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PurposeThis study aims to focus on the preparation and characterization of the silver nanowire (AgNWs), as well as their application as antimicrobial and antivirus activities either with incorporation on the waterborne coating formulation or on their own.Design/methodology/approachPrepared AgNWs are characterized by different analytical instruments, such as ultraviolet-visible spectroscope, scanning electron microscope and X-ray diffraction spectrometer. All the paint formulation's physical and mechanical qualities were tested using American Society for Testing and Materials, a worldwide standard test procedure. The biological activities of the prepared AgNWs and the waterborne coating based on AgNWs were investigated. And, their effects on pathogenic bacteria, antioxidants, antiviral activity and cytotoxicity were also investigated.FindingsThe obtained results of the physical and mechanical characteristics of the paint formulation demonstrated the formulations' greatest performance, as well as giving good scrub resistance and film durability. In the antimicrobial activity, the paint did not have any activity against bacterial pathogen, whereas the AgNWs and AgNWs with paint have similar activity against bacterial pathogen with inhibition zone range from 10 to 14 mm. The development of antioxidant and cytotoxicity activity of the paint incorporated with AgNWs were also observed. The cytopathic effects of herpes simplex virus type 1 (HSV-1) were reduced in all three investigated modes of action when compared to the positive control group (HSV-1-infected cells), suggesting that these compounds have promising antiviral activity against a wide range of viruses, including DNA and RNA viruses.Originality/valueThe new waterborne coating based on nanoparticles has the potential to be promising in the manufacturing and development of paints, allowing them to function to prevent the spread of microbial infection, which is exactly what the world requires at this time.
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[...]on 25 Nov. 2020, the European Commission (EC) announced the new Pharmaceutical Strategy for Europe, which is likely to result in significant changes to the European Union (EU) regulatory framework and will have a substantial impact on both the marketing of medicinal products and the strategic business planning of pharmaceutical companies (2). (2021), the priority areas are as follows: * The performance and adequacy of the current legislation * Unmet medical needs-with a definition or set of principles for "unmet medical needs" under discussion * Incentives for innovation, including the area of unmet needs and a reflexion on regulatory data and market exclusivity * Antimicrobial resistance that includes measures to support innovation of antibiotic development * Future-proofing the regulatory framework for novel products * Improved patient access to, and affordability of, medicines in the EU * Competitiveness of the European markets to ensure affordable medicines, including considering measures to support patients' access to affordable medicines * Encouraging the repurposing of off patent medicines * Ensuring security of supply of medicinal products in the EU * Ensuring high-quality manufacture and distribution in the EU including consideration of the need to strengthen or adapt good manufacturing practice (GMP) to reflect new manufacturing methodologies * Environmental challenges (4). Availability, accessibility, and affordability of medicinal products The section on 'Prioritising unmet medical needs' in the strategy reflects the belief within EU Bianca Piachaud-Moustakis is lead writer at PharmaVision, Pharmavision.co.uk. institutions that "current incentive models neither provide an adequate solution for unmet medical needs nor appropriately incentivise investments in innovation" (2).
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Kefir is a fermented milk beverage different in consistency and taste from other popular milk-product yogurt. Unlike yogurt prepared using lactic acid bacteria in fermentation, milk is fermented for kefir production using preculture in the form of kefir grains. Therefore, the metabolic activities of a mixed culture, including strains of bacteria and yeast, contribute to the probiotic characteristics in kefir. This article is based on the review of published studies on the functionality and nutraceutical properties of kefir. The therapeutic and dietary properties of kefir beverage and its probiotic strains have been discussed for their several health benefits. Concise selected information mostly from recent reports has been presented for two categories of kefir products: milk used for the production of dairy-based traditional kefir beverages for the lactose-tolerant population, and the plant-sourced substrates used for the production of dairy-free kefir beverages for lactose-intolerant and vegan consumers.
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The present study aims to provide deeper knowledge about the structural, vibrational, chemical, antimicrobial activity, molecular dynamic simulation and drug likeness of synthesized compound 4-Methoxy-N-(nitrobenzylidene)-aniline. The FT-IR and FT-Raman spectra of 4-Methoxy-N-(nitrobenzylidene)-aniline have been recorded in the powder form in the region 4000–500 cm−1 and 3500–50 cm−1. The vibrational analysis were carried out with the help of normal coordinate analysis (NCA). The molecular geometry, hydrogen bonding interaction and vibrational frequencies have been calculated using the density functional method (DFT/B3LYP) with 6-311 G (D) basis set. The natural bond orbital (NBO), atoms in molecule (AIM), and Hirshfeld surface analysis and RDG were applied to evaluate the relative strength of hydrogen bond interactions and represent their effect on the stabilities of molecular arrangements. Related molecules were compared by computation in order to understand the effect of non-bonded interactions (i.e. intermolecular and intramolecular hydrogen bonding). The HOMO and LUMO analysis was used to determine the charge transfer within the molecule. Furthermore, the in vitro antimicrobial study was carried out for the title compound against Aspergillus niger and Staphylococcus aureus. The antimicrobial activity was confirmed on the compounds with molecular docking (A.niger, S.aureus, Homosapians, Sars-Cov-19 and anticancer) studies and molecular dynamic simulation. The non-linear optical (NLO) properties were also analyzed for the molecules.
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James Price, Senior Lecturer and Honorary Consultant in Infection, Brighton and Sussex Medical School, University of Sussex, UK Broad infection prevention and control (IPC) measures are routinely employed to prevent surgical site infections (SSIs),1 including screening for (and subsequent suppression of) key pathogens and surgical antimicrobial prophylaxis. Prediction There is growing literature on the application of mathematical modelling to routinely collected healthcare data in order to accurately predict an individual's: (i) risk of carrying or acquiring key pathogens;(ii) future need for surgery;and (iii) likelihood of developing a healthcare associated infection. [...]with large proportions of the population yet to receive routine vaccinations, incorporation of assessment and vaccine delivery within secondary care pathways has the potential to support post-discharge outcomes and to optimise preparation of future hospital admissions and procedures.
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4CPS-018 Table 1MARCH-JUNE 2020 MAY-AUGUST 2021 EVOLUTION 2020-2021 CICU CMW GLOBAL CICU CMW GLOBAL CICU CMW GLOBAL BED-DAYS 573 2346 2919 493 2114 2607 Co-amoxiclav DDD/100BED-DAYS 0,9 22 17,9 1,2 21,1 17,3 +0,3 (33,3%) -0,9 (-4%) -0,6 (-3,4%) 3rd generation cephalosporins DDD/100BED-DAYS 32,3 8,9 13,5 35,7 3,5 9,6 +3,4 (10,5%) -5,4 (-60%) -3,9 (-28,9%) Antipseudomonal antibiotics DDD/100BED-DAYS 16,1 9,1 10,5 27,8 5,9 10 +11,7 (72,7%) -3.2 (-35.1%) -0,5 (-4,%) Quinolones DDD/100BED-DAYS 2,3 3,6 3,4 10,8 1,4 3,2 +8,5 (370%) -2,2 (-61,1%) -0,2 (-5,9%) Anti-MRSA antibiotics DDD/100BED-DAYS 23,4 3,4 7,3 18,6 2 5,1 -4,8 (-20,5%) -1,4 (-41,2%) -2,2 (-30,1%) Antifungal treatments DDD/100BED-DAYS 4,4 1 1,6 22,9 0 4,4 +18,5 (420%) -4,4 (-100%) +2,8 (175%) Total antimicrobial consumption DDD/100BED-DAYS 135,1 62,6 76,8 187,3 43,7 70,8 +52,2 (38,6%) -18,9 (-30,2%) -6 (-7,8%) The antibiotic use in the two periods showed a significance correlation (p<0,001).Conclusion and RelevanceThere is a light decrease of antimicrobial prescriptions in all COVID-19 patients.There is an important decrease in antimicrobial use in CMW and a considerable increase in CICU.These results suggest the need for more antimicrobial stewardship programmes in CICUReferences and/or AcknowledgementsConflict of InterestNo conflict of interest
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Two tetranuclear [Zn4Cl2(ClQ)6]·2DMF (1) and [Zn4Cl2(ClQ)6(H2O)2]·4DMF (2), as well as three dinuclear [Zn2(ClQ)3(HClQ)3]I3 (3), [Zn2(dClQ)2(H2O)6(SO4)] (4) and [Zn2(dBrQ)2(H2O)6(SO4)] (5), complexes (HClQ = 5-chloro-8-hydroxyquinoline, HdClQ = 5,7-dichloro-8-hydroxyquinoline and HdBrQ = 5,7-dibromo-8-hydroxyquinoline) were prepared as possible anticancer or antimicrobial agents and characterized by IR spectroscopy, elemental analysis and single crystal X-ray structure analysis. The stability of the complexes in solution was verified by NMR spectroscopy. Antiproliferative activity and selectivity of the prepared complexes were studied using in vitro MTT assay against the HeLa, A549, MCF-7, MDA-MB-231, HCT116 and Caco-2 cancer cell lines and on the Cos-7 non-cancerous cell line. The most sensitive to the tested complexes was Caco-2 cell line. Among the tested complexes, complex 3 showed the highest cytotoxicity against all cell lines. Unfortunately, all complexes showed only poor selectivity to normal cells, except for complex 5, which showed a certain level of selectivity. Antibacterial potential was observed for complex 5 only. Moreover, the DNA/BSA binding potential of complexes 1–3 was investigated by UV-vis and fluorescence spectroscopic methods.
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Objectives: The bacteria in the ‘ESKAPE' group are monitored due to their ability to resist antibiotic action. During the COVID-19 pandemic at our hospital, the usage of meropenem and levofloxacin as the empirical treatment for bacterial pneumonia increased and might have contributed to the antimicrobial resistance problem. In this study, we evaluated the ESKAPE group infection rates and their susceptibility to antibiotics in Dr. Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia. Methods: Data for ESKAPE pathogens in 2019–2021 were taken from the microbiology laboratory of Dr. Sardjito Hospital and were evaluated. Results: The proportion of ESKAPE isolates among positive cultures during 2019–2021 slightly increased from 49.4% to 48.4% to 50.7% each year (P > .05). The dominant ESKAPE infections were pneumonia, bloodstream infection, and urinary tract infection by K. pneumoniae, and wound infection by P. aeruginosa. The susceptibility pattern of ESKAPE to meropenem decreased from 72% in 2019 to 68% in 2020 but increased to 84% in 2021. To levofloxacin, the susceptibility pattern was decreased in a fluctuating trend from 68% in 2019 to 33% in 2020 and to 39% in 2021. During the COVID-19 pandemic (2020–2021), the pattern of ESKAPE infections was similar to that of 2019. In descending order, the frequency rank was K. pneumoniae, P. aeruginosa, A. baumannii, Enterobacter spp, and S. aureus. The proportions of MDR isolates increased from the prepandemic period to the COVID-19 pandemic era for E. faecium (from 5% to 24.4%), for A. baumannii (from 9.6% to 38.5%), and for P. aeruginosa (from 7.4% to 13.5%) (P < .05). These patterns did not differ between non–COVID-19 patients and COVID-19 patients. These results highlight the general impact of overused antibiotics beyond COVID-19 patients. Usage of watched and restricted antibiotics must be more controlled because bacterial coinfection and superinfection in COVID-19 patients was relatively low. Conclusions: During the COVID-19 pandemic, ESKAPE infections increased and their susceptibility to meropenem and levofloxacin decreased. Tight control of antibiotic usage is needed.
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Objectives: Over the past 2 years, many infection prevention and control (IPC) resources have been diverted to manage the COVID-19 pandemic. Its impact on the incidence of antimicrobial-resistant organisms has not been adequately studied. We investigated the impact of the pandemic on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore. Methods: We extracted data on unique CRE isolates (clinical and/or surveillance cultures) and patient days for 6 public hospitals in Singapore from the carbapenemase-producing Enterobacteriaceae (CaPES) study group database, and we calculated the monthly incidence of CRE (per 10,000 patient days). Interrupted time-series (ITS) analysis was conducted with the pre–COVID-19 period defined as before February 2020, and the COVID-19 period defined as after February 2020. Statistical analyses were performed using Stata version 15 software. Results: From January 2017 to March 2021, 6,770 CRE isolates and 9,126,704 patient days were documented. The trend in CRE monthly incidence increased significantly during the pre–COVID-19 period (0.060;95% CI, 0.033–0.094;P < .001) but decreased during the COVID-19 period (−0.183;95% CI, −0.390 to 0.023;P = .080) without stepwise change in the incidence (−1.496;95% CI, −3.477 to 0.485;P = .135). The trend in monthly incidence rate of CRE clinical cultures increased significantly during the pre–COVID-19 period (0.046;95% CI, 0.028–0.064;P < .001) and decreased significantly during COVID-19 period (−0.148;95% CI, −0.249 to −0.048;P = .048) with no stepwise change in the incidence (−0.063;95% CI, −0.803 to 0.677;P = .864). The trend in monthly incidence rate of CRE surveillance cultures decreased during the pre–COVID-19 period (−0.020;95% CI, −0.062 to 0.022;P = .341) and the COVID-19 period (−0.067;95% CI, −0.291to 0.158;P = .552) without stepwise change in the incidence (−1.327;95% CI, −3.535 to 0.881;P = .233). Conclusions: The rate of CRE in clinical cultures decreased during COVID-19 but not the rate in surveillance cultures. Further studies are warranted to study the impact of COVID-19 on CREs.(DUPLICATE DELETED)
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Moving to 133 years of the synthesis of citrate-stabilized silver nanoparticles (AgNPs) by M. C. Lea (published in Am. J. Sci, 1889), a myriad of scholarly works and patents were published globally demonstrating the applicability of this microbial-killing nanoparticles in various industries. One of the favorite applications is on the food supply chain whereby AgNPs serve to improve food safety and quality. In this paper, the adaptation of AgNPs in each phase of a typical food supply chain is disclosed, doubts associated with the potential risks brought by this technology, and what a consumer shall be aware of are highlighted.
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Viruses lacking the capacity to infect mammals exhibit minimal toxicity, good biocompatibility, and well-defined structures. As self-organized biomolecular assemblies, they can be produced from standard biological techniques on a large scale at a low cost. Genetic, chemical, self-assembly, and mineralization techniques have been applied to allow them to display functional peptides or proteins, encapsulate therapeutic drugs and genes, assemble with other materials, and be conjugated with bioactive molecules, enabling them to bear different biochemical properties. So far, a variety of viruses (infecting bacteria, plants, or animals), as well as their particle variants, have been used as biomaterials to advance human disease prevention, diagnosis, and treatment. Specifically, the virus-based biomaterials can serve as multifunctional nanocarriers for targeted therapy, antimicrobial agents for infectious disease treatment, hierarchically structured scaffolds for guiding cellular differentiation and promoting tissue regeneration, versatile platforms for ultrasensitive disease detection, tissue-targeting probes for precision bioimaging, and effective vaccines and immunotherapeutic agents for tackling challenging diseases. This review provides an in-depth discussion of these exciting applications. It also gives an overview of the viruses from materials science perspectives and attempts to correlate the structures, properties, processing, and performance of virus-based biomaterials. It describes the use of virus-based biomaterials for preventing and treating COVID-19 and discusses the challenges and future directions of virus-based biomaterials research. It summarizes the progressive clinical trials of using viruses in humans. With the impressive progress made in the exciting field of virus-based biomaterials, it is clear that viruses are playing key roles in advancing important areas in biomedicine such as early detection and prevention, drug delivery, infectious disease treatment, cancer therapy, nanomedicine, and regenerative medicine. © 2023 Elsevier B.V.
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Objectives: Public health emergencies caused by airborne infectious agents are a significant concern, re-emphasized by the current COVID-19 pandemic. It is therefore vital to employ a technology that destroys microbes of all phyla and genera. We describe a novel technology called "Zebox” that can extract, trap, and destroy microbes from the air. This technology destroys even microbes that are resistant to known antibiotics. Methods: Airborne microbial load was enumerated using standard microbiological methods in both hospital ICUs and controlled conditions. Significant microbial reductions due to the ZeBox intervention in the ICUs were confirmed by statistical analysis. Results: ZeBox eliminated a broad spectrum of airborne pathogens (ie, viruses, bacteria, and fungi) in laboratory tests and in hospital ICUs, which are characterized by high, stochastic microbial loads. In closed-chamber experiments, ZeBox achieved a >99.999% reduction of airborne microbes. In the hospital ICU, ZeBox achieved a consistent >90% reduction across several months. Some of the airborne pathogens that ZeBox eliminated in the hospital ICU were multidrug resistant. Conclusions: ZeBox is an effective preventive technology against the spread of airborne pathogens and potentially associated infections. ZeBox could be used to reduce healthcare-associated infections in clinics and hospitals, as well as in burns units and immunocompromised patients. Zebox has the potential to be a significant prophylactic device in the global war on antimicrobial resistance.
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The Covid-19 pandemic has sparked global fretfulness. The concern is that the virus is spreading too far, too fast and medical scientists can't seem to find a way to contain it. Juan Dumois, a pediatric infectious-diseases physician at Johns Hopkins All Children's Hospital in St. Petersburg, Florida reported that "coronavirus in general will last a lot longer on a solid, nonporous surface compared to porous fabrics". He also suggested they would survive for longer on artificial fibres such as polyester rather than cotton, which is one of the mediums for spreading infection. In concurrence with an increasing public awareness of infectious diseases, the textile industry, including Sarex, would like to re-introduce two of its effective antimicrobial agents which are effective against a broad spectrum of microbes, pathogens and viruses. In this study, Sarex have treated various textile substrates - cotton, polyester and polyamide fabrics - with these anti-microbial agents and have tested them for durability using the AATCC100 test method. The results are very encouraging and can help in controlling the spread of the infections, thus contributing to the well-being of humankind. © 2020 World Textile Information Network. All rights reserved.
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Background: The susceptibility to SARS-CoV-2 infection is complex and not yet fully elucidated, being related to many variables; these include human microbiome and immune status, which are both affected for a long period by antibiotic use. We therefore aimed to examine the association of previous antibiotic consumption and SARS-CoV-2 infection in a large-scale population-based study with control of known confounders. Methods: A matched case-control study was performed utilizing the electronic medical records of a large Health Maintenance Organization. Cases were subjects with confirmed SARS-CoV-2 infection (n = 31,260), matched individually (1:4 ratio) to controls without a positive SARS-CoV-2 test (n = 125,039). The possible association between previous antibiotic use and SARS-CoV-2 infection was determined by comparing antibiotic consumption in the previous 6 and 12 months between the cases and controls. For each antibiotic consumed we calculated the odds ratio (OR) for documented SARS-CoV-2 infection, 95% confidence interval (CI), and p-value using univariate and multivariate analyses. Results: The association between previous antibiotic consumption and SARS-CoV-2 infection was complex and bi-directional. In the multivariate analysis, phenoxymethylpenicillin was associated with increased rate of SARS-CoV-2 infection (OR 1.110, 95% CI: 1.036-1.191) while decreased rates were associated with previous consumption of trimethoprim-sulfonamides (OR 0.783, 95% CI: 0.632-0.971) and azithromycin (OR 0.882, 95% CI: 0.829-0.938). Fluroquinolones were associated with decreased rates (OR 0.923, 95% CI: 0.861-0.989) only in the univariate analysis. Previous consumption of other antibiotics had no significant association with SARS-CoV-2 infection. Conclusions: Previous consumption of certain antibiotic agents has an independent significant association with increased or decreased rates of SARS-CoV-2 infection. Plausible mechanisms, that should be further elucidated, are mainly antibiotic effects on the human microbiome and immune modulation.
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As a common antioxidant and antimicrobial agent in plants, luteolin has a variety of pharmacological activities and biological effects, the ability to specifically bind proteins and thus inhibit novel coronaviruses and treat asthma. Here, Co doped nitrogen-containing carbon frameworks/MoS2−MWCNTs (Co@NCF/MoS2−MWCNTs) nanocomposites have been synthesized and successfully applied to electrochemical sensors. X-ray photoelectron spectroscopy, scanning electron microscopy and X-ray diffraction were used to examine the morphology and structure of the samples. Meanwhile, the electrochemical behavior of Co@NCF/MoS2−MWCNTs was investigated. Due to its excellent electrical conductivity, electrocatalytic activity and adsorption, it is used for the detection of luteolin. The Co@NCF/MoS2−MWCNTs/GCE sensor can detect luteolin in a linear range from 0.1 nM to 1.3 μM with a limit of detection of 0.071 nM. Satisfactory results were obtained for the detection of luteolin in natural samples. In addition, the redox mechanism and electrochemical reaction sites of luteolin were investigated by the scan rate of CV curves and density functional theory. This work demonstrates for the first time the combination of ZIF-67-derived Co@NCF and MoS2−MWCNTs as electrochemical sensors for the detection of luteolin, which opens a new window for the sensitive detection of luteolin. © 2022 Elsevier Ltd
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Cationic surfactants have gained significant interest since their introduction. Their properties and adsorption behavior onto different surfaces have driven the development of a plethora of surfactants with distinctive functionalities. This paper reviews self-assembly, intermolecular interactions, and the properties of cationic surfactants also when interacting with co-solutes, which may be small molecules or macromolecules, and surfaces. The versatile properties of single- and double-chain cationic surfactants and other special cationics such as gemini, catanionic, bolaform, amino acid- and sugar-based surfactants, are presented and discussed together with skin toxicity and environmental considerations. The effects of cationic surfactant mixing with other surfactants, polymers, proteins, and DNA are also shown and examined. We also outline established applications of cationic surfactants as disinfectants, in fabric softening, hard surface cleaning, personal care applications, road surfacing, and oil field applications, as well as emerging applications such as soft antimicrobial agents and nucleic acid delivery, which has contributed, for instance, to the enormously successful surfactant-based mRNA COVID-19 vaccines. © 2023 Elsevier B.V.
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During current COVID-19 crises, the antimicrobial textiles primarily those utilized in hospital by doctors and paramedical staff have become increasingly important. Thus, there is an unmet requirement to develop antimicrobial textiles for infection control and hygiene practices. Metallic nanoparticles exhibit great effectiveness towards resistant microbial species making them a potential solution to the increasing antibiotic resistance. Due to this, nanoparticles particularly copper and silver have become most prevalent forms of antibacterial finishing agents for the development of antimicrobial textiles. This review is mainly focused on the significance of copper and silver nanoparticles for the development of antimicrobial textiles. The comparative analysis of the antibacterial effectiveness of copper and silver nanoparticles as well as the possible physical and chemical interactions responsible for their antibacterial action are explained. The negative impact of pathogenic microbes on textiles and possible interactions of antimicrobial agents with microbes have also been highlighted. The significance of nanotechnology for the development of antimicrobial textiles and their applications in medical textiles domain have also been discussed. Various green synthesis and chemical methods used for the synthesis of Ag and Cu nanoparticles and their application on textile substrates to impart antimicrobial functionality have also been discussed. The various qualitative and quantitative standard testing protocols utilised for the antimicrobial characterization of textiles have also discussed in this review. The developed Cu and Ag coated textiles could be effectively applied in the field of hospital textiles for the preparation of antibacterial scrub suits, surgical gowns, panel covers, protective clothing, bedding textiles, coveralls, wound dressings, table covers, curtains, and chair covers etc. © The Author(s) 2022.
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Background: The COVID-19 pandemic has made a significant impact on antimicrobial use patterns across health systems. We have described antibiotic use patterns at an academic medical center in Richmond, Virginia, before and after the onset of COVID-19. We also examined the impact on the proportional consumption of carbapenems (PoCC) metric. PoCC represents meropenem utilization relative to the narrower-spectrum antipseudomonal agents cefepime and piperacillin-tazobactam. Our institution practices antimicrobial restriction for meropenem. All other antibiotics included in the study data can be freely ordered by any provider. Methods: We evaluated antimicrobial use data from September 2018 through August 2021 using days of therapy (DOT) per 1,000 patient days. We included 18 months of data before and after the first recorded COVID-19 admission at our institution in March 2020. Mean comparisons were performed using the Welch 2-sample t test. The Bonferonni correction for multiple comparisons was utilized to determine significance with an initial baseline α of 0.05. All data analyses were performed using R software (R Foundation for Statistical Computing, Vienna, Austria, 2021). Results: Normality was evaluated with QQ-plots and all data demonstrated normality. Bonferroni correction produced an adjusted α value of 0.007. We detected significant increases in the use of cefepime, piperacillin-tazobactam, ceftriaxone, and azithromycin following the onset of the COVID-19 pandemic. We noted a significant decrease in the PoCC metric during this period. No significant change was noted for levofloxacin or meropenem. Conclusions: The COVID-19 pandemic produced significant changes in antimicrobial use patterns at our institution. We noted statistically significant increases in bacterial community-acquired pneumonia-focused antibiotics (ceftriaxone and azithromycin). We observed significant increases for cefepime and piperacillin-tazobactam. Interestingly, relative utilization of carbapenems as measured by the PoCC metric continued to decrease during this time. This trend was primarily driven by increases in cefepime and piperacillin-tazobactam utilization while meropenem utilization remained relatively constant. This study highlights the importance of looking at normalized antibiotic consumption data and not relative-use data alone.Funding: NoneDisclosures: None
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Background: Hospitalized patients with COVID-19 often receive antimicrobial therapies due to concerns for bacterial and fungal coinfections. We analyzed patients admitted with COVID-19 to our VA facility to understand antimicrobial use, frequency of coinfections, and outcomes in our population. Methods: This retrospective study included veterans who were 18 years or older and hospitalized with COVID-19 from March 10, 2020, to March 9, 2021 at the Louis Stokes VA Medical Center in Cleveland, Ohio. We identified antimicrobials administered and coinfections with bacterial or fungal pathogens. Patients were deemed to have coinfection if there was supporting microbiological data and a consistent clinical course upon review of clinical records. Urinary tract infections were excluded because of difficulty determining infection. Odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day mortality were derived using multivariate logistic regression models that included age, Charlson comorbidity index (CCI), corticosteroid use, and time of infection. Results: In our cohort of 312 patients, the median age was 70 years and 97% of the patients were male. The mean CCI was 3.7 (SD, 3.0), and 111 patients (35.6%) had a score ≥5. Oxygen was administered to 250 patients (80.1%), and 20 (6.4%) required mechanical ventilation. Antimicrobials were administered to 164 patients (52.6%) (Fig. 1). Of 20 patients (6.4%) with coinfection, 11 (3.5%) had a bloodstream infection (BSI) and 9 (2.9%) had bacterial pneumonia (Fig. 2). The overall 30-day mortality rate was 12.5% (39 of 312). Among patients with coinfection, the 30-day mortality rate was 45% (9 of 20). Diagnoses of BSI (OR, 6.35;95% CI, 1.41–26.30) and bacterial pneumonia (OR, 9.34;95% CI, 2.01–46.34) were associated with increased mortality. Of the data available, 12 (63%) of 19 patients with coinfection had elevated procalcitonin levels (ie, >0.50). At the time of COVID-19 diagnosis, the median absolute lymphocyte count in patients who died was 0.7 K/mm3 (95% CI, 0.6–1.12) in comparison to 1 K/mm3 (95% CI, 0.7–1.4) in patients who survived at 30 days. Conclusions: Our analysis of hospitalized COVID-19 patients with advanced age and underlying comorbid conditions demonstrated that coinfections were infrequent but that they were independently associated with increased mortality. This finding highlights the need for better tools to diagnose the presence or absence of bacterial and fungal coinfection in COVID-19 patients. Our findings also emphasize the need for judicious use of antimicrobials while discerning which patients are at risk of critical illness and mortality.Funding: NoneDisclosures: None