1
|
Saleem S, Yasmin H, Moore JL, Rahim A, Shakeel I, Lokangaka A, Tshefu A, Bauserman M, Mwenechanya M, Chomba E, Goudar SS, Kavi A, Derman RJ, Krebs NF, Figueroa L, Mazariegos M, Nyongesa P, Bucher S, Esamai F, Patel A, Waikar M, Shivkumar P, Hibberd PL, Petri WA, Billah SM, Haque R, Carlo WA, Tita A, Koso-Thomas M, Hemingway-Foday J, McClure EM, Goldenberg RL. Intrapartum and postpartum antibiotic use in seven low- and middle-income countries: Findings from the A-PLUS trial. BJOG 2024. [PMID: 39140197 DOI: 10.1111/1471-0528.17930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 07/24/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE To describe the intrapartum and postpartum use of non-study antibiotics in low- and middle-income countries (LMICs) during the double-blinded NICHD Global Network Azithromycin in Labor (A-PLUS) trial. DESIGN The antibiotic use sub-study was a planned prospective, observational sub-study of the A-PLUS trial. SETTINGS The study was carried out in hospitals or health centres affiliated with eight sites of the Global Network for Women's and Children's Health Research (Global Network) in seven countries: Bangladesh, Pakistan, India (two sites), Kenya, Zambia, The Democratic Republic of the Congo (DRC) and Guatemala. POPULATION Totally, 29 278 pregnant women enrolled in the A-PLUS trial. METHODS We collected data on 29 278 pregnant women admitted to a facility for delivery related to non-study antibiotic use overall and during three time periods: (1) in the facility prior to delivery, (2) after delivery until facility discharge and (3) after discharge to 42 days post-partum. MAIN OUTCOME MEASURES Non-study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods. RESULTS Of the 29 278 women in the study, 5020 (17.1%; 95% CI 16.7%-17.6%) received non-study antibiotics in the facility prior to delivery, 11 956 (40.8%; 95% CI 40.3%-41.4%) received non-study antibiotics in the facility after delivery, and 13 390 (47.6%; 95% CI 47.0%-48.2%) women received non-study antibiotics after delivery and after facility discharge. Antibiotics were prescribed more often among women in the Asian and Guatemalan sites than in the African sites. In the three time-periods, among those receiving antibiotics, prophylaxis was the indication in 82.3%, 97.7% and 90.7% of the cases, respectively. The type of antibiotics used varied substantially by time-period and site, but generally, penicillin-type drugs, cephalosporin-type drugs and metronidazole were used more frequently than other types. CONCLUSIONS Across the eight sites of the Global Network, in the facility before delivery, and in the post-partum periods before and after facility discharge, antibiotics were used frequently, but use was highly variable by site and time-period.
Collapse
Affiliation(s)
| | | | | | | | | | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Elwyn Chomba
- University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | | | - Sherri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA
| | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Higher Education and Research, Sawangi, India
| | | | | | | | | | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
- University of Sydney, Sydney, New South Wales, Australia
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | | | - Alan Tita
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | | | | | | |
Collapse
|
2
|
Visan AI, Negut I. Coatings Based on Essential Oils for Combating Antibiotic Resistance. Antibiotics (Basel) 2024; 13:625. [PMID: 39061307 PMCID: PMC11273621 DOI: 10.3390/antibiotics13070625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
In the current era of widespread antimicrobial resistance, the utilization of essential oils (EOs) derived from plants has emerged as a promising alternative in combating pathogens that have developed resistance to antibiotics. This review explores the therapeutic potential of essential oils as valuable tools in restoring the efficacy of antibiotics, highlighting their unique ability to affect bacteria in multiple ways and target various cellular systems. Despite the challenge of elucidating their precise mode of action, EOs have shown remarkable results in rigorous testing against a diverse range of bacteria. This review explores the multifaceted role of EOs in combating bacterial microorganisms, emphasizing their extraction methods, mechanisms of action, and comparative efficacy against synthetic antibiotics. Key findings underscore the unique strategies EOs deploy to counter bacteria, highlighting significant differences from conventional antibiotics. The review extends to advanced coating solutions for medical devices, exploring the integration of EO formulations into these coatings. Challenges in developing effective EO coatings are addressed, along with various innovative approaches for their implementation. An evaluation of these EO coatings reveals their potential as formidable alternatives to traditional antibacterial agents in medical device applications. This renaissance in exploring natural remedies emphasizes the need to combine traditional wisdom with modern scientific advancements to address the urgent need for effective antimicrobial solutions in the post-antibiotic era.
Collapse
Affiliation(s)
| | - Irina Negut
- National Institute for Lasers, Plasma and Radiation Physics, 409 Atomistilor Street, 077125 Magurele, Ilfov, Romania;
| |
Collapse
|
3
|
Almowallad SJ, Alqahtani LS. Synergistic antimicrobial action of chitosan-neem extracts nanoformulation as a promising strategy for overcoming multi-drug resistant bacteria. Int J Biol Macromol 2024; 272:132337. [PMID: 38797302 DOI: 10.1016/j.ijbiomac.2024.132337] [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] [Received: 01/13/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
The objective of the present study was to analyze and identify the phytochemical components found in neem leaf extracts using gas chromatography-mass spectrometry (GC-MS) and Fourier-transform infrared spectroscopy (FTIR) methods. The extract samples were acquired using ethyl acetate (EA) and petroleum ether (PE) solvents. Moreover, the extracts were assessed for their antibacterial and antioxidant features. In addition, chitosan nanoparticles (Cs NPs) containing neem extracts were synthesized and evaluated for their potential antibacterial properties, explicitly targeting multi-drug resistant (MDR) bacteria. The neem extracts were analyzed using GC-MS, which identified components such as hydrocarbons, phenolic compounds, terpenoids, alkaloids, and glycosides. Results revealed that the PE extract showed significant antibacterial activity against a range of bacteria. In addition, the PE extract exhibited significant antioxidant activity, exceeding both the EA extract and vitamin C. In addition, both extracts exhibited notable antibiofilm activity, significantly inhibiting the production of biofilm. The Cs NPs, loaded with neem extracts, exhibited significant antibacterial action against multidrug-resistant (MDR) microorganisms. The Cs NPs/EA materials had the greatest zone of inhibition values of 24 ± 2.95 mm against Pseudomonas aeruginosa. Similarly, the Cs NPs/PE materials exhibited a zone of inhibition measurement of 22 ± 3.14 mm against P. aeruginosa. This work highlights the various biochemical components of neem extracts, their strong abilities to combat bacteria and oxidative stress, and the possibility of Cs NPs containing neem extracts as effective treatments for antibiotic-resistant bacterial strains.
Collapse
Affiliation(s)
- Sanaa J Almowallad
- Department of Biochemistry, Faculty of Science, University of Tabuk, Tabuk 71421, Saudi Arabia.
| | - Leena S Alqahtani
- Department of Biochemistry, College of Science, University of Jeddah, Jeddah 23445, Saudi Arabia
| |
Collapse
|
4
|
Helmi RT, Al-Maqbali JS, Gamal S, Ba Wazir H, Al Sulemani Y, Al Za'abi M. Short-term effects of antimicrobial stewardship programs on antibiotics usage, clinical outcomes, and multidrug resistant organisms in the post COVID-19 era. J Infect Public Health 2024; 17:819-824. [PMID: 38537576 DOI: 10.1016/j.jiph.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Antimicrobial resistance is associated with increasing mortality rates and the emergence of multidrug-resistant (MDR) organisms. There is scarcity of data on the short-term impact of Antimicrobial Stewardship Programs (ASP) on antibiotic usage, clinical outcome and MDR organisms' pattern following the COVID-19 pandemic. This study evaluated the short-term effects of ASP on antibiotic usage, clinical outcomes and MDR organisms' pattern in the post COVID-19 era. METHODS Conducted at a tertiary academic health center, this observational study involved adult patients (≥18 years) in the general medical unit, treated with oral or intravenous antibiotics from May 1, 2021, to April 30, 2022. The applied ASP strategy was a prospective audit and feedback where a weekly meeting was held to discuss the antimicrobial therapy of admitted patient, after which recommendations were made regarding antimicrobial use. RESULTS The study included 301 patients with 166 (55.1%) pre-ASP and 135 (44.9%) post-ASP. The median (IQR) age was 69 (55-77) years with 56.1% were female. Antibiotic usage dropped by 25.2% post-ASP. The length of hospital stay (LOS) was longer post-ASP (7 days vs. 7.9 days, p = 0.001), with MDR infections being a significant predictor (OR: 0.486, p < 0.001). There were no significant differences in 28-day readmission, recurrence of infections and all-cause mortality. Post-ASP, MDR pathogens increased (17.0% vs. 6.6%, p = 0.013), however, after separating post-ASP into two three-months periods, MDROs numbers decreased slightly (13 vs. 10). CONCLUSION Short-term ASP implementation post COVID-19 reduced antibiotic usage while other clinical outcomes remained unchanged. Nonetheless an increase in MDR pathogens and LOS was observed. Further research is required to assess ASP's long-term impact on MDR infections rates and specific patient group outcomes.
Collapse
Affiliation(s)
- Rania Tarek Helmi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman
| | - Juhaina Salim Al-Maqbali
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman; Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sarah Gamal
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hashim Ba Wazir
- Infectious Diseases Unit, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Department of Medicine, Sultan Qaboos Hospital, Salalah, Oman
| | - Yousuf Al Sulemani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al Za'abi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman.
| |
Collapse
|
5
|
Palaiopanos K, Krystallaki D, Mellou K, Kotoulas P, Kavakioti CA, Vorre S, Vertsioti G, Gkova M, Maragkos A, Tryfinopoulou K, Paraskevis D, Tsiodras S, Zaoutis T. Healthcare-associated infections and antimicrobial use in acute care hospitals in Greece, 2022; results of the third point prevalence survey. Antimicrob Resist Infect Control 2024; 13:11. [PMID: 38273402 PMCID: PMC10809483 DOI: 10.1186/s13756-024-01367-8] [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] [Received: 09/22/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The burden of healthcare-associated infections (HAIs) and the extent of antimicrobial use (AU) are periodically recorded through Point Prevalence Surveys (PPS) in acute care hospitals coordinated by the European Centre for Disease Prevention and Control (ECDC). In previous PPSs, Greece demonstrated increased HAI and AU prevalence: 9% and 54.7% in 2011-2012, and 10% and 55.6% in 2016-2017, respectively. The 2022 PPS aimed to estimate HAIs and AU indicators among inpatients, especially amid the COVID-19 pandemic. METHODS A cross-sectional study was conducted in 50 hospitals during October-December 2022, in Greece. Patients admitted before 8.00 a.m. of the survey day were observed. Patients with at least one HAI or receiving at least one antimicrobial agent were included. Data were collected by hospital infection control teams. Hospital and ward-level variables were analysed. RESULTS From 9,707 inpatients, 1,175 had at least one HAI (12.1%), and 5,376 were receiving at least one antimicrobial (55.4%). Intensive care unit patients had the highest HAI (45.7%) and AU (71.3%) prevalence. Of the 1,408 recorded HAIs, lower respiratory tract (28.9%), bloodstream (20%), and urinary tract infections (13.1%) were the most common. Among 1,259 isolates, Klebsiella (20.5%) and Acinetobacter (12.8%) were most frequently identified. Resistance to first-level antibiotic markers was 69.3%. Among the 9,003 antimicrobials, piperacillin-tazobactam (10.9%), and meropenem (7.7%) were frequently prescribed. The ratio of broad-spectrum to narrow-spectrum antibiotics was 1.4. As defined by the 2021 WHO AWaRe (Access, Watch, Reserve) classification, restricted classes of Watch and Reserve agents comprised 76.7% of antibiotics. Usual indications were treatment of community-acquired infections (34.6%) and HAIs (22.9%). For surgical prophylaxis, cefoxitin was commonly used (20.2%), and typical courses (75.7%) lasted more than one day. HAI and AU prevalence were positively associated with bed occupancy (p = 0.027) and secondary hospitals (p = 0.014), respectively. CONCLUSIONS The 2022 PPS highlighted the increasing trend of HAI prevalence and high AU prevalence in Greece, the emergence of difficult-to-treat pathogens, and the extensive use of broad-spectrum antimicrobials. Strengthening infection control and antimicrobial stewardship programs in hospital settings is essential.
Collapse
Affiliation(s)
- Konstantinos Palaiopanos
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece.
| | - Dimitra Krystallaki
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
| | - Kassiani Mellou
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
| | - Petros Kotoulas
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
| | - Christina-Anna Kavakioti
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
| | - Styliani Vorre
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
| | - Georgia Vertsioti
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
| | - Maria Gkova
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
| | - Antonios Maragkos
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
| | - Kyriaki Tryfinopoulou
- Central Public Health Laboratory, National Public Health Organization, Athens, Greece
| | - Dimitrios Paraskevis
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
- 4th Department of Internal Medicine , "Attikon" University Hospital, National and Kapodistrian University of Athens , Athens, Greece
| | - Theoklis Zaoutis
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization (EODY), Athens, Greece
- 2nd Department of Pediatrics, "P. and A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
6
|
Yang J, Bao C, Gu J. Investigating how tamsulosin combined with levofloxacin impacts wound healing in patients with chronic prostatitis who may also have perineal or urethral wounds. Int Wound J 2024; 21:e14656. [PMID: 38272823 PMCID: PMC10789924 DOI: 10.1111/iwj.14656] [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] [Received: 12/11/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Chronic prostatitis, which frequently manifests with perineal or urethral ulcers, can have substantial impact on the quality of life experienced by affected individuals. Present treatment approaches primarily target the alleviation of symptoms and control of complications. In patients with chronic prostatitis, this investigation examined the potential synergistic effects of tamsulosin and levofloxacin on urinary function and urethral and perineal wounds healing. This cross-sectional observational study was carried out at Chongqing Western Hospital, China, from February to November 2023. The participants comprised 88 males aged 40-75 years who had been clinically diagnosed with chronic prostatitis and complications that accompany the wound healing process. The participants were equally distributed into two groups: one assigned to the treatment group, which received a daily combination of levofloxacin (500 mg) and tamsulosin (0.4 mg) and other to receive conventional care. The wound healing rate and improvement in urinary function were the primary outcomes evaluated monthly for 9 months. Patient satisfaction and symptom amelioration were secondary outcomes, in addition to the surveillance of adverse effects. In comparison to the control, treatment group exhibited significantly higher rate of wound closure (78.08% at 1 month and 79.38% at 9 months) and urinary function improvement (66.69% at 1 month and 67.95% at 9 months). In addition, the treatment group exhibited a greater degree of symptom amelioration; however, a rise in adverse effects was observed. In every domain, patient satisfaction scores were significantly higher in the treatment group. Thus the combination of tamsulosin and levofloxacin improved urinary function and wound repair in patients with chronic prostatitis, while also exhibiting tolerable profile of adverse effects.
Collapse
Affiliation(s)
- Jingruo Yang
- Department of Urology SurgeryChongqing Western HospitalChongqingChina
| | - Congcong Bao
- Department of Urology SurgeryChongqing Western HospitalChongqingChina
| | - Jianglin Gu
- Department of Urology SurgeryChongqing Western HospitalChongqingChina
| |
Collapse
|