1
|
Read DS, Gweon HS, Bowes MJ, Anjum MF, Crook DW, Chau KK, Shaw LP, Hubbard A, AbuOun M, Tipper HJ, Hoosdally SJ, Bailey MJ, Walker AS, Stoesser N. Dissemination and persistence of antimicrobial resistance (AMR) along the wastewater-river continuum. WATER RESEARCH 2024; 264:122204. [PMID: 39116608 DOI: 10.1016/j.watres.2024.122204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 07/15/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
Antimicrobial resistance (AMR) is a global health hazard. Although clinical and agricultural environments are well-established contributors to the evolution and dissemination of AMR, research on wastewater treatment works (WwTWs) has highlighted their potential role as disseminators of AMR in freshwater environments. Using metagenomic sequencing and analysis, we investigated the changes in resistomes and associated mobile genetic elements within untreated wastewater influents and treated effluents of five WwTWs, and sediments collected from corresponding river environments in Oxfordshire, UK, across three seasonal periods within a year. Our analysis demonstrated a high diversity and abundance of antimicrobial resistance genes (ARGs) in untreated wastewater influents, reflecting the varied anthropogenic and environmental origins of wastewater. WwTWs effectively reduced AMR in the final effluent, with an average 87 % reduction in normalised ARG abundance and an average 63 % reduction in richness. However, wastewater effluents significantly impacted the antimicrobial resistome of the receiving rivers, with an average 543 % increase in ARG abundance and a 164 % increase in richness from upstream sediments to downstream sediments. The normalised abundance of the human gut-associated bacteriophage crAssphage was highly associated with both ARG abundance and richness. We observed seasonal variation in the resistome of raw influent which was not found in the effluent-receiving sediments. We illustrate the potential of WwTWs as focal points for disseminating ARGs and resistance-selecting chemicals, contributing to the elevation of environmental AMR. Our study emphasises the need for a comprehensive understanding of the anthropogenic impacts on AMR evolution and dissemination in wastewater and river environments, informing efforts to mitigate this growing public health crisis.
Collapse
Affiliation(s)
- Daniel S Read
- UK Centre for Ecology & Hydrology (UKCEH), Benson Lane, Crowmarsh Gifford, Wallingford OX10 8BB, UK.
| | - H Soon Gweon
- UK Centre for Ecology & Hydrology (UKCEH), Benson Lane, Crowmarsh Gifford, Wallingford OX10 8BB, UK; School of Biological Sciences, University of Reading, Reading, UK
| | - Michael J Bowes
- UK Centre for Ecology & Hydrology (UKCEH), Benson Lane, Crowmarsh Gifford, Wallingford OX10 8BB, UK
| | - Muna F Anjum
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey KT15 3NB, UK
| | - Derrick W Crook
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kevin K Chau
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Liam P Shaw
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Biology, University of Oxford, 11a Mansfield Road, Oxford OX1 3SZ, UK
| | - Alasdair Hubbard
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Biosciences, Nottingham Trent University, Nottingham NG11 8NS, UK
| | - Manal AbuOun
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, Surrey KT15 3NB, UK
| | - Holly J Tipper
- UK Centre for Ecology & Hydrology (UKCEH), Benson Lane, Crowmarsh Gifford, Wallingford OX10 8BB, UK
| | | | - Mark J Bailey
- UK Centre for Ecology & Hydrology (UKCEH), Benson Lane, Crowmarsh Gifford, Wallingford OX10 8BB, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicole Stoesser
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
2
|
Blair PS, Young GJ, Clement C, Dixon P, Seume P, Ingram J, Taylor J, Horwood J, Lucas PJ, Cabral C, Francis NA, Beech E, Gulliford M, Creavin S, Lane JA, Bevan S, Hay AD. A multifaceted intervention to reduce antibiotic prescribing among CHIldren with acute COugh and respiratory tract infection: the CHICO cluster RCT. Health Technol Assess 2023; 27:1-110. [PMID: 38204218 PMCID: PMC11017154 DOI: 10.3310/ucth3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Clinical uncertainty in primary care regarding the prognosis of children with respiratory tract infections contributes to the unnecessary use of antibiotics. Improved identification of children at low risk of future hospitalisation might reduce clinical uncertainty. A National Institute for Health and Care Research-funded 5-year programme (RP-PG-0608-10018) was used to develop and feasibility test an intervention. Objectives The aim of the children with acute cough randomised controlled trial was to reduce antibiotic prescribing among children presenting with acute cough and respiratory tract infection without increasing hospital admission. Design An efficient, pragmatic open-label, two-arm trial (with embedded qualitative and health economic analyses) using practice-level randomisation using routinely collected data as the primary outcome. Setting General practitioner practices in England. Participants General practitioner practices using the Egton Medical Information Systems® patient-record system for children aged 0-9 years presenting with a cough or upper respiratory tract infection. Recruited by Clinical Research Networks and Clinical Commissioning Groups. Intervention Comprised: (1) elicitation of parental concerns during consultation; (2) a clinician-focused prognostic algorithm to identify children with acute cough and respiratory tract infection at low, average or elevated risk of hospitalisation in the next 30 days accompanied by prescribing guidance, (3) provision of a printout for carers including safety-netting advice. Main outcome measures Co-primaries using the practice list-size for children aged 0-9 years as the denominator: rate of dispensed amoxicillin and macrolide items at each practice (superiority comparison) from NHS Business Services Authority ePACT2 and rate of hospital admission for respiratory tract infection (non-inferiority comparison) from Clinical Commissioning Groups, both routinely collected over 12 months. Results Of the 310 practices required, 294 (95%) were recruited (144 intervention and 150 controls) with 336,496 registered 0-9-year-olds (5% of all 0-9-year-old children in England) from 47 Clinical Commissioning Groups. Included practices were slightly larger than those not included, had slightly lower baseline dispensing rates and were located in more deprived areas (reflecting the distribution for practice postcodes nationally). Twelve practices (4%) subsequently withdrew (six related to the pandemic). The median number of times the intervention was used was 70 per practice (by a median of 9 clinicians) over 12 months. There was no evidence that the antibiotic dispensing rate in the intervention practices [0.155 (95% confidence interval 0.135 to 0.179)] differed to controls [0.154 (95% confidence interval 0.130 to 0.182), relative risk= 1.011 (95% confidence interval 0.992 to 1.029); p = 0.253]. There was, overall, a reduction in dispensing levels and intervention usage during the pandemic. The rate of hospitalisation for respiratory tract infection in the intervention practices [0.019 (95% confidence interval 0.014 to 0.026)] compared to the controls [0.021 (95% confidence interval 0.014 to 0.029)] was non-inferior [relative risk = 0.952 (95% confidence interval 0.905 to 1.003)]. The qualitative evaluation found the clinicians liked the intervention, used it as a supportive aid, especially with borderline cases but that it, did not always integrate well within the consultation flow and was used less over time. The economic evaluation found no evidence of a difference in mean National Health Service costs between arms; mean difference -£1999 (95% confidence interval -£6627 to 2630). Conclusions The intervention was feasible and subjectively useful to practitioners, with no evidence of harm in terms of hospitalisations, but did not impact on antibiotic prescribing rates. Future work and limitations Although the intervention does not appear to change prescribing behaviour, elements of the approach may be used in the design of future interventions. Trial registration This trial is registered as ISRCTN11405239 (date assigned 20 April 2018) at www.controlled-trials.com (accessed 5 September 2022). Version 4.0 of the protocol is available at: https://www.journalslibrary.nihr.ac.uk/ (accessed 5 September 2022). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (NIHR award ref: 16/31/98) programme and is published in full in Health Technology Assessment; Vol. 27, No. 32. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Peter S Blair
- Centre for Academic Child Health, University of Bristol, Bristol Medical School, Bristol, UK
| | - Grace J Young
- Bristol Trials Centre (Bristol Randomised Trials Collaboration), Bristol Medical School, Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Trials Centre (Bristol Randomised Trials Collaboration), Bristol Medical School, Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Padraig Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Oxford, UK
| | - Penny Seume
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jenny Ingram
- Centre for Academic Child Health, University of Bristol, Bristol Medical School, Bristol, UK
| | - Jodi Taylor
- Bristol Trials Centre (Bristol Randomised Trials Collaboration), Bristol Medical School, Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Christie Cabral
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Nick A Francis
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | | | - Martin Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Sam Creavin
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Janet A Lane
- Bristol Trials Centre (Bristol Randomised Trials Collaboration), Bristol Medical School, Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Scott Bevan
- Bristol Trials Centre (Bristol Randomised Trials Collaboration), Bristol Medical School, Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
3
|
Serletti L, Dutcher L, Degnan KO, Szymczak JE, Cluzet V, David MZ, Cressman L, Glassman LW, Hamilton KW. Analysis of seasonal variation of antibiotic prescribing for respiratory tract diagnoses in primary care practices. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e147. [PMID: 37771744 PMCID: PMC10523546 DOI: 10.1017/ash.2023.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 09/30/2023]
Abstract
Objective To determine antibiotic prescribing appropriateness for respiratory tract diagnoses (RTD) by season. Design Retrospective cohort study. Setting Primary care practices in a university health system. Patients Patients who were seen at an office visit with diagnostic code for RTD. Methods Office visits for the entire cohort were categorized based on ICD-10 codes by the likelihood that an antibiotic was indicated (tier 1: always indicated; tier 2: sometimes indicated; tier 3: rarely indicated). Medical records were reviewed for 1,200 randomly selected office visits to determine appropriateness. Based on this reference standard, metrics and prescriber characteristics associated with inappropriate antibiotic prescribing were determined. Characteristics of antibiotic prescribing were compared between winter and summer months. Results A significantly greater proportion of RTD visits had an antibiotic prescribed in winter [20,558/51,090 (40.2%)] compared to summer months [11,728/38,537 (30.4%)][standardized difference (SD) = 0.21]. A significantly greater proportion of winter compared to summer visits was associated with tier 2 RTDs (29.4% vs 23.4%, SD = 0.14), but less tier 3 RTDs (68.4% vs 74.4%, SD = 0.13). A greater proportion of visits in winter compared to summer months had an antibiotic prescribed for tier 2 RTDs (80.2% vs 74.2%, SD = 0.14) and tier 3 RTDs (22.9% vs 16.2%, SD = 0.17). The proportion of inappropriate antibiotic prescribing was higher in winter compared to summer months (72.4% vs 62.0%, P < .01). Conclusions Increases in antibiotic prescribing for RTD visits from summer to winter were likely driven by shifts in diagnoses as well as increases in prescribing for certain diagnoses. At least some of this increased prescribing was inappropriate.
Collapse
Affiliation(s)
- Lacey Serletti
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lauren Dutcher
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kathleen O. Degnan
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Julia E. Szymczak
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Valerie Cluzet
- Division of Infectious Diseases, Nuvance Health, Poughkeepsie, NY, USA
| | - Michael Z. David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Leigh Cressman
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Keith W. Hamilton
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | |
Collapse
|
4
|
Pirsaheb M, Moradi N, Hossini H. Sonochemical processes for antibiotics removal from water and wastewater: A systematic review. Chem Eng Res Des 2022. [DOI: 10.1016/j.cherd.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
5
|
Wang Y, Zhao X, Li Y, Wang N, Jiang F, Lambert H, Yan F, Fu C, Jiang Q. Patterns and Determinants of Antibiotic Use Behaviors among Rural Community Residents in Eastern China. Antibiotics (Basel) 2022; 11:823. [PMID: 35740229 PMCID: PMC9220009 DOI: 10.3390/antibiotics11060823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 01/01/2023] Open
Abstract
Inappropriate antibiotic use may lead to antibiotic resistance, which has become a serious global crisis. Addressing suboptimal antibiotic use in the general population can play a significant role in the fight against antimicrobial resistance. This study aims to describe antibiotic use and sources of acquisition, and to identify factors influencing antibiotic access among rural community residents in Eastern China. A cross-sectional survey was conducted from July to August 2020, and 1494 participants from two villages in Eastern China were enrolled. Information was obtained using face-to-face interviews with a structured electronic questionnaire. Chi-squared and multinominal logistic regression analysis were used to explore possible determinants. In total, 1379 participants were eligible for the analysis. In the past 12 months, nearly half the respondents had taken any antibiotic (48.4%), and this proportion varied across marital status and age group. Two thirds of them (59.9%) obtained antibiotics from medical facilities with a prescription when they last took antibiotics, while 17.7% and 22.4% chose retail pharmacies and other sources, respectively. Multinominal analysis found that a higher proportion obtained antibiotics outside medical facilities among those aged 15 to 44 years, unmarried, non-white collar workers, with more years of education, lower annual household income per capita and lower levels of antibiotic knowledge. The antibiotic use behavior of rural community residents in Eastern China remains suboptimal. Antibiotic use and access behaviors need to be further addressed. Effective antibiotic stewardship in non-medical facility sources and training programs targeted for rural Chinese is warranted in future.
Collapse
Affiliation(s)
- Yanhuan Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Xinping Zhao
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Yurong Li
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Na Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Feng Jiang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Fei Yan
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Chaowei Fu
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Qingwu Jiang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| |
Collapse
|
6
|
Mustafa L, Islami H, Sutej I. Administration of Systemic Antibiotics for Dental Treatment in Kosovo Major Dental Clinics: A National Survey. Eur J Dent 2022; 16:430-436. [PMID: 35016236 PMCID: PMC9339925 DOI: 10.1055/s-0041-1735931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Antibiotics misuse and a high level of antibiotics resistance is observed worldwide, but particularly in developing countries. Kosovo in the last decade is facing challenges regarding antimicrobial resistance. The purpose of the present study was to investigate patterns of antibiotics prescriptions of dentists in Kosovo's major dental clinics. MATERIALS AND METHODS For Kosovo's prescribing pattern, data collection was obtained from 10 Regional Dental Clinics and a Tertiary Health Center regarding patients who were prescribed antibiotics in the years 2015 to 2019. Data analysis was performed by using descriptive statistics and was processed by using MS Excel. RESULTS Most prescribed antibiotic during the observed period from 2015 to 2019 in Kosovo was amoxicillin, although a drastic increase of amoxicillin with clavulanic acid-as a broad-spectrum antibiotic-is observed. The trend of antibiotics use in tertiary health institutions is in an overall decrease in Kosovo with an exception in the year 2017. Despite this overall decrease, inconsistency in prescribing is observed when the pattern is analyzed for each region separately. The highest number of patients in health care dental clinics received antibiotics for maxilla-related health conditions and the lowest number of them for oncologic ones. CONCLUSION The patterns of antibiotics prescriptions by dental practitioners in Kosovo during the years 2015 to 2019 are fluctuating. Compared with the global health care standards, the irrational use of antibiotics in dental health care clinics in Kosovo still exist and this issue should be further addressed by respective actors.
Collapse
Affiliation(s)
- Lirim Mustafa
- Department of Health Management - Economy, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Hilmi Islami
- Pharmacology Department, Medical Faculty, University "Hasan Prishtina", Kosovo, Republic of Kosovo
| | - Ivana Sutej
- Department of Pharmacology, School of Dental Medicine, University in Zagreb, Croatia
| |
Collapse
|
7
|
Development and validation of antibiotic stewardship metrics for outpatient respiratory tract diagnoses and association of provider characteristics with inappropriate prescribing. Infect Control Hosp Epidemiol 2022; 43:56-63. [PMID: 34075872 PMCID: PMC9904452 DOI: 10.1017/ice.2021.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine metrics and provider characteristics associated with inappropriate antibiotic prescribing for respiratory tract diagnoses (RTDs). DESIGN Retrospective cohort study. SETTING Primary care practices in a university health system. PARTICIPANTS Patients seen by an attending physician or advanced practice provider (APP) at their primary care office visit with International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM)-coded RTDs. METHODS Medical records were reviewed for 1,200 randomly selected office visits in which an antibiotic was prescribed to determine appropriateness. Based on this gold standard, metrics and provider characteristics associated with inappropriate antibiotic prescribing were determined. RESULTS Overall, 69% of antibiotics were inappropriate. Metrics utilizing prespecified RTDs most strongly associated with inappropriate prescribing were (1) proportion prescribing for RTDs for which antibiotics are almost never required (eg, bronchitis) and (2) proportion prescribing for any RTD. Provider characteristics associated with inappropriate antibiotic prescribing were APP versus physician (72% vs 58%; P = .02), family medicine versus internal medicine (76% vs 63%; P = .01), board certification 1997 or later versus board certification before 1997 (75% vs 63%; P = .02), nonteaching versus teaching practice (73% vs 51%; P < .01), and nonurban vs urban practice (77% vs 57%; P < .01). CONCLUSIONS Metrics utilizing proportion prescribing for RTDs for which antibiotics are almost never required and proportion prescribing for any RTD were most strongly associated with inappropriate prescribing. APPs and clinicians with family medicine training, with board certification 1997 or later, and who worked in nonteaching or nonurban practices had higher proportions of inappropriate prescribing. These findings could inform design of interventions to improve prescribing and could represent an efficient way to track inappropriate prescribing.
Collapse
|
8
|
Penicillins' Solubility in Supercritical Carbon Dioxide: Modeling by Cubic Equations of States Revisited. Antibiotics (Basel) 2021; 10:antibiotics10121448. [PMID: 34943660 PMCID: PMC8698022 DOI: 10.3390/antibiotics10121448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 01/18/2023] Open
Abstract
Development of processes using green solvents as supercritical fluids (SCFs) depends on the accuracy of modeling and predicting phase equilibrium which is of considerable importance to exploit the use of SCF process at the level of pharmaceutical industries. Solid-Fluid equilibrium modeling is associated to many drawbacks when compressed gas-based models as cubic equations of states (cEoSs) are used. The unavailability of experimental values of solute's sublimation pressure presents one of the major obstacles to the solubility modeling with this type of models, and thus, its estimation is essential and inevitable. This work is an attempt to address a question regarding "accurate estimated value" of sublimation pressure of two antibiotics Penicillin G (benzyl penicillin) and Penicillin V (phenoxymethyl penicillin). Toward that, first, cEoSs are provided as the thermodynamics modeling framework and fundamental approach. Second, a discussion and a review of some literature results are given. Third, results are invoked to present a criticism analysis that comes from the use of modified form of Peng-Robinson (PR) equation of states. Finally, considerable improvement of modeling results by using a new sublimation pressure is shown.
Collapse
|
9
|
Demeke CA, Adinew GM, Abebe TB, Gelaye AT, Gemeda SG, Yimenu DK. Comparative analysis of the effectiveness of narrow-spectrum versus broad-spectrum antibiotics for the treatment of childhood pneumonia. SAGE Open Med 2021; 9:20503121211044379. [PMID: 34527245 PMCID: PMC8436284 DOI: 10.1177/20503121211044379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/18/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: The main objective of this study was to compare the effectiveness of empiric treatment with narrow-spectrum therapy versus broad-spectrum therapy for children hospitalized with community-acquired pneumonia (CAP) at the University of Gondar Referral Hospital, Gondar, Ethiopia. Methods: Institutional-based retrospective chart review was conducted at the University of Gondar Referral Hospital (GURH) pediatrics ward from 1 February 2016 to 30 April 2016. The collected data were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were done to present the basic features and summary of the data set. In addition, binary logistics and multivariable logistic regression analysis were conducted to test for an association between the dependent and independent variables. A P value of <0.05 was taken to declare statistical significance at a 95% confidence interval. Result: A total of 147 patients with CAP were included in the study. Seven different treatment regimens were employed for the 147 children hospitalized. About 63 (42.9%) of the study participants received a narrow-spectrum antibiotic and 84 (57.1%) received a broad-spectrum antibiotic. There was no significant difference between the broad and narrow spectrum treatment groups in main treatment outcomes. The median length of stay (LOS) for the study population was 3 days. The median LOS was shorter among those receiving narrow-spectrum therapy compared with those receiving broad-spectrum therapy. Treatment dose and duration of therapy were significantly associated with treatment outcome (P < 0.0001 and P = 0.003), respectively. Conclusion: The effectiveness of narrow-spectrum therapy is similar to that of broad-spectrum therapy for children hospitalized with CAP. Treatment regimens for children with community-acquired pneumonia should be selected based on their safety profile and their tendency for antibiotic resistance.
Collapse
Affiliation(s)
- Chilot Abiyu Demeke
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getnet Mequanent Adinew
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University (FAMU), Tallahassee, FL, USA
| | - Tamrat Befekadu Abebe
- Division of Cardiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Abebech Tewabe Gelaye
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sisay G/Hana Gemeda
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Kumilachew Yimenu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
10
|
Bruyndonckx R, Adriaenssens N, Versporten A, Hens N, Monnet DL, Molenberghs G, Goossens H, Weist K, Coenen S. Consumption of antibiotics in the community, European Union/European Economic Area, 1997-2017. J Antimicrob Chemother 2021; 76:ii7-ii13. [PMID: 34312654 PMCID: PMC8314117 DOI: 10.1093/jac/dkab172] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives Data on antibiotic consumption in the community were collected from 30 EU/EEA countries over two decades. This article reviews temporal trends, seasonal variation, presence of change-points and changes in the composition of the main antibiotic groups. Methods For the period 1997–2017, data on consumption of antibiotics, i.e. antibacterials for systemic use (ATC group J01), in the community, aggregated at the level of the active substance, were collected using the WHO ATC/DDD methodology (ATC/DDD index 2019). Consumption was expressed in DDD per 1000 inhabitants per day and in packages per 1000 inhabitants per day. Antibiotic consumption was analysed based on ATC-3 groups, and presented as trends, seasonal variation, presence of change-points and compositional changes. Results In 2017, antibiotic consumption in the community expressed in DDD per 1000 inhabitants per day varied by a factor 3.6 between countries with the highest (Greece) and the lowest (the Netherlands) consumption. Antibiotic consumption in the EU/EEA did not change significantly over time. Antibiotic consumption showed a significant seasonal variation, which decreased over time. The number of DDD per package significantly increased over time. The proportional consumption of sulphonamides and trimethoprim (J01E) relative to other groups significantly decreased over time, while the proportional consumption of other antibacterials (J01X) relative to other groups significantly increased over time. Conclusions Overall, antibiotic consumption in the community in the EU/EEA did not change during 1997–2017, while seasonal variation consistently decreased over time. The number of DDD per package increased during 1997–2017.
Collapse
Affiliation(s)
- Robin Bruyndonckx
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Belgium
| | - Dominique L Monnet
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium.,Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Catholic University of Leuven, Leuven, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Klaus Weist
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | | |
Collapse
|
11
|
Bruyndonckx R, Coenen S, Hens N, Vandael E, Catry B, Goossens H. Antibiotic use and resistance in Belgium: the impact of two decades of multi-faceted campaigning. Acta Clin Belg 2021; 76:280-288. [PMID: 32024450 DOI: 10.1080/17843286.2020.1721135] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To present an overview of almost two decades of multi-faceted campaigning by the Belgian Antibiotic Policy Coordination Committee (BAPCOC) and partners, and its impact on public and prescribers' awareness, outpatient antibiotic use, its cost and antimicrobial resistance in Belgium.Methods: Awareness of both public and prescribers was assessed through pre- and post-campaign interviews and surveys. Outpatient antibiotic use was evaluated using national reimbursement data expressed in number of defined daily doses and packages (a good proxy for treatments) per 1000 inhabitants per day (DID and PID, respectively) from July 1997 to June 2018. Its cost was studied using the same data expressed in number of euros per 1000 inhabitants per day. Antimicrobial resistance was evaluated between 1986 and 2017 using national data on the proportion of Streptococcus pneumoniae isolates not susceptible to penicillins, macrolides and tetracyclines.Results: Antibiotic awareness improved significantly, with general practitioners preferred by 87.5% of respondents as source of information. The Belgian outpatient antibiotic use has decreased by 12.8% in DID and by 42.8% in PID in the 2017-2018 winter compared to the winter before the start of its public awareness campaigns (1999-2000). This evolution coincided with decreasing costs for antibiotics and decreasing antimicrobial resistance. Despite multi-faceted campaigning, outpatient antibiotic use and use of broad-spectrum antibiotics, especially fluoroquinolones and amoxicillin with clavulanic acid, are still high in Belgium.Conclusion: Almost two decades of multi-faceted campaigning coincide with improvements in antibiotic awareness among the public and prescribers, outpatient antibiotic use and resistance. Nevertheless, additional efforts are needed to reach the targets set in BAPCOC's national action plan 2014-2019. Therefore, a new national action plan was developed for 2020-2024 using a One Health approach.
Collapse
Affiliation(s)
- R. Bruyndonckx
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-biostat), Hasselt University, Hasselt, Belgium
| | - S. Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
- Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium
| | - N. Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-biostat), Hasselt University, Hasselt, Belgium
- Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - E. Vandael
- Healthcare-associated Infection & Antimicrobial Resistance (NSIH), Scientific Directorate Epidemiology and Public Health, Brussels, Belgium
| | - B. Catry
- Healthcare-associated Infection & Antimicrobial Resistance (NSIH), Scientific Directorate Epidemiology and Public Health, Brussels, Belgium
- Faculty of Medicine, Université Libre De Bruxelles (ULB), Brussels, Belgium
| | - H. Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| |
Collapse
|
12
|
Bruyndonckx R, Hoxha A, Quinten C, Ayele GM, Coenen S, Versporten A, Adriaenssens N, Muller A, Heuer O, Monnet DL, Goossens H, Molenberghs G, Weist K, Hens N. Change-points in antibiotic consumption in the community, European Union/European Economic Area, 1997-2017. J Antimicrob Chemother 2021; 76:ii68-ii78. [PMID: 34312659 PMCID: PMC8314102 DOI: 10.1093/jac/dkab179] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Surveillance of antibiotic consumption in the community is of utmost importance to inform and evaluate control strategies. Data on two decades of antibiotic consumption in the community were collected from 30 EU/European Economic Area (EEA) countries. This article reviews temporal trends and the presence of abrupt changes in subgroups of relevance in antimicrobial stewardship. METHODS For the period 1997-2017, data on yearly antibiotic consumption in the community, aggregated at the level of the active substance, were collected using the WHO ATC classification and expressed in DDD (ATC/DDD index 2019) per 1000 inhabitants per day. We applied a range of non-linear mixed models to assess the presence of changes in the consumption of antibacterials for systemic use (ATC group J01) and eight antibiotic subgroups. RESULTS For the majority of the studied groups, a country-specific change-point model provided the best fit. Depending on the antibiotic group/subgroup and on the country, change-points were spread out between 2000 and 2013. CONCLUSIONS Due to the heterogeneity in antibiotic consumption in the community across EU/EEA countries, a country-specific change-point model provided the better fit. Given the limitations of this model, our recommendation for the included countries is to carefully interpret the country-specific results presented in this article and to use the tutorial included in this series to conduct their own change-point analysis when evaluating the impact of changes in regulations, public awareness campaigns, and other national interventions to improve antibiotic consumption in the community.
Collapse
Affiliation(s)
- Robin Bruyndonckx
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
| | | | - Chantal Quinten
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Arno Muller
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Ole Heuer
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Dominique L Monnet
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Catholic University of Leuven, Leuven, Belgium
| | - Klaus Weist
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
13
|
Bruyndonckx R, Adriaenssens N, Versporten A, Hens N, Monnet DL, Molenberghs G, Goossens H, Weist K, Coenen S. Consumption of antibiotics in the community, European Union/European Economic Area, 1997-2017: data collection, management and analysis. J Antimicrob Chemother 2021; 76:ii2-ii6. [PMID: 34312651 PMCID: PMC8314094 DOI: 10.1093/jac/dkab171] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES This article introduces a series of articles on antibiotic consumption in the community between 1997 and 2017, which provide an update of previous articles covering the periods 1997-2003 and 1997-2009. METHODS In this article, differences in participating countries, the ATC/DDD classification system, and data collection, validation and analysis between the current and previous series are described. RESULTS In the previous series, 33 European countries provided valid data for further analysis, while the current series focused on 30 countries belonging to the EU or the European Economic Area (EEA). For both series, data were collected in accordance with the WHO ATC classification system. While the previous series reported data in accordance with the ATC/DDD index 2011, the current series employed the ATC/DDD index 2019. Both series focused on consumption of antibacterials for systemic use (ATC J01) and collected data expressed in DDD per 1000 inhabitants per day and packages per 1000 inhabitants per day. When studying consumption expressed in packages per 1000 inhabitants per day, countries reporting total care data, i.e. community and hospital sector combined, were included in the previous series but excluded in the current series. While the previous series used non-linear mixed models to evaluate time trends in antibiotic consumption, the current series allowed for inclusion of change-points with a data-driven location. In addition, both series assessed the composition and quality of antibiotic consumption in the EU/EEA. CONCLUSIONS The updated analyses of two decades of ESAC-Net data provide the most comprehensive and detailed description of antibiotic consumption in the community in Europe.
Collapse
Affiliation(s)
- Robin Bruyndonckx
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Dominique L Monnet
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Catholic University of Leuven, Leuven, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Klaus Weist
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| |
Collapse
|
14
|
Zhao X, Zhang Q, Sicheritz-Pontén T, Liu Y, Clokie MR. inPhocus: Perspectives of the Application of Bacteriophages in Poultry and Aquaculture Industries Based on Varms in China. PHAGE (NEW ROCHELLE, N.Y.) 2021; 2:69-74. [PMID: 36148039 PMCID: PMC9041493 DOI: 10.1089/phage.2021.29016.xzh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Xiaonan Zhao
- Department of Public Health, Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan, China
| | - Qing Zhang
- Department of Public Health, Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan, China
| | - Thomas Sicheritz-Pontén
- Section for Evolutionary Genomics, The GLOBE Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yuqing Liu
- Department of Public Health, Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Jinan, China
| | - Martha R.J. Clokie
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
15
|
Hassan MM, El Zowalaty ME, Lundkvist Å, Järhult JD, Khan Nayem MR, Tanzin AZ, Badsha MR, Khan SA, Ashour HM. Residual antimicrobial agents in food originating from animals. Trends Food Sci Technol 2021; 111:141-150. [PMID: 33746363 PMCID: PMC7953985 DOI: 10.1016/j.tifs.2021.01.075] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The agricultural food products industry in Bangladesh depends on utilizing antimicrobials indiscriminately as growth promoters and for controlling infectious diseases. Thus, there is always a risk of antimicrobial agent accumulation in food sources that originate from agricultural production. METHODS In the present study, we collected data from published articles between January, 2013 and December, 2019 on antimicrobial residues in human food sources such as meat, milk, eggs, and fishes. RESULTS Liver contained the highest percentage of antimicrobial residues (74%; 95% CI: 59.66-85.37) against the in vitro enteric pathogen Escherichia coli in layer chickens. Similar results were demonstrated in liver (68%; 95% CI: 53.30-80.48) and kidney (66%, 95% CI: 51.23-78.79) of layer chickens against Bacillus cereus and Bacillus subtilis. Amongst all antibiotics, the highest concentrations of ciprofloxacin were detected in kidney (48.57%; 95% CI: 31.38-66.01), followed by liver (47.56; 95% CI: 40.88-54.30) of broiler chickens. Ciprofloxacin was also present in liver (46.15%; 95% CI: 33.70-58.96) of layer chickens. The percentage of ciprofloxacin in thigh and breast meat in broiler bird were 41.54% (95% CI: 34.54-48.79) and 37.95% (95% CI: 31.11-45.15) respectively. Enrofloxacin was the second most dominant antimicrobial agent and was present in the liver of both types of poultry (Broiler and Layer chickens: 41.54%; 95% CI: 29.44-54.4 and 437.33%; 95% CI: 30.99-44.01). The prevalence rates of enrofloxacin in thigh and breast meat of broiler chickens were 24.10% (95% CI: 18.28-30.73) and 20.51% (95% CI: 15.08-26.87), respectively. Tetracycline, a commonly used antibiotic in livestock, was present in the liver (49.23%; 95% CI: 36.60-61.93) of layer chickens. In case of aquaculture food products, the highest amount of amoxicillin (683.2 mg/kg) was detected in Tilapia fish (Oreochromis niloticus), followed by 584.4 mg/kg in climbing perch (Anabas testudineus) and 555.6 mg/kg in Rui fish (Labeo rohita). Among the five types of fishes, Rui fish (0.000515 mg/kg) contained the highest concentrations of chloramphenicol antibiotic residues. CONCLUSIONS The presence of antimicrobial residues in meat, milk, egg, and fish is a serious public health threat due to the potential induction of antimicrobial resistance. It can negatively impact the food supply chain, especially with the current strain that it is already facing with the current COVID-19 pandemic. The findings of the present study highlight the ongoing risk of residual antimicrobial agents in food of animal origin in Bangladesh and countries with similar practices. This can draw the attention of public health officials to propose plans to mitigate or stop this practice.
Collapse
Affiliation(s)
- Mohammad Mahmudul Hassan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Mohamed E El Zowalaty
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates
- Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, SE 75 123, Sweden
| | - Åke Lundkvist
- Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, SE 75 123, Sweden
| | - Josef D Järhult
- Zoonosis Science Center, Department of Medial Sciences, Uppsala University, Sweden
| | - Md Raihan Khan Nayem
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Abu Zubayer Tanzin
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Md Rahim Badsha
- Faculty of Food Science and Technology, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Shahneaz Ali Khan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Hossam M Ashour
- Department of Integrative Biology, College of Arts and Sciences, University of South Florida, St.Petersburg, Florida, 33701, USA
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| |
Collapse
|
16
|
Gashaw T, Sisay M, Tesfa T, Baye Y, Amare F. Amoxicillin Utilization Pattern at Governmental Hospitals in Eastern Ethiopia. Infect Drug Resist 2021; 14:193-203. [PMID: 33505162 PMCID: PMC7829130 DOI: 10.2147/idr.s288387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Penicillin is among the highly used antibiotics in most parts of the world, with amoxicillin being the most frequently utilized drug in the category. However, amoxicillin use has been found to deviate from standard treatment guidelines (STGs). OBJECTIVE This study aimed to evaluate amoxicillin utilization patterns based on Ethiopian STGs criteria at four governmental hospitals in Harar town: Hiwot Fana Specialized University Hospital, Jugel Hospital, South East Command III Hospital, and Federal Harar Police Hospital in Eastern Ethiopia in 2016. METHODS A hospital-based retrospective cross-sectional study was employed using medication records of patients who received amoxicillin in 2016 at four governmental hospitals from May 15 to June 30, 2018. A total of 502 medication records were proportionally allocated based on the ratio of consumption data of each hospital. Simple random sampling was employed to collect the required sample from the sampling frame. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis. RESULTS Amoxicillin was used in all age groups, including pregnant and lactating women. The majority (96.2%) of patients were from the outpatient departments. Complete blood count was the most laboratory investigation carried out in 24.9% whereas microbiological culture was not recorded at all. Top three indications include nonspecific upper respiratory tract infections (15.1%), pneumonia (13.5%) and dental problems (10.6%). Non-steroidal anti-inflammatory drugs (56.2%) were frequently co-administered agents. An appropriate utilization was made considering indication, dose, frequency and therapy duration in 23.9% as per the Ethiopian STG. The wrong indication (65.4%) was the prime reason for inappropriateness, followed by dose (14.6%) and duration of therapy (12.2%). CONCLUSION Amoxicillin utilization was appropriate in less than a quarter of patients. The wrong indication was the main reason for inappropriateness, predisposing to resistance development. Further studies identifying factors related to misuse and sensitivity tests should be the next steps.
Collapse
Affiliation(s)
- Tigist Gashaw
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- Microbiology Unit, Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Baye
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
17
|
Antimicrobial Resistance in the Context of the Sustainable Development Goals: A Brief Review. Eur J Investig Health Psychol Educ 2021; 11:71-82. [PMID: 34542450 PMCID: PMC8314330 DOI: 10.3390/ejihpe11010006] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/15/2022] Open
Abstract
The reduction in infectious disease morbidity and mortality may be attributed to a variety of factors; however, improved sanitation and public health, and the introduction of vaccines and antibiotics are among the most significant. The development of antimicrobial resistance (AMR) in bacterial pathogens is an expected consequence of evolutionary adaptation to these noxious agents and the widespread use of these drugs has significantly sped up this process. Infections caused by multidrug resistant pathogens are directly associated with worse clinical outcomes, longer hospital stays, excess mortality in the affected patients and an increasing burden and costs on the healthcare infrastructure. The Sustainable Development Goals (SDGs) were published in 2015 by the United Nations to serve as a global blueprint for a better, more equitable, more sustainable life on our planet. The SDGs contextualize AMR as a global public health and societal issue; in addition, the continuing emergence of AMR may limit the attainment on many SDGs. The aim of this mini-review is to provide insight on the interface between attainment of SDGs and the clinical problem of drug resistance in bacteria.
Collapse
|
18
|
Huang W, Wang Y, Wang L, Pan C, Shen G. Colorimetric detection of ciprofloxacin in aqueous solution based on an unmodified aptamer and the aggregation of gold nanoparticles. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2021; 13:90-98. [PMID: 33300899 DOI: 10.1039/d0ay01811b] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A colorimetric method is described for detection of the antibiotic ciprofloxacin (CIP) in aqueous solutions based on an unmodified CIP-aptamer and gold nanoparticles (AuNPs), which are regarded as a probe and an indicator, respectively. In the absence of CIP, aptamers can hybridize with poly dimethyl diallyl ammonium chloride (PDDA) to form a 'duplex' structure through electrostatic interactions, and AuNPs remain dispersed in solution, leading to a red solution and an obvious absorption peak at 520 nm. Contrarily, the CIP-aptamer can specifically bind to CIP after the introduction of CIP into the solution. Then PDDA is thus free to aggregate AuNPs. The solution turns blue from red accordingly, presenting a strong absorption at 650 nm. Hence, the concentration of CIP can be quantified through the changes of the absorption. This sensitive and selective colorimetric method for CIP detection has a good linear response (R = 0.9935) in the 20 to 300 nM CIP concentration range, with a limit of detection (LOD) of 0.215 nM. Importantly, the proposed aptasensor demonstrates great application potential in CIP determination in aqueous samples.
Collapse
Affiliation(s)
- Weiwen Huang
- School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | | | | | | | | |
Collapse
|
19
|
Martínez-González NA, Di Gangi S, Pichierri G, Neuner-Jehle S, Senn O, Plate A. Time Trends and Factors Associated with Antibiotic Prescribing in Swiss Primary Care (2008 to 2020). Antibiotics (Basel) 2020; 9:E837. [PMID: 33238587 PMCID: PMC7700253 DOI: 10.3390/antibiotics9110837] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023] Open
Abstract
Antibiotic resistance (ABR) is a major threat to public health, and the majority of antibiotics are prescribed in the outpatient setting, especially in primary care. Monitoring antibiotic consumption is one key measure in containing ABR, but Swiss national surveillance data are limited. We conducted a retrospective cross-sectional study to characterise the patterns of antibiotic prescriptions, assess the time trends, and identify the factors associated with antibiotic prescribing in Swiss primary care. Using electronic medical records data, we analysed 206,599 antibiotic prescriptions from 112,378 patients. Based on 27,829 patient records, respiratory (52.1%), urinary (27.9%), and skin (4.8%) infections were the commonest clinical indications for antibiotic prescribing. The most frequently prescribed antibiotics were broad-spectrum penicillins (BSP) (36.5%), fluoroquinolones (16.4%), and macrolides/lincosamides (13.8%). Based on the WHO AWaRe classification, antibiotics were 57.9% Core-Access and 41.7% Watch, 69% of which were quinolones and macrolides. Between 2008 and 2020, fluoroquinolones and macrolides/lincosamides prescriptions significantly declined by 53% and 51%; BSP prescriptions significantly increased by 54%. Increasing patients' age, volume, and employment level were significantly associated with antibiotic prescribing. Our results may inform future antibiotic stewardship interventions to improve antibiotic prescribing.
Collapse
Affiliation(s)
- Nahara Anani Martínez-González
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (S.D.G.); (G.P.); (S.N.-J.); (O.S.); (A.P.)
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, CH-6002 Lucerne, Switzerland
| | - Stefania Di Gangi
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (S.D.G.); (G.P.); (S.N.-J.); (O.S.); (A.P.)
| | - Giuseppe Pichierri
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (S.D.G.); (G.P.); (S.N.-J.); (O.S.); (A.P.)
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (S.D.G.); (G.P.); (S.N.-J.); (O.S.); (A.P.)
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (S.D.G.); (G.P.); (S.N.-J.); (O.S.); (A.P.)
| | - Andreas Plate
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (S.D.G.); (G.P.); (S.N.-J.); (O.S.); (A.P.)
| |
Collapse
|
20
|
Bekoe SO, Orman E, Asare-Nkansah S, Sørensen AML, Björklund E, Adosraku RK, Hansen M, Styrishave B. Detection and quantification of antibiotic residues in urine samples of healthy individuals from rural and urban communities in Ghana using a validated SPE-LC-MS/MS method. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-020-03742-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
21
|
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.
Collapse
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.
| |
Collapse
|
22
|
Mathibe LJ, Zwane NP. Unnecessary antimicrobial prescribing for upper respiratory tract infections in children in Pietermaritzburg, South Africa. Afr Health Sci 2020; 20:1133-1142. [PMID: 33402958 PMCID: PMC7751518 DOI: 10.4314/ahs.v20i3.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Acute upper respiratory tract infections (URTIs) are contagious diseases of the upper airways, but they are self-limiting in nature. Therefore, antimicrobial-use for the majority of the URTIs is considered inappropriate. Unfortunately, globally, antimicrobials are still being prescribed for the treatment of URTIs, especially in children. However, there is insufficient evidence on the causes of this phenomenon in South Africa. Objective To investigate whether the parents/guardians accompanying children with URTIs expected/influenced physicians and/or nurses to prescribe antibiotics. Methods This was a prospective descriptive and explorative questionnaire-based study. Participants were guardians who accompanied children aged five years and below, diagnosed with acute URTIs. Findings Three hundred and six parents/guardians participated in this study. Seventy six percent (n=233) of participants received antibiotics for URTIs for their children, and 67% (n=156) of these did not make requests for antimicrobial therapy. On overall, there was a statistically significant (p < 0.0001) chance (with OR of 5.9; 95% CI, 2.4 – 14.2) for receiving antibiotics for URTIs without a request. Conclusion Physicians and other healthcare providers need education on rational prescribing of antimicrobials, and to implement evidence-based standard treatment guidelines, to reduce inappropriate use of antibiotics in children with self-limiting URTIs.
Collapse
Affiliation(s)
- Lehlohonolo John Mathibe
- Division of Pharmacology (Therapeutics), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | | |
Collapse
|
23
|
Anyanwu PE, Pouwels K, Walker A, Moore M, Majeed A, Hayhoe BWJ, Tonkin-Crine S, Borek A, Hopkins S, Mcleod M, Costelloe C. Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study. BJGP Open 2020; 4:bjgpopen20X101052. [PMID: 32665235 PMCID: PMC7465585 DOI: 10.3399/bjgpopen20x101052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In 2017, approximately 73% of antibiotics in England were prescribed from primary care practices. It has been estimated that 9%-23% of antibiotic prescriptions between 2013 and 2015 were inappropriate. Reducing antibiotic prescribing in primary care was included as one of the national priorities in a financial incentive scheme in 2015-2016. AIM To investigate whether the effects of the Quality Premium (QP), which provided performance-related financial incentives to clinical commissioning groups (CCGs), could be explained by practice characteristics that contribute to variations in antibiotic prescribing. DESIGN & SETTING Longitudinal monthly prescribing data were analysed for 6251 primary care practices in England from April 2014 to March 2016. METHOD Linear generalised estimating equations models were fitted, examining the effect of the 2015-2016 QP on the number of antibiotic items per specific therapeutic group age-sex related prescribing unit (STAR-PU) prescribed, adjusting for seasonality and months since implementation. Consistency of effects after further adjustment for variations in practice characteristics were also examined, including practice workforce, comorbidities prevalence, prescribing rates of non-antibiotic drugs, and deprivation. RESULTS Antibiotics prescribed in primary care practices in England reduced by -0.172 items per STAR-PU (95% confidence interval [CI] = -0.180 to -0.171) after 2015-2016 QP implementation, with slight increases in the months following April 2015 (+0.014 items per STAR-PU; 95% CI = +0.013 to +0.014). Adjusting the model for practice characteristics, the immediate and month-on-month effects following implementation remained consistent, with slight attenuation in immediate reduction from -0.172 to -0.166 items per STAR-PU. In subgroup analysis, the QP effect was significantly greater among the top 20% prescribing practices (interaction p<0.001). Practices with low workforce and those with higher diabetes prevalence had greater reductions in prescribing following 2015-2016 QP compared with other practices (interaction p<0.001). CONCLUSION In high-prescribing practices, those with low workforce and high diabetes prevalence had more reduction following the QP compared with other practices, highlighting the need for targeted support of these practices and appropriate resourcing of primary care.
Collapse
Affiliation(s)
- Philip Emeka Anyanwu
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Koen Pouwels
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Anne Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Michael Moore
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Benedict W J Hayhoe
- Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Sarah Tonkin-Crine
- National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Aleksandra Borek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susan Hopkins
- Healthcare-Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, London, UK
- Directorate of Infection, Royal Free London NHS Foundation Trust, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Monsey Mcleod
- Pharmacy Department, Centre for Medication Safety and Service Quality, Imperial College London, London, UK
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Céire Costelloe
- Department of Primary Care and Public Health, Imperial College London, London, UK
| |
Collapse
|
24
|
Tian Y, He X, Chen W, Tian X, Nie Y, Han B, Lin HM, Yang C, Wang Y. Significant enhancement of photo-Fenton degradation of ofloxacin over Fe-Dis@Sep due to highly dispersed FeC 6 with electron deficiency. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 723:138144. [PMID: 32224407 DOI: 10.1016/j.scitotenv.2020.138144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/06/2020] [Accepted: 03/21/2020] [Indexed: 06/10/2023]
Abstract
An efficient strategy for enhancing iron efficiency in heterogeneous Fenton reaction via the pyrolysis of ferrocene chemically modified sepiolite (Sep) was proposed in this study. Highly dispersed FeC6 on sepiolite (Fe-Dis@Sep) was synthesized as an efficient photo-Fenton catalyst for the visible light degradation of ofloxacin (OFX). It exhibits an excellent Fenton activity and stability towards OFX degradation. The pseudo-first order reaction rate constant of Fe-Dis@Sep was 5.1-fold higher than that of the supported catalyst with aggregated iron oxides prepared by traditional impregnation method (Fe-Agg@Sep). Based on TEM images and density functional theory (DFT) calculation, the enhanced Fenton activity of Fe-Dis@Sep was attributed to the unique incorporation of FeC6 on Sep via Si-O-C-Fe bond which not only favor the high dispersion of FeC6 with an electron deficiency but also promote Fe(III) to Fe(II) cycle via the formation of surface Fe-H2O2 complex. OH and O2- were identified as active species for OFX degradation in Fe-Dis@Sep-H2O2-Vis system. 98.7% of F and 97.0% of N in OFX was converted into F- and NO3- with a TOC removal efficiency of 89.35%. The possible degradation pathway of OFX was also proposed according to HPLC-MS results. Finally, the Fenton reaction mechanism over Fe-Dis@Sep was discussed.
Collapse
Affiliation(s)
- Yayang Tian
- Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, PR China
| | - Xiaoyu He
- Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, PR China; MNR Key Laboratory of Marine Mineral Resources, Guangzhou Marine Geological Survey, China Geological Survey, Guangzhou 510075, PR China
| | - Wei Chen
- Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, PR China
| | - Xike Tian
- Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, PR China
| | - Yulun Nie
- Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, PR China.
| | - Bo Han
- Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, PR China
| | - Hong-Ming Lin
- Department Materials Engineering, Tatung University, 104 Taipei, PR China
| | - Chao Yang
- Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, PR China
| | - Yanxin Wang
- School of Environmental Studies, China University of Geosciences, Wuhan 430074, PR China
| |
Collapse
|
25
|
Bekele NA, Hirbu JT. Drug Therapy Problems and Predictors Among Patients Admitted to Medical Wards of Dilla University Referral Hospital, South Ethiopia: A Case of Antimicrobials. Infect Drug Resist 2020; 13:1743-1750. [PMID: 32606824 PMCID: PMC7297345 DOI: 10.2147/idr.s247587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To assess antimicrobial use-related problems and associated factors among patients admitted to medical wards of Dilla University Referral Hospital. Patients and Methods A hospital-based prospective observational study design was employed to assess the antimicrobial use-related problems among adult patients admitted to Dilla University Referral Hospital from 5 March to 4 September 2018. The antimicrobial therapy was reviewed to assure compliance with the recommendations of the national guidelines or evidence-based international clinical guidelines and drug therapy problem was identified. The logistic regression model was fit to determine the association between the different factors and the occurrence of drug therapy problems. Odds ratio was used to show a comparison of factors contributing to drug therapy problems. Statistical significance was considered at p-value <0.05. Results In this follow-up to 229 participants, the prevalence of antimicrobial therapy-related problem was 70.74%. “Noncompliance to therapy” was the most frequent DTP experienced by 68 (29.69%) of the patients followed by “needs additional drug therapy” seen among 31 (13.54%) patients. “Adverse drug reaction” was the least and experienced by 7 (3.06%) patients. Others include: dosage too low among 22 (9.61%), dose too high among 17 (8.30%), unnecessarily prescribed antimicrobials among 17 (7.42%) and ineffective antimicrobials among 8 (3.49%) patients. Compared with those who used less than four drugs, the use of four to six (AOR: 4.024) and seven and above (AOR: 13.516) drugs were determinants for antimicrobial use problems. Additionally, infectious cases not addressed by the national guideline (AOR: 3.328) and the unavailability of appropriate lab values results within 48 hours of hospital admission (AOR: 1.285) were determinants for antimicrobial use problems. Conclusion Antimicrobial use problem was prevalent with 0.94-problems-per-patient. Polypharmacy, coverage of national guidelines and availing laboratory values within 48 hours of hospital admission were independent determinants of antimicrobial use problems.
Collapse
Affiliation(s)
- Nigatu Addisu Bekele
- Department of Pharmacy, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Jarsso Tadesse Hirbu
- Department of Internal Medicine, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| |
Collapse
|
26
|
Zhao Q, Li M, Zhang K, Wang N, Wang K, Wang H, Meng S, Mu R. Effect of ultrasound irradiation combined with ozone pretreatment on the anaerobic digestion for the biosludge exposed to trace-level levofloxacin: Degradation, microbial community and ARGs analysis. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2020; 262:110356. [PMID: 32250825 DOI: 10.1016/j.jenvman.2020.110356] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 06/11/2023]
Abstract
Anaerobic digestion, the principal method of stabilizing biosolids in wastewater treatment plants (WWTPs), can efficiently and largely attenuate the antibiotic resistances in biosludge. This study aims to investigate the effect of oxidative pretreatment with ultrasound irradiation combined with ozone (US/O3) on the mesophilic and thermophilic anaerobic digestion (MAD and TAD) for the biosludge bearing trace fluoroquinolones contaminants-levofloxacin (LEVO) which was widely used in recent years. During the oxidation, the trace-level LEVO was almost completely degraded. The methanogenic activity in US/O3 pretreated TAD dosed 0.1 mg/L LEVO was much higher than those in single MAD and TAD, therefore leading to a remarkable increase in biogas production. The identification of levofloxacin intermediates during chemical degradation was analyzed using LCMS technique and the reaction pathway based on them was proposed. Hydroxyl radicals provided by US/O3 contributed to oxidative ring opening of LEVO as well as degradation of other biomacromolecules in the biosludge. Besides, the quinoline resistance genes-qnrA and qnrS declined significantly by 1-2 orders of magnitude in US/O3-pretreated TAD, indicating that the active radicals produced by US/O3 oxidized and degraded LEVO and therefore inactivated the antibiotic resistant bacteria or genes in the biosolids. Meanwhile, the composition and structure of the microbial community altered and the diversity and richness of total bacterial and potential human pathogens decreased, the pattern of which was correlated with LEVO-resistant genes. Among the well-known AD-related phylum including Bacteroidetes, Firmicutes, Methanobacteria as well as Thermotogae which has been previously detected in TAD and performed organic hydrolysis and degradation, the potential LEVO-resistant bacteria were probably affiliated to Actinobacteria, Bacteroidetes, Proteobacteria, Thermotogae. This study revealed the contribution of US/O3 pretreatment to the anaerobic digestion in terms of ARGs reduction for trace-LEVO- exposed biosludge and could provide useful guidance for controlling the dissemination of ARB and ARGs in sewage sludge.
Collapse
Affiliation(s)
- Qian Zhao
- School of Municipal and Environmental Engineering, Shandong Jianzhu University, 1000 Fengming Road, Jinan, 250101, China; Shandong Province Co-Innovation Center of Green Building, Jinan, 250101, China; Shandong Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Qingdao, 266237, China.
| | - Mei Li
- School of Municipal and Environmental Engineering, Shandong Jianzhu University, 1000 Fengming Road, Jinan, 250101, China; Shandong Province Co-Innovation Center of Green Building, Jinan, 250101, China
| | - Kefeng Zhang
- School of Municipal and Environmental Engineering, Shandong Jianzhu University, 1000 Fengming Road, Jinan, 250101, China; Shandong Province Co-Innovation Center of Green Building, Jinan, 250101, China
| | - Ning Wang
- School of Municipal and Environmental Engineering, Shandong Jianzhu University, 1000 Fengming Road, Jinan, 250101, China; Shandong Province Co-Innovation Center of Green Building, Jinan, 250101, China
| | - Kaikai Wang
- School of Municipal and Environmental Engineering, Shandong Jianzhu University, 1000 Fengming Road, Jinan, 250101, China
| | - Hongbo Wang
- School of Municipal and Environmental Engineering, Shandong Jianzhu University, 1000 Fengming Road, Jinan, 250101, China; Shandong Province Co-Innovation Center of Green Building, Jinan, 250101, China.
| | - Shujuan Meng
- School of Space and Environment, Beihang University, Beijing, 100191, China
| | - Ruimin Mu
- School of Municipal and Environmental Engineering, Shandong Jianzhu University, 1000 Fengming Road, Jinan, 250101, China; Shandong Province Co-Innovation Center of Green Building, Jinan, 250101, China
| |
Collapse
|
27
|
Thiebault T. Sulfamethoxazole/Trimethoprim ratio as a new marker in raw wastewaters: A critical review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 715:136916. [PMID: 32041046 DOI: 10.1016/j.scitotenv.2020.136916] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/07/2020] [Accepted: 01/23/2020] [Indexed: 05/23/2023]
Abstract
Global Trimethoprim (TMP) and Sulfamethoxazole (SMX) occurrences in raw wastewaters were systematically collected from the literature (n = 140 articles) in order to assess the relevance of using the SMX/TMP ratio as a marker of the main origin of wastewaters. These two antibiotics were selected due to their frequent use in association (i.e. co-trimoxazole) in a 5:1 ratio (SMX:TMP) for medication purposes, generating a unique opportunity to globally evaluate the validity of this ratio based on concentration values. Several parameters (e.g. sorption, biodegradation) may affect the theoretical SMX/TMP ratio. However, the collected data highlighted the good agreement between the theoretical ratio and the experimental one, especially in wastewater treatment plant influents and hospital effluents. Only livestock effluents displayed a very high SMX/TMP ratio, indicative of the very significant use of sulfonamide alone in this industry. Conversely, several countries displayed low SMX/TMP ratio values, highlighting local features in the human pharmacopoeia. This review provides new insights in order to develop an easy to handle and sound marker of wastewater origins (i.e. human/livestock), beyond atypical local customs.
Collapse
Affiliation(s)
- Thomas Thiebault
- EPHE, PSL University, UMR 7619 METIS, Sorbonne University, CNRS, F-75005, Paris, France.
| |
Collapse
|
28
|
Antimicrobial Resistance Profiles for Different Isolates in Aden, Yemen: A Cross-Sectional Study in a Resource-Poor Setting. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1810290. [PMID: 32382529 PMCID: PMC7195635 DOI: 10.1155/2020/1810290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/02/2020] [Indexed: 11/17/2022]
Abstract
Background There is a rapid deterioration in the effectiveness of antibiotics due to the global prevalence of bacterial antimicrobial resistance (AMR). AMR can cause an increase in mortality and morbidity due to treatment failures and a lack of effective therapy. Objective The purpose of this study was to evaluate the AMR pattern of different bacterial isolates at hospitals and laboratories. Materials and Methods A cross-sectional study from March 2019 to June 2019 was conducted at different governmental and private hospitals and laboratories in Aden, Yemen. Age, sex, specimen type, bacterial isolates, and antibiotic susceptibility pattern were collected using a data extraction sheet. Descriptive statistics were used for data analysis. Result Data were recorded for 412 patients from whom 20 clinical specimens were collected and analyzed. The most common bacteria isolated were Staphylococcus spp. (n = 172, 41.74%), E. coli (n = 164, 39.80%), Pseudomonas spp. (n = 37, 8.98%), and Klebsiella pneumoniae (n = 18, 4.36%); other bacteria were less common. The overall bacterial resistance was highest against the combination of sulfamethoxazole with trimethoprim (73.12%), followed by amoxicillin and clavulanate (65.19%). The cephalosporin antibiotics also showed high resistance rates. The study also showed moderate bacterial resistance to gentamycin (32.65%), azithromycin (29.92%), cefoxitin (62.65%), and ciprofloxacin (25.60%). Ertapenem (16.67%) and levofloxacin (15.56%) had the lowest resistance rates. Conclusion There was a high percentage of bacteria resistant to several antibiotics. Antibiotic susceptibility testing is a prerequisite guide for the selection of appropriate antibiotic therapy for bacterial infections.
Collapse
|
29
|
Elbalkiny HT, Yehia AM, Riad SM, Elsaharty YS. Derivative constant wavelength synchronous fluorescence spectrometry for the simultaneous detection of cefadrine and cefadroxil in water samples. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2020; 229:117903. [PMID: 31887677 DOI: 10.1016/j.saa.2019.117903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
A sensitive accurate spectrofluorimetric technique was developed to detect cefadroxil and cefradine traces in water samples simultaneously, by applying a procedure based on the formation of hydrolysis products corresponding to these compounds by sodium hydroxide (1 N NaOH) treatment. The conventional and the synchronous fluorescence spectra of these hydrolyzed products were totally overlapped making resolving of this mixture impossible. The second-derivative constant-wavelength synchronous fluorescence spectra allowed their detection simultaneously in a single scan after experimental conditions optimization, which was measured at 390 nm and 379 nm for cefadroxil and cefradine, respectively at Δλ = 30.0. The calibration curves between derivative synchronous fluorescence intensity and drugs concentration showed suitable linear correlation in the range of 0.1 to 5 μg.mL-1 for cefadroxil and 0.5-10 μg.mL-1 for cefradine. The proposed fluorimetric method is superior in being simple, environmental friendly and cost effective in comparison to the previously published reported methods.
Collapse
Affiliation(s)
- Heba T Elbalkiny
- Analytical Chemistry Department, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), 11787 6(th) October City, Egypt.
| | - Ali M Yehia
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr-El Aini 13 Street, 11562 Cairo, Egypt; Chemistry Department, School of Pharmacy and Pharmaceutical Industries, Badr University in Cairo, Badr City, 11829, Cairo, Egypt
| | - Safa'a M Riad
- Analytical Chemistry Department, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), 11787 6(th) October City, Egypt; Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr-El Aini 13 Street, 11562 Cairo, Egypt
| | - Yasser S Elsaharty
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr-El Aini 13 Street, 11562 Cairo, Egypt
| |
Collapse
|
30
|
Karinauske E, Kasciuskeviciute S, Morkuniene V, Garuoliene K, Kadusevicius E. Antibiotic prescribing trends in a pediatric population in Lithuania in 2003-2012: Observational study. Medicine (Baltimore) 2019; 98:e17220. [PMID: 31725600 PMCID: PMC6867790 DOI: 10.1097/md.0000000000017220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to determine the trends in consumption of antibiotics and evaluate the antibiotic prescription rates in the pediatric population in Lithuania during 2003 to 2012.A cross-sectional study. Data of systemic antibiotic use in pediatric population for outpatient treatment was derived from National Health Insurance Fund database. Consumption was expressed as WHO ATC defined daily dose (DDD)/1000 children/day and as a number of prescriptions written in the general population per year. Statistical analysis was performed using the SPSS/W 20.0 software (Statistical Product and Service Solutions for Windows).Total utilization of antibiotics (expressed in DDD units) during study period increased by 8.40% (from 5.67 to 6.19 DDD/1000 children/day) and by 5.96% expressed in prescription rate (from 585.84 to 622.97 prescriptions/1000 children/year). The most popular antibiotic group was macrolides which showed the highest increase of utilization 5.9 times (from 0.27 DDD/1000 children/day in 2003 to 1.66 DDD/1000 children/day in 2012).The most common indications for antibiotic prescribing for children in 2012 were acute bronchitis (25.6%), acute tonsillitis (21.7%) and acute pharyngitis (14.6%). Amoxicillin had the highest probability to be chosen to treat acute tonsillitis (prob. [probability] = .2875) and acute pharyngitis (prob. = .5553). Clarithromycin had the highest probability to be chosen to treat acute bronchitis (prob. = .4222).Most of the diseases treated with antibiotics were viral infections. The most commonly prescribed antibiotics were broad-spectrum. The consumption of antibiotics was evenly increasing during 2003 to 2012 period, but the distribution of separate antibiotic group remained the same.
Collapse
Affiliation(s)
- Egle Karinauske
- Department of Clinical Pharmacology, Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences
| | - Skaiste Kasciuskeviciute
- Department of Clinical Pharmacology, Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences
| | | | | | - Edmundas Kadusevicius
- Department of Clinical Pharmacology, Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences
| |
Collapse
|
31
|
Ipte PR, Kumar S, Satpati AK. Electrochemical synthesis of carbon nano spheres and its application for detection of ciprofloxacin. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2019; 55:142-150. [PMID: 31594467 DOI: 10.1080/10934529.2019.1674591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
Carbon nano spheres (CNSs) were synthesized by single step electrochemical synthesis route in ultra-pure water as a medium of synthesis. Characterization of synthesized CNSs was carried out using atomic force microscope (AFM), particle size analyzer, zeta potential analyzer and Fourier Transform Infrared (FTIR) measurements, from which the information about the morphology and functional groups present on the surface of the particles are obtained. The particle size of the CNSs was found to be 6 nm. FTIR spectrum shows the presence of functional groups such as -OH, C≡C, C = C and on the CNSs. Electrochemical and spectroscopic experiments were conducted to determine the interaction of the drug molecule ciprofloxacin (Cf) with CNSs, strong interaction between Cf and CNSs leads to the development of analytical method of detection of Cf using CNSs as the pre-concentrating agent. The detection of limit of the present method is obtained as 0.15 μM at (S/N) ratio of 3. CNSs can be considered as a potential candidate for the fabrication of sensor for high sensitive determination of Cf.
Collapse
Affiliation(s)
- Priyanka R Ipte
- Analytical Chemistry Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Sriram Kumar
- Analytical Chemistry Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | | |
Collapse
|
32
|
Chen M, Zhao H, Wang Y, Bekele TG, Liu W, Chen J. Uptake and depuration of eight fluoroquinolones (FQs) in common carp (Cyprinus carpio). ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 180:202-207. [PMID: 31096125 DOI: 10.1016/j.ecoenv.2019.04.075] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/02/2019] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
Fluoroquinolones (FQs) are extensively used in humans and animals, which have aroused wide attention due to the emergence of FQ resistant bacteria and frequent detection in water, sediment and organism. However, little information is available about the bioconcentration and tissue distribution of FQs in fish. In the present study, we investigated the uptake and depuration of eight FQs (balofloxacin (BAL), enoxacin (ENO), enrofloxacin (ENR), fleroxacin (FLE), lomefloxacin (LOM), moxifloxacin (MOX), ofloxacin (OFL), sparfloxacin (SPA)) in common carp under controlled laboratory conditions. The results showed that all target FQs could accumulate in fish tissues, and had a similar tendency over time during the whole uptake and depuration periods. The uptake rate constant (k1), depuration rate constant (k2) and half-lives (t1/2) were in the ranges of 0.007-3.599 L/(kg·d), 0.051-0.283 d-1 and 2.4-10.7 d, respectively. The ranges of bioconcentration factors (BCFs) were 0.24-39.55 L/kg, 0.21-24.97 L/kg and 0.04-1.07 L/kg in liver, kidney and muscle, respectively. BCFs of eight FQs decreased in the order: MOX > ENR > ENO ≈ BAL ≈ FLE ≈ OFL ≈ LOM ≈ SPA, which may be correlated with the substituents at positions 7 and 8 of the basic quinolone nucleus and the metabolic capacity. Besides, BCFs were relative with pH-adjusted distribution coefficient (log D), suggesting that molecular status of ionizable compounds strongly influenced the bioconcentration processes. The present study provides important insights for understanding the bioconcentration and tissues distribution of FQs.
Collapse
Affiliation(s)
- Mo Chen
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian, 116024, China
| | - Hongxia Zhao
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian, 116024, China.
| | - Yan Wang
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian, 116024, China
| | - Tadiyose Girma Bekele
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian, 116024, China
| | - Wanyu Liu
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian, 116024, China
| | - Jingwen Chen
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), School of Environmental Science and Technology, Dalian University of Technology, Linggong Road 2, Dalian, 116024, China
| |
Collapse
|
33
|
Fatima S, Rasool A, Sajjad N, Bhat EA, Hanafiah MM, Mahboob M. Analysis and evaluation of penicillin production by using soil fungi. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2019. [DOI: 10.1016/j.bcab.2019.101330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
34
|
Yehia AM, Elbalkiny HT, Riad SM, Elsaharty YS. Chemometrics for resolving spectral data of cephalosporines and tracing their residue in waste water samples. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2019; 219:436-443. [PMID: 31063958 DOI: 10.1016/j.saa.2019.04.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 06/09/2023]
Abstract
Chemometrics approaches have been used in this work to trace cephalosporins in aquatic system. Principal component regression (PCR), partial least squares (PLS), multivariate curve resolution-alternating least squares (MCR-ALS), and artificial neural networks (ANN) were compared to resolve the severally overlapped spectrum of three selected cephalosporins; cefprozil, cefradine and cefadroxil. The analytical performance of chemometric methods was compared in terms of errors. Artificial neural networks provide good recoveries with lowest error. Satisfactory results were obtained for the proposed chemometric methods whereas ANN showed better analytical performance. The qualitative meaning in MCR-ALS transformation provided very well correlations between the pure and estimated spectra of the three components. This multivariate processing of spectrophotometric data could successfully detect the studied antibiotics in waste water samples and compared favorably to alternative costly chromatographic methods.
Collapse
Affiliation(s)
- Ali M Yehia
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr-El Aini 13 Street, 11562 Cairo, Egypt; Chemistry Department, School of Pharmacy and Pharmaceutical Industries, Badr University in Cairo, Badr City, 11829, Cairo, Egypt
| | - Heba T Elbalkiny
- Analytical Chemistry Department, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), 11787 6(th) of October City, Egypt.
| | - Safa'a M Riad
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr-El Aini 13 Street, 11562 Cairo, Egypt; Analytical Chemistry Department, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), 11787 6(th) of October City, Egypt
| | - Yasser S Elsaharty
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr-El Aini 13 Street, 11562 Cairo, Egypt
| |
Collapse
|
35
|
Farkaš M, Glažar Ivče D, Stojanović S, Mavrinac M, Mićović V, Tambić Andrašević A. Parental Knowledge and Awareness Linked to Antibiotic Use and Resistance: Comparison of Urban and Rural Population in Croatia. Microb Drug Resist 2019; 25:1430-1436. [PMID: 31314687 DOI: 10.1089/mdr.2018.0424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To investigate the differences in parental knowledge, attitudes, and practice about antibiotic use and resistance among the urban and rural populations in Croatia. Materials and Methods: A cross-sectional study based on a structured questionnaire was distributed to 1,000 parents of children attending 11 elementary schools of Primorsko-Goranska County in 2017. Results: The overall response rate was 65.1% (651/1,000)-50.6% (253/500) in urban and 79.6% (398/500) in rural population. Urban parents had a higher overall knowledge about antibiotics (p < 0.001), while urban and rural parents held mostly similar knowledge and attitudes related to antibiotic use when split into individual statements (p > 0.05). Age, education, income, work, and family member working in a health-related field were significantly related with the overall knowledge about antibiotics. In the previous year, 28.2% of children and 28.9% of parents reported using an antibiotic. Croatian parents had a high level of trust in doctors' antibiotic-prescribing practices (96.3% reported trusting the doctors' decision not to prescribe antibiotics, 93.5% to prescribe antibiotics) and high awareness of antimicrobial resistance (94.8%). The public's misconception regarding the terms "bacteria" and "virus" was found in 15.5% of parents. The source of information about antimicrobial resistance was television (60.4%), internet (57.1%), newspapers (44.2%), and medical professionals (30.9%). Conclusions: Although the knowledge about antibiotics was higher in urban parents, it was not reflected on the level of antibiotic consumption. There are indications that medical professionals should be more involved in communicating the problems of antibiotic use and resistance to patients.
Collapse
Affiliation(s)
- Maja Farkaš
- Department of Microbiology, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia
| | - Daniela Glažar Ivče
- Department of School and University Medicine, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia.,Department of Epidemiology, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia
| | - Senka Stojanović
- Department of School and University Medicine, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia.,Department of Epidemiology, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia
| | - Martina Mavrinac
- Department of Medical Informatics, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | - Vladimir Mićović
- Department of Environmental Health, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | - Arjana Tambić Andrašević
- Division of Bacteriology and Hospital Infections, Department of Clinical Microbiology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević," Zagreb, Croatia
| |
Collapse
|
36
|
Kianmehr H, Sabounchi NS, Seyedzadeh Sabounchi S, Cosler LE. Patient expectation trends on receiving antibiotic prescriptions for respiratory tract infections: A systematic review and meta-regression analysis. Int J Clin Pract 2019; 73:e13360. [PMID: 31066959 DOI: 10.1111/ijcp.13360] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/17/2019] [Accepted: 05/04/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Despite a variety of programs developed to control inappropriate antibiotic prescribing for viral infections, antibiotics are still prescribed excessively for Respiratory Tract Infections (RTI). The patient's expectation to receive an antibiotic often influences the clinician's decision and can lead to inappropriate antibiotic prescriptions. Our objective was to investigate the changes in patient expectations over time when presenting with symptoms of a respiratory infection. METHODS We performed a systematic review of patient's expectation to receive antibiotics for RTIs. Two reviewers independently evaluated the collected studies based on inclusion and exclusion criteria. Our search initially identified 12 070 studies, of which 321 studies were eligible for full text review and 37 articles were selected for final evaluation. Meta-regression analysis was used to evaluate the association between patient expectations and different years. Heterogeneity was evaluated using the Q statistic. RESULTS Patient expectations (effect size) were pooled using a random effects model. The effect-equality test showed heterogeneity among studies (Q = 3304.23, df = 40, P < 0.0001, k = 40, τ2 = 0.63). Meta-regression results revealed that there is a significant linear negative relationship (B = -1.8374, P < 0.05) between patient expectation and year of data collection, at the global level. A similar finding is observed for the subset of studies conducted outside United States (U.S.) (B = -1.2411, P < 0.1). However, there is no discernible trend for patient expectation in the U.S. or among children and adult subgroups. Also, no significant differences are observed between the patient expectations when considering different age groups. CONCLUSION The trend of patient expectation for receiving antibiotics for RTIs is declining over time on a global level and also outside the U.S.
Collapse
Affiliation(s)
- Hamed Kianmehr
- Thomas J. Watson School of Engineering and Applied Science, Binghamton University, Binghamton, New York
| | - Nasim S Sabounchi
- Thomas J. Watson School of Engineering and Applied Science, Binghamton University, Binghamton, New York
| | | | - Leon E Cosler
- Department of Health Outcomes and Administrative Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, New York
| |
Collapse
|
37
|
Elbalkiny HT, Yehia AM, Riad SM, Elsaharty YS. Removal and tracing of cephalosporins in industrial wastewater by SPE-HPLC: optimization of adsorption kinetics on mesoporous silica nanoparticles. J Anal Sci Technol 2019. [DOI: 10.1186/s40543-019-0180-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
|
38
|
Bagnulo A, Muñoz Sastre MT, Kpanake L, Sorum PC, Mullet E. Why patients want to take or refuse to take antibiotics: an inventory of motives. BMC Public Health 2019; 19:441. [PMID: 31029110 PMCID: PMC6487028 DOI: 10.1186/s12889-019-6834-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate use of antibiotics is a worldwide issue. In order to help public health institutions and each particular physician to change patterns of consumption among patients, it is important to understand better the reasons why people accept to take or refuse to take the antibiotic drugs. This study explored the motives people give for taking or refusing to take antibiotics. METHODS Four hundred eighteen adults filled out a 60-item questionnaire that consisted of assertions referring to reasons for which the person had taken antibiotics in the past and a 70-item questionnaire that listed reasons for which the person had sometimes refused to take antibiotics. RESULTS A six-factor structure of motives to take antibiotics was found: Appropriate Prescription, Protective Device, Enjoyment (antibiotics as a quick fix allowing someone to go out), Others' Pressure, Work Imperative, and Personal Autonomy. A four-factor structure of motives not to take antibiotics was found: Secondary Gain (through prolonged illness), Bacterial Resistance, Self-defense (the body is able to defend itself) and Lack of trust. Scores on these factors were related to participants' demographics and previous experience with antibiotics. CONCLUSION Although people are generally willing to follow their physician's prescription of antibiotics, a notable proportion of them report adopting behaviors that are beneficial to micro-organisms and, as a result, potentially detrimental to humans.
Collapse
Affiliation(s)
- Adriana Bagnulo
- Jean-Jaurès University, CERPPS, Maison de la recherche, 5 allées Antonio Machado, 31058, Toulouse cedex 9, France
| | - Maria-Teresa Muñoz Sastre
- Jean-Jaurès University, CERPPS, Maison de la recherche, 5 allées Antonio Machado, 31058, Toulouse cedex 9, France
| | - Lonzozou Kpanake
- University of Québec (TELUQ), 5800, rue Saint-Denis, Bureau 1105, Montréal, Québec, H2S 3L5, Canada.
| | - Paul Clay Sorum
- Albany Medical College, Albany, Latham Med-Ped, 724 Watervliet-Shaker Road, Latham, NY, 12110, USA
| | - Etienne Mullet
- Institute of Advanced Studies (EPHE), 17 bis, rue Quefes, Plaisance du Touch, 31830, Paris, France
| |
Collapse
|
39
|
Chai J, Coope C, Cheng J, Oliver I, Kessel A, Hu Z, Wang D. Cross-sectional study of the use of antimicrobials following common infections by rural residents in Anhui, China. BMJ Open 2019; 9:e024856. [PMID: 30975670 PMCID: PMC6500192 DOI: 10.1136/bmjopen-2018-024856] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe help seeking behaviour from a medical doctor and antimicrobial use for common infections among rural residents of Anhui province, China. DESIGN A cross-sectional retrospective household survey. SETTING 12 administrative villages from rural Anhui, China. PARTICIPANTS 2760 rural residents selected through cluster-randomised sampling using an interviewer administered questionnaire. METHOD Logistic regression models were used to estimate associations between exposures (health insurance and antimicrobial-related knowledge), adjusted for confounders (sex, age and education), and help-seeking behaviour from a medical doctor and antimicrobial use following common infections, including acute respiratory tract infections (ARTIs), gastrointestinal tract infections (GTIs) and urinary tract infections (UTIs). RESULTS In total 2611 (94.6%) rural residents completed the questionnaire. Help seeking from a medical doctor was highest for ARTIs (59.4%) followed by GTIs (42.1%), and UTIs (27.8%). Around two-thirds (82.3% for ARTIs, 87.0% for GTIs and 66.0% for UTIs) of respondents sought help within 3 days following symptom onset and over three quarters (88% for ARTIs, 98% for GTIs and 77% for UTIs) reported complete recovery within 7 days. Of the help-seeking respondents, 94.5% with ARTI symptoms recalled being prescribed either oral or intravenous antimicrobials (GTIs 81.7% and UTIs 70.4%). Use of antimicrobials bought from medicine shops without prescriptions ranged from 8.8% for GTIs to 17.2% for ARTIs; while use of antimicrobials leftover from previous illnesses or given by a relative ranged from 7.6% for UTIs to 13.4% for ARTIs. Multivariate logistic regression analysis revealed that respondents with a higher antimicrobial-related knowledge score and lack of insurance were associated with lower levels of help-seeking for ARTIs; while respondents with a higher antimicrobial-related knowledge score were less likely to be prescribed either oral or intravenous antimicrobials. CONCLUSIONS Excessive antimicrobial use in the studied primary care settings is still prevalent.
Collapse
Affiliation(s)
- Jing Chai
- School of Public Health, Anhui Medical University, Hefei, China
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Caroline Coope
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol, UK
- National Infection Service, Public Health England, Bristol, UK
| | - Jing Cheng
- School of Public Health, Anhui Medical University, Hefei, China
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Isabel Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol, UK
- National Infection Service, Public Health England, Bristol, UK
| | - Anthony Kessel
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Zhi Hu
- School of Public Health, Anhui Medical University, Hefei, China
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, China
| |
Collapse
|
40
|
Dyar OJ, Lund M, Lindsjö C, Stålsby Lundborg C, Pulcini C. Preparedness to prescribe antibiotics responsibly: a comparison between final year medical students in France and Sweden. Eur J Clin Microbiol Infect Dis 2019; 38:711-717. [PMID: 30771121 PMCID: PMC6425071 DOI: 10.1007/s10096-019-03494-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/22/2019] [Indexed: 11/25/2022]
Abstract
Students should graduate from medical school feeling prepared to prescribe antibiotics responsibly. We assessed self-reported preparedness among students at medical schools in Europe, and we focus here on the results from students in Sweden and France, countries with wide differences in the intensity of antibiotic consumption and burden of antibiotic resistance. We conducted a cross-sectional web-based survey in 2015, based on a comprehensive set of topics related to prudent antibiotic use. All final year students at a medical school in France or Sweden were eligible to participate. Preparedness scores were calculated for each student, and mean scores were compared at medical school and country levels. Comparisons were also made on availability of teaching methods. We received responses from 2085/7653 (response rate 27.2%) students from 31/34 eligible medical schools in France and 302/1124 (26.9%) students from 7/7 schools in Sweden. The relative ranking order of curriculum topics by preparedness level was consistent between countries, but students in Sweden had higher self-reported levels of preparedness in 21/27 topics. There was higher availability for eight of nine teaching methods at Swedish medical schools. Students in France were more likely to report a need for further education on antibiotic use (63.5% vs. 20.3%, p < 0.001). Final year students in France report lower levels of preparedness, less availability of teaching methods and higher needs for more education on antibiotic use. Furthermore, we have identified specific areas for improvement in education on prudent antibiotic use in both Sweden and France.
Collapse
Affiliation(s)
- Oliver James Dyar
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Maria Lund
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lindsjö
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| |
Collapse
|
41
|
Benko R, Matuz M, Silva A, Ferreira J, Machado MC, Furtado C, Fungie Galistiani G, Bordas R, Blix HS. Cross-national comparison of paediatric antibiotic use in Norway, Portugal and Hungary. Basic Clin Pharmacol Toxicol 2019; 124:722-729. [PMID: 30589992 DOI: 10.1111/bcpt.13198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
Abstract
A cross-national comparison was performed on paediatric (0-19 years) antibiotic use in Hungary, Norway and Portugal to explore and compare the scale and pattern of paediatric antibiotic use in these three European countries. Ambulatory care systemic antibiotic use (ATC: J01) was retrieved from national databases for year 2014. The main outcome measure was number of antibacterial packages per child inhabitant per year (packages/child/year) and was further stratified by age groups. Paediatric antibiotic use peaked in Hungary with 1.3 packages/child/year, followed by Portugal (0.8) and Norway (0.3). This ranking was retained and was most prominent in the 5- to 9-year and 10- to 14-year age groups. The pattern of antibiotic use in different paediatric age groups varied also substantially between countries. Narrow-spectrum penicillins were much commonly used in Norway in all paediatric age subgroups in comparison with Hungary and Portugal. Newer, broad-spectrum cephalosporins and macrolides were widely prescribed for Hungarian and Portuguese children in all paediatric subgroups in contrast to Norway, while tetracyclines were commonly prescribed for Norwegian adolescents. The scale and pattern of paediatric antibiotic use in Hungary and Portugal were very different compared with Norway. The high antibiotic exposure and the high consumption of broad-spectrum penicillins begin in childhood in Hungary and Portugal which underpins the responsibility of paediatric GPs.
Collapse
Affiliation(s)
- Ria Benko
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Maria Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Ana Silva
- Information and Strategic Planning Directorate, Infarmed IP - National Authority of Medicines and Health Products, Public Institut, Lisbon, Portugal
| | - Joaquina Ferreira
- Information and Strategic Planning Directorate, Infarmed IP - National Authority of Medicines and Health Products, Public Institut, Lisbon, Portugal
| | - Maria Céu Machado
- Executive Board, Infarmed IP - National Authority of Medicines and Health Products, IP, Lisbon, Portugal
| | - Cláudia Furtado
- Information and Strategic Planning Directorate, Infarmed IP - National Authority of Medicines and Health Products, Public Institut, Lisbon, Portugal
| | - Githa Fungie Galistiani
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary.,Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Reka Bordas
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Hege Salvesen Blix
- Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
42
|
Assessing the impact of Medical Microbiology classes using active strategies on short- and long-term retention on medical students: an innovative study. Braz J Microbiol 2018; 50:165-173. [PMID: 30637632 DOI: 10.1007/s42770-018-0031-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/18/2018] [Indexed: 10/27/2022] Open
Abstract
One of teachers' concerns, with students in general and medical students in particular, is to ensure as much as possible that information goes from students' short-term memories to their long-term memories. The present study focuses on knowledge retention in Medical Microbiology and assesses the effectiveness of some strategies implemented for short- and long-term retention. A pre- and post-test was used to assess student's learning. This study involved students of Porto University (test group). Test group participants were all attending the third year of the Medicine Degree Program. The results of post-test 1 were considered very positive and support the importance of these applied active activities and/or methodologies in Medical Microbiology for short-term retention. However, the results obtained in post-test 2 showed that knowledge retention after 9 months, despite substantial, decreases.
Collapse
|
43
|
Adsorption properties, kinetics & thermodynamics of tetracycline on carboxymethyl-chitosan reformed montmorillonite. Int J Biol Macromol 2018; 124:557-567. [PMID: 30500496 DOI: 10.1016/j.ijbiomac.2018.11.235] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/03/2018] [Accepted: 11/26/2018] [Indexed: 11/23/2022]
Abstract
This paper describes a modification method of Na-montmorillonite (Na-Mt) with carboxymethyl-chitosan (CMC). The as-prepared samples were analyzed by Fourier transform infrared (FT-IR), X-ray diffraction (XRD), Brunauer-Emmett-Teller (BET) surface analyzer and thermogravimetric analysis (TGA). Two common tetracycline antibiotics, tetracycline (TET) and chlortetracycline (CTC), were selected as the represented pollutants and adsorbed by CMC-Mt under different experimental conditions. The intercalation of CMC obviously amplified the basal spacing of the interlayers confirmed by XRD measurements and improved the adsorption capacities of montmorillonite to some degree. The results showed that the tetracycline antibiotic sorption onto CMC-Mt was mainly dependent on pH and was not affected by temperature. Besides, the removal of TET and CTC rapidly attained an equilibrium within 2 h of contact time. The kinetic data of adsorption was determined by first-order, second-order kinetics and intraparticle diffusion models. The kinetic study indicates that the TET and CTC adsorption processes obeyed the second-order kinetics. The Freundlich isotherm study was in agreement with the practical data, suggesting a heterogeneous sorption process. Furthermore, the thermodynamic studies revealed that the removal process was more spontaneous at a lower temperature, implying it an exothermic reaction. The synthesized adsorbent CMC-Mt can be widely used in the treatment of wastewater.
Collapse
|
44
|
Dyar OJ, Beović B, Pulcini C, Tacconelli E, Hulscher M, Cookson B. ESCMID generic competencies in antimicrobial prescribing and stewardship: towards a European consensus. Clin Microbiol Infect 2018; 25:13-19. [PMID: 30414817 DOI: 10.1016/j.cmi.2018.09.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/14/2018] [Accepted: 09/23/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a consensus-based set of generic competencies in antimicrobial prescribing and stewardship for European prescribers through a structured consensus procedure. METHODS The RAND-modified Delphi procedure comprised two online questionnaire rounds, a face-to-face meeting between rounds, and a final review. Our departure point was a set of competencies agreed previously by consensus among a UK multi-disciplinary panel, and which had been subsequently revised through consultation with ESCMID Study Group representatives. The 46 draft competency points were reviewed by an expert panel consisting of specialists in infectious diseases and clinical microbiology, and pharmacists. Each proposed competency was assessed using a nine-point Likert scale, for relevance as a minimum standard for all independent prescribers in all European countries. RESULTS A total of 65 expert panel members participated, from 24 European countries (one to six experts per country). There was very high satisfaction (98%) with the final competencies set, which included 35 competency points, in three sections: core concepts in microbiology, pathogenesis and diagnosing infections (11 points); antimicrobial prescribing (20 points); and antimicrobial stewardship (4 points). CONCLUSIONS The consensus achieved enabled the production of generic antimicrobial prescribing and stewardship competencies for all European independent prescribers, and of possible global utility. These can be used for training and can be further adapted to the needs of specific professional groups.
Collapse
Affiliation(s)
- O J Dyar
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - B Beović
- University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - E Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - M Hulscher
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B Cookson
- Division of Infection and Immunity, University College London, London, UK
| |
Collapse
|
45
|
Access to medicines for acute illness and antibiotic use in residents: A medicines household survey in Sichuan Province, western China. PLoS One 2018; 13:e0201349. [PMID: 30114193 PMCID: PMC6095499 DOI: 10.1371/journal.pone.0201349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 07/13/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate medicine accessibility and antibiotic use in households in western China using World Health Organization (WHO) methodology as well as to identify the influencing factor of care-seeking outside the home and primary determinant factors that influence the use of antibiotics in Chinese residents. METHODS A cross-sectional household survey was conducted from March to July 2015, and 1200 households from six cities in Sichuan China were selected for a questionnaire survey using stratified multistage random cluster sampling. We used logistic regression models to identify the determinants of care-seeking outside the home and subsequent antibiotic use among the surveyed residents. RESULTS Overall, 1103 valid questionnaires were collected, and 458 households reported that they had had experienced at least one acute illness in the previous 2 weeks. Of these households, 97.2% of individuals with acute conditions sought care outside their homes and 40.1% of individuals who took medicine received antibiotics. Only 15.9% of the individuals with acute conditions reported that the medical insurance reimbursement covered at least one medicine. According to the multivariate analyses, women were less likely to seek care outside the home compared to men. Among those who sought outside care, fever and upper respiratory symptoms increased the odds of taking antibiotics, and visiting a private hospital also increased antibiotic use. Low-income households were less likely to receive antibiotics. Symptoms were strong determinants of antibiotic use when patients sought outside care. CONCLUSION The accessibility of medicine for acute illness among households in western China was favorable; however, medical insurance reimbursement must be improved. The nature of the symptoms and patterns of care-seeking had the greatest influence on the decision to take antibiotics among residents with acute conditions. The percentage of antibiotic use in patients with acute illness has declined, but the indications for using antibiotics must be standardized.
Collapse
|
46
|
Determination of flumequine enantiomers and 7-hydroxyflumequine in water and sediment by chiral HPLC coupled with hybrid quadrupole-time-of-flight mass spectrometer. Sci Rep 2018; 8:7582. [PMID: 29765079 PMCID: PMC5953928 DOI: 10.1038/s41598-018-25889-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/30/2018] [Indexed: 12/23/2022] Open
Abstract
A liquid chromatography-tandem mass spectrometric (LC-MS/MS) method for simultaneous enantiomeric analysis of flumequine and its metabolite 7-hydroxyflumequine in water and sediment had been developed based on the separation method. Sediment samples were extracted with ACN and EDTA-Mcllvaine buffer solution (40:60, v/v) then were enriched and cleaned-up by Cleanert PEP solid-phase extraction cartridges. The extract solvent, solid cartridges, mobile phase ratios, and chiral separation column were all optimized to reach high sensitivity and selectivity, good peak shape, and satisfactory resolution. The results showed that the calibration curves of flumequine enantiomers and 7-hydroxyflumequine were linear in the range of 1.0 to 200.0 µg/L with correlation coefficients of 0.9822–0.9988, the mean recoveries for both the enantiomers ranged from 69.9–84.6% with relative standard deviations (RSDs) being 13.1% or below. The limits of detection (LODs) for both flumequine enantiomers were 2.5 µg/L and 5.0 µg/kg in water and sediment samples, whereas the limits of quantification (LOQs) were 8.0 µg/L and 15.0 µg/kg, respectively. While the LODs for 7-hydroxyflumequine were 3.2 µg/L in water samples and 7.0 µg/kg in sediment samples. The proposed method will be extended for studies on the degradation kinetics and environmental behaviors and providing additional information for reliable risk assessment of these chiral antibiotics.
Collapse
|
47
|
Horvat O, Mijatović V, Milijasević B, Tomas A, Kusturica MP, Tomić Z, Sabo A. Are There Striking Differences in Outpatient Use of Antibiotics Between South Backa District, Serbia, and Some Scandinavian Countries? Front Public Health 2018; 6:91. [PMID: 29651413 PMCID: PMC5884880 DOI: 10.3389/fpubh.2018.00091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/08/2018] [Indexed: 11/23/2022] Open
Abstract
There is little published information about antibiotic utilization in outpatients in Serbia. The objective of this study was to determine the amount and structure of outpatient antibiotic use in South Backa District (SBD) in Serbia, to assess prescibing quality of antibiotics and to compare with results from Scandinavian countries. Data on the antibiotic use were collected from all private and state-owned pharmacies from January through March 2008 in SBD. Results were expressed as the number of defined daily doses/1,000 inhabitants/day. The drug utilization 90% method was also used. Penicillins were the most frequently used antibiotic subgroup in SBD (35.20%), followed by cephalosporins (19.16%) and macrolides (13.18%). Thirteen drugs accounted for 90% of total antibiotics consumption (DU90% segment). The average cost/DDD within the DU90% segment was 0.95 euros, whereas the average cost/DDD beyond the DU90% segment was 1.89 euros, indicating that less expensive antibiotics were more frequently used. High use of ampicillin, third-generation cefalosporins, co-trimoxazole, and gentamicin, will aggravate the alarming problem of resistance in Serbia. Differences in the amount and structure of antibiotic consumption between SBD and Scandinavian countries indicate the need of updated national guidelines for rational antimicrobial drug use in Serbia.
Collapse
Affiliation(s)
- Olga Horvat
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vesna Mijatović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Boris Milijasević
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ana Tomas
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Milica Paut Kusturica
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zdenko Tomić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ana Sabo
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
48
|
Wushouer H, Tian Y, Guan XD, Han S, Shi LW. Trends and patterns of antibiotic consumption in China's tertiary hospitals: Based on a 5 year surveillance with sales records, 2011-2015. PLoS One 2017; 12:e0190314. [PMID: 29281716 PMCID: PMC5744988 DOI: 10.1371/journal.pone.0190314] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/12/2017] [Indexed: 01/21/2023] Open
Abstract
The consumption of antibiotics is a major driver in the development of antimicrobial resistance. This study aims to identify the trends and patterns of the total antibiotic consumption in China's tertiary hospitals from 2011 to 2015 by retrospectively analyzing aggregated monthly surveillance data on antibiotic sales made to 468 hospitals from 28 provinces. Antibiotic consumption was expressed in DDD per 1,000 inhabitants per day (DID). We compared population weighted antibiotic consumption patterns in China with European countries using indicators from the European Surveillance of Antimicrobial Consumption (ESAC). Total antibiotic consumption, including all the specific antibiotic class except for aminoglycoside antibacterials, were significantly increased during the study period from an average of 7.97 DID in 2011 to 10.08 DID in 2015. In 2015, the eastern regions of China consumed the most antibiotics using population denominator while the western regions consumed the most using inpatient denominator. Cephalosporins accounted for 28.6% of total DID, followed by beta-lactam-beta-lactamase inhibitor combinations (20.0%), macrolides (17.4%), and fluoroquinolones (10.5%). Antibiotic in parenteral form accounted for nearly half of all antibiotics. Although over the past few years major efforts had been made to reduce the risks of excessive antibiotic use through antibiotic stewardship, total antibiotic consumption showed a significant upward trend during the study period. A consistent preference for cephalosporins, macrolides, beta-lactam-beta-lactamase inhibitor combinations, as well as parenteral preparations was observed.
Collapse
Affiliation(s)
- Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Ye Tian
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Xiao-Dong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing, China
| | - Sheng Han
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing, China
| | - Lu-Wen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing, China
| |
Collapse
|
49
|
Andersson ML, Böttiger Y, Kockum H, Eiermann B. High Prevalence of Drug-Drug Interactions in Primary Health Care is Caused by Prescriptions from other Healthcare Units. Basic Clin Pharmacol Toxicol 2017; 122:512-516. [DOI: 10.1111/bcpt.12939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/07/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Marine L. Andersson
- Division of Clinical Pharmacology; Department of Laboratory Medicine; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Ylva Böttiger
- Division of Drug Research; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Henrik Kockum
- Department of Anaesthesiology and Intensive Care; Östersund Hospital; Östersund Sweden
| | - Birgit Eiermann
- Division of Clinical Pharmacology; Department of Laboratory Medicine; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
50
|
Horn R, Heng C, Chea C, Sieng C, Louv C, Turton B, Durward C, Abu Kasim NH. Perceptions of oral health among older Cambodians and their caregivers: A qualitative study. Gerodontology 2017; 35:45-50. [PMID: 29226455 DOI: 10.1111/ger.12315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Older adults (those above the age of 60) are an emerging demographic in Cambodia, and very little is understood about their oral health experiences, needs, perceptions and behaviours. The aim of this study was to explore the oral health experiences, practices and perceptions of a convenience sample of a small but diverse group of older adults in Cambodia. METHOD A cross-sectional qualitative study in which focus group interviews were conducted by 5 trained senior Cambodian dental students. A convenience sample of 56 older adults and caregivers was recruited across urban, semi-urban and rural locations. Focus group conversations were recorded, transcribed and analysed thematically. RESULTS The themes that emerged were around low expectations for both general health and oral health. A communal responsibility for health was expressed, and both money and transport were identified as key barriers to accessing care. Participants recognised that they had oral health problems, and acknowledged the impact of poor oral function on health and nutrition. CONCLUSION This study is an important first step in better understanding the oral health experiences and perceptions of older people in Cambodia. Participants described the impacts of poor oral health as being important, even when compared with other general health conditions.
Collapse
Affiliation(s)
| | - Chanlay Heng
- University of Puthisastra, Puthisastra, Cambodia
| | | | | | - Chenlay Louv
- University of Puthisastra, Puthisastra, Cambodia
| | - Bathsheba Turton
- University of Puthisastra, Puthisastra, Cambodia.,University of Melbourne, Parkville, VIC, Australia
| | | | - Noor Hayaty Abu Kasim
- Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.,Wellness Research Cluster, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|