Epidemiological observations of the judicious use of antibiotics in a pediatric teaching hospital.

OBJECTIVE: This study in a tertiary care teaching center with 361 beds was conducted to assess use, misuse, and abuse of antibiotics. MATERIALS AND METHODS: Every day of the study, a computer program was used to compile a list of patients' bedside records. On a specific day, the bedside charts of selected patients were reviewed to determine whether: (1) a justification for antibiotic prescription was recorded; (2) duration of antibiotic therapy had been defined; (3) suitable cultures had been obtained; and (4) treatment was appropriate for the infection to be treated. For 6 months, charts were evaluated 3 days per week. RESULTS: Of 750 bedside charts 500 (67%) were selected for review. Of the 500 patients, 175 (35%) did not receive antibiotics. The abuses or misuses of antibiotics most frequently observed among the 325 treated patients were no record of justification for the antibiotic prescribed (130/325, 40%); no appropriate blood or fluid samples obtained for culture (45/325, 14%); no subsequent control cultures or cultures obtained before modifying therapy (80/175, 46%); no indication of a planned duration of therapy (180/325, 55%); and improper dosage prescribed in relation to weight (25/325, 8%). Abuse or misuse of antibiotics was more frequently observed among surgical patients than among nonsurgical patients (P<0.05). CONCLUSION: Rational use of antibiotics should be emphasized in every training program as a main strategy to control the increase in drug resistance and to prolong the usefulness of antibiotics

Clostridium difficile colitis in older adults in long-term facilities and the community: do their outcomes differ?

OBJECTIVE: To determine if older adults from long-term care facilities (LTCF) have a greater risk of death than older people in the community after the development of Clostridium difficile (CD) colitis during hospitalization. DESIGN: A retrospective review of medical records from all older hospitalized patients with a confirmed diagnosis of CD colitis from February 1995 to February 1997 at Our Lady of Mercy Medical Center, Bronx, NY, a University hospital of the New York Medical College. METHODS: A total of 108 patients (aged 60-97 yrs.) with a positive diagnosis of CD colitis (EIA of CD cytotoxin A and B) were identified. Residence (nursing home vs. community), sex and age, length of hospital stay, laboratory values, the number, dose, and duration of all antibiotics used, and co-morbid medical conditions were examined as potential risk factors for adverse outcome (mortality). RESULTS: Fifty-two nursing home and 56 older patients living in the community were compared. Outcome (survival vs. death) was equivalent between nursing home (13 of 52 died, 25% death rate) and community elderly (13 of 56 died, 23% death rate). The patients in the nursing home were, on average, 3 years older than community those in the community, but age was not related to outcome in either group. Death occurred significantly more often in LTCF and community patients who received prolonged antibiotic therapy (P = 0.0056) or were prescribed four or more antibiotics (P = 0.036) during hospitalization. Low serum albumin level was found to be a strong predictor of death (P = 0.002). However, nursing home and community elderly had similar mean serum albumin levels (P = 0.2797). Death was also predicted by the use of clindamycin alone (P = 0.046) or penicillin-like antibiotics (excluding cephalosporins) and clindamycin (P = 0.021), or a history of cardiac disease (coronary artery disease or congestive heart failure) (P = 0.022). CONCLUSIONS: Patients from LTCF do not have an increased risk of mortality compared with older people in the community after developing CD colitis during hospitalization. Factors such as low serum albumin, prolonged antibiotic therapy, the number of antibiotics used, use of specific antibiotics, and cardiac disease were significantly related to an increased risk of death in both LTCF and community older adults. Age did not influence outcome in either group of older adults

Natural antibiotic susceptibility of Salmonella enterica strains.

The susceptibility of 100 Salmonella enterica strains belonging to S. enterica subsp. enterica (n=90) and S. enterica subsp. arizonae (n=10) was examined to 71 antibiotics. Within S. enterica subsp. enterica, strains of different serovars (typhimurium (n=17), enteritidis (n=17), dublin (n=10), typhi (n=16), paratyphi A (n=6), others (n=24)) were studied. MICs were determined using a microdilution procedure and apart from fosfomycin there were no significant differences in susceptibility between the subspecies and serovars of S. enterica. All salmonellae were sensitive or intermediately resistant to tetracyclines, aminoglycosides, most beta-lactam antibiotics, quinolones, co-trimoxazole group antibiotics, chloramphenicol, nitrofurantoin and azithromycin ( Zithromax ). S. enterica strains were intrinsically resistant to benzylpenicillin, oxacillin, most macrolides, rifampicin, lincosamides, streptogramins, glycopeptides and fusidic acid. Apart from some slight differences in antibiotic susceptibility between strains of S. enterica subsp. enterica and S. enterica subsp. arizonae, only the susceptibility to fosfomycin varied among the taxa studied. Whereas 'enteric' salmonellae including S. enterica subsp. arizonae were sensitive to fosfomycin, 'typhoid' salmonellae were intrinsically resistant. A database of the antibiotic susceptibility of S. enterica was set up. It may be of use to validate antibiotic susceptibility test results of these bacteria

Treatment of post-burns bacterial infections by bacteriophages, specifically ubiquitous Pseudomonas spp. notoriously resistant to antibiotics.

Post-burn microbial infections are a major problem in recovering from the trauma of third-degree burns, and the survival of patients can depend upon the severity of the burn and the infections encountered. Within 24 hours, patients can start suffering from opportunistic bacterial attacks, which can vary from simple infection, such as those easily treatable by antibiotics, to more complicated types, which may have natural or acquired resistance to drugs. Infection by multiple drug-resistant bacteria can create additional complexity to the problem. As an alternative to treating bacterial infections by antibiotics, bacteriophages have been in use in certain parts of the world, such as at Tbilisi in Georgia and in Poland, and this approach has now been more widely recognized. Results have shown that phage therapy has an 80% success rate against Enterococcus infections and up to 90% against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae. Here it is proposed that bacteriophages can effectively be used for the treatment of post-burn infections, particularly the ubiquitous opportunistic pathogens, Pseudomonas spp., known to be notoriously resistant to a variety of antibiotics. This kind of treatment may be of particular importance in Third World countries where the incidence of burns and infections, due to lack of stringent safety regulations and proper hygiene respectively, may be more common and where cocktails of antibiotics may be less affordable. Phages that can possibly be employed in the treatment and their advantages compared to the use of antibiotics are also highlighted. 2002 Elsevier Science Ltd. All rights reserved