Research

9 pages, 536 KiB

Open AccessArticle

Severity and Bothersomeness of Urinary Tract Infection Symptoms in Women before and after Menopause

by Signe Teglbrænder-Bjergkvist, Volkert Siersma and Anne Holm

Antibiotics 2023, 12(7), 1148; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12071148 - 04 Jul 2023

Cited by 1 | Viewed by 1149

Urinary tract infection (UTI) is a common cause for prescription of antibiotics among women in general practice. Diagnosis is often established by inquiry into clinical history and symptoms, and these may be experienced differently depending on menopause status of the woman. The aim [...] Read more.

Urinary tract infection (UTI) is a common cause for prescription of antibiotics among women in general practice. Diagnosis is often established by inquiry into clinical history and symptoms, and these may be experienced differently depending on menopause status of the woman. The aim of this study was to assess differences in severity and bothersomeness of UTI symptoms between pre- and postmenopausal women. We used a convenience sample of 313 women with suspected UTIs and typical symptoms recruited in general practice. Each woman completed the Holm and Cordoba UTI score (HCUTI), measuring the severity and bothersomeness of the dimensions: dysuria, frequency, lower back, and general symptoms. The exposure was menopausal status. Differences in the various HCUTI dimensions between the menopause groups were investigated in linear regression models, adjusting for potential confounders. Premenopausal women had a significantly higher severity score for the item “feeling unwell” than postmenopausal women (mean difference −0.59, 95% CI −0.88 to −0.31). They also had a significantly higher bothersomeness score for the items “pain on urination” (mean difference −0.54, 95% CI −0.83 to −0.25), “feeling unwell” (mean difference −0.62, 95% CI −0.92 to −0.32), and for the dimension “dysuria” (mean difference −0.38, 95% CI −0.61 to −0.15) than postmenopausal women. This study found differences in some aspects of symptom severity and bothersomeness between pre- and postmenopausal women presenting in general practice with suspected UTIs. Menopausal status should be taken into account when using symptoms to diagnose and evaluate response to UTI treatment in both clinical practice and research. Full article

(This article belongs to the Special Issue Optimization of Antimicrobial Stewardship in Public Health)

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16 pages, 1047 KiB

Open AccessArticle

Antibiotic Consumption in a Cohort of Hospitalized Adults with Viral Respiratory Tract Infection

by Sara Debes, Jon Birger Haug, Birgitte Freiesleben De Blasio, Jonas Christoffer Lindstrøm, Christine Monceyron Jonassen and Susanne Gjeruldsen Dudman

Antibiotics 2023, 12(4), 788; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12040788 - 20 Apr 2023

Viewed by 1646

Abstract

Development of antibiotic resistance, a threat to global health, is driven by inappropriate antibiotic usage. Respiratory tract infections (RTIs) are frequently treated empirically with antibiotics, despite the fact that a majority of the infections are caused by viruses. The purpose of this study [...] Read more.

Development of antibiotic resistance, a threat to global health, is driven by inappropriate antibiotic usage. Respiratory tract infections (RTIs) are frequently treated empirically with antibiotics, despite the fact that a majority of the infections are caused by viruses. The purpose of this study was to determine the prevalence of antibiotic treatment in hospitalized adults with viral RTIs, and to investigate factors influencing the antibiotic decision-making. We conducted a retrospective observational study of patients ≥ 18 years, hospitalized in 2015–2018 with viral RTIs. Microbiological data were taken from the laboratory information system and information on antibiotic treatment drawn from the hospital records. To investigate decisions for prescribing antibiotic treatment, we evaluated relevant factors such as laboratory and radiological results, in addition to clinical signs. In 951 cases without secondary bacterial RTIs (median age 73 years, 53% female), 720 (76%) were prescribed antibiotic treatment, most frequently beta-lactamase-sensitive penicillins, but cephalosporins were prescribed as first-line in 16% of the cases. The median length of treatment (LOT) in the patients treated with antibiotics was seven days. Patients treated with antibiotics had an average of two days longer hospital stay compared to patients with no such treatment, but no difference in mortality was found. Our study revealed that there is still a role for antimicrobial stewardship to further improve antibiotic use in patients admitted for viral RTIs in a country with relatively low antibiotic consumption. Full article

(This article belongs to the Special Issue Optimization of Antimicrobial Stewardship in Public Health)

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12 pages, 281 KiB

Open AccessArticle

Factors Influencing Inappropriate Use of Antibiotics in Infants under 3 Years of Age in Primary Care: A Qualitative Study of the Paediatricians’ Perceptions

by José Arnau-Sánchez, Casimiro Jiménez-Guillén, Manuel Alcaraz-Quiñonero, Juan José Vigueras-Abellán, Beatriz Garnica-Martínez, Juan Francisco Soriano-Ibarra and Gema Martín-Ayala

Antibiotics 2023, 12(4), 727; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12040727 - 07 Apr 2023

Cited by 2 | Viewed by 1531

Abstract

Antibiotic consumption in infants of less than three years is higher than average the average consumption for general population. The aim of this study was to explore paediatricians’ opinions regarding factors influencing inappropriate use of antibiotics in early infancy in primary care. A [...] Read more.

Antibiotic consumption in infants of less than three years is higher than average the average consumption for general population. The aim of this study was to explore paediatricians’ opinions regarding factors influencing inappropriate use of antibiotics in early infancy in primary care. A qualitative study based on the grounded theory using convenience sampling was conducted in Murcia Region, Spain. Three focal discussion groups were developed with 25 participants from 9 health areas (HA) of Murcia Region. Paediatricians perceived that health care pressure was an influential factor in the prescribing behaviour, forcing them to prescribe antibiotics for a rapid cure in unjustified circumstances. Participants believed that antibiotic consuming was related to parents’ self-medication due to their perceptions about the curative potential of antibiotics together with facilities to obtain these agents from pharmacies without prescription. The misuse of antibiotics by paediatricians was associated to the lack of education on antibiotic prescription and the limited use of clinical guidelines. Not prescribing an antibiotic in the presence of a potentially severe disease generated more fear than an unnecessary prescription. The clinical interaction asymmetry was more evident, when paediatricians use trapping risk strategies as a mechanism to justify a restrictive prescribing behaviour. The rational model of clinical decision-making in antibiotic prescribing among paediatricians was determined by factors associated with health care management, social awareness and knowledge of the population and pressure of families’ demands. The present findings have contributed to the design and implementation of health interventions in the community for improving awareness of the appropriate use of antibiotics, as well as for a better quality of prescription by peadiatricians. Full article

(This article belongs to the Special Issue Optimization of Antimicrobial Stewardship in Public Health)

17 pages, 1139 KiB

Open AccessArticle

Studying Factors Affecting Success of Antimicrobial Resistance Interventions through the Lens of Experience: A Thematic Analysis

by Tiscar Graells, Irene A. Lambraki, Melanie Cousins, Anaïs Léger, Kate Lillepold, Patrik J. G. Henriksson, Max Troell, Carolee A. Carson, Elizabeth Jane Parmley, Shannon E. Majowicz, Didier Wernli and Peter Søgaard Jørgensen

Antibiotics 2022, 11(5), 639; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11050639 - 10 May 2022

Cited by 6 | Viewed by 2919

Abstract

Antimicrobial resistance (AMR) affects the environment, and animal and human health. Institutions worldwide have applied various measures, some of which have reduced antimicrobial use and AMR. However, little is known about factors influencing the success of AMR interventions. To address this gap, we [...] Read more.

Antimicrobial resistance (AMR) affects the environment, and animal and human health. Institutions worldwide have applied various measures, some of which have reduced antimicrobial use and AMR. However, little is known about factors influencing the success of AMR interventions. To address this gap, we engaged health professionals, designers, and implementers of AMR interventions in an exploratory study to learn about their experience and factors that challenged or facilitated interventions and the context in which interventions were implemented. Based on participant input, our thematic analysis identified behaviour; institutional governance and management; and sharing and enhancing information as key factors influencing success. Important sub-themes included: correct behaviour reinforcement, financial resources, training, assessment, and awareness of AMR. Overall, interventions were located in high-income countries, the human sector, and were publicly funded and implemented. In these contexts, behaviour patterns strongly influenced success, yet are often underrated or overlooked when designing AMR interventions. Improving our understanding of what contributes to successful interventions would allow for better designs of policies that are tailored to specific contexts. Exploratory approaches can provide encouraging results in complex challenges, as made evident in our study. Remaining challenges include more engagement in this type of study by professionals and characterisation of themes that influence intervention outcomes by context. Full article

(This article belongs to the Special Issue Optimization of Antimicrobial Stewardship in Public Health)

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Review

Jump to: Research, Other

17 pages, 1924 KiB

Open AccessReview

Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

by Maria Ludovica Costanzo, Vito D’Andrea, Augusto Lauro and Maria Irene Bellini

Antibiotics 2023, 12(3), 482; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12030482 - 28 Feb 2023

Cited by 4 | Viewed by 4502

Abstract

Biliary lithiasis is a global disorder affecting nearly 20% of the world’s population, although most cases occur without symptoms. Gallbladder stones could move into the common bile duct after gallbladder contraction, causing acute cholecystitis. The progression of the acute disease can take different [...] Read more.

Biliary lithiasis is a global disorder affecting nearly 20% of the world’s population, although most cases occur without symptoms. Gallbladder stones could move into the common bile duct after gallbladder contraction, causing acute cholecystitis. The progression of the acute disease can take different forms, from mild inflammation, treatable with oral antibiotics, to the most severe forms with septic shock or biliary peritonitis, requiring specific treatment. Liver function tests and abdominal ultrasound are generally sufficient for diagnostic purposes. The most commonly used antibiotic is penicillin, with piperacillin achieving the best results; alternatively, fluoroquinolones could also be used, although there is no univocal consensus and surgery remains the only definitive treatment. A prolonged antibiotic therapy after cholecystectomy seems inadvisable, except in severe cases and/or in the immuno-compromised patient, where it should be periodically evaluated to avoid antibiotic resistance and unnecessary use. This review presents an evidence-based analysis to describe the advantages and disadvantages of the available options for the treatment of biliary lithiasis and cholecystitis, from the pathophysiological mechanisms behind lithiasis formation and also covering the main diagnostic findings for biliary stones, recommending an approach tailored to the patient’s characteristics and to the team’s expertise. Full article

(This article belongs to the Special Issue Optimization of Antimicrobial Stewardship in Public Health)

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31 pages, 9539 KiB

Open AccessReview

An Overview of Antimicrobial Stewardship Optimization: The Use of Antibiotics in Humans and Animals to Prevent Resistance

by Md. Mominur Rahman, Mst. Afroza Alam Tumpa, Mehrukh Zehravi, Md. Taslim Sarker, Md. Yamin, Md. Rezaul Islam, Md. Harun-Or-Rashid, Muniruddin Ahmed, Sarker Ramproshad, Banani Mondal, Abhijit Dey, Fouad Damiri, Mohammed Berrada, Md. Habibur Rahman and Simona Cavalu

Antibiotics 2022, 11(5), 667; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11050667 - 16 May 2022

Cited by 32 | Viewed by 7917

Abstract

Antimicrobials are a type of agent widely used to prevent various microbial infections in humans and animals. Antimicrobial resistance is a major cause of clinical antimicrobial therapy failure, and it has become a major public health concern around the world. Increasing the development [...] Read more.

Antimicrobials are a type of agent widely used to prevent various microbial infections in humans and animals. Antimicrobial resistance is a major cause of clinical antimicrobial therapy failure, and it has become a major public health concern around the world. Increasing the development of multiple antimicrobials has become available for humans and animals with no appropriate guidance. As a result, inappropriate use of antimicrobials has significantly produced antimicrobial resistance. However, an increasing number of infections such as sepsis are untreatable due to this antimicrobial resistance. In either case, life-saving drugs are rendered ineffective in most cases. The actual causes of antimicrobial resistance are complex and versatile. A lack of adequate health services, unoptimized use of antimicrobials in humans and animals, poor water and sanitation systems, wide gaps in access and research and development in healthcare technologies, and environmental pollution have vital impacts on antimicrobial resistance. This current review will highlight the natural history and basics of the development of antimicrobials, the relationship between antimicrobial use in humans and antimicrobial use in animals, the simplistic pathways, and mechanisms of antimicrobial resistance, and how to control the spread of this resistance. Full article

(This article belongs to the Special Issue Optimization of Antimicrobial Stewardship in Public Health)

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Other

Jump to: Research, Review

15 pages, 2493 KiB

Open AccessSystematic Review

The Role of Antibiotic Prophylaxis in Anastomotic Leak Prevention during Elective Colorectal Surgery: Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Lidia Castagneto-Gissey, Maria Francesca Russo, James Casella-Mariolo, Angelo Serao, Rosa Marcellinaro, Vito D’Andrea, Massimo Carlini and Giovanni Casella

Antibiotics 2023, 12(2), 397; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12020397 - 16 Feb 2023

Cited by 4 | Viewed by 1861

Abstract

Introduction: Despite several perioperative care advancements and innovations in surgical procedures and technologies, the incidence rate of anastomotic leaks (ALs) after colorectal surgery has not substantially decreased. Gut microbiota can play a critical role in the healing process of anastomotic tissue and [...] Read more.

Introduction: Despite several perioperative care advancements and innovations in surgical procedures and technologies, the incidence rate of anastomotic leaks (ALs) after colorectal surgery has not substantially decreased. Gut microbiota can play a critical role in the healing process of anastomotic tissue and alterations in its composition may be largely to blame for anastomotic insufficiency. The use of specific antibiotics for preoperative large bowel decontamination could significantly influence the rate of ALs. The aim of this study was to systematically assess the various antibiotic prophylactic regimen strategies for primary prevention of ALs during colorectal surgery, in view of the available evidence. Methods: A systematic review of the literature was conducted, and randomized clinical trials (RCTs) analyzing prophylactic antibiotic bowel preparation in colorectal surgery were included. PubMed, Embase, the Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials were searched from inception through to 30 November 2022. The methodological quality of the included trials was evaluated. The primary outcome was AL rate; secondary outcomes were superficial/deep surgical site infections (SSIs). The PRISMA guidelines were used to carry out the present systematic review. Results: Thirteen RCTs published between 1977 and 2022, with a total of 4334 patients were included in the meta-analysis. Antibiotic prophylaxis was administered orally in 11/13 studies and intravenously in 2 studies. Patients randomly assigned to antibiotic prophylaxis, regardless of the regimen, had a reduced risk of ALs (p = 0.003) compared to mechanical bowel preparation (MBP) alone. The use of antibiotic prophylaxis was also more effective in significantly reducing SSIs (p < 0.001). Conclusions: The evidence points to an advantage of oral antibiotic prophylaxis in terms of AL rate, a significant contributor to perioperative morbidity, mortality, and rising healthcare expenditures. In light of such results, the use of antibiotic prophylaxis should be strongly encouraged prior to colorectal surgery. Full article

(This article belongs to the Special Issue Optimization of Antimicrobial Stewardship in Public Health)

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7 pages, 527 KiB

Open AccessPerspective

Tailoring Antimicrobial Stewardship (AMS) Interventions to the Cultural Context: An Investigation of AMS Programs Operating in Northern Italian Acute-Care Hospitals

by Costanza Vicentini, Valentina Blengini, Giulia Libero, Manuela Martella and Carla Maria Zotti

Antibiotics 2022, 11(9), 1257; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11091257 - 16 Sep 2022

Cited by 1 | Viewed by 1343

Abstract

Antibiotic misuse and overuse are important contributors to the development of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programs are coordinated sets of actions aiming to promote appropriate antibiotic use, improving patient outcomes whilst reducing AMR. Two main organizational models for AMS programs have [...] Read more.

Antibiotic misuse and overuse are important contributors to the development of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programs are coordinated sets of actions aiming to promote appropriate antibiotic use, improving patient outcomes whilst reducing AMR. Two main organizational models for AMS programs have been described: restrictive strategies (RS) vs. enabling strategies (ES). Evaluating and understanding social and cultural influences on antibiotic decision-making are critical for the development of successful and sustainable context-specific AMS programs. Characteristics and surrogate outcomes of AMS programs operating in acute-care hospitals of Piedmont in north-western Italy were investigated. The aim of this study was assessing whether RS vs. ES operating in our context were associated with different outcomes in terms of total antimicrobial usage and percentage of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) over invasive isolates. In total, 24 AMS programs were assessed. ES were more frequently chosen compared to RS, with the latter being implemented only in broader AMS programs involving enabling components (combined strategy, CS). This study found no difference in evaluated outcomes among hospitals implementing ES vs. CS, suggesting both approaches could be equally valid in our context. Full article

(This article belongs to the Special Issue Optimization of Antimicrobial Stewardship in Public Health)

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