Factors affecting the cost effectiveness of antibiotics

Frailty associated urinary tract infections (FaUTIs)

This review summarizes the current literature on the correlation between frailty and urinary tract infections (UTIs), as well as the potential causes and measures that can be taken to prevent and treat these frailty associated UTIs (FaUTIs). A narrative review of the literature was carried out using the keywords and other associated terms (catheter associated UTIs and frailty, causes of UTIs, prevention of UTIs in the frail, treatment of UTIs in the frail). As it is shown in the literature, many risk factors that are associated with frailty such as dehydration, reduced mobility and cognitive impairment, as well as other anatomical or functional abnormalities can make frail patients prone to UTIs that are also more difficult to treat. Early correction of these risk factors (for example avoiding long term catheters, increasing hydration, treating lower urinary tract obstruction or incontinence), can prevent UTIs and improve the quality of life of frail patients. Prompt and individualized antimicrobial treatment of UTIs in the frail population can result in decreasing mortality rates but also minimize unnecessary antimicrobial drug use.

Withholding antibiotics does not reduce clinical pregnancy outcomes of natural cycle frozen embryo transfers

OBJECTIVE

To assess the impact of withholding doxycycline on the success rate of natural cycle frozen embryo transfers (NC-FET).

DESIGN

Retrospective cohort study.

SETTING

Single academic institution.

PATIENT(S)

Women undergoing 250 NC-FET with euploid blastocysts performed by a single provider.

INTERVENTION(S)

One hundred and twenty-five NC-FET cycles performed after January 2019 without antibiotic administration compared with 125 NC-FET cycles before January 2019 with doxycycline administration.

MAIN OUTCOME MEASURE(S)

Primary outcome: live birth (LB) or ongoing pregnancy rate (OPR, defined as pregnancies ≥13 weeks); secondary outcomes included positive β-human chorionic gonadotropin (β-hCG) level and clinical pregnancy rate (CPR, defined as the presence of fetal cardiac activity on ultrasound).

RESULT(S)

Each group of women comprised 125 NC-FET during the study period of March 2017 to March 2020. The women's mean age was 36.3 years and mean body mass index was 24 kg/m². Between the two groups, the baseline characteristics were similar, including age, body mass index, race, smoking status, parity, endometrial thickness, Society of Assisted Reproductive Technology diagnosis, and number of prior failed transfers. Comparing NC-FET with doxycycline administration versus without, we found no statistically significant difference in LB-OPR (64% vs. 62.6%), positive β-hCG (72.8% vs. 74.0%), or CPR (68% vs. 65.9%). After controlling for all variables in a logistic regression, doxycycline still had no effect on LB-OPR.

CONCLUSION(S)

In this analysis of similar patients undergoing NC-FET by a single provider, withholding doxycycline does not reduce success rates. Given the risks of antibiotics, our findings support withholding their use in NC-FET.

Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health

Antimicrobial resistance (AMR) is a serious threat to global public health. It increases morbidity and mortality, and is associated with high economic costs due to its health care burden. Infections with multidrug-resistant (MDR) bacteria also have substantial implications on clinical and economic outcomes. Moreover, increased indiscriminate use of antibiotics during the COVID-19 pandemic will heighten bacterial resistance and ultimately lead to more deaths. This review highlights AMR's scale and consequences, the importance, and implications of an antimicrobial stewardship program (ASP) to fight resistance and protect global health. Antimicrobial stewardship (AMS), an organizational or system-wide health-care strategy, is designed to promote, improve, monitor, and evaluate the rational use of antimicrobials to preserve their future effectiveness, along with the promotion and protection of public health. ASP has been very successful in promoting antimicrobials' appropriate use by implementing evidence-based interventions. The "One Health" approach, a holistic and multisectoral approach, is also needed to address AMR's rising threat. AMS practices, principles, and interventions are critical steps towards containing and mitigating AMR. Evidence-based policies must guide the "One Health" approach, vaccination protocols, health professionals' education, and the public's awareness about AMR.

Antibiotic prophylaxis for implant placement: a systematic review of effects on reduction of implant failure

Introduction Despite excellent reviews in the past several years, the use of antibiotics as prophylaxis for implant placement remains controversial.Aim To assess the literature on the efficacy of prophylactic antibiotics prescribed prior to and immediately following implant surgery (PIFS).Outcomes Whether administration of antibiotics reduced implant failure and post-operative complications.Design Databases searched were PubMed and Medline via Ovid (1946 to February 2018), Cochrane Library (Wiley) and Google Scholar.Materials and methods Quality assessment, meta-analysis with a forest plot and incorporated assessment of heterogeneity. A two-tailed paired t-test was performed, analysing differences in mean failure rates between groups.Results Fourteen publications were collected; 5,334 implants were placed with pre-operative antibiotics, 82 implants with antibiotics PIFS and 3,862 placed with no antibiotics. The overall risk ratio (RR) was 0.47 (95% CI 0.39-0.58), with the implant failure rates significantly affected by pre-operative intervention (Z = 7.00, P <0.00001). The number needed to treat (NNT) was 35 (95% CI 26.3-48.2). The difference between mean failure rates was statistically significant (P = 0.0335).Conclusion Administering prophylactic antibiotics reduced the risk of implant failures. Further investigations are recommended to establish a standardised protocol for the proper use of antibiotic regimen.

Calculated parenteral initial treatment of bacterial infections: Economic aspects of antibiotic treatment

This is the seventeenth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. This chapter analyses economic aspects of antiinfective therapy. Any treatment decision is also a cost decision. In this chapter the authors particularly analyse whether or not there is evidence that certain clinically effective strategies as Antimicrobial Stewardship programs (AMS), guideline adherent initial therapy, early diagnostics, De-escalation, sequence therapy or therapeutic drug monitoring also have benficial economic effects. These can be direct savings or shortening of length of stay to free resources.

Characterisation and Antibiotic Resistance of Selected Bacterial Pathogens Recovered from Dairy Cattle Manure during Anaerobic Mono-Digestion in a Balloon-Type Digester

Dairy cattle manure serves as a potential source of contamination and infection of animals, humans and the environment. Manure samples withdrawn from a balloon-type digester during anaerobic digestion were evaluated for the presence of antibiotic-resistant bacterial pathogens. The bacterial load of the samples was determined via a viable plate count method and the recovered isolates were subjected to characterisation and identification. These isolates were employed in antibiotic susceptibility testing using a disc diffusion method against a suite of 10 conventional antibiotics. The multiple antibiotic resistance (MAR) index was calculated and MAR phenotypes were generated. Although all the bacterial pathogens showed a certain degree of resistance to the studied antibiotics, a marked resistance was demonstrated by Campylobacter sp. to co-trimoxazole (87.5%) and nalidixic acid (81.5%). Remarkably, a high resistance (82.42%) was demonstrated against the antibiotic class, macrolide, followed by beta-lactams (40.44%), suggesting that bacterial resistance depended on the chemical structure of the antibiotics. However, individual bacterial isolates varied in resistance to particular antibiotics. Of the 83 bacterial isolates, 40(48.19%) observed MAR > 0.2 and, thus, were described as multidrug-resistant isolates. A total of 28 MAR phenotypes were revealed with the highest frequency of MAR phenotypes (37.5%) expressed against 3 antibiotics. Results indicated a high risk of exposure to various antibiotics and wide diversity of antibiotic resistance.

Antibiotic Resistance of Bacteria Involved in Urinary Infections in Brazil: A Cross-Sectional and Retrospective Study

Empirical and prolonged antimicrobial treatment of urinary tract infections caused by Escherichia coli is associated with the emergence of bacterial resistance, and not all countries have strict policies against the indiscriminate use of drugs in order to prevent resistance. This cross-sectional and retrospective study (2010–2015) aimed to evaluate the sensitivity and resistance of patient-derived E. coli to different drugs broadly used to treat urinary infections in Brazil: ampicillin + sulbactam, cephalothin, ciprofloxacin, norfloxacin, and nitrofurantoin. We obtained 1654 E. coli samples from ambulatory patients with disease symptoms of the urinary tract from a Brazilian public hospital. While all antibiotics were effective in killing E. coli to a large degree, nitrofurantoin was the most effective, with fewer samples exhibiting antibiotic resistance. We assessed the costs of generic and brand name versions of each antibiotic. Nitrofurantoin, the most effective antibiotic, was the cheapest, followed by the fluoroquinolones (ciprofloxacin and norfloxacin), ampicillin + sulbactam and, lastly, cephalothin. Finally, assessment of antibiotic resistance to fluoroquinolones over the study period and extrapolation of the data led to the conclusion that these antibiotics could no longer be effective against E. coli-based urinary infections in approximately 20 years if their indiscriminate use in empirical treatment continues.