province. Methods A quasiexperiment design was conducted in Jiangsu province where 99 county public hospitals implemented the reform successively in different periods. Of these, 37 county public hospitals implemented the reform since January 2013, which were regarded as the intervention group, and the remaining 62 hospitals were included in the control group. A difference-in-differences (DID) analysis with generalized linear regressions was used on the procurement records of antibiotics from January 2012 to December 2013. Modified Park test was used for family distribution and Box–Cox test for log link. Placebo tests were employed to test the common-trend hypothesis of two groups. Results For the intervention group, the average volume of procured restricted antibiotics and injectable antibiotics increased by 24.12% and 2.75% while the costs increased by 19.01% and 9.09%, respectively. The average costs per DDD of restricted and injectable antibiotics were much higher than unrestricted and oral antibiotics. The DID results showed that the reform had a positive impact on the average volume (p = 0.005) and costs (p = 0.001) of nonrestricted antibiotics. In addition, the implementation of the reform was associated with a reduction in volume (p = 0.031) and costs (p = 0.043) of procured oral antibiotics. The reform also contributed to an increase in average costs per DDD of total antibiotics (p = 0.049). Conclusions The reform is effective in reducing the consumption and costs of unrestricted and oral antibiotics, but it has failed to reduce the consumption and costs of expensive restricted and injectable antibiotics, leading to increased burden of diseases. It is critical that the health policy initiatives can deincentivize overuse of antibiotics at both hospital and individual physician's levels. The reform should enforce government financial support, improve hospital governance, optimize performance evaluation, and establish specialized management approach for antibiotic use.
Collapse
|
16
|
Huang Y, Hu H, Yan R, Lin L, Song M, Yao X. Synthesis and evaluation of antimicrobial and anticancer activities of 3-phenyl-1-phenylsulfonyl pyrazoles containing an aminoguanidine moiety. Arch Pharm (Weinheim) 2020; 354:e2000165. [PMID: 33047391 DOI: 10.1002/ardp.202000165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/01/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022]
Abstract
A series of 3-phenyl-1-phenylsulfonyl pyrazoles containing an aminoguanidine moiety was designed, synthesized, and evaluated for their antimicrobial and anticancer activities. The majority of the target compounds showed broad-spectrum antimicrobial activity against the tested strains, with minimum inhibitory concentration (MIC) values ranging from 2 to 64 μg/ml. Compound 5k, showing the most potent antimicrobial activity against Bacillus subtilis CMCC 63501 and multidrug-resistant Staphylococcus aureus ATCC 43300 with an MIC value of 2 μg/ml, was the most promising one in this series. It was also effective for S. aureus ATCC 33591 and multidrug-resistant Escherichia coli ATCC BAA-196 at higher concentrations. The bactericidal time-kill kinetics test illustrated that compound 5k had rapid bactericidal potential. Docking results exhibited that compound 5k showed various kinds of binding to the FabH receptor, reflecting that 5k could bind with the active site well. All compounds showed excellent activity against the investigated cancer cells, with IC50 values ranging from 1.90 to 54.53 µM. Among them, compound 5f showed prominent cytotoxicity with IC50 = 1.90 µM against A549 cells, while exhibiting lower inhibitory activity against 293T cells (IC50 = 41.72 µM), indicating that it has the potential for a good therapeutic index as an anticancer drug.
Collapse
Affiliation(s)
- Yushan Huang
- Medical College, Jinggangshan University, Ji'an, Jiangxi, China
| | - Hongmei Hu
- Medical College, Jinggangshan University, Ji'an, Jiangxi, China
| | - Rui Yan
- Medical College, Jinggangshan University, Ji'an, Jiangxi, China
| | - Liwen Lin
- Medical College, Jinggangshan University, Ji'an, Jiangxi, China
| | - Mingxia Song
- Medical College, Jinggangshan University, Ji'an, Jiangxi, China.,Research Center of Chinese Medicinal Resources and Functional Molecules, Jinggangshan University, Ji'an, China
| | - Xiaodong Yao
- Jiangxi Institute of Biological Products Inc., Ji'an, Jiangxi, China
| |
Collapse
|
17
|
Hu D, Zou L, Gao Y, Jin Q, Ji J. Emerging nanobiomaterials against bacterial infections in postantibiotic era. VIEW 2020. [DOI: 10.1002/viw.20200014] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Dengfeng Hu
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education Department of Polymer Science and Engineering Zhejiang University Hangzhou China
| | - Lingyun Zou
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education Department of Polymer Science and Engineering Zhejiang University Hangzhou China
| | - Yifan Gao
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education Department of Polymer Science and Engineering Zhejiang University Hangzhou China
| | - Qiao Jin
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education Department of Polymer Science and Engineering Zhejiang University Hangzhou China
| | - Jian Ji
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education Department of Polymer Science and Engineering Zhejiang University Hangzhou China
| |
Collapse
|
18
|
Han M, Zhang X. Impact of medical professionals on Carbapenem-resistant Pseudomonas aeruginosa: moderating effect of workload based on the panel data in China. BMC Health Serv Res 2020; 20:670. [PMID: 32690017 PMCID: PMC7372746 DOI: 10.1186/s12913-020-05535-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 07/13/2020] [Indexed: 12/18/2022] Open
Abstract
Background Antimicrobial resistance (AMR), especially carbapenem-resistant Pseudomonas aeruginosa (CRPA), causes a serious increase in morbidity, mortality and costs. Medical professionals play an important role in curbing AMR. Previous studies overlooked the impact of workload on the relationship between medical professionals and AMR. This study aimed to explore the relationship between medical professionals and the CRPA rate as well as the moderating effect of medical professionals’ workload on this relationship. Methods A provincial-level panel dataset from 2014 to 2017 was constructed. Medical professionals were measured by the numbers of physicians, registered nurses, pharmacists, and clinical microbiologists per 1000 population. Workload was measured by the number of daily physician visits. Fixed effect model and hierarchical regression analysis were performed to explore the moderating effect of workload on medical professionals and the CRPA rate. Results The numbers of physicians, registered nurses, pharmacists and clinical technicians were significantly negative associated with the CRPA rate (coef. = − 0.889, − 0.775, − 1.176, and − 0.822; P = 0.003, 0.003, 0.011, and 0.007, respectively). Workload had a significant and positive moderating effect on physicians, registered nurses, pharmacists, clinical technicians and the CRPA rate (coef. = 1.270, 1.400, 2.210, and 1.634; P = 0.004, 0.001, 0.035, and 0.003, respectively). Conclusions Increasing the number of medical professionals may help curb the CRPA rate. Measures aimed at reducing medical professionals’ workload should be implemented to further improve CRPA performance.
Collapse
Affiliation(s)
- Meng Han
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, 430030, Hubei Province, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13. Hangkong Road, Wuhan, 430030, Hubei Province, China.
| |
Collapse
|
19
|
Dong D, Zheng Y, Chen Q, Guo Y, Yang Y, Wu S, Zhu D, Deng D, Bradford PA, Reinhart H, Hu F. In vitro activity of omadacycline against pathogens isolated from Mainland China during 2017-2018. Eur J Clin Microbiol Infect Dis 2020; 39:1559-1572. [PMID: 32356026 DOI: 10.1007/s10096-020-03877-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
Antibiotic resistance of bacterial pathogens isolated in China is a major concern. Omadacycline is a novel tetracycline derivative that has been approved for use in skin infections and community-acquired pneumonia. This study was conducted to determine the in vitro activity of omadacycline against a large collection of patient isolate medical centers across Mainland China. A total of 1041 recent clinical isolates are obtained from patients hospitalized in 29 provinces and municipalities across China. The in vitro activity of omadacycline and comparator agents was assessed using the microbroth dilution methodology. Omadacycline was active against methicillin-susceptible and -resistant Staphylococcus aureus with MIC90 values of 0.25 and 1 mg/L, respectively. All isolates of Enterococcus faecalis and Enterococcus faecium, including vancomycin-resistant isolates, were inhibited by ≤ 0.25 mg/L of omadacycline. It was active against Streptococcus pneumoniae irrespective of susceptibility to penicillin or macrolides (MIC90 =0.12 mg/L). The minimum inhibitory concentration (MIC) distribution of omadacycline was nearly identical against (extended-spectrum beta-lactamases) ESBL-positive, ESBL-negative, and carbapenemase-producing Escherichia coli (MIC90 = 4 mg/L). Omadacycline also showed good activity against Acinetobacter baumannii, inhibiting all isolates at ≤ 8 mg/L. Against Hemophilus influenzae and Moraxella catarrhalis, the MICs of omadacycline were low and not influenced by the presence of β-lactamase. Overall, the activity of omadacycline was very good against isolates commonly associated with skin infections and pneumonia, and the susceptibility of Chinese isolates was similar to that reported for these pathogens from large surveillance studies outside China. This suggests that omadacycline could be an option for treatment of these infections in Chinese patients.
Collapse
Affiliation(s)
- Dong Dong
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 M. Wulumuqi Rd., Shanghai, 200040, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Yonggui Zheng
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 M. Wulumuqi Rd., Shanghai, 200040, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Qingqing Chen
- Laboratory Medicine, First Hospital of Quanzhou city, QuanZhou, Fujian, China
| | - Yan Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 M. Wulumuqi Rd., Shanghai, 200040, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Yang Yang
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 M. Wulumuqi Rd., Shanghai, 200040, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Shi Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 M. Wulumuqi Rd., Shanghai, 200040, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | - Demei Zhu
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 M. Wulumuqi Rd., Shanghai, 200040, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China
| | | | | | | | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 M. Wulumuqi Rd., Shanghai, 200040, People's Republic of China. .,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.
| |
Collapse
|
20
|
Smiley Evans T, Shi Z, Boots M, Liu W, Olival KJ, Xiao X, Vandewoude S, Brown H, Chen JL, Civitello DJ, Escobar L, Grohn Y, Li H, Lips K, Liu Q, Lu J, Martínez-López B, Shi J, Shi X, Xu B, Yuan L, Zhu G, Getz WM. Synergistic China-US Ecological Research is Essential for Global Emerging Infectious Disease Preparedness. ECOHEALTH 2020; 17:160-173. [PMID: 32016718 PMCID: PMC7088356 DOI: 10.1007/s10393-020-01471-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/03/2019] [Accepted: 12/10/2019] [Indexed: 05/14/2023]
Abstract
The risk of a zoonotic pandemic disease threatens hundreds of millions of people. Emerging infectious diseases also threaten livestock and wildlife populations around the world and can lead to devastating economic damages. China and the USA-due to their unparalleled resources, widespread engagement in activities driving emerging infectious diseases and national as well as geopolitical imperatives to contribute to global health security-play an essential role in our understanding of pandemic threats. Critical to efforts to mitigate risk is building upon existing investments in global capacity to develop training and research focused on the ecological factors driving infectious disease spillover from animals to humans. International cooperation, particularly between China and the USA, is essential to fully engage the resources and scientific strengths necessary to add this ecological emphasis to the pandemic preparedness strategy. Here, we review the world's current state of emerging infectious disease preparedness, the ecological and evolutionary knowledge needed to anticipate disease emergence, the roles that China and the USA currently play as sources and solutions to mitigating risk, and the next steps needed to better protect the global community from zoonotic disease.
Collapse
Affiliation(s)
- Tierra Smiley Evans
- One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, USA.
| | - Zhengli Shi
- Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - Michael Boots
- Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, CA, USA.
| | - Wenjun Liu
- Key Laboratory of Pathogenic Microbiology and Immunology, Chinese Academy of Sciences, Beijing, China
| | | | - Xiangming Xiao
- Department of Microbiology and Plant Biology, Center for Spatial Analysis, University of Oklahoma, Norman, OK, USA
| | | | - Heidi Brown
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Ji-Long Chen
- College of Animal Sciences, Fujian Agriculture and Forestry University, Fuzhou, China
| | | | - Luis Escobar
- Department of Fish and Wildlife Conservation, Virginia Tech, Blacksburg, VA, USA
| | - Yrjo Grohn
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | | | - Karen Lips
- Department of Biology, University of Maryland, College Park, MD, USA
| | - Qiyoung Liu
- Department of Vector Biology and Control, National Institute for Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiahai Lu
- One Health Center of Excellence for Research and Training, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | | | - Jishu Shi
- Laboratory of Vaccine Immunology, US-China Center for Animal Health, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
| | - Xiaolu Shi
- Department of Microbiology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Lihong Yuan
- School of Life Sciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, China
| | - Guoqiang Zhu
- Jiangsu Co-Innovation Center for Important Animal Infectious Diseases and Zoonoses, Joint International Research Laboratory of Agriculture and Agri-Product Safety of Ministry of Education of China, College of Veterinary Medicine, Yangzhou University, Yangzhou, China
| | - Wayne M Getz
- Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, CA, USA.
- School of Mathematical Sciences, University of KwaZulu-Natal, Durban, South Africa.
| |
Collapse
|
21
|
Salem MA, Ragab A, El-Khalafawy A, Makhlouf AH, Askar AA, Ammar YA. Design, synthesis, in vitro antimicrobial evaluation and molecular docking studies of indol-2-one tagged with morpholinosulfonyl moiety as DNA gyrase inhibitors. Bioorg Chem 2020; 96:103619. [PMID: 32036161 DOI: 10.1016/j.bioorg.2020.103619] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/12/2019] [Accepted: 01/22/2020] [Indexed: 01/26/2023]
Abstract
A series of Schiff bases 3, 5, 7 and hydrazones 9 were achieved via reaction of 5-(morpholinosulfonyl)indol-2,3-dione (1) with appropriate amines and/or hydrazide derivatives. Representative compounds of the synthesized products were tested and evaluated as antimicrobial agents. According to MIC and MBC results from compounds 9a, 9c, 7a, 3b, 3c, and 5b were able to exhibit significant antibacterial activity against both Gram-positive and Gram-negative bacteria together with moderate antifungal activities. Also, a multi-drug resistance study (MDRS) was carried out to evaluate the activity of most potent compounds, and these compounds showed considerable results compared with Norfloxacin and Tetracycline which observed no results against strains used in this study. The inhibitory activity of most potent compounds (3b, 3c, 5b, 7a, 9a, and 9c) against DNA gyrase isolated from S. aureus was examined. The results indicated that all of these derivatives inhibiting DNA gyrase and therefore lead to separate bacterial DNA and inhibit cell division. Compounds 3b, 9c showed to be very potent inhibitors towards S. aureus DNA gyrase with IC50 values (18.75 ± 1.2 and 19.32 ± 0.99 µM) respectively, compared with Ciprofloxacin (26.43 ± 0.64 µM). Molecular docking studies indicated that the synthesized compounds observed good binding with the enzyme and showed lower binding energy of the most promising compounds than a standard drug used, and enabled a better understanding of their structural features.
Collapse
Affiliation(s)
- Mohamed A Salem
- Department of Chemistry, Faculty of Science and Arts, King Khalid University, Mohail, Assir, Saudi Arabia.
| | - Ahmed Ragab
- Department of Chemistry, Faculty of Science (Boys), Al-Azhar University, Nasr City, Cairo, Egypt.
| | - Abeer El-Khalafawy
- Department of Chemistry, Faculty of Science, King Khalid University, Abha, Saudi Arabia
| | - Abeer H Makhlouf
- Department of Agricultural Botany, Faculty of Agricultural, Menoufiya University, Egypt
| | - Ahmed A Askar
- Department of Botany and Microbiology, Faculty of Science (Boys), Al-Azhar University, Cairo, Egypt
| | - Yousry A Ammar
- Department of Chemistry, Faculty of Science (Boys), Al-Azhar University, Nasr City, Cairo, Egypt
| |
Collapse
|
22
|
Jung D, Rubin JE. Identification of antimicrobial resistant bacteria from plant-based food products imported into Canada. Int J Food Microbiol 2020; 319:108509. [PMID: 31945714 DOI: 10.1016/j.ijfoodmicro.2020.108509] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/22/2019] [Accepted: 01/06/2020] [Indexed: 02/08/2023]
Abstract
The role of plant-based foods in the epidemiology of antimicrobial resistance has been inadequately studied. In this investigation, resistant organisms from vegetables, fruits and spices imported into Canada were identified and characterized. A total of 143 products imported from primarily Asian and African countries were purchased from international markets in Saskatoon, Saskatchewan. Samples were selectively cultured for bacterial species where resistance is known to be emerging. The proportions of samples positive for each organism were as follows: E. coli (n = 13, 9.1%), Salmonella spp. (n = 2, 1.4%), ESBL producing Enterobacter spp. (n = 2, 1.4%) and K. pneumoniae (n = 2, 1.4%), S. aureus (n = 7, 4.9%) and Enterococcus spp. (n = 66, 46.2%). Antimicrobial minimum inhibitory concentrations were determined by broth micro-dilution and agar-dilution. Based on the susceptibility of each organism, isolates were screened for resistance genes (β-lactamases and plasmid mediated quinolones resistance determinants) by PCR. Extended-spectrum β-lactamase producing Enterobacteriaceae and methicillin resistant S. aureus (MRSA) were identified from 6/143 (4.2%) and 2/143 (1.4%) of samples respectively. The qnrB, qnrS and aac(6')-Ib-cr plasmid mediated quinolone resistance determinants were identified in 2/143 (1.4%) of samples tested. None of the Enterobacteriaceae isolates were resistant to meropenem or colistin. Similarly, all Enterococcus isolates remained susceptible to ampicillin, penicillin and vancomycin. Finding multi-drug resistant bacteria which are frequently isolated from human infections is concerning, although the contribution of the global food trade to the dissemination of resistance remains cryptic. These results suggest that imported plant-based foods may be an underappreciated source of clinically relevant resistant organisms. Further study is required to address these gaps in our understanding of the epidemiology of resistance, and the magnitude of the risk posed to human health by these organisms.
Collapse
Affiliation(s)
- Dongyun Jung
- Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joseph E Rubin
- Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| |
Collapse
|
23
|
Bai XQ, Li CS, Cui MY, Song ZW, Zhou XY, Zhang C, Zhao Y, Zhang TY, Jiang TY. Synthesis and molecular docking studies of novel pyrimidine derivatives as potential antibacterial agents. Mol Divers 2019; 24:1165-1176. [PMID: 31792660 DOI: 10.1007/s11030-019-10019-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
The present work describes the in vitro antibacterial evaluation of some new pyrimidine derivatives. Twenty-two target compounds were designed, synthesized and preliminarily explored for their antimicrobial activities. The antimicrobial assay revealed that some target compounds exhibited significantly inhibitory efficiencies toward bacteria and fungal including drug-resistant pathogens. Compound 7c presented the most potent inhibitory activities against Gram-positive bacteria (e.g., Staphylococcus aureus 4220), Gram-negative bacteria (e.g., Escherichia coli 1924) and the fungus Candida albicans 7535, with an MIC of 2.4 μmol/L. Compound 7c was also the most potent, with MICs of 2.4 or 4.8 μmol/L against four multidrug-resistant, Gram-positive bacterial strains. The toxicity evaluation of the compounds 7c, 10a, 19d and 26b was assessed in human normal liver cells (L02 cells). Molecular docking simulation and analysis suggested that compound 7c has a good interaction with the active cavities of dihydrofolate reductase (DHFR). In vitro enzyme study implied that compound 7c also displayed DHFR inhibition.
Collapse
Affiliation(s)
- Xue-Qian Bai
- Jilin Medical University, Jilin, 132013, People's Republic of China
| | - Chun-Shi Li
- The Third People's Hospital of Dalian, Dalian, 116000, People's Republic of China
| | - Ming-Yue Cui
- The Third People's Hospital of Dalian, Dalian, 116000, People's Republic of China
| | - Ze-Wen Song
- Jilin Medical University, Jilin, 132013, People's Republic of China.,Department of Pharmary, Yanbian University, Yanji, 133002, People's Republic of China
| | - Xing-Yu Zhou
- Jilin Medical University, Jilin, 132013, People's Republic of China
| | - Chao Zhang
- Jilin Medical University, Jilin, 132013, People's Republic of China
| | - Yang Zhao
- Jilin Medical University, Jilin, 132013, People's Republic of China
| | - Tian-Yi Zhang
- Jilin Medical University, Jilin, 132013, People's Republic of China.
| | - Tie-Yan Jiang
- Changning Branch of Shanghai Municipal Public Security Bureau, Shanghai, 200336, People's Republic of China.
| |
Collapse
|
24
|
The Clinical and Economic Impact of Antibiotic Resistance in China: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2019; 8:antibiotics8030115. [PMID: 31405146 PMCID: PMC6784351 DOI: 10.3390/antibiotics8030115] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022] Open
Abstract
Antibiotic resistance (ABR) is one of the biggest threats to global health, especially in China. This study aims to analyze the published literature on the clinical and economic impact of ABR or multi-drug resistant (MDR) bacteria compared to susceptible bacteria or non-infection, in mainland China. English and Chinese databases were searched to identify relevant studies evaluating mortality, hospital stay, and hospital costs of ABR. A meta-analysis of mortality was performed using a random effects model. The costs were converted into 2015 United States (US) dollars. Of 13,693 studies identified, 44 eligible studies were included. Twenty-nine investigated the impact of ABR on hospital mortality, 37 were focused on hospital stay, and 21 on hospital costs. Patients with ABR were associated with a greater risk of overall mortality compared to those with susceptibility or those without infection (odds ratio: 2.67 and 3.29, 95% confidence interval: 2.18–3.26 and 1.71–6.33, p < 0.001 and p < 0.001, respectively). The extra mean total hospital stay and total hospital cost were reported, ranging from 3 to 46 days, and from US$238 to US$16,496, respectively. Our study indicates that ABR is associated with significantly higher mortality. Moreover, ABR is not always, but usually, associated with significantly longer hospital stay and higher hospital costs.
Collapse
|
25
|
Chai J, Coope C, Cheng J, Oliver I, Kessel A, Hu Z, Wang D. Cross-sectional study of the use of antimicrobials following common infections by rural residents in Anhui, China. BMJ Open 2019; 9:e024856. [PMID: 30975670 PMCID: PMC6500192 DOI: 10.1136/bmjopen-2018-024856] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe help seeking behaviour from a medical doctor and antimicrobial use for common infections among rural residents of Anhui province, China. DESIGN A cross-sectional retrospective household survey. SETTING 12 administrative villages from rural Anhui, China. PARTICIPANTS 2760 rural residents selected through cluster-randomised sampling using an interviewer administered questionnaire. METHOD Logistic regression models were used to estimate associations between exposures (health insurance and antimicrobial-related knowledge), adjusted for confounders (sex, age and education), and help-seeking behaviour from a medical doctor and antimicrobial use following common infections, including acute respiratory tract infections (ARTIs), gastrointestinal tract infections (GTIs) and urinary tract infections (UTIs). RESULTS In total 2611 (94.6%) rural residents completed the questionnaire. Help seeking from a medical doctor was highest for ARTIs (59.4%) followed by GTIs (42.1%), and UTIs (27.8%). Around two-thirds (82.3% for ARTIs, 87.0% for GTIs and 66.0% for UTIs) of respondents sought help within 3 days following symptom onset and over three quarters (88% for ARTIs, 98% for GTIs and 77% for UTIs) reported complete recovery within 7 days. Of the help-seeking respondents, 94.5% with ARTI symptoms recalled being prescribed either oral or intravenous antimicrobials (GTIs 81.7% and UTIs 70.4%). Use of antimicrobials bought from medicine shops without prescriptions ranged from 8.8% for GTIs to 17.2% for ARTIs; while use of antimicrobials leftover from previous illnesses or given by a relative ranged from 7.6% for UTIs to 13.4% for ARTIs. Multivariate logistic regression analysis revealed that respondents with a higher antimicrobial-related knowledge score and lack of insurance were associated with lower levels of help-seeking for ARTIs; while respondents with a higher antimicrobial-related knowledge score were less likely to be prescribed either oral or intravenous antimicrobials. CONCLUSIONS Excessive antimicrobial use in the studied primary care settings is still prevalent.
Collapse
Affiliation(s)
- Jing Chai
- School of Public Health, Anhui Medical University, Hefei, China
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Caroline Coope
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol, UK
- National Infection Service, Public Health England, Bristol, UK
| | - Jing Cheng
- School of Public Health, Anhui Medical University, Hefei, China
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Isabel Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol, UK
- National Infection Service, Public Health England, Bristol, UK
| | - Anthony Kessel
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Zhi Hu
- School of Public Health, Anhui Medical University, Hefei, China
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, China
| |
Collapse
|
26
|
Mousavi SM, Zarei M, Hashemi SA, Babapoor A, Amani AM. A conceptual review of rhodanine: current applications of antiviral drugs, anticancer and antimicrobial activities. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:1132-1148. [DOI: 10.1080/21691401.2019.1573824] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Seyyed Mojtaba Mousavi
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Zarei
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Alireza Hashemi
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aziz Babapoor
- Department of Chemical Engineering, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Ali Mohammad Amani
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
27
|
Song M, Wang S, Wang Z, Fu Z, Zhou S, Cheng H, Liang Z, Deng X. Synthesis, antimicrobial and cytotoxic activities, and molecular docking studies of N-arylsulfonylindoles containing an aminoguanidine, a semicarbazide, and a thiosemicarbazide moiety. Eur J Med Chem 2019; 166:108-118. [DOI: 10.1016/j.ejmech.2019.01.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/19/2018] [Accepted: 01/15/2019] [Indexed: 01/01/2023]
|
28
|
Carvalhaes CG, Huband MD, Reinhart HH, Flamm RK, Sader HS. Antimicrobial Activity of Omadacycline Tested against Clinical Bacterial Isolates from Hospitals in Mainland China, Hong Kong, and Taiwan: Results from the SENTRY Antimicrobial Surveillance Program (2013 to 2016). Antimicrob Agents Chemother 2019; 63:e02262-18. [PMID: 30617092 PMCID: PMC6395890 DOI: 10.1128/aac.02262-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/03/2019] [Indexed: 11/20/2022] Open
Abstract
Omadacycline is a derivative of minocycline and the first agent of the aminomethylcycline class. A total of 3,282 organisms (1 per patient) were consecutively collected from patients hospitalized in China (including Hong Kong) and Taiwan. Susceptibility testing was performed by broth microdilution methods in a central laboratory (JMI Laboratories). The collection included Gram-positive and Gram-negative organisms from patients with pneumonia, bloodstream, skin, community-acquired respiratory, and other infections. Omadacycline was very potent against Staphylococcus aureus (n = 689; MIC50/90, 0.12/0.25 mg/liter), including methicillin-resistant Staphylococcus aureus (MRSA; n = 299; MIC50/90, 0.12/0.5 mg/liter), and had similar activity across geographic regions. Omadacycline was very active against Streptococcus pneumoniae (highest MIC, 0.25 mg/liter), β-hemolytic streptococci (highest MIC, 1 mg/liter), viridans group streptococci (highest MIC, 0.25 mg/liter), and Enterococcus spp. (highest MIC, 0.5 mg/liter) from all geographic regions. Overall, 53.8% of S. pneumoniae isolates were penicillin resistant (penicillin MIC, ≥2 mg/liter) and 10.7% of enterococci (21.2% among E. faecium isolates) were vancomycin resistant. Omadacycline was active against Haemophilus influenzae (MIC50/90, 0.5/1 mg/liter) regardless of β-lactamase production and was active against Moraxella catarrhalis (MIC50/90, ≤0.12/0.25 mg/liter). Against Enterobacteriaceae, omadacycline was most active against Escherichia coli (MIC50/90, 1/2 mg/liter), Klebsiella oxytoca (MIC50/90, 1/4 mg/liter), and Enterobacter cloacae (MIC50/90, 2/4 mg/liter). Omadacycline had potent in vitro activity against Gram-positive and Gram-negative pathogens isolated from China and Taiwan and retained activity against problem pathogens, such as MRSA, vancomycin-resistant enterococci (VRE), penicillin-resistant S. pneumoniae (PRSPN), and extended-spectrum β-lactamase-producing E. coli The observed MIC profile in Chinese isolates was very similar to that seen in the U.S. and European surveillance studies.
Collapse
|
29
|
Tang J, Chen J, He T, Jiang Z, Zhou J, Hu B, Yang S. Diversity of upper respiratory tract infections and prevalence of Streptococcus pneumoniae colonization among patients with fever and flu-like symptoms. BMC Infect Dis 2019; 19:24. [PMID: 30616564 PMCID: PMC6323860 DOI: 10.1186/s12879-018-3662-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Many upper respiratory pathogens cause similar symptoms. In China, routine molecular tests for upper respiratory pathogens are not widely performed and antibiotics abuse in treating upper respiratory tract infections (URTIs) is a major public health concern. METHODS We performed qualitative real-time PCR tests to detect common upper respiratory tract pathogens including 9 viruses and 3 bacteria in 1221 nasopharyngeal swabs from patients with fever and influenza-like symptoms in a Chinese city. A quantitative real-time PCR was also performed to measure the bacterial density of the colonizing Streptococcus pneumoniae in these samples. RESULTS We found very diverse pathogens including 81.7% viruses, 11.6% bacteria and 6.7% mixed viruses and bacteria. S. pneumoniae colonization was found in 8.0% of the cases but most of them had low bacterial density (Mean = 3.9 log cfu/ml). We also discovered an increase of S. pneumoniae colonization frequency (but not the density) in patients with detectable upper respiratory tract pathogens, in a pathogen variety-dependent manner. CONCLUSIONS Our study provided strong evidence against empiric antibiotic use for treating URTIs, and highlighted a strong need for improving the diagnostic capacity for URTIs by using more molecular testing in China.
Collapse
Affiliation(s)
- Jialiang Tang
- Shaoxing Center for Disease Control and Prevention, Shaoxing, Zhejiang, China
| | - Jinkun Chen
- Shaoxing Center for Disease Control and Prevention, Shaoxing, Zhejiang, China
| | - Tingting He
- Shaoxing Center for Disease Control and Prevention, Shaoxing, Zhejiang, China
| | - Zhuojing Jiang
- Shaoxing Center for Disease Control and Prevention, Shaoxing, Zhejiang, China
| | - Jiale Zhou
- IngeniGen XunMinKang Biotechnology Inc. Shaoxing, Zhejiang, China
| | - Bin Hu
- IngeniGen XunMinKang Biotechnology Inc. Shaoxing, Zhejiang, China
| | - Shangxin Yang
- Zhejiang-Californina International Nanosystems Institute, Zhejiang University, Zhejiang, Hangzhou, China. .,Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, University of California Los Angeles, 11633 San Vicente Blvd, Los Angeles, CA, 90049, USA.
| |
Collapse
|
30
|
Wu G, Gong S, Cai H, Ding Y. The availability, price and affordability of essential antibacterials in Hubei province, China. BMC Health Serv Res 2018; 18:1013. [PMID: 30594189 PMCID: PMC6310993 DOI: 10.1186/s12913-018-3835-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China ranks first amongst the countries for the abuse of antibacterials. Essential antibacterials could help solve the problem. The aim of the work is to evaluate the availability, price and affordability of essential antibacterials in Hubei province, China. METHOD The standardized methodology developed by the World Health Organization and Health Action International was used to collect data on the availability and prices of 16 antibacterials in 5 cities of Hubei province, China. RESULTS First, in total, the median availability of originator brands and lowest-priced generics for the essential antibacterials was low, 3.0% (0.0, 18.2%) and 33.3% (0.0, 87.9%) for each, respectively. Second, the median price ratio of originator brands for the antibacterials was 20.30 (4.71, 35.80), while for generics, it was 0.49 (0.07, 1.18). Third, the affordability of originator brands for the antibacterials was 28.14 (21.70, 41.90) times the daily wages of an unskilled government worker, while for generics, the affordability was 0.35 (0.04, 6.11). Finally, we found that in Hubei province, lowest-priced generics for essential antibacterials with (fairly) high availability and relatively low price included Amoxicillin/Clavulanic Acid, Ceftazidime, Metronidazole, Gentamicin Sulfate and Ceftriaxone. CONCLUSION The prices of lowest-priced generics for essential antibacterials in Hubei province were reasonable, and in tertiary hospitals the availability was the highest, while in secondary and primary hospitals, it was relatively lower. Originator brands were not only extremely expensive but also difficult to obtain. Measures should be taken to improve the availability of essential antibacterials and the affordability of originator brands.
Collapse
Affiliation(s)
- Guangjie Wu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China. .,Tongji Hospital, No.1095, Jiefang Avenue, Wuhan, Hubei province, China.
| | - Shiwei Gong
- Department of Pharmacy Business and Administration; School of Pharmacy; Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China.,Tongji Medical College, No.13, Jiefang Avenue, Wuhan, Hubei province, China
| | - Hongbing Cai
- Department of Pharmacy Business and Administration; School of Pharmacy; Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China.,Tongji Medical College, No.13, Jiefang Avenue, Wuhan, Hubei province, China
| | - Yufeng Ding
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China. .,Tongji Hospital, No.1095, Jiefang Avenue, Wuhan, Hubei province, China.
| |
Collapse
|
31
|
Yan K, Xue M, Ye D, Yang C, Chang J, Jiang M, Zhao M, Zhang H, Fang Y. Antibiotic prescribing practices in secondary and tertiary hospitals in Shaanxi province, western China, 2013-2015. PLoS One 2018; 13:e0207229. [PMID: 30540753 PMCID: PMC6291232 DOI: 10.1371/journal.pone.0207229] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/26/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction The irrational use of antibiotics is a major driver of antimicrobial resistance. This study aimed to explore how antibiotics were used in secondary and tertiary hospitals in Shaanxi Province, western China from 2013 to 2015. Method A retrospective study was conducted with a sample of 16 hospitals in Shaanxi Province (2 tertiary and 14 secondary hospitals; 8 public and 8 private hospitals) using a stratified random sampling method. All of the macro data from these hospitals from 2013 to 2015 were analyzed. All collected data were double-entered and analyzed using Excel 2007. Results The percentage of injectable antibiotic prescriptions was 26.6% of all of the antibiotic prescriptions in the secondary hospitals and 14.2% in the tertiary hospitals. Injectable antibiotic prescriptions in private tertiary hospitals (enter %) were more than two times that of public tertiary hospitals (enter %). In both tertiary and secondary hospitals, the percentage of antibiotic prescriptions for outpatients, emergency patients and inpatients were within the scope of the national standards, while the intensity of antibiotic use was higher than the national standard of 40 DDD/100 bed-days. The prophylactic antibiotic use rate in clean surgery was 40.4% in tertiary hospitals and 60.7% in secondary hospitals, which were both higher than the national standard of 30%. The preventive use rate of antibiotics in private tertiary hospitals (55.00%) was more than two times that of public tertiary hospitals (25.90%), and the rate was also higher in private secondary hospitals (61.50%) than in public secondary hospitals (59.70%). Conclusions Substantial antibiotic abuse occurred in the sample Chinese hospitals, especially in secondary hospitals. The government should continue to strengthen the administration of antimicrobial use in hospitals. At the same time, medical professional training and interventions for physicians should be conducted to fundamentally reduce the irrational use of antibiotics.
Collapse
Affiliation(s)
- Kangkang Yan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Department of Pharmacy, Xi’an No. 3 Hospital, Xi’an, China
| | - Meiling Xue
- Department of Drug and Equipment, No. 521 Hospital of Ordnance Industry, Xi’an, China
| | - Dan Ye
- Department of Pharmacy, Xi’an No. 3 Hospital, Xi’an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
| | - Hongli Zhang
- Department of Pharmacy, Xi’an Central Hospital, Xi’an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- * E-mail:
| |
Collapse
|
32
|
Zhang Z, Dawkins B, Hicks JP, Walley JD, Hulme C, Elsey H, Deng S, Lin M, Zeng J, Wei X. Cost-effectiveness analysis of a multi-dimensional intervention to reduce inappropriate antibiotic prescribing for children with upper respiratory tract infections in China. Trop Med Int Health 2018; 23:1092-1100. [PMID: 30058210 DOI: 10.1111/tmi.13132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We developed a multifaceted intervention to reduce antibiotic prescription rate for children with upper respiratory tract infections (URTIs) among primary care doctors in township hospitals in China. The intervention achieved a 29% (95% CI 16-42) absolute risk reduction in antibiotic prescribing. This study was to assess the cost-effectiveness of our intervention at reducing antibiotic prescribing in rural primary care facilities as measured by the intervention's effect on the antibiotic prescription rates for childhood URTIs. METHODS We took a healthcare provider perspective, measuring costs of consultation (time cost of doctor), prescription monitoring process and peer-review meetings (time cost of participants) and medication costs. Costs on provider side were collected through a bespoke questionnaire from all 25 township hospitals in December 2016, while medication costs were collected prospectively in the trial. Incremental cost-effectiveness ratios were calculated by dividing the mean difference in cost of the two trial arms by the mean difference in antibiotic prescribing rate. RESULTS This showed an incremental cost of $0.03 per percentage point reduction in antibiotic prescribing. In addition to this incremental cost, the cost of implementing the intervention, including training and materials delivered by township hospitals, was $390.65 (SD $145.68) per healthcare facility. CONCLUSIONS This study shows that a multifaceted intervention programme, when embedded into routine practice, is very cost-effective at reducing antibiotic prescribing in primary care facilities and has the potential of scale up in similar resource limited settings.
Collapse
Affiliation(s)
- Zhitong Zhang
- China Global Health Research and Development, Shenzhen, China
| | - Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joseph P Hicks
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John D Walley
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Helen Elsey
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Simin Deng
- China Global Health Research and Development, Shenzhen, China
| | - Mei Lin
- Guangxi Autonomous Region Centre for Disease Control and Prevention, Nanning, China
| | - Jun Zeng
- Guangxi Autonomous Region Centre for Disease Control and Prevention, Nanning, China
| | - Xiaolin Wei
- Division of Clinical Public Health and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
33
|
Teoh L, Stewart K, Marino R, McCullough M. Antibiotic resistance and relevance to general dental practice in Australia. Aust Dent J 2018; 63:414-421. [DOI: 10.1111/adj.12643] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 12/20/2022]
Affiliation(s)
- L Teoh
- Melbourne Dental School; University of Melbourne; Carlton Victoria Australia
| | - K Stewart
- Centre for Medicine Use and Safety; Monash University; Parkville Victoria Australia
| | - R Marino
- Melbourne Dental School; University of Melbourne; Carlton Victoria Australia
| | - M McCullough
- Melbourne Dental School; University of Melbourne; Carlton Victoria Australia
| |
Collapse
|
34
|
Zhen X, Sun X, Dong H. Health Technology Assessment and Its Use in Drug Policies in China. Value Health Reg Issues 2018; 15:138-148. [PMID: 29729645 DOI: 10.1016/j.vhri.2018.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/08/2018] [Accepted: 01/16/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review drug policies, health technology assessment (HTA), and HTA's use in drug policies in China, to further improve the quality and efficiency of drugs. METHODS This study draws on multiple methods. A systematic review of the literature, review of Chinese government documents and statistical handbooks, and authors' experiences in drug policies and HTA in China were combined to achieve the objective. RESULTS Of 571 studies identified in the initial search, 14 eligible articles (6 English, 8 Chinese) were finally included. On the Web site of the National Health and Family Planning Commission, the National Development and Reform Commission, and the Ministry of Human Resources and Social Security, we found that HTA or pharmacoeconomics evaluation is mentioned in recent years and its frequency has been increasing; however, there was not one hit about HTA or PE on the Web site of China Food and Drug Administration. CONCLUSIONS The decision makers have realized the importance and value of HTA and have tried to integrate HTA into drug policies and regulations. However, the application of HTA findings to drug policymaking is not yet widespread and there are a number of challenges in using HTA in China. Therefore, it is necessary to establish a national HTA commission and develop pharmacoeconomics guidelines to support the use of HTA in decision making. Moreover, the most important steps are to encourage technology innovation, groom more HTA experts, and build reliable databases in China.
Collapse
Affiliation(s)
- Xuemei Zhen
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xueshan Sun
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| |
Collapse
|
35
|
Qu X, Yin C, Sun X, Huang S, Li C, Dong P, Lu X, Zhang Z, Yin A. Consumption of antibiotics in Chinese public general tertiary hospitals (2011-2014): Trends, pattern changes and regional differences. PLoS One 2018; 13:e0196668. [PMID: 29723230 PMCID: PMC5933762 DOI: 10.1371/journal.pone.0196668] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/17/2018] [Indexed: 12/04/2022] Open
Abstract
Background China has a high rate of antibiotic use. The Chinese Ministry of Health (MOH) established the Center for Antibacterial Surveillance (CAS) to monitor the use of antibacterial agents in hospitals in 2005. The purpose of this study was to identify trends, pattern changes and regional differences in antibiotic consumption in 151 public general tertiary hospitals across China from 2011–2014. Materials and methods Valid data for antibiotic use were collected quarterly, and the antibiotic consumption data were expressed as the defined daily dose (DDD) per 100 inpatient days (ID). We compared the patterns of antibiotic use in different classes and geographical clusters. Results Total antibiotic use significantly decreased (P = 0.018) from 75.86 DDD/100 ID in 2011 to 47.03 DDD/100 ID in 2014. The total consumption of flomoxef sodium and cefminox increased from 1.31 DDD/100 BD in 2011 to 8.6 DDD/100 BD in 2014. Cephalosporins were the most frequently used antibiotics in all regions. Third-generation cephalosporins accounted for more than 45% of the cephalosporins used. Carbapenem use substantially increased (P = 0.043). Penicillin combinations with inhibitors accounted for 50% of the penicillin used, and prescribed meropenem accounted for most of the carbapenems used in all regions in 2014. The subclasses in each antibiotic group were used differently between the seven regions, and the total hospital antibiotic use in 2014 differed significantly by region (P = 0.014). Conclusion Although the volume and intensity of total antibiotic use decreased, the antibiotic use patterns were not optimal, and broad-spectrum antibiotics were still the main classes. The aggregate data obtained during the study period reveal similar antibiotic consumption patterns in different regions. These findings provide useful information for improving the rational use of antibiotics. More detailed data on antibiotics linked to inpatient diseases need to be collected in future studies.
Collapse
Affiliation(s)
- Xiaoyuan Qu
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPS, Shandong University, Jinan, Shandong, China
| | - Chang Yin
- Information Center, National Institute of Hospital Administration, Beijing, China
| | - Xihong Sun
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPS, Shandong University, Jinan, Shandong, China
| | - Shusheng Huang
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPS, Shandong University, Jinan, Shandong, China
| | - Chaofan Li
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPS, Shandong University, Jinan, Shandong, China
| | - Panpan Dong
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPS, Shandong University, Jinan, Shandong, China
| | - Xiufang Lu
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPS, Shandong University, Jinan, Shandong, China
| | - Zhuo Zhang
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPS, Shandong University, Jinan, Shandong, China
| | - Aitian Yin
- School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPS, Shandong University, Jinan, Shandong, China
- * E-mail:
| |
Collapse
|
36
|
Sun Q, Wang Y, Hulth A, Xiao Y, Nilsson LE, Li X, Bi Z, Liu Y, Yin H, Luo Y, Nilsson M, Sun C, Zhu Y, Zheng B, Chen B, Sun P, Ding L, Xia X, Ottoson J, Löfmark S, Dyar OJ, Börjesson S, Lundborg CS. Study protocol for One Health data collections, analyses and intervention of the Sino-Swedish integrated multisectoral partnership for antibiotic resistance containment (IMPACT). BMJ Open 2018; 8:e017832. [PMID: 29358424 PMCID: PMC5780695 DOI: 10.1136/bmjopen-2017-017832] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION To effectively minimise the emergence and dissemination of antibiotic resistant bacteria, a holistic One Health approach is called for. The Sino-Swedish Integrated Multisectoral Partnership for Antibiotic Resistance Containment is a cross-sectoral and integrated project on antibiotic resistance, conducted in Shandong Province in China. This paper outlines the overall study protocol for the project. To our knowledge, this is the first research programme aiming to take a true holistic approach across multiple sectors simultaneously in China, and the first to incorporate both antibiotic use and infection prevention and control in addition to antibiotic resistance patterns. The project aims to address gaps in current knowledge and seeks to improve the situation through a system-wide intervention. By using a One Health approach we can address important research questions that individual discipline investigations are unable to. The results obtained should thus more closely reflect the world in which human health, animal health and the environment are inextricably and intimately interlinked. METHODS AND ANALYSIS Both quantitative and qualitative studies are included for households from 12 villages, their surrounding environment and a tertiary care hospital in a nearby town. The studies include analyses of antibiotic consumption for humans and pigs; qualitative and quantitative data on perceptions, knowledge and attitudes; faecal carriage of extended spectrum β-lactamase and carbapenemase-producing Enterobacteriaceae from pigs and humans, and occurrence in household drinking water, surface water, waste water and clinical bacterial isolates from the hospital. Carriage of methicillin-resistant Staphylococcus aureus in humans, household pigs and clinical bacterial isolates is also investigated. Furthermore, potential inter-relationships between these sources are analysed. A multifaceted One Health intervention is designed and implemented in 6 of the 12 villages. Repeated and continuous data collections take place over 2 years, where the repeated data collection is performed after 1 year of intervention. Comparisons are made between intervention and control villages, before and after the intervention. ETHICS Ethics approval was obtained from the first Affiliated Hospital, College of Medicine, Zhejiang University, China, reference number 2015#185 and 2015#283.
Collapse
Affiliation(s)
- Qiang Sun
- Shandong University, Center for Health Management and Policy, Jinan, China
- NHFPC (Shandong University), Key Laboratory of Health Economics and Policy Research, Jinan, China
| | - Yang Wang
- China Agricultural University, College of Veterinary Medicine, Beijing, China
| | - Anette Hulth
- Public Health Agency of Sweden, Solna, Sweden
- Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, Solna, Sweden
| | - Yonghong Xiao
- First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lennart E Nilsson
- Department of Clinical and Experimental Medicine, Linkopings universitet, Linkoping, Sweden
| | - Xuewen Li
- Department of Environment and Health, School of Public Health, Shandong University, Jinan, China
| | - Zhenwang Bi
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, China
| | - Yuqing Liu
- Shandong Academy of Agricultural Sciences, Jinan, China
- Key Laboratory of Animal Epidemic Prevention and Breeding in Shandong Province, Jinan, China
| | - Hong Yin
- Department of Clinical and Experimental Medicine, Linkopings universitet, Linkoping, Sweden
| | - Yanbo Luo
- Shandong Academy of Agricultural Sciences, Jinan, China
- Key Laboratory of Animal Epidemic Prevention and Breeding in Shandong Province, Jinan, China
| | - Maud Nilsson
- Department of Clinical and Experimental Medicine, Linkopings universitet, Linkoping, Sweden
| | - Chengtao Sun
- China Agricultural University, College of Veterinary Medicine, Beijing, China
| | - Yiqing Zhu
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Beiwen Zheng
- First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Baoli Chen
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, China
| | - Pan Sun
- Department of Environment and Health, School of Public Health, Shandong University, Jinan, China
| | - Lilu Ding
- Center for Health Management and Policy, Shandong University, Jinan, Shandong, China
- Affiliated Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Jiangsu, China
| | - Xi Xia
- China Agricultural University, College of Veterinary Medicine, Beijing, China
| | - Jakob Ottoson
- Risk and Benefit Assessment Department, National Food Agency, Uppsala, Sweden
| | | | - Oliver James Dyar
- Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, Solna, Sweden
| | | | | | - Cecilia Stalsby Lundborg
- Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, Solna, Sweden
| |
Collapse
|
37
|
Qiao M, Ying GG, Singer AC, Zhu YG. Review of antibiotic resistance in China and its environment. ENVIRONMENT INTERNATIONAL 2018; 110:160-172. [PMID: 29107352 DOI: 10.1016/j.envint.2017.10.016] [Citation(s) in RCA: 823] [Impact Index Per Article: 137.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/21/2017] [Accepted: 10/21/2017] [Indexed: 05/21/2023]
Abstract
Antibiotic resistance is a global health crisis linked to increased, and often unrestricted, antibiotic use in humans and animals. As one of the world's largest producers and consumers of antibiotics, China is witness to some of the most acute symptoms of this crisis. Antibiotics and antibiotic resistance genes (ARGs) are widely distributed in surface water, sewage treatment plant effluent, soils and animal wastes. The emergence and increased prevalence of ARGs in the clinic/hospitals, especially carbapenem-resistant gram negative bacteria, has raised the concern of public health officials. It is important to understand the current state of antibiotic use in China and its relationship to ARG prevalence and diversity in the environment. Here we review these relationships and their relevance to antimicrobial resistance (AMR) trends witnessed in the clinical setting. This review highlights the issues of enrichment and dissemination of ARGs in the environment, and also future needs in mitigating the spread of antibiotic resistance in the environment, particularly under the 'planetary health' perspective, i.e., the systems that sustain or threaten human health.
Collapse
Affiliation(s)
- Min Qiao
- State Key Lab of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Guang-Guo Ying
- State Key Laboratory of Organic Geochemistry, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China
| | - Andrew C Singer
- NERC Centre for Ecology & Hydrology, Wallingford OX10 8BB, United Kingdom
| | - Yong-Guan Zhu
- State Key Lab of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; Key Lab of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China.
| |
Collapse
|
38
|
Graham CJ. The global threat of antibiotic resistance: what can be done? JOURNAL OF GLOBAL HEALTH REPORTS 2017. [DOI: 10.29392/joghr.1.e2017002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
|
39
|
Li X, Chen Y, Gao W, Ye H, Shen Z, Wen Z, Wei J. A 6-year study of complicated urinary tract infections in southern China: prevalence, antibiotic resistance, clinical and economic outcomes. Ther Clin Risk Manag 2017; 13:1479-1487. [PMID: 29184412 PMCID: PMC5687777 DOI: 10.2147/tcrm.s143358] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Urinary tract infections (UTIs) are common nosocomial infections. This study evaluated the prevalence, pathogens, antibiotic resistances, clinical outcomes, and hospitalization costs associated with complicated UTIs in southern China, and risk factors delaying patient discharge. We retrospectively reviewed electronic medical records of 4,284 (61.4% women) complicated UTI-related hospitalizations from 2008 to 2013. Average patient age was 61.1 years and median hospital stay was 11 days. Pathogens were isolated from 1,071 urine and 148 blood specimens. Gram-negative bacteria were the most frequent and included Escherichia coli (48.2%), Klebsiella pneumoniae (9.5%), Pseudomonas aeruginosa (4.9%), and Proteus mirabilis (4.6%), while Enterococcus spp. (14.4%) was the most common Gram-positive bacteria causing UTIs. Both E. coli and K. pneumoniae showed high resistance rates (>45%) to wide-spectrum penicillins, cephalosporins, aztreonam, and ciprofloxacin. Resistances to beta-lactamase inhibitor/beta-lactam antibiotic combination were relatively lower. Imipenem, meropenem, and amikacin had the greatest activity against E.coli and K. pneumoniae. Recurrent infection was a risk factor for mortality. Age, sex, previous surgery, diabetes, and renal insufficiency were significant risk factors for delayed discharge (P<0.01). Response to initial treatment was associated with a lower cost. Initial empiric use of antibiotics least associated with resistance may reduce costs and medical resource usage.
Collapse
Affiliation(s)
- Xiaoyan Li
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou
| | - Yunqin Chen
- R&D Information, AstraZeneca, Pudong.,School of Life Sciences and Biotechnology, Shanghai JiaoTong University, Shanghai, China
| | | | - Hao Ye
- R&D Information, AstraZeneca, Pudong
| | | | - Zehuai Wen
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou
| | - Jia Wei
- R&D Information, AstraZeneca, Pudong
| |
Collapse
|
40
|
Wang X, Peng D, Wang W, Xu Y, Zhou X, Hesketh T. Massive misuse of antibiotics by university students in all regions of China: implications for national policy. Int J Antimicrob Agents 2017; 50:441-446. [PMID: 28668688 DOI: 10.1016/j.ijantimicag.2017.04.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 11/30/2022]
Abstract
Antimicrobial resistance (AMR) is one of the greatest threats to global health this century. The primary cause of AMR is antibiotic misuse, especially routine use of antibiotics for self-limiting illnesses. This study aimed to explore behaviours related to antibiotic use in university students across China. An electronic questionnaire was distributed at a major university in each of the six regions. A cluster random sampling method was adopted. The χ2 test and logistic regression were used to assess the relationship between knowledge and behaviour. A total of 11,192 students completed the questionnaire. In the past month, 3337 students (29.8%) reported a self-limiting illness, of whom 913 (27.3%) saw a doctor, 600 (65.7%) of whom were prescribed antibiotics [190 (31.7%) by infusion]; 136 students (22.7%) asked for and received antibiotics. Of the 1711 students (51.3%) who treated themselves, 507 (29.6%) self-medicated with antibiotics. In the past year, 23.0% of students had used antibiotics as prophylaxis, 63.1% kept a personal stock of antibiotics and 56.0% had bought antibiotics at a drugstore (two-thirds without a prescription). Students with lower knowledge scores about antibiotics were significantly more likely to see a doctor, be prescribed with antibiotics, self-medicate with antibiotics, and use antibiotics prophylactically. This massive misuse of antibiotics for self-limiting illnesses by well-educated young adults is a serious concern. A national campaign is urgently required to address rational prescribing of antibiotics by doctors, enforce existing restrictions on over-the-counter sale of antibiotics, and educate the general public about antibiotics and the management of self-limiting illnesses.
Collapse
Affiliation(s)
- Xiaomin Wang
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China
| | - Dandan Peng
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China
| | - Weiyi Wang
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China
| | - Yannan Xu
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China
| | - Xudong Zhou
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China.
| | - Therese Hesketh
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China; UCL Institute for Global Health, London, UK
| |
Collapse
|
41
|
Song MX, Li SH, Peng JY, Guo TT, Xu WH, Xiong SF, Deng XQ. Synthesis and Bioactivity Evaluation of N-Arylsulfonylindole Analogs Bearing a Rhodanine Moiety as Antibacterial Agents. Molecules 2017; 22:molecules22060970. [PMID: 28613234 PMCID: PMC6152656 DOI: 10.3390/molecules22060970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022] Open
Abstract
Due to the rapidly growing bacterial resistance to antibiotics and the scarcity of novel agents under development, bacterial infections are still a pressing global problem, making new types of antibacterial agents, which are effective both alone and in combination with traditional antibiotics, urgently needed. In this paper, seven series of N-arylsulfonylindole analogs 5–11 bearing rhodanine moieties were synthesized, characterized, and evaluated for antibacterial activity. According to the in vitro antimicrobial results, half of the synthesized compounds showed potent inhibition against four Gram-positive bacteria, with MIC values in the range of 0.5–8 µg/mL. For multidrug-resistant strains, compounds 6a and 6c were the most potent, with MIC values of 0.5 µg/mL, having comparable activity to gatifloxacin, moxiflocaxin and norfloxacin and being 128-fold more potent than oxacillin (MIC = 64 µg/mL) and 64-fold more active than penicillin (MIC = 32 µg/mL) against Staphylococcus aureusATCC 43300.
Collapse
Affiliation(s)
- Ming-Xia Song
- Basic Medical and Pharmacy College, Jinggangshan University, Ji'an 343009, Jiangxi, China.
| | - Song-Hui Li
- Basic Medical and Pharmacy College, Jinggangshan University, Ji'an 343009, Jiangxi, China.
| | - Jiao-Yang Peng
- Basic Medical and Pharmacy College, Jinggangshan University, Ji'an 343009, Jiangxi, China.
| | - Ting-Ting Guo
- Basic Medical and Pharmacy College, Jinggangshan University, Ji'an 343009, Jiangxi, China.
| | - Wen-Hui Xu
- Basic Medical and Pharmacy College, Jinggangshan University, Ji'an 343009, Jiangxi, China.
| | - Shao-Feng Xiong
- Basic Medical and Pharmacy College, Jinggangshan University, Ji'an 343009, Jiangxi, China.
| | - Xian-Qing Deng
- Basic Medical and Pharmacy College, Jinggangshan University, Ji'an 343009, Jiangxi, China.
| |
Collapse
|
42
|
Yang C, Cai WQ, Zhou ZJ. Evaluation of Outpatient Antibiotic Use in Beijing General Hospitals in 2015. Chin Med J (Engl) 2017; 130:288-296. [PMID: 28139511 PMCID: PMC5308010 DOI: 10.4103/0366-6999.198929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medical misuse of antibiotics is associated with the acquisition and spread of antibiotic resistance, resulting in a lack of effective drugs and increased health-care cost. Nevertheless, inappropriate antibiotic use in China remains common and the situation requires urgent improvement. Here, we analyzed the prescriptions of antibiotics and evaluated the rationality of antibiotic use among outpatients in Beijing general hospitals during 2015. METHODS We collected basic medical insurance claim data from January 1, 2015 to December 31, 2015 in 507 general hospitals of Beijing. A descriptive analysis of outpatient antibiotic prescribing was performed. The Anatomical Therapeutic Chemical Classification/defined daily doses system was used to evaluate the rationality of antibiotic use. RESULTS Over the study, an estimated 721,930, 613,520, and 822,480 antibiotics were dispensed in primary, secondary, and tertiary general hospitals corresponding to 5.09%, 5.06%, and 2.53% of all prescriptions, respectively. Antibiotic combinations represented 2.95%, 7.74%, and 10.18% of the total antibiotic prescriptions, respectively. Expenditure for the top twenty antibiotics in primary, secondary, and tertiary general hospitals was RMB 42.92, 65.89, and 83.26 million Yuan, respectively. Cephalosporins were the most frequently prescribed class of antibiotic in clinical practice. The antibiotics used inappropriately included azithromycin enteric-coated capsules, compound cefaclor tablets and nifuratel nysfungin vaginal soft capsules in primary hospitals, amoxicillin and clavulanate potassium dispersible tablets (7:1) and cefonicid sodium for injection in secondary hospitals, cefminox sodium for injection and amoxicillin sodium and sulbactam sodium for injection in tertiary hospitals. CONCLUSIONS Antibiotic use in Beijing general hospitals is generally low; however, inappropriate antibiotic use still exists. Inappropriately used antibiotics should be subject to rigorous control and management, and public policy initiatives are required to promote the judicious use of antibiotics.
Collapse
Affiliation(s)
- Chuan Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - Wen-Qiang Cai
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - Zi-Jun Zhou
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| |
Collapse
|
43
|
Li Y, Pang Y, Tong X, Zheng H, Zhao Y, Wang C. Mycobacterium kansasii Subtype I Is Associated With Clarithromycin Resistance in China. Front Microbiol 2016; 7:2097. [PMID: 28082964 PMCID: PMC5184217 DOI: 10.3389/fmicb.2016.02097] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022] Open
Abstract
Mycobacterium kansasii is the second most common cause of slowly growing non-tuberculous mycobacteria diseases in China. The aim of the present study was to analyze M. kansasii subtypes isolated from patients in China, and to explore the antimicrobial susceptibility of the differentiation among these diverse subtypes. A total of 78 M. kansasii strains from 16 provinces of China were enrolled in this study. Amikacin (AMK) was the most highly active against M. kansasii strains, and only 4 isolates (5.1%) exhibited in vitro resistance to AMK. The percentage of levofloxacin (LFX) resistant strains among the 78 M. kansasii isolates was 39.7% (31/78), which was significantly higher than that of moxifloxacin (16.7%, P = 0.001) and gatifloxacin (19.2%, P = 0.005). By using PCR-restriction fragment analysis of the hsp65 gene (PRA), all the isolates were classified as four different subtypes. Of these four subtypes, M. kansasii subtype I was the most frequent genotype in China, accounting for 71.8% (56/78) of M. kansasii isolates. Resistance to clarithromycin (CLA) was noted in 26.8% (15/56) of subtype I isolates, which was significant higher than that of other subtypes (4.5%, P = 0.031). DNA sequencing revealed that the presence of mutations in 23S rRNA was associated with 56.2% (9/16) of CLA-resistant M. kansasii isolates. In conclusion, our data demonstrate that AMK is the most active agent against M. kansasii in vitro, while the high proportion of CLA resistance is noted in M. kansasii isolates. In addition, the predominant subtype I is associated with CLA resistance in China.
Collapse
Affiliation(s)
- Yanming Li
- Graduate School, Peking Union Medical CollegeBeijing, China; Department of Respiratory and Critical Care Medicine, Beijing HospitalBeijing, China
| | - Yu Pang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention Beijing, China
| | - Xunliang Tong
- Department of Geriatrics, Beijing Hospital Beijing, China
| | - Huiwen Zheng
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention Beijing, China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention Beijing, China
| | - Chen Wang
- Graduate School, Peking Union Medical CollegeBeijing, China; Department of Respiratory Medicine, Chinese-Japanese Friendship HospitalBeijing, China
| |
Collapse
|
44
|
Cars O, Xiao Y, Stålsby Lundborg C, Nilsson LE, Shen J, Sun Q, Bi Z, Börjesson S, Greko C, Wang Y, Liu Y, Ottoson J, Li X, Nilsson M, Yin H, Bi Z, Zheng B, Xia X, Chen B, Ding L, Sun P, Dyar OJ, Hulth A, Tomson G. Building bridges to operationalise one health - A Sino-Swedish collaboration to tackle antibiotic resistance. One Health 2016; 2:139-143. [PMID: 28616488 PMCID: PMC5441327 DOI: 10.1016/j.onehlt.2016.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 01/21/2023] Open
Abstract
Antibiotic resistance is a complex global health challenge. The recent Global Action Plan on antimicrobial resistance highlights the importance of adopting One Health approaches that can cross traditional disciplinary boundaries. We report on the early experiences of a multisectoral Sino-Swedish research project that aims to address gaps in our current knowledge and seeks to improve the situation through system-wide interventions. Our research project is investigating antibiotic use and resistance in a rural area of China through a combination of epidemiological, health systems and laboratory investigations. We reflect here on the challenges inherent in conducting long distance cross-disciplinary collaborations, having now completed data and sample collection for a baseline situation analysis. In particular, we recognise the importance of investing in aspects such as effective communication, shared conceptual frameworks and leadership. We suggest that our experiences will be instructive to others planning to develop similar international One Health collaborations. Antibiotic resistance is a complex global health challenge One Health approaches are needed to facilitate understanding and action China is one of the largest producers and consumers of antibiotics in the world China is giving attention to antibiotic resistance at the highest political level We report on the early stages of a Sino-Swedish One Health research programme
Collapse
Affiliation(s)
- Otto Cars
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Yonghong Xiao
- First Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Cecilia Stålsby Lundborg
- Global Health - Health Systems and Policy, Dept of Public Health Sciences, Karolinska Institutet, Sweden
| | - Lennart E Nilsson
- Dept of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Jianzhong Shen
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Qiang Sun
- Center for Health Management and Policy, Shandong University, China
| | - Zhenqiang Bi
- Shandong Center for Disease Control and Prevention, Jinan, China
| | | | | | - Yang Wang
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Yuqing Liu
- Shandong Academy of Agricultural Science, Jinan, China
| | | | - Xuewen Li
- School of Public Health, Shandong University, China
| | - Maud Nilsson
- Dept of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Hong Yin
- Dept of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Zhenwang Bi
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Beiwen Zheng
- First Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Xi Xia
- College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Baoli Chen
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Lilu Ding
- Center for Health Management and Policy, Shandong University, China
| | - Pan Sun
- School of Public Health, Shandong University, China
| | - Oliver James Dyar
- Global Health - Health Systems and Policy, Dept of Public Health Sciences, Karolinska Institutet, Sweden
| | - Anette Hulth
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Göran Tomson
- Global Health - Health Systems and Policy, Dept of Public Health Sciences, Karolinska Institutet, Sweden.,Dept of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| |
Collapse
|
45
|
Gong S, Qiu X, Song Y, Sun X, He Y, Chen Y, Li M, Luo R, He L, Wei Q, Shen S, Liu Y, Zhang L, Zhou W, Huang P, Mai J, Liu L, Xu Y, Liang H, Xia H. Effect of Financially Punished Audit and Feedback in a Pediatric Setting in China, within an Antimicrobial Stewardship Program, and as Part of an International Accreditation Process. Front Public Health 2016; 4:99. [PMID: 27242991 PMCID: PMC4870519 DOI: 10.3389/fpubh.2016.00099] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/02/2016] [Indexed: 01/21/2023] Open
Abstract
Background Prior authorization, audit and feedback, and pay for performance are the three core “active” strategies of antimicrobial stewardship program (ASP), yet little is known about the individual or combined benefits of such programs, particularly in a pediatric setting. Objectives The aim of this study was to compare these core ASP strategies and determine the incremental effect of financially punished audit and feedback. Methods During the journey to the Joint Commission International accreditation, a tertiary pediatric medical center performed two different hospital-wide stewardship interventions in succession. The first stage without formalized ASPs served as pre-intervention period, January 2011 to April 2011. The ASP used prior authorization alone during the first-intervention period, May 2011 to September 2011. In October 2011, financially punished audit and feedback was introduced, marking the start of the second-intervention period, October 2011 to November 2012. We compared the differences of the change in monthly average use of antibiotics and expenditure on antibiotics before and after the ASP changes by using interrupted time series via dynamic regression. The main end points included the proportions of antibiotic prescriptions and expenditure on antibacterial relative to all medications. Results Before the second-intervention period, neither the proportion of antibiotic prescriptions nor the proportion of expenditure on antibiotics declined significantly in both ambulatory and inpatient settings. However, after the introduction of financially punished audit and feedback, the proportion of both antibiotic prescriptions (β = −6.269, P < 0.001, and reduction = 59.4% for outpatients; β = −1.235, P < 0.001, and reduction = 19.8% for inpatients) and expenditure on antibiotics (β = −7.777, P < 0.001, and reduction = 46.7% for outpatients; β = −4.933, P = 0.001, and reduction = 16.3% for inpatients) dropped immediately. Conclusion The combination of more than one core strategies (prior authorization, audit and feedback, and pay for performance) will be more effective than one strategy alone.
Collapse
Affiliation(s)
- Sitang Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Yanyan Song
- Department of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Xin Sun
- Department of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Yanling He
- Department of Pharmacy, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Yilu Chen
- Department of Pharmacy, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Minqing Li
- Department of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Rui Luo
- Department of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Liya He
- Department of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Qing Wei
- Department of Medical Administration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Songying Shen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Yu Liu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Lian Zhang
- Department of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Wei Zhou
- Department of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Ping Huang
- Department of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Jianning Mai
- Department of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Li Liu
- Department of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Yi Xu
- Department of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| | - Huiying Liang
- Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou Medical University , Guangzhou , China
| | - Huimin Xia
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China
| |
Collapse
|
46
|
Fan Y, Hao F, Wang W, Lu Y, He L, Wang G, Chen W. Multicenter cross-sectional observational study of antibiotic resistance and the genotypes of Propionibacterium acnes isolated from Chinese patients with acne vulgaris. J Dermatol 2015; 43:406-13. [PMID: 26508505 DOI: 10.1111/1346-8138.13149] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/19/2015] [Indexed: 12/01/2022]
Abstract
Antibiotics are widely applied in management of acne vulgaris, which raises the issue of antibiotic resistance. Due to improper application and supervision of antibiotics, antibiotic resistance has become a serious problem in China. So, the efficacy of antimicrobial therapy in acne is unclear without an objective monitor of antibiotic resistance of Propionibacterium acnes. This cross-sectional, multicenter observational study is aimed at understanding the status of antibiotic resistance in P. acnes, investigating the measures of acne management in China and analyzing the genotypes of antibiotic-resistant strains of P. acnes. Altogether, 312 strains of P. acnes were collected from patients in five medical centers across central China after reviewing the corresponding medical history in detail. The samples underwent antibiotic susceptibility assays by agar dilution method with a total of 11 classes of antibiotics being tested. The antibiotic-resistant strains were screened and further analyzed by investigation of the genotypes regarding 23S rRNA, 16S rRNA and erm(X). The predominant resistance occurred in macrolides and lincomycin with an overall resistance rate of 47.8%. The resistance to tetracyclines was scarce with only two cases identified. The emergence of minimum inhibitory concentration elevation for tetracyclines is associated with its application history (P < 0.005). The genotypes of the reported macrolide-lincosamide-streptogramin B resistance strains were also spotted in Chinese subjects while other resistance determinants may also exist. The tetracyclines have been proved to be vastly susceptible while macrolides and lincomycin face a serious resistance status in China.
Collapse
Affiliation(s)
- Yukun Fan
- Department of Dermatology and Venereology, Southwest Hospital Affiliated to The Third Military Medical University, Chongqing, China
| | - Fei Hao
- Department of Dermatology and Venereology, Southwest Hospital Affiliated to The Third Military Medical University, Chongqing, China
| | - Weizhen Wang
- Department of Dermatology, The First Hospital of Wuhan, Tongji Medical College, Wuhan, China
| | - Yonghong Lu
- Department of Dermatology and Venereology, The Second People's Hospital of Chengdu, Chengdu, China
| | - Li He
- Department of Dermatology and Venereology, The First Hospital Affiliated to The Kunming Medical University, Kunming, China
| | - Gang Wang
- Department of Dermatology and Venereology, Xijing Hospital Affiliated to The Fourth Military Medical University, Xi'an, China
| | - Wenchieh Chen
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| |
Collapse
|
47
|
Yang W, Hu L, Wang Z, Nie G, Li X, Lin D, Luo J, Qin H, Wu J, Wen W, Lei W. Deep Neck Infection: A Review of 130 Cases in Southern China. Medicine (Baltimore) 2015; 94:e994. [PMID: 26166132 PMCID: PMC4504584 DOI: 10.1097/md.0000000000000994] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The study aims to present our experience of the clinical course and management of deep neck infection and try to determine if the characteristics of this kind of infection were similar between the children and adults in southern China.Patients diagnosed with deep neck infection in the Division of Otolaryngology in the First Affiliated Hospital of Sun Yat-sen University between January 2002 and December 2011 were screened retrospectively for demographic characteristics, presenting symptoms, antibiotic therapy before admission, the history of antibiotics abuse, leucocyte count, etiology, bacteriology, disease comorbidity, imaging, treatment, complications, and outcomes.One hundred thirty patients were included and 44 (33.8%) were younger than 18 years old (the children group), 86 patients (66.2%) were older than 18 years old (the adults group). Fever, trismus, neck pain, and odynophagia were the most common symptoms in both groups. Forty children (90.9%) and 49 adults (57.0%) had been treated with broad-spectrum antibiotic therapy before admission. Thirty one children (70.5%) and 24 adults (27.9%) had a history of antibiotics abuse. In children group, the site most commonly involved was the parapharyngeal space (18 patients, 40.9%). In adults group, the site most commonly involved was multispace (30 patients, 34.9%). In children group, the most common cause was branchial cleft cyst (5 patients, 11.4%) and the cause remained unknown in 31 patients (70.5%). In adults group, the most common cause was pharyngeal infection (19 patients, 22.2%). All of the 27 patients with associated disease comorbidity were adults and 17 were diabetes mellitus (DM). Streptococcus viridans was the most common pathogen in both children and adults groups. Eighty six (66.2%) underwent surgical drainage and complications were found in 31 patients (4 children, 27 adults).Deep neck infection in adults is easier to have multispace involvement and lead to complications and appears to be more serious than that in children. Understanding the different characteristics between the children and adults with deep neck infection may be helpful in accurate evaluation and proper management.
Collapse
Affiliation(s)
- Weiqiang Yang
- From the Otorhinolaryngology Hospital, Otorhinolaryngology Institute, The First Affiliated Hospital, Sun Yat-sen University (WY, LH, ZW, JL, JW, WW, WL); the Otolaryngological Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong (WY, GN); Master Candidate in Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou (XL); Division of Otorhinolaryngology, First People's Hospital of Foshan, Foshan (HQ); and Division of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (DL)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Zhang R, Wang F, Kang J, Wang X, Yin D, Dang W, Duan J. Prevalence of multidrug resistant Gram-positive cocci in a Chinese hospital over an 8-year period. Int J Clin Exp Med 2015; 8:9462-9469. [PMID: 26309609 PMCID: PMC4538018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
Gram-positive cocci are common causes of bloodstream and nosocomial infections, and their multi-drug resistance is an increasingly serious problem. The present study aimed to assess the prevalence of multi-drug-resistant Gram-positive cocci in a Chinese population. In this retrospective study, data about Gram-positive cocci from in-patients (January 2006 and December 2013) at the Second Hospital of Shanxi Medical University, Taiyuan, China, were reviewed. Antimicrobial susceptibility profile of the isolated Gram-positive cocci was evaluated using the disk diffusion method. Antibiotic resistance was determined according to the Clinical and Laboratory Standards Institute 2009 guidelines. The prevalence of drug resistance was determined, as well as correlation coefficients for various drugs between the resistance rate and year of sample collection. A total of 7789 Gram-positive cocci isolates were found, including 2576 (33%) coagulase-negative Staphylococci, 1477 (19%) Staphylococci aureus, 1343 (17%) Enterococcus faecalis, and 1139 (15%) Enterococcus faecium. The proportions of methicillin-resistant Staphylococci aureus (MRSA) and methicillin-resistant Staphylococci (MRS) were 31.5% (465/1477) and 61.6% (1587/2576), respectively. Among all isolates, MRS had much higher drug resistance rate than methicillin-sensitive Staphylococci (P<0.05). E. faecalis had a higher multi-drug resistance rate than E. faecium (P<0.01). Interestingly, MRSA resistance rates declined over the years, showing a negative correlation coefficient for all drugs, with significance for levofloxacin, azithromycin, erythromycin, and clindamycin (P<0.05), but not sulphamethoxazole/trimethoprim (P=0.057) and gentamicin (P=0.186). These results indicated that Staphylococci were the predominant Gram-positive cocci isolated. There was a trend of decreasing MRSA in the population studied.
Collapse
Affiliation(s)
- Ruiqin Zhang
- Department of Pharmacy, The Second Hospital of Shanxi Medical UniversityTaiyuan 030000, Shanxi Province, China
| | - Fengzhi Wang
- Department of Medicine, The Second Hospital of Shanxi Medical UniversityTaiyuan 030000, Shanxi Province, China
| | - Jianbang Kang
- Department of Pharmacy, The Second Hospital of Shanxi Medical UniversityTaiyuan 030000, Shanxi Province, China
| | - Xinchun Wang
- Department of Pharmacy, The Second Hospital of Shanxi Medical UniversityTaiyuan 030000, Shanxi Province, China
| | - Donghong Yin
- Department of Pharmacy, The Second Hospital of Shanxi Medical UniversityTaiyuan 030000, Shanxi Province, China
| | - Wen Dang
- Department of Pharmacy, The Second Hospital of Shanxi Medical UniversityTaiyuan 030000, Shanxi Province, China
| | - Jinju Duan
- Department of Pharmacy, The Second Hospital of Shanxi Medical UniversityTaiyuan 030000, Shanxi Province, China
| |
Collapse
|
49
|
Otter J. Journal Roundup. J Hosp Infect 2015. [DOI: 10.1016/j.jhin.2015.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
50
|
Guo W, He Q, Wang Z, Wei M, Yang Z, Du Y, Wu C, He J. Influence of antimicrobial consumption on gram-negative bacteria in inpatients receiving antimicrobial resistance therapy from 2008-2013 at a tertiary hospital in Shanghai, China. Am J Infect Control 2015; 43:358-64. [PMID: 25838134 DOI: 10.1016/j.ajic.2014.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Irrational use of antimicrobial agents is a major cause of increased antimicrobial resistance. Effective antibiotic stewardship strategies nationwide or in local health care settings are necessary to reduce antibiotic use and bacteria resistance. METHODS We evaluated the effectiveness of China's antimicrobial stewardship policy on antimicrobial use and applied time-series analysis methodology to determine the temporal relationship between antibiotic use and gram-negative bacteria resistance at Changhai Hospital from 2008-2013. Isolates investigated included Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. RESULTS Consumption of 7 restricted-use antibiotics was dramatically reduced. Resistance to ceftazidime in P aeruginosa and A baumannii and resistance to ciprofloxacin in P aeruginosa significantly decreased. By using cross-correlation analysis, associations between ciprofloxacin resistance in P aeruginosa and fluoroquinolones consumption (r = 0.48; lag = 0; P = .02), ceftazidime resistance in P aeruginosa and third-generation cephalosporins consumption (r = 0.54; lag = -1; P = .01) were identified. No substantial association between other pairs was found. CONCLUSIONS Enhanced nationwide antimicrobial stewardship campaigns launched in 2011 have made great achievements in regard to antibiotic use but have had limited effects on the reversal of gram-negative bacteria resistance in health care settings. Sound infection prevention and control programs to reduce the transmission of resistant pathogens for hospitals in China are urgently needed.
Collapse
|