Changing antibiotic prescribing practices in outpatient primary care settings in China: Study protocol for a health information system-based cluster-randomised crossover controlled trial

Assessment of antimicrobial drugs employed at government-operated hospitals in central and northern provinces of Iraq

OBJECTIVE

Aim: To document the clinical patterns of antibiotic prescriptions in government hospitals, where the majority of physicians possess a degree-based training.

PATIENTS AND METHODS

Materials and Methods: A Retrospective cross section study carried out between 1/7/2022 and April 2023 that enrolling 300 patients from governmental hospitals from different provinces of Central and northern Iraq. The research form contained 15 fields divided into three sections. The first section contains social information such as age, gender, field of work, Residence and education. The second part consists of diagnosis and lab. Finding. The third part related to antibiotic uses: Number of AB prescribed, duration of using, type of use, route of administration, AB interaction, dose administration of AB, indication of Ab, and Class of AB.

RESULTS

Results: A total of 300 eligible patients, 165 patients (55.0%) were male and 135 (45.0%) were female, patients were <20 years ages were 117 (39.0%), 25 (8.3%) from the 20-29 years age group, 40-49 years ages were 28 (9.3%) and >50 years ages were 105 (35.0%) were which belong to the pediatric population. The 198 patients (66.0%) were used cephalosporins and 106 (53.5%) of them used alone. A 13-19% percentage of patients had used penicillin, carbapenem, anti-fungal, and aminoglycoside in combination form.

CONCLUSION

Conclusions: The implementation of clinical guidelines, the provision of direct instruction, and the regular dissemination of antibiogram data have the potential to encourage a more judicious consumption of antibiotics.

Artificial intelligence, machine learning and deep learning: Potential resources for the infection clinician

BACKGROUND

Artificial intelligence (AI), machine learning and deep learning (including generative AI) are increasingly being investigated in the context of research and management of human infection.

OBJECTIVES

We summarise recent and potential future applications of AI and its relevance to clinical infection practice.

METHODS

1617 PubMed results were screened, with priority given to clinical trials, systematic reviews and meta-analyses. This narrative review focusses on studies using prospectively collected real-world data with clinical validation, and on research with translational potential, such as novel drug discovery and microbiome-based interventions.

RESULTS

There is some evidence of clinical utility of AI applied to laboratory diagnostics (e.g. digital culture plate reading, malaria diagnosis, antimicrobial resistance profiling), clinical imaging analysis (e.g. pulmonary tuberculosis diagnosis), clinical decision support tools (e.g. sepsis prediction, antimicrobial prescribing) and public health outbreak management (e.g. COVID-19). Most studies to date lack any real-world validation or clinical utility metrics. Significant heterogeneity in study design and reporting limits comparability. Many practical and ethical issues exist, including algorithm transparency and risk of bias.

CONCLUSIONS

Interest in and development of AI-based tools for infection research and management are undoubtedly gaining pace, although the real-world clinical utility to date appears much more modest.

Disparities of Health Program Information Systems in Indonesia: A Cross-Sectional Indonesian Health Facility Research 2019

Although a recording and reporting format for health centers already exists for Indonesia's standard information system, numerous health applications still need to meet the needs of each program. Therefore, this study aimed to demonstrate the potential disparities in information systems in the application and data collection of health programs among Indonesian community health centers (CHCs) based on provinces and regions. This cross-sectional research used data from 9831 CHCs from the Health Facilities Research 2019 (RIFASKES). Significance was assessed using a chi-square test and analysis of variance (ANOVA). The number of applications was depicted on a map using the spmap command with STATA version 14. It showed that region 2, which represented Java and Bali, was the best, followed by regions 1, which comprised Sumatra Island and its surroundings, and 3, Nusa Tenggara. The highest mean, equaling that of Java, was discovered in three provinces of region 1, namely, Jambi, Lampung, and Bangka Belitung. Furthermore, Papua and West Papua had less than 60% for all types of data-storage programs. Hence, there is a disparity in the health information system in Indonesia by province and region. The results of this analysis recommend future improvement of the CHCs' information systems.

Potent and Broad-Spectrum Bactericidal Activity of a Nanotechnologically Manipulated Novel Pyrazole

The antimicrobial potency of the pyrazole nucleus is widely reported these days, and pyrazole derivatives represent excellent candidates for meeting the worldwide need for new antimicrobial compounds against multidrug-resistant (MDR) bacteria. Consequently, 3-(4-chlorophenyl)-5-(4-nitrophenylamino)-1H-pyrazole-4-carbonitrile (CR232), recently reported as a weak antiproliferative agent, was considered to this end. To overcome the CR232 water solubility issue and allow for the determination of reliable minimum inhibitory concentration values (MICs), we initially prepared water-soluble and clinically applicable CR232-loaded nanoparticles (CR232-G5K NPs), as previously reported. Here, CR232-G5K NPs have been tested on several clinically isolates of Gram-positive and Gram-negative species, including MDR strains. While for CR232 MICs ≥ 128 µg/mL (376.8 µM) were obtained, very low MICs (0.36–2.89 µM) were observed for CR232-G5K NPs against all of the considered isolates, including colistin-resistant isolates of MDR Pseudomonas aeruginosa and Klebsiella pneumoniae carbapenemases (KPCs)-producing K. pneumoniae (0.72 µM). Additionally, in time–kill experiments, CR232-G5K NPs displayed a rapid bactericidal activity with no significant regrowth after 24 h on all isolates tested, regardless of their difficult-to-treat resistance. Conjecturing a clinical use of CR232-G5K NPs, cytotoxicity experiments on human keratinocytes were performed, determining very favorable selectivity indices. Collectively, due to its physicochemical and biological properties, CR232-G5K NPs could represent a new potent weapon to treat infections sustained by broad spectrum MDR bacteria.

Managing sepsis in the era of precision medicine: challenges and opportunities

INTRODUCTION

Precision medicine is a medical model in which decisions, practices, interventions and therapies are tailored to the individual patient based on their predicted response or risk of disease. Sepsis is a life-threatening condition characterized by immune system dysregulation whose pathophysiology remains incompletely understood. There is much hope that precision medicine can lead to better outcomes in patients with sepsis.

AREAS COVERED

In this review from a comprehensive literature search in PubMed for English-language studies conducted in adults, we highlight recent advances in the diagnosis and treatment of sepsis of bacterial origin in adults using precision medicine approaches including rapid diagnostic tests, predictive biomarkers, genomic methods, rapid antimicrobial susceptibility testing, and monitoring cell mediated immunity. Challenges and directions for future research are also discussed.

EXPERT OPINION

Current diagnostic testing in sepsis relies primarily on conventional cultures (e.g. blood cultures), which are time-consuming and may delay critical therapeutic decisions. Nonculture-based techniques including nucleic acid amplification technologies (NAAT), other molecular methods (biomarkers), and genomic sequencing offer promise to overcome some of the inherent limitations seen with culture-based techniques.