Aetiology of Bacterial Infections and Antibiotic Resistance in Pediatric Patients from a Romanian Hospital
Lorena PăduraruAlexandru Daniel JurcăDana Carmen ZahaFlorica Ramona DorobanțuMădălin Alexandru HasanMihaela Simona Popoviciu
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The development of microorganism resistance to antibiotics is a topic of global interest and Romania is among the most vulnerable countries in terms of antimicrobial resistance. Our retrospective study was carried out for a year at the Emergency Clinical Hospital for Children "Saint John" in Galati, on a number of 9910 pathological samples. The main isolated strains were Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. A percent of 25.4 was methicillin-resistant StapKeywords:
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Antibiotic Stewardship
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Successful treatment of patients with nosocomial pneumonia depends primarily on providing adequate initial antibiotic treatment in a timely manner, because an inappropriate course is closely associated with increased mortality. Gram-negative bacteria are commonly responsible for nosocomial pneumonia, and the increasing prevalence of drug resistance among these bacteria complicates decision making with regard to treatment with antibiotics. Infections due to Pseudomonas aeruginosa are particularly problematic because of their intrinsic resistance to multiple classes of antibiotics and their ability to acquire adaptive resistance during a therapeutic course. Numerous strategies, including the use of combination therapy followed by de-escalation of antibiotics, have shown promise in the treatment of these serious infections. However, future success in treating nosocomial infections depends on the appropriate and responsible use of antibiotics in the intensive care unit, to ensure that the antibiotics available today maintain their effectiveness in the future.
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Antimicrobial resistance is an increasing problem worldwide that has been exacerbated by antibiotic misuse worldwide. Growing antibiotic resistance can be attributed to as well as leads to severe infections, complications, prolonged hospital admissions, and higher mortality. One of the most important goals of administering antimicrobials is to avoid establishing antibiotic resistance during therapy. This can be done by drastically lowering worldwide antimicrobial usage, both in present and future. While current management methods to legislate antimicrobials and educate the healthcare community on the challenges are beneficial, they do not solve the problem of attaining an overall reduction in antimicrobial usage in humans. Application of rapid microbiological diagnostics for identification and antimicrobial susceptibility testing, use of inflammation markers to guide initiation and duration of therapies, reduction of standard antibiotic course durations, individualization of antibiotic treatments, and dosing considering pharmacokinetics are all possible strategies to optimize antibiotic use in everyday clinical practice and reduce the risk of inducing bacterial resistance. Furthermore, to remove any impediments to proper prescribing, strategies to improve antibiotic prescribing and antibiotic stewardship programs should enable clinical reasoning and enhance the prescribing environment. In addition, the well-established association between antimicrobial usage and resistance should motivate efforts to develop antimicrobial treatment regimens that facilitate the evolution of resistance. This review discusses the role of antibiotics, their current application in human medicine, and how the resistance has evolved to the existing antibiotics based on the existing literature.
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Increasing bacterial resistance combined with a steady decline in the discovery of new antibiotics has resulted in a global healthcare crisis. Overuse of antibiotics, for example, in the poultry and cattle industry, and misuse and improper prescription of antibiotics are leading causes of multidrug resistance (MDR). The increasing use of antibiotics, particularly in developing countries, is a big concern for antibiotic resistance and can cause other health threats such as increased risk of recurrent infections and increased risk of cardiovascular death with chronic use of macrolides. Carbapenems are the last line of defense in many cases of resistant infection, but trends show that resistance against these agents is also increasing. This narrative review is based on relevant literature according to the experience and expertise of the authors and presents an overview of the current knowledge on antibiotic resistance, the key driving factors, and possible strategies to tackle antibiotic resistance. Collectively, studies show that hospital-wide antibiotic stewardship programs are effective in decreasing the spread of antibacterial resistance. As resistance varies according to local patterns of use, it is essential to observe the epidemiology at both a regional and an institutional level. Furthermore, adaptation of clinical guidelines is necessary, particularly for inpatient care. Future guidelines should include a justification step for continued treatment of antibiotic treatments and criteria for selection of antibiotics at the start of treatment. Nonantibiotic prevention strategies can limit infections and should also be considered in treatment plans. Vaccines against MDR organisms have shown some efficacy in phase II trials in critical care patients. Nonimmunogenic and microbiologic treatment options such as fecal transplants may be particularly important for elderly and immune-compromised patients.
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Antibiotic resistance remains a global public health concern with significant patient morbidity and tremendous associated health care costs. Drivers of antibiotic resistance are multifaceted and differ between developing and developed countries. Under evolutionary pressure, microbes acquire antibiotic tolerance through a variety of mechanisms at the cellular level. Patients after orthopaedic trauma are vulnerable to drug-resistant pathogens, particularly after open fractures. Traumatologists practicing appropriate antibiotic prophylaxis and treatment regimens mitigate infection and propagation of antibiotic resistance.
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Many concerns have been expressed in the field of clinical practice regarding antimicrobial resistance since many infections with severe complications and bad prognosis have been described since the end of the last century. In primary healthcare facilities, the risks for developing high rates of antibiotic resistance is high, probably due to the high prevalence of bacterial infections in these places, and due to the overuse of antibiotics without any relevance of evidence of bacterial infections. For instance, people usually administer high doses of broad-spectrum antibiotics for non-severe, self-limiting respiratory tract infections. Moreover, for fighting bacterial infections, patients usually discontinue the treatment course once the symptoms of the disease were relieved. These factors among many others had led to the high prevalence of antibiotic resistance which may lead to serious complications. Many approaches are being made to reduce the resistance that has been reviewed in this review. These include optimizing the dosage and timing of antibiotics administration which can be achieved by more understanding of the pharmacology of the antibiotics. Moreover, training and education programs that target the prescribers and patients have been proven to be efficient in reducing the rates. These efforts are encouraged to last and target more people for more favorable outcomes.
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Antimicrobial resistance is a global problem and is particularly pressing in developing countries where the infectious disease burden is very high. In developing countries, where relatively easy availability and higher consumption of medicines have led to disproportionately higher incidence of inappropriate use of antibiotics and greater levels of resistance compared to developed countries. The bacterial disease burden in India is among the highest in the world; consequently, antibiotics will play a critical role in limiting morbidity and mortality in the country. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance. Responsible antibiotic therapy is one of the most important components of antibiotic stewardship. The current article is an attempt to provide a set of key principles to guide efforts to improve responsible and rational antibiotic use.
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Febrile urinary tract infection (UTI) is currently considered the most frequent cause of serious bacterial illness in children in the first 2 years of life. UTI in paediatrics can irreversibly damage the renal parenchyma and lead to chronic renal insufficiency and related problems. To avoid this risk, an early effective antibiotic treatment is essential. Moreover, prompt treatment is mandatory to improve the clinical condition of the patient, prevent bacteraemia, and avoid the risk of bacterial localization in other body sites. However, antibiotic resistance for UTI-related bacterial pathogens continuously increases, making recommendations rapidly outdated and the definition of the best empiric antibiotic therapy more difficult. Variation in pathogen susceptibility to antibiotics is essential for the choice of an effective therapy. Moreover, proper identification of cases at increased risk of difficult-to-treat UTIs can reduce the risk of ineffective therapy. In this review, the problem of emerging antibiotic resistance among pathogens associated with the development of paediatric febrile UTIs and the best potential solutions to ensure the most effective therapy are discussed. Literature analysis showed that the emergence of antibiotic resistance is an unavoidable phenomenon closely correlated with the use of antibiotics themselves. To limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be made. An increased use of antibiotic stewardship can be greatly effective in this regard.
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Antimicrobial resistance is now being recognized as a major factor determining morbidity, mortality, and cost in the intensive care unit (ICU). Various strategies to limit its spread have evolved with our understanding and are based on four basic principles: infection prevention, infection eradication, containment of resistant species, and optimization of antibiotic utilization. The optimization of antibiotic utilization, at its most basic level, is the appropriate use of antibiotics and the limitation of unnecessary antibiotic administration/exposure consisting of appropriate diagnosis, acquiring appropriate culture and sensitivity data, implementing the most appropriate treatment, selecting appropriate antibiotics, and dosing appropriately. In addition various antibiotic utilization strategies including antibiotic utilization guidelines, formulary restriction, and antibiotic cycling or rotation have evolved from our understanding of the impact of changes in antibiotic utilization on subsequent antibiotic susceptibility patterns. These strategies can be utilized as a part of a multidisciplinary approach to limit the appearance and dissemination of antimicrobial resistance in our ICUs.
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Ventilator-associated Pneumonia
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