Ways of increasing the effectiveness of antibacterial therapy in newborns

Ways for increasing antibiotic therapy efficacy in newborns are discussed. They are the following: consideration of the structure of the antibiotic use, improvement of infection diagnosis, the use of computers in epidemiological supervision of antibiotic resistance, the use of "old" antibiotics in new dosage forms, pharmacokinetic monitoring. The data on the frequency of the antibiotic use in newborns in maternity hospitals, at home and in neonatal departments as well as on diagnosis and treatment of chlamydiosis in newborns are presented. Requirements to the computer programs on control of antibiotic resistance are described. With the account of the requirements an original epidemiological program for personal computers was developed. The results of the pharmacokinetic monitoring of the use of sisomicin and amikacin are presented as well.     

Antibiotic Use in a Small Community Hospital

Audits of medical records were done for similar one-month periods in 1974 and 1977 in a 125-bed community hospital in Hawaii to determine patterns of antibiotic use. One quarter of all hospital patients in both study periods received antibiotics. In 1977 cephalosporins, ampicillin and aminoglycosides were the most commonly used antibiotics. Half of the antibiotics used by surgical specialty departments in both periods were for prophylactic indications. The cost of antimicrobial prophylaxis per patient was reduced by about 57 percent in 1977 compared with 1974. In the 1977 period, 58 percent of patients received proper prophylactic antibiotic regimens; this was statistically higher than the 15 percent of patients given appropriate prophylactic antibiotics in 1974. Fewer than half of the patients in both study periods treated for infections received correct antibiotic therapy. In contrast, 82 percent of infectious disease consultations were considered appropriate by an independent specialist in infectious disease. However, these consultations were obtained in only 15 percent of the patients who received therapeutic antibiotics. It was concluded that audits of patients receiving antibiotics can be effective in the development of appropriate prophylactic surgical regimens. However, during the study period in 1977, we were not able to show large scale improvement in therapeutic antimicrobial use at this community hospital, either by our attempts at physician education or by making infectious disease consultations available.     

Epidemiologic characteristics of suppurative-septic diseases in newborn infants at obstetrical hospitals keeping mother and child together and separated

The advantages of keeping mothers together with their infants at the postnatal period have been revealed; these advantages are manifested by the quick colonization of newborns by maternal microflora, thus preventing their further colonization by opportunistic hospital microbial strains. As compared with common maternity hospitals, those maternity hospitals where mothers are kept together with their infants have less intensive circulation of hospital microflora, and the morbidity rate in purulent and septic diseases among newborns is twice as low in such hospitals. All these findings may be regarded as the epidemiological substantiation of propositions in favor of further development of maternity hospitals where mothers and their infants are kept together.     

Microbial colonization and succession in the large intestine of newborn infants during their stay with mothers at the maternity hospital]

Formation of microflora in the large intestine of 5-day old infants was studied in one of the Moscow maternity homes. The up-to-date procedures for isolation and identification of aerobic and anaerobic organisms were used in the study and the findings were processed on a computer. In the newborns of the maternity home of the "mother-infant" type there was observed colonization of the large intestine with aerobic and anaerobic organisms. A wave-like dynamics in the formation of the symbiotic microflora was revealed. It reflected the phenomenon of the microbial succession in the infants. The attempts to detect microbial interference between the species colonizing the large intestine showed that it was extremely rare in the 5-day old infants. This was likely the reason of the low intestine resistance to the colonization in the newborns which in its turn defined the frequent colonization of the intestine mucosa with S. aureus and the organisms of the Klebsiella, Enterobacter and Citrobacter group.     

Population frequency of neural tube defects in the population of the city of Moscow]

A sample investigation was carried out in 14 maternity homes of Moscow during 1970--1976 in order to determine the population incidence of defects of the neural tibe. Among 282336 newborns 220 probands with these anomalies were found including 11 with syndromes of non-multifactorial etiology. The total incidence of multifactorial forms was 0.74 +/- 0.10 per 1000 newborns, the incidence of the anencephaly was 0.33 +/- 0.07% and the frequency of the spina bifida was 0.41 +/- 0.07% respectively. The sex ratio 0.61 among probands was statistically significantly different from that normal among newborns. An insignificant increase of the incidence of the defects was observed during the autumn and winter seasons. No correlation was observed between the mother's age, the birth order and the incidence of the neural tube defects.     

Intestinal dysbacteriosis in antibacterial therapy and perspectives in treatment by antibiotic-resistant probiotics]

Effect of different antibiotics and standard antibacterial therapy regimes on intestine microflora was investigated. Lincozamides demonstrated the most negative effect. Early addition of probiotics to the treatment with antibacterials had positive effect. Susceptibility of 21 strains of normal microflora to 25 antibiotics was tested. Resistance to antibiotics of lactobacilli varied significantly (more among strains and less among species). It was shown that L. acidophilus (probiotic "Acilact") was resistant to metronidazole only. High resistance to antibiotics was shown for L. plantarum 8RA3, L. fermentum 90T4C (components of probiotic "Lactobacterin"), L. fermentum BL96, L. acidophilus BL and L. acidophilus (component of "Linex"). Susceptibility of microorganisms in complex formulation "Linex" to the modern antibiotics was low. It is concluded that the use of stable antibiotic-resistant strains of normal microflora is favorable as addition to antibiotic therapy.     

行政干预对Ⅰ类切口围术期预防性使用抗菌药物的影响

目的:探讨行政干预对I类切口围术期预防性使用抗菌药物的影响。方法:2011年4月～6月对全院手术科室进行行政干预,具体做法:卫生行政部门与医院一把手、医院与手术科室主任、科室主任与科室执业医生分别签订目标责任状;医院配合全国抗菌药物临床应用专项整治活动方案进行全员培训,并对医师进行抗菌药物临床应用培训并考核合格后,授予其相应级别的抗菌药物处方权,明确各级医师使用抗菌药物的处方权限;由医务科牵头与院感染科、药剂科、质控科联合对I类切口手术患者预防使用抗菌药物情况进行检查,定期实施目标奖罚,责任到科室主任和临床医生。然后抽取我院2010年7月～12月(行政干预前)和2011年7月～12月(行政干预后)I类切口手术病历各210份,参考《抗菌药物临床应用指导原则》、卫办医政发[2009]38号通知对420例I类切口手术患者预防使用抗菌药物情况进行回顾性分析。结果:行政干预前(2010年7月～12月)I类切口围手术期预防性抗菌药物的使用率达83.81%(176/210),术后抗菌药物使用时间在2～7天者占69.52%,大于7天者占6.67%;行政干预后(2011年7月～12月)210例患者预防使用抗菌药物使用率为30%(63/210),显著低于未使用行政干预的Ⅰ类切口术患者(P<0.05),围术期术后抗菌药物使用时间在2～7天者占16.67%,没有1例患者用药超过7天,抗菌药物的使用时间较未使用行政干预的Ⅰ类切口术患者显著缩短(P<0.05)。结论:有效的行政干预可以强化临床医生合理应用抗菌药物的意识,提高合理用药的水平,明显降低I类切口预防性抗菌药物的使用率,缩短抗菌药物的使用疗程。     

The sensitivity to 12 antibiotics of 125 strains of Streptococcus group B isolated in a maternity home

Sensitivity of 125 strains of group B streptococci isolated from newborns, their mothers and personnel in a maternity home was studied with respect to 12 antibiotics: benzylpenicillin, ampicillin, methicillin, cephalotin, erythromycin, lincomycin, levomycetin (chloramphenicol), oxacillin, tetracycline, streptomycin, gentamicin and ristomycin. The method of serial dilutions in a solid medium was applied. All the strains were sensitive to ristomycin and erythromycin. The predominating number of the strains were sensitive to lincomycin, levomycetin and the beta-lactam antibiotics. Strains resistant or moderately resistant to benzylpenicillin, ampicillin, oxacillin, methicillin and cephalotin were detected. The majority of the strains were resistant to streptomycin, tetracycline and gentamicin. Multiple antibiotic resistance with 2-7 determinants was revealed in 11.2 per cent of the strains. The antibiotic sensitivity of the strains isolated from the newborns, their mothers and the personnel in the maternity home was on the whole similar or insignificantly differed.     

Survey of antibiotic prophylaxis in gastrointestinal surgery in Scotland.

The current use of prophylactic antibiotics in gastrointestinal surgery in Scotland was established by postal questionnaire. Twenty-one per cent of surgeons used prophylactic antibiotics during cholecystectomy, 49% during appendicectomy, and 95% for elective colorectal surgery. Two-thirds of those surgeons who did not provide routine antibiotic cover considered that the incidence of wound sepsis in their surgical practice was too low to merit special measures. Most surgeons using prophylaxis chose an appropriate antibiotic. The parenteral route for administration of antibiotic was used by 93% of surgeons during cholecystectomy, 29% during appendicectomy, and 45% in elective colorectal surgery. Most did not prolong cover beyond 24 hours postoperatively. This survey shows that the concepts governing the use of antibiotic prophylaxis have been absorbed into current surgical practice. Most surgeons used appropriate antibiotic regimens; many prefer the parenteral route of administration; most do not prolong cover beyond 24 hours.     

Antibiotic sensitivity of the microflora isolated in ENT diseases]

Sensitivity of beta-hemolytic streptococci of group A, Streptococcus viridans, Staphylococcus aureus, epidermal staphylococci, pneumococci, Proteus and Ps. aeruginosa isolated in 1975-1978 from patients with tonsillitis, otitis, sinusitis and other otorhinolaryngological diseases was studied with respect to 19 antibiotics. Data on comparison of the antibiotic sensitivity of the microflora isolated from the patients with otorhinolaryngological diseases in 1964-1974 and 1975-1978 are presented. It was shown that beta-hemolytic streptococci were highly sensitive to all the antibiotics tested except tetracycline. Among Streptococcus viridans the strains resistant to many antibiotics were more frequent than among beta-hemolytic streptococci. Most of the Staphylococcus aureus strains were sensitive to gentamycin, cephaloridin, oxacillin and resistant to the other antibiotics. The epidermal staphylococci were characterized by approximately the same antibiotic sensitivity as Staphylococcus aureus. Resistance of the predominating majority of the Pneumococcus strains to tetracycline was noted. Proteus and Ps. aeruginosa were resistant to all the antibiotics except aminoglycosides. The microflora isolated from the cases with otorhinolaryngological diseases in 1975-1978 were mainly characterized by lower antibiotic sensitivity than that isolated from the cases with the same diseases in 1964-1974. It is possible to suppose that the microorganisms isolated from the patients with otorhinolaringological diseases had no significant differences with respect to their antibiotic sensitivity from those isolated from the patients with other pathological processes.     

Geographical variation in cloacal microflora and bacterial antibiotic resistance in a threatened avian scavenger in relation to diet and livestock farming practices

The impact on wildlife health of the increase in the use of antimicrobial agents with the intensification of livestock production remains unknown. The composition, richness and prevalence of cloacal microflora as well as bacterial resistance to antibiotics in nestlings and full-grown Egyptian vultures Neophron percnopterus were assessed in four areas of Spain in which the degree of farming intensification differs. Differences in diet composition, especially the role of stabled livestock carrion, appear to govern the similarities of bacterial flora composition among continental populations, while the insular vulture population (Fuerteventura, Canary Islands) showed differences attributed to isolation. Evidence of a positive relationship between the consumption of stabled livestock carrion and bacterial resistance to multiple antibiotics was found. Bacterial resistance was high for semisynthetic penicillins and enrofloxacin, especially in the area with the most intensive stabled livestock production. The pattern of antibiotic resistance was similar for the different bacterial species within each area. Bacterial resistance to antibiotics may be determined by resistance of bacteria present in the livestock meat remains that constituted the food of this species, as indicated by the fact that resistance to each antibiotic was correlated in Escherichia coli isolated from swine carrion and Egyptian vulture nestlings. In addition, resistance in normal faecal bacteria (present in the microflora of both livestock and vultures) was higher than in Staphylococcus epidermidis, a species indicator of the transient flora acquired presumably through the consumption of wild rabbits. Potential negative effects of the use of antimicrobials in livestock farming included the direct ingestion of these drug residues and the effects of bacterial antibiotic resistance on the health of scavengers.     

Effects of dietary antibiotics on intestinal microflora in broiler chickens

Changes were examined in the intestinal microflora in broiler chickens fed a diet containing antibiotics to obtain fundamental information on the mechanisms of beneficial effect of the antibiotics upon livestock production. Three antibiotics (colistin, bacitracin, and enramycin) were employed as feed additives. Experiments were conducted with broiler chickens in two ways. In one way dietary antibiotics were fed continually at levels approved for use as feed additives for a long term. In the other they were fed the same antibiotics for a short term. Significant changes in microflora were observed mainly in such bacterial groups as aerobic bacteria and Lactobacillus. In the long term administration, three possible modes of variance in the bacterial flora were postulated: Changes directly related to the antibacterial spectrum of antibiotics. Antagonistic changes related to an ecological balance in the bacterial flora. Changes in quantitative balance of bacteria constituting each bacterial group. The change in the intestinal microflora during administration of the antibiotic diet was expressed as a complex form of these transition modes. In the short term administration, it was demonstrated that the effect of the antibiotic diet lingered even 7 days after administration. This suggests that antibiotics used as feed additives may possibly affect the stability of the intestinal microflora.     

A meta-analysis of prophylactic antibiotics in head and neck surgery.

Although it is generally agreed that prophylactic antibiotics are necessary for the prevention of postoperative wound infection, the choice of antibiotic regimen is controversial. In an attempt to determine the most effective antibiotic regimen, a meta-analysis of published clinical trials of prophylactic antibiotics for head and neck surgery was undertaken. The meta-analysis revealed a relative difference in infection rates of 43.7 percent in favor of the use of antibiotics versus placebo, of 8.3 percent in favor of multiple antibiotics versus a single antibiotic, of 13.7 percent in favor of multiple antibiotics versus cefazolin, and of 4.1 percent in favor of multiple-day prophylaxis versus single-day prophylaxis. This meta-analysis suggests that a 1-day course of clindamycin may be the most effective prophylactic antibiotic regimen for head and neck surgery.     

剖宫产术围术期预防性应用抗生素的成本效果分析

目的:探讨剖宫产术围术期预防性应用抗生素的成本效果,为剖宫产手术提供有效、经济的抗生素应用方案。方法:选取我院近3年接诊的80例实施剖宫产产妇纳入本次研究,将其随机分为研究组和对照组,每组产妇40例。研究组在胎儿娩出断脐后立即静脉滴注头孢呋辛,术后不再应用抗生素,而对照组术后静脉滴注头孢呋辛,对比两组产妇的成本效果。结果:两组产妇术后体温(平均体温、最高体温)、体温恢复时间、住院时间和术后感染发生率对比均无统计学差异(P0.05);研究组成本效果明显低于对照组(P0.05)。结论:剖宫产术围术期预防性应用抗生素可达到良好的抗感染效果,选择头孢呋辛作为剖宫产手术围术期预防性抗菌药物,是一种有效、经济的方案,可避免围术期过度使用抗生素。     

Epidemiological aspects of antibiotic resistance in hospital microorganisms

A total of 37490 medical histories of patients with "pure" and conditionally "pure" operations were analysed with a purpose of studying the scales of hospital infections in surgical inpatients and the effect of the prophylactic use of antibiotics on the frequency of postoperative complications. It was found that postoperative purulent complications developed in 10-25 per cent of patients. Antibiotics and mainly penicillin and streptomycin were used in the treatment of 75 per cent of patients before, during and after operations. The prophylactic use of the antibiotics in mass operations did not prevent the development of infections. Infiltrates and purulent wounds were more frequent (P less than 0.001) in patients subjected to the antibiotic prophylaxis. This indicates that the use of the antibiotics for preventing possible complications in patients with the "pure" operations and in the majority of patients with the conditionally "pure" operations is not advisable. The strategy of the rational use of antibiotics requires that the staff of the large hospitals should include a chemotherapeutist for defining the tactics of chemotherapy and controlling the use of antibiotics which should promote a decrease in the incidence of hospital infections and in the rate of lethality.     

婴幼儿期使用抗生素所致菌群失衡 对疾病发生的影响研究进展

人体表面定植的各种细菌承载庞大的基因库,它们之间的互相作用对维持人体微生态的稳定必不可少。婴幼儿期是生长发育的重要时期,同样也是菌群演替的关键时期。此时期免疫系统发育尚未成熟,容易受病毒及细菌感染,而使用抗生素治疗细菌感染是难以避免的。然而抗生素的使用不仅改变正常菌群,进而改变人体的免疫反应和代谢模式,同时对人体产生长远的影响,导致疾病的发生,甚至引起人体定植的正常菌群产生耐药性,构成新的耐药菌株的来源。本文就近年来婴幼儿期使用抗生素所致菌群失衡对疾病发生的影响作一综述。     

How far does prophylaxis against infection in total joint replacement offset its cost?

Selection of a cost effective method of prophylaxis against infection for patients undergoing total joint replacement was shown to depend on the number of arthroplasties performed each year at individual hospitals. When 100 arthroplasties were performed each year the prophylactic use of systemic antibiotics minimised the total costs of the department—that is, the combined costs of prophylaxis and reoperation for deep sepsis. Some departments also used local antibiotic prophylaxis in the form of polymethylmethacrylate cement impregnated with gentamicin or a combination of systemic and local prophylaxis at almost as low a total cost and with comparable effect.Selection of a method of prophylaxis should not be determined solely on the basis of reducing costs. When a value was assigned to the effects of loss of health an economic optimum was established that allowed selection of a more costly method of prophylaxis together with further reductions in the incidence of infection and the need for reoperation.     

Antibiotic Resistance Among Cultured Bacterial Isolates from Bioethanol Fermentation Facilities Across the United States

Bacterial contamination of fuel ethanol fermentations by lactic acid bacteria (LAB) can have crippling effects on bioethanol production. Producers have had success controlling bacterial growth through prophylactic addition of antibiotics to fermentors, yet concerns have arisen about antibiotic resistance among the LAB. Here, we report on mechanisms used by 32 LAB isolates from eight different US bioethanol facilities to persist under conditions of antibiotic stress. Minimum inhibitory concentration assays with penicillin, erythromycin, and virginiamycin revealed broad resistance to each of the antibiotics as well as high levels of resistance to individual antibiotics. Phenotypic assays revealed that antibiotic inactivation mechanisms contributed to the high levels of individual resistances among the isolates, especially to erythromycin and virginiamycin, yet none of the isolates appeared to use a β-lactamase. Biofilm formation was noted among the majority of the isolates and may contribute to persistence under low levels of antibiotics. Nearly all of the isolates carried at least one canonical antibiotic resistance gene and many carried more than one. The erythromycin ribosomal methyltransferase (erm) gene class was found in 19 of 32 isolates, yet a number of these isolates exhibit little to no resistance to erythromycin. The erm genes were present in 15 isolates that encoded more than one antibiotic resistance mechanism, suggestive of potential genetic linkages.     

The microbial colonization of the skin of newborn infants rooming in with the mother in maternity homes]

The formation of skin biocenosis in children under the conditions of a maternity hospital with the joint care of mother and child was studied with the use of commercial bacteriological imprints manufactured in the USSR. The colonization of newborn infants in maternity hospitals with opportunistic, saprophytic and normal microflora was established. In newborn infants aged up to 5 years low skin resistance to colonization and, as a consequence, frequent colonization of the skin with opportunistic and saprophytic microflora was observed.     

In Silico Analysis of Antibiotic Resistance Genes in the Gut Microflora of Individuals from Diverse Geographies and Age-Groups

The spread of antibiotic resistance, originating from the rampant and unrestrictive use of antibiotics in humans and livestock over the past few decades has emerged as a global health problem. This problem has been further compounded by recent reports implicating the gut microbial communities to act as reservoirs of antibiotic resistance. We have profiled the presence of probable antibiotic resistance genes in the gut flora of 275 individuals from eight different nationalities. For this purpose, available metagenomic data sets corresponding to 275 gut microbiomes were analyzed. Sequence similarity searches of the genomic fragments constituting each of these metagenomes were performed against genes conferring resistance to around 240 antibiotics. Potential antibiotic resistance genes conferring resistance against 53 different antibiotics were detected in the human gut microflora analysed in this study. In addition to several geography/country-specific patterns, four distinct clusters of gut microbiomes, referred to as ‘Resistotypes’, exhibiting similarities in their antibiotic resistance profiles, were identified. Groups of antibiotics having similarities in their resistance patterns within each of these clusters were also detected. Apart from this, mobile multi-drug resistance gene operons were detected in certain gut microbiomes. The study highlighted an alarmingly high abundance of antibiotic resistance genes in two infant gut microbiomes. The results obtained in the present study presents a holistic ‘big picture’ on the spectra of antibiotic resistance within our gut microbiota across different geographies. Such insights may help in implementation of new regulations and stringency on the existing ones.