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1561. Faecal phageome of healthy individuals: presence of antibiotic resistance genes and variations caused by ciprofloxacin treatment. (Abstract)

Faecal phageome of healthy individuals: presence of antibiotic resistance genes and variations caused by ciprofloxacin treatment. Antimicrobial resistance genes (ARGs) can be transferred by means of mobile genetic elements, which play a critical role in the dissemination of resistance in the bacterial community. ARG transmission within mobile genetic elements has been reported in plasmids and transposons but less frequently in bacteriophages. Here, the bacteriophage fraction of seven human (...) particles supports the description of phages as mobile elements contributing to the dissemination of bacterial antibiotic resistance and suggests ciprofloxacin treatment may play a role in the release of ARG-carrying particles, thereby increasing resistance.© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

2019 Journal of Antimicrobial Chemotherapy

1562. The antimicrobial resistome in relation to antimicrobial use and biosecurity in pig farming, a metagenome-wide association study in nine European countries. (Abstract)

The antimicrobial resistome in relation to antimicrobial use and biosecurity in pig farming, a metagenome-wide association study in nine European countries. Previous studies in food-producing animals have shown associations between antimicrobial use (AMU) and resistance (AMR) in specifically isolated bacterial species. Multi-country data are scarce and only describe between-country differences. Here we investigate associations between the pig faecal mobile resistome and characteristics (...) data (AMU, biosecurity) were collected. Random-effects meta-analyses were performed by country, relating farm-level data to relative ARG abundances (FPKM).Total AMU during fattening was positively associated with total ARG (total FPKM). Positive associations were particularly observed between widely used macrolides and tetracyclines, and ARGs corresponding to the respective antimicrobial classes. Significant AMU-ARG associations were not found for β-lactams and only few colistin ARGs were found

2019 Journal of Antimicrobial Chemotherapy

1563. Symptom profile of patients receiving antibiotics for upper respiratory tract infections in general practice: an observational study using smartphone technology. Full Text available with Trip Pro

Symptom profile of patients receiving antibiotics for upper respiratory tract infections in general practice: an observational study using smartphone technology. Upper respiratory tract infections (URTIs) are a common presentation in general practice and are linked to high rates of inappropriate antibiotic prescription. There is limited information about the trajectory of patients with this condition who have been prescribed antibiotics.To document the symptom profile of patients receiving (...) antibiotics for URTIs in Australian general practice using smartphone technology and online surveys.In total, 8218 patients received antibiotics after attending one of the 32 general practice clinics in Australia from June to October 2017: 4089 were identified as URTI presentations and were the cohort studied. Patients completed the Wisconsin Upper Respiratory Symptom Survey (WURSS-24) 3 and 7 days after visiting their general practitioner (GP).Six hundred fourteen URTI-specific patients responded

2019 Family Practice

1564. Outpatient Parenteral Antibiotic Treatment (OPAT) for Infective Endocarditis: a Prospective Cohort Study From the GAMES Cohort. (Abstract)

Outpatient Parenteral Antibiotic Treatment (OPAT) for Infective Endocarditis: a Prospective Cohort Study From the GAMES Cohort. Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious and safe for treating infective endocarditis (IE). However, the 2001 IDSA criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT).Retrospective analysis of data from a multicenter prospective cohort study (...) of antibiotic treatment was 42 days (IQR 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P<0.001), 1.4% of patients relapsed, and 10.9% were readmitted during the first three months after discharge (no significant differences compared with HBAT). Charlson score (OR 1.21, 95%CI 1.04-1.42; P=0.01) and cardiac surgery (OR 0.24, 95%CI 0.09-0.63; P=0.04) were associated with one-year mortality, whereas aortic valve involvement (OR 0.47, 95%CI 0.22-0.98; P=0.007

2019 Clinical Infectious Diseases

1565. Combined antibacterial effect of essential oils from three most commonly used Ethiopian traditional medicinal plants on multidrug resistant bacteria. Full Text available with Trip Pro

Combined antibacterial effect of essential oils from three most commonly used Ethiopian traditional medicinal plants on multidrug resistant bacteria. An alarm increase the rate of emerging and re-emerging of multidrug resistant bacteria have been caused great public health concern in the worldwide. They have been resisting for most or majority of currently available and affordable antibiotics and imposed socioeconomic catastrophe at global scale. As a result, there is utmost important (...) to discover new or modify currently available antibiotics. The aim of this study was to evaluate combined antibacterial effect of essential oils obtained from Blepharis cuspidata, Boswellia ogadensis and Thymus schimper against multidrug resistance (MDR) Escherichia coli, Klebsiella pneumoniae and Methicillin resistant S. aureus.Essential oil (EO) was extracted from the aerial part of B. cuspidata, B.ogadensis and T. schimper by steam distillation and stored in brown bottles at 4 °C. There were mixed in 1

2019 BMC Complementary and Alternative Medicine

1566. Antibiotics-induced monodominance of a novel gut bacterial order. Full Text available with Trip Pro

Antibiotics-induced monodominance of a novel gut bacterial order. The composition of the healthy human adult gut microbiome is relatively stable over prolonged periods, and representatives of the most highly abundant and prevalent species have been cultured and described. However, microbial abundances can change on perturbations, such as antibiotics intake, enabling the identification and characterisation of otherwise low abundant species.Analysing gut microbial time-series data, we used (...) far undescribed order of Firmicutes, (2) is ubiquitously present at low abundances in at least one third of adults, (3) is opportunistically growing, being ecologically similar to typical probiotic species and (4) is stably associated to healthy hosts as determined by single nucleotide variation analysis. It was the first coloniser after the antibiotic intervention that led to a long-lasting microbial community shift and likely permanent loss of nine commensals.The bloom of UB. ceftriaxensis

2019 Gut

1567. Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006-2016. Full Text available with Trip Pro

Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006-2016. War-wounded civilians in Middle East countries are at risk of post-traumatic osteomyelitis (PTO). We aimed to describe and compare the bacterial etiology and proportion of first-line antibiotics resistant bacteria (FLAR) among PTO cases in civilians from Syria, Iraq and Yemen admitted to the reconstructive surgical program of Médecins Sans

2019 BMC Infectious Diseases

1568. Antibiotic prescribing for residents in long-term-care facilities across the UK. Full Text available with Trip Pro

Antibiotic prescribing for residents in long-term-care facilities across the UK. Antimicrobial resistance (AMR) is a major public health problem. Elderly residents in long-term-care facilities (LTCFs) are frequently prescribed antibiotics, particularly for urinary tract infections. Optimizing appropriate antibiotic use in this vulnerable population requires close collaboration between NHS healthcare providers and LTCF providers.Our aim was to identify and quantify antibiotic prescribing (...) , suggesting that there is an opportunity to optimize antibiotic use in this vulnerable population to minimize the risk of AMR and treatment failure. Pharmacy teams are well placed to support prudent antibiotic prescribing and improved antimicrobial stewardship in this population.

2019 Journal of Antimicrobial Chemotherapy

1569. Microbiology and Antibiotic Resistance in Peripartum Bacteremia. (Abstract)

Microbiology and Antibiotic Resistance in Peripartum Bacteremia. To examine the microbiology and associated antibiotic resistance patterns among febrile peripartum women with positive blood cultures.We conducted a retrospective cohort study in which we reviewed all bacteremia cases between 2009 and 2016 that occurred between 7 days before and 30 days after delivery. Institutional guidelines include obtaining blood cultures and promptly initiating intravenous antibiotics for all obstetric (...) patients with fever of 100.4°F or higher. We describe antibiotic resistance patterns for the most frequently isolated organisms and perform univariate analyses regarding maternal and neonatal outcomes based on type of bacteremia.Among 56,835 deliveries, 3,797 (6.7%) obstetric patients had blood cultures drawn and 120 (3.2%) had documented bacteremia. The most commonly cultured organisms were Escherichia coli (17.5%, n=21), Bacteroides species (10.8%, n=13), Enterococcus species (10.8%, n=13), group B

2019 Obstetrics and Gynecology

1570. Antimicrobial Activity of Omadacycline Tested against Clinical Bacterial Isolates from Hospitals in China (including Hong Kong) and Taiwan: Results from the SENTRY Antimicrobial Surveillance Program (2013-2016). Full Text available with Trip Pro

Antimicrobial Activity of Omadacycline Tested against Clinical Bacterial Isolates from Hospitals in China (including Hong Kong) and Taiwan: Results from the SENTRY Antimicrobial Surveillance Program (2013-2016). Omadacycline is a derivative of minocycline and the first agent of the aminomethylcycline class. A total of 3,282 organisms (1 per patient) were consecutively collected from patients hospitalized in China (including Hong Kong) and Taiwan. Susceptibility testing was performed by broth

2019 Antimicrobial Agents and Chemotherapy

1571. Cost-effectiveness analysis of a GP- and parent-directed intervention to reduce antibiotic prescribing for children with respiratory tract infections in primary care. (Abstract)

and less expensive compared with usual care was 41%.The online training for GPs and the information booklet for parents resulted in a decrease in antibiotic prescribing in children with RTI, at very low cost, and should therefore be considered for implementation in primary care.© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com. (...) Cost-effectiveness analysis of a GP- and parent-directed intervention to reduce antibiotic prescribing for children with respiratory tract infections in primary care. We evaluated costs and effects of the RAAK (RAtional Antibiotic use Kids) intervention (GP online training and information booklets for parents), aiming to reduce antibiotic prescribing for children with respiratory tract infection (RTI).We conducted a trial-based cost-effectiveness analysis from a societal perspective. We

2019 Journal of Antimicrobial Chemotherapy Controlled trial quality: uncertain

1572. Common uropathogens and their antibiotic susceptibility pattern among diabetic patients. Full Text available with Trip Pro

Common uropathogens and their antibiotic susceptibility pattern among diabetic patients. Urinary tract infection (UTIs) is a significant health problem in diabetic patients because of the multiple effects of this disease on the urinary tract and host immune system. Complicated UTIs occur most commonly in patients with abnormal genitourinary tract. Proper investigation and prompt treatment are needed to prevent morbidity and serious life threatening condition associated with UTI and diabetes co (...) -morbidities.To determine common uropathogens and antibiotic susceptibility patterns with associated risk factors among adult diabetic patients attending at St. Paul Specialized Hospital Millennium Medical College, Addis Ababa, Ethiopia.A hospital based, cross-sectional study was conducted from April-July 2015. A total of 248 diabetic patients with asymptomatic and symptomatic UTI were investigated for common uropathogens. Clean catch mid-stream urine specimens were collected from each study subjects

2019 BMC Infectious Diseases

1573. Acne, the Skin Microbiome, and Antibiotic Treatment. (Abstract)

Acne, the Skin Microbiome, and Antibiotic Treatment. Acne vulgaris is a chronic skin disorder involving hair follicles and sebaceous glands. Multiple factors contribute to the disease, including skin microbes. The skin microbiome in the follicle is composed of a diverse group of microorganisms. Among them, Propionibacterium acnes and Malassezia spp. have been linked to acne development through their influence on sebum secretion, comedone formation, and inflammatory response. Antibiotics (...) targeting P. acnes have been the mainstay in acne treatment for the past four decades. Among them, macrolides, clindamycin, and tetracyclines are the most widely prescribed. As antibiotic resistance becomes an increasing concern in clinical practice, understanding the skin microbiome associated with acne and the effects of antibiotic use on the skin commensals is highly relevant and critical to clinicians. In this review, we summarize recent studies of the composition and dynamics of the skin microbiome

2019 American journal of clinical dermatology

1574. Clinical Outcomes of Failing to Dose-Reduce Cephalosporin Antibiotics in Older Adults with CKD. Full Text available with Trip Pro

Clinical Outcomes of Failing to Dose-Reduce Cephalosporin Antibiotics in Older Adults with CKD. Current dosing recommendations for cephalosporin antibiotics are on the basis of pharmacokinetic studies and are frequently ignored in practice. This study was undertaken to investigate the clinical outcomes of failing to dose-reduce cephalosporin antibiotics in CKD.Retrospective cohort study conducted in Ontario, Canada using linked population-based health care databases. Nine thousand three hundred (...) ) with a condition listed as a possible side-effect of cephalosporins. Secondary outcomes were antibiotic treatment failure and all-cause mortality. All measures were assessed in the 30 days after cephalosporin initiation.Patients who received a higher than recommended dose of a cephalosporin antibiotic were similar in multiple indicators of baseline health to patients who received a reduced dose. Overall, 6% of patients presented to hospital with a possible cephalosporin side-effect, 13% failed antibiotic

2019 Clinical Journal of the American Society of Nephrology

1575. Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014. Full Text available with Trip Pro

Antibiotic Prescribing for Children in United States Emergency Departments: 2009-2014. : media-1vid110.1542/5972296744001PEDS-VA_2018-1056Video Abstract OBJECTIVES: To characterize and compare ambulatory antibiotic prescribing for children in US pediatric and nonpediatric emergency departments (EDs).A cross-sectional retrospective study of patients aged 0 to 17 years discharged from EDs in the United States was conducted by using the 2009-2014 National Hospital Ambulatory Medical Care Survey ED (...) data. We estimated the proportion of ED visits resulting in antibiotic prescriptions, stratified by antibiotic spectrum, class, diagnosis, and ED type ("pediatric" defined as >75% of visits by patients aged 0-17 years, versus "nonpediatric"). Multivariable logistic regression was used to determine factors independently associated with first-line, guideline-concordant prescribing for acute otitis media, pharyngitis, and sinusitis.In 2009-2014, of the 29 million mean annual ED visits by children, 14

2019 Pediatrics

1576. Late-Career Physicians Prescribe Longer Courses of Antibiotics. Full Text available with Trip Pro

interval 1.38-1.58) and mid-career physicians (1.25, 1.16-1.34) when compared to early-career physicians.We observed substantial variability in prescribed antibiotic duration across family physicians, with durations particularly long among late-career physicians. These findings highlight opportunities for community antimicrobial stewardship interventions to improve antibiotic use through addressing practice differences in later career stage physicians. (...) Late-Career Physicians Prescribe Longer Courses of Antibiotics. Antibiotic duration is often longer than necessary. Understanding the reasons for variability in antibiotic duration can inform interventions to reduce prolonged antibiotic use. We aim to describe patterns of inter-physician variability in prescribed antibiotic treatment durations and determine physician predictors of prolonged antibiotic duration in the community setting.We performed a retrospective cohort analysis of family

2019 Clinical Infectious Diseases

1577. A rapid unravelling of mycobacterial activity and of their susceptibility to antibiotics. Full Text available with Trip Pro

A rapid unravelling of mycobacterial activity and of their susceptibility to antibiotics. The development of antibiotic-resistant bacteria is a worldwide health-related emergency that calls for new tools to study the bacterial metabolism and to obtain fast diagnoses. Indeed, the conventional analysis time scale is too long and affects our ability to fight infections. Slowly growing bacteria represent a bigger challenge, since their analysis may require up to months. Among these bacteria (...) , Mycobacterium tuberculosis, the causative agent of tuberculosis, has caused more than 10 million new cases and 1.7 million deaths in 2016 only. We employed a particularly powerful nanomechanical oscillator, the nanomotion sensor, to characterize rapidly and in real time tuberculous and nontuberculous bacterial species, Mycobacterium bovis bacillus Calmette-Guérin and Mycobacterium abscessus, respectively, exposed to different antibiotics. Here, we show how high-speed and high-sensitivity detectors

2019 Antimicrobial Agents and Chemotherapy

1578. Effects of Antibiotic Cycling Policy on Incidence of Healthcare-Associated MRSA and Clostridioides difficile Infection in Secondary Healthcare Settings. Full Text available with Trip Pro

Effects of Antibiotic Cycling Policy on Incidence of Healthcare-Associated MRSA and Clostridioides difficile Infection in Secondary Healthcare Settings. This quasi-experimental study investigated the effect of an antibiotic cycling policy based on time-series analysis of epidemiologic data, which identified antimicrobial drugs and time periods for restriction. Cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin were undertaken over a 2-year period (...) in the intervention hospital. The resistance of new ESBL isolates to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly in the intervention hospital; however, resistance to piperacillin/tazobactam increased after a return to the standard policy. The results question the value of antibiotic cycling to antibiotic stewardship.

2019 Emerging Infectious Diseases

1579. Prescription of Antibacterial Drugs for HIV-Exposed, Uninfected Infants, Malawi, 2004-2010. Full Text available with Trip Pro

Prescription of Antibacterial Drugs for HIV-Exposed, Uninfected Infants, Malawi, 2004-2010. Antimicrobial drug resistance is a serious health hazard driven by overuse. Administration of antimicrobial drugs to HIV-exposed, uninfected infants, a population that is growing and at high risk for infection, is poorly studied. We therefore analyzed factors associated with antibacterial drug administration to HIV-exposed, uninfected infants during their first year of life. Our study population (...) was 2,152 HIV-exposed, uninfected infants enrolled in the Breastfeeding, Antiretrovirals and Nutrition study in Lilongwe, Malawi, during 2004-2010. All infants were breastfed through 28 weeks of age. Antibacterial drugs were prescribed frequently (to 80% of infants), and most (67%) of the 5,329 prescriptions were for respiratory indications. Most commonly prescribed were penicillins (43%) and sulfonamides (23%). Factors associated with lower hazard for antibacterial drug prescription included receipt

2019 Emerging Infectious Diseases

1580. New antibiotics for community-acquired pneumonia. (Abstract)

New antibiotics for community-acquired pneumonia. This review provides the rationale for the development of new antibiotics to treat community-acquired pneumonia (CAP). It also provides an overview of the new antibiotics targeting CAP that have recently received approval by the regulatory agencies, and those antibiotics that are in the development pipeline.CAP is one of the most common reasons for hospitalization and carries a significant morbidity and risk of mortality. Increasing antibiotic (...) resistance amongst the common bacterial pathogens associated with CAP, especially staphylococci and Streptococcus pneumoniae, has made the empiric treatment of this infection increasingly problematic. Moreover, failure of initial empiric therapy to cover the causative agents associated with CAP can be associated with worse clinical outcomes. There have been several antibiotics newly approved or in development for the treatment of CAP. These agents include delafloxacin, omadacycline, lefamulin

2019 Current Opinion in Infectious Diseases

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