Antibiotics in Paediatrics: A Boon or a Bane?

Antibiotics play an essential role in antimicrobial therapy. Among all the medications in children, the most commonly prescribed therapy is antibiotics and is currently the indispensable means to cure transmissible diseases. Several categories of antibiotics have been introduced into clinical practice to treat microbial infections. Reducing the unnecessary use of antibiotics is a global need and priority. This article aims to provide better knowledge and understanding of the impact of the early use of antibiotics. This article highlights the proper use of antibiotics in chil-dren, detailing how early and inappropriate use of antibiotics affect the gut microbiome during normal body development and consequently affect the metabolism due to diabetes mellitus, obe-sity, and recurrence of infections, such as UTI. Several new antibiotics in their development stage, newly marketed antibiotics, and some recalled and withdrawn from the market are also briefly discussed in this article. This study will help future researchers in exploring the latest information about antibiotics used in paediatrics.Copyright © 2023 Bentham Science Publishers.

Molecular detection of plasmid-mediated quinolone resistance genes among clinical isolates of Klebsiella pneumoniae during Covid-19 pandemic

Plasmid-mediated quinolone resistance (PMQR) genes confer low resistance to Fluoroquinolones (FQs). This study aims to detect five PMQR genes among FQs-resistant Klebsiella pneumoniae isolated from various clinical specimens. Out of 120 K. pneumoniae isolates, 68 FQs-resistance K. pneumoniae were included in a molecular study. Standard microbiological tests were used for identification and antimicrobial susceptibility. For the detection of PMQR genes, conventional polymerase chain reaction was used. A molecular study revealed that (73.5%) of samples harbored PMQR genes, and among them, 58% were co-carriages of PMQR gene variants. Aac (6')-Ib-cr gene was predominant (47.1%) among samples, and qepA had the lowest percentage (11.8%), qnr genes were (32.4%) (29.4%) (20.6%) qnrS, qnrB, and qnrA respectively. Overall, high percentages of PMQR genes were detected, and almost all of samples were phenotypically resistant to ciprofloxacin. As well, there was a significant statistical relationship between phenotypically ESBL-producers and qnrB and qepA genes.Copyright © Abdulkareem MM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

COVID-19 in a patient with Good's syndrome and in 13 patients with common variable immunodeficiency

Antibody deficiencies constitute the majority of primary immunodeficiencies in adults. These patients have a well-established increased risk of bacterial infections but there is a lack of knowledge regarding the relative risks upon contracting COVID-19. In this monocentric study the disease course of COVID-19 in 1 patient with Good's syndrome and in 13 patients with common variable immunodeficiency (CVID) is described. The severity of disease ranged from very mild to severe. Several patients required hospitalization and immunomodulatory treatment but all survived. Although viral infections are not a typical feature of humoral immunodeficiencies we recommend that vigilance is increased in the management of patients with Good's syndrome and CVID during the COVID-19 pandemic.Copyright © 2021

Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015-2020.

Recurrent Clostridioides difficile infection (RCDI) causes an increased burden on the healthcare system. We calculated RCDI incidence and identified factors associated with RCDI cases in New Haven County, Connecticut, USA, during 2015-2020 by using data from population-based laboratory surveillance. A subset of C. difficile cases had complete chart reviews conducted for RCDI and potentially associated variables. RCDI was defined as a positive C. difficile specimen occurring 2-8 weeks after incident C. difficile infection. We compared cases with and without RCDI by using multiple regression. RCDI occurred in 12.0% of 4,301 chart-reviewed C. difficile cases, showing a U-shaped time trend with a sharp increase in 2020, mostly because of an increase in hospital-onset cases. Malignancy (odds ratio 1.51 [95% CI 1.11-2.07]) and antecedent nitrofurantoin use (odds ratio 2.37 [95% CI 1.23-4.58]) were medical risk factors for RCDI. The 2020 increase may reflect the impact of the COVID-19 pandemic.

Bladder HOTline: The Impact of COVID-19 and Telemedicine on Empiric Urinary Tract Infection Treatment in Women

INTRODUCTION: Urinary tract infection (UTI) is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic on UTI treatment are largely unknown. We evaluated the impact of COVID-19 and telemedicine on empiric UTI treatment in women, hypothesizing that increased telemedicine during the pandemic would increase empiric UTI treatment. METHODS: This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with and without hematuria during the first 6 months of the pandemic versus the preceding 6 months. Our primary outcome was empiric antibiotic treatment, defined by treatment based on clinical picture with/without pending urine testing. To reach 80% power, we included 222 patients. RESULTS: The average age of participants was 42. Fifty-two percent were White, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (P<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% pandemic (P=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (P<.0001). Nitrofurantoin or trimethoprim/sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The treatment adjustment rate was 17.1%. CONCLUSION: COVID-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine's impact on treatment of this common condition.

THE IMPACT OF COVID-19 AND TELEMEDICINE ON EMPIRIC UTI TREATMENT IN WOMEN

INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI), one of the most common reasons women seek acute care, is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic and telemedicine on UTI treatment are largely unknown. Here, we evaluated the impact of Covid-19 and telemedicine on empiric UTI treatment in women. We hypothesized that increased use of telemedicine during the pandemic would increase the rate of empiric UTI treatment. METHODS: This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with (N30.00) and without (N30.01) hematuria during the first 6 months of the pandemic (March 2020 - August 2020) versus the 6 months preceding the pandemic (September 2019 - February 2020). Our primary outcome was presence of empiric antibiotic treatment, defined by treatment based on clinical picture with or without pending urine testing. Secondary analysis included determining which antibiotics were most commonly prescribed and treatment adjustment. To reach 80% power to detect a 10% difference with p≤0.05, we included 222 patients. Exclusion criteria included inpatient encounter, long-term facility residence, urinary procedure in last 2 weeks, previous UTI treatment within 30 days. RESULTS: The average age of participants was 42 years. Fiftytwo percent were white, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (p<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% during the pandemic (p=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (p<.0001). Nitrofurantoin or trimethoprim/ sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The overall rate of treatment adjustment was 17.1%;there was no significant difference by time period. CONCLUSIONS: Covid-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine's impact on treatment of this common condition. (Table Presented).

A retroprospective study of an antimicrobial stewardship program on antimicrobial utilization at a tertiary care medical center in kolkata

The WHO has set Defined Daily Dose which represent the average daily dose of an antibiotic in a standard patient. The DDD mai nly focuses on population-based parameters & assumes that patients as well as hospitals are homogenous entities. DOTs are very useful in order to classify antibiotic days based on patient-level exposure. DOTs merely mean the number of days that a patient is on an antibiotic, irrespective of dose. DOTs signifies that the underlying assumptions about antibiotic dosing was appropriate. Additionally, when patients receive more than one antibiotic, supplementary DOT may be counted. The 300-bed tertiary care medical center serves adults and paediatrics. An all-time Microbiology Consultant and a Clinical Pharmacology trainee used to go for round daily and used to collect data for ASP for the period of 3 months that is April to June,2021. In this study we have compared DOT of some important antibiotics for a specific period of time for both COVID and NON COVID patient. ASP-focused antibiotics were antibiotics routinely evaluated by the ASP team for appropriateness during therapy and the potential to optimize their appropriate use through policies, protocols, formulary restrictions, or clinician education. ASP-focused antibiotics included meropenem, linezolid, pip-taz, poly b, colistin, teicoplanin. In this study we have compared the DDD for 2 specific period of time for better understanding the consumption of those antibiotics. In conclusion, following the initiation of an ASP, significant decreases in utilization, increases in cost savings occurred. In our study we have reduced the consumption and DDD of linezolid which is clinically significant. When it comes to DOTs;We have reduced the DOTs of piptaz and teicoplanin for covid patient And Reduced the DOTs of meropenem and teicoplanin for non-covid patient which is clinically and statistically significant.