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Ferrara F, Capuozzo M, Pasquinucci R, Langella R, Trama U, Nava E, Zovi A. Antibacterial agents and the fight against antibiotic resistance: A real-world evidence analysis of consumption and spending by an Italian healthcare company. Ann Pharm Fr 2024; 82:545-552. [PMID: 38218426 DOI: 10.1016/j.pharma.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/27/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
INTRODUCTION The escalating bacterial resistance stands as an increasingly pertinent concern, particularly in the post-pandemic era where the use of antibiotics appears to be relentlessly surging, giving rise to profound apprehensions. The substantial utilization of last-generation penicillins and cephalosporins is anticipated to imminently result in the emergence of superbugs for which therapeutic solutions will be scarce. METHODS An analysis of antibiotic consumption in the hospital setting has been conducted in an Italian healthcare organization. Querying the internal management system facilitated the calculation of indicators and assessment of prescription trends. RESULTS A comparison has been made between the first half of 2023 and the first half of 2022, to highlight the exponential growth in the consumption of beta-lactam antibiotics, with consumption doubling compared to the previous year's semester. Overall, considering the prescription averages, there is a prescribing growth of +29% concerning hospitalization and +28% concerning hospital discharge. However, it should be noted that the consumption of certain antibiotics such as sulphonamides and trimethoprim (-103.00%), tetracyclines (-54.00%), macrolides, lincosamides and streptogramins (-50.00%) and colistin (-13.00%) decreased. CONCLUSION This real-world evidence analysis aimed to support the justified and comprehensible global concerns regarding bacterial resistance. The extensive consumption of antibiotics will inevitably lead to the development of increasingly drug-resistant bacteria for which no antibiotic may be efficacious. National programs addressing antibiotic resistance and the awareness of all healthcare personnel must be accorded the utmost priority to enhance consumption data and, consequently, safeguard future human survival.
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Affiliation(s)
- Francesco Ferrara
- Pharmaceutical department, Asl Napoli 3 Sud, 22, Dell'amicizia street, 80035 Nola, Naples, Italy.
| | - Maurizio Capuozzo
- Pharmaceutical department, Asl Napoli 3 Sud, 3,Marittima street, 80056 Ercolano, Naples, Italy
| | - Roberta Pasquinucci
- Pharmaceutical department, Asl Napoli 3 Sud, 22, Dell'amicizia street, 80035 Nola, Naples, Italy
| | - Roberto Langella
- Italian Society of Hospital Pharmacy (SIFO), SIFO Secretariat of the Lombardy Region, 81, Carlo Farini street, 20159 Milan, Italy
| | - Ugo Trama
- General Direction for Health Protection and Coordination of the Campania Regional Health System, Naples, Italy
| | - Eduardo Nava
- Pharmaceutical department, Asl Napoli 3 Sud, 22, Dell'amicizia street, 80035 Nola, Naples, Italy
| | - Andrea Zovi
- Ministry of Health, 5, Viale Giorgio Ribotta, 00144 Rome, Italy
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Ferrara F, Zovi A, Nava E, Trama U, Vitiello A. SARS-CoV-2 caused a surge in antibiotic consumption causing a silent pandemic inside the pandemic. A retrospective analysis of Italian data in the first half of 2022. Ann Pharm Fr 2023:S0003-4509(23)00022-6. [PMID: 36858285 PMCID: PMC9970653 DOI: 10.1016/j.pharma.2023.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND The phenomenon of antibiotic resistance shows no sign of stopping, despite global policies to combat it that have been in place for several years. The risk of forms of pathogenic microorganisms that are increasingly resistant to common antibiotics has led health authorities around the world to pay greater attention to the phenomenon. The worrying situation, has led to further recommendations from the World Health Organization (WHO) and national recommendations in Italy through the new National Plan against Antibiotic Resistance 2022-2025 (PNCAR 2022-2025). AIM This manuscript aims to raise the awareness of all health professionals to follow what is suggested by regulatory agencies and scientific societies. METHOD We conducted a retrospective study of antibiotic pharmacoutilization in Italy, in the Campania region at the Azienda Sanitaria Locale (ASL) Napoli 3 Sud, on consumption in the first half of 2022 in a population of more than 1 million people. RESULT The results indicate that consumption, based on defined daily doses (DDDs), is above the national average. Probably the COVID-19 pandemic has influenced this growth in prescriptions. CONCLUSIONS Our study suggests an informed and appropriate use of antibiotics, so as to embark on a virtuous path in the fight against antibiotic resistance.
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Affiliation(s)
- F Ferrara
- Pharmaceutical Department, Asl Napoli 3 Sud, Dell'amicizia street 22, 80035 Nola, Naples, Italy.
| | - A Zovi
- School of Pharmacy, University of Camerino, Via Sant'Agostino 1, 62032 Camerino, Italy.
| | - E Nava
- Pharmaceutical Coordination Area, Asl Napoli 3 Sud, Dell'amicizia street 22, 80035 Nola, Naples, Italy.
| | - U Trama
- General Direction for Health Protection and Coordination of the Campania Regional Health System, Naples, Italy.
| | - A Vitiello
- Pharmaceutical Department, USL Umbria 1, Via Guerriero Guerra, 21, 06127 Perugia, Italy.
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Hösli M, Overesch G, Willi B, Heim D, Hatt JM. [Survey on the use of antibiotics in exotic pets among Swiss veterinarians]. SCHWEIZ ARCH TIERH 2021; 163:227-237. [PMID: 33650523 DOI: 10.17236/sat00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Monitoring programs and guidelines on the use of antibiotics and antibiotic resistance in human and veterinary medicine have been developed worldwide to promote the prudent use of antibiotics in recent years. However, such information on the use of antibiotics in exotic pets is absent. This fact must be taken into account, since the number of exotic pet patients is constantly increasing and the administration of antibiotics is particular challenging due to the diversity of species and the differences in physiology. The present study reports the results of a survey of frequently used antibiotics and the criteria of antibiotic usage in exotic pets (rabbits, rodents, birds and reptiles) among Swiss veterinarians. These data should form the basis for the development of antibiotic usage guidelines in exotic pets. A total of 61 veterinarians returned the questionnaire. The most important decision-making criteria for antibiotic treatment and antibiotic selection were clinical symptoms (55/59, 93% for antibiotic treatment and 40/59, 68% for antibiotic selection), experience (41/59, 69% and 36/59, 61%, respectively) and textbooks (39/59, 66% and 40/59, 68%). The most important decision-making criteria for dosage and duration of therapy were textbooks (59/59, 100%) and experience (31/59, 53%). The use of a microbial culture was used as a decision criterion for both antibiotic treatment and antibiotic selection by 39% of the participants, sensitivity testing was chosen as a decision criterion by 37% for antibiotic treatment and by 46% for antibiotic selection. Fluoroquinolones were used most frequently, 46/56 (82% of the participants) for rabbits, 49/57 (86%) for rodents, 36/37 (97%) for reptiles and 38/46 (83%) for birds. The vast majority of veterinarians (57/58, 98%) would consult a guide for the use of antibiotics. The frequent use of critical antibiotics in exotic pets underscores the need for a guide to the prudent use of antibiotics. The positive influence of such guidelines has already been proven in dogs and cats.
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Affiliation(s)
- M Hösli
- Klinik für Zoo-, Heim- und Wildtiere, Vetsuisse-Fakultät, Universität Zürich
| | - G Overesch
- Institut für Veterinärbakteriologie, Vetsuisse-Fakultät, Universität Bern
| | - B Willi
- Klinik für Kleintiermedizin, Vetsuisse-Fakultät, Universität Zürich
| | - D Heim
- Bundesamt für Lebensmittelsicherheit und Veterinärwesen BLV, Bern
| | - J-M Hatt
- Klinik für Zoo-, Heim- und Wildtiere, Vetsuisse-Fakultät, Universität Zürich
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Maalej SM, Ben Abdallah R, Hammami A. [Antibiotic Susceptibility of Haemophilus influenzae in Sfax: Two Years after the Introduction of the Hib Vaccination in Tunisia]. Bull Soc Pathol Exot 2020; 113:12-16. [PMID: 32881444 DOI: 10.3166/bspe-2020-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/14/2020] [Indexed: 06/11/2023]
Abstract
A retrospective study was conducted at the Sfax hospitals between 2013 and 2014 to study the susceptibility to antibiotics of Haemophilus influenzae after the introduction of Hib vaccination in Tunisia. Capsular typing was done by PCR. MICs for β-lactams were determined by E-test®. The blaTEM, blaROB and ftsI genes were searched using PCR. Among the 259 strains of H. influenzae isolated, 248 (95.7%) were non-invasive. Five strains were encapsulated (3 type b and 2 type c). Resistance rates were 33.4% for ampicillin, 10.4% for amoxicillin-clavulanic acid, 2.3% for cefixime, 1.1% for cefotaxime and 1.9% for fluoroquinolones. Among the strains resistant to β-lactams, 67 produced β-lactamase type TEM and 40 had a modification of PLP3. This study shows the change in the epidemiology of H. influenzae induced by vaccination with a dramatic decrease of invasive infections. Replacement with other capsular types or with non-typable strains that may be resistant to antibiotics requires continuous surveillance for H. influenzae infections.
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Affiliation(s)
- S Mezghani Maalej
- Laboratoire de microbiologie, CHU Habib-Bourguiba, Sfax, Tunisie
- Laboratoire de microbiologie, faculté de médecine de Sfax, université de Sfax, Tunisie
| | - R Ben Abdallah
- Laboratoire de microbiologie, CHU Habib-Bourguiba, Sfax, Tunisie
- Laboratoire de microbiologie, faculté de médecine de Sfax, université de Sfax, Tunisie
| | - A Hammami
- Laboratoire de microbiologie, CHU Habib-Bourguiba, Sfax, Tunisie
- Laboratoire de microbiologie, faculté de médecine de Sfax, université de Sfax, Tunisie
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Marzouk M, Toumi N, Ben Hadj Hassine A, Haj Ali M, Boukadida J. [Profile and antibiotic susceptibility of 5187 uropathogenic bacteria in Tunisia]. Med Mal Infect 2016; 46:330-2. [PMID: 27318607 DOI: 10.1016/j.medmal.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/02/2016] [Accepted: 05/06/2016] [Indexed: 11/20/2022]
Affiliation(s)
- M Marzouk
- Laboratoire de microbiologie et d'immunologie, UR12SP34, CHU Farhat-Hached Sousse, Sousse, Tunisie.
| | - N Toumi
- Laboratoire de microbiologie et d'immunologie, UR12SP34, CHU Farhat-Hached Sousse, Sousse, Tunisie
| | - A Ben Hadj Hassine
- Laboratoire de microbiologie et d'immunologie, UR12SP34, CHU Farhat-Hached Sousse, Sousse, Tunisie; Faculté de pharmacie de Monastir, Monastir, Tunisie
| | - M Haj Ali
- Laboratoire de microbiologie et d'immunologie, UR12SP34, CHU Farhat-Hached Sousse, Sousse, Tunisie
| | - J Boukadida
- Laboratoire de microbiologie et d'immunologie, UR12SP34, CHU Farhat-Hached Sousse, Sousse, Tunisie
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Rasamiravaka T, Shaista Sheila HSL, Rakotomavojaona T, Rakoto-Alson AO, Rasamindrakotroka A. Changing profile and increasing antimicrobial resistance of uropathogenic bacteria in Madagascar. Med Mal Infect 2015; 45:173-6. [PMID: 25866374 DOI: 10.1016/j.medmal.2015.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/25/2015] [Accepted: 03/13/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We wanted to update the distribution of community-acquired uropathogens and to estimate their susceptibility profile to newly available antibiotics in Antananarivo (Madagascar). MATERIALS AND METHODS We conducted a 3-year preliminary study (2011-2013) on bacteria isolated from the urine of patients at the Laboratory of Training and Research in Medical Biology (Antananarivo). RESULTS Three hundred and fifty-seven pathogens were isolated: 234 (65.55%) Gram-negative bacilli and 123 (34.45%) Gram-positive cocci. The most commonly isolated bacteria were Escherichia coli (89 strains) followed by Staphylococcus aureus (48 strains). Thirty-three percent of Gram-negative bacilli were resistant to 3 CG. Forty percent of Klebsiella pneumoniae strains were significantly resistant to imipenem (P = 0.01). CONCLUSIONS The increased resistance to newly available antibiotics and the increased rate of Gram-positive cocci strains require a drastic surveillance of antibiotic resistance to ensure appropriate empirical treatment.
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Affiliation(s)
- T Rasamiravaka
- Laboratory of Training and Research in Medical Biology, 7, rue Joel-Rakotomalala - lot IIH 11 Bis Faravohitra 101, Antananarivo, Madagascar.
| | - H S L Shaista Sheila
- Laboratory of Training and Research in Medical Biology, 7, rue Joel-Rakotomalala - lot IIH 11 Bis Faravohitra 101, Antananarivo, Madagascar
| | - T Rakotomavojaona
- Laboratory of Training and Research in Medical Biology, 7, rue Joel-Rakotomalala - lot IIH 11 Bis Faravohitra 101, Antananarivo, Madagascar
| | - A O Rakoto-Alson
- Department of Medical Biology, Faculty of Medicine, University of Antananarivo 101, Antananarivo, Madagascar
| | - A Rasamindrakotroka
- Laboratory of Training and Research in Medical Biology, 7, rue Joel-Rakotomalala - lot IIH 11 Bis Faravohitra 101, Antananarivo, Madagascar
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de Lastours V, Fantin B. [Resistance to fluoroquinolones in 2013: what are the consequences in internal medicine?]. Rev Med Interne 2014; 35:601-8. [PMID: 24909440 DOI: 10.1016/j.revmed.2014.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 02/18/2014] [Accepted: 05/09/2014] [Indexed: 12/31/2022]
Abstract
Because of their important qualities, fluoroquinolones are amongst the most prescribed antibiotics in the world. The corollary of this success is the rapid increase in resistance to fluoroquinolones, responsible for treatment failures. Moreover, fluoroquinolone-resistance is often accompanied by resistance to other classes of antibiotics. Currently, significant levels of resistance are found both in hospitals and in community settings, severely limiting possibilities for empirical use of fluoroquinolones. A major mechanism explaining the rapid emergence of resistance to fluoroquinolones is their specific impact on human microbiota and the selection of resistant strains in the microbiota, which seems to be an unavoidable ecological side effect. In order to preserve the efficiency of this important class of antibiotics, limiting their use and respecting good practice recommendations are essential.
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Affiliation(s)
- V de Lastours
- Service de médecine interne, hôpital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92100 Clichy, France; Équipe d'accueil 3964 « emergence de la résistance aux antibiotiques in vivo », faculté de médecine Xavier-Bichat, université Paris Diderot, 75018 Paris, France.
| | - B Fantin
- Service de médecine interne, hôpital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92100 Clichy, France; Équipe d'accueil 3964 « emergence de la résistance aux antibiotiques in vivo », faculté de médecine Xavier-Bichat, université Paris Diderot, 75018 Paris, France
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Souna D, Amir AS, Bekhoucha SN, Berrazeg M, Drissi M. Molecular typing and characterization of TEM, SHV, CTX-M, and CMY-2 β-lactamases in Enterobacter cloacae strains isolated in patients and their hospital environment in the west of Algeria. Med Mal Infect 2014; 44:146-52. [PMID: 24731757 DOI: 10.1016/j.medmal.2014.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 11/27/2013] [Accepted: 01/15/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Enterobacter cloacae is a major nosocomial bacterium causing severe infections. A multicenter retrospective cohort study was conducted to collect baseline information on the molecular characteristics of β-lactamase producing Enterobacter cloacae in the west of Algeria. MATERIALS AND METHODS We report a series of 42 extended-spectrum β-lactamase (ESBL) producing non-repetitive Enterobacter cloacae strains, collected in 3 university hospital (Tlemcen, Oran, and Sidi Bel Abbes). Antibiotic susceptibility testing (antibiogram and MIC) and screening for ESBL were performed according to the French Society for Microbiology guidelines. PFGE typing was used to characterize the clonality of all the strains. β-lactamase genes (blaTEM, blaSHV, blaCTX-M, blaECB, and blaCMY-2) were amplified by PCR with specific primers. Plasmid isolation, electroporation, and conjugation experiments were carried out using standard methods. RESULTS Sequence analysis revealed that most strains produced CTX-M type ESBLs (CTX-M-15 and CTX-M-3), whereas only 5 produced SHV-type ESBLs (SHV-12). The blaTEM gene was identified in all strains of Enterobacter cloacae. Several epidemic clones were determined. One strain was found to produce plasmid-mediated AmpC β-lactamase (CMY-2); this gene was transferred from E. cloacae by electroporation. Conjugation experiments showed that blaCTX-M, blaTEM, and blaSHV were carried by conjugative plasmids of high molecular weight (≥70kb). CONCLUSION The emergence of resistance genes is a public health problem.
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Biance-Valero E, Quiniou PY, Valero B, Navarrot JC, Soullié B. [Gonococcal conjunctivitis in a young woman]. J Fr Ophtalmol 2013; 36:e201-6. [PMID: 24210280 DOI: 10.1016/j.jfo.2013.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 03/26/2013] [Accepted: 04/03/2013] [Indexed: 11/18/2022]
Abstract
We describe the management of a female patient who developed an uncomplicated unilateral purulent conjunctivitis with no other clinical signs. The typical clinical presentation and Gram stain of the discharge suggested gonococcal conjunctivitis, allowing treatment to be initiated. Indeed, a strain of Neisseria gonorrhoeae resistant to penicillin and tetracycline was isolated. In collaboration with the patient's primary care physician, management included lavage of the infected eye, systemic antibiotic treatment with erythromycin and topical antibiotic treatment with azithromycin, followed by local steroid treatment in response to persistent hyperemia, which was discontinued and replaced by azithromycin again because of recurrent discharge. Eleven days after the first consultation, a complete cure was achieved without sequelae, and a final check to rule out a residual gonococcal carrier state is planned. Gonococcal conjunctivitis, a diagnostic and therapeutic emergency, is a potentially blinding sexually transmitted disease with which general practitioners and ophthalmologists are not well aquainted. Although rare in developed countries, its incidence is rising in parallel with the global recrudescence of gonococcal infections. This case of gonococcal conjunctivitis is discussed as a review of the clinical and biological elements necessary for diagnosis and therapeutic management, which must occur as early as possible, taking into account rapidly increasing gonococcal resistance to antimicrobial therapies, so as to interrupt spread of the disease.
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Affiliation(s)
- E Biance-Valero
- Fédération des laboratoires, hôpital d'instruction des armées Robert-Picqué, 351, route de Toulouse, CS 80002, 33882 Villenave d'Ornon cedex, France.
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