# ent

id: cord-010479-2zua4mji
type: ORG
entity:
  Healthcare Infection Control Practices Advisory Committee Centers for Disease Control and Prevention Guideline


id: cord-010479-2zua4mji
type: ORG
entity:
  the Children s Hospital Medical Center Performance Improvement Department IT Department Pharmacy and Antimicrobial Stewardship Program


id: cord-009967-fyqc5bat
type: ORG
entity:
  Veterans Administration Ad Hoc Interdisciplinary Advisory Committee on Antimicrobial Use Audits of Antimicrobial Usage


id: cord-017799-2nvrakbs
type: DISEASE
entity:
  abnormal mucosal thickening of the sinuses on CT 19 Equally important imaging cannot distinguish between viral and bacterial rhinosinusitis


id: cord-011310-fm578rm5
type: ORG
entity:
  Minnesota Department of Health One Health Antibiotic Stewardship Collaborative World Health Organization


id: cord-016187-58rqc0cg
type: GGP
entity:
  Staphylococcus aureus Drug effl ux as a mechanism of resistance Active effl ux a common mechanism for biocide and antibiotic resistance Inner membrane effl ux components


id: cord-011189-c0ytamge
type: DNA
entity:
  ICU date 2019 11 27 journal Intensive Care Med DOI 10 1007 s00134 019 05863 z sha f4c4574bde9270b3e9316ee253930fdbe5ff5657 doc_id 11189 cord_uid c0ytamge nan


id: cord-021419-nypnib0h
type: PROTEIN
entity:
  AmB molecule C 16 3 H N sulfo derivative 87 and 3 H N mono and 3 H N N dialkyl derivatives 88a and 89 Scheme 22 52 Amide 83


id: cord-021419-nypnib0h
type: DNA
entity:
  C 6 atom 5 phenyldiazenyl olivomycin 112 5 4 sulfamidophenyldiazenyl olivomycin 113 5 4methoxyphenyldiazenyl olivomycin 114 5 3 4 dichlorophenyldiazenyl olivomycin 115 and 5 4 methylphenyldiazenyl olivomycin 116 see Scheme 31 72


id: cord-021419-nypnib0h
type: CHEMICAL
entity:
  olivomycin N tert butyl amide 122 and 2 H carboxymethoxime olivomycin N 1 3 dihydroxy 2 methylpropan 2 yl amide 123


id: cord-013105-tmhce7p5
type: ORG
entity:
  European Society of Clinical Microbiology and Infectious Diseases ESCMID Critically Ill Patients Study Group


id: cord-252243-ua2w6xki
type: ORG
entity:
  Diagnosis of Urinary Tract Infections Quick Reference Tool for Primary Care Census Aggregate Data Population Profile Gloucestershire County Council Gloucestershire County Health Profile Validation


id: cord-252243-ua2w6xki
type: ORG
entity:
  the Theoretical Domains Framework A Randomized Controlled Trial of Telephone Management of Suspected Urinary Tract Infections


id: cord-252243-ua2w6xki
type: ORG
entity:
  Management of Urinary Tract Infections in Direct to Consumer Telemedicine Millions of Patients Benefiting


id: cord-252243-ua2w6xki
type: ORG
entity:
  Urinary Tract Infection Lower Antimicrobial Prescribing National Institute for Health and Care Excellence Urinary Tract Infection


id: cord-252243-ua2w6xki
type: ORG
entity:
  Antimicrobial Prescribing National Institute for Health and Care Excellence Effect of Increased Daily Water Intake


id: cord-018566-dd5gw66t
type: ORG
entity:
  United States Department of Health and Human Services Public Health Service Food and Drug Administration Bureau of Veterinary Medicine Prudent


id: cord-295605-c6z9n3ij
type: ORG
entity:
  American College of Physicians American Society of Internal Medicine American Academy of Family Physicians Infectious Diseases Society of America


id: cord-295605-c6z9n3ij
type: WORK_OF_ART
entity:
  Otitis Media Principles of Judicious Use of Antimicrobial Agents American Academy of Family Physicians AAFP


id: cord-018557-iuu38yes
type: GGP
entity:
  penicillin V 79 80 81 however these treatments amount to a much greater expense Attempts at short course therapy have been studied with azithromycin 82


id: cord-018557-iuu38yes
type: DISEASE
entity:
  influenza rhinovirus adenovirus coronavirus parainfluenza and respiratory syncytial virus 85 Nonviral pathogens


id: cord-027860-s97hdhh6
type: CL
entity:
  lymphocytic meningitis cranial neuropathy especially facial nerve palsy radiculoneuritis migratory joint and muscle pains myocarditis and transient atrioventricular blocks of varying degree If left untreated the disease can progress to intermittent swelling and pain of one or a few joints usually large weight bearing joints such as the knee cognitive disorders sleep disturbance fatigue and personality changes The diagnosis is based primarily on clinical findings and it is often appropriate to treat patients with early disease solely on the basis of objective signs and a known exposure Serologic testing may provide valuable supportive diagnostic information in patients with endemic exposure and objective clinical findings that suggest later stage disseminated Lyme disease Treatment for 3 to 4 weeks with doxycycline or amoxicillin


id: cord-027860-s97hdhh6
type: GGP
entity:
  Castleman s disease HSV Herpes simplex virus EBV Epstein Barr virus HHV human herpesvirus VZV varicella zoster virus RSV respiratory syncytial virus GVHD graft


id: cord-027860-s97hdhh6
type: ORG
entity:
  Infectious Diseases Society American Thoracic Society Consensus Guidelines on Management of Community Acquired Pneumonia in Adults


id: cord-027860-s97hdhh6
type: ORG
entity:
  Infectious Diseases Society American Thoracic Society Consensus Guidelines on Management of Community Acquired Pneumonia


id: cord-027860-s97hdhh6
type: ORG
entity:
  the Infectious Diseases Society of America Infectious Viral Hepatitis National Institutes of Health Consensus Development Conference Statement


id: cord-027860-s97hdhh6
type: DISEASE
entity:
  HBV hepatitis B virus Abscesses Hepatic subhepatic gallbladder subphrenic splenic periappendiceal perinephric pelvic


id: cord-263430-zq6huaoz
type: WORK_OF_ART
entity:
  Antimicrobial Resistance A One Health Perspective Usage of Antimicrobial Agents and Occurence of Antimicrobial Resistance


id: cord-310474-hip7t0jx
type: ORG
entity:
  the Development of Novel Therapies for Severe and Resistant Infections A Case Study on CAL02 a Non Traditional Broad Spectrum Anti Virulence Drug Monoclonal Antibodies


id: cord-333950-e0hd3iuu
type: WORK_OF_ART
entity:
  A Microbiological Survey of Campylobacter Contamination in Fresh While UK Produced Chilled Chickens at Retail Sale Centers for Disease Control and Prevention Campylobacteriosis


id: cord-333950-e0hd3iuu
type: ORG
entity:
  Home Hygiene Minimum Infective Dose of the Major Human Respiratory and Enteric Viruses Transmitted Through Food and


id: cord-333950-e0hd3iuu
type: ORG
entity:
  Multiple Cleaning and Disinfection Interventions on Infectious Diseases in Children A Group Randomized Trial


id: cord-333950-e0hd3iuu
type: ORG
entity:
  Preservation Wolters Kluwer Philadelphia Scientific Committee on Emerging and Newly Identified Health Risks SCENIHR Recent


id: cord-297125-la20vi9j
type: ORG
entity:
  A Milbank Foundation Report World Health Organization Maximizing Positive Synergies Collaborative Group


id: cord-297125-la20vi9j
type: CHEMICAL
entity:
  atenolol bezafibrate clofibric acid cyclophosphamide diazepam erythromycin furosemide lincomycin oleandomycin ranitidine


id: cord-346726-u7dhbmht
type: TAXON
entity:
  pathogens adenovirus coronavirus HKU1 coronavirus NL63 coronavirus 229E coronavirus OC43 hMPV rhinovirus enterovirus


id: cord-346726-u7dhbmht
type: DISEASE
entity:
  influenza virus rhinovirus adenovirus respiratory syncytial virus RSV human coronavirus and parainfluenza virus cause infections


id: cord-312417-li41ng7v
type: DISEASE
entity:
  Stewart Williams Jennifer Wertheim Heiman Khan Wasif Ali Matin Abdul Kinsman John title Rural community


id: cord-297216-1b99hm1e
type: ORG
entity:
  Predictive Analytics Deliver Precision Public Health Public Health Genom From Public Health Genomics to


id: cord-297216-1b99hm1e
type: ORG
entity:
  Polygenic Characters A Heterozygote Expression of a Recessive Identical Mutations and Phenotypic Variation Temporal Perturbations


id: cord-297216-1b99hm1e
type: ORG
entity:
  the Spectrum of Holoprosencephaly Phenotypes Role of Pharmacogenetics in Public Health and Clinical Health Care A SWOT Analysis Population Pharmacogenomics for Precision Public Health


id: cord-297216-1b99hm1e
type: WORK_OF_ART
entity:
  The Limits of the Self Immunology and Biological Identity Philosophy of Immunology Influences of Microbiota on Intestinal Immune System Development Role of Commensal Bacteria in Development of Gut Associated Lymphoid Tissues


id: cord-297216-1b99hm1e
type: WORK_OF_ART
entity:
  Twins Discordant for Obesity Modulate Metabolism in Mice Analysis of Intestinal Flora Development in Breast Fed


id: cord-297216-1b99hm1e
type: ORG
entity:
  Formula Fed Infants by Using Molecular Identification and Detection Methods Human Milk Glycobiome and Its Impact on the Infant Gastrointestinal


id: cord-297216-1b99hm1e
type: ORG
entity:
  the United Kingdom Review of Antimicrobial Resistance in the Environment and Its Relevance to Environmental Regulators Understanding the Contribution of Environmental Factors


id: cord-257460-e6anaxck
type: WORK_OF_ART
entity:
  Treating the Immunocompetent Patient Who Presents with an Upper Respiratory Infection Pharyngitis Sinusitis


id: cord-349775-zwslhjju
type: PROTEIN
entity:
  influenza virus B IfB human metapneumovirus respiratory syncytial virus RSV human rhinovirus hRV enterovirus EV adenovirus AdV


id: cord-333334-90q1xkld
type: ORG
entity:
  the Department of Pulmonary and Critical Care Medicine Department of Traditional Chinese Medicine Lung Disease


id: cord-333334-90q1xkld
type: DISEASE
entity:
  influenza A H1N1 H7N9 virus influenza B virus respiratory syncytial virus parainfluenza virus adenovirus EpsteineBarr virus herpes simplex


id: cord-280158-3fhhuzg5
type: WORK_OF_ART
entity:
  Countering Gram Negative Antibiotic Resistance Recent Progress in Disrupting the Outer Membrane with Novel Therapeutics A Novel Inhibitor


id: cord-280158-3fhhuzg5
type: LAW
entity:
  Thinking Outside the Bug Molecular Targets and Strategies to Overcome Antibiotic Resistance Defeating Antibiotic Resistant Bacteria Exploring Alternative Therapies for a Post Antibiotic Era Drug


id: cord-292094-vmsdhccp
type: ORG
entity:
  American Thoracic Society Centers for Disease Control and Prevention Infectious Diseases Society of America


id: cord-292094-vmsdhccp
type: DISEASE
entity:
  influenza A H5N1 World Health Organization Production of pilot lots of inactivated influenza vaccines from reassortants derived from avian influenza viruses interim biosafety assessment Avian influenza A H5N1 infection


id: cord-317410-hc06yo32
type: WORK_OF_ART
entity:
  Clinical Screening Tools to Diagnose Group A Streptococcal Pharyngotonsillitis in Primary Care Clinics


id: cord-346308-9h2fk9qt
type: DNA
entity:
  aminoglycoside aac aad aph chloramphenicol cat cml sulfonamide sulI sulII sulIII sulA trimethoprim dfrA dfrB quinolone qnrA B S tetracycline tetA E G H J Y Z


id: cord-346308-9h2fk9qt
type: CL
entity:
  C perfringens Extracellular vesicles EVs are also infectious particles said to be produced by all types of microorganisms


id: cord-346308-9h2fk9qt
type: CHEMICAL
entity:
  Trichothecium roseum Rhizopus nigricans Aspergillus flavus Aspergillus parasiticus Microsporum canis


id: cord-304972-aktfbriw
type: WORK_OF_ART
entity:
  Antibiotic Prescribing Prescribing of Antibiotics for Self Limiting Respiratory Tract Infections in Adults and Children in Primary Care Guidance London National Institute for Health and Clinical Excellence


id: cord-312266-hnbgaxft
type: ORG
entity:
  Recommendations for Management of Common Childhood Conditions Evidence for Technical Update of Pocket Book Recommendations Newborn Conditions Dysentery Pneumonia Oxygen Use and Delivery


id: cord-312266-hnbgaxft
type: DISEASE
entity:
  impaired immunity and lung function dysfunctional nasal mucociliary clearance lung and heart diseases


id: cord-286574-t9z2ynt5
type: PROTEIN
entity:
  disease Programmable nucleasesincluding zinc finger nucleases ZFNs transcription activator like effector nucleases TALENs


id: cord-281836-j1r771nq
type: FAC
entity:
  the Instituto de Salud Carlos III Spanish Network for Research on Infectious Diseases RD16 0016 0011


id: cord-281836-j1r771nq
type: ORG
entity:
  Leviathan Baltimore Penguin Books Culture s Consequences Comparing Values Behaviors Institutions and Organizations Across Nations Adsorption


id: cord-281836-j1r771nq
type: WORK_OF_ART
entity:
  The Essential Rousseau The Social Contract Discourse on the Origin of Inequality Discourse on the Arts and Sciences


id: cord-351231-aoz5jbf1
type: ORG
entity:
  California World Health Organization Multicentre Collaborative Network for Severe Acute Respiratory Syndrome


id: cord-351231-aoz5jbf1
type: DISEASE
entity:
  influenza A H7N9 and influenza A H5N1 28 29 30 Both show high mortality rates but little evidence so far of that single critical mutation permitting attachment to the hemagglutinin antigen


# bib

id: cord-009967-fyqc5bat
title: Cost‐Effective Antibiotic Prescribing
author: Gleckman, Richard
date: 2012-01-24
txt: ./txt/cord-009967-fyqc5bat.txt
cache: ./cache/cord-009967-fyqc5bat.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167648/
doi: 10.1002/j.1875-9114.1983.tb03264.x
summary:
  Recent studies have confirmed the efficacy and reduced expense of oral antibiotics prescribed for selected children with osteomyelitis and septic arthritis.1"22 In 1973, it was reported that favorable results ensued when oral antibiotic therapy was prescribed for hospitalized patients with serious infectionsz3 Fourteen patients with osteomyelitis were treated successfully with oral cephalexin after they had received a short course of parenteral cephaloridine. Adults with disseminated gonococcal infection can be effectively treated with a one week program consisting initially of 2 million units of penicillin G administered every 4 hours followed by oral ampicillin or amoxicillin prescribed as 500 mg four times daily.34,35 Hospitalization is usually recommended to establish the diagnosis of disseminated gonococcal disease since misdiagnosis occurs not infrequently with this disorder.33 Selected patients can complete the oral regimens in an outpatient setting or, alternatively, they can be treated entirely without ho~pitalization.~~ Acceptable oral regimens consist of giving amoxicillin (500 mg four times daily), tetracycline (500 mg four times daily), or erythromycin (500 mg four times daily) for at least 7 days.

abstract:
  Antibiotics are often misused, resulting in a high frequency of adverse effects, emergence of drug‐resistant organisms, and excessive costs. The high cost of antibiotics is currently receiving the greatest attention. Considerable cost savings can be achieved by appropriate prescribing of antibiotics for patients receiving these drugs prophylactically as well as for those with established infections. This article cites specific examples of how cost‐effective antibiotic prescribing practices can realize substantial cost savings without any diminished quality in patient care.


id: cord-010012-1hrx1w8r
title: Optimizing Economic Outcomes in Acute Exacerbations of Chronic Bronchitis
author: Destache, Christopher J.
date: 2012-01-17
txt: ./txt/cord-010012-1hrx1w8r.txt
cache: ./cache/cord-010012-1hrx1w8r.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167996/
doi: 10.1592/phco.22.2.12s.33134
summary:
  The treatment of community‐acquired respiratory tract infections, such as acute exacerbations of chronic bronchitis (AECB), constitutes a huge socioeconomic burden. The treatment of community-acquired respiratory tract infections (RTIs), such as acute exacerbations of chronic bronchitis (AECB), constitutes a huge socioeconomic burden. Indeed, antibiotic treatment is associated with lower relapse rates, longer periods between exacerbations, shorter duration of symptoms, and reduced hospitalizations. However, studies of antibiotic therapy for AECB have failed to either account for differences among patients or examine the effect of increasing rates of antimicrobial resistance on clinical and economic outcomes. 22 It was concluded that this study found that in patients with COPD experiencing an AECB, the use of third-line antibiotics significantly reduced treatment failure rates and the need for hospitalization, while prolonging the time between AECB episodes. The infection-free interval: its use in evaluating antimicrobial treatment of acute exacerbation of chronic bronchitis

abstract:
  The treatment of community‐acquired respiratory tract infections, such as acute exacerbations of chronic bronchitis (AECB), constitutes a huge socioeconomic burden. In most cases, an antimicrobial agent is advocated to lessen morbidity and prevent serious clinical sequelae. Use of antimicrobial agents for AECB, however, is controversial, as it is difficult to distinguish between bacterial and nonbacterial AECB, and only marginal benefits have been reported. Antimicrobial agents, however, have reduced relapse rates, prolonged the time between exacerbations, shortened the duration of symptoms, and reduced the need for hospitalization. Microbiologic resistance and individual patient characteristics play important roles in determining the most appropriate antimicrobial agent for patients with AECB. More research on the effect of resistant bacteria on antimicrobial response rates will enable physicians to prescribe economically rational antimicrobial therapy for this common infection.


id: cord-010479-2zua4mji
title: Improving the Compliance of Intraoperative Antibiotic Redosing: A Quality Improvement Initiative
author: LeRiger, Michelle M.
date: 2020-04-10
txt: ./txt/cord-010479-2zua4mji.txt
cache: ./cache/cord-010479-2zua4mji.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190263/
doi: 10.1097/pq9.0000000000000285
summary:
  7 Correctly administered perioperative prophylactic antibiotics decrease the rate of SSIs. 1, 2 Clinical practice guidelines for antimicrobial prophylaxis published in the American Journal of Health-System Pharmacy recommend intraoperative antibiotic dosing intervals during surgical procedures based on the pharmacokinetics of each drug. The secondary project goal was to decrease SSIs. Methods: With recommendations from the Infectious Disease Society of America, we developed new organizational redosing guidelines, as well as a new antibiotic-specific reminder alert in the electronic medical record. The secondary project goal was to decrease SSIs. Methods: With recommendations from the Infectious Disease Society of America, we developed new organizational redosing guidelines, as well as a new antibiotic-specific reminder alert in the electronic medical record. Conclusions: This project demonstrates that comprehensive education along with antibiotic-specific electronic medical record alerts significantly increased the compliance of intraoperative antibiotic redosing at Children''s Hospital & Medical Center.

abstract:
  INTRODUCTION: At Children’s Hospital and Medical Center in Omaha, Nebraska, the intraoperative antibiotic redosing guidelines and the time frame considered compliant for redosing were unclear. This lack of clarity plus an ill-defined process for ensuring intraoperative antibiotic redosing resulted in a compliance rate of 11%. The organization’s surgical site infection (SSI) rate was 3.19%, above the national benchmark of 1.87%. The primary project goal was to increase intraoperative antibiotic redosing compliance. The secondary project goal was to decrease SSIs. METHODS: With recommendations from the Infectious Disease Society of America, we developed new organizational redosing guidelines, as well as a new antibiotic-specific reminder alert in the electronic medical record. Implementation of the new guidelines and processes occurred after providing education to the anesthesiologists, surgeons, and circulating nurses. Monthly evaluation of data allowed for quick recognition of oversights followed by the initiation of process updates. RESULTS: Data showed that the initial compliance rate for the intraoperative redosing of antibiotics was 11%. Following interventions, compliance has reached and sustained an average of 99%. Survey results show that provider knowledge of the guidelines and process has improved. Though not directly related, the National Surgical Quality Improvement Program observed that the SSI rate decreased from 3.19% in 2014 to 2.3% in 2018. CONCLUSIONS: This project demonstrates that comprehensive education along with antibiotic-specific electronic medical record alerts significantly increased the compliance of intraoperative antibiotic redosing at Children’s Hospital & Medical Center. Continuous education and monthly updates sustained results for over 40 months.


id: cord-011189-c0ytamge
title: Less empiric broad-spectrum antibiotics is more in the ICU
author: da Fonseca Pestana Ribeiro, Jose Mauro
date: 2019-11-27
txt: ./txt/cord-011189-c0ytamge.txt
cache: ./cache/cord-011189-c0ytamge.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223771/
doi: 10.1007/s00134-019-05863-z
abstract: nan
summary:
  The real impact of MDRs on the outcomes of ICU patients is debatable, but despite this controversy, the incidence of MDRs is related to poor quality-of-care, as an expression of reduced compliance to hand hygiene [14] , and a high burden of antibiotic exposure [15] . De-escalation decreases the time of antibiotic use, but a short exposure still exists; in this way, a single antibiotic dose may be enough to treat severe infections such as Fig. 1 Two different mindsets in the decision making process to initiate antibiotics to critically ill patients who are getting worse. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program Aggressive versus conservative initiation of antimicrobial treatment in critically ill surgical patients with suspected intensivecare-unit-acquired infection: a quasi-experimental, before and after observational cohort study


id: cord-011310-fm578rm5
author: Leja, Mārcis
date: 2019-10-28
txt: ./txt/cord-011310-fm578rm5.txt
cache: ./cache/cord-011310-fm578rm5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224010/
doi: 10.1007/s10620-019-05893-z
summary:
  Several guidelines recommend the screen-and-treat strategy, i.e. active search for the presence of Helicobacter pylori infection and its eradication to prevent the possibility of gastric cancer. Furthermore, no differences in the eradication regimen are currently recommended, depending on whether the treatment is given for a clinically evident disease, e.g. for complicated ulcer disease or MALT lymphoma from prevention strategies in population-based settings. The recent guidelines of ASEAN (Association Southeast Asian Nations) countries support eradication to prevent gastric cancer by considering this strategy as costeffective, depending on the disease burden in the relevant community [19] . An expert group hosted by IARC has suggested the need for interventional strategies to decrease the burden of gastric cancer [1, 22] ; however, experts recommended that this be done by the means of well-designed clinical studies evaluating the feasibility, acceptance, costs, effectiveness and adverse consequences.

title:
  What Would the Screen-and-Treat Strategy for Helicobacter pylori Mean in Terms of Antibiotic Consumption?

abstract:
  Several guidelines recommend the screen-and-treat strategy, i.e. active search for the presence of Helicobacter pylori infection and its eradication to prevent the possibility of gastric cancer. It is thought that a relatively short duration antibiotic regimen given once in a lifetime would not significantly increase overall antibiotic consumption. However, this would mean offering antibiotic treatment to the majority of the population in countries with the biggest burden of gastric cancer who would, therefore, have the greatest benefit from such a strategy. So far, no country has implemented an eradication strategy. With an example based on the current situation in Latvia, we have estimated the increase in antibiotic consumption if the screen-and-treat strategy was applied. Depending on the scenario that might be chosen, clarithromycin consumption would increase up to sixfold, and amoxicillin consumption would double if the recommendations of the current guideline in the local circumstances was applied. It appears that an increase in commonly used antibiotic consumption cannot be justified from the viewpoint of antibiotic stewardship policies. Solutions to this problem could be the use of antibiotics that are not required for treating life-threatening diseases or more narrow selection of the target group, e.g. young people before family planning to avoid transmission to offspring. Additional costs related to the increase in resistome should be considered for future cost-effectiveness modelling of the screen-and-treat strategy.


id: cord-013105-tmhce7p5
title: Less is more: critically ill status is not a carte blanche for unlimited antibiotic use
author: Kalil, Andre C.
date: 2020-10-09
txt: ./txt/cord-013105-tmhce7p5.txt
cache: ./cache/cord-013105-tmhce7p5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545809/
doi: 10.1007/s00134-020-06260-7
abstract: nan
summary:
  In addition, we propose that health-care providers can bring concrete and direct benefits to each of our critically ill patients at the bedside by preventing the excessive use of unnecessary antibiotics. The clinical deterioration of mechanically ventilated patients may be associated with a new infection process; however, the majority of ventilator-associated events leading to antibiotic administration is related to noninfectious processes [6] ; thus, the appropriate antimicrobial de-escalation is essential and can be safely done if culture results are negative [7, 8] . For many decades, critically ill patients have been treated with antibiotics during two to three weeks for severe infections including pneumonias, abdominal and urinary infections, all of which still comprise the majority of infections leading to sepsis and admission to the intensive care unit. Effect of aminoglycoside and beta-lactam combination therapy versus beta-lactam monotherapy on the emergence of antimicrobial resistance: a meta-analysis of randomized, controlled trials


id: cord-016187-58rqc0cg
title: The Challenge of Emerging Infections and Progressive Antibiotic Resistance
author: Opal, S. M.
date: 2006
txt: ./txt/cord-016187-58rqc0cg.txt
cache: ./cache/cord-016187-58rqc0cg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120399/
doi: 10.1007/3-540-29730-8_6
abstract: nan
summary:
  Community and nosocomial outbreaks of multidrug resistant pathogens as evidenced by methicillin and vancomycin resistance [17] in Staphylococcus aureus and resistance to the new anti-viral neuraminidase inhibitors [18, 19] by recent infl uenza isolates are cause for real concern. Beta-lactam antibiotics have been known for almost 80 years and their widespread use has created selection pressures on bacterial pathogens to resist their inhibitory actions. These investigators discovered that the resistant strain had acquired a new methylase gene that blocked the binding site for inhibition by aminoglycosides on a specifi c sequence on 16S ribosomal RNA. Mutations resulting in the loss of specifi c porins can occur in clinical isolates and determine increased resistance to beta-lactam antibiotics. If we could discover new targets for future antimicrobial drugs it may be possible to keep pace or even exceed the rate of antibiotic resistance gene development by microbial pathogens.


id: cord-017393-kx8kmdej
title: Acute Myelogenous Leukemia and Febrile Neutropenia
author: Herbers, Alexandra
date: 2009-08-31
txt: ./txt/cord-017393-kx8kmdej.txt
cache: ./cache/cord-017393-kx8kmdej.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121946/
doi: 10.1007/978-1-59745-415-5_5
summary:
  Despite numerous clinical studies, since the 1970s, no single empirical antibiotic regimen has been shown to be superior for initial treatment of patients who become febrile during a neutropenic episode after therapy with chemotherapy drugs for hematological malignancies (see Table 5 -2) [4, 9, [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44] . Similarly, bacteremias due to Staphylococcus aureus, Pseudomonas aeruginosa, and Clostridium species as well as candidemias are more frequently encountered in patients with acute leukemia who suffer from neutropenic enterocolitis or typhlitis, the most serious disturbance of the delicate balance between mucosal damage and microbial flora in the setting of prolonged exposure to antibiotics after intermediate or high-dose cytarabine chemotherapy. In addition, if a persistently neutropenic patient has no complaints and displays no clinical, radiological, or laboratory evidence of infection, cessation of antibiotic therapy or a change to oral antimicrobials should be considered after 4 days without symptoms.

abstract:
  Aggressive chemotherapy has a deleterious effect on all components of the defense system of the human body. The resulting neutropenia as well as injury to the pulmonary and gastrointestinal mucosa allow pathogenic micro-organisms easy access to the body. The symptoms of an incipient infection are usually subtle and limited to unexplained fever due to the absence of granulocytes. This is the reason why prompt administration of antimicrobial agents while waiting for the results of the blood cultures, the so-called empirical approach, became an undisputed standard of care. Gram-negative pathogens remain the principal concern because their virulence accounts for serious morbidity and a high early mortality rate. Three basic intravenous antibiotic regimens have evolved: initial therapy with a single antipseudomonal β-lactam, the so-called monotherapy; a combination of two drugs: a β-lactam with an aminoglycoside, a second β-lactam or a quinolone; and, thirdly, a glycopeptide in addition to β-lactam monotherapy or combination. As there is no single consistently superior empirical regimen, one should consider the local antibiotic susceptibility of bacterial isolates in the selection of the initial antibiotic regimen. Not all febrile neutropenic patients carry the same risk as those with fever only generally respond rapidly, whereas those with a clinically or microbiologically documented infection show a much slower reaction and less favorable response rate. Once an empirical antibiotic therapy has been started, the patient must be monitored continuously for nonresponse, emergence of secondary infections, adverse effects, and the development of drug-resistant organisms. The averageduration of fever in serious infections in eventually successfully treated neutropenic patients is 4–5 days. Adaptations of an antibiotic regimen in a patient who is clearly not responding is relatively straightforward when a micro-organism has been isolated; the results of the cultures, supplemented by susceptibility testing, will assist in selecting the proper antibiotics. The management of febrile patients with pulmonary infiltrates is complex. Bronchoscopy and a high resolution computer-assisted tomographic scan represent the cornerstones of all diagnostic procedures, supplemented by serological tests for relevant viral pathogens and for aspergillosis. Fungi have been found to be responsible for two thirds of all superinfections that may surface during broad-spectrum antibiotic treatment of neutropenic patients. Antibiotic treatment is usually continued for a minimum of 7 days or until culture results indicate that the causative organism has been eradicated and the patient is free of major signs and symptoms. If a persistently neutropenic patient has no complaints and displays no evidence of infection, early watchful cessation of antibiotic therapy or a change to the oral regimen should be considered.


id: cord-017799-2nvrakbs
title: Acute Bacterial Rhinosinusitis
author: Patel, Zara M.
date: 2018-05-04
txt: ./txt/cord-017799-2nvrakbs.txt
cache: ./cache/cord-017799-2nvrakbs.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7122468/
doi: 10.1007/978-3-319-74835-1_11
summary:
  Acute bacterial rhinosinusitis most commonly occurs as a complication of viral infection, complicating 0.5-2.0% of cases of the common cold [10] , However, other factors may also predispose to ABRS, such as allergy, immune dysfunction, impaired ciliary function, anatomic narrowing of the sinuses, or poor dentition [11] . Only for suspected complication involving orbit or central nervous system Similar recommendations for adults Initial therapy of ABRS Antibiotics for worsening course or severe onset ("2" or "3" above), but antibiotics or watchful waiting (for up to 3 days) for "persistent illness" ("1" above) 

abstract:
  Acute bacterial rhinosinusitis (ABRS) is a highly prevalent disease associated with significant direct and indirect costs. It is paramount that a practitioner can distinguish between acute viral rhinosinusitis and ABRS to avoid unnecessary antibiotic usage. It is also important to understand that establishing a diagnosis of ABRS does not necessitate the prescribing of antibiotics, unless the ABRS patient presents with severe or worsening symptoms or an ABRS complication. Complications include extension of infection to the orbit and central nervous system. Injudicious use of antibiotics imparts societal costs in terms of financial expense as well as contributing to higher levels of bacterial resistance. This chapter reviews the epidemiology, clinical features, diagnosis, and treatment of ABRS.


id: cord-018557-iuu38yes
title: Upper Respiratory Infections and Acute Bronchitis
author: Mainous, Arch G.
date: 2009-09-10
txt: ./txt/cord-018557-iuu38yes.txt
cache: ./cache/cord-018557-iuu38yes.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123462/
doi: 10.1007/978-1-60327-239-1_8
summary:
  Treatment recommendations from the AAP/AAFP guidelines for the management of acute otitis media suggest that observation rather the initial use of antibiotics is appropriate depending on the child''s overall health, age, severity of illness, and likelihood that they can follow-up if necessary. When antibiotics are selected for the management of acute suppurative otitis media, selection of an agent should provide coverage for the two most common organisms, the AAP/AAFP recommends initial treatment with amoxicillin at a dose of 80-90 mg/kg per day. • Evidence does not support the use of antibiotics for the common cold, acute bronchitis, initial cases of otitis media with effusion, and non-group A streptococcal pharyngitis. • Although the data are mixed regarding the utility of antibiotic treatment for acute sinusitis, otitis media, and group A streptococcal pharyngitis, antibiotics may have some benefit.

abstract:
  Upper respiratory infections include the following: uncomplicated upper respiratory infections also known as the “common cold,” acute otitis media, pharyngitis/tonsillitis, and acute sinusitis. These conditions, along with acute bronchitis, are very common illnesses that are commonly seen in outpatient settings and are widely treated with antibiotics. In fact, these conditions are the primary indications for outpatient antibiotic prescriptions. These conditions tend to have overlapping clinical characteristics yet evidence regarding the utility of antimicrobial treatments varies across conditions.


id: cord-018566-dd5gw66t
title: The Political Economy of US Antibiotic Use in Animal Feed
author: Armbruster, Walter J.
date: 2018-05-30
txt: ./txt/cord-018566-dd5gw66t.txt
cache: ./cache/cord-018566-dd5gw66t.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123476/
doi: 10.1007/978-3-319-92138-9_15
summary:
  This chapter examines the evidence for antibiotic resistance in the United States and globally, the public health implications, and the impact of—and related industry and political responses to—antibiotic use in animal feed. The major stakeholders include pharmaceutical companies, production integrators, feed suppliers, farm groups, producers, restaurants, food retailers, the public, the medical community, the scientific community, government regulators and policy makers. In 1969, the United Kingdom''s (UK) Parliament received the Swann Report, which concluded that using antimicrobials at sub-therapeutic levels in food-producing animals created risks to human and animal health (Joint Committee on the use of Antibiotics in Animal Husbandry and Veterinary Medicine 1969). This scenario could be exacerbated to the extent FSIS approves additional international facilities, local regulations, and inspections as "equivalent to the United States." Future trade agreements will need to include provisions which address reduced use of medically important antibiotics in producing food animals.

abstract:
  This chapter examines the evidence for antibiotic resistance in the United States and globally, the public health implications, and the impact of—and related industry and political responses to—antibiotic use in animal feed. In 1969, the Swann Report in the United Kingdom noted a dramatic increase in antibiotic-resistant bacteria in food animals receiving low levels of antibiotics in their feed. While the Food and Drug Administration of the United States sought to control antibiotics in animal feed as far back as 1977, only in 2016 were such regulations fully implemented. The farm-level costs of such controls are estimated by the US Department of Agriculture’s Economic Research Service to be minimal, while the Centers for Disease Control and Prevention’s estimates of the public health costs of antibiotic resistance without implementing controls are $7 billion annually. The complex interactions which exist between economic interests, regulatory policy, and human and animal health are explored in this chapter.


id: cord-021158-075vh5jg
author: Fortané, Nicolas
date: 2020-01-06
txt: ./txt/cord-021158-075vh5jg.txt
cache: ./cache/cord-021158-075vh5jg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149086/
doi: 10.1007/s41130-019-00098-4
summary:
  Using recent debates on the AMR problem, it proposes to examine the relationship between the development of professional veterinary expertise and of the drug market, based on the case of a specific segment of the profession, namely veterinarians specializing in industrial poultry and pig production in western France. Indeed, it is common to hear professional organizations or public authorities state that in order to reduce their economic dependence on antibiotic sales, vets must rethink their activity by favouring preventive approaches to animal health which would involve a diversified range of services and would contribute to placing vets in an advisory role with a holistic vision of livestock farming or even of the food supply chain (VetFuturs France 2018) .

title:
  Antimicrobial resistance: preventive approaches to the rescue? Professional expertise and business model of French “industrial” veterinarians

abstract:
  This article focuses on the development of veterinary medicine in the industrial pig and poultry production sector. In the current context of controversies over the public problem of antimicrobial resistance (AMR), the veterinary profession is tending to promote a model of preventive medicine that is supposed to reduce the use of antibiotics in livestock farming. However, veterinarians specializing in pig and poultry production (“industrial vets”) have in fact been adopting such approaches to animal health for several decades. Based on 28 interviews with pig and poultry veterinarians practicing or having practiced in western France between the 1970s and the 2010s, the article aims to understand how such a form of professional expertise has developed, and the business model that underpins it. Contrary to public discourses which promote preventive approaches as a way to diversify professional expertise and to disconnect veterinary incomes from drug sales, it is indeed this economic model that has allowed the development of such approaches within industrial livestock farming. Modern strategies for reducing antibiotic use should therefore seek less to renew the professional expertise of veterinarians than to find new ways to valorize it economically.


id: cord-021419-nypnib0h
title: Main trends in the design of semi-synthetic antibiotics of a new generation
author: Olsufyeva, Evgenia N.
date: 2020-03-17
txt: ./txt/cord-021419-nypnib0h.txt
cache: ./cache/cord-021419-nypnib0h.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149660/
doi: 10.1070/rcr4892
summary:
  In this review, the following classes of compounds are considered as scaffolds for the synthesis of new antibiotics: polycyclic glycopeptides of the vancomycin ± teicoplanin group, classical macrolides, macrolides of the amphotericin B ± oligomycin group, anthracyclines, aureolic acid derivatives, heliomycin, synthetic benzoxaboroles and some other antibiotics. 42 Antibacterial activity of derivatives 52 ± 55 modified at the C(11)7OH group of the aglycone was evaluated compared to the starting antibiotics vancomycin (1) and azithromycin (30) on a panel of Gram-positive and Gramnegative bacterial strains (8 and 3 strains, respectively). In order to improve antifungal properties, cytotoxic and therapeutic characteristics and to study the mechanisms of action, series of new semi-synthetic derivatives based on AmB (63a) and bioengineered analogues S44HP (64a), BSG005 (65a), BSG022 (66a), BSG019 (67), BSG003 (68a) and BSG018 (69) were synthesized (in collaboration with the company BIOSERGEN, Norway) (Scheme 17).

abstract:
  This review summarizes main advances achieved by Russian researchers in the synthesis and characterization of semi-synthetic antibiotics of a new generation in the period from 2004 to 2019. The following classes of compounds are considered as the basis for modification: polycyclic antibacterial glycopeptides of the vancomycin group, classical macrolides, antifungal polyene macrolides, the antitumour antibiotic olivomycin A, antitumour anthracyclines and broad-spectrum antibiotics, in particular, oligomycin A, heliomycin and some other. Main trends in the design of modern anti-infective and antitumour agents over this period are considered in relation to original natural antibiotics, which have been independently discovered by Russian researchers. It is shown that a new type of hybrid structures can, in principle, be synthesized based on glycopeptides, macrolides and other antibiotics, including heterodimers containing a new benzoxaborole pharmacophore. The review addresses the influence of the length of the spacer between two antibiotic molecules on the biological activity of hybrid structures. A combination of genetic engineering techniques and methods of organic synthesis is shown to be useful for the design of new potent antifungal antibiotics based on polyenes of the amphotericin B group. Many new semi-synthetic analogues exhibit important biological properties, such as a broad spectrum of activity and low toxicity. Emphasis is given to certain aspects related to investigation of a broad range of biological activity and mechanisms of action of new derivatives. The bibliography includes 101 references.


id: cord-027860-s97hdhh6
title: Infectious Diseases
author: Zeimet, Anthony
date: 2020-06-22
txt: ./txt/cord-027860-s97hdhh6.txt
cache: ./cache/cord-027860-s97hdhh6.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315328/
doi: 10.1016/b978-1-4377-1160-8.10016-8
abstract: nan
summary:
  Although common upper respiratory bacterial pathogens, such as Moraxella (Branhamella) catarrhalis, Streptococcus pneumoniae, and Haemophilus influenzae, may be isolated from patients with acute bronchitis, their relevance is questionable because these bacteria can be present in the respiratory tract of healthy individuals. In the treatment of Bordetella pertussis, early administration of a macrolide antibiotic and patient isolation will likely decrease coughing paroxysms and limit spread of disease (Braman, 2006) (SOR: A). Risk factors for Pseudomonas infection include severe structural lung disease (e.g., bronchiectasis) and recent antibiotic therapy, health care-associated exposures or stay in hospital (especially in the ICU). Patients who present with severe infection or whose infection is progressing despite empiric antibiotic therapy should be treated more aggressively; the treatment strategy should be based on results of appropriate Gram stain, culture, and drug susceptibility analysis. For suspected MRSA skin infections, oral treatment options include trimethoprim-sulfamethoxazole, clindamycin, and doxycycline of purulent material when performing incision and drainage in the event that the patient fails to improve and antibiotic coverage becomes necessary.


id: cord-030184-5iv6qt7t
title: Gut Microbiota Modulation: Implications for Infection Control and Antimicrobial Stewardship
author: Tan, Glorijoy Shi En
date: 2020-08-07
txt: ./txt/cord-030184-5iv6qt7t.txt
cache: ./cache/cord-030184-5iv6qt7t.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412295/
doi: 10.1007/s12325-020-01458-z
summary:
  Fecal microbiota transplant has been found to be one of the most effective ways to regulate the gut microbiota dysbiosis in the setting of CDI [49] Fecal microbiota transplant has been studied in gut decolonization of MDRO, but has not conclusively been found to be effective [55, 56, 58] Selective oral decontamination and selective digestive decontamination with oral antibiotics has been evaluated as a means of reducing infections caused by endogenous MDRO, but has not been found to be efficacious [61] [62] [63] Restoration of the gut microbiota diversity through probiotics and prebiotics have some role in restoring gut diversity in specific diseases, such as necrotizing enterocolitis, acute infectious diarrhea and antibiotic-associated diarrhea [64] [65] [66] [67] [68] [69] Randomized controlled trials have shown positive effects on gut health by probiotics in a myriad of conditions, such as infectious and antibiotic-associated diarrhea (AAD), irritable bowel syndrome, and enterocolitis [64] .

abstract:
  The human microbiome comprises a complex ecosystem of microbial communities that exist within the human body, the largest and most diverse of which are found within the human intestine. It has been increasingly implicated in human health and diseases, demonstrably playing a critical role in influencing host immune response, protection against pathogen overgrowth, biosynthesis, and metabolism. As our understanding of the links between the gut microbiota with host immunity and infectious diseases deepens, there is a greater need to incorporate methods of modulating it as a means of therapy or infection prevention in daily clinical practice. Traditional antimicrobial stewardship principles have been evaluated to assess their impact on the gut microbiota diversity and the consequent repercussions, taking into consideration antibiotic pharmacokinetic and pharmacodynamic properties. Novel strategies of selective digestive decontamination and fecal microbiota transplantation to regulate the gut microbiota have also been tested in different conditions with variable results. This review seeks to provide an overview of the available literature on the modulation of the gut microbiota and its implications for infection control and antimicrobial stewardship. With increased understanding, gut microbiota profiling through metataxonomic analysis may provide further insight into modulating microbial communities in the context of infection prevention and control.


id: cord-252243-ua2w6xki
author: Cooper, Emily
date: 2020-09-07
txt: ./txt/cord-252243-ua2w6xki.txt
cache: ./cache/cord-252243-ua2w6xki.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/antibiotics9090581
doi: 10.3390/antibiotics9090581
summary:
  Results: Staff were very aware of common UTI symptoms and nitrofurantoin as first-line treatment, but some were less aware about when to send a urine culture, second-line and non-antibiotic management, and did not probe for signs and symptoms to specifically exclude vaginal causes or pyelonephritis before prescribing. • Clearly outlines how to clinically assess someone with suspected UTI; • Includes prompts/considerations around differential diagnosis, pyelonephritis, and sepsis; • Clearly outlines the steps for clinical assessment of someone with suspected UTI and when a urine dipstick test or culture is needed; • Provides information on the sensitivity and specificity when using urine dipsticks to diagnose a UTI for women under 65 years; • Has been developed as an update to previous guidance; • Links to latest national guidance on antimicrobial prescribing for UTI management (developed since this study was conducted); • Links to UTI leaflets and resources for women under 65 years that explains evidenced-based prevention and self-care recommendations.

title:
  Diagnosis and Management of UTI in Primary Care Settings—A Qualitative Study to Inform a Diagnostic Quick Reference Tool for Women Under 65 Years

abstract:
  Background: To inform interventions to improve antimicrobial use in urinary tract infections (UTIs) and contribute to a reduction in Escherichia coli bloodstream infection, we explored factors influencing the diagnosis and management of UTIs in primary care. Design: Semi-structured focus groups informed by the Theoretical Domains Framework. Setting: General practice (GP) surgeries in two English clinical commissioning groups (CCGs), June 2017 to March 2018. Participants: A total of 57 GP staff within 8 focus groups. Results: Staff were very aware of common UTI symptoms and nitrofurantoin as first-line treatment, but some were less aware about when to send a urine culture, second-line and non-antibiotic management, and did not probe for signs and symptoms to specifically exclude vaginal causes or pyelonephritis before prescribing. Many consultations were undertaken over the phone, many by nurse practitioners, and followed established protocols that often included urine dipsticks and receptionists. Patient expectations increased use of urine dipsticks, and immediate and 5 days courses of antibiotics. Management decisions were also influenced by patient co-morbidities. No participants had undertaken recent UTI audits. Patient discussions around antibiotic resistance and back-up antibiotics were uncommon compared to consultations for respiratory infections. Conclusions: Knowledge and skill gaps could be addressed with education and clear, accessible, UTI diagnostic and management guidance and protocols that are also appropriate for phone consultations. Public antibiotic campaigns and patient-facing information should cover UTIs, non-pharmaceutical recommendations for “self-care”, prevention and rationale for 3 days antibiotic courses. Practices should be encouraged to audit UTI management.


id: cord-255635-0pr9oae6
title: Molecular iodine
author: Riad, A.
date: 2020-09-11
txt: ./txt/cord-255635-0pr9oae6.txt
cache: ./cache/cord-255635-0pr9oae6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1038/s41415-020-2127-0
doi: 10.1038/s41415-020-2127-0
abstract: nan
summary:
  on the antiseptic efficacy of povidone-iodine (PVP-I) against SARS-CoV-2; we aim to demonstrate the potential prophylactic capacity of the new generation of uncomplexed molecular iodine (I 2 ) mouthwashes. The number of antibiotics dispensed each month by community pharmacists in England relating to NHS dental prescription forms from January 2018 to May 2020 is given in Figure 1 . 2 Antibiotics may have been used: • As a ''quick fix'' to avoid the life-time impact of an unnecessary extraction, in anticipation that AGPs might soon be permissible in general dental practices • Because dentists felt pressured by some patients for antibiotics, irrespective of their efficacy or appropriateness for treating toothache • Because of difficulties diagnosing a patient''s condition remotely prompting a ''just in case'' approach through concerns of life-threatening deterioration without treatment • As some UDCs were requiring patients to have tried antibiotics before accepting referral for face-to-face care, highlighting system and process impact on antibiotic prescribing.


id: cord-257244-gryp0khc
author: Edwards, M. R.
date: 2017-08-10
txt: ./txt/cord-257244-gryp0khc.txt
cache: ./cache/cord-257244-gryp0khc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/28722755/
doi: 10.1111/all.13257
summary:
  Despite these important associations, the use of antiinfectives (antibiotics, antivirals, antifungals, vaccines) that specifically target known pathogens, or drugs that are based on or exploit microbe-host receptor interactions (toll-like receptor agonists, bacterial lysates) or are immunomodulators (vitamin D), and/or may work in part by altering our associated microbiology (probiotics) are, with the exception of severe asthma, seldom considered in asthma treatment, prevention and guidelines. Overall, antibiotic use is associated with asthma risk rather than protection at most stages of human development, including pregnancy, 10, 11 early life 12 and childhood, 13 although why this is so is a subject widely debated. 10 In retrospective studies, the association between antibiotic use and increased risk of asthma or wheezing in children is further confused due to the potential of reverse causation. Inhibiting virus replication through interfering with viral enzymes active within cells poses additional problems in drug discovery; however, several useful inhibitors for respiratory tract viruses have found their way into phase I/II clinical trials.

title:
  The potential of anti‐infectives and immunomodulators as therapies for asthma and asthma exacerbations

abstract:
  Asthma is responsible for approximately 25,000 deaths annually in Europe despite available medicines that maintain asthma control and reduce asthma exacerbations. Better treatments are urgently needed for the control of chronic asthma and reduction in asthma exacerbations, the major cause of asthma mortality. Much research spanning >20 years shows a strong association between microorganisms including pathogens in asthma onset, severity and exacerbation, yet with the exception of antibiotics, few treatments are available that specifically target the offending pathogens. Recent insights into the microbiome suggest that modulating commensal organisms within the gut or lung may also be a possible way to treat/prevent asthma. The European Academy of Allergy & Clinical Immunology Task Force on Anti‐infectives in Asthma was initiated to investigate the potential of anti‐infectives and immunomodulators in asthma. This review provides a concise summary of the current literature and aimed to identify and address key questions that concern the use of anti‐infectives and both microbe‐ and host‐based immunomodulators and their feasibility for use in asthma.


id: cord-257460-e6anaxck
author: Mostov, Perry D.
date: 2007-05-03
txt: ./txt/cord-257460-e6anaxck.txt
cache: ./cache/cord-257460-e6anaxck.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0095454306000777
doi: 10.1016/j.pop.2006.09.009
abstract: nan
summary:
  As such, the term URI has come to encompass multiple clinical entities including pharyngitis, sinusitis, and bronchitis, as well as nonspecific respiratory infections, a designation that includes the common cold. Use of a sore throat score to determine treatment of children and adults in a university-based family practice demonstrated a 48% reduction in antibiotic prescription compared with usual care [35] . Acute bacterial rhinosinusitis (ABRS) shares symptoms with the viral URI, including rhinorrhea, nasal congestion, facial pressure, and fever, which may lead the patient to request antibiotics from their physician. Like pharyngitis and sinusitis, however, it is a condition that shares a primary symptom, in this case cough, with the nonspecific URI, an illness of viral origin not requiring antibiotic therapy. A Patient education by the physician on the appropriate treatment of acute bronchitis can result in lower antibiotic usage without affecting clinical outcomes [93] . Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults

title:
  Treating the Immunocompetent Patient Who Presents with an Upper Respiratory Infection: Pharyngitis, Sinusitis, and Bronchitis


id: cord-259945-nmjwzk4e
title: Antibiotics in acute bronchitis: a meta-analysis
author: Bent, Stephen
date: 1999-07-07
txt: ./txt/cord-259945-nmjwzk4e.txt
cache: ./cache/cord-259945-nmjwzk4e.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0002934399001679
doi: 10.1016/s0002-9343(99)00167-9
summary:
  Only randomized trials that enrolled otherwise healthy patients with a diagnosis of acute bronchitis, used an antibiotic in the treatment group and a placebo in the control group, and provided sufficient data to calculate an effect size were included. Only randomized trials that enrolled otherwise healthy patients with a diagnosis of acute bronchitis, used an antibiotic in the treatment group and a placebo in the control group, and provided sufficient data to calculate an effect size were included. Inclusion criteria consisted of the following: randomized trials using an antibiotic in the treatment group and a placebo in the control group; subjects with acute bronchitis, no history of chronic lung disease, and pneumonia excluded by chest radiograph or clinical exam; therapy for at least 5 days; and the presentation of sufficient data to calculate the difference in efficacy between the treatment and the placebo as a continuous variable.

abstract:
  PURPOSE: Most patients with acute bronchitis who seek medical care are treated with antibiotics, although the effectiveness of this intervention is uncertain. We performed a meta-analysis of randomized, controlled trials to estimate the effectiveness of antibiotics in the treatment of acute bronchitis. SUBJECTS AND METHODS: English-language studies published January 1966 to April 1998 were retrieved using MEDLINE, bibliographies, and consultation with experts. Only randomized trials that enrolled otherwise healthy patients with a diagnosis of acute bronchitis, used an antibiotic in the treatment group and a placebo in the control group, and provided sufficient data to calculate an effect size were included. RESULTS: We identified eight randomized controlled trials that satisfied all inclusion criteria. These studies used one of three antibiotics (erythromycin, doxycycline, trimethoprim/sulfamethoxazole). The use of antibiotics decreased the duration of cough and sputum production by approximately one-half day (summary effect size 0.21; 95% CI, 0.05 to 0.36). For specific symptoms, there were nonsignificant trends favoring the use of antibiotics: a decrease of 0.4 days of purulent sputum (95% CI, −0.1 to 0.8), a decrease of 0.5 days of cough (95% CI, −0.1 to 1.1), and a decrease of 0.3 days lost from work (95% CI, −0.6 to 1.1). CONCLUSION: This meta-analysis suggests a small benefit from the use of the antibiotics erythromycin, doxycycline, or trimethoprim/sulfamethoxazole in the treatment of acute bronchitis in otherwise healthy patients. As this small benefit must be weighed against the risk of side effects and the societal cost of increasing antibiotic resistance, we believe that the use of antibiotics is not justified in these patients.


id: cord-263430-zq6huaoz
title: The Primary Care Perspective on the Norwegian National Strategy against Antimicrobial Resistance
author: Rørtveit, Guri
date: 2020-09-19
txt: ./txt/cord-263430-zq6huaoz.txt
cache: ./cache/cord-263430-zq6huaoz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32961691/
doi: 10.3390/antibiotics9090622
summary:
  title: The Primary Care Perspective on the Norwegian National Strategy against Antimicrobial Resistance Hence, a substantial proportion of antibiotic prescriptions are issued by primary care physicians, implying that this part of the healthcare sector needs to be heavily involved in any strategy to reduce AMR. Three of the specific goals for the healthcare sector in the current strategy are directly relevant for primary healthcare (Box 2), including reducing antibiotics use by 30%, reducing the number of prescriptions from 450 to 250 per 1000 inhabitants, and reducing prescriptions for respiratory infections by 20%-all compared to the 2012 level. Both primary care physicians and the general population may question the safety and legitimacy of "ever lower antibiotic prescription" and thus jeopardize the strong alliance between healthcare providers, public health authorities and the population, which has been a key success factor in the present strategy.

abstract:
  A national strategy to combat antimicrobial resistance (AMR) has been subject to cyclic processes in Norway since 1998. In 2020, a renewed process cycle was launched. Here, we describe the process and the approach of the process. In addition, we describe two concepts from philosophy of science that may help to frame the process: AMR is an example of a super wicked problem, and post-normal science provides tools to analyze the problem from a new angle.


id: cord-267023-w5ig7mrl
author: Nori, Priya
date: 2017-07-20
txt: ./txt/cord-267023-w5ig7mrl.txt
cache: ./cache/cord-267023-w5ig7mrl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/28748196/
doi: 10.1093/ofid/ofx117
summary:
  We integrated case-based modules, group learning activities, smartphone applications (apps), decision support tools, and prescription audit and feedback into curricula of the medical school, medicine residency program, infectious diseases (ID) fellowship program, and hospital medicine program operations. In a 2013 follow-up multicenter survey of fourth year medical students, 90% desired further education on antimicrobial prescribing, but only 40% were familiar with the role of antimicrobial stewardship (AS) in promoting judicious antimicrobial use and preventing multidrug resistance [3, 4] . It consists of 5 educational strategies designed to bridge perceived learning gaps and lay the foundation for best practices in stewardship and infection prevention in medical students, postgraduate trainees, and mature clinicians. The majority used a quasi-experimental, before-and-after study design with preand postintervention knowledge assessment questions, surveys of learners, or chart review with post-antibiotic prescription audit as methods of evaluation.

title:
  Developing Interactive Antimicrobial Stewardship and Infection Prevention Curricula for Diverse Learners: A Tailored Approach

abstract:
  BACKGROUND. To impart principles of antimicrobial stewardship (AS) and infection prevention and control (IPC), we developed a curriculum tailored to the diverse aptitudes of learners at our medical center. METHODS. We integrated case-based modules, group learning activities, smartphone applications (apps), decision support tools, and prescription audit and feedback into curricula of the medical school, medicine residency program, infectious diseases (ID) fellowship program, and hospital medicine program operations. Interventions were implemented in 2012–2016 using a quasi-experimental before-and-after study design, and this was assessed using pre- and postintervention surveys or audit of antibiotic prescriptions. RESULTS. Over 180 medical students participated in the AS and IPC seminars. After smartphone app introduction, 69% reported using the app as their preferred source of antibiotic information. Approximately 70% of students felt comfortable prescribing antibiotics for a known infection compared with 40% at baseline (P = .02), and approximately 83% were able to identify the appropriate personal protective equipment for specific scenarios. Approximately 99% agreed that they have a role in promoting patient safety and preventing healthcare-associated infections as medical students. At 20 months, appropriateness of trainee antibiotic prescriptions increased by 20% (P < .01). Almost all ID fellows indicated that the AS and IPC seminar was a vital training supplement. Uptake of internist antibiotic recommendations using AS decision support tools was approximately 70%. CONCLUSIONS. All 5 interventions addressed learning objectives and knowledge gaps and are applicable across a range of environments. Evaluating long-term impact of our curriculum is the focus of future study.


id: cord-270051-rs3cz9lq
title: Increased antibiotics use
author: Wordley, V.
date: 2020-09-11
txt: ./txt/cord-270051-rs3cz9lq.txt
cache: ./cache/cord-270051-rs3cz9lq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32917989/
doi: 10.1038/s41415-020-2128-z
abstract: nan
summary:
  The number of antibiotics dispensed each month by community pharmacists in England relating to NHS dental prescription forms from January 2018 to May 2020 is given in Figure 1 . This is despite the significantly poorer access to dentistry (only around 7,500 patients were seen at designated urgent dental centres [UDCs] across England) compared to May when the capacity of these centres increased and saw over 27,000 patients. 2 Antibiotics may have been used: • As a ''quick fix'' to avoid the life-time impact of an unnecessary extraction, in anticipation that AGPs might soon be permissible in general dental practices • Because dentists felt pressured by some patients for antibiotics, irrespective of their efficacy or appropriateness for treating toothache • Because of difficulties diagnosing a patient''s condition remotely prompting a ''just in case'' approach through concerns of life-threatening deterioration without treatment Finally, the NHS may have seen an influx in patients who might otherwise receive care privately, resulting in an increase in NHS dental prescriptions as, anecdotally, not all practices were open for telephone triage during April and May 2020.


id: cord-275700-tx4hirm4
title: Acute bronchitis: a review of diagnosis and evidence-based management
author: Whiteside, James L
date: 2002-06-30
txt: ./txt/cord-275700-tx4hirm4.txt
cache: ./cache/cord-275700-tx4hirm4.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1068607X02000987
doi: 10.1016/s1068-607x(02)00098-7
summary:
  Because of the increasing bacterial resistance to antibiotics, the cost of prescription drugs, and the potential adverse reactions to them, the present management of acute bronchitis has important shortcomings. This definition highlights the first two steps for treatment: 1) identify patients who have chronic pulmonary disease or other coexisting medical illnesses such as congestive heart failure or immunosuppression and 2) appropriately rule out other causes of acute cough, such as pneumonia and sinusitis. For the patient who presents with acute onset of cough and no history of chronic pulmonary disease or evidence of other more serious illnesses, studies have consistently shown either no benefit or, at best, modest benefit from the use of antibiotics. Antibiotic prescribing for adults with colds, upper respiratory tract infections and bronchitis by ambulatory care physicians National trends in the use of antibiotics by primary care physicians for adult patients with cough

abstract:
  Abstract Obstetricians and gynecologists are increasingly involved in primary care. Acute bronchitis is among the most common ambulatory complaints. Although the cause of acute bronchitis is predominantly viral, 50–70% of patients presenting with this condition are treated with antibiotics. Because of the increasing bacterial resistance to antibiotics, the cost of prescription drugs, and the potential adverse reactions to them, the present management of acute bronchitis has important shortcomings. Also, inhaled bronchodilators are underused for symptomatic management. Improved awareness among physicians about the recommended management of acute bronchitis has been targeted as an important means of decreasing unnecessary antibiotic use. Patient satisfaction motivates physicians to prescribe antibiotics in managing acute bronchitis. However, patient satisfaction does not necessarily correlate with prescribing of antibiotics but rather with patient education. We present a review of the diagnosis and differential diagnosis of acute bronchitis and its management.


id: cord-279483-gwikyux2
author: Wong, Joshua Guoxian
date: 2020-11-02
txt: ./txt/cord-279483-gwikyux2.txt
cache: ./cache/cord-279483-gwikyux2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33138859/
doi: 10.1186/s13756-020-00825-3
summary:
  title: Risk prediction models to guide antibiotic prescribing: a study on adult patients with uncomplicated upper respiratory tract infections in an emergency department We aim to provide an evidence-based clinical decision support tool for antibiotic prescribing using prediction models developed from local data. From 2009 to 2010, adults had the highest rate of inappropriate antibiotic use for acute respiratory tract infections (URTIs, influenza, and viral pneumonia), with 500 antibiotic prescriptions per 1000 ED visits for adults aged 20-64 years and 666 per 1000 visits for those aged > = 65 years [10] . In this study, we aim to develop prediction models based on local clinical and laboratory data to guide antibiotic prescribing for adult patients with uncomplicated URTI with the ultimate goal of deploying them as an evidencebased clinical decision support tool for routine practice. Antibiotic prescribing for patients with upper respiratory tract infections by emergency physicians in a Singapore tertiary hospital

title:
  Risk prediction models to guide antibiotic prescribing: a study on adult patients with uncomplicated upper respiratory tract infections in an emergency department

abstract:
  BACKGROUND: Appropriate antibiotic prescribing is key to combating antimicrobial resistance. Upper respiratory tract infections (URTIs) are common reasons for emergency department (ED) visits and antibiotic use. Differentiating between bacterial and viral infections is not straightforward. We aim to provide an evidence-based clinical decision support tool for antibiotic prescribing using prediction models developed from local data. METHODS: Seven hundred-fifteen patients with uncomplicated URTI were recruited and analysed from Singapore’s busiest ED, Tan Tock Seng Hospital, from June 2016 to November 2018. Confirmatory tests were performed using the multiplex polymerase chain reaction (PCR) test for respiratory viruses and point-of-care test for C-reactive protein. Demographic, clinical and laboratory data were extracted from the hospital electronic medical records. Seventy percent of the data was used for training and the remaining 30% was used for validation. Decision trees, LASSO and logistic regression models were built to predict when antibiotics were not needed. RESULTS: The median age of the cohort was 36 years old, with 61.2% being male. Temperature and pulse rate were significant factors in all 3 models. The area under the receiver operating curve (AUC) on the validation set for the models were similar. (LASSO: 0.70 [95% CI: 0.62–0.77], logistic regression: 0.72 [95% CI: 0.65–0.79], decision tree: 0.67 [95% CI: 0.59–0.74]). Combining the results from all models, 58.3% of study participants would not need antibiotics. CONCLUSION: The models can be easily deployed as a decision support tool to guide antibiotic prescribing in busy EDs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13756-020-00825-3.


id: cord-280158-3fhhuzg5
title: Antibacterial Discovery: 21st Century Challenges
author: Hoffman, Paul S.
date: 2020-04-28
txt: ./txt/cord-280158-3fhhuzg5.txt
cache: ./cache/cord-280158-3fhhuzg5.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/antibiotics9050213
doi: 10.3390/antibiotics9050213
summary:
  The key questions dealt with in this review include: (1) If mutation based drug resistance is the major challenge to any new antibiotic, is it possible to find drug targets and new chemical entities that can escape this outcome; (2) Is the number of novel chemical classes of antibacterials limited by the number of broad spectrum drug targets; and (3) If true, then should we focus efforts on subgroups of pathogens like Gram negative or positive bacteria only, anaerobic bacteria or other group where the range of common essential genes is likely greater?. The pharmaceutical industry abandoned NP divisions long ago in favor of high throughput screens of compound libraries against novel drug targets (another failure, see below); or, more productively to create next generation derivatives of existing antibiotics, a strategy that has worked well and continues today as judged by the number of analogues in the current pipeline.

abstract:
  It has been nearly 50 years since the golden age of antibiotic discovery (1945–1975) ended; yet, we still struggle to identify novel drug targets and to deliver new chemical classes of antibiotics to replace those rendered obsolete by drug resistance. Despite herculean efforts utilizing a wide range of antibiotic discovery platform strategies, including genomics, bioinformatics, systems biology and postgenomic approaches, success has been at best incremental. Obviously, finding new classes of antibiotics is really hard, so repeating the old strategies, while expecting different outcomes, seems to boarder on insanity. The key questions dealt with in this review include: (1) If mutation based drug resistance is the major challenge to any new antibiotic, is it possible to find drug targets and new chemical entities that can escape this outcome; (2) Is the number of novel chemical classes of antibacterials limited by the number of broad spectrum drug targets; and (3) If true, then should we focus efforts on subgroups of pathogens like Gram negative or positive bacteria only, anaerobic bacteria or other group where the range of common essential genes is likely greater?. This review also provides some examples of existing drug targets that appear to escape the specter of mutation based drug resistance, and provides examples of some intermediate spectrum strategies as well as modern molecular and genomic approaches likely to improve the odds of delivering 21st century medicines to combat multidrug resistant pathogens.


id: cord-281188-0cql96hu
title: Proximate and ultimate causes of the bactericidal action of antibiotics
author: Baquero, Fernando
date: 2020-10-06
txt: ./txt/cord-281188-0cql96hu.txt
cache: ./cache/cord-281188-0cql96hu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1038/s41579-020-00443-1
doi: 10.1038/s41579-020-00443-1
summary:
  (1) only free drug is active against the target bacteria, and protein binding of the drug decreases the rate of killing 19 ; (2) there are structures (such as porins) and mechanisms facilitating drug uptake, but also barriers that prevent the drug from entering the cells 20 ; (3) the drug can be pumped out, so the concentration needed for killing takes longer to achieve 21, 22 ; (4) the antibiotics with weak target-binding affinity will take longer to achieve the doses necessary for killing than those with greater affinity 23 ; (5) the targeted function might increase in the presence of the drug, thereby compensating for the inhibition by the drug 24 ; (6) the target function corresponds to the build-up of a cellular structure with slow turnover, which increases the amount of time for the antibiotic to kill 25,26 ; (7) the cells repair the damage produced by the antibiotics at rates that differ between drugs 27 ; (8) the damaged bacteria have inducible antibiotic-deactivating mechanisms 28 ; (9) the bacteria use alternative metabolic pathways that, to some extent, bypass those inhibited by the antibiotic 29, 30 ; (10) antibiotics differ in the extent to which they induce reactive oxygen species (ROS; deleterious) or SOS (potentially protective) responses and thereby the rate at which they kill the exposed bacteria [31] [32] [33] [34] ; (11) members of the antibiotic-exposed populations are either www.nature.com/nrmicro not replicating or are replicating slowly, and as such are killed at lower rates than the more active members of the population or their death is delayed; (12) the antibiotics produce a kind of ''stationary phase'' by activating the general RpoS-mediated stringent response 35 .

abstract:
  During the past 85 years of antibiotic use, we have learned a great deal about how these ‘miracle’ drugs work. We know the molecular structures and interactions of these drugs and their targets and the effects on the structure, physiology and replication of bacteria. Collectively, we know a great deal about these proximate mechanisms of action for virtually all antibiotics in current use. What we do not know is the ultimate mechanism of action; that is, how these drugs irreversibly terminate the ‘individuality’ of bacterial cells by removing barriers to the external world (cell envelopes) or by destroying their genetic identity (DNA). Antibiotics have many different ‘mechanisms of action’ that converge to irreversible lethal effects. In this Perspective, we consider what our knowledge of the proximate mechanisms of action of antibiotics and the pharmacodynamics of their interaction with bacteria tell us about the ultimate mechanisms by which these antibiotics kill bacteria.


id: cord-281836-j1r771nq
author: Hernando-Amado, Sara
date: 2020-08-28
txt: ./txt/cord-281836-j1r771nq.txt
cache: ./cache/cord-281836-j1r771nq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32983000/
doi: 10.3389/fmicb.2020.01914
summary:
  Global Health is based on a broad collaborative and transnational approach to establish "health for all humans." In this case, it focuses AR at a general (global) scale, considering that the selection and global spread of antibiotic-resistant bacteria (ARBs) and antibiotic resistance genes (ARGs) are a problem that influences the health of human societies with disparate social and economic structures and is linked to many societal and ecological factors (Chokshi et al., 2019) . Although not belonging to the antibiotic resistome, genes frequently associated with resistance to other antimicrobials, such as heavy metals or biocides, as well as the genes of the MGEs backbones, eventually involved in the transmission and selection of ARGs among microbial populations, the mobilome at large, are also relevant to track the emergence and dissemination of AR among different habitats Martinez et al., 2017; Baquero et al., 2019) .

title:
  Antibiotic Resistance: Moving From Individual Health Norms to Social Norms in One Health and Global Health

abstract:
  Antibiotic resistance is a problem for human health, and consequently, its study had been traditionally focused toward its impact for the success of treating human infections in individual patients (individual health). Nevertheless, antibiotic-resistant bacteria and antibiotic resistance genes are not confined only to the infected patients. It is now generally accepted that the problem goes beyond humans, hospitals, or long-term facility settings and that it should be considered simultaneously in human-connected animals, farms, food, water, and natural ecosystems. In this regard, the health of humans, animals, and local antibiotic-resistance–polluted environments should influence the health of the whole interconnected local ecosystem (One Health). In addition, antibiotic resistance is also a global problem; any resistant microorganism (and its antibiotic resistance genes) could be distributed worldwide. Consequently, antibiotic resistance is a pandemic that requires Global Health solutions. Social norms, imposing individual and group behavior that favor global human health and in accordance with the increasingly collective awareness of the lack of human alienation from nature, will positively influence these solutions. In this regard, the problem of antibiotic resistance should be understood within the framework of socioeconomic and ecological efforts to ensure the sustainability of human development and the associated human–natural ecosystem interactions.


id: cord-282628-6uoberfu
title: Future impacts and trends in treatment of hospital wastewater
author: Tiwari, Bhagyashree
date: 2020-05-01
txt: ./txt/cord-282628-6uoberfu.txt
cache: ./cache/cord-282628-6uoberfu.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/B9780128197226000171
doi: 10.1016/b978-0-12-819722-6.00017-1
summary:
  The causative agent of most emerging infectious diseases is viruses; every year approximately more than two novel viral pathogens are identified, which can cause illness in a human. Factors for emergence include natural process (evolution of pathogen), infectious agents transfer from vertebrate to mammals, antimicrobial resistance (AMR), and climate change. The factors responsible for the emergence of infectious diseases such as (1) the evolution of new strain, (2) the introduction of a host to enzootic, (3) translocation of infected wildlife, (4) farming practices, and (5) others were provided. Due to emergence of antibiotic-resistant pathogens and unavoidable use of antibiotics, concomitant environmental perturbation caused by climate change might make the earth is not suitable for humans and other livings. Increasing resistance to antibiotics and the emergence of "superbugs" that are resistant to drugs of last resort have highlighted the great need for alternative treatments of bacterial disease. Furthermore, development of drug-resistant organisms and increased pathogen survival rate, only raising panic about the human, animal, and environmental health.

abstract:
  The world’s population growth and economic development result in the increased requirement of land, water, and energy. This increased demand leads to the deforestation, loss in biodiversity, imbalance in agriculture and food supply, climate change, and increase in food and travel trade, which result in emergence and reemergence of infectious diseases. This chapter discussed various emerging infectious diseases and their causative agents (Buruli ulcer and Bunyvirus). Furthermore, this chapter further illustrates the emergence of superbugs and the associated threat due to the presence of pharmaceutical compounds in the environment. The prevalence of pharmaceuticals in the environment exerts ecotoxic effects on living organisms and causes thousands of death every year. The threats associated with the pharmaceutical presence in the environment were briefly discussed in this chapter. Finally, this chapter provides the alternative methods to avoid the use of antibiotics and to develop novel treatment technologies (such as Phage therapy) to degrade and remove the pharmaceutical compounds.


id: cord-286574-t9z2ynt5
title: Speaker presentations
author: nan
date: 2017-09-30
txt: ./txt/cord-286574-t9z2ynt5.txt
cache: ./cache/cord-286574-t9z2ynt5.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S0924857917303400
doi: 10.1016/s0924-8579(17)30340-0
abstract: nan
summary:
  Data on the economic impact of AMR in major pathogens showed that healthcare costs significantly increase in the treatment of infections caused by antibiotic-resistant strains (Maragakis et al. In principle, the major high-level goals consist of optimizing the use of such drugs in health and agriculture and minimizing environmental contamination; sustaining the development of new classes of antimicrobials drugs and other medicines and making them affordable and accessible to all who need them; and much more effective application of infection control and prevention principles. These new agents are bound to change the paradigm for the treatment of infections caused by colistin-resistant Gram-negatives, but uncertainties are still likely to remain, including which agent to use, how to optimize dosing in to maximize efficacy and minimize toxicity as well as potential for development of resistance, and whether use of more than one agent would still be needed.


id: cord-289382-bnl9i9oy
title: Q&A: Antibiotic resistance: where does it come from and what can we do about it?
author: Wright, Gerard D
date: 2010-09-20
txt: ./txt/cord-289382-bnl9i9oy.txt
cache: ./cache/cord-289382-bnl9i9oy.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/1741-7007-8-123
doi: 10.1186/1741-7007-8-123
abstract: nan
summary:
  • the spread of virulent MRSA (methicillin-resistant Staphylococcus aureus) in the community; • the rise of multi-drug resistant Neisseria gonorrhoea; • the emergence and global dissemination of multi-drug resistant Acinetobacter baumannii, Pseudomonas aerugi nosa, Klebsiella pneumoniae and Enterobacteriaceae; • the spread of extensively drug resistant Mycobacterium tuberculosis; • the development of resistance to the two newest antibiotics to be approved for clinical use -daptomycin and linezolid. Microbial natural products have evolved over millennia to interact with biological molecules, whereas the synthetic chemical libraries used in antibiotic drug-discovery screens were generally developed with a focus on eukaryotic drug-discovery campaigns, as noted earlier. Efforts to develop physical-property rules for antibiotics and to incorporate natural-product-like chemical complexity in libraries of synthetic chemicals will no doubt improve success in identifying new synthetic antibiotic leads. Furthermore, natural-product producing bacteria from non-soil environments are being investigated and these have already resulted in new chemical matter, suggesting that there is a fantastic wealth of untapped chemical diversity waiting to be discovered.


id: cord-292094-vmsdhccp
author: Mandell, Lionel A.
date: 2007-03-01
txt: ./txt/cord-292094-vmsdhccp.txt
cache: ./cache/cord-292094-vmsdhccp.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/17278083/
doi: 10.1086/511159
abstract: nan
summary:
  Severity-of-illness scores, such as the CURB-65 criteria (confusion, uremia, respiratory rate, low blood pressure, age 65 years or greater), or prognostic models, such as the Pneumonia Severity Index (PSI), can be used to identify patients with CAP who may be candidates for outpatient treatment. A respiratory fluoroquinolone should be used for penicillin-allergic patients.) Increasing resistance rates have suggested that empirical therapy with a macrolide alone can be used only for the treat-ment of carefully selected hospitalized patients with nonsevere disease and without risk factors for infection with drug-resistant pathogens. Advantages include the high specificity, the ability of some assays to distinguish between influenza A and B, the rapidity with which the results can be obtained, the possibly reduced use of antibacterial agents, and the utility of establishing this diagnosis for epidemiologic purposes, especially in hospitalized patients who may require infection control precautions.

title:
  Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults


id: cord-295605-c6z9n3ij
title: Drugs in upper respiratory tract infections in paediatric patients in North Trinidad
author: Mungrue, Kameel
date: 2009-03-15
txt: ./txt/cord-295605-c6z9n3ij.txt
cache: ./cache/cord-295605-c6z9n3ij.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/25147589/
doi: nan
summary:
  OBJECTIVE: We explored the prescribing patterns of physicians in North Trinidad in treating upper respiratory tract infections (URTI) in paediatric patients and the appropriateness of drugs prescribed. CONCLUSIONS: A large proportion of paediatric patients diagnosed with an URTI in North Trinidad was prescribed antibiotics although not indicated The inappropriate use of antibiotics can potentiate the worldwide trend of antimicrobial resistance. 8 Data from the National Centre for Health Statistics in the United States indicate that in recent years, approximately 75% of all outpatient prescriptions for antimicrobial medications have been issued primarily for five conditions: otitis media, sinusitis, bronchitis, pharyngitis or non-specific URTIs. 9 The majority of URTIs are of viral origin, due to rhinovirus, parainfluenza virus, coronavirus, adenovirus, Coxsackie virus, and influenza virus. 15 Mohan et al in 2004 reported that the five most frequent URTIs presenting in children in Trinidad are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media in rank order.

abstract:
  OBJECTIVE: We explored the prescribing patterns of physicians in North Trinidad in treating upper respiratory tract infections (URTI) in paediatric patients and the appropriateness of drugs prescribed. METHODS: A retrospective observational study was conducted, with a sample size of 523 paediatric patients, diagnosed with an URTI during the period of June 2003 to 22 June 2005. The study was conducted at five Primary Health Care Facilities in North Trinidad. RESULTS: The three most frequent URTIs diagnosed were non-specific URTI, common cold, and acute tonsillitis in rank order. Four patterns of prescribing were identified, (1) no drug therapy [1.9%]; (2) antibiotic therapy alone [6.1%]; (3) antibiotic and symptomatic therapy [53.0%]; and (4) symptomatic therapy alone [39.0%]. The, most frequently prescribed antibiotics were penicillins (amoxicillin [46.3%] and amoxicillin/clavulanate [5.3%]) and a macrolide (erythromycin [6.1%]). The three symptomatic agents most frequently prescribed were paracetamol [40.1%]; diphenhydramine [29.1%]; and normal saline nasal drops [14.2%]. In 112 cases with swab analyses done, of these, 98.2% revealed a growth of commensals only, while 1.8% grew pathogenic micro-organisms. Of the cases showing commensal growth only, 84.6% were treated with an antibiotic, 14.5% were treated with symptomatic agents alone and 0.9% received no drug therapy at all. CONCLUSIONS: A large proportion of paediatric patients diagnosed with an URTI in North Trinidad was prescribed antibiotics although not indicated The inappropriate use of antibiotics can potentiate the worldwide trend of antimicrobial resistance.


id: cord-297125-la20vi9j
title: The Threat and Response to Infectious Diseases (Revised)
author: Brower, Jennifer L.
date: 2016-08-01
txt: ./txt/cord-297125-la20vi9j.txt
cache: ./cache/cord-297125-la20vi9j.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/27480226/
doi: 10.1007/s00248-016-0806-9
summary:
  In just the past year, the United States has been bombarded with headlines on the dangers of infectious diseases: "HIV ''Epidemic'' Triggered by Needle-Sharing Hits Scott County, Indiana [1] ;" "American with Ebola Now in Critical Condition [2] ;" "Seasonal Flu Vaccine Even Less Effective than Thought: CDC [3] ;" "''Superbug'' Outbreak at California Hospital, more than 160 Exposed [4] ;" "Deadly CRE Bugs Linked to Hard to Clean Medical Scopes [5] ;" "Painful Virus [Chikungunya] Sweeps Central America, Gains a Toehold in U.S. Many factors have reduced the number of new antibiotics approved in the United States each year as well as reduced domestic production including demanding Food and Drug Administration (FDA) regulations, the cost and time to market of development, the consolidation in the pharmaceutical industry, and the lack of financial impetus to produce and distribute antibiotics, which are generally used on a one-off basis versus drugs used to treat chronic conditions such as statins, Viagra, and allergy medications.

abstract:
  The threat from microorganisms is complex, and the approaches for reducing the challenges the world is facing are also multifaceted, but a combination approach including several simple steps can make a difference and reduce morbidity and mortality and the economic cost of fighting infectious diseases. This paper discusses the continually evolving infectious disease landscape, contributing factors in the rise of the threat, reasons for optimism, and the policies, technologies, actions, and institutions that might be harnessed to further reduce the dangers introduced by pathogens. It builds upon and updates the work of other authors that have recognized the dangers of emerging and re-emerging pathogens and have explored and documented potential solutions.


id: cord-297216-1b99hm1e
author: Sariola, Salla
date: 2020-05-16
txt: ./txt/cord-297216-1b99hm1e.txt
cache: ./cache/cord-297216-1b99hm1e.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/microorganisms8050746
doi: 10.3390/microorganisms8050746
summary:
  In the Anthropocene, the conditions for microbial evolution have been altered by human interventions, and public health initiatives must recognize both the beneficial (indeed, necessary) interactions of microbes with their hosts as well as their pathogenic interactions. Its website proclaims this to be a big genome, big data approach to public health, whereby "taking into account individual differences in lifestyle, environment, and biology, researchers will uncover paths toward delivering precision medicine..." PPH is getting a shot in the other arm from pharmacogenomics, the study of how responses to drugs are influenced by the genetic makeup of the person receiving the drug. Holobiont public health would do well to recognize both the parasitic and the mutualistic branches of symbiosis [204] It would also recognize the two major changes in our scientific knowledge of microbial evolution that have occurred in this century: (1) organisms are holobionts composed of several species, wherein microbes help maintain healthy physiology and resilience; and (2) bacteria can pass genes through horizontal genetic transmission, thereby facilitating the rapid spread of antibiotic resistance through numerous bacterial species.

title:
  Toward a Symbiotic Perspective on Public Health: Recognizing the Ambivalence of Microbes in the Anthropocene

abstract:
  Microbes evolve in complex environments that are often fashioned, in part, by human desires. In a global perspective, public health has played major roles in structuring how microbes are perceived, cultivated, and destroyed. The germ theory of disease cast microbes as enemies of the body and the body politic. Antibiotics have altered microbial development by providing stringent natural selection on bacterial species, and this has led to the formation of antibiotic-resistant bacterial strains. Public health perspectives such as “Precision Public Health” and “One Health” have recently been proposed to further manage microbial populations. However, neither of these take into account the symbiotic relationships that exist between bacterial species and between bacteria, viruses, and their eukaryotic hosts. We propose a perspective on public health that recognizes microbial evolution through symbiotic associations (the hologenome theory) and through lateral gene transfer. This perspective has the advantage of including both the pathogenic and beneficial interactions of humans with bacteria, as well as combining the outlook of the “One Health” model with the genomic methodologies utilized in the “Precision Public Health” model. In the Anthropocene, the conditions for microbial evolution have been altered by human interventions, and public health initiatives must recognize both the beneficial (indeed, necessary) interactions of microbes with their hosts as well as their pathogenic interactions.


id: cord-304972-aktfbriw
title: Recommendations for Management of Acute Pharyngitis in Adults
author: Cots, Josep M.
date: 2015-06-30
txt: ./txt/cord-304972-aktfbriw.txt
cache: ./cache/cord-304972-aktfbriw.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S2173573515000423
doi: 10.1016/j.otoeng.2015.05.003
summary:
  4---7 In normal practice, a diagnosis is made based on clinical criteria (fever, tonsillar exudate, anterior cervical lymphadenopathy and no cough), which are of low sensitivity in predicting GABHS (49%---74%), and therefore the indication for the prescription of antibiotics increases as there are a great many false positives. Validity depends on the sample collection technique (false-negative results can be given when little material has been obtained), on the area from which it is collected (there is a better yield when collected from the tonsils and/or the wall posterior to the pharynx), on the culture procedure and conditions, on the probability of streptococcal infection (some authors have found a spectrum bias, so that the sensitivity of Strep A increases the higher the Centor criteria number presented by a patient), the presence of other germs in the pharynx (false-positive results can be given if the pharynx presents major growth of Staphylococcus aureus), on the use of tests which are past their expiry date, and on commercial brand.

abstract:
  Abstract Acute pharyngitis in adults is one of the most common infectious diseases seen in general practitioners’ consultations. Viral aetiology is the most common. Among bacterial causes, the main agent is Streptococcus pyogenes or group A β-haemolytic streptococcus (GABHS), which causes 5%–30% of the episodes. In the diagnostic process, clinical assessment scales can help clinicians to better predict suspected bacterial aetiology by selecting patients who should undergo a rapid antigen detection test. If these techniques are not performed, an overdiagnosis of streptococcal pharyngitis often occurs, resulting in unnecessary prescriptions of antibiotics, most of which are broad spectrum. Consequently, management algorithms that include the use of predictive clinical rules and rapid tests have been set up. The aim of the treatment is speeding up symptom resolution, reducing the contagious time span and preventing local suppurative and non-suppurative complications. Penicillin and amoxicillin are the antibiotics of choice for the treatment of pharyngitis. The association of amoxicillin and clavulanate is not indicated as the initial treatment of acute infection. Neither are macrolides indicated as first-line therapy; they should be reserved for patients allergic to penicillin. The appropriate diagnosis of bacterial pharyngitis and proper use of antibiotics based on the scientific evidence available are crucial. Using management algorithms can be helpful in identifying and screening the cases that do not require antibiotic therapy.


id: cord-306600-cxz8hf9q
author: Matarazzo, Laura
date: 2019-04-09
txt: ./txt/cord-306600-cxz8hf9q.txt
cache: ./cache/cord-306600-cxz8hf9q.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3389/fimmu.2019.00723
doi: 10.3389/fimmu.2019.00723
summary:
  Previous studies of the TLR5 agonist flagellin in animal models showed that standalone TLR stimulation does not result in the effective treatment of pneumococcal respiratory infection but does significantly improve the therapeutic outcome of concomitant antibiotic treatment. Previous studies of the TLR5 agonist flagellin in animal models showed that standalone TLR stimulation does not result in the effective treatment of pneumococcal respiratory infection but does significantly improve the therapeutic outcome of concomitant antibiotic treatment. pneumoniae lung infection, we recently demonstrated that combination treatment with mucosally administered flagellin and an orally or intraperitoneally administered low-dose (i.e., subtherapeutic) antibiotic is more effective than the antibiotic alone (i.e., with a lower bacterial load in the lung, and a lower mortality rate). Our data showed that several antimicrobial peptides (S100A9), cytokines (IL-1β and TNF), and chemokines (CCL20, CXCL1, and CXCL2) that were associated to epithelial responses are also upregulated after the administration of the combination treatment in the post-flu superinfection model, suggesting that the epithelium is also an important flagellin-specific driving force in the lung damaged by viral and bacterial infections.

title:
  Therapeutic Synergy Between Antibiotics and Pulmonary Toll-Like Receptor 5 Stimulation in Antibiotic-Sensitive or -Resistant Pneumonia

abstract:
  Bacterial infections of the respiratory tract constitute a major cause of death worldwide. Given the constant rise in bacterial resistance to antibiotics, treatment failure is increasingly frequent. In this context, innovative therapeutic strategies are urgently needed. Stimulation of innate immune cells in the respiratory tract [via activation of Toll-like receptors (TLRs)] is an attractive approach for rapidly activating the body's immune defenses against a broad spectrum of microorganisms. Previous studies of the TLR5 agonist flagellin in animal models showed that standalone TLR stimulation does not result in the effective treatment of pneumococcal respiratory infection but does significantly improve the therapeutic outcome of concomitant antibiotic treatment. Here, we investigated the antibacterial interaction between antibiotic and intranasal flagellin in a mouse model of pneumococcal respiratory infection. Using various doses of orally administered amoxicillin or systemically administered cotrimoxazole, we found that the intranasal instillation of flagellin (a dose that promotes maximal lung pro-inflammatory responses) induces synergistic rather than additive antibacterial effects against antibiotic–susceptible pneumococcus. We next set up a model of infection with pneumococcus that is resistant to multiple antibiotics in the context of influenza superinfection. Remarkably, the combination of amoxicillin and flagellin effectively treated superinfection with the amoxicillin-resistant pneumococcus since the bacterial clearance was increased by more than 100-fold compared to standalone treatments. Our results also showed that, in response to flagellin, the lung tissue generated an innate immune response even though it had been damaged by the influenza virus and pneumococcal infections. In conclusion, we demonstrated that the selective boosting of lung innate immunity is a conceptually advantageous approach for improving the effectiveness of antibiotic treatment and fighting antibiotic-resistant bacteria.


id: cord-307429-ll109j3i
author: Phuong, Nguyen T. K.
date: 2017-04-25
txt: ./txt/cord-307429-ll109j3i.txt
cache: ./cache/cord-307429-ll109j3i.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1186/s41479-017-0031-4
doi: 10.1186/s41479-017-0031-4
summary:
  The authors conducted a comprehensive literature review to explore the antibiotic resistance profile of bacteria associated with pneumonia in the Western Pacific Region, with a focus on Vietnam. In order to encourage more rational use of intravenous antibiotics in children with communityacquired pneumonia, the authors performed a comprehensive review of common bacterial pathogens and their reported drug resistance profiles in the Western Pacific Region-Vietnam in particular. PubMed, Google Scholar and Embase databases were searched using the following terms: antibacterial agents OR antibiotics OR drug therapy AND community acquired pneumonia OR acute respiratory tract infection AND child OR children OR childhood. With enhanced diagnostic tools, respiratory viruses and atypical bacteria such as Mycoplasma pneumonia are commonly detected in children with community-acquired pneumonia, particularly in studies from the Western Pacific Region [7] [8] [9] . Despite the available evidence, most doctors in Vietnam routinely hospitalize children with "clinical pneumonia" to administer intravenous antibiotics; unnecessary hospitalization increases both healthcare cost and the risk of nosocomial infection.

title:
  Encouraging rational antibiotic use in childhood pneumonia: a focus on Vietnam and the Western Pacific Region

abstract:
  Globally, pneumonia is considered to be the biggest killer of infants and young children (aged <5 years) outside the neonatal period, with the greatest disease burden in low- and middle-income countries. Optimal management of childhood pneumonia is challenging in settings where clinicians have limited information regarding the local pathogen and drug resistance profiles. This frequently results in unnecessary and poorly targeted antibiotic use. Restricting antibiotic use is a global priority, particularly in Asia and the Western Pacific Region where excessive use is driving high rates of antimicrobial resistance. The authors conducted a comprehensive literature review to explore the antibiotic resistance profile of bacteria associated with pneumonia in the Western Pacific Region, with a focus on Vietnam. Current management practices were also considered, along with the diagnostic dilemmas faced by doctors and other factors that increase unnecessary antibiotic use. This review offers some suggestions on how these issues may be addressed.


id: cord-308001-gkd9d3k0
title: Infectious Disease and Primary Care Research—What English General Practitioners Say They Need
author: Lecky, Donna M.
date: 2020-05-20
txt: ./txt/cord-308001-gkd9d3k0.txt
cache: ./cache/cord-308001-gkd9d3k0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.3390/antibiotics9050265
doi: 10.3390/antibiotics9050265
summary:
  In a 1999 survey of GPs, we found that genital chlamydia infection, antibiotic resistance surveillance, vaginal discharge, leg ulcers, sinusitis, otitis media/externa, dyspepsia/Helicobacter pylori, Creutzfeldt-Jakob disease (CJD) and tonsillitis were the top 10 priorities for improvements to diagnostic tests, and stronger evidence on which to base treatment decisions [9, 10] . Of the 27 named conditions/illnesses, suspected infection in the elderly (82.2%), recurrent urinary tract infection (UTI) (81.2%), surveillance of antibiotic resistance in the community (81.0%), leg ulcers (75.4%), and persistent cough (75.2%) were the five most highly rated illness/conditions where respondents felt they required more evidence to support their daily practice. Of the 27 named conditions/illnesses, suspected infection in the elderly (82.2%), recurrent urinary tract infection (UTI) (81.2%), surveillance of antibiotic resistance in the community (81.0%), leg ulcers (75.4%), and persistent cough (75.2%) were the five most highly rated illness/conditions where respondents felt they required more evidence to support their daily practice.

abstract:
  Background: Infections are one of the most common reasons for patients attending primary care. Antimicrobial resistance (AMR) is perhaps one of the biggest threats to modern medicine; data show that 81% of antibiotics in the UK are prescribed in primary care. Aim: To identify where the perceived gaps in knowledge, skills, guidance and research around infections and antibiotic use lie from the general practitioner (GP) viewpoint. Design and Setting: An online questionnaire survey. Method: The survey, based on questions asked of Royal College of General Practitioners (RCGP) members in 1999, and covering letter were electronically sent to GPs between May and August 2017 via various primary care dissemination routes. Results: Four hundred and twenty-eight GPs responded. Suspected Infection in the elderly, recurrent urinary tract infection (UTI), surveillance of AMR in the community, leg ulcers, persistent cough and cellulitis all fell into the top six conditions ranked in order of importance that require further research, evidence and guidance. Acute sore throat, otitis media and sinusitis were of lower importance than in 1999. Conclusion: This survey will help the NHS, the UK National Institute for Health and Care Excellence (NICE) and researchers to prioritise for the development of guidance and research for chronic conditions highlighted for which there is little evidence base for diagnostic and management guidelines in primary care. In contrast, 20 years of investment into research, guidance and resources for acute respiratory infections have successfully reduced these as priority areas for GPs.


id: cord-308480-t2vukbwp
title: Molecular Basis of NDM-1, a New Antibiotic Resistance Determinant
author: Liang, Zhongjie
date: 2011-08-24
txt: ./txt/cord-308480-t2vukbwp.txt
cache: ./cache/cord-308480-t2vukbwp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1371/journal.pone.0023606
doi: 10.1371/journal.pone.0023606
summary:
  In addition, the detailed analysis indicates that the more flexible and hydrophobic loop1, together with the evolution of more positive-charged loop2 leads to NDM-1 positive strain more potent and extensive in antibiotics resistance compared with other MBLs. Furthermore, through biological experiments, we revealed the molecular basis for antibiotics catalysis of NDM-1 on the enzymatic level. Taking two typical antibiotics, imipenem and carbapenem as example, the docked complex structures revealed that although the antibiotics adopted diverse conformations in the active site, the lactam motifs were positioned in the same orientation by coordinating with zinc ions tightly ( Figure 2C ), which suggested that the catalytic mechanisms were highly conserved among B1 subclass enzymes, as shown in Figure 3 . To gain the structural insight into the mechanism of the potent hydrolysis of NDM-1, the intermolecular interactions of three models of NDM-1, VIM-2 and FEZ-1 in complex with antibiotics meropenem were compared and analyzed in details ( Figure 4A -C).

abstract:
  The New Delhi Metallo-β-lactamase (NDM-1) was first reported in 2009 in a Swedish patient. A recent study reported that Klebsiella pneumonia NDM-1 positive strain or Escherichia coli NDM-1 positive strain was highly resistant to all antibiotics tested except tigecycline and colistin. These can no longer be relied on to treat infections and therefore, NDM-1 now becomes potentially a major global health threat. In this study, we performed modeling studies to obtain its 3D structure and NDM-1/antibiotics complex. It revealed that the hydrolytic mechanisms are highly conserved. In addition, the detailed analysis indicates that the more flexible and hydrophobic loop1, together with the evolution of more positive-charged loop2 leads to NDM-1 positive strain more potent and extensive in antibiotics resistance compared with other MBLs. Furthermore, through biological experiments, we revealed the molecular basis for antibiotics catalysis of NDM-1 on the enzymatic level. We found that NDM-1 enzyme was highly potent to degrade carbapenem antibiotics, while mostly susceptible to tigecycline, which had the ability to slow down the hydrolysis velocity of meropenem by NDM-1. Meanwhile, the mutagenesis experiments, including D124A, C208A, K211A and K211E, which displayed down-regulation on meropenem catalysis, proved the accuracy of our model. At present, there are no effective antibiotics against NDM-1 positive pathogen. Our study will provide clues to investigate the molecular basis of extended antibiotics resistance of NDM-1 and then accelerate the search for new antibiotics against NDM-1 positive strain in clinical studies.


id: cord-310474-hip7t0jx
title: Nontraditional Antibiotics—Challenges and Triumphs
author: Hansford, Karl A.
date: 2020-04-09
txt: ./txt/cord-310474-hip7t0jx.txt
cache: ./cache/cord-310474-hip7t0jx.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32283718/
doi: 10.3390/antibiotics9040169
summary:
  Although the future potential of nontraditional therapies is viewed with cautious optimism, adequate resourcing will be critical to demonstrate clinical impact, especially when many of the translational criteria associated with direct-acting small molecule therapeutics will likely be incongruent with the nontraditional development pathway. The three review articles by Zurawski and McLendon [5] , Nikolich and Filippov [6] , and Ghose and Euler [7] give a superb timely survey of how monoclonal antibodies, bacteriophages and lysins, respectively, are currently being explored in the treatment of bacterial infections. Turning to small molecule therapeutics, Frei''s perspective on the untapped potential of metal complexes as antibiotics provides a compelling view that chemical classes often misconstrued as only being useful for certain applications should not be overlooked as potential sources of new chemotypes to fight bacterial infections [8] . Critical Parameters for the Development of Novel Therapies for Severe and Resistant Infections-A Case Study on CAL02, a Non-Traditional Broad-Spectrum Anti-Virulence Drug

abstract:
  The pursuit of nontraditional antibiotics is becoming an increasingly important means to tackle seemingly insurmountable challenges faced by contemporary antibiotic researchers as they overcome the shifting landscape of bacterial pathogenesis, particularly for Gram-negative bacteria [...].


id: cord-312266-hnbgaxft
title: Current therapeutics and prophylactic approaches to treat pneumonia
author: Krishnamurthy, A.
date: 2016-08-05
txt: ./txt/cord-312266-hnbgaxft.txt
cache: ./cache/cord-312266-hnbgaxft.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/B9780128045435000178
doi: 10.1016/b978-0-12-804543-5.00017-8
summary:
  The Haemophilus influenzae type b (Hib) vaccine and the pneumococcal conjugate vaccines are increasingly available in both developed as well as developing countries, especially the 7-and 13-valent pneumococcal conjugate vaccines which have shown effectiveness in reducing the incidence and severity of pneumonia and other lower respiratory infections in children. 61 The efficacy of ribavirin for the treatment of RSV CAP in infants is debatable, as certain in vitro studies have shown activity of ribavirin against RSV, but its usage for RSV infection is not routinely recommended in the management of lower respiratory tract disease because of the high cost, aerosol administration, and possible toxic effects among healthcare providers. 90 Zabofloxacin: is being developed as a new fluoroquinolone antibiotic that is a potent and selective inhibitor of the essential bacterial type II topoisomerases and topoisomerase IV and is indicated for community-acquired respiratory infections due to Gram-positive bacteria.

abstract:
  Bacterial pneumonia caused by Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Mycoplasma pneumoniae, and Klebsiella pneumoniae represents a frequent cause of mortality worldwide. The increased incidence of pneumococcal diseases in both developed and developing countries is alarmingly high, affecting infants and aged adult populations. The growing rate of antibiotic resistance and biofilm formation on medical device surfaces poses a greater challenge for treating respiratory infections. Over recent years, a better understanding of bacterial growth, metabolism, and virulence has offered several potential targets for developing therapeutics against bacterial pneumonia. This chapter will discuss the current and developing trends in treating bacterial pneumonia.


id: cord-312417-li41ng7v
author: Chowdhury, Moyukh
date: 2020-10-12
txt: ./txt/cord-312417-li41ng7v.txt
cache: ./cache/cord-312417-li41ng7v.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33040695/
doi: 10.1080/16549716.2020.1824383
summary:
  title: Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh OBJECTIVE: To explore factors and practices around access and use of antibiotics and understanding of antimicrobial resistance in rural communities in Bangladesh from a socio-cultural perspective. METHODS: This qualitative study comprises the second phase of the multi-country ABACUS (Antibiotic Access and Use) project in Matlab, Bangladesh. Multi-sectoral action is needed to confront the underlying social, economic, cultural and political drivers that impact on the access and use of antibiotic medicines in Bangladesh. The objective of this study is to explore factors and practices around access and use of antibiotics and understanding of antimicrobial resistance in rural communities in Bangladesh from a socio-cultural perspective. This study found that people in rural communities in Matlab were either not informed or knew little about appropriate access and use of antibiotic medicines.

title:
  Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

abstract:
  BACKGROUND: The use of large quantities of antimicrobial drugs for human health and agriculture is advancing the predominance of drug resistant pathogens in the environment. Antimicrobial resistance is now a major public health threat posing significant challenges for achieving the Sustainable Development Goals. In Bangladesh, where over one third of the population is below the poverty line, the achievement of safe and effective antibiotic medication use for human health is challenging. OBJECTIVE: To explore factors and practices around access and use of antibiotics and understanding of antimicrobial resistance in rural communities in Bangladesh from a socio-cultural perspective. METHODS: This qualitative study comprises the second phase of the multi-country ABACUS (Antibiotic Access and Use) project in Matlab, Bangladesh. Information was collected through six focus group discussions and 16 in-depth interviews. Informants were selected from ten villages in four geographic locations using the Health and Demographic Surveillance System database. The Access to Healthcare Framework guided the interpretation and framing of the findings in terms of individuals’ abilities to: perceive, seek, reach, pay and engage with healthcare. RESULTS: Village pharmacies were the preferred and trusted source of antibiotics for self-treatment. Cultural and religious beliefs informed the use of herbal and other complementary medicines. Advice on antibiotic use was also sourced from trusted friends and family members. Access to government-run facilities required travel on poorly maintained roads. Reports of structural corruption, stock-outs and patient safety risks eroded trust in the public sector. Some expressed a willingness to learn about antibiotic resistance. CONCLUSION: Antimicrobial resistance is both a health and development issue. Social and economic contexts shape medicine seeking, use and behaviours. Multi-sectoral action is needed to confront the underlying social, economic, cultural and political drivers that impact on the access and use of antibiotic medicines in Bangladesh.


id: cord-317410-hc06yo32
author: Muthanna, Abdulrahman
date: 2018-12-28
txt: ./txt/cord-317410-hc06yo32.txt
cache: ./cache/cord-317410-hc06yo32.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/30914875/
doi: 10.21315/mjms2018.25.6.2
summary:
  However, a patient with a score of four should be tested by using rapid antigen detection test or throat culture, and empiric antibiotic therapy is required due to chance of streptococcal infection is high between 38% and 64% ( Figure 3 ) (61). To help physicians to prescribe the appropriate antibiotics for children and adults with streptococcus pharyngitis, Centres for Disease Control and Prevention (CDC), American Academy of Family Physicians (AAFP), and the Institute for Medical Research (IMR) have developed the clinical practice guidelines for respiratory tract infections (47, 64, 65) . According to the CDC, AAFP guidelines, and the National Antibiotic Guideline in Malaysia, antibiotics should be prescribed only to patients with group A streptococcal infection (Streptococcus pyogenes) which group A streptococcus usually cause symptoms including sore throat, fever more than 38 °C, exudates, nausea, vomiting, headache, stiff and swollen neck, abdominal pain, and tender enlarged cervical lymph nodes.

title:
  Clinical Screening Tools to Diagnose Group A Streptococcal Pharyngotonsillitis in Primary Care Clinics to Improve Prescribing Habits

abstract:
  This review highlights the clinical scoring tools used for the management of acute pharyngotonsillitis in primary care clinics. It will include the prevalence of group A pharyngotonsillitis among children and adults worldwide and the selective tests employed for diagnosing group A streptococcal pharyngotonsillitis. Pharyngotonsillitis is one of the common reasons for visits to primary care clinics worldwide, and physicians tend to prescribe antibiotics according to the clinical symptoms, which leads to overprescribing antibiotics. This in turn may lead to serious health impacts and severe reactions and may promote antibiotic resistance. These significantly add on to the health care costs. The available information from health organisations and previous studies has indicated the need to manage the diagnosis of pharyngotonsillitis to improve prescribing habits in primary care clinics.


id: cord-322915-zrjx31ev
title: Microbial drug discovery: 80 years of progress
author: Demain, Arnold L
date: 2009-01-09
txt: ./txt/cord-322915-zrjx31ev.txt
cache: ./cache/cord-322915-zrjx31ev.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1038/ja.2008.16
doi: 10.1038/ja.2008.16
summary:
  Evidence of the importance of natural products in the discovery of leads for the development of drugs for the treatment of human diseases is provided by the fact that close to half of the best selling pharmaceuticals in 1991 were either natural products or their derivatives. In addition to the antibiotic-resistance problem, new families of anti-infective compounds are needed to enter the marketplace at regular intervals to tackle the new diseases caused by evolving pathogens. 28 Among the novel class of antimicrobial agents used in treating resistance to Gram-positive infections, we can also mention the cyclic lipopeptide antibiotic daptomycin produced by Streptomyces roseosporus. 44 Other applications include antitumor drugs, enzyme inhibitors, gastrointestinal motor stimulator agents, hypocholesterolemic drugs, ruminant growth stimulants, insecticides, herbicides, coccidiostats, antiparasitics vs coccidia, helminths and other pharmacological activities. Considering that animal health research and the development of new anti-infective product discovery have decreased, the discovery of new antibiotics has decreased over the past 15 years, with few new drug approvals.

abstract:
  Microbes have made a phenomenal contribution to the health and well-being of people throughout the world. In addition to producing many primary metabolites, such as amino acids, vitamins and nucleotides, they are capable of making secondary metabolites, which constitute half of the pharmaceuticals on the market today and provide agriculture with many essential products. This review centers on these beneficial secondary metabolites, the discovery of which goes back 80 years to the time when penicillin was discovered by Alexander Fleming.


id: cord-333334-90q1xkld
author: Shengchen, D.
date: 2019-06-20
txt: ./txt/cord-333334-90q1xkld.txt
cache: ./cache/cord-333334-90q1xkld.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.cmi.2019.06.012
doi: 10.1016/j.cmi.2019.06.012
summary:
  title: Evaluation of a molecular point-of-care testing for viral and atypical pathogens on intravenous antibiotic duration in hospitalized adults with lower respiratory tract infection: a randomized clinical trial OBJECTIVES: The primary objective was to evaluate whether a molecular point-of-care test (POCT) for viral and atypical pathogens added to routine real-time PCR could reduce duration of intravenous antibiotics in hospitalized patients with lower respiratory tract infection (LRTI) compared with routine real-time PCR. The median and interquartile range of the primary outcome (duration of intravenous antibiotics) and secondary outcomes, including length of hospital stay, cost of intravenous antibiotics and cost of hospitalization, were calculated and the difference between intervention and control group was compared using the Wilcoxon rank-sum test. In conclusion, this study found the addition of molecular POCT testing to routine real-time PCR testing for respiratory viruses and atypical pathogens might help to reduce intravenous antibiotic use in LRTI patients without resulting in adverse outcomes.

title:
  Evaluation of a molecular point-of-care testing for viral and atypical pathogens on intravenous antibiotic duration in hospitalized adults with lower respiratory tract infection: a randomized clinical trial

abstract:
  OBJECTIVES: The primary objective was to evaluate whether a molecular point-of-care test (POCT) for viral and atypical pathogens added to routine real-time PCR could reduce duration of intravenous antibiotics in hospitalized patients with lower respiratory tract infection (LRTI) compared with routine real-time PCR. METHODS: In this single-centre, open-label, randomized controlled study, we enrolled hospitalized adults diagnosed with LRTI. Patients were randomized to an intervention group (POCT FilmArray Panel for 20 viruses, atypical pathogens and bacteria plus routine real-time PCR) or a control group (routine real-time PCR for ten pathogens). The primary outcome was duration of intravenous antibiotics during hospitalization. The secondary outcomes included length of stay, cost of hospitalization and de-escalation within 72 hours and between 72 hours and 7 days. Intention-to-treat analysis was used. RESULTS: Between October 2017 and July 2018, we enrolled 800 eligible patients (398 in the intervention group and 402 in the control group). Duration of intravenous antibiotics in the intervention group was shorter than in the control (7.0 days (interquartile range (IQR) 5.0–9.0) versus 8.0 days (IQR 6.0–11.0); p <0.001). Length of hospital stay in the intervention group was significantly shorter (8.0 days (IQR 7.0–11.0) versus 9.0 days (IQR 7.0–12.0; p <0.001) and the cost of hospitalization in the intervention group was significantly lower ($1804.7 (IQR 1298.4–2633.8) versus $2042.5 (IQR 1427.4–2926.2); p 0.002) than control group. More patients in the intervention group achieved de-escalation within 72 hours (7.9%, 29/367 versus 3.2%, 12/377; p 0.005) and between 72 hours and 7 days (29.7%, 109/367 versus 22.0%, 83/377; p 0.024). CONCLUSIONS: Use of molecular POCT testing for respiratory viruses and atypical pathogens might help to reduce intravenous antibiotic use in hospitalized LRTI patients. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03391076.


id: cord-333535-pzjj2wxc
title: Antimicrobial Decision Making for Enteric Diseases of Cattle
author: Smith, Geof
date: 2015-02-20
txt: ./txt/cord-333535-pzjj2wxc.txt
cache: ./cache/cord-333535-pzjj2wxc.txt
extension: .txt
mime: text/plain
url: https://api.elsevier.com/content/article/pii/S074907201400084X
doi: 10.1016/j.cvfa.2014.11.004
summary:
  Despite the limited number of enteric diseases in adult cattle that would benefit from antimicrobial therapy, surveys indicate that diarrhea is a relatively common reason for the use of antibiotics. If Salmonella are the main target of antimicrobial therapy in adult cattle with diarrhea, drug selection should ideally be based on the results of susceptibility testing using bacterial strains recovered from that particular dairy or feedlot. Despite this importance, the United States Department of Agriculture Dairy 2007 study shows a preweaned Antimicrobial Decision Making heifer calf mortality rate of 8.7% and reports that only 40% of farms can supply an adequate number of replacements from their own herd. The investigators concluded that amoxicillin had a significant effect on disease by decreasing mortality and number of scouring days; however, treatment success could not be predicted by whether the E coli cultured from rectal swabs was susceptible or resistant to the antimicrobial being used.

abstract:
  Diarrhea in neonatal and adult cattle is common and can be caused by several etiologic agents. As diagnostic testing is not always readily available, practitioners must often decide on a course of treatment based on knowledge of the likely pathogen and their own clinical experience. Antimicrobials have long been used to treat diarrhea in adults and neonates; however, there is increased pressure to prevent unnecessary use of antibiotics in food animal species. This article reviews existing data on the use of antibiotics given to cattle with enteric diseases to decide when they are necessary and which antimicrobials should be used.


id: cord-333950-e0hd3iuu
author: Maillard, Jean-Yves
date: 2020-04-18
txt: ./txt/cord-333950-e0hd3iuu.txt
cache: ./cache/cord-333950-e0hd3iuu.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0196655320302091?v=s5
doi: 10.1016/j.ajic.2020.04.011
summary:
  The authors call upon national and international policy makers, health agencies and healthcare professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR. 3, 4 The main driver is overuse and misuse of antibiotics in medicine and agriculture including unregulated over-the-counter sales, while global spread of resistant bacteria or resistance genes is attributed to poor infection prevention and control in healthcare facilities, and sub-optimal hygiene and sanitation in communities, confounded by poor infrastructure and weak governance. 94 Studies in day-care centers and schools in which hand hygiene was combined with cleaning and/or disinfection of environmental surfaces indicate a positive impact on illness rates and reduction in the use of antibiotics. The evidence set out in this paper suggests that, if combined with measures ensuring clean water and adequate sanitation, targeted hygiene practices in home and everyday life settings could make a significant contribution to tackling AMR through infection prevention and a consequential reduction in antibiotic prescribing.

title:
  Reducing antibiotic prescribing and addressing the global problem of antibiotic resistance by targeted hygiene in the home and everyday life settings: A Position Paper

abstract:
  Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of healthcare facilities with home and everyday life settings barely addressed. As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms. This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in healthcare settings requires a mirrored reduction in the community. The authors call upon national and international policy makers, health agencies and healthcare professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.


id: cord-337955-4p6wbd0h
title: Screening figures
author: Mark, C.
date: 2020-09-11
txt: ./txt/cord-337955-4p6wbd0h.txt
cache: ./cache/cord-337955-4p6wbd0h.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1038/s41415-020-2129-y
doi: 10.1038/s41415-020-2129-y
abstract: nan
summary:
  The number of antibiotics dispensed each month by community pharmacists in England relating to NHS dental prescription forms from January 2018 to May 2020 is given in Figure 1 . 2 Antibiotics may have been used: • As a ''quick fix'' to avoid the life-time impact of an unnecessary extraction, in anticipation that AGPs might soon be permissible in general dental practices • Because dentists felt pressured by some patients for antibiotics, irrespective of their efficacy or appropriateness for treating toothache • Because of difficulties diagnosing a patient''s condition remotely prompting a ''just in case'' approach through concerns of life-threatening deterioration without treatment Finally, the NHS may have seen an influx in patients who might otherwise receive care privately, resulting in an increase in NHS dental prescriptions as, anecdotally, not all practices were open for telephone triage during April and May 2020. When this figure is combined with the average number of patients that we have seen each week, since lockdown was eased, and the local population, this enables us to quantify the risk of us seeing an undiagnosed COVID-19 patient in the practice.


id: cord-346308-9h2fk9qt
title: Microbiology of hospital wastewater
author: Kaur, Rajwinder
date: 2020-05-01
txt: ./txt/cord-346308-9h2fk9qt.txt
cache: ./cache/cord-346308-9h2fk9qt.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/B9780128197226000043
doi: 10.1016/b978-0-12-819722-6.00004-3
summary:
  The study of hospital wastewater (HWW) microbiology is important to understand the pollution load, growth of particular pathogenic microbes, shift and drift in microbial community, development and spread of antibiotic resistance in microbes, and subsequent change in treatment efficiencies. Within past years, pieces of evidence have shown mobilization of these resistance genes from the environment into pathogenic bacteria causing health risks to humans and animals and also, demonstrating a link between environmental and clinical resistance [123] . The HWW has been reported to have two overexpressed β-lactam-resistance genes (bla GES and bla OXA ) as compared with the water collected from other aquatic bodies, which could be correlated with antibiotic usage over the time in hospitals and discharge of the residues of antibiotics in the wastewater [176] . Urban wastewater treatment plants as hotspots for antibiotic resistant bacteria and genes spread into the environment: a review

abstract:
  The study of hospital wastewater (HWW) microbiology is important to understand the pollution load, growth of particular pathogenic microbes, shift and drift in microbial community, development and spread of antibiotic resistance in microbes, and subsequent change in treatment efficiencies. This chapter investigates the potential microbes such as bacteria, viruses, fungi, and parasites present in HWW along with the diseases associated and methods of treatment used. Due to the indiscriminate release of antibiotics from hospitals, HWW serves as a hotspot for emergence of antibiotic-resistance genes (ARGs) and antibiotic-resistance bacteria. This chapter discusses the ARGs occurrence in HWW, their prevalence in the environment, the molecular tools used for identification, and different mechanisms of horizontal gene transfer. Thus better understanding of the microbiology of HWW could further help in development of advanced treatment technologies for effective removal of microbes and their bioproducts (toxins and infectious nucleic acid) from HWW and contaminated water.


id: cord-346726-u7dhbmht
author: Keske, Şiran
date: 2018-01-13
txt: ./txt/cord-346726-u7dhbmht.txt
cache: ./cache/cord-346726-u7dhbmht.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/29332209/
doi: 10.1007/s10096-017-3174-6
summary:
  We aimed to describe the potential benefit of new rapid molecular respiratory tests (MRT) in decreasing inappropriate antibiotic use among the inpatients presenting with influenza-like illness (ILI). It is time to increase the awareness about the viral etiology in respiratory tract infections (RTIs) and implement MRT in clinical practice. In adults, influenza virus, rhinovirus, adenovirus, respiratory syncytial virus (RSV), human coronavirus, and parainfluenza virus cause infections with considerable morbidity and mortality [1, 3] , and in infants, RSV is the most common reason for RTIs among hospitalized patients [4] . In this study, we aimed to describe the viral etiology in influenza-like illness (ILI) in children and adults and to show the benefit of new rapid molecular respiratory tests (MRT) in decreasing inappropriate antibiotic use. By using molecular rapid tests (MRT) in our hospital, inappropriate antibiotic use and also duration of inappropriate antibiotic use after the detection of virus was significantly decreased among inpatients.

title:
  The rapid diagnosis of viral respiratory tract infections and its impact on antimicrobial stewardship programs

abstract:
  We aimed to describe the potential benefit of new rapid molecular respiratory tests (MRT) in decreasing inappropriate antibiotic use among the inpatients presenting with influenza-like illness (ILI). We included patients from inpatient and outpatient departments who had ILI and performed MRT between 1 January 2015 and 31 December 2016 in a 265-bed private hospital in Istanbul. At the end of 2015, we implemented antimicrobial stewardship including systematic use of MRT. Then, we compared our observations between the year 2015 and the year 2016. We designed the study according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) tool. A U.S. Food and Drug Administration (FDA)-cleared multiplexed polymerase chain reaction (PCR) system (BioFire FilmArray, Idaho Technology, Salt Lake City, UT) which detects 17 viruses and three bacteria was used for diagnosis. In total, 1317 patients were included; 630 (48%) were inpatients and 569 (43%) were older than 16 years of age. At least one virus was detected in 747 (57%) patients. Rhinovirus/enterovirus, influenza virus, and adenovirus were the most commonly detected. Among hospitalized patients, in children, a significant decrease in antibiotic use (44.5% in 2015 and 28.8% in 2016, p = 0.009) was observed, but in adults, the decrease was not statistically significant (72% in 2015 and 63% in 2016, p = 0.36). The duration of antibiotic use after the detection of virus was significantly decreased in both children and adults (p < 0.001 and p = 0.007, respectively). By using MRT, inappropriate antibiotic use and, also, duration of inappropriate antibiotic use after the detection of virus was significantly decreased. It is time to increase the awareness about the viral etiology in respiratory tract infections (RTIs) and implement MRT in clinical practice.


id: cord-349775-zwslhjju
author: Brittain-Long, Robin
date: 2011-04-26
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url: https://www.ncbi.nlm.nih.gov/pubmed/21521505/
doi: 10.1186/1741-7015-9-44
summary:
  The objective of this study was to evaluate whether access to a multiplex polymerase chain reaction (PCR) assay panel for etiologic diagnosis of acute respiratory tract infections (ARTIs) would have an impact on antibiotic prescription rate in primary care clinical settings. Acute respiratory tract infections (ARTIs) represent a major global health burden [1] , and viruses cause a large proportion of ARTIs. Distinguishing bacterial ARTIs that require antibiotic treatment from viral ARTIs not needing an antibiotic prescription can be difficult on clinical grounds alone and causes unnecessary use of antibiotics, with the highest rates occurring in the primary care setting [2, 3] . The present study was designed to evaluate whether access to a multiplex RT-PCR method targeting thirteen viruses would have an impact on antibiotic prescription rates for ARTI in a primary care setting.

title:
  Access to a polymerase chain reaction assay method targeting 13 respiratory viruses can reduce antibiotics: a randomised, controlled trial

abstract:
  BACKGROUND: Viral respiratory infections are common worldwide and range from completely benign disease to life-threatening illness. Symptoms can be unspecific, and an etiologic diagnosis is rarely established because of a lack of suitable diagnostic tools. Improper use of antibiotics is common in this setting, which is detrimental in light of the development of bacterial resistance. It has been suggested that the use of diagnostic tests could reduce antibiotic prescription rates. The objective of this study was to evaluate whether access to a multiplex polymerase chain reaction (PCR) assay panel for etiologic diagnosis of acute respiratory tract infections (ARTIs) would have an impact on antibiotic prescription rate in primary care clinical settings. METHODS: Adult patients with symptoms of ARTI were prospectively included. Nasopharyngeal and throat swabs were analysed by using a multiplex real-time PCR method targeting thirteen viruses and two bacteria. Patients were recruited at 12 outpatient units from October 2006 through April 2009, and samples were collected on the day of inclusion (initial visit) and after 10 days (follow-up visit). Patients were randomised in an open-label treatment protocol to receive a rapid or delayed result (on the following day or after eight to twelve days). The primary outcome measure was the antibiotic prescription rate at the initial visit, and the secondary outcome was the total antibiotic prescription rate during the study period. RESULTS: A total sample of 447 patients was randomised. Forty-one were excluded, leaving 406 patients for analysis. In the group of patients randomised for a rapid result, 4.5% (9 of 202) of patients received antibiotics at the initial visit, compared to 12.3% (25 of 204) (P = 0.005) of patients in the delayed result group. At follow-up, there was no significant difference between the groups: 13.9% (28 of 202) in the rapid result group and 17.2% (35 of 204) in the delayed result group (P = 0.359), respectively. CONCLUSIONS: Access to a rapid method for etiologic diagnosis of ARTIs may reduce antibiotic prescription rates at the initial visit in an outpatient setting. To sustain this effect, however, it seems necessary to better define how to follow and manage the patient according to the result of the test, which warrants further investigation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01133782.


id: cord-351231-aoz5jbf1
title: Why Infectious Diseases
author: Bartlett, John G.
date: 2014-09-15
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url: https://doi.org/10.1093/cid/ciu441
doi: 10.1093/cid/ciu441
summary:
  The value of the infectious disease practitioner is now magnified by the crisis of antibiotic resistance, the expanding consequences of international travel, the introduction of completely new pathogen diagnostics, and healthcare reform with emphasis on infection prevention and cost in dollars and lives. The point is that epidemics are the domain of infectious diseases and public health, with the expectation for management or prevention of outbreaks with requirements for detection, reporting, isolation, and case management. This began with a patient transferred from a New York City hospital with a KPC infection and became the source of an institutional outbreak that required extraordinary efforts to control, including a wall constructed to isolate cases, removal of plumbing (as a possible source), use of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) molecular diagnostics to detect cases and carriers, hydrogen peroxide room aerosols, and "whole house" surveillance cultures. The new healthcare system should value infectious disease expertise based on its important role in addressing resistance and costs associated with nosocomial infections.

abstract:
  Infectious diseases is a broad discipline that is almost unique in contemporary medicine with its ability to cure and prevent disease, to identify specific disease causes (microbes), and to deal with diverse, sometimes massive outbreaks. The value of the infectious disease practitioner is now magnified by the crisis of antibiotic resistance, the expanding consequences of international travel, the introduction of completely new pathogen diagnostics, and healthcare reform with emphasis on infection prevention and cost in dollars and lives. Infectious disease careers have great personal rewards to the practitioner based on these observations. It is unfortunate that we have been so effective in our work, but relatively ineffective in convincing the healthcare system of this value.


