Social dilemma in the excess use of antimicrobials incurring antimicrobial resistance

The straight and narrow: A game theory model of broad- and narrow-spectrum empiric antibiotic therapy

Physicians prescribe empiric antibiotic treatment when definitive knowledge of the pathogen causing an infection is lacking. The options of empiric treatment can be largely divided into broad- and narrow-spectrum antibiotics. Prescribing a broad-spectrum antibiotic increases the chances of covering the causative pathogen, and hence benefits the current patient's recovery. However, prescription of broad-spectrum antibiotics also accelerates the expansion of antibiotic resistance, potentially harming future patients. We analyse the social dilemma using game theory. In our game model, physicians choose between prescribing broad and narrow-spectrum antibiotics to their patients. Their decisions rely on the probability of an infection by a resistant pathogen before definitive laboratory results are available. We prove that whenever the equilibrium strategies differ from the socially optimal policy, the deviation is always towards a more excessive use of the broad-spectrum antibiotic. We further show that if prescribing broad-spectrum antibiotics only to patients with a high probability of resistant infection is the socially optimal policy, then decentralization of the decision making may make this policy individually irrational, and thus sabotage its implementation. We discuss the importance of improving the probabilistic information available to the physician and promoting centralized decision making.

Perceptions of antibiotic resistance among hospital healthcare professionals in high-income countries: A systematic review of causes, consequences, and solutions

OBJECTIVE

Antibiotic resistance (ABR) is a major threat to public health. Hospital healthcare professionals are important stakeholders in curbing ABR. To be able to encourage healthcare professionals to act against ABR, information on their perceptions is needed. Yet, summary evidence on how healthcare professionals perceive ABR causes, consequences, and solutions is outdated. This review aims to elucidate these perceptions.

METHODS

We searched MEDLINE, EMBASE, PsycINFO, and CINAHL for literature published until July 6th, 2022, and used Web of Science and Scopus to identify reports citing included studies. Reports of quantitative original research from high-income countries were included if they investigated hospital healthcare professionals' perceptions about ABR. Descriptive data and data on perceptions about causes, consequences, and solutions regarding ABR were extracted. PROSPERO registration: CRD42022359249.

RESULTS

The database search and citation tracking yielded 13,551 and 694 papers respectively. Forty-eight reports from 46 studies were included in the review. These studies were performed between 1999 and 2023 and included between 8 and 1362 participants. Healthcare professionals perceived ABR as a problem that is more severe nationally than locally and they primarily recognize ABR as a distant and abstract problem. Studies mostly concurred on prescribing behavior as a cause and a solution for ABR, while external causes and solutions (e.g., in agriculture) elicited less agreement.

CONCLUSIONS

Studies with a primary focus on the perceptions of healthcare professionals about ABR are limited. Healthcare professionals perceive prescribing behavior as a major cause of ABR and a focus area for ABR solutions.

Antimicrobial Hydrogels: Potential Materials for Medical Application

Microbial infections based on drug-resistant pathogenic organisms following surgery or trauma and uncontrolled bleeding are the main causes of increased mortality from trauma worldwide. The prevalence of drug-resistant pathogens has led to a significant increase in medical costs and poses a great threat to the normal life of people. This is an important issue in the field of biomedicine, and the emergence of new antimicrobial materials hydrogels holds great promise for solving this problem. Hydrogel is an important material with good biocompatibility, water absorption, oxygen permeability, adhesion, degradation, self-healing, corrosion resistance, and controlled release of drugs as well as structural diversity. Bacteria-disturbing hydrogels have important applications in the direction of surgical treatment, wound dressing, medical device coating, and tissue engineering. This paper reviews the classification of antimicrobial hydrogels, the current status of research, and the potential of antimicrobial hydrogels for one application in biomedicine, and analyzes the current research of hydrogels in biomedical applications from five aspects: metal-loaded hydrogels, drug-loaded hydrogels, carbon-material-loaded hydrogels, hydrogels with fixed antimicrobial activity and biological antimicrobial hydrogels, and provides an outlook on the high antimicrobial activity, biodegradability, biocompatibility, injectability, clinical applicability and future development prospects of hydrogels in this field.

Study of bismuth metal organic skeleton composites with photocatalytic antibacterial activity

A composite based on Ag and carbon quantum dot (CQDs) doped bismuth metal organic framework (CAU-17) was synthesized by a one-step thermal solvent in situ growth. The microstructure, chemical composition, morphology, photogenerated electron-hole pairs, and photocatalytic activity of the composite were characterized. The produced composite with its unique energy band structure, enhances the visible light absorption and effectively delays the recombination of the photogenerated carriers. On the other hand, the modification with CQDs increases the concentration and transport rate of photogenerated carriers mainly attributed to their superior electron transport capacity and light trapping ability. The photocatalytic antibacterial effect of CAU-17/Ag/CQDs against common Gram-positive, Gram-negative bacteria (Staphylococcus aureus, Escherichia coli) and drug-resistant bacteria (methicillin-resistant Staphylococcus aureus), as well as its inhibition against HepG2 tumor cell were investigated. The results showed that CAU-17/Ag/CQDs exhibited a photocatalytic antibacterial effect with an inactivation rate as high as 99.9 %. At the low dose (0.2 mg/mL), CAU-17/Ag/CQDs indicated a significant inhibition against bacterial growth 20 min after visible light exposure, whereas at the concentration of 0.5 mg/mL, CAU-17/Ag/CQDs completely killed all the tested bacteria. At the concentration of 0.8 mg/mL, the inhibition rate against HepG2 tumor cells reached 75 %. The excellent photocatalytic property of the as prepared composite contributed to the doping of Ag and CQDs, which fundamentally altered the morphology and energy band distribution. Such a composite can be developed into an effective photocatalytic disinfection system and applied to water purification systems, biofilm rejection, combating different antibiotic resistances, and tumor therapy.