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Lewnard JA, Charani E, Gleason A, Hsu LY, Khan WA, Karkey A, Chandler CIR, Mashe T, Khan EA, Bulabula ANH, Donado-Godoy P, Laxminarayan R. Burden of bacterial antimicrobial resistance in low-income and middle-income countries avertible by existing interventions: an evidence review and modelling analysis. Lancet 2024; 403:2439-2454. [PMID: 38797180 DOI: 10.1016/s0140-6736(24)00862-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/18/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
National action plans enumerate many interventions as potential strategies to reduce the burden of bacterial antimicrobial resistance (AMR). However, knowledge of the benefits achievable by specific approaches is needed to inform policy making, especially in low-income and middle-income countries (LMICs) with substantial AMR burden and low health-care system capacity. In a modelling analysis, we estimated that improving infection prevention and control programmes in LMIC health-care settings could prevent at least 337 000 (95% CI 250 200-465 200) AMR-associated deaths annually. Ensuring universal access to high-quality water, sanitation, and hygiene services would prevent 247 800 (160 000-337 800) AMR-associated deaths and paediatric vaccines 181 500 (153 400-206 800) AMR-associated deaths, from both direct prevention of resistant infections and reductions in antibiotic consumption. These estimates translate to prevention of 7·8% (5·6-11·0) of all AMR-associated mortality in LMICs by infection prevention and control, 5·7% (3·7-8·0) by water, sanitation, and hygiene, and 4·2% (3·4-5·1) by vaccination interventions. Despite the continuing need for research and innovation to overcome limitations of existing approaches, our findings indicate that reducing global AMR burden by 10% by the year 2030 is achievable with existing interventions. Our results should guide investments in public health interventions with the greatest potential to reduce AMR burden.
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Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
| | - Esmita Charani
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Alec Gleason
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Clare I R Chandler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Tapfumanei Mashe
- One Health Office, Ministry of Health and Child Care, Harare, Zimbabwe; Health System Strengthening Unit, WHO, Harare, Zimbabwe
| | - Ejaz Ahmed Khan
- Department of Pediatrics, Shifa Tameer-e-Millat University, Shifa International Hospital, Islamabad, Pakistan
| | - Andre N H Bulabula
- Division of Disease Control and Prevention, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Pilar Donado-Godoy
- AMR Global Health Research Unit, Colombian Integrated Program of Antimicrobial Resistance Surveillance, Corporación Colombiana de Investigación Agropecuaria, Cundinamarca, Colombia
| | - Ramanan Laxminarayan
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
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Gacheri J, Hamilton KA, Munywoki P, Wakahiu S, Kiambi K, Fèvre EM, Oluka MN, Guantai EM, Moodley A, Muloi DM. Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003046. [PMID: 38662675 PMCID: PMC11045065 DOI: 10.1371/journal.pgph.0003046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
The COVID-19 pandemic has significantly impacted healthcare systems, including antibiotic use practices. We present data on patterns of antibiotic dispensing and use in community and hospital settings respectively in Nairobi, Kenya during the pandemic. We conducted interviews with 243 pharmacies in Nairobi using a standardised questionnaire from November to December 2021. The data collected included demographic characteristics, antibiotic customers, types of antibiotics sold, and antibiotic prescribing practices. Additionally, we retrospectively reviewed health records for 992 and 738 patients admitted in COVID-19 and general wards at two large inpatient hospitals between April 2020 and May 2021, and January 2019 to October 2021, respectively. Demographic, utilisation of laboratory services, treatment, clinical, and outcome data were collected using a modified Global WHO Point Prevalence Surveys (Global-PPS) tool. Almost all pharmacies (91.4%) served customers suspected of having COVID-19 with a mean weekly number of 15.6 customers. All pharmacies dispensed antibiotics, mainly azithromycin and beta lactams to suspected COVID-19 infected customers. 83.4% of hospitalised COVID-19 patients received at least one antibiotic at some point during their hospitalisation, which was significantly higher than the 53.8% in general ward patients (p<0.001). Similarly, the average number of antibiotics administered to COVID-19 patients was higher than that of patients in the general ward (1.74 vs 0.9). Azithromycin and ceftriaxone were the most commonly used antibiotics in COVID-19 patients compared to ceftriaxone and metronidazole in the general wards. Only 2% of antibiotic prescriptions for COVID-19 patients were supported by microbiological investigations, which was consistent with the proportion of 6.8% among the general ward population. Antibiotics were commonly prescribed to customers and patients suspected of having COVID-19 either in community pharmacies or in hospital, without a prescription or laboratory diagnosis. These findings emphasize the crucial role of antibiotic stewardship, particularly in community pharmacies, in the context of COVID-19.
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Affiliation(s)
- June Gacheri
- International Livestock Research Institute, Nairobi, Kenya
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, University of Nairobi, Nairobi, Kenya
| | - Katie A. Hamilton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Karen Kiambi
- International Livestock Research Institute, Nairobi, Kenya
| | - Eric M. Fèvre
- International Livestock Research Institute, Nairobi, Kenya
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Margaret N. Oluka
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, University of Nairobi, Nairobi, Kenya
| | - Eric M. Guantai
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, University of Nairobi, Nairobi, Kenya
| | - Arshnee Moodley
- International Livestock Research Institute, Nairobi, Kenya
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Dishon M. Muloi
- International Livestock Research Institute, Nairobi, Kenya
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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3
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Kovacevic A, Smith DRM, Rahbé E, Novelli S, Henriot P, Varon E, Cohen R, Levy C, Temime L, Opatowski L. Exploring factors shaping antibiotic resistance patterns in Streptococcus pneumoniae during the 2020 COVID-19 pandemic. eLife 2024; 13:e85701. [PMID: 38451256 PMCID: PMC10923560 DOI: 10.7554/elife.85701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Non-pharmaceutical interventions implemented to block SARS-CoV-2 transmission in early 2020 led to global reductions in the incidence of invasive pneumococcal disease (IPD). By contrast, most European countries reported an increase in antibiotic resistance among invasive Streptococcus pneumoniae isolates from 2019 to 2020, while an increasing number of studies reported stable pneumococcal carriage prevalence over the same period. To disentangle the impacts of the COVID-19 pandemic on pneumococcal epidemiology in the community setting, we propose a mathematical model formalizing simultaneous transmission of SARS-CoV-2 and antibiotic-sensitive and -resistant strains of S. pneumoniae. To test hypotheses underlying these trends five mechanisms were built into the model and examined: (1) a population-wide reduction of antibiotic prescriptions in the community, (2) lockdown effect on pneumococcal transmission, (3) a reduced risk of developing an IPD due to the absence of common respiratory viruses, (4) community azithromycin use in COVID-19 infected individuals, (5) and a longer carriage duration of antibiotic-resistant pneumococcal strains. Among 31 possible pandemic scenarios involving mechanisms individually or in combination, model simulations surprisingly identified only two scenarios that reproduced the reported trends in the general population. They included factors (1), (3), and (4). These scenarios replicated a nearly 50% reduction in annual IPD, and an increase in antibiotic resistance from 20% to 22%, all while maintaining a relatively stable pneumococcal carriage. Exploring further, higher SARS-CoV-2 R0 values and synergistic within-host virus-bacteria interaction mechanisms could have additionally contributed to the observed antibiotic resistance increase. Our work demonstrates the utility of the mathematical modeling approach in unraveling the complex effects of the COVID-19 pandemic responses on AMR dynamics.
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Affiliation(s)
- Aleksandra Kovacevic
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - David RM Smith
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- Health Economics Research Centre, Nuffield Department of Health, University of OxfordOxfordUnited Kingdom
| | - Eve Rahbé
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - Sophie Novelli
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
| | - Paul Henriot
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiersParisFrance
| | - Emmanuelle Varon
- Centre National de Référence des Pneumocoques, Centre Hospitalier Intercommunal de CréteilCréteilFrance
| | - Robert Cohen
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000CréteilFrance
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200NiceFrance
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier, Intercommunal de CréteilCréteilFrance
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000CréteilFrance
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000OrléansFrance
| | - Corinne Levy
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000CréteilFrance
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200NiceFrance
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000CréteilFrance
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000OrléansFrance
| | - Laura Temime
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiersParisFrance
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiersParisFrance
| | - Lulla Opatowski
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE) unitParisFrance
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Inserm U1018, CESP, Anti-infective evasion and pharmacoepidemiology teamMontigny-Le-BretonneuxFrance
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4
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Sarkar S, Okafor C. Effect of veterinary feed directive rule changes on tetracycline-resistant and erythromycin-resistant bacteria (Salmonella, Escherichia, and Campylobacter) in retail meats in the United States. PLoS One 2023; 18:e0289208. [PMID: 37535600 PMCID: PMC10399851 DOI: 10.1371/journal.pone.0289208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Antimicrobial-resistant bacteria are a growing public health threat. In 2017 the U.S. Food and Drug Administration implemented Veterinary Feed Directive (VFD) rules changes to limit medically important antimicrobial use in food-producing animals, combating antimicrobial-resistant bacteria. The effect of the VFD rule changes on the occurrence of bacteria resistant to medically-important antimicrobials in retail meats is yet to be investigated in the U.S. This study investigates whether the VFD rule changes affected the occurrence of tetracycline-resistant and erythromycin-resistant bacteria (Salmonella, Escherichia, and Campylobacter) in retail meats in the U.S. METHODS Multivariable mixed effect logistic regression models were used to analyze 2002-2019 retail meats surveillance data from the National Antimicrobial Resistance Monitoring System (NARMS) in the U.S. Variables included VFD rule changes, meat type, quarter of year, and raising claims. A potential association between these variables and the occurrence of tetracycline-resistant and erythromycin-resistant bacteria (Salmonella, Escherichia, and Campylobacter) in retail meats was estimated. RESULTS Analysis included data regarding tetracycline-resistant Salmonella (n = 8,501), Escherichia (n = 20, 283), Campylobacter (n = 9,682), and erythromycin-resistant Campylobacter (n = 10,446) in retail meats. The odds of detecting tetracycline-resistant Escherichia (OR = 0.60), Campylobacter (OR = 0.89), and erythromycin-resistant Campylobacter (OR = 0.43) in chicken breast significantly decreased after the VFD rule changes, compared to the pre-VFD rule change period. The odds of detecting tetracycline-resistant Salmonella (0.66), Escherichia (OR = 0.56), and Campylobacter (OR = 0.33) in ground turkey also significantly decreased. However, the odds of detecting tetracycline-resistant Salmonella (OR = 1.49) in chicken breast and erythromycin-resistant Campylobacter (OR = 4.63) in ground turkey significantly increased. There was no significant change in the odds of detecting tetracycline-resistant Salmonella and Escherichia in ground beef or pork chops. CONCLUSIONS The implementation of VFD rule changes had a beneficial effect by reducing the occurrence of tetracycline-resistant and erythromycin-resistant bacteria in chicken and ground turkey. Ongoing surveillance of antimicrobial resistance and antimicrobial use could complement the implementation of stewardship such as VFD rule in food-producing animals in the U.S.
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Affiliation(s)
- Shamim Sarkar
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States of America
| | - Chika Okafor
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States of America
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5
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Danion F, Margue M, Ruch Y, Séverac F, Hansmann Y. Seasonal variation in azithromycin prescription. THE LANCET. INFECTIOUS DISEASES 2023; 23:277-278. [PMID: 36736337 DOI: 10.1016/s1473-3099(23)00009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Affiliation(s)
- François Danion
- Department of Infectious Diseases, CHU de Strasbourg, University of Strasbourg, 67 000 Strasbourg, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Inserm UMR_S 1109, Strasbourg, France.
| | - Magali Margue
- Department of Infectious Diseases, CHU de Strasbourg, University of Strasbourg, 67 000 Strasbourg, France
| | - Yvon Ruch
- Department of Infectious Diseases, CHU de Strasbourg, University of Strasbourg, 67 000 Strasbourg, France
| | - François Séverac
- Groupe Méthodes en Recherche Clinique (GMRC), CHU de Strasbourg, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious Diseases, CHU de Strasbourg, University of Strasbourg, 67 000 Strasbourg, France
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Rogawski McQuade ET, Brennhofer SA, Elwood SE, McMurry TL, Lewnard JA, Mduma ER, Shrestha S, Iqbal N, Bessong PO, Kang G, Kosek M, Lima AAM, Ahmed T, Liu J, Houpt ER, Platts-Mills JA. Frequency of bystander exposure to antibiotics for enteropathogenic bacteria among young children in low-resource settings. Proc Natl Acad Sci U S A 2022; 119:e2208972119. [PMID: 36037372 PMCID: PMC9457395 DOI: 10.1073/pnas.2208972119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Children in low-resource settings carry enteric pathogens asymptomatically and are frequently treated with antibiotics, resulting in opportunities for pathogens to be exposed to antibiotics when not the target of treatment (i.e., bystander exposure). We quantified the frequency of bystander antibiotic exposures for enteric pathogens and estimated associations with resistance among children in eight low-resource settings. We analyzed 15,697 antibiotic courses from 1,715 children aged 0 to 2 y from the MAL-ED birth cohort. We calculated the incidence of bystander exposures and attributed exposures to respiratory and diarrheal illnesses. We associated bystander exposure with phenotypic susceptibility of E. coli isolates in the 30 d following exposure and at the level of the study site. There were 744.1 subclinical pathogen exposures to antibiotics per 100 child-years. Enteroaggregative Escherichia coli was the most frequently exposed pathogen, with 229.6 exposures per 100 child-years. Almost all antibiotic exposures for Campylobacter (98.8%), enterotoxigenic E. coli (95.6%), and typical enteropathogenic E. coli (99.4%), and the majority for Shigella (77.6%), occurred when the pathogens were not the target of treatment. Respiratory infections accounted for half (49.9%) and diarrheal illnesses accounted for one-fourth (24.6%) of subclinical enteric bacteria exposures to antibiotics. Bystander exposure of E. coli to class-specific antibiotics was associated with the prevalence of phenotypic resistance at the community level. Antimicrobial stewardship and illness-prevention interventions among children in low-resource settings would have a large ancillary benefit of reducing bystander selection that may contribute to antimicrobial resistance.
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Affiliation(s)
| | - Stephanie A. Brennhofer
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
| | - Sarah E. Elwood
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
| | - Timothy L. McMurry
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22908
| | - Joseph A. Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720
| | - Estomih R. Mduma
- Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Sanjaya Shrestha
- Walter Reed/AFRIMS Research Unit, Nepal, Kathmandu, 44600, Nepal
| | | | - Pascal O. Bessong
- University of Venda, Thohoyandou, 0950, South Africa
- Center for Global Health Equity, University of Virginia, Charlottesville, VA 22908
| | | | - Margaret Kosek
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
- Asociación Benéfica PRISMA, Iquitos, 15088, Peru
| | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, 1212, Bangladesh
| | - Jie Liu
- School of Public Health, Qingdao University, Qingdao, Shandong, 266071, China
| | - Eric R. Houpt
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
| | - James A. Platts-Mills
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908
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Comparison of the Respiratory Resistomes and Microbiota in Children Receiving Short versus Standard Course Treatment for Community-Acquired Pneumonia. mBio 2022; 13:e0019522. [PMID: 35323040 PMCID: PMC9040816 DOI: 10.1128/mbio.00195-22] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pediatric community-acquired pneumonia (CAP) is often treated with 10 days of antibiotics. Shorter treatment strategies may be effective and lead to less resistance. The impact of duration of treatment on the respiratory microbiome is unknown. Data are from children (n = 171), ages 6 to 71 months, enrolled in the SCOUT-CAP trial (NCT02891915). Children with CAP were randomized to a short (5 days) versus standard (10 days) beta-lactam treatment strategy. Throat swabs were collected at enrollment and the end of the study and used for shotgun metagenomic sequencing. The number of beta-lactam and multidrug efflux resistance genes per prokaryotic cell (RGPC) was significantly lower in children receiving the short compared to standard treatment strategy at the end of the study (Wilcoxon rank sum test, P < 0.05 for each). Wilcoxon effect sizes were small for beta-lactam (r: 0.15; 95% confidence interval [CI], 0.01 to 0.29) and medium for multidrug efflux RGPC (r: 0.23; 95% CI, 0.09 to 0.37). Analyses comparing the resistome at the beginning and end of the trial indicated that in contrast to the standard strategy group, the resistome significantly differed in children receiving the short course strategy. Relative abundances of commensals such as Neisseria subflava were higher in children receiving the standard strategy, and Prevotella species and Veillonella parvula were higher in children receiving the short course strategy. We conclude that children receiving 5 days of beta-lactam therapy for CAP had a significantly lower abundance of antibiotic resistance determinants than those receiving standard 10-day treatment. These data provide an additional rationale for reductions in antibiotic use when feasible. IMPORTANCE Antibiotic resistance is a major threat to public health. Treatment strategies involving shorter antibiotic courses have been proposed as a strategy to lower the potential for antibiotic resistance. We examined relationships between the duration of antibiotic treatment and its impact on resistance genes and bacteria in the respiratory microbiome using data from a randomized controlled trial of beta-lactam therapy for pediatric pneumonia. The randomized design provides reliable evidence of the effectiveness of interventions and minimizes the potential for confounding. Children receiving 5 days of therapy for pneumonia had a lower prevalence of two different types of resistance genes than did those receiving the 10-day treatment. Our data also suggest that children receiving longer durations of therapy have a greater abundance of antibiotic resistance genes for a longer period of time than do children receiving shorter durations of therapy. These data provide an additional rationale for reductions in antibiotic use.
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Sun DS, Kissler SM, Kanjilal S, Olesen SW, Lipsitch M, Grad YH. Analysis of multiple bacterial species and antibiotic classes reveals large variation in the association between seasonal antibiotic use and resistance. PLoS Biol 2022; 20:e3001579. [PMID: 35263322 PMCID: PMC8936496 DOI: 10.1371/journal.pbio.3001579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/21/2022] [Accepted: 02/21/2022] [Indexed: 01/24/2023] Open
Abstract
Understanding how antibiotic use drives resistance is crucial for guiding effective strategies to limit the spread of resistance, but the use-resistance relationship across pathogens and antibiotics remains unclear. We applied sinusoidal models to evaluate the seasonal use-resistance relationship across 3 species (Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae) and 5 antibiotic classes (penicillins, macrolides, quinolones, tetracyclines, and nitrofurans) in Boston, Massachusetts. Outpatient use of all 5 classes and resistance in inpatient and outpatient isolates in 9 of 15 species-antibiotic combinations showed statistically significant amplitudes of seasonality (false discovery rate (FDR) < 0.05). While seasonal peaks in use varied by class, resistance in all 9 species-antibiotic combinations peaked in the winter and spring. The correlations between seasonal use and resistance thus varied widely, with resistance to all antibiotic classes being most positively correlated with use of the winter peaking classes (penicillins and macrolides). These findings challenge the simple model of antibiotic use independently selecting for resistance and suggest that stewardship strategies will not be equally effective across all species and antibiotics. Rather, seasonal selection for resistance across multiple antibiotic classes may be dominated by use of the most highly prescribed antibiotic classes, penicillins and macrolides.
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Affiliation(s)
- Daphne S. Sun
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Stephen M. Kissler
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sanjat Kanjilal
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Scott W. Olesen
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Marc Lipsitch
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Yonatan H. Grad
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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9
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Kown J, Chung J. Therapeutics for acute otitis media. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.9.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Acute otitis media (AOM) is diagnosed in patients with acute onset of signs and symptoms of inflammation in the middle ear, accompanied by middle ear effusion. AOM is a common infectious disease in children, and its diagnosis and treatment can have significant impacts on the health of children.Current Concepts: The evidence-based clinical practice guidelines in Korea and other countries provide recommendations to primary care clinicians regarding the management of children with AOM. The treatment strategy for AOM depends on the patient’s age, severity of symptoms, the presence of otorrhea, and the laterality.Discussion and Conclusion: For children aged from 6-months to 2-years with unilateral non-severe AOM and children aged 2 years or older with unilateral or bilateral non-severe AOM, the published guidelines provide the option of observation rather than immediate treatment with antibiotics. High-dose amoxicillin (80 to 90 mg a day) is the firstline antibiotic for treating AOM in patients without penicillin allergies. Children in whom symptoms persist after 48 to 72 hours of antibiotic treatment should be re-examined and amoxicillin/clavulanate should be used as second-line antibiotics. Careful follow-up is required to identify the complications and sequelae of AOM, and to determine the optimum treatment.
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10
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Wong DW. Carriage of antibiotic resistant bacteria flora and its role in the guidance of clinical decision making. Pathog Dis 2021; 78:5863937. [PMID: 32592391 DOI: 10.1093/femspd/ftaa030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/26/2020] [Indexed: 11/14/2022] Open
Abstract
There is considerable literature on the threat of antibiotic resistance and its impact on morbidity. However, an under-studied consideration is how carriage of these antibiotic resistant bacteria persist in an individual. The duration that a person harbors a resistant organism is critical in guiding future antimicrobial therapy. Key unexplored questions are the rate of clearance of these organisms and what drives their persistence. This paper attempts to examine these questions and offers some initial answers as well as avenues for further study.
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Affiliation(s)
- Darren W Wong
- Division of Infectious Diseases, Keck School of Medicine at the University of Southern California (USC), 2020 Zonal Avenue RM 430, Los Angeles, CA 90033, USA
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11
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Danino D, Van Der Beek BA, Givon-Lavi N, Greenberg D, Ben-Shimol S, Dagan R. Unravelling the Impact of Pneumococcal Conjugate Vaccines on Ambulatory Antibiotic Drug Consumption in Young Children: An Interrupted Time Series Analysis. Clin Infect Dis 2021; 73:1268-1278. [PMID: 34013338 DOI: 10.1093/cid/ciab413] [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: 12/09/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) reduce respiratory infections in young children, the main antibiotic consumers. Following PCV implementation, dispensed antibiotic prescription (DAP) rates in young children were expected to decline. METHODS Computerized data on DAP for children <5 years were examined during a 13-year period (including 4 pre-PCV years). All DAPs from clinics with ≥50 insured children, active both pre- and post-PCV implementation were included. Interrupted time series with segmented regression was applied to analyze monthly DAP rate trends, adjusted for age, ethnicity and season. Incidence rate ratios (IRR) DAPs during late PCV13 period vs. 4 years pre-PCV were calculated both as absolute rate ratios (aIRR) and relative to expected rates (rIRR). RESULTS Of 1,090,870 DAPs, 57% were in children <2 years. All-DAP rates peaked in the cold season. Post-PCV7/PCV13 implementation, all DAP-rates abruptly and significantly declined, reaching a plateau within 5 years. This was largely driven by amoxicillin/amoxicillin-clavulanate (75% of DAPs). Age <2 years and Bedouin ethnicity were significantly associated with higher pre-PCV DAP rates but with faster and greater decline post-PCV, achieving near elimination of gaps between ages and ethnic groups. Overall reduction (and 95% CIs) in DAP rates per 1,000 was estimated between aIRR value (344.7 [370.9-358.4]) and rIRR value (110.4 [96.9-123.7]). CONCLUSIONS Shortly following PCV implementation, overall DAP rates showed an abrupt and steep decline, stabilizing within 5 years, in parallel to post-PCV respiratory infection trends previously described in this population, suggesting causality. The variable patterns of certain drug categories suggest additional influences beyond PCV.
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Affiliation(s)
- Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Noga Givon-Lavi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Pan M, Yau PC. Fate of Macrolide Antibiotics with Different Wastewater Treatment Technologies. WATER, AIR, AND SOIL POLLUTION 2021; 232:103. [PMID: 33678919 PMCID: PMC7914119 DOI: 10.1007/s11270-021-05053-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED This comprehensive study addressed the occurrence, seasonal changes, removal efficiencies, and environmental risk assessments of three macrolide antibiotics in five wastewater treatment plants (WWTPs) with conventional and different additional treatment processes. A 1-year monitoring study was conducted, and influents and effluents were collected from Guangzhou (GZ), Shenzhen (SZ), Tai Po (TP), Shatin (ST), and Stonecutters Island (SI) WWTPs. Solid phase extraction and HPLC-MS/MS were used for the pretreatment and determination. The detection limits for azithromycin (AZI), erythromycin (ERY), and roxithromycin (ROX) ranged from 0.80 to 2.13 ng/L for the influent and effluent water samples. AZI was the most abundant antibiotic found in the influents, with average concentrations ranging from 571 ng/L to 1046 ng/L at all the target WWTPs. The seasonal average AZI concentration was the highest in all five WWTPs with the concentration of 984 ng/L in autumn, 849 ng/L in winter, 741 ng/L in summer, and 533 ng/L in spring. The seasonal AZI removal rates in the WWTPs were similar, with an average removal rate above 63.3% from spring to winter. All the treatments in the five WWTPs showed removal abilities for AZI, ERY, and ROX, regardless of the three phase treatments, namely, the UV disinfection process and conventional or chemically enhanced process within the WWTPs. For ERY and ROX, the average total removal rates were significantly decreased in the spring among all five WWTPs, at 53.1% and 57.8%, respectively. The GZ and SZ WWTPs displayed better removal rates than the TP, ST, and SI WWTPs, because the activity underlying the modified A2/O process in the GZ and SZ WWTPs has important effects on the antibiotic removal because the bacteria could produce compact granules and make the antibiotics settle faster in the wastewater. The additional UV disinfection in the SZ WWTP improved the removal efficiencies of the target antibiotics; it enhanced the biodegradability of residual organic pollutants in the WWTP effluent. Moreover, the corresponding environmental risks have been assessed and are viewed as a necessary component of future research. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11270-021-05053-y.
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Affiliation(s)
- Min Pan
- Faculty of Design and Environment, Technological and Higher Education Institute of Hong Kong, Hong Kong, China
| | - Pui Ching Yau
- Faculty of Design and Environment, Technological and Higher Education Institute of Hong Kong, Hong Kong, China
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13
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Abstract
Antibiotic use is a key driver of antibiotic resistance. Understanding the quantitative association between antibiotic use and resulting resistance is important for predicting future rates of antibiotic resistance and for designing antibiotic stewardship policy. However, the use-resistance association is complicated by "spillover," in which one population's level of antibiotic use affects another population's level of resistance via the transmission of bacteria between those populations. Spillover is known to have effects at the level of families and hospitals, but it is unclear if spillover is relevant at larger scales. We used mathematical modeling and analysis of observational data to address this question. First, we used dynamical models of antibiotic resistance to predict the effects of spillover. Whereas populations completely isolated from one another do not experience any spillover, we found that if even 1% of interactions are between populations, then spillover may have large consequences: The effect of a change in antibiotic use in one population on antibiotic resistance in that population could be reduced by as much as 50%. Then, we quantified spillover in observational antibiotic use and resistance data from US states and European countries for three pathogen-antibiotic combinations, finding that increased interactions between populations were associated with smaller differences in antibiotic resistance between those populations. Thus, spillover may have an important impact at the level of states and countries, which has ramifications for predicting the future of antibiotic resistance, designing antibiotic resistance stewardship policy, and interpreting stewardship interventions.
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Affiliation(s)
- Scott W Olesen
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115
| | - Marc Lipsitch
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA 02115
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115;
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
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14
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Sabri NA, van Holst S, Schmitt H, van der Zaan BM, Gerritsen HW, Rijnaarts HHM, Langenhoff AAM. Fate of antibiotics and antibiotic resistance genes during conventional and additional treatment technologies in wastewater treatment plants. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 741:140199. [PMID: 32615424 DOI: 10.1016/j.scitotenv.2020.140199] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 05/23/2023]
Abstract
Information on the removal of antibiotics and ARGs in full-scale WWTPs (with or without additional treatment technology) is limited. However, it is important to understand the efficiency of full-scale treatment technologies in removing antibiotics and ARGs under a variety of conditions relevant for practice to reduce their environmental spreading. Therefore, this study was performed to evaluate the removal of antibiotics and ARGs in a conventional wastewater treatment plant (WWTP A) and two full-scale combined with additional treatment technologies. WWTP B, a conventional activated sludge treatment followed by an activated carbon filtration step (1-STEP® filter) as a final treatment step. WWTP C, a treatment plant using aerobic granular sludge (NEREDA®) as an alternative to activated sludge treatment. Water and sludge were collected and analysed for 52 antibiotics from four target antibiotic groups (macrolides, sulfonamides, quinolones, tetracyclines) and four target ARGs (ermB, sul 1, sul 2 and tetW) and integrase gene class 1 (intI1). Despite the high removal percentages (79-88%) of the total load of antibiotics in all WWTPs, some antibiotics were detected in the various effluents. Additional treatment technology (WWTP C) showed antibiotics removal up to 99% (tetracyclines). For ARGs, WWTP C reduced 2.3 log followed by WWTP A with 2.0 log, and WWTP B with 1.3 log. This shows that full-scale WWTP with an additional treatment technology are promising solutions for reducing emissions of antibiotics and ARGs from wastewater treatment plants. However, total removal of the antibiotics and ARGS cannot be achieved for all types of antibiotics and ARGs. In addition, the ARGs were more abundant in the sludge compared to the wastewater effluent suggesting that sludge is an important reservoir representing a source for later ARG emissions upon reuse, i.e. as fertilizer in agriculture or as resource for bioplastics or bioflocculants. These aspects require further research.
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Affiliation(s)
- N A Sabri
- Department of Environmental Technology, Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, the Netherlands
| | - S van Holst
- Department of Environmental Technology, Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, the Netherlands
| | - H Schmitt
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands
| | - B M van der Zaan
- Deltares, Subsurface and Groundwater Systems, Daltonlaan 600, 3584 KB Utrecht, the Netherlands
| | - H W Gerritsen
- Wageningen Food Safety Research (WFSR), Wageningen University & Research, P.O. Box 230, 6700 AE Wageningen, the Netherlands
| | - H H M Rijnaarts
- Department of Environmental Technology, Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, the Netherlands
| | - A A M Langenhoff
- Department of Environmental Technology, Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, the Netherlands.
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15
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Jeffrey B, Aanensen DM, Croucher NJ, Bhatt S. Predicting the future distribution of antibiotic resistance using time series forecasting and geospatial modelling. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.16153.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Increasing antibiotic resistance in a location may be mitigated by changes in treatment policy, or interventions to limit transmission of resistant bacteria. Therefore, accurate forecasting of the distribution of antibiotic resistance could be advantageous. Two previously published studies addressed this, but neither study compared alternative forecasting algorithms or considered spatial patterns of resistance spread. Methods: We analysed data describing the annual prevalence of antibiotic resistance per country in Europe from 2012 – 2016, and the quarterly prevalence of antibiotic resistance per clinical commissioning group in England from 2015 – 2018. We combined these with data on rates of possible covariates of resistance. These data were used to compare the previously published forecasting models, with other commonly used forecasting models, including one geospatial model. Covariates were incorporated into the geospatial model to assess their relationship with antibiotic resistance. Results: For the European data, which was recorded on a coarse spatiotemporal scale, a naïve forecasting model was consistently the most accurate of any of the forecasting models tested. The geospatial model did not improve on this accuracy. However, it did provide some evidence that antibiotic consumption can partially explain the distribution of resistance. The English data were aggregated at a finer scale, and expected-trend-seasonal (ETS) forecasts were the most accurate. The geospatial model did not significantly improve upon the median accuracy of the ETS model, but it appeared to be less sensitive to noise in the data, and provided evidence that rates of antibiotic prescription and bacteraemia are correlated with resistance. Conclusion: Annual, national-level surveillance data appears to be insufficient for fitting accurate antibiotic resistance forecasting models, but there is evidence that data collected at a finer spatiotemporal scale could be used to improve forecast accuracy. Additionally, incorporating antibiotic prescription or consumption data into the model could improve the predictive accuracy.
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16
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Danino D, Givon-Lavi N, Ben-Shimol S, Greenberg D, Dagan R. Understanding the Evolution of Antibiotic-nonsusceptible Pneumococcal Nasopharyngeal Colonization Following Pneumococcal Conjugate Vaccine Implementation in Young Children. Clin Infect Dis 2020; 69:648-656. [PMID: 30371763 DOI: 10.1093/cid/ciy926] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/28/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Four main processes determine pneumococcal conjugate vaccine (PCV) antibiotic-nonsusceptible Streptococcus pneumoniae (ANSP) carriage: reduction of PCV serotypes, increase of non-PCV serotypes, potential overall reduction in carriage, and within-serotype nonsusceptibility resulting from continuous antibiotic pressure. The post-PCV implementation dynamics of these components were examined in young children from 2 distinct ethnic populations: Jewish and Bedouin. METHODS We performed ongoing, prospective, population-based, active surveillance initiated at the time of 7- and 13-valent PCVs (PCV7; PCV13) implementation. Nasopharyngeal cultures for S. pneumoniae were obtained daily from children aged <5 years who visited the only pediatric emergency room in the district during a 6-year period (2009 to 2015). RESULTS Of 8446 nasopharyngeal samples, 48.3% were positive (42.0% and 52.8% for Jewish and Bedouin children, respectively; P < .001). Nonsusceptibility was significantly more frequent among PCV serotypes than among non-PCV serotypes and among Bedouin children than among Jewish children. PCV serotype carriage declined by 80%, while that of non-PCV serotypes increased by 140%. The overall (all serotypes) pneumococcal carriage significantly declined (33% and 11% in Bedouin and Jewish children, respectively). Among non-PCV isolates, the proportion of ANSP significantly increased with time in both populations. As a summation of all 4 processes, ANSP carriage significantly decreased among both Bedouin and Jewish children. CONCLUSIONS PCV impact on ANSP nasopharyngeal carriage is a dynamic, multicomponent process, highly dependent on antibiotic consumption in the community, which may result in a continuous increase in antibiotic resistance in the replacing serotypes.
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Affiliation(s)
- Dana Danino
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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17
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Olesen SW, Grad YH. Deciphering the Impact of Bystander Selection for Antibiotic Resistance in Neisseria gonorrhoeae. J Infect Dis 2020; 221:1033-1035. [PMID: 30957162 PMCID: PMC7360351 DOI: 10.1093/infdis/jiz156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Scott W Olesen
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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18
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Olesen SW, Torrone EA, Papp JR, Kirkcaldy RD, Lipsitch M, Grad YH. Azithromycin Susceptibility Among Neisseria gonorrhoeae Isolates and Seasonal Macrolide Use. J Infect Dis 2019; 219:619-623. [PMID: 30239814 DOI: 10.1093/infdis/jiy551] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/12/2018] [Indexed: 12/19/2022] Open
Abstract
Rising azithromycin nonsusceptibility among Neisseria gonorrhoeae isolates threatens current treatment recommendations, but the cause of this rise is not well understood. We performed an ecological study of seasonal patterns in macrolide use and azithromycin resistance in N. gonorrhoeae, finding that population-wide macrolide use is associated with increased azithromycin nonsusceptibility. These results, indicative of bystander selection, have implications for antibiotic prescribing guidelines.
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Affiliation(s)
- Scott W Olesen
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Elizabeth A Torrone
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John R Papp
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert D Kirkcaldy
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marc Lipsitch
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Ben-Shimol S, Givon-Lavi N, Greenberg D, Stein M, Megged O, Bar-Yochai A, Negari S, Dagan R, On Behalf Of The Israel Bacteremia And Meningitis Active Surveillance Group. Impact of pneumococcal conjugate vaccines introduction on antibiotic resistance of Streptococcus pneumoniae meningitis in children aged 5 years or younger, Israel, 2004 to 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 30482264 PMCID: PMC6341944 DOI: 10.2807/1560-7917.es.2018.23.47.1800081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Empiric treatment of pneumococcal meningitis includes ceftriaxone with vancomycin to overcome ceftriaxone resistant disease. The addition of vancomycin bears a risk of adverse events, including increased antibiotic resistance. We assessed antibiotic resistance rates in pneumococcal meningitis before and after pneumococcal conjugate vaccine (PCV) implementation. Methods All pneumococcal meningitis episodes in children aged 5 years and younger, from 2004 to 2016, were extracted from the nationwide bacteremia and meningitis surveillance database. For comparison purposes, we defined pre-PCV period as 2004–2008 and PCV13 period as 2014–2016. Minimal inhibitory concentration (MIC) > 0.06 and > 0.5 μg/mL were defined as penicillin and ceftriaxone resistance, respectively. Results Overall, 325 episodes were identified. Pneumococcal meningitis incidence rates declined non-significantly by 17%, comparing PCV13 and pre-PCV periods. Throughout the study, 90% of isolates were tested for antibiotic susceptibility, with 26.6%, 2.1% and 0% of isolates resistant to penicillin, ceftriaxone and vancomycin, respectively. Mean proportions (± SD) of meningitis caused by penicillin-resistant pneumococci were 40.5% ± 8.0% and 9.6% ± 7.4% in the pre-PCV and the PCV13 periods, respectively, resulting in an overall 83.9% reduction (odd ratio:0.161; 95% confidence interval: 0.059–0.441) in penicillin resistance rates. The proportions of meningitis caused by ceftriaxone resistant pneumococci were 5.0% ± 0.8% in the pre-PCV period, but no ceftriaxone resistant isolates were identified since 2010. Conclusions PCV7/PCV13 sequential introduction resulted in > 80% reduction of penicillin- resistant pneumococcal meningitis and complete disappearance of ceftriaxone resistant disease. These trends should be considered by the treating physician when choosing an empiric treatment for pneumococcal meningitis.
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Affiliation(s)
- Shalom Ben-Shimol
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal Stein
- Infectious Diseases and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel and Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Orli Megged
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Avihu Bar-Yochai
- Infectious Disease Unit, Assaf Harofe Medical Center, Zerifin, Israel
| | - Shahar Negari
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Dunai A, Spohn R, Farkas Z, Lázár V, Györkei Á, Apjok G, Boross G, Szappanos B, Grézal G, Faragó A, Bodai L, Papp B, Pál C. Rapid decline of bacterial drug-resistance in an antibiotic-free environment through phenotypic reversion. eLife 2019; 8:e47088. [PMID: 31418687 PMCID: PMC6707769 DOI: 10.7554/elife.47088] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/05/2019] [Indexed: 11/18/2022] Open
Abstract
Antibiotic resistance typically induces a fitness cost that shapes the fate of antibiotic-resistant bacterial populations. However, the cost of resistance can be mitigated by compensatory mutations elsewhere in the genome, and therefore the loss of resistance may proceed too slowly to be of practical importance. We present our study on the efficacy and phenotypic impact of compensatory evolution in Escherichia coli strains carrying multiple resistance mutations. We have demonstrated that drug-resistance frequently declines within 480 generations during exposure to an antibiotic-free environment. The extent of resistance loss was found to be generally antibiotic-specific, driven by mutations that reduce both resistance level and fitness costs of antibiotic-resistance mutations. We conclude that phenotypic reversion to the antibiotic-sensitive state can be mediated by the acquisition of additional mutations, while maintaining the original resistance mutations. Our study indicates that restricting antimicrobial usage could be a useful policy, but for certain antibiotics only.
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Affiliation(s)
- Anett Dunai
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
- Doctoral School in Biology, Faculty of Science and InformaticsUniversity of SzegedSzegedHungary
| | - Réka Spohn
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
| | - Zoltán Farkas
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
| | - Viktória Lázár
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
| | - Ádám Györkei
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
| | - Gábor Apjok
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
- Doctoral School in Biology, Faculty of Science and InformaticsUniversity of SzegedSzegedHungary
| | - Gábor Boross
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
| | - Balázs Szappanos
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
| | - Gábor Grézal
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
| | - Anikó Faragó
- Doctoral School in Biology, Faculty of Science and InformaticsUniversity of SzegedSzegedHungary
- Department of Biochemistry and Molecular BiologyUniversity of SzegedSzegedHungary
| | - László Bodai
- Department of Biochemistry and Molecular BiologyUniversity of SzegedSzegedHungary
| | - Balázs Papp
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
| | - Csaba Pál
- Synthetic and Systems Biology Unit, Institute of Biochemistry, Biological Research CentreHungarian Academy of SciencesSzegedHungary
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21
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Martinez EP, Cepeda M, Jovanoska M, Bramer WM, Schoufour J, Glisic M, Verbon A, Franco OH. Seasonality of antimicrobial resistance rates in respiratory bacteria: A systematic review and meta-analysis. PLoS One 2019; 14:e0221133. [PMID: 31415656 PMCID: PMC6695168 DOI: 10.1371/journal.pone.0221133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) rates may display seasonal variation. However, it is not clear whether this seasonality is influenced by the seasonal variation of infectious diseases, geographical region or differences in antibiotic prescription patterns. Therefore, we assessed the seasonality of AMR rates in respiratory bacteria. METHODS Seven electronic databases (Embase.com, Medline Ovid, Cochrane CENTRAL, Web of Science, Core Collection, Biosis Ovid, and Google Scholar), were searched for relevant studies from inception to Jun 25th, 2019. Studies describing resistance rates of Streptococcus pneumoniae and Haemophilus influenzae were included in this review. By using random-effects meta-analysis, pooled odd ratios of seasonal AMR rates were calculated using winter as the reference group. Pooled odd ratios were obtained by antibiotic class and geographical region. RESULTS We included 13 studies, of which 7 were meta-analyzed. Few studies were done in H. influenzae, thus this was not quantitively analyzed. AMR rates of S. pneumoniae to penicillins were lower in other seasons than in winter with pooled OR = 0.71; 95% CI = 0.65-0.77; I2 = 0.0%, and to all antibiotics with pooled OR = 0.68; 95% CI = 0.60-0.76; I2 = 14.4%. Irrespective of geographical region, the seasonality of AMR rates in S. pneumoniae remained the same. CONCLUSION The seasonality of AMR rates could result from the seasonality of infectious diseases and its accompanied antibiotic use.
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Affiliation(s)
- Evelyn Pamela Martinez
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito, Ecuador
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Magda Cepeda
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Marija Jovanoska
- Medical Faculty, Saints Cyril and Methodius University of Skopje, Skopje, Macedonia
| | - Wichor M. Bramer
- Medical Library, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Josje Schoufour
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Marija Glisic
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Annelies Verbon
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine, Faculty of Medicine, University of Bern, Bern, Switzerland
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22
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Rodriguez C, Bouchafa L, Soumillion K, Ngyuvula E, Taminiau B, Van Broeck J, Delmée M, Daube G. Seasonality of Clostridium difficile in the natural environment. Transbound Emerg Dis 2019; 66:2440-2449. [PMID: 31338965 DOI: 10.1111/tbed.13301] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023]
Abstract
Clostridium difficile is considered the leading cause of antibiotic-associated disease worldwide. In the past decade, a large number of studies have focused on identifying the main sources of contamination in order to elucidate the complete life cycle of the infection. Hospitals, animals and retail foods have been considered as potential vectors. However, the prevalence of C. difficile in these types of samples was found to be rather low, suggesting that other contamination routes must exist. This study explores the presence of C. difficile in the natural environment and the seasonal dynamics of the bacterium. C. difficile was isolated from a total of 45 samples out of 112 collected (40.2%) on 56 sampling points. A total of 17 points were positive only during the winter sampling (30.4%), 10 were positive only during the summer sampling (17.9%) and 9 sampling points (16.1%) were positive in both summer sampling and winter sampling. Spore counts in soil samples ranged between 50 and 250 cfu/g for 24.4% of the positive samples, with the highest concentrations detected in samples collected in the forest during winter campaign (200-250 cfu/g). A total of 17 different PCR ribotypes were identified, and 15 of them had the genes coding for toxins A and B. Most of those ribotypes had not previously been found or had been isolated only sporadically (<1% of samples) from hospitals in Belgium. Regarding antimicrobial susceptibility, most of the resistant strains were found during the summer campaign. These findings bear out that C. difficile is present in the natural environment, where the bacterium undergoes seasonal variations.
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Affiliation(s)
- Cristina Rodriguez
- Fundamental and Applied Research for Animals & Health (FARAH), Department of Food Microbiology, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Lamia Bouchafa
- Fundamental and Applied Research for Animals & Health (FARAH), Department of Food Microbiology, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Kate Soumillion
- National Reference Center Clostridium Difficile, Microbiology Unit, Catholic University of Louvain, Brussels, Belgium
| | - Eleonore Ngyuvula
- National Reference Center Clostridium Difficile, Microbiology Unit, Catholic University of Louvain, Brussels, Belgium
| | - Bernard Taminiau
- Fundamental and Applied Research for Animals & Health (FARAH), Department of Food Microbiology, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Johan Van Broeck
- National Reference Center Clostridium Difficile, Microbiology Unit, Catholic University of Louvain, Brussels, Belgium
| | - Michel Delmée
- National Reference Center Clostridium Difficile, Microbiology Unit, Catholic University of Louvain, Brussels, Belgium
| | - Georges Daube
- Fundamental and Applied Research for Animals & Health (FARAH), Department of Food Microbiology, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
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Mayanskiy N, Kulichenko T, Alyabieva N, Brzhozovskaya E, Ponomarenko O, Savinova T, Lazareva A. Changing serotype distribution and resistance patterns among pediatric nasopharyngeal pneumococci collected in Moscow, 2010–2017. Diagn Microbiol Infect Dis 2019; 94:385-390. [DOI: 10.1016/j.diagmicrobio.2019.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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24
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Ramsey EG, Royer J, Bookstaver PB, Justo JA, Kohn J, Albrecht H, Al-Hasan MN. Seasonal variation in antimicrobial resistance rates of community-acquired Escherichia coli bloodstream isolates. Int J Antimicrob Agents 2019; 54:1-7. [DOI: 10.1016/j.ijantimicag.2019.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/21/2019] [Accepted: 03/09/2019] [Indexed: 12/23/2022]
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25
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Blanquart F. Evolutionary epidemiology models to predict the dynamics of antibiotic resistance. Evol Appl 2019; 12:365-383. [PMID: 30828361 PMCID: PMC6383707 DOI: 10.1111/eva.12753] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 12/12/2022] Open
Abstract
The evolution of resistance to antibiotics is a major public health problem and an example of rapid adaptation under natural selection by antibiotics. The dynamics of antibiotic resistance within and between hosts can be understood in the light of mathematical models that describe the epidemiology and evolution of the bacterial population. "Between-host" models describe the spread of resistance in the host community, and in more specific settings such as hospitalized hosts (treated by antibiotics at a high rate), or farm animals. These models make predictions on the best strategies to limit the spread of resistance, such as reducing transmission or adapting the prescription of several antibiotics. Models can be fitted to epidemiological data in the context of intensive care units or hospitals to predict the impact of interventions on resistance. It has proven harder to explain the dynamics of resistance in the community at large, in particular because models often do not reproduce the observed coexistence of drug-sensitive and drug-resistant strains. "Within-host" models describe the evolution of resistance within the treated host. They show that the risk of resistance emergence is maximal at an intermediate antibiotic dose, and some models successfully explain experimental data. New models that include the complex host population structure, the interaction between resistance-determining loci and other loci, or integrating the within- and between-host levels will allow better interpretation of epidemiological and genomic data from common pathogens and better prediction of the evolution of resistance.
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Affiliation(s)
- François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERMPSL Research UniversityParisFrance
- IAME, UMR 1137, INSERMUniversité Paris DiderotParisFrance
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26
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Yang R, Okonkwo OS, Zurakowski D, Kohane DS. Synergy between chemical permeation enhancers and drug permeation across the tympanic membrane. J Control Release 2018; 289:94-101. [PMID: 29932959 DOI: 10.1016/j.jconrel.2018.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/23/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
Chemical permeation enhancers (CPEs) can enable antibiotic flux across the tympanic membrane. Here we study whether combinations of CPEs (sodium dodecyl sulfate, limonene, and bupivacaine hydrochloride) are synergistic and whether they could increase the peak drug flux. Synergy is studied by isobolographic analysis and combination indices. CPE concentration-response (i.e. trans-tympanic flux of ciprofloxacin) curves are demonstrated for each CPE, isobolograms constructed for pairs of CPEs, and synergy demonstrated for all three pairs. Synergy is much greater at earlier (6 h) than later (48 h) time points, although the effect sizes are greater later. Synergy is also demonstrated with the three-drug combination. Combinations of CPEs also greatly enhance the maximum drug flux achievable over that achieved by individual CPEs.
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Affiliation(s)
- Rong Yang
- Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Obiajulu S Okonkwo
- Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - David Zurakowski
- Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Daniel S Kohane
- Department of Anesthesiology, Division of Critical Care Medicine, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
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27
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Tong S, Amand C, Kieffer A, Kyaw MH. Trends in healthcare utilization and costs associated with acute otitis media in the United States during 2008-2014. BMC Health Serv Res 2018; 18:318. [PMID: 29720156 PMCID: PMC5932897 DOI: 10.1186/s12913-018-3139-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/22/2018] [Indexed: 11/23/2022] Open
Abstract
Background Acute otitis media (AOM) is the most common cause of pediatric medical visits and antibiotic prescriptions worldwide, but its current impact on the US healthcare system is not clear. The aim of this study was to investigate changes in the incidence of AOM from 2008, just before 13-valent pneumococcal conjugate vaccine was introduced, to 2014 using US insurance records in the Truven MarketScan® database. The study also examined the costs associated with index AOM events during the two most recent years for which data were available (2013–2014). Methods AOM cases in the MarketScan database during 2008–2014 were identified using ICD9 diagnosis codes 381.xx and 382.xx. Incidence rates of healthcare utilization related to the index AOM episode were calculated using the annual number of enrolled person-years as the denominator and the number of individuals with AOM as the numerator. AOM-associated costs were calculated as the mean payment per episode during the 2 years from 2013 to 2014. Results The overall annual rate of AOM-related healthcare utilization was 60.5 per 1000 person-years and changed little from 2008 to 2014 (range, 58.4–62.6). Most of this was due to office/outpatient visits (55.7 [range, 52.0–58.8] per 1000 person-years). Emergency department/urgent care visits (4.7 [range 3.7–6.3] per 1000 person-years) and hospitalization (0.0 [range, 0.0–0.1] per 1000 person-years) contributed little. The rate of AOM-related healthcare utilization per 1000 person-years was highest in the youngest children and declined with age (474.3 for < 1 year, 503.9 for 1 year, 316.3 for 2–4 years, 94.9 for 5–17 years, 33.1 for 18–49 years, 28.6 for 50–64 years, 23.7 for 65–74 years, 20.2 for 75–84 years, and 16.1 for ≥85 years). The mean cost per AOM episode in 2013–2014 (95% confidence interval) was $199.0 (198.4–199.6) for office or outpatient visits, $329.6 (328.2–331.0) for emergency department/urgent care visits, and $1592.9 (1422.0–1763.8) for hospitalization. Conclusions In the US, AOM-associated healthcare utilization and costs remain substantial. More effective preventive measures such as new vaccines are needed to reduce the burden of AOM.
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Affiliation(s)
- Sabine Tong
- IVIDATA Stats, 79 Rue Baudin, 92300, Levallois-Perret, France
| | - Caroline Amand
- Sanofi, 1 Avenue Pierre Brossolette, 91380, Chilly-Mazarin, France
| | - Alexia Kieffer
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France
| | - Moe H Kyaw
- Sanofi Pasteur, 1 Discovery Drive, Swiftwater, PA, 18370, USA.
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28
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Cobey S, Baskerville EB, Colijn C, Hanage W, Fraser C, Lipsitch M. Host population structure and treatment frequency maintain balancing selection on drug resistance. J R Soc Interface 2018; 14:rsif.2017.0295. [PMID: 28835542 PMCID: PMC5582124 DOI: 10.1098/rsif.2017.0295] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/28/2017] [Indexed: 11/15/2022] Open
Abstract
It is a truism that antimicrobial drugs select for resistance, but explaining pathogen- and population-specific variation in patterns of resistance remains an open problem. Like other common commensals, Streptococcus pneumoniae has demonstrated persistent coexistence of drug-sensitive and drug-resistant strains. Theoretically, this outcome is unlikely. We modelled the dynamics of competing strains of S. pneumoniae to investigate the impact of transmission dynamics and treatment-induced selective pressures on the probability of stable coexistence. We find that the outcome of competition is extremely sensitive to structure in the host population, although coexistence can arise from age-assortative transmission models with age-varying rates of antibiotic use. Moreover, we find that the selective pressure from antibiotics arises not so much from the rate of antibiotic use per se but from the frequency of treatment: frequent antibiotic therapy disproportionately impacts the fitness of sensitive strains. This same phenomenon explains why serotypes with longer durations of carriage tend to be more resistant. These dynamics may apply to other potentially pathogenic, microbial commensals and highlight how population structure, which is often omitted from models, can have a large impact.
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Affiliation(s)
- Sarah Cobey
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA
| | | | - Caroline Colijn
- Department of Mathematics, Imperial College London, London, UK
| | - William Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Christophe Fraser
- Oxford Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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29
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Outpatient Antibiotic Prescription Trends in the United States: A National Cohort Study. Infect Control Hosp Epidemiol 2018; 39:584-589. [PMID: 29485018 DOI: 10.1017/ice.2018.26] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015SETTINGNational administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from Express Scripts Holding CompanyMEASUREMENTSAnnual and seasonal percent change in antibiotic prescriptionsRESULTSApproximately 98 million outpatient antibiotic prescriptions were filled by 39 million insurance beneficiaries during the 3-year study period. The most commonly prescribed antibiotics were azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. No significant changes in individual or overall annual antibiotic prescribing rates were found during the study period. Significant seasonal variation was observed, with antibiotics being 42% more likely to be prescribed during February than September (peak-to-trough ratio [PTTR], 1.42; 95% confidence interval [CI], 1.39-1.61). Similar seasonal trends were found for azithromycin (PTTR, 2.46; 95% CI, 2.44-3.47), amoxicillin (PTTR, 1.52; 95% CI, 1.42-1.89), and amoxicillin/clavulanate (PTTR, 1.78; 95% CI, 1.68-2.29).CONCLUSIONSThis study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period. Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season. These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings.Infect Control Hosp Epidemiol 2018;39:584-589.
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30
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Tan C, Graves E, Lu H, Chen A, Li S, Schwartz KL, Daneman N. A decade of outpatient antimicrobial use in older adults in Ontario: a descriptive study. CMAJ Open 2017; 5:E878-E885. [PMID: 29273579 PMCID: PMC5741418 DOI: 10.9778/cmajo.20170100] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Antimicrobials are frequently prescribed to community-dwelling older adults. Our aim was to examine the prevalence, quantity and indications of antimicrobial prescriptions to older residents of Ontario. METHODS We conducted a population-based analysis of outpatient antimicrobial prescriptions to residents of Ontario aged 65 years or more from 2006 to 2015. Antimicrobial prescriptions, infectious disease diagnoses and prescriber information were determined from linked health care databases. Our analyses were primarily focused on antibiotics, which account for most antimicrobial use. RESULTS We identified 2 879 779 unique Ontario residents aged 65 years or more over our study period. On average, 40.7% (range 40.1%-41.5%) of older adult outpatients in any given year received 1 or more antibiotic prescriptions. Antibiotic use remained stable over the study period, averaging 25.1 (range 24.1-25.6) defined daily doses per 1000 person-days per year. Selection of antibiotics evolved, with increasing use of penicillins and decreasing use of fluoroquinolones and macrolides. For 65.7% of prescriptions, no infectious disease diagnoses were identified within 7 days of the prescription. Among prescriptions with an associated diagnosis, upper respiratory tract infection was most common (18.9%), followed by urinary tract infection (6.2%), skin/soft-tissue infection (4.3%), lower respiratory tract infection (4.2%) and other infection (1.2%). Most antibiotics were prescribed by family physicians. INTERPRETATION Antibiotic use among older adult outpatients in Ontario remained stable between 2006 and 2015. Current methods of measuring use are not capable of accurately determining indication, and, thus, additional data sources to monitor the appropriateness of community antimicrobial use are needed.
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Affiliation(s)
- Charlie Tan
- Affiliations: Sunnybrook Research Institute (Tan, Daneman) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences (Graves, Lu, Chen, Li, Schwartz, Daneman); Public Health Ontario (Schwartz, Daneman); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont
| | - Erin Graves
- Affiliations: Sunnybrook Research Institute (Tan, Daneman) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences (Graves, Lu, Chen, Li, Schwartz, Daneman); Public Health Ontario (Schwartz, Daneman); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont
| | - Hong Lu
- Affiliations: Sunnybrook Research Institute (Tan, Daneman) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences (Graves, Lu, Chen, Li, Schwartz, Daneman); Public Health Ontario (Schwartz, Daneman); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont
| | - Anna Chen
- Affiliations: Sunnybrook Research Institute (Tan, Daneman) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences (Graves, Lu, Chen, Li, Schwartz, Daneman); Public Health Ontario (Schwartz, Daneman); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont
| | - Shudong Li
- Affiliations: Sunnybrook Research Institute (Tan, Daneman) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences (Graves, Lu, Chen, Li, Schwartz, Daneman); Public Health Ontario (Schwartz, Daneman); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont
| | - Kevin L Schwartz
- Affiliations: Sunnybrook Research Institute (Tan, Daneman) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences (Graves, Lu, Chen, Li, Schwartz, Daneman); Public Health Ontario (Schwartz, Daneman); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont
| | - Nick Daneman
- Affiliations: Sunnybrook Research Institute (Tan, Daneman) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences (Graves, Lu, Chen, Li, Schwartz, Daneman); Public Health Ontario (Schwartz, Daneman); Dalla Lana School of Public Health (Schwartz), University of Toronto, Toronto, Ont
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Blanquart F, Lehtinen S, Fraser C. An evolutionary model to predict the frequency of antibiotic resistance under seasonal antibiotic use, and an application to Streptococcus pneumoniae. Proc Biol Sci 2017; 284:rspb.2017.0679. [PMID: 28566489 PMCID: PMC5454275 DOI: 10.1098/rspb.2017.0679] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/02/2017] [Indexed: 11/12/2022] Open
Abstract
The frequency of resistance to antibiotics in Streptococcus pneumoniae has been stable over recent decades. For example, penicillin non-susceptibility in Europe has fluctuated between 12% and 16% without any major time trend. In spite of long-term stability, resistance fluctuates over short time scales, presumably in part due to seasonal fluctuations in antibiotic prescriptions. Here, we develop a model that describes the evolution of antibiotic resistance under selection by multiple antibiotics prescribed at seasonally changing rates. This model was inspired by, and fitted to, published data on monthly antibiotics prescriptions and frequency of resistance in two communities in Israel over 5 years. Seasonal fluctuations in antibiotic usage translate into small fluctuations of the frequency of resistance around the average value. We describe these dynamics using a perturbation approach that encapsulates all ecological and evolutionary forces into a generic model, whose parameters quantify a force stabilizing the frequency of resistance around the equilibrium and the sensitivity of the population to antibiotic selection. Fitting the model to the data revealed a strong stabilizing force, typically two to five times stronger than direct selection due to antibiotics. The strong stabilizing force explains that resistance fluctuates in phase with usage, as antibiotic selection alone would result in resistance fluctuating behind usage with a lag of three months when antibiotic use is seasonal. While most antibiotics selected for increased resistance, intriguingly, cephalosporins selected for decreased resistance to penicillins and macrolides, an effect consistent in the two communities. One extra monthly prescription of cephalosporins per 1000 children decreased the frequency of penicillin-resistant strains by 1.7%. This model emerges under minimal assumptions, quantifies the forces acting on resistance and explains up to 43% of the temporal variation in resistance.
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Affiliation(s)
- François Blanquart
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Sonja Lehtinen
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christophe Fraser
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Korth J, Kukalla J, Rath PM, Dolff S, Krull M, Guberina H, Bienholz A, Wilde B, Becker S, Ross B, Anastasiou OE, Kribben A, Witzke O. Increased resistance of gram-negative urinary pathogens after kidney transplantation. BMC Nephrol 2017; 18:164. [PMID: 28525997 PMCID: PMC5437586 DOI: 10.1186/s12882-017-0580-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Urinary tract infection is the most common complication after kidney transplantation. It can cause severe sepsis and transplant loss. Emergence of drug resistance among gram-negative urinary pathogens is the current challenge for urinary tract infection treatment after kidney transplantation. METHODS This study analyzes the antimicrobial susceptibility of gram-negative urinary pathogens after kidney transplantation from 2009 to 2012 at the Transplant Outpatient Clinic of the University Hospital Essen, Germany. Kidney transplant patients at the University Hospital Essen receive regular follow up examinations after transplantation. Midstream urines were examined for bacteriuria at each follow up visit. RESULTS From 2009 to 2012 15.741 urine samples were obtained from 859 patients. In 2985 (19%) samples bacterial growth was detected. The most frequently detected gram-negative bacteria were E.coli 1109 (37%), Klebsiella spp. 242 (8%) and Pseudomonas aeruginosa 136 (4.5%). Klebsiella spp. showed a significant increase of resistance to trimethoprim-sulfamethoxazole by 19% (p = 0.02), ciprofloxacin by 15% (p = 0.01) and ceftazidime by 17% (p = 0.004). E.coli and P. aeruginosa isolates presented no significant differences of antimicrobial susceptibility to the analyzed antibiotics. CONCLUSIONS Antimicrobial resistance of Klebsiella spp. increased significant to trimethoprim-sulfamethoxazole, ciprofloxacin and ceftazidime from 2009 to 2012.
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Affiliation(s)
- Johannes Korth
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Julia Kukalla
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Peter-Michael Rath
- Institute for Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Marco Krull
- Institute of Hygiene, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Hana Guberina
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Anja Bienholz
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Stefan Becker
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Birgit Ross
- Institute of Hygiene, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Olympia Evdoxia Anastasiou
- Department of Gastroenterology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Dinali R, Ebrahiminezhad A, Manley-Harris M, Ghasemi Y, Berenjian A. Iron oxide nanoparticles in modern microbiology and biotechnology. Crit Rev Microbiol 2017; 43:493-507. [DOI: 10.1080/1040841x.2016.1267708] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ranmadugala Dinali
- Faculty of Science and Engineering, University of Waikato, Hamilton, New Zealand
| | - Alireza Ebrahiminezhad
- Faculty of Science and Engineering, University of Waikato, Hamilton, New Zealand
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Younes Ghasemi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aydin Berenjian
- Faculty of Science and Engineering, University of Waikato, Hamilton, New Zealand
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Fasugba O, Mitchell BG, Mnatzaganian G, Das A, Collignon P, Gardner A. Five-Year Antimicrobial Resistance Patterns of Urinary Escherichia coli at an Australian Tertiary Hospital: Time Series Analyses of Prevalence Data. PLoS One 2016; 11:e0164306. [PMID: 27711250 PMCID: PMC5053592 DOI: 10.1371/journal.pone.0164306] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/22/2016] [Indexed: 11/19/2022] Open
Abstract
This study describes the antimicrobial resistance temporal trends and seasonal variation of Escherichia coli (E. coli) urinary tract infections (UTIs) over five years, from 2009 to 2013, and compares prevalence of resistance in hospital- and community-acquired E. coli UTI. A cross sectional study of E. coli UTIs from patients attending a tertiary referral hospital in Canberra, Australia was undertaken. Time series analysis was performed to illustrate resistance trends. Only the first positive E. coli UTI per patient per year was included in the analysis. A total of 15,022 positive cultures from 8724 patients were identified. Results are based on 5333 first E. coli UTIs, from 4732 patients, of which 84.2% were community-acquired. Five-year hospital and community resistance rates were highest for ampicillin (41.9%) and trimethoprim (20.7%). Resistance was lowest for meropenem (0.0%), nitrofurantoin (2.7%), piperacillin-tazobactam (2.9%) and ciprofloxacin (6.5%). Resistance to amoxycillin-clavulanate, cefazolin, gentamicin and piperacillin-tazobactam were significantly higher in hospital- compared to community-acquired UTIs (9.3% versus 6.2%; 15.4% versus 9.7%; 5.2% versus 3.7% and 5.2% versus 2.5%, respectively). Trend analysis showed significant increases in resistance over five years for amoxycillin-clavulanate, trimethoprim, ciprofloxacin, nitrofurantoin, trimethoprim-sulphamethoxazole, cefazolin, ceftriaxone and gentamicin (P<0.05, for all) with seasonal pattern observed for trimethoprim resistance (augmented Dickey-Fuller statistic = 4.136; P = 0.006). An association between ciprofloxacin resistance, cefazolin resistance and ceftriaxone resistance with older age was noted. Given the relatively high resistance rates for ampicillin and trimethoprim, these antimicrobials should be reconsidered for empirical treatment of UTIs in this patient population. Our findings have important implications for UTI treatment based on setting of acquisition.
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Affiliation(s)
- Oyebola Fasugba
- Faculty of Health Sciences, Australian Catholic University, Australian Capital Territory, Australia
- * E-mail:
| | - Brett G. Mitchell
- Faculty of Health Sciences, Australian Catholic University, Australian Capital Territory, Australia
- Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, Wahroonga, New South Wales, Australia
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia
| | - Anindita Das
- Australian Capital Territory Pathology, Canberra Hospital and Health Services, Garran, Australian Capital Territory, Australia
| | - Peter Collignon
- Australian Capital Territory Pathology, Canberra Hospital and Health Services, Garran, Australian Capital Territory, Australia
- Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Anne Gardner
- Faculty of Health Sciences, Australian Catholic University, Australian Capital Territory, Australia
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Kim L, McGee L, Tomczyk S, Beall B. Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective. Clin Microbiol Rev 2016; 29:525-52. [PMID: 27076637 PMCID: PMC4861989 DOI: 10.1128/cmr.00058-15] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Streptococcus pneumoniae inflicts a huge disease burden as the leading cause of community-acquired pneumonia and meningitis. Soon after mainstream antibiotic usage, multiresistant pneumococcal clones emerged and disseminated worldwide. Resistant clones are generated through adaptation to antibiotic pressures imposed while naturally residing within the human upper respiratory tract. Here, a huge array of related commensal streptococcal strains transfers core genomic and accessory resistance determinants to the highly transformable pneumococcus. β-Lactam resistance is the hallmark of pneumococcal adaptability, requiring multiple independent recombination events that are traceable to nonpneumococcal origins and stably perpetuated in multiresistant clonal complexes. Pneumococcal strains with elevated MICs of β-lactams are most often resistant to additional antibiotics. Basic underlying mechanisms of most pneumococcal resistances have been identified, although new insights that increase our understanding are continually provided. Although all pneumococcal infections can be successfully treated with antibiotics, the available choices are limited for some strains. Invasive pneumococcal disease data compiled during 1998 to 2013 through the population-based Active Bacterial Core surveillance program (U.S. population base of 30,600,000) demonstrate that targeting prevalent capsular serotypes with conjugate vaccines (7-valent and 13-valent vaccines implemented in 2000 and 2010, respectively) is extremely effective in reducing resistant infections. Nonetheless, resistant non-vaccine-serotype clones continue to emerge and expand.
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Affiliation(s)
- Lindsay Kim
- Epidemiology Section, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lesley McGee
- Streptococcus Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara Tomczyk
- Epidemiology Section, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard Beall
- Streptococcus Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lewnard JA, Givon-Lavi N, Huppert A, Pettigrew MM, Regev-Yochay G, Dagan R, Weinberger DM. Epidemiological Markers for Interactions Among Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in Upper Respiratory Tract Carriage. J Infect Dis 2015; 213:1596-605. [PMID: 26704617 DOI: 10.1093/infdis/jiv761] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/15/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cocolonization by Streptococcus pneumoniae and Haemophilus influenzae among children has been noted in numerous studies, as has an inverse relationship involving colonization with these species and Staphylococcus aureus. Interactions among these pathogens could mediate unanticipated outcomes of clinical interventions, including changes in H. influenzae and S. aureus disease incidence following pneumococcal vaccine introduction. However, it remains unclear whether cocolonization patterns represent true interspecies interactions or whether they result from confounding factors. METHODS We investigated polymicrobial carriage using longitudinal data from 369 Bedouin children and 400 Jewish children in Israel who were enrolled in a 7-valent pneumococcal conjugate vaccine (PCV7) trial. Children were swabbed 10 times between 2 and 30 months of age. RESULTS The pathogens followed distinct age and seasonal distributions, but polymicrobial carriage associations persisted after controlling for these and other confounding factors. Receipt of PCV7 resulted in pneumococcal serotype replacement but did not influence total carriage of S. pneumoniae, H. influenzae, or S. aureus. CONCLUSIONS The fact that S. pneumoniae, H. influenzae, and S. aureus polymicrobial carriage patterns do not result from confounding by age and season supports the idea of active interspecies interactions. However, pneumococcal serotype replacement may prevent changes in H. influenzae and S. aureus carriage among PCV7 recipients.
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Affiliation(s)
- Joseph A Lewnard
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Noga Givon-Lavi
- Pediatric Infectious Disease Unit, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva
| | | | - Melinda M Pettigrew
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Gili Regev-Yochay
- Section of Infectious Disease Epidemiology, Gertner Institute for Epidemiology and Health Policy Research Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Ron Dagan
- Pediatric Infectious Disease Unit, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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de Cellès MD, Pons-Salort M, Varon E, Vibet MA, Ligier C, Letort V, Opatowski L, Guillemot D. Interaction of Vaccination and Reduction of Antibiotic Use Drives Unexpected Increase of Pneumococcal Meningitis. Sci Rep 2015; 5:11293. [PMID: 26063589 PMCID: PMC4462765 DOI: 10.1038/srep11293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/11/2015] [Indexed: 01/18/2023] Open
Abstract
Antibiotic-use policies may affect pneumococcal conjugate-vaccine effectiveness. The reported increase of pneumococcal meningitis from 2001 to 2009 in France, where a national campaign to reduce antibiotic use was implemented in parallel to the introduction of the 7-valent conjugate vaccine, provides unique data to assess these effects. We constructed a mechanistic pneumococcal transmission model and used likelihood to assess the ability of competing hypotheses to explain that increase. We find that a model integrating a fitness cost of penicillin resistance successfully explains the overall and age-stratified pattern of serotype replacement. By simulating counterfactual scenarios of public health interventions in France, we propose that this fitness cost caused a gradual and pernicious interaction between the two interventions by increasing the spread of nonvaccine, penicillin-susceptible strains. More generally, our results indicate that reductions of antibiotic use may counteract the benefits of conjugate vaccines introduced into countries with low vaccine-serotype coverages and high-resistance frequencies. Our findings highlight the key role of antibiotic use in vaccine-induced serotype replacement and suggest the need for more integrated approaches to control pneumococcal infections.
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Affiliation(s)
- Matthieu Domenech de Cellès
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Pierre et Marie Curie, Cellule Pasteur UPMC, F–75005 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
| | - Margarita Pons-Salort
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Pierre et Marie Curie, Cellule Pasteur UPMC, F–75005 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
| | - Emmanuelle Varon
- AP–HP, Hôpital Européen Georges-Pompidou, Laboratoire de Bactériologie, F–75015 Paris, France
- Centre National de Référence des Pneumocoques, F–75015 Paris, France
| | - Marie-Anne Vibet
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Pierre et Marie Curie, Cellule Pasteur UPMC, F–75005 Paris, France
| | - Caroline Ligier
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
| | - Véronique Letort
- École Centrale Paris, Laboratoire de Mathématiques Appliquées aux Systèmes, F–92290 Châtenay-Malabry, France
| | - Lulla Opatowski
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
| | - Didier Guillemot
- Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, F–75015 Paris, France
- INSERM, U1181, F–75015 Paris, France
- Univ. Versailles Saint Quentin, UFR des Sciences de la Santé Simone-Veil, EA 4499, F–78180 Montigny–le-Bretonneux, France
- AP–HP, Hôpital Raymond-Poincaré, Unité Fonctionnelle de Santé Publique, F–92380 Garches, France
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Abstract
We evaluated prospectively laboratory surveillance data from Massachusetts to investigate whether seasonal variation in invasive pneumococcal disease is associated with the proportion of penicillin-susceptible isolates. The proportion of penicillin-susceptible isolates associated with invasive pneumococcal disease varied by season, with proportions highest in the winter and lowest in the summer, and rates of invasive disease were highest in the autumn and winter seasons and lowest in the summer.
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MacLean RC, Vogwill T. Limits to compensatory adaptation and the persistence of antibiotic resistance in pathogenic bacteria. EVOLUTION MEDICINE AND PUBLIC HEALTH 2014; 2015:4-12. [PMID: 25535278 PMCID: PMC4323496 DOI: 10.1093/emph/eou032] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Antibiotic resistance carries a fitness cost that could potentially limit the spread of resistance in bacterial pathogens. In spite of this cost, a large number of experimental evolution studies have found that resistance is stably maintained in the absence of antibiotics as a result of compensatory evolution. Clinical studies, on the other hand, have found that resistance in pathogen populations usually declines after antibiotic use is stopped, suggesting that compensatory adaptation is not effective in vivo. In this article, we argue that this disagreement arises because there are limits to compensatory adaptation in nature that are not captured by the design of current laboratory selection experiments. First, clinical treatment fails to eradicate antibiotic-sensitive strains, and competition between sensitive and resistant strains leads to the rapid loss of resistance following treatment. Second, laboratory studies overestimate the efficacy of compensatory adaptation in nature by failing to capture costs associated with compensatory mutations. Taken together, these ideas can potentially reconcile evolutionary theory with the clinical dynamics of antibiotic resistance and guide the development of strategies for containing resistance in clinical pathogens.
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Affiliation(s)
- R Craig MacLean
- Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK
| | - Tom Vogwill
- Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK
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Seasonal variation in penicillin use in Mexico and Brazil: analysis of the impact of over-the-counter restrictions. Antimicrob Agents Chemother 2014; 59:105-10. [PMID: 25313222 DOI: 10.1128/aac.03629-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
During 2010, Mexico and Brazil implemented policies to enforce existing laws of restricting over-the-counter sales of antibiotics. We determined if the enforcement led to more appropriate antibiotic use by measuring changes in seasonal variation of penicillin use. We used retail quarterly sales data in defined daily doses per 1,000 inhabitant-days (DDD/TID) from IMS Health from the private sector in Mexico and Brazil from the first quarter of 2007 to the first quarter of 2013. This database contains information on volume of antibiotics sold in retail pharmacies using information from wholesalers. We used interrupted time-series models controlling for external factors with the use of antihypertensives with interaction terms to assess changes in trend, level, and variation in use between quarters for total penicillin use and by active substance. The most used penicillin was amoxicillin, followed by amoxicillin-clavulanic acid and ampicillin (minimal use in Brazil). Before the restrictions, the seasonal variation in penicillin use was 1.1 DDD/TID in Mexico and 0.8 DDD/TID in Brazil. In Mexico, we estimated a significant decrease in the seasonal variation of 0.4 DDD/TID after the restriction, mainly due to changes in seasonal variation of amoxicillin and ampicillin. In Brazil, the seasonal variation did not change significantly, overall and in the breakdown by individual active substances. For Mexico, inappropriate penicillin use may have diminished after the restrictions were enforced. For Brazil, increasing use and no change in seasonal variation suggest that further efforts are needed to reduce inappropriate penicillin use.
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Parameswaran GI, Sethi S. Long-term macrolide therapy in chronic obstructive pulmonary disease. CMAJ 2014; 186:1148-52. [PMID: 25096664 DOI: 10.1503/cmaj.121573] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ganapathi Iyer Parameswaran
- Division of Infectious Diseases (Parameswaran) and Division of Pulmonary, Critical Care and Sleep Medicine (Sethi), Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY; Veterans Affairs Western New York Healthcare System (Parameswaran, Sethi), Buffalo, NY
| | - Sanjay Sethi
- Division of Infectious Diseases (Parameswaran) and Division of Pulmonary, Critical Care and Sleep Medicine (Sethi), Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY; Veterans Affairs Western New York Healthcare System (Parameswaran, Sethi), Buffalo, NY.
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Abstract
Cervicitis has been described by some as the female counterpart of urethritis in men. Over the years a number of clinical and microscopy-based definitions have been suggested in the literature. Clinical manifestations include mucopurulent discharge from the cervix, cervical friability (easy bleeding from the cervix with passage of a swab) and cervical ectopy. Microscopic definitions involving the use of Gram stain of cervical secretions have included either more than 10 white blood cells (WBCs) or more than 30 WBCs per high-power field. Combinations of these clinical and microscopic findings have been used in attempts to increase the accuracy of cervicitis diagnosis. When cervicitis was initially recognized as a clinical entity, several investigators reported the primary pathogens causing cervicitis as Neisseria gonorrhoeae and Chlamydia trachomatis. It is now well established that most cases of cervicitis are not caused by these two organisms. Most cases of cervicitis are of unknown etiology.
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Affiliation(s)
- Stephanie N Taylor
- Section of Infectious Diseases, Louisiana State University Health Sciences Center, 517 N. Rampart St., New Orleans, LA, 70112, USA,
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Al-Mazrou KA, Shibl AM, Kandeil W, Pirçon JY, Marano C. A prospective, observational, epidemiological evaluation of the aetiology and antimicrobial susceptibility of acute otitis media in Saudi children younger than 5years of age. J Epidemiol Glob Health 2014; 4:231-8. [PMID: 25107659 PMCID: PMC7333816 DOI: 10.1016/j.jegh.2014.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/28/2014] [Accepted: 03/15/2014] [Indexed: 11/28/2022] Open
Abstract
Background: Information regarding acute otitis media (AOM) aetiology is important for developing effective vaccines. Here, bacterial aetiology and antimicrobial susceptibility of AOM were determined in young Saudi children. Methods: Children aged 3–60 months with a new episode of AOM, who had not received antibiotics or had received antibiotics for 48–72 h but remained symptomatic, were enrolled in this prospective, observational, epidemiological study in Riyadh. Middle ear fluid (MEF) samples were collected by tympanocentesis or from spontaneous otorrhea, and tested for the presence of Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes and Moraxella catarrhalis. Antimicrobial susceptibility of the identified pathogens was assessed using E-tests. Results: Between June 2009 and May 2011, 66 children were enrolled. S. pneumoniae was detected in 6 episodes and non-typeable H. influenzae (NTHi) in 8 episodes. Moreover, Staphylococcus aureus, which is an uncommon cause of AOM, was detected in 17 episodes. Pneumococcal serotypes were 7F (n = 2), 23F (n = 2), 19F (n = 1) and 15F (n = 1). Susceptibility to cefotaxime was observed in all pneumococcal and H. influenzae isolates, to cefuroxime in 4/6 pneumococcal and 8/8 H. influenzae isolates, and to penicillin in 5/6 pneumococcal isolates. Conclusions:S. pneumoniae and NTHi were major bacterial contributors for AOM in Saudi children.
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Affiliation(s)
- Khalid A Al-Mazrou
- King Saud University and King Saud bin Abdulaziz University for Health Sciences, PO Box 86118, Riyadh, Saudi Arabia.
| | - Atef M Shibl
- King Saud University, PO Box 2457, Riyadh 11451, Saudi Arabia.
| | - Walid Kandeil
- GlaxoSmithKline Vaccines, Avenue Fleming 20, 1300 Wavre, Belgium.
| | - Jean-Yves Pirçon
- GlaxoSmithKline Vaccines, Avenue Fleming 20, 1300 Wavre, Belgium.
| | - Cinzia Marano
- GlaxoSmithKline Vaccines, Avenue Fleming 20, 1300 Wavre, Belgium.
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Microbiological spectrum and antibiotic sensitivity in endophthalmitis: a 25-year review. Ophthalmology 2014; 121:1634-42. [PMID: 24702755 DOI: 10.1016/j.ophtha.2014.02.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To identify the spectrum and susceptibility pattern of pathogens responsible for culture-positive endophthalmitis referred to a single institution and investigate possible trends in both pathogens and antibiotic sensitivities over the past 25 years. DESIGN A retrospective, laboratory-based study of consecutive microbiological isolates. PARTICIPANTS A total of 988 consecutive culture-positive endophthalmitis isolates from 911 eyes. METHODS All culture-positive endophthalmitis isolates collected from 1987 to 2011 were identified. Susceptibility rates to a variety of antibiotics were calculated. Chi-square test for trend was used to detect changes in spectrum or susceptibility over time. MAIN OUTCOME MEASURES Microbial spectrum and susceptibility pattern over time. RESULTS A total of 988 isolates were identified from 911 eyes. The average patient age was 67 ± 18 years, and 55% of the patients were female. The most prevalent pathogens were coagulase-negative staphylococcus (39.4%), followed by Streptococcus viridans species (12.1%) and Staphylococcus aureus (11.1%). Gram-negative organisms and fungi accounted for 10.3% and 4.6% of all isolates, respectively. With the exception of 2 isolates, Enterococcus faecium and Nocardia exalbida, all the other 725 (99.7%) gram-positive bacteria tested were susceptible to vancomycin. Of the 94 gram-negative organisms tested against ceftazidime, 2 were of intermediate sensitivity and 6 were resistant. For 8 antibiotics, increasing microbial resistance over time was observed: cefazolin (P = 0.02), cefotetan (P = 0.006), cephalothin (P<0.0001), clindamycin (P = 0.04), erythromycin (P<0.0001), methicillin/oxacillin (P<0.0001), ampicillin (P = 0.01), and ceftriaxone (P = 0.006). For 3 antibiotics, increasing microbial susceptibility was observed: gentamicin (P<0.0001), tobramycin (P = 0.005), and imipenem (P<0.0001). CONCLUSIONS Coagulase-negative staphylococcus remains the most frequently identified cause of endophthalmitis. Vancomycin and ceftazidime seem to be excellent empiric antibiotics for treating endophthalmitis. Although a statistically significant trend toward increasing microbial resistance against a variety of antibiotics, including cephalosporins and methicillin, was observed, a significant trend toward decreasing microbial resistance against aminoglycosides and imipenem also was detected.
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Trends and seasonal variation in outpatient antibiotic prescription rates in the United States, 2006 to 2010. Antimicrob Agents Chemother 2014; 58:2763-6. [PMID: 24590486 DOI: 10.1128/aac.02239-13] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antibiotic-resistant bacteria are an increasing threat to the effectiveness of antibiotics. The majority of antibiotics are prescribed in primary care settings for upper respiratory tract infections. The purpose of this study was to describe seasonal trends in outpatient antibiotic prescriptions (Rx) in the United States over a 5-year period. This study was a retrospective, cross-sectional observation of systemic antibiotic prescriptions in the outpatient setting from 2006 to 2010. Winter months were defined as the first and fourth quarters of the calendar year. Antibiotic prescribing rates were calculated (prescriptions/1,000 population) using annual U.S. Census Bureau population data. Over 1.34 billion antibiotic prescriptions were dispensed over the 5-year period. The antibiotic prescription (Rx) rate decreased from 892 Rx/1,000 population in 2006 to 867 Rx/1,000 population in 2010. Penicillins and macrolides were the primary antibiotic classes prescribed, but penicillin prescribing decreased while macrolide prescribing increased over the study period. Overall, antibiotic prescriptions were 24.5% higher in winter months than in the summer, with the largest difference (28.8%) in 2008 and the smallest (20.4%) in 2010. This seasonality was consistently drug class dependent, driven by 75% and 100% increases in penicillin and macrolide prescriptions, respectively, in the winter months. The mean outpatient antibiotic prescription rate decreased in the United States from 2006 to 2010. More antibiotic prescribing, predominately driven by the macrolide and penicillin classes, in the outpatient setting was observed in the winter months. Understanding annual variability in antibiotic use can assist with designing interventions to improve the judicious use of antibiotics.
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Haubitz S, Mueller B, Schuetz P. Streamlining antibiotic therapy with procalcitonin protocols: consensus and controversies. Expert Rev Respir Med 2014; 7:145-57. [DOI: 10.1586/ers.13.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Gomes ALC, Galagan JE, Segrè D. Resource competition may lead to effective treatment of antibiotic resistant infections. PLoS One 2013; 8:e80775. [PMID: 24349015 PMCID: PMC3862480 DOI: 10.1371/journal.pone.0080775] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/07/2013] [Indexed: 12/20/2022] Open
Abstract
Drug resistance is a common problem in the fight against infectious diseases. Recent studies have shown conditions (which we call antiR) that select against resistant strains. However, no specific drug administration strategies based on this property exist yet. Here, we mathematically compare growth of resistant versus sensitive strains under different treatments (no drugs, antibiotic, and antiR), and show how a precisely timed combination of treatments may help defeat resistant strains. Our analysis is based on a previously developed model of infection and immunity in which a costly plasmid confers antibiotic resistance. As expected, antibiotic treatment increases the frequency of the resistant strain, while the plasmid cost causes a reduction of resistance in the absence of antibiotic selection. Our analysis suggests that this reduction occurs under competition for limited resources. Based on this model, we estimate treatment schedules that would lead to a complete elimination of both sensitive and resistant strains. In particular, we derive an analytical expression for the rate of resistance loss, and hence for the time necessary to turn a resistant infection into sensitive (tclear). This time depends on the experimentally measurable rates of pathogen division, growth and plasmid loss. Finally, we estimated tclear for a specific case, using available empirical data, and found that resistance may be lost up to 15 times faster under antiR treatment when compared to a no treatment regime. This strategy may be particularly suitable to treat chronic infection. Finally, our analysis suggests that accounting explicitly for a resistance-decaying rate may drastically change predicted outcomes in host-population models.
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Affiliation(s)
- Antonio L. C. Gomes
- Bioinformatics Program, Boston University, Boston, Massachusetts, United States of America
| | - James E. Galagan
- Bioinformatics Program, Boston University, Boston, Massachusetts, United States of America
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Daniel Segrè
- Bioinformatics Program, Boston University, Boston, Massachusetts, United States of America
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
- Department of Biology, Boston University, Boston, Massachusetts, United States of America
- * E-mail:
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48
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Abstract
BACKGROUND Mucopurulent cervicitis (MPC) is a clinical syndrome characterized by mucopurulent discharge from the cervix and other signs of inflammation. This was a phase III, multicenter study designed to evaluate the effectiveness of placebo versus empiric antibiotic treatment for clinical cure of MPC of unknown etiology at 2-month follow-up. Unfortunately, enrollment was terminated because of low accrual of women with cervicitis of unknown etiology, but important prevalence and outcome data were obtained. METHODS Five hundred seventy-seven women were screened for MPC. Women with MPC were randomized to the treatment or placebo arm of the study, and the 2 arms were evaluated based on the etiology, clinical cure rates, adverse events (AEs), and rates of pelvic inflammatory disease. RESULTS One hundred thirty-one (23% [131/577]) screened women were found to have MPC. Eighty-seven were enrolled and randomized. After excluding women with sexually transmitted infections and other exclusions, 61% (53/87) had cervicitis of unknown etiology. The overall clinical failure rate was 30% (10/33), and the clinical cure rate was only 24% (8/33). Rates were not significantly different between the arms. There were 24 gastrointestinal AEs in the treatment arm compared with 1 AE in the placebo arm. CONCLUSIONS More than half of the cases of MPC were of unknown etiology. Clinical cure rates for the placebo and treatment arms were extremely low, with most women concluding the study with a partial response. Gastrointestinal AEs were higher in the treatment arm.
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Opatowski L, Varon E, Dupont C, Temime L, van der Werf S, Gutmann L, Boëlle PY, Watier L, Guillemot D. Assessing pneumococcal meningitis association with viral respiratory infections and antibiotics: insights from statistical and mathematical models. Proc Biol Sci 2013; 280:20130519. [PMID: 23782877 DOI: 10.1098/rspb.2013.0519] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Pneumococcus is an important human pathogen, highly antibiotic resistant and a major cause of bacterial meningitis worldwide. Better prevention requires understanding the drivers of pneumococcal infection incidence and antibiotic susceptibility. Although respiratory viruses (including influenza) have been suggested to influence pneumococcal infections, the underlying mechanisms are still unknown, and viruses are rarely considered when studying pneumococcus epidemiology. Here, we propose a novel mathematical model to examine hypothetical relationships between Streptococcus pneumoniae meningitis incidence (SPMI), acute viral respiratory infections (AVRIs) and antibiotic exposure. French time series of SPMI, AVRI and penicillin consumption over 2001-2004 are analysed and used to assess four distinct virus-bacteria interaction submodels, ascribing the interaction on pneumococcus transmissibility and/or pathogenicity. The statistical analysis reveals strong associations between time series: SPMI increases shortly after AVRI incidence and decreases overall as the antibiotic-prescription rate rises. Model simulations require a combined impact of AVRI on both pneumococcal transmissibility (up to 1.3-fold increase at the population level) and pathogenicity (up to threefold increase) to reproduce the data accurately, along with diminished epidemic fitness of resistant pneumococcal strains causing meningitis (0.97 (0.96-0.97)). Overall, our findings suggest that AVRI and antibiotics strongly influence SPMI trends. Consequently, vaccination protecting against respiratory virus could have unexpected benefits to limit invasive pneumococcal infections.
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Affiliation(s)
- Lulla Opatowski
- Unité de Pharmaco-épidémiologie et Maladies Infectieuses PhEMI, Institut Pasteur, 75015 Paris, France.
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50
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Dumpis U, Dimiņa E, Akermanis M, Tirāns E, Veide S. Assessment of antibiotic prescribing in Latvian general practitioners. BMC FAMILY PRACTICE 2013; 14:9. [PMID: 23311389 PMCID: PMC3562523 DOI: 10.1186/1471-2296-14-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 01/10/2013] [Indexed: 12/02/2022]
Abstract
BACKGROUND Though general antibiotic consumption data is available, information on the actual patterns of prescribing antibiotics locally is difficult to obtain. An easy to use methodology was designed to assess ambulatory management of infections by Latvian general practitioners (GPs). METHODS GPs were asked to record data in a patient data collection form for every patient that received antibiotics. Study period - (7 days) one week in November, 2008. Data recorded included the following details: an antibiotic, the prescribed dose, dosing interval, route of administration combined with the demographic factors of the patient and clinical diagnosis based on a pre-defined list. RESULTS Two hundred forty eight forms out of the 600 (41%) were returned by post. Antibiotics were prescribed in 6.4% (1711/26803) of outpatient consultations. In total, 1763 antibiotics were prescribed during the study period. Ninety seven percent of the patients received monotherapy and only 47 (2.7%) patients were prescribed two antibiotics. The most commonly prescribed antibiotics were amoxicillin (33.9% of prescribed), amoxicillin/clavulanate (18,7%) and clarithromycin (7.6%). The most commonly treated indications were pharyngitis (29.8%), acute bronchitis (25.3%) and rhinosinusitis (10.2%). Pneumonia was mostly treated with amoxicillin/clavulanate (25,7%), amoxicillin (15.7%) and clarithromycin (19.3%). CONCLUSIONS Methodology employed provided useful additional information on ambulatory practice of prescribing antibiotics and could be used in further assessment studies. Educational interventions should be focused on treatment of acute pharyngitis and bronchitis in children and unnecessary use of quinolones in adults for uncomplicated urinary tract infection.
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Affiliation(s)
- Uga Dumpis
- Department of Infection Control, Pauls Stradins University Hospital, Pilsonu street 12, LV-1002, Riga, Latvia
- University of Latvia, Riga, Latvia
| | - Elīna Dimiņa
- Department of Infection Control, Pauls Stradins University Hospital, Pilsonu street 12, LV-1002, Riga, Latvia
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