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Antibiotics, Volume 2, Issue 3 (September 2013), Pages 328-449

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Research

Jump to: Review

Open AccessArticle Exploratory Spatial Mapping of the Occurrence of Antimicrobial Resistance in E. coli in the Community
Antibiotics 2013, 2(3), 328-338; doi:10.3390/antibiotics2030328
Received: 25 April 2013 / Revised: 11 June 2013 / Accepted: 21 June 2013 / Published: 1 July 2013
Cited by 3 | PDF Full-text (1173 KB) | HTML Full-text | XML Full-text
Abstract
The use of antimicrobials over the past six decades has been associated with the emergence and dissemination of antimicrobial-resistant bacteria. To explore local geographical patterns in the occurrence of acquired antimicrobial resistance (AMR), AMR of E. coli causing urinary tract infections (UTI) [...] Read more.
The use of antimicrobials over the past six decades has been associated with the emergence and dissemination of antimicrobial-resistant bacteria. To explore local geographical patterns in the occurrence of acquired antimicrobial resistance (AMR), AMR of E. coli causing urinary tract infections (UTI) in the community in the West of Ireland was mapped. All adult patients consulting with a suspected UTI in 22 general practices in the West of Ireland over a nine-month study period were requested to supply a urine sample. Those with a laboratory confirmed E. coli infection were included (n = 752) in the study. Antimicrobial susceptibility testing was performed by standardized disc diffusion. Patient addresses were geocoded. The diameters of the zone of inhibition of growth for trimethoprim (5 μg) and ciprofloxacin (5 μg) for the relevant isolate was mapped against the patient address using ArcGIS software. A series of maps illustrating spatial distribution of AMR in the West of Ireland were generated. The spatial data demonstrated a higher proportion of isolates with AMR from urban areas. Some rural areas also showed high levels of resistant E. coli. Our study is the first to demonstrate the feasibility of using a geographical information system (GIS) platform for routine visual geographical analysis of AMR data in Ireland. Routine presentation of AMR data in this format may be valuable in understanding AMR trends at a local level. Full article
(This article belongs to the Special Issue Rational Use of Antibiotics)
Open AccessArticle Occurrence and Distribution of Synthetic Organic Substances in Boreal Coniferous Forest Soils Fertilized with Hygienized Municipal Sewage Sludge
Antibiotics 2013, 2(3), 352-366; doi:10.3390/antibiotics2030352
Received: 17 April 2013 / Revised: 20 June 2013 / Accepted: 10 July 2013 / Published: 17 July 2013
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Abstract
The occurrence and distribution of synthetic organic substances following application of dried and granulated (hygienized) municipal sewage sludge in Swedish boreal coniferous forests were investigated. Elevated concentrations of triclosan (TCS), polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs) were detected in the [...] Read more.
The occurrence and distribution of synthetic organic substances following application of dried and granulated (hygienized) municipal sewage sludge in Swedish boreal coniferous forests were investigated. Elevated concentrations of triclosan (TCS), polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs) were detected in the humus layer. Concentrations of ethinyl estradiol (EE2), norfloxacin, ciprofloxacin, ofloxacin (FQs), and polyaromatic hydrocarbons (PAHs) were not significantly influenced. Maximum concentrations in humus were as follows (in ng/g dry matter): TCS; 778; PBDEs; 25; and PCB7; 16.7. Fertilization did not alter the levels of the substances in mineral soil, ground water, and various types of samples related to air. Further research within this area is needed, including ecotoxicological effects and fate, in order to improve the knowledge regarding the use of sludge as a fertilizing agent. Continuous annual monitoring, with respect to sampling and analysis, should be conducted on the already-fertilized fields. Full article
(This article belongs to the Special Issue The Environmental Footprint of Antibiotics)
Open AccessArticle “How Do You Feel about Antibiotics for This?” A Qualitative Study of Physician Attitudes towards a Context-Rich Communication Skills Method
Antibiotics 2013, 2(3), 439-449; doi:10.3390/antibiotics2030439
Received: 26 June 2013 / Revised: 28 August 2013 / Accepted: 29 August 2013 / Published: 16 September 2013
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Abstract
To explore experiences with and views of general practitioners (GPs) on a physician communication training method in primary care and its applicability and implementation in daily practice, we performed a semi-structured qualitative study of GPs’ experience of training in and implementing a [...] Read more.
To explore experiences with and views of general practitioners (GPs) on a physician communication training method in primary care and its applicability and implementation in daily practice, we performed a semi-structured qualitative study of GPs’ experience of training in and implementing a communication skills training program for managing lower respiratory tract infection (LRTI) which included a seminar, simulated patient consultation together with providing and receiving feedback on ones own transcript, and a seminar in a structured approach to the LRTI consultation. Seventeen out of 20 eligible GPs who had participated in the IMPAC3T trial and were allocated to receiving enhanced physician communication training for managing lower respiratory tract infection participated. GPs’ experiences with the physician communication training method and its specific components were positive. The method gave GPs additional tools for managing LRTI consultations and increased their sense of providing evidence-based management. During the study, GPs reported using almost all communication items covered in the training, but some GPs stated that the communication skills diluted over time, and that they continued to use a selected set of the skills. The general communication items were most regularly used. Implementation of the method in daily practice helped GPs to prescribe fewer antibiotics in LRTI with the only perceived disadvantage being time-pressure. This study suggests that GPs felt positive about the physician communication training method for enhanced management of LRTI in primary care. GPs continued to use some of the communication items, of which general communication items were the most common. Furthermore, GPs believed that implementation of the communication skills in daily practice helped them to prescribe fewer antibiotics. The context-rich communication method could have wider application in common conditions in primary care. Full article
(This article belongs to the Special Issue Antibiotics and Respiratory Tract Infections)

Review

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Open AccessReview Empirical Antibiotic Therapy for Ventilator-Associated Pneumonia
Antibiotics 2013, 2(3), 339-351; doi:10.3390/antibiotics2030339
Received: 2 April 2013 / Revised: 15 June 2013 / Accepted: 18 June 2013 / Published: 4 July 2013
Cited by 2 | PDF Full-text (353 KB) | HTML Full-text | XML Full-text
Abstract
Ventilator-associated pneumonia (VAP) is the most common infectious complication in the intensive care unit. It can increase duration of mechanical ventilation, length of stay, costs, and mortality. Improvements in the administration of empirical antibiotic therapy have potential to reduce the complications of [...] Read more.
Ventilator-associated pneumonia (VAP) is the most common infectious complication in the intensive care unit. It can increase duration of mechanical ventilation, length of stay, costs, and mortality. Improvements in the administration of empirical antibiotic therapy have potential to reduce the complications of VAP. This review will discuss the current data addressing empirical antibiotic therapy and the effect on mortality in patients with VAP. It will also address factors that could improve the administration of empirical antibiotics and directions for future research. Full article
(This article belongs to the Special Issue Antibiotics and Respiratory Tract Infections)
Open AccessReview Environmental and Public Health Implications of Water Reuse: Antibiotics, Antibiotic Resistant Bacteria, and Antibiotic Resistance Genes
Antibiotics 2013, 2(3), 367-399; doi:10.3390/antibiotics2030367
Received: 17 June 2013 / Revised: 19 July 2013 / Accepted: 24 July 2013 / Published: 31 July 2013
Cited by 12 | PDF Full-text (843 KB) | HTML Full-text | XML Full-text
Abstract
Water scarcity is a global problem, and is particularly acute in certain regions like Africa, the Middle East, as well as the western states of America. A breakdown on water usage revealed that 70% of freshwater supplies are used for agricultural irrigation. [...] Read more.
Water scarcity is a global problem, and is particularly acute in certain regions like Africa, the Middle East, as well as the western states of America. A breakdown on water usage revealed that 70% of freshwater supplies are used for agricultural irrigation. The use of reclaimed water as an alternative water source for agricultural irrigation would greatly alleviate the demand on freshwater sources. This paradigm shift is gaining momentum in several water scarce countries like Saudi Arabia. However, microbial problems associated with reclaimed water may hinder the use of reclaimed water for agricultural irrigation. Of particular concern is that the occurrence of antibiotic residues in the reclaimed water can select for antibiotic resistance genes among the microbial community. Antibiotic resistance genes can be associated with mobile genetic elements, which in turn allow a promiscuous transfer of resistance traits from one bacterium to another. Together with the pathogens that are present in the reclaimed water, antibiotic resistant bacteria can potentially exchange mobile genetic elements to create the “perfect microbial storm”. Given the significance of this issue, a deeper understanding of the occurrence of antibiotics in reclaimed water, and their potential influence on the selection of resistant microorganisms would be essential. In this review paper, we collated literature over the past two decades to determine the occurrence of antibiotics in municipal wastewater and livestock manure. We then discuss how these antibiotic resistant bacteria may impose a potential microbial risk to the environment and public health, and the knowledge gaps that would have to be addressed in future studies. Overall, the collation of the literature in wastewater treatment and agriculture serves to frame and identify potential concerns with respect to antibiotics, antibiotic resistant bacteria, and antibiotic resistance genes in reclaimed water. Full article
(This article belongs to the Special Issue The Environmental Footprint of Antibiotics)
Figures

Open AccessReview Antimicrobial Stewardship: The Need to Cover All Bases
Antibiotics 2013, 2(3), 400-418; doi:10.3390/antibiotics2030400
Received: 4 June 2013 / Revised: 18 August 2013 / Accepted: 21 August 2013 / Published: 27 August 2013
Cited by 4 | PDF Full-text (359 KB) | HTML Full-text | XML Full-text
Abstract
Increasing antimicrobial resistance has necessitated an approach to guide the use of antibiotics. The necessity to guide antimicrobial use via stewardship has never been more urgent. The decline in anti-infective innovation and the failure of currently available antimicrobials to treat some serious [...] Read more.
Increasing antimicrobial resistance has necessitated an approach to guide the use of antibiotics. The necessity to guide antimicrobial use via stewardship has never been more urgent. The decline in anti-infective innovation and the failure of currently available antimicrobials to treat some serious infections forces clinicians to change those behaviors that drive antimicrobial resistance. The majority of antimicrobial stewardship (AMS) programs function in acute-care hospitals, however, hospitals are only one setting where antibiotics are prescribed. Antimicrobial use is also high in residential aged care facilities and in the community. Prescribing in aged care is influenced by the fact that elderly residents have lowered immunity, are susceptible to infection and are frequently colonized with multi-resistant organisms. While in the community, prescribers are faced with public misconceptions about the effectiveness of antibiotics for many upper respiratory tract illnesses. AMS programs in all of these locations must be sustainable over a long period of time in order to be effective. A future with effective antimicrobials to treat bacterial infection will depend on AMS covering all of these bases. This review discusses AMS in acute care hospitals, aged care and the community and emphasizes that AMS is critical to patient safety and relies on government, clinician and community engagement. Full article
(This article belongs to the Special Issue Rational Use of Antibiotics)
Open AccessReview Designing Safer and Greener Antibiotics
Antibiotics 2013, 2(3), 419-438; doi:10.3390/antibiotics2030419
Received: 29 May 2013 / Revised: 17 August 2013 / Accepted: 21 August 2013 / Published: 4 September 2013
Cited by 1 | PDF Full-text (641 KB) | HTML Full-text | XML Full-text
Abstract
Since the production of the first pharmaceutically active molecules at the beginning of the 1900s, drug molecules and their metabolites have been observed in the environment in significant concentrations. In this review, the persistence of antibiotics in the environment and their associated [...] Read more.
Since the production of the first pharmaceutically active molecules at the beginning of the 1900s, drug molecules and their metabolites have been observed in the environment in significant concentrations. In this review, the persistence of antibiotics in the environment and their associated effects on ecosystems, bacterial resistance and health effects will be examined. Solutions to these problems will also be discussed, including the pharmaceutical industries input, green chemistry, computer modeling and representative ionic liquid research. Full article
(This article belongs to the Special Issue The Environmental Footprint of Antibiotics)

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