This study examined antibiotic use in the neonatal intensive care unit (NICU) of Misurata Medical Center in Libya. The researchers reviewed records of 37 newborns treated with antibiotics from January to February 2018. They found that 97.3% received penicillin alone or with gentamicin, usually for less than one week based on suspected risks for sepsis rather than confirmed diagnosis. Only 5.4% underwent full sepsis workup. Most common risks were preterm birth, cesarean delivery, and rupture of membranes over 18 hours prior. The study aims to evaluate appropriate antibiotic use and duration in the NICU to prevent overuse and development of resistance.
Study about antibiotic abuse in NICU of pediatric department in misurata medical center (MMC) in interval between 1/1/2018 to 28/2/2018 under supervision of community medicine department in faulty of medicine in misurate university
Please find the power point on Antimicrobial resistance. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
updated statistics about antimicrobial resistance,causes and mechanism of antimicrobial resistances, national antimicrobial policy, national antimicrobial surveillance, new delhi b metallo-lactamase-1 bacteria
The use of antimicrobial in humans and animals, the consequences of this use, the political and economic barriers to improve prudent use and possible solutions for this problem.
Antimicrobial resistance as an emerging food-borne infectious diseaseJean Jacques Bernatas
Food safety is also about acquired antimicrobial resistance in big farms, and its spread in the environment. Be a smart consumer, a smart producer, and a smart patient to contributing to get antimicrobial resistance under control.
Study about antibiotic abuse in NICU of pediatric department in misurata medical center (MMC) in interval between 1/1/2018 to 28/2/2018 under supervision of community medicine department in faulty of medicine in misurate university
Please find the power point on Antimicrobial resistance. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
updated statistics about antimicrobial resistance,causes and mechanism of antimicrobial resistances, national antimicrobial policy, national antimicrobial surveillance, new delhi b metallo-lactamase-1 bacteria
The use of antimicrobial in humans and animals, the consequences of this use, the political and economic barriers to improve prudent use and possible solutions for this problem.
Antimicrobial resistance as an emerging food-borne infectious diseaseJean Jacques Bernatas
Food safety is also about acquired antimicrobial resistance in big farms, and its spread in the environment. Be a smart consumer, a smart producer, and a smart patient to contributing to get antimicrobial resistance under control.
Rational Use of Antibiotics. Infection was a major cause of morbidity and mortality, before the development of antibiotics.
The treatment of infections faced a great challenge during those periods.
Later in 1928, the discovery of Penicillin, a beta-lactam antibiotic, by Alexander Fleming opened up the golden era of antibiotics.
It marked a revolution in the treatment of infectious diseases and stimulated new efforts to synthesize newer antibiotics.
The period between the 1950s and 1970s is considered the golden era of discovery of novel antibiotic classes, with very few classes discovered since then.
Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals, and antifungals) from working against it.
Fighting the growing threat of antimicrobial resistance webinar4 All of Us
Lord Jim O’Neill, the UK Commercial Secretary to the Treasury and Chair of the Review on Antimicrobial Resistance, recently released a report laying out recommendations to fight the global threat of antimicrobial resistance (AMR).
Overuse of antibiotics, especially of broad spectrum antibiotics rather than targeted narrow spectrum therapies, has led to an increase in drug-resistant bacterial infections. This emerging health issue is poised to have devastating global consequences, making it impossible to treat previously curable diseases. AMR already contributes to 700,000 deaths a year, and the report warns that it could cause 10 million deaths a year and $100 trillion in lost global productivity by 2050 if nothing is done to stop its spread.
In recent years, advances in diagnostic technology have made rapid point-of-care testing possible for many diseases – enabling providers to immediately prescribe the most appropriate therapy during the course of a patient’s visit.
This webinar will focused on the importance of understanding the need for diagnostics, what is being done in development and the solutions that are available now.
Antibiotic Resistance form food of animal origint- Debatable issueAsima Zehra
Contribution to the development of antibiotic resistance is multifactorial wherein human medicine plays a major role and food of animal origin are least to bother.
Antibiotics and similar drugs, together called antimicrobial agents, have been used for the last many years to treat patients who have infectious diseases. The treatment of bacterial infections is increasingly complicated because microorganisms can develop resistance to antimicrobial agents, since the first usage of antimicrobials, the resistance among bacteria has progressively increased and has accelerated within the last 10 years. This is largely due to the increasing presence of pathogenic microorganisms with resistance to previous antibiotic agents, resulting in the administration of improper treatment, not only in humans but also in companion and food animals and the environment which has caused the rise in antibiotic resistance. Although efforts are being made in all the areas, there is an urgent need to increase the effectiveness of these interventions or some bacterial infections will become difficult if not impossible to treat reliably.
The Johns Hopkins Center for a Livable Future Capitol Hill Briefing: Antibiot...Johns Hopkins University
On 12/2/09 on Capitol Hill, leading experts in economics, public health and public policy and Rep. Louise Slaughter (D-NY), a leading voice on antibiotic resistance, discussed the impact of resistant infections on the U.S. healthcare system and the need to phase out inappropriate use of antibiotics as growth promoters in the production of food animals. The Johns Hopkins Center for a Livable Future (CLF) hosted the event with Rep. Slaughter. This is a complication of the panelists' presentations.
Are we running out of antibiotics? - Slideset by Professor EspositoWAidid
How does antibiotic resistance happen?
This work, edited by the professor Susanna Esposito, tries to answer this question underlining the importance of prescribing the right drug with the right dose and duration, to avoid any kind of abuse that may cause or increase antibiotic resistance.
To learn more please visit www.waidid.org
A well-prepared presentation explaining most of topics related to the anti-microbial resistance especially resistance in bacteria. This presentation covers the Introduction, mechanism, causes, prevention and solutions to control this growing menace.
Dr. Brian Lubbers - Animal Agriculture's Contribution to Antibiotic Resistanc...John Blue
Animal Agriculture's Contribution to Antibiotic Resistance - What Should (& Should Not) Be On The Table - Dr. Brian Lubbers, Kansas State University College of Veterinary Medicine, Director of Clinical Microbiology, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Dr. Richard Raymond - Antibiotics and Food Safety: Perceptions vs. RealityJohn Blue
"Antibiotics and Food Safety: Perceptions vs. Reality - Dr. Richard Raymond, Former Undersecretary for Food Safety, U.S. Department of Agriculture, from the 2014 Minnesota Pork Congress, January 14-15, Minneapolis, MN, USA.
More presentations at http://www.swinecast.com/2014-minnesota-pork-congress"
Antibiotic resistance: causes, consequences and means to limit itGreenFacts
Over the last century, antibiotics have radically changed the
way we treat infections. They are an important tool for modern medicine, but unfortunately their misuse have led to the emergence of bacteria that are resistant to antibiotics.
What has caused it and how can the spread of resistance be limited?
a research presentation done by Augustine Mwaawaaru Level 400) and Matthew Frimpong Antwi (Level 300) students of( Presbyterian University College-Ghana on Antimicrobial resistance and the way foeward in Ghana. contact 0261825262
Rational Use of Antibiotics. Infection was a major cause of morbidity and mortality, before the development of antibiotics.
The treatment of infections faced a great challenge during those periods.
Later in 1928, the discovery of Penicillin, a beta-lactam antibiotic, by Alexander Fleming opened up the golden era of antibiotics.
It marked a revolution in the treatment of infectious diseases and stimulated new efforts to synthesize newer antibiotics.
The period between the 1950s and 1970s is considered the golden era of discovery of novel antibiotic classes, with very few classes discovered since then.
Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals, and antifungals) from working against it.
Fighting the growing threat of antimicrobial resistance webinar4 All of Us
Lord Jim O’Neill, the UK Commercial Secretary to the Treasury and Chair of the Review on Antimicrobial Resistance, recently released a report laying out recommendations to fight the global threat of antimicrobial resistance (AMR).
Overuse of antibiotics, especially of broad spectrum antibiotics rather than targeted narrow spectrum therapies, has led to an increase in drug-resistant bacterial infections. This emerging health issue is poised to have devastating global consequences, making it impossible to treat previously curable diseases. AMR already contributes to 700,000 deaths a year, and the report warns that it could cause 10 million deaths a year and $100 trillion in lost global productivity by 2050 if nothing is done to stop its spread.
In recent years, advances in diagnostic technology have made rapid point-of-care testing possible for many diseases – enabling providers to immediately prescribe the most appropriate therapy during the course of a patient’s visit.
This webinar will focused on the importance of understanding the need for diagnostics, what is being done in development and the solutions that are available now.
Antibiotic Resistance form food of animal origint- Debatable issueAsima Zehra
Contribution to the development of antibiotic resistance is multifactorial wherein human medicine plays a major role and food of animal origin are least to bother.
Antibiotics and similar drugs, together called antimicrobial agents, have been used for the last many years to treat patients who have infectious diseases. The treatment of bacterial infections is increasingly complicated because microorganisms can develop resistance to antimicrobial agents, since the first usage of antimicrobials, the resistance among bacteria has progressively increased and has accelerated within the last 10 years. This is largely due to the increasing presence of pathogenic microorganisms with resistance to previous antibiotic agents, resulting in the administration of improper treatment, not only in humans but also in companion and food animals and the environment which has caused the rise in antibiotic resistance. Although efforts are being made in all the areas, there is an urgent need to increase the effectiveness of these interventions or some bacterial infections will become difficult if not impossible to treat reliably.
The Johns Hopkins Center for a Livable Future Capitol Hill Briefing: Antibiot...Johns Hopkins University
On 12/2/09 on Capitol Hill, leading experts in economics, public health and public policy and Rep. Louise Slaughter (D-NY), a leading voice on antibiotic resistance, discussed the impact of resistant infections on the U.S. healthcare system and the need to phase out inappropriate use of antibiotics as growth promoters in the production of food animals. The Johns Hopkins Center for a Livable Future (CLF) hosted the event with Rep. Slaughter. This is a complication of the panelists' presentations.
Are we running out of antibiotics? - Slideset by Professor EspositoWAidid
How does antibiotic resistance happen?
This work, edited by the professor Susanna Esposito, tries to answer this question underlining the importance of prescribing the right drug with the right dose and duration, to avoid any kind of abuse that may cause or increase antibiotic resistance.
To learn more please visit www.waidid.org
A well-prepared presentation explaining most of topics related to the anti-microbial resistance especially resistance in bacteria. This presentation covers the Introduction, mechanism, causes, prevention and solutions to control this growing menace.
Dr. Brian Lubbers - Animal Agriculture's Contribution to Antibiotic Resistanc...John Blue
Animal Agriculture's Contribution to Antibiotic Resistance - What Should (& Should Not) Be On The Table - Dr. Brian Lubbers, Kansas State University College of Veterinary Medicine, Director of Clinical Microbiology, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Dr. Richard Raymond - Antibiotics and Food Safety: Perceptions vs. RealityJohn Blue
"Antibiotics and Food Safety: Perceptions vs. Reality - Dr. Richard Raymond, Former Undersecretary for Food Safety, U.S. Department of Agriculture, from the 2014 Minnesota Pork Congress, January 14-15, Minneapolis, MN, USA.
More presentations at http://www.swinecast.com/2014-minnesota-pork-congress"
Antibiotic resistance: causes, consequences and means to limit itGreenFacts
Over the last century, antibiotics have radically changed the
way we treat infections. They are an important tool for modern medicine, but unfortunately their misuse have led to the emergence of bacteria that are resistant to antibiotics.
What has caused it and how can the spread of resistance be limited?
a research presentation done by Augustine Mwaawaaru Level 400) and Matthew Frimpong Antwi (Level 300) students of( Presbyterian University College-Ghana on Antimicrobial resistance and the way foeward in Ghana. contact 0261825262
Vaccine Victories Against Microbial Resistance - Dr. Donald F. GersonPnuVax
Vaccine and novel immunotherapies offer a window of opportunity to combat emerging infectious disease as well as the rising threat of antibiotic resistance.
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BY- RICHA KRISHNA
(M.PHARMACY)
Antibiotic resistance occurs when bacteria change in response to the use of these medicines. Bacteria, not humans or animals, become antibiotic-resistant. These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.
ALKAMAGIC PLAN 1350.pdf plan based of door to door delivery of alkaline water...rowala30
Alka magic plan 1350 -we deliver alkaline water at your door step and you can make handsome money by referral programme
we also help and provide systematic guideline to setup 1000 lph alkaline water plant
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
Under Pressure : Kenneth Kruk's StrategyKenneth Kruk
Kenneth Kruk's story of transforming challenges into opportunities by leading successful medical record transitions and bridging scientific knowledge gaps during COVID-19.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
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This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
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ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Bringing AI into a Mid-Sized Company: A structured Approach
Antibiotic abuse
1. MISURATA UNIVERSITY
FACULTY OF MEDICINE
DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE
Study About Antibiotic Abuse in NICU in
Paediatrics Department of MMC
PREPARED BY: Ahmed Gamal Yassin
Altaf Mohammed Patel
Abulaali Abdullah Qamie
UNDER SUPERVISION OF:
Dr.Ibrahim Beitalmal
2. Antibiotics AbuseCommunity Medicine Dept.
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DEDICATION
These piles of pieces of papers are dedicated to those loving
science for purpose benefiting people with its knowledge away
from material motives. Also we dedicate this work to those who
sacrifice their life and blood for their country and to those who
struggle to upsurge their own knowledge towers, but not ivory
towers, in the middle of hostile materialistic environment seeing
people with money oriented vision. It is also sent to the spirits
of the martyrs who offered their blood and souls for the cause of
freedom and democracy.
3. Antibiotics AbuseCommunity Medicine Dept.
3|P A G E
ABSTRACT
An antibiotics is a type of drugs that kill or stop the growth of
bacteria. Examples include penicillin and ciprofloxacin.
The antibiotics uses in form of misuse, overuse/abuse and over prescription
is the most important factor leading to development of antibiotics
resistance.
Antimicrobial resistance (AMR) is the ability of a microbes to resist the
effects of medications previously used to treat them.
Antibiotics resistance nowadays is one of the biggest threats to global
health.
In this study we concentrate on manifestations of antibiotics abuse in ICU
especially neonatal ICU as it known as epicenter of infections &
multidrug resistance (MDR).
MDR is antimicrobial resistance shown by species of microorganism to
multiple antimicrobial drugs.
Severe infections represent the main cause of neonatal mortality accounting
for more than one million neonatal deaths worldwide every year.
Antibiotics are the most commonly prescribed medications in neonatal
intensive care units (NICUs).
4. Antibiotics AbuseCommunity Medicine Dept.
4|P A G E
INTRODUCTION
ANTIBIOTICS ABUSE & ANTIBIOTICS
RESISTANCE
An antibiotics is a type of drugs that kill or stop the growth of
bacteria. Examples include penicillin and ciprofloxacin.
Humans developed antimicrobials to destroy disease-causing microbes. The
most commonly known antimicrobials are antibiotics, which target
bacteria. Other forms of antimicrobials are antivirals, antifungals, and
antiparasitics.
Penicillin, the first commercialized antibiotic, was discovered in 1928 by
Alexander Fleming. While it wasn’t distributed among the general public
until 1945, it was widely used in World War II for surgical and wound
infections among the Allied Forces.
Actually, discovery of antibiotics achieve great advances in medicine &
surgery, as once they started to use, then infections that was lethal in the
past became treatable.
But over the last decades, the antibiotics uses in form of misuse,
overuse/abuse and overprescription was the most important factor leading
to development of antibiotics resistance, promising return of pre –
antibiotics discovery era, so we will take interest in this section
"antibiotics abuse" topic.
Common situations in which antibiotics are overused include: treatment of
respiratory infections which apparently are viral in nature (as cold & flu),
use of oral antibiotics instead of local one in treatment of viral otitis media,
also treatment of viral conjunctivitis or viral sinusitis and treatment of
eczema, in addition to massive use of antibiotics in livestock…etc.
Antimicrobial resistance (AMR) is the ability of a microbes to resist the
effects of medications previously used to treat them.
5. Antibiotics AbuseCommunity Medicine Dept.
5|P A G E
Antibiotics resistance nowadays is one of the biggest threats to global
health as it can affect anyone, any age, & any country (can spread
globally), also it can leads to higher medical costs, prolonged hospital
stays, and increased mortality. All these because the antibiotics that was
effective in the past, nowadays become not effective, as infections that
caused by resistant bacteria are harder to treat than those caused by non-
resistant bacteria & then requiring alternative medications or higher doses,
both of which may be more expensive or more toxic.
Resistance arises through one of three mechanisms: natural resistance in
certain types of bacteria, genetic mutation (arise spontaneously), or by one
species acquiring resistance from another (vertical or horizontal), and
antibiotics accelerate this process.
All classes of microbes can develop resistance: fungi can develop resistance
against antifungal, virus can develop resistance against antiviral, protozoa
can develop resistance against antiprotozoal & of course bacteria can
develop resistance against antibiotics.
Microbes resistant to multiple antimicrobials are called multidrug
resistant (MDR); or sometimes superbugs.
Therefore, preventive measures include only using antibiotics when needed,
& then stopping misuse of antibiotics or antimicrobials.
How the resistance happen?
As mentioned before, antibiotics resistance either present naturally in
certain types of bacteria, arise spontaneously due to point mutation, or
acquired from other bacteria by genetic materials which carry resistance
genes either vertically via clonal expansion (bacterial multiplication) or
horizontally by mobile genetic elements (MGE)/ plasmids.
Antibiotics overuse will accelerate these processes by selective pressure in
bacterial populations, causing vulnerable bacteria to die; this increases the
percentage of resistant bacteria which continue growing & spreading.
7. Antibiotics AbuseCommunity Medicine Dept.
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Mechanism by which bacteria can resist antibiotics
There are a number of ways by which microorganisms become resistant
to antimicrobial agents. These include:
• Production of enzymes.
• Alteration in outer membrane permeability.
• Alteration of target sites.
• Efflux pumps.
• Alteration of metabolic pathways.
Therefore we conclude the following:
• Cause of antibiotics resistance: 3 main causes; naturally present, point
mutation (spontaneous) & acquired from other bacteria either vertically or
horizontally
• Key/ accelerating factor: antibiotics abuse
• Mechanism of antibiotics resistance:
o Production of enzymes.
o Alteration in outer membrane permeability.
o Alteration of target sites.
o Efflux pumps.
o Alteration of metabolic pathways.
8. Antibiotics AbuseCommunity Medicine Dept.
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List of common antibiotics resistant bacteria:
ICU & ANTIBIOTICS RESISTANCE
In this section, we are going to explain how ICU department play role in
emergence & spread of antibiotics resistance.
As we know, intensive care unit (ICU) is a hospital department for
provision of intensive nursing & medical care of critically ill patients,
characterized by high quantity of continuous nursing & supervision, & by
sophisticated monitoring & resuscitative equipment.
9. Antibiotics AbuseCommunity Medicine Dept.
9|P A G E
ICU is known as epicenter of infections (i.e: focal points for the
emergence and spread of antibiotics resistant pathogens) because of:
• Its extremely vulnerable population of critically ill patients (i.e:
highly susceptible to infections).
• Critically ill patients often receive broad – spectrum antimicrobial
therapy during their hospitalization.
• High use of invasive procedures (such as urine catheter, NGT, central
line, peripheral line/ cannula, intubation..etc).
• Several drugs are given, which contribute in infections either by some
drugs that interfere with patients immunity if given in high doses or
for long time, also by drugs that given parenterally for several times
with bad aseptic precautions.
• Transmission of infections in between patients or medical staff.
• Disrespect for correct aseptic techniques.
• Patient who admitted with already community acquired infections.
This patient will act as source of infections to other patients in the
same room.
• Due to the administration of inadequate or inappropriate antimicrobial
treatment.
• Antibiotic abuse/ overuse.
Because of all these causes, then ICU considered as epicenter of infections
that will contribute in emergence of antibiotics resistance strains of bacteria
especially MDR.
Actually, the main reason for taking interest in this section, mainly because
ICU is epicenter of MDR (multidrug resistance).
MDR is antimicrobial resistance shown by species of microorganism to
multiple antimicrobial drugs. MDR is the most threatening form of
antibiotics resistance to public health.
Although ICU account for fewer than 10 percent of total beds in most
hospitals, but more than 20 percent of all nosocomial infections are
10. Antibiotics AbuseCommunity Medicine Dept.
10|P A G E
acquired in ICUs, suggesting substantial rates of mortality & morbidity &
then result in a considerable clinical & economic burden for hospitals.
Common MDR organisms:
• Methicillin-Resistant Staphylococcus Aureus (MRSA).
• Vancomycin-Resistant Enterococci (VRE).
• Extended spectrum β-lactamase (ESBLs) producing gram – negative
bacteria.
• Klebsiella Pneumonia Carbapenemase (KPC) producing gram-
negatives.
• MultiDrug-resistant Gram Negative Rods (MDR GNR) MDRGN
bacteria such as Enterobacter species (Enterobacteriaceaes), E.coli,
Klebsiella Pneumonia, Acinetobacter Baumannii, Pseudomonas
aeruginosa.
ANTIBIOTIC USE IN NEONATAL ICU
Severe infections represent the main cause of neonatal mortality
accounting for more than one million neonatal deaths worldwide every year
(Study by National Institutes of Health's National Library of Medicine
published in 2013).
Antibiotics are the most commonly prescribed medications in neonatal
intensive care units (NICUs).
Sepsis has often subtle, nonspecific signs and symptoms and results in
serious consequences ranging from neurodevelopmental deficits to death.
As a result, clinicians frequently administer empirical antibiotics to infants
with first signs of suspected sepsis or infants at high risk of sepsis while
awaiting culture results. However continued use of empiric broad-spectrum
antibiotic treatment in the setting of negative cultures especially in preterm
infants may not be benefit.
11. Antibiotics AbuseCommunity Medicine Dept.
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The benefits of antibiotic therapy when indicated are clearly enormous, but
the continued empirical treatment by both broad spectrum antibiotics &
prolonged duration without any microbiological justification is dangerous
and associated with adverse outcomes including invasive candidiasis,
increased antimicrobial resistance, necrotizing enterocolitis, late-onset
sepsis (LOS), and deaths.
Most common neonatal pathogens are susceptible to narrow-spectrum
antibiotics.
The choice of antibiotic and duration of empirical treatment are strongly
associated with center-based rather than with individual patient risk factors,
implying that these choices are modifiable across centers. Thus, clinicians
should aim to treat with short courses of narrow-spectrum antibiotics
whenever possible, choosing the appropriate antibiotics and treatment
duration to balance the risks of potentially untreated sepsis against the
adverse effects of treatment in infants with sterile cultures.
Definitions:
• Neonate: period from birth up to 28 days of life (i.e: first month of
life).
• Low birth weight (LBW): if birth weight less than 2.5 Kg.
• Very low birth weight (VLBW): If birth weight less than 1.5 kg.
• Extremely low birth weight (ELBW): if birth weight less than 1kg.
• Preterm baby: born before 37 weeks of gestational age.
• Neonatal mortality rate (NMR): number of neonatal death per 1000
live births.
12. Antibiotics AbuseCommunity Medicine Dept.
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AIM OF STUDY
The purpose of this review is to highlight the inappropriate use of
antibiotics in the NICUs, to exam the impact of antibiotic treatment in
neonates with negative cultures and to summarize existing knowledge
regarding the appropriate choice of antimicrobial agents and optimal
duration of therapy in neonates with suspected or culture-proven sepsis in
order to prevent serious consequences.
13. Antibiotics AbuseCommunity Medicine Dept.
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LITERATURE REVIEW
A previous study used multicenter retrospective observational study of
antibiotic use, was performed in 4 tertiary care NICUs in USA to assess
adherence to the guidelines defined by the CDC 12-Step campaign
regarding antibiotic use in NICU . Performed in 2015 by U.S. National
Institutes of Health's National Library of Medicine (NIH/NLM), &
available in PubMed Central (PMC) & published in website of NCBI.
Fifty infants per NICU were identified who received intravenous antibiotics
at greater than 72 hours of age (> 3 days of duration). Antibiotic regimens,
clinical and microbiologic data, and indications for initiation and
continuation of antibiotics (after 72 hours of use) were recorded.
Inappropriate utilization was characterized at initiation, continuation, by
agent, and by CDC 12-Step.
Two hundred neonates received 323 antibiotic courses totaling 3344
antibiotic-days. Ninety (28%) courses and 806 (24%) days were judged to
be nonadherent to a CDC 12-Step. Inappropriate use was more common
with continuation of antibiotics (39%) than with initiation (4%) of therapy.
Vancomycin was the most commonly used drug (n = 895 antibiotic-days)
of which 284 (32%) days were considered inappropriate. Carbapenems
were used less frequently (n = 310 antibiotic-days), and 132 (43%) of these
days were inappropriate. Common reasons for nonadherence at the time of
continuation included failure to narrow antibiotic coverage after
microbiologic results were known and prolonged antibiotic prophylaxis
after surgery with chest tube placement.
14. Antibiotics AbuseCommunity Medicine Dept.
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MATERIALS & METHODS
Study design: Observational descriptive retrospective study based on
patients records review.
Study population: Misurata city.
Study area: Misurata Medical Center (MMC), Paediatrics department,
Neonatal ICU.
Study population size: 37 newborn babies.
Study variables: Sex, GA at time of delivery, Mode of delivery, Birth
weight, APGAR score, Sources of infections, Types of AB & duration,
Septic screen, Septic evidence, Duration of stay in hospital, Respiration
Support.
Time of study: the hospital records were reviewed by the researchers
between 1st
of Jan 2018 to 31st
of Feb 2018.
Method of analysis: data are presented in tabular & graphical presentation
using frequency distribution table and multiple bar chart respectively.
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RESULTS
We collect all data about cases which admitted to NICU in paediatrics
department of MMC & treated by antibiotics during period from 1st
of Jan
2018 to 31st
of Feb 2018.
• Total number of cases which treated by antibiotics in this period is 37
cases.
• Types of used antibiotics: benzyl penicillin (penicillin G),
gentamycin, amikacin & meropenem.
• 97.3% cases (36 cases) are treated by penicillin G:
o 77.7% (28 cases) of them are given penicillin G only.
o 22.2% (8 cases) of them are given penicillin G + gentamycin.
o 2.7% (1 case) of them is given amikacin + meropenem after
period of non-response to penicillin G & gentamycin.
o 38.8% (14 cases) of them treated for duration < 3 days.
o 52.7% (19 cases) of them treated for duration 3 – 7 days.
o 11. 1% (4 cases) of them treated for duration > 7 days.
• In almost all cases, evidences of sepsis are investigated only
depending on inflammatory indices (WBC, CRP & ESR) & clinical
data . In 35 cases, results of investigation was suggest sepsis, while
other 2 cases results was normal.
• Only 2 cases (5.4%) of total underwent to real septic workup
(microbiological data).
• In all cases, main causes of admission to NICU & initiation of
antibiotics treatment was not depending on microbiological data for
diagnosis of sepsis (documented sepsis), but mainly depend on
clinically suspected risks for sepsis (suspected sepsis). These risks:
o 54% of cases (20 cases) are preterm babies.
o 72.9% of cases (27 cases) are delivered by caesarean section
(CS). 21 cases (77.7%) of them are delivered by urgent CS.
o 27% of cases (10 cases) are low birth weight (LBW); < 2.5kg.
o APGAR score of 4 cases (10.8%) was record <7.
o 86.5% of cases (32 cases) have sources of infection:
▪ 68.75% (22 cases) of them came after several hours from
rupture of membrane (ROM). 21 cases of them came after
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premature spontaneous ROM (PROM), 19% (4 cases) of
21 cases came after 18 hours from PROM. 1 case of 22
cases came after artificial ROM (AROM).
▪ 15.6% (5 cases) of them came from mother has history of
chorioamnionitis.
▪ 15.6% (5 cases) of them came with breach presentation.
▪ 9.3% (3 cases) of them came from mother has history of
UTI.
▪ 6.25% (2 cases) of them came from mother has history of
per vaginal bleeding.
o 40.5% of total cases (15 cases) was have respiratory distress
symptoms.
o 10.8% (4 cases) was have neonatal jaundice.
o 13.5% (5 cases) kept on CPAP during admission period in
o NICU & 2.7% (1 case) kept on SIMV.
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DISCUSSION
In comparison with study in USA at 2015 that performed by
(NIH/NLM) in which its results was:
• Study done on 200 cases.
• Vancomycin was the most common used antibiotic.
• 50 cases (25%) received antibiotics >3days duration.
• In most of cases, initiation of antibiotics treatment & continuation
with them was not depend on microbiological data, but inappropriate
use was more clear with continuation than initiation because of low
response to antibiotics which lead to lengthening durations of
treatment for >3 days in many cases.
In our study results was :
• Study done on 37 cases.
• Penicillin G was the most common used antibiotic.
• 23 cases (62.1%) received antibiotics >3 days duration. 19 cases (51.3
%) for 3 – 7 days, & 4 cases (10.8%) for >7 days.
• 35 cases (94.6%) received antibiotics independence of
microbiological data & also inappropriate use was more clear with
continuation because of low response to antibiotics which lead to
lengthening durations of treatment for >3 days in many cases.
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CONCLUSION
We conclude in almost all cases admitted in period of study, initiation of
antibiotics treatment was only depend on clinical data (i.e: "Antibiotics
Use" in suspected sepsis), & duration of antibiotics treatment exceed 3
days in most of the cases, which confirm inappropriate use of antibiotics.
All of that because of treatment initiation & continuation was independence
of microbiological data.
Only 2 cases (5.4%) of total cases admitted in period of study, treated by
antibiotics after real septic workup (i.e: "Antibiotics Use" in documented
sepsis).
Most common used antibiotic is benzyl penicillin (penicillin G).
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RECOMMENDATIONS
Although manifestations of antibiotic abuse in paediatrics department is
lesser than other departments in MMC, but we hope to completely avoid
antibiotics abuse by deciding that antibiotics treatment not initiated unless
after establishing diagnosis of sepsis definitively depending on
microbiological data for all patients.
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REFERENCES
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Press.
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Perichon, & P. Courvalin (Eds.), The Desk Encyclopedia of
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• Singer, M., & Webb, A. R. (2009). Infection and Inflammation,
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TABLE OF CONTENTS
1. Title……………………………………………………………… 1
2. Dedication……………………………………………………….. 2
3. Abstract………………………………………………………….. 3
4. Introduction……………………………………………………... 4
4.1. Antibiotics Abuse & Antibiotics Resistance……………………. 4
4.2. How the resistance happen……………………………………… 5
4.3. List of common antibiotics resistant bacteria…………………… 8
4.4. ICU & Antibiotics Resistance…………………………………... 8
4.5. Common MDR organisms………………………………………. 10
4.6. Antibiotic Use In Neonatal ICU………………………………… 10
5. Aim of study…………………………………………………….. 12
6. Literature Review……………………………………………….. 13
7. Materials & Methods……………………………………………. 14
8. Results…………………………………………………………... 15
9. Discussion……………………………………………………….. 19
10. Conclusion………………………………………………………. 20
11. Recommendations……………………………………………..... 21
12. References………………………………………………………. 22
13. Contents………………………………………………………… 25