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Antimicrobial resistance (AMR) is a "silent pandemic" that threatens the efficacy of antibiotics and other antimicrobials. It is imperative to take into account the ethical implications of how these resources are used and distributed as the world deals with this silent pandemic. This commentary discusses the ethical considerations surrounding the use and distribution of antibiotics in the age of resistance, including issues of equity and access, responsibility for antimicrobial stewardship, the environmental impact of antibiotic use, and the development and promotion of these drugs. The ethical implications of unequal access to antibiotics and the role of social determinants of health in shaping this access are considered, as well as the globalization of AMR and the need for multiple stakeholders to be involved in addressing this issue. The opportunities of antimicrobial stewardship programmes for optimising antibiotic use and reducing the emergence and spread of resistant bacteria, as well as the ethical implications of implementing such programmes, are examined. The potential environmental outcomes of antibiotic use and the ethical implications of these impacts are also discussed, as well as the role of the pharmaceutical industry in the development and promotion of these drugs, the potential conflicts of interest that may arise and the ethical dimension of resource transfer from Global North to Global South. This paper emphasises the significance of a holistic strategy to AMR that considers these ethical components, as well as the importance of preserving antibiotic efficacy for future generations., (© 2023. The Author(s).)

Abstract Ribosomal RNA (rRNA) modifications are involved in multiple biological processes. KsgA is a 16S rRNA adenine dimethyltransferase that methylates at the adenines 1518 and 1519 (A1518/1519) positions, which are located near the ribosome decoding center. These methylations are conserved and important for ribosome biogenesis and protein translation. In this study, we demonstrated the absence of A1518/1519 methylation in the 16S rRNA of a Pseudomonas aeruginosa ksgA mutant. Biolog phenotypic microarrays were used to screen the phenotypes of the ksgA mutant against various antimicrobial agents. The loss of ksgA led to increased sensitivity to menadione, a superoxide generator, which was, at least in part, attributed to decreased in a superoxide dismutase (SOD) activity. Interestingly, the decrease in SOD activity in the ksgA mutant was linked to a decrease in the SodM protein levels, but not the sodM mRNA levels. Furthermore, the ksgA mutant strain exhibited sensitivity to hygromycin B and tylosin antibiotics. The tylosin-sensitive phenotype was correlated with decreased transcriptional levels of tufA, tufB, and tsf, which encode elongation factors. Additionally, the ksgA mutant showed resistance to kasugamycin. Collectively, these findings highlight the role of KsgA in oxidative stress responses and antibiotic sensitivity in P. aeruginosa.

Abstract Antibiotics are crucial in treating infections; however, their unnecessary and incorrect use can lead to numerous health issues, notably antibiotic resistance. Evaluating the accuracy and awareness of antibiotic prescription practices among dentists, who play a significant role in antibiotic use, is critical in developing effective health policies and professional training programs. This study assesses dentists’ knowledge levels and practice habits regarding antibiotic use. Using a structured questionnaire, the research employed a cross-sectional design and was conducted with 202 general dentists, 98 pediatric dentists, and 43 oral and maxillofacial surgeons. Data were analyzed using demographic characteristics, antibiotic prescription practices, and scenario-based questions measuring knowledge levels. The results revealed that while most participants were generally knowledgeable about antibiotic use, inconsistencies in prescription practices were evident. Notably, unnecessary antibiotic prescriptions were identified in some cases, contributing to significant health issues such as antibiotic resistance. This study emphasizes the necessity of promoting conscious antibiotic use by evaluating dentists’ practices. Therefore, the urgent need for developing professional training programs and strengthening strategies to combat antibiotic resistance is paramount.

Abstract Micropollutants, especially pharmaceutical compounds, are of significant concern owing to their ngL− 1 to µgL− 1 concentration, making them difficult for conventional treatment plants to remove from wastewater. Despite municipal wastewater treatment plant being a primary source of these compounds to be released into the wastewater, on comparison little attention has been given to hospital wastewater. The major focus of studies addressing pharmaceutical compounds is based on synthetic wastewater. This study addresses this research gap by treating wastewater to remove micropollutants (Fluvastatin, ketoprofen, paracetamol, ciprofloxacin, carbamazepine, sulfamethoxazole, and lorazepam) by employing a fluidized aerobic bioreactor. Tubesettler was attached to a fluidized-bed bioreactor to see if it could be used as a polishing unit rather than a secondary clarifier. The environmental risk from the effluent discharge into the environment was assessed regarding the hazard quotient. The paracetamol and ketoprofen were removed at an efficiency of 51% and 60%, respectively, followed by carbamazepine at 50%, ciprofloxacin at 40%, fluvastatin at 47%, sulfamethoxazole at 31%, and lorazepam at 20%. The influent posed moderate environmental risk with (Hazard Quotient) HQ > 0.5, while in effluent the risk was reduced with HQ value 0.4. For effluent from fluidized bed bioreactors (HQ 0.13) and tube setters (HQ 0.15). The associated tube settler was found suitable for polishing units with additional removal efficiencies of 15–43% for all the targeted pharmaceutical compounds. Further studies are required to explore disinfectants’ effect on the reactor’s biodegradation efficiency. Also, further modification and a hybrid version of the fluidized bed bioreactor can be used.

Abstract The use of supramolecular assemblies in pharmaceuticals has garnered significant interest. Recent studies have shown that the activities of antibacterial agents can be enhanced through complexation with cyclic oligomers and metal ions. Notably, these complexes sometimes possess greater therapeutic properties than the parent drugs. To develop microbiologically potent supramolecular drugs, the complexation of macrocyclic hosts with fluoroquinolone (FQ) antibiotics was investigated. FQs are a successful family of antibiotics that target the bacterial enzymes DNA gyrase and DNA topoisomerase IV, leading to bacterial cell death through the inhibition of DNA synthesis. However, antibiotic resistance resulting from the repeated use of FQs over time has limited their effectiveness against resistant pathogens. To overcome this issue, the encapsulation of FQs in polyphenolic macrocycles was investigated. This study highlights resorcinarene, a polyphenolic host with antibacterial properties, and its ability to chemically interact with FQs. The inclusion complexation process was analyzed using NMR and FTIR techniques. The binding constants determined by 1H-NMR titration revealed that levofloxacin forms more stable complexes with resorcinarene than with β-cyclodextrin, which aligned with MD simulations. Assessment of the geometric characteristics of the inclusion complexes using 2D NMR analysis confirmed that different moieties of various FQs can fit into a single host cavity and improve activity against gram-negative bacteria. Overall, these findings suggest that encapsulation in polyphenolic macrocycles is a promising strategy for utilizing FQs against antibiotic-resistant bacteria.

Abstract Scope The underlying medical conditions and gut dysbiosis is known to influence COVID-19 severity in high-risk patients. The current review proposed the optimal usage of nutraceuticals & pharmacological interventions can help regulate the protective immune response and balance the regulatory functionality of gut microbiota. Summary Many studies have revealed that the probiotic interventions viz., Lactobacillus rhamnosus, L. plantarum & other bacterial spp. reduce IFNγ & TNF-α and increase IL-4 & IL-10 secretions to control the immunostimulatory effects in upper respiratory tract infection. Dietary fibres utilized by beneficial microbiota and microbial metabolites can control the NF-kB regulation. Vitamin C halts the propagation of pathogens and vitamin D and A modulate the GM. Selenium and Flavonoids also control the redox regulations. Interferon therapy can antagonize the viral replications, while corticosteroids may reduce the death rates. BCG vaccine reprograms the monocytes to build trained immunity. Bifidobacterium and related microbes were found to increase the vaccine efficacy. Vaccines against COVID-19 and season flu also boost the immunity profile for robust protection. Over all, the collective effects of these therapeutics could help increase the opportunities for faster recovery from infectious diseases. Conclusion The nutraceutical supplements and pharmacological medicines mediate the modulatory functionalities among beneficial microbes of gut, which in turn eliminate pathogens, harmonize the activity of immune cells to secrete essential regulatory molecular receptors and adaptor proteins establishing the homeostasis in the body organs through essential microbiome. Therefore, the implementation of this methodology could control the severity events during clinical sickness and reduce the mortalities.

Abstract The emission of glyphosate and antibiotic residues from human activities threatens the diversity and functioning of the microbial community. This study examines the impact of a glyphosate-based herbicide (GBH) and common antibiotics on Gram-negative bacteria within the ESKAPEE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli). Ten strains, including type and multidrug-resistant strains for each species were analysed and eight antibiotics (cefotaxime, meropenem, aztreonam, ciprofloxacin, gentamicin, tigecycline, sulfamethoxazole-trimethoprim, and colistin) were combined with the GBH. While most combinations yielded additive or indifferent effects in 70 associations, antagonistic effects were observed with ciprofloxacin and gentamicin in five strains. GBH notably decreased the minimum inhibitory concentration of colistin in eight strains and displayed synergistic activity with meropenem against metallo-β-lactamase (MBL)-producing strains. Investigation into the effect of GBH properties on outer membrane permeability involved exposing strains to a combination of this GBH and vancomycin. Results indicated that GBH rendered strains sensitive to vancomycin, which is typically ineffective against Gram-negative bacteria. Furthermore, we examined the impact of GBH in combination with three carbapenem agents on 14 strains exhibiting varying carbapenem-resistance mechanisms to assess its effect on carbapenemase activity. The GBH efficiently inhibited MBL activity, demonstrating similar effects to EDTA (ethylenediaminetetraacetic acid). Chelating effect of GBH may have multifaceted impacts on bacterial cells, potentially by increasing outer membrane permeability and inactivating metalloenzyme activity.

Background: Antibiotics are drugs used to treat bacterial infections. A major problem with the irrational use of antibiotics is the emergence of drug resistance. Antimicrobial resistance is a current problem worldwide, particularly in developing countries. Objectives: The objectives of the study were to evaluate the knowledge and awareness level of the general public of Shimoga district of Karnataka, regarding responsible antibiotic use and to correlate the findings with the sociodemographic details. Methodology: A community-based cross-sectional study was carried out in the Shimoga district of Karnataka. Data were collected from 800 adults by door-step interview using a questionnaire after obtaining consent. Data were entered in Microsoft Excel and were analyzed using Epi Info software. Results: Hardly 8% of the respondents could recall the name of the antibiotic and most were oblivious about the commonly used classes of drugs. Almost 60% believed that antibiotic therapy could be stopped as and when the symptoms were relieved or they felt alright. We tested the respondents’ knowledge of antibiotics and found that it was not favorable. Conclusions: We observed a significant gap in respondents’ knowledge and awareness of the responsible use of antibiotics. There is an urgent need for enlightening people on the dangers of the irrational use of antibiotics and training them on responsible ways of using antibiotics.

Abstract This study aimed to assess the current water quality status across various regions within the Fayoum depression by examining water canals, drains, and potential contaminants impacting public health and the local ecosystem. Additionally, an adsorption treatability investigation was conducted on various antibiotics identified during the assessment. Fifteen sampling points were selected across the Fayoum depression, covering surface water bodies and agricultural drainage systems during both winter and summer seasons. Physico-chemical, microbiological, and antibiotic analyses were performed on collected water samples. The water quality parameters investigated included pH, electrical conductivity, total dissolved solids (TDS), total coliforms, fecal coliforms, and concentrations of antibiotics such as ciprofloxacin and tetracycline. The findings revealed significant variations in water quality parameters among different water sources, categorizing them into three types: irrigation canals, polluted canals, and drains. High contamination levels were observed in certain water canals and drains due to untreated sewage and agricultural drainage discharge. Notably, elevated TDS levels (exceeding 1200 mg/L), microbial indicators count (with total coliforms reaching up to 2.3 × 106 CFU/100 mL), and antibiotics (with concentrations of ciprofloxacin and tetracycline exceeding 4.6 µg/L) were detected. To mitigate antibiotic contamination, a Phyto-adsorption treatability study using magnetite nanoparticles prepared with Phragmites australis plant extract demonstrated promising results, achieving complete removal of high antibiotic concentrations with an adsorption capacity of up to 67 mg/g. This study provides updated insights into water quality in the Fayoum depression and proposes a novel approach for addressing antibiotic contamination, potentially safeguarding human and environmental health.

Abstract Brucellosis is a difficult to treat infection that requires antibiotic combinations administered over several weeks for clearance of infection and relapse prevention. This systematic review summarizes current evidence for antibiotic treatment of human brucellosis. PubMed, EMBASE, Scopus, CINAHL, Web of Science, and China Academic Journal databases were searched for prospective studies that had compared different antibiotic regimens for treating human brucellosis in the last 25 years. Thirty-four studies recruiting 4182 participants were eligible. Standard dual therapy with doxycycline + rifampicin had a higher risk of treatment failure compared to triple therapy which added streptomycin (RR: 1.98, 95% CI 1.17–3.35, p = 0.01) or levofloxacin (RR: 2.98, 95% CI 1.67–5.32, p = 0.0002), but a similar or lower risk compared to alternative dual antibiotic combinations (p > 0.05). The same combination had a higher risk of relapses compared to triple therapy which added streptomycin (RR: 22.12, 95% CI 3.48–140.52, p = 0.001), or levofloxacin (RR: 4.61, 95% CI 2.20–9.66, p 0.05). Triple antibiotic therapy is more effective than standard dual therapy with rifampicin and doxycycline. However, the latter is also efficacious and suitable for uncomplicated disease.

Abstract Intrapartum antibiotic prophylaxis (IAP) is commonly used during C-section delivery and in Group B Streptococcus-positive women before vaginal delivery. Here, we primarily aimed to investigate the effect of IAP on the neonatal oral and fecal bacteriomes in the first week of life. In this preliminary study, maternal and neonatal oral swabs and neonatal fecal (meconium and transitional stool) swabs were selected from a pool of samples from healthy mother-neonate pairs participating in the pilot phase of CELSPAC: TNG during their hospital stay. The DNA was extracted and bacteriome profiles were determined by 16S rRNA amplicon sequencing (Illumina). In the final dataset, 33 mother-neonate pairs were exposed to antibiotics during C-section or vaginal delivery (cases; +IAP) and the vaginal delivery without IAP (controls, -IAP) took place in 33 mother-neonate pairs. Differences in alpha diversity (Shannon index, p=0.01) and bacterial composition (PERMANOVA, p0.05). However, the IAP was associated with decreased alpha diversity (number of amplicon sequence variants, p

Background: Ocular infections, including conjunctivitis, keratitis, and endophthalmitis, significantly impact eye health, leading to morbidity, visual impairment, and blindness if not treated. Aims and Objectives: This study focuses on reviewing and analyzing the prevalence of bacterial and fungal pathogens in ocular infections and assessing their antimicrobial susceptibility patterns at Vijayanagar Institute of Medical Sciences, Ballari. Materials and Methods: A cross-sectional study was conducted by collecting ocular infection samples from January 01, 2022, to December 31, 2022. Samples, including corneal scrapings and conjunctival swabs, underwent initial procedures such as Gram staining and were inoculated on various agars. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method. Results: Out of 404 evaluated samples, corneal scrapings were predominant, with a significant incidence of fungal and bacterial growth. Aspergillus spp. and Pseudomonas spp. were the most common fungal and bacterial isolates, respectively. Antimicrobial susceptibility testing revealed that Gram-negative bacilli showed more susceptibility to gentamycin, ceftriaxone, and ciprofloxacin, whereas Gram-positive cocci were more susceptible to tetracycline and doxycycline. Conclusion: The study highlights the cornea as the most common source of ocular infections, with Aspergillus and Pseudomonas spp. being the predominant fungal and bacterial pathogens, respectively. Identifying the prevalent species in this geographical area aids in early diagnosis and treatment, thereby preventing morbidity and improving patient outcomes. The antimicrobial susceptibility pattern observed suggests effective options for treatment, emphasizing the need for ongoing surveillance to adapt to resistance patterns.

Abstract The standard treatment duration for acute cholangitis (AC) involves a 4–7-day antimicrobial treatment post-biliary drainage; however, recent studies have suggested that a ≤ 2–3 days is sufficient. However, clinical practice frequently depends on body temperature as a criterion for discontinuing antimicrobial treatment. Therefore, in this study, we assessed whether patients with AC can achieve successful outcomes with a ≤ 7-day antimicrobial treatment, even with a fever, assuming the infection source is effectively controlled. We conducted a single-center retrospective study involving patients with AC, defined following the Tokyo Guidelines 2018 for any cause, who underwent successful biliary drainage and completed a ≤ 7-day antimicrobial treatment. Patients were categorized into the febrile and afebrile groups based on their body temperature within 24 h before completing antimicrobial treatment. The primary outcome was the clinical cure rate, defined as no initial presenting symptoms by day 14 post-biliary drainage without recurrence or death by day 30. The secondary outcome was a 3-month recurrence rate. Logistic regression with inverse probability of treatment weighting was used. Overall, 408 patients were selected, among whom 40 (9.8%) were febrile. The two groups showed no significant differences in the clinical cure and 3-month recurrence rates. Notably, the subgroups limited to patients with a ≤ 3-day antibiotic treatment duration also showed no differences in these outcomes. Therefore, our results suggest that discontinuing antibiotics within the initially planned treatment period was sufficient for successful drainage cases of AC, regardless of the patient's fever status during the 24 h leading up to termination.

Background:Staphylococcus aureus is a significant pathogen that causes nosocomial infections as well as community-acquired diseases; the spectrum of S. aureus infections ranges from pimples and furuncles to toxic shock syndrome and sepsis. Probiotics, which are defined as “live microorganisms that, when taken in suitable proportions, impart a health benefit on the host beyond basic nourishment,” have attracted increasing public and scientific interest in recent years; probiotics are crucial for preserving the integrity of the gut mucosal barrier and preventing the expansion of potentially harmful bacteria. Objectives:The aim of this study was to evaluate the efficiency of probiotics to protect against the Staphylococcal enterotoxin A (SEA) of S. aureus on different organs of rats comparing with the effect of antibiotics. Materials and Methods:Twenty-five isolates were obtained from a variety of clinical locations. The gene sea was detected by using specific primer, 20 rats were used in this study and randomly divided into 5 groups. A complete necropsy was performed for all the animals. Results:The results of the sea gene showed that 16 out of 25 isolates harbored this gene. And the photomicrograph of liver and intestine, after treatment by probiotics (bacteria and yeast), revealed normal hepatocytes and newly formed villi with mild thickness and intact a muscular layer, respectively. At the same time, after treatment with antibiotics, the results showed remarkable reversible changes of hepatic architecture, areas of hepatocytes with normal arrangements and reversible changes, and these were represented by a significant villi length and the areas of necrosis in a muscular layer in liver and intestine, respectively. Conclusion:The conclusion revealed, probiotics of both types (bacteria and yeast) showed curable effect in the organs under study that were altered by SEA and gave efficient effect as much as antibiotics, and also suggested the usage of probiotics instead of antibiotics for better health.

Background:Otitis media is a very common infection among people of different age groups. Objective:The goal of the current work was to determine the existence of PstS gene among Pseudomonas aeruginosa isolates recovered from otitis media cases in Iraqi patients. Materials and Methods:A total of 100 ear swabs were collected from patients suffering from otitis media attending the ENT outpatient clinic at Baghdad Teaching Hospital from July 2022 to the end of December 2022. The age range was 18-75 years. Detection of morphology and biochemical testing by Vitek 2 system. The antibiotic sensitivity test of the bacteria spp. was the detection of 18 antibiotics for different types using Vitek2 system. Identify the genes for antibiotic resistance mechanisms. DNA was extracted from samples, and resistance genes PstS were amplified using polymerase chain reaction (PCR). Results:This study showed 80 out of 100 swabs revealed Pseudomonas aeruginosa isolates, and 71 (89%) isolates out of these 80 exhibited PstS genes. Age groups of the patients were 38-47, 48-57, and 58-67 years with percentages of 22.5%, 25%, and 25%, respectively. The highest resistance percentages of strains to tested antibiotics were for Ceftoriaxone, Cefpodoxime (100%), and the lowest resistant percentage was 22.5% for colistin, which determined the relationship between the presence of Psts and resistance to 18 antibiotics for different types. Colistin was the most effective antibiotic and can be considered as the drug of choice against Pseudomonas aeruginosa. Conclusions:Pseudomonas aeruginosa isolates recovered from patients suffering otitis media show the prevalence rate appears to be higher among the elderly and high virulence and antibiotic resistance due to the presence of PstS antibiotic resistance gene and ability to form biofilms, thus aggressive antimicrobial therapy is highly recommended in such conditions.

background : Neontal septicaemia is the major cause of morbility and motality is the tropics. The aerological and antibiotic sensitivity patterns of this condition are continuously changing, hence the need for continuous surveillance of the newborn unit. Objectives: To determine the bacterial agents of neonatal septicaemia and their ancibiotics sensitivity pattern in Zaria. Patients and Methods: Babies admitted into the Newborn Union Ahmadu Bello University Teaching Hospital, Zaria with diagnosis of sepricaencia were studied. The resuls Fac analyzed with EPI info o software. Statistical signali AIK was selalu

Background: Diarrhoea is one of the main causes of mortalityand morbidity in childhood. Bacterial diarrhoea is a common disorder. Aeromonas species and Escherichia coli (E. coli) are some of the aetiological agents associated with diarrhoea in children. Objective: To determine the prevalenceof Aeromonas species and E. coli in the stool samples of primary school children as well as the antibiotic sensitivity pattern of the isolates. Methods: Stool samples were obtained from pupils (diarrhoeic and non- diarrhoeic) aged four to eighteen years in two primary schools in Ofada. The stool specimens were processed by standard microbiological methods and antibiotic susceptibility was determined using disc diffusion method. Results: Out of 104 stool samples, E. coli was isolated from seven (6.73%) stool samples while threestool samples yielded other pathogens such as Salmonella species, Shigella species, and Proteus vulgaris. Aeromonas spp was not isolated. Pathogenic E. coli was more prevalent among pupils aged 11 to 15 years. The susceptibility of E. coli to commonly used antibiotics (such as tetracycline and ampicillin) was < 30% compared to > 70% for Augmentin, ofloxacin and nalidixic acid. E. coli showed 100% susceptibility to only gentamicin. Conclusion: E. coli was the predominant bacterial agent isolated from stool samples of school children in Ofada, Ogun State. Gentamicin may be recommended as an effective antibiotic agent against E. coli diarrhoeal diseases in the population studied.

Background: Bacterial meningitis in the newborn is globally renowned for high mortality. The associated morbidities also include audiologic, motor, visual and mental deficits. Objective: To highlight the peculiarities in the current diagnostic and management strategies in newborn meningitis. Methods: Relevant literature on the subject published only in English language or translated to English language was searched manually and electronically. The Medline, PUBMED and HINARI were searched for the period between 1966 and 2012. The following keywords were used during the search: newborn/neonatal , bacter ial /pyogenic meningitis, central nervous system infections, antibiotics, dexamethasone and fluid restriction. Results: The pattern of bacterial aetiology and mortality differ between the developed and developing world. The usefulness of bacteriologic culture in the diagnosis of meningitis can be improved with serologic method like polymerase chain reaction. Widespread resistance of pathogens may be threatening the use of penicillins and gentamicin for empirical treatment of newborn meningitis. No sufficient evidence presently supports the current practices of fluid restriction, prolonged duration of antibiotic treatment and non-use of adjuvant steroid therapies in the newborn. Conclusion: Efforts to reduce the incidence of newborn meningitis cannot be separated from the prevention of newborn sepsis generally. In addition, more controlled trials are required in the developing world with respect to the various aspects of management of newborn meningitis, particularly fluid management and the use of adjuvant steroids.

Background: Diarrhoea is a common reason for hospitalisation among under-fives. Caregivers often administer medications, including antibiotics before hospitalisation. Objective: To determine the pattern of antibiotic use by caregivers before hospitalisation of under-fives with diarrhoeal diseases. Methods: This was a descriptive, cross-sectional study of under-fives admitted for diarrhoea at the University of Uyo Teaching Hospital, Uyo. A validated semi-structured questionnaire was used to obtain information on diarrhoeal illness in the children and home treatment by caregivers. Results: One hundred under-five children were enrolled in the study. Of these, 75 (75.0%) had acute watery diarrhoea, 22 (22.0%) had dysentery, and 3 (3.0%) had persistent diarrhoea. Caregivers administered antibiotics to 32 (32.0%) children. Twenty-five children (78.1%) received a single antibiotic, while 7 (21.9%) received multiple antibiotics. Metronidazole 10/39 (25.6%), Amoxicillin 9/39 (23.1%) and Cefuroxime 5/39 (12.8%) were the most frequently administered antibiotics. The rate of antibiotic use was high in children of high social class and those with dysentery. The association between diarrhoea type and unwarranted antibiotic use by caregivers was statistically significant (χ2 = 4.127; p = 0.04). Conclusion: About one-third of the caregivers administered antibiotics in home treatment of childhood diarrhoea. Metronidazole, amoxicillin and cefuroxime were the most frequently used antibiotics. Antibiotic use was related to social class and children with dysentery. The type of childhood diarrhoea was significantly associated with unwarranted use of antibiotics.

Abstract Concerns about challenges with water availability in the Tadla Plain region of Morocco have grown as a result of groundwater contamination brought on by human activity, climate change, and insufficient groundwater management. The objective of the study is to measure the number of resistant bacteria in the groundwater of Beni Moussa and Beni Aamir, as well as to evaluate the level of water pollution in this area. 200 samples were therefore gathered from 43 wells over the course of four seasonal campaigns in 2017 and 2018. Additionally, the samples were examined to determine whether Salmonella species were present and if they were resistant to the 16 antibiotics that were tested. Salmonella spp. have been identified in 31 isolated strains in total, accounting for 18.02% of all isolated strains. Data on antibiotic resistance show that 58.1% of Salmonella spp. strains are multidrug-resistant (MDR); 38.7% of Salmonella strains are tolerant to at least six antibiotics, 19.4% to at least nine antibiotics, 9.7% to four to seven antibiotics, 6.5% to at least eleven antibiotics, and the remaining 3.2% to up to twelve antibiotics. A considerable level of resistance to cefepime (61.29%), imipenem (54.84%), ceftazidime (45.16%), ofloxacin (70.97%), and ertapenem (74.19%) was found in the data. Consequently, it is important to monitor and regulate the growth of MDR in order to prevent the groundwater's quality from declining.

Abstract Antibiotic resistance is a worldwide problem that imposes a devastating effect on developing countries and requires immediate interventions. Initially, most of the antibiotic drugs were identified by culturing soil microbes. However, this method is prone to discovering the same antibiotics repeatedly. The present study employed a shotgun metagenomics approach to investigate the taxonomic diversity, functional potential, and biosynthetic capacity of microbiomes from two natural agricultural farmlands located in Bekeka and Welmera Choke Kebelle in Ethiopia for the first time. Analysis of the small subunit rRNA revealed bacterial domain accounting for 83.33% and 87.24% in the two selected natural farmlands. Additionally, the analysis showed the dominance of Proteobacteria representing 27.27% and 28.79% followed by Actinobacteria making up 12.73% and 13.64% of the phyla composition. Furthermore, the analysis revealed the presence of unassigned bacteria in the studied samples. The metagenome functional analysis showed 176,961 and 104, 636 number of protein-coding sequences (pCDS) from the two samples found a match with 172,655 and 102, 275 numbers of InterPro entries, respectively. The Genome ontology annotation suggests the presence of 5517 and 3293 pCDS assigned to the “biosynthesis process”. Numerous Kyoto Encyclopedia of Genes and Genomes modules (KEGG modules) involved in the biosynthesis of terpenoids and polyketides were identified. Furthermore, both known and novel Biosynthetic gene clusters, responsible for the production of secondary metabolites, such as polyketide synthases, non-ribosomal peptide synthetase, ribosomally synthesized and post-translationally modified peptides (Ripp), and Terpene, were discovered. Generally, from the results it can be concluded that the microbiomes in the selected sampling sites have a hidden functional potential for the biosynthesis of secondary metabolites. Overall, this study can serve as a strong preliminary step in the long journey of bringing new antibiotics to the market.

Abstract Background With the global challenge of antimicrobial resistance intensified during the COVID-19 pandemic, evaluating adverse events (AEs) post-antibiotic treatment for common infections is crucial. This study aims to examines the changes in incidence rates of AEs during the COVID-19 pandemic and predict AE risk following antibiotic prescriptions for common infections, considering their previous antibiotic exposure and other long-term clinical conditions. Methods With the approval of NHS England, we used OpenSAFELY platform and analysed electronic health records from patients aged 18–110, prescribed antibiotics for urinary tract infection (UTI), lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI), sinusitis, otitis externa, and otitis media between January 2019 and June 2023. We evaluated the temporal trends in the incidence rate of AEs for each infection, analysing monthly changes over time. The survival probability of emergency AE hospitalisation was estimated in each COVID-19 period (period 1: 1 January 2019 to 25 March 2020, period 2: 26 March 2020 to 8 March 2021, period 3: 9 March 2021 to 30 June 2023) using the Kaplan–Meier approach. Prognostic models, using Cox proportional hazards regression, were developed and validated to predict AE risk within 30 days post-prescription using the records in Period 1. Results Out of 9.4 million patients who received antibiotics, 0.6% of UTI, 0.3% of URTI, and 0.5% of LRTI patients experienced AEs. UTI and LRTI patients demonstrated a higher risk of AEs, with a noted increase in AE incidence during the COVID-19 pandemic. Higher comorbidity and recent antibiotic use emerged as significant AE predictors. The developed models exhibited good calibration and discrimination, especially for UTIs and LRTIs, with a C-statistic above 0.70. Conclusions The study reveals a variable incidence of AEs post-antibiotic treatment for common infections, with UTI and LRTI patients facing higher risks. AE risks varied between infections and COVID-19 periods. These findings underscore the necessity for cautious antibiotic prescribing and call for further exploration into the intricate dynamics between antibiotic use, AEs, and the pandemic.

Background: Ventilator-associated pneumonia (VAP) in acute respiratory distress syndrome patients is expected in the setting of prolonged mechanical ventilation due to abridged immunity and dysregulation of the microorganisms inhabiting the oral cavity. We conducted this study to identify the spectrum of microorganisms causing VAP in patients admitted to the medicine intensive care unit (MICU) and their antibiotic susceptibility patterns. Materials and Methods: We conducted a retrospective cross-sectional laboratory-based study from January 2021 to April 2021. Our cohort included patients with respiratory distress who were admitted to the MICU. We observed the incidence of VAP and the risk factors responsible for multidrug resistance (MDR) microorganisms in the MICU, along with 250-day survival in the existence of specific comorbidities along with VAP. Results: Clinical charts of patients (n = 366) admitted to the MICU between January 2021 and April 2021 were used. The mean age of patients admitted to MICU was 57.3 ± 18.7 years with a male predominance (n = 252, 68.8%). VAP was diagnosed in 69.1% (n = 253) of patients, and the most common microorganism in our cohort was Klebsiella pneumoniae (n = 78, 30.8%), followed by Acinetobacter spp. (n = 77, 30.4%). None of the K. pneumoniae isolates (n = 0/78) and only a minority of Acinetobacter spp. (n = 4/77, 5.2%) and Pseudomonas aeruginosa isolates (n = 8/54, 14.8%) were susceptible to fluoroquinolones. A higher proportion of K. pneumoniae (n = 1/78, 1.3%), Acinetobacter spp. (n = 2/77, 2.6%), and P. aeruginosa isolates (n = 9/54, 16.7%) were susceptible to aminoglycosides. The incidence rate of MDR microorganisms among the 253 patients diagnosed with VAP was 92.8% (n = 219/253). Conclusion: There is a high prevalence of multidrug resistance (MDR) isolates among those causing VAP in the MICU setting. Knowing the broad spectrum of causative pathogens and their susceptibility to various antibiotics may guide the physician in judicious and appropriate use of antibiotics for treatment.

Abstract Background Uropathogens are microorganisms that cause urinary tract infections (UTIs). Owing to higher blood glucose levels and compromised immune functions, treatment of uropathogens in diabetic patients is a challenge. Aim This study aims to assess the prevalence of uropathogens and their antibiotic susceptibility among diabetic patients at St. John of God Hospital at Duayaw Nkwanta (SJGHDN) in the Ahafo region of Ghana. Methods The cross‐sectional study recruited 175 diabetic patients at SJGHDN between August and September 2023. Questionnaires were used to collect patients’ background information. Fasting Blood Sugar (FBS) was assessed by using a glucometer. Urine samples were examined for the presence of uropathogens. A sterile inoculating loop with a calibrated volume of 2 µl was used for plating. Each colony equals 500 CFU/mL. Significant uropathogen was determined by multiplying the counted colonies by 500 to obtain CFU/mL. Positive uropathogen was defined as CFU ≥ 105/mL. Significant uropathogen was defined as ≥200 colonies per sample. The disc diffusion method was used to determine antibiotic susceptibility. Results Out of the 175 patients, 19.4% expressed various uropathogens with Escherichia coli being the predominant. Suboptimal glucose level was the most significant risk factor (p = 0.038). Glucosuria (p = 0.036), hazy urine (p = 0.028), positive leukocyte esterase (p = 0.001), and pus cells in urine sediment (p = 0.020) were significant indicators of uropathogen occurrence. Klebsiella pneumonia and Proteus mirabilis were resistant to ≥4 antibiotics. Amikacin, nitrofurantoin, levofloxacin, ciprofloxacin, and ceftriaxone demonstrated efficacy against the isolates. Conclusion This study underscores the notable prevalence of uropathogens in diabetic patients and the alarming levels of antibiotic resistance observed. The results highlight the critical need for vigilant monitoring and customized treatment approaches, particularly for diabetic patients exhibiting risk factors such as elevated urine glucose levels, cloudy urine, and presence of leukocyte esterase and pus cells in urine sediment. The significant resistance to frequently used antibiotics like co‐trimoxazole and tetracycline points to the necessity of routine susceptibility testing and the use of alternative antibiotics for effective treatment. These findings can assist healthcare providers in more effectively managing and preventing UTIs in diabetic populations.

ObjectiveTo understand the usage of antibiotics in outpatients in a county of Zhejiang Province from 2015 to 2020， so as to provide a basis for further standardizing the clinical application of antibiotics in this region.MethodsOutpatient records and prescription records of 146 public medical institutions from 2015 to 2020 were extracted from the electronic medical record data sharing platform system of medical institutions in a county of Zhejiang Province. The utilization rates and the number of types of antibiotics used in outpatient patients were described. According to the drug anatomy， therapeutic and chemical classification system （ATC）， clinical application classification and dosage form， the use status of different types of antibiotics was observed. The annual percentage change （APC） was used to analyze the time trend of antibiotic use. Among the antibiotic prescriptions in each year， the proportions of prescriptions aimed for different use reasons and patients were compared to analyze the changes in the structures of antibiotic prescriptions.ResultsDuring 2015‒2020， a total of 2 861 438 prescriptions were issued in 146 primary public medical institutions in this county， including 314 642 prescriptions for antibiotics， and the overall utilization rate of antibiotics was 11%. The utilization rate of antibiotics showed a decreased trend across the years （from 14.23% in 2015 to 7.59% in 2020， APC=-11.51%， 95%CI=-0.01%‒-21.7%， t=-12.05， P

Abstract Helicobacter pylori infection, a worldwide health issue, is typically treated with standard antibiotic therapies. However, these treatments often face resistance and non-compliance due to side effects. In this umbrella review, we aimed to comprehensively assess the impact of probiotics supplementation in different preparations on Helicobacter pylori standard treatment. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials in the Cochrane Library from inception to June 1, 2023, to identify systematic reviews with meta-analyses that focused on eradication rates, total side effects and other outcomes of interest. The most comprehensive meta-analysis was selected for data extraction. AMSTAR 2 was used to assess quality of meta-analyses. Overall, 28 unique meta-analyses based on 534 RCTs were included. The results suggests that probiotics supplementation with pooled probiotic strains was significantly associated with improved eradication rates (RR 1.10, 95% CI 1.06–1.14) and reduced risk of total side effects (RR 0.54, 95% CI 0.42–0.70) compared with standard therapy alone. Single-strained or multi-strained preparation of probiotics supplementation showed similar results. Despite Bifidobacterium spp. showing the highest potential for eradication, the study quality was critically low for most meta-analyses, necessitating further high-quality research to explore the optimal probiotic strains or their combinations for Helicobacter pylori treatment.aq_start?>Kindly check and confirm the edit made in article title.

Abstract Antimicrobial/antibiotic de-escalation (ADE) is a key feature of antimicrobial stewardship programs (ASP) that relies mainly on individual panels for determining ADE events based on subjective ranking of antibiotics’ spectrum activity. The lack of consensus among ASP experts leads to reproducibility issues in the measure of this clinical outcome, making difficult to assess its real impact on patient care. The S3 score (Simplified Spectrum Score) app was developed to allow an objective ranking of antibiotics. Ranking was achieved by developing a database harboring pairs of bacteria-antibiotics for which each molecule was assigned a score based on published and clinically validated data from a recognized international committee. S3 score shows a strong correlation relationship and substantial agreement to a clinically validated spectrum score, and its framework enables any person to use it for ADE detection without assuming prior knowledge or training. In addition, its design enables regular updates and sustainability.

Abstract Background Antibiotic resistance has been identified as a global health threat. Knowledge, attitudes, and inappropriate prescription practices of antibiotics by physicians play a crucial role in this problem. In Colombia, research addressing this issue is scarce. Methods A cross-sectional study involving 258 physicians was conducted. A scale with questions on sociodemographic aspects, level of education, satisfaction with antibiotic education received, and knowledge, attitudes, and practices was administered. The scale was designed for each item to be analyzed individually or as a total score ranging from 0 to 100 (0 being the lowest and 100 the highest). Results 31.5% of physicians rated the education received on antibiotics as fair to poor. The knowledge score was 80.1 (IQR 70.5–87.5); however, 25.2% agreed to some extent that amoxicillin is useful in treating most respiratory infections, and 15% agreed that antibiotics are effective in treating upper respiratory infections. Attitudes scored 80.2 (IQR 75.0-86.5), with 99% stating that bacterial resistance is a public health problem in Colombia, but only 56.9% considering it a problem affecting their daily practice. Practices scored 75.5 (IQR 68.8–81.2), and 71.7% affirmed that if they refuse to prescribe antibiotics to a patient who does not need them, the patient can easily obtain them from another physician. General practitioners were found to have lower scores in all three indices evaluated. Conclusion The study reveals enduring misconceptions and concerning practices in antibiotic prescription, particularly among general practitioners. Enhancing knowledge necessitates the implementation of continuous medical education programs that focus on updated antibiotic guidelines, and resistance patterns. Fostering positive attitudes requires a culture of trust and collaboration among healthcare professionals. Practical enhancements can be realized through the establishment of evidence-based prescribing guidelines and the integration of regular feedback mechanisms. Moreover, advocating for the inclusion of antimicrobial stewardship principles in medical curricula is crucial, emphasizing the significance of responsible antibiotic use early in medical education.

Abstract Background The effects of gut microbiota and metabolites on the responses to immune checkpoint inhibitors (ICIs) in advanced epidermal growth factor receptor (EGFR) wild-type non-small cell lung cancer (NSCLC) have been studied. However, their effects on EGFR-mutated (EGFR +) NSCLC remain unknown. Methods We prospectively recorded the clinicopathological characteristics of patients with advanced EGFR + NSCLC and assessed potential associations between the use of antibiotics or probiotics and immunotherapy efficacy. Fecal samples were collected at baseline, early on-treatment, response and progression status and were subjected to metagenomic next-generation sequencing and ultra-high-performance liquid chromatography-mass spectrometry analyses to assess the effects of gut microbiota and metabolites on immunotherapy efficacy. Results The clinical data of 74 advanced EGFR + NSCLC patients were complete and 18 patients’ fecal samples were dynamically collected. Patients that used antibiotics had shorter progression-free survival (PFS) (mPFS, 4.8 vs. 6.7 months; P = 0.037); probiotics had no impact on PFS. Two dynamic types of gut microbiota during immunotherapy were identified: one type showed the lowest relative abundance at the response time point, whereas the other type showed the highest abundance at the response time point. Metabolomics revealed significant differences in metabolites distribution between responders and non-responders. Deoxycholic acid, glycerol, and quinolinic acid were enriched in responders, whereas L-citrulline was enriched in non-responders. There was a significant correlation between gut microbiota and metabolites. Conclusions The use of antibiotics weakens immunotherapy efficacy in patients with advanced EGFR + NSCLC. The distribution characteristics and dynamic changes of gut microbiota and metabolites may indicate the efficacy of immunotherapy in advanced EGFR + NSCLC.

To standardize the use of antibiotics for surgical prophylaxis, ensure patient safety, improve medical quality, and combat bacterial resistance, the editorial committee at Peking Union Medical College Hospital for the management of antibiotics for surgical prophylaxis has formed management practice of perioperative prophylactic use of antibiotics. The management practice, based on the Guideline Principles for the Clinical Application of Antimicrobial Drugs (2015 edition) issued by the National Health Commission of People's Republic of China, also reviews the authoritative literature at home and abroad and combines with our hospital's antimicrobial drugs catalog and characteristics of bacterial resistance, with the hope of promoting the rational use of antibiotics.

Abstract Purpose The prevalence of atopic diseases has increased in recent decades. A possible link between antibiotic use during pregnancy and childhood atopic disease has been proposed. The aim of this study is to explore the association of antibiotic exposure during pregnancy with childhood atopic diseases from a nationwide, population-based perspective. Methods This was a nationwide population-based cohort study. Taiwan’s National Health Insurance Research Database was the main source of data. The pairing of mothers and children was achieved by linking the NHIRD with the Taiwan Maternal and Child Health Database. This study enrolled the first-time pregnancies from 2004 to 2010. Infants of multiple delivery, preterm delivery, and death before 5 years old were excluded. All participants were followed up at least for 5 years. Antenatal antibiotics prescribed to mothers during the pregnancy period were reviewed. Children with more than two outpatient visits, or one admission, with a main diagnosis of asthma, allergic rhinitis, or atopic dermatitis were regarded as having an atopic disease. Results A total of 900,584 children were enrolled in this study. The adjusted hazard ratios of antibiotic exposure during pregnancy to childhood atopic diseases were 1.12 for atopic dermatitis, 1.06 for asthma, and 1.08 for allergic rhinitis, all of which reached statistical significance. The trimester effect was not significant. There was a trend showing the higher the number of times a child was prenatally exposed to antibiotics, the higher the hazard ratio was for childhood atopic diseases. Conclusions Prenatal antibiotic exposure might increase the risk of childhood atopic diseases in a dose-dependent manner.

Background: Community pharmacists have an essential role in antimicrobial stewardship by providing self-care advice for self-limiting infections. Aim: To explore community pharmacists' perceptions and experiences of advising patients on management of acute respiratory tract infections (RTIs) and urinary tract infections (UTIs), and to explore issues regarding use of over-the-counter (OTC) medicines, including herbal medicines. Design & setting: A qualitative study using semi-structured interviews with community pharmacists in England. Method: Qualitative interviews with community pharmacists were carried out face to face and by telephone between November 2019 and March 2020. Data were collected through in-depth, semi-structured interviews, recorded and transcribed. A reflexive thematic analysis was undertaken. Results: In total, 18 community pharmacists were interviewed. Three main themes were identified. Theme 1 was self-management recommendations. Community pharmacists considered patients' preferences when recommending self-management strategies. Some believed that conventional OTC medications had quicker and stronger effects, while others preferred herbal OTCs as a more natural approach, particularly for less severe symptoms. Theme 2 was factors influencing pharmacists' recommendations for acute infections. This included pharmacists' perceptions of patient preferences, nature or severity of illness, research evidence, training, commercial pressures, and patient concerns about medication cost. Theme 3 was pharmacist-patient communication. Pharmacists sometimes experienced challenges with language barriers and patients' expectations of receiving antibiotics. Pharmacists emphasised the importance of being trusted by their patients. There was widespread acceptance of their role in self-management advice for acute illness and interest in the role of herbal medicines, but pharmacists did not feel confident in recommending these. Conclusion: Pharmacists are central to the management of self-limiting infections. There is a need to educate the public about appropriate use of antibiotics and provide training and support for pharmacists on self-management strategies including herbal medicine. [ABSTRACT FROM AUTHOR]

Abstract Background Antimicrobial resistance (AMR) has evolved into a severe public health issue that defies all current control strategies and needs multidisciplinary, creative solutions. Antimicrobial stewardship (AMS) activities demand a set of tools and abilities that can be used by health systems. In view of the growing AMR and the difficulty for the surveillance of it in the developing country, this study was conducted to incorporate pharmacovigilance (PV) in the AMS program. Materials and Methods A cross‐sectional pilot study was conducted to collect the PV database of antimicrobials induced adverse drug reactions (ADR) from the Adverse Drug Reactions Monitoring Center (AMC) of the institute for a period of 2 months from August 2022 to September 2022. The information from the database was analyzed to estimate the usage of antibiotics from the PV database from AMC and classified it under the Anatomical Therapeutic Chemical, to assess the rationality of the antimicrobial's usage based on “Access,” “Watch,” and “Reserve” (AWaRe) classification, and to assess the ADR of the antibiotics. The analysis was done by using the SPSS version 20.0 for Windows. Results The results showed that the prevalence of ADRs were more in adults’ population with preponderance in female. The antibiotics usage was as per with World Health Organization standard and most of the antibiotics used were from the Access group of AWaRe classifications. Tetracyclines and penicillins were the most used antibiotic group of drugs. The number of patients included in the study was 70. Most of the causality assessment was “possible” (62.85%). In the study, almost 90% of the drug was withdrawn and 70% of the patients were in the recovering stage. Conclusion Using existing PV approaches to address usage of antibiotics and AMR issues would allow PV to progress as a field, and governments will get a stronger return on their PV investments.

As the most widely distributed scavenger birds on the Qinghai-Tibetan Plateau, Himalayan vultures (Gyps himalayensis) feed on the carcasses of various wild and domestic animals, facing the dual selection pressure of pathogens and antibiotics and are suitable biological sentinel species for monitoring antibiotic resistance genes (ARGs). This study used metagenomic sequencing to comparatively investigate the ARGs and mobile genetic elements (MGEs) of wild and captive Himalayan vultures. Overall, the resistome of Himalayan vultures contained 414 ARG subtypes resistant to 20 ARG types, with abundances ranging from 0.01 to 1,493.60 ppm. The most abundant resistance type was beta-lactam (175 subtypes), followed by multidrug resistance genes with 68 subtypes. Decreases in the abundance of macrolide-lincosamide-streptogramin (MLS) resistance genes were observed in the wild group compared with the zoo group. A total of 75 genera (five phyla) of bacteria were predicted to be the hosts of ARGs in Himalayan vultures, and the clinical (102 ARGs) and high-risk ARGs (35 Rank I and 56 Rank II ARGs) were also analyzed. Among these ARGs, twenty-two clinical ARGs, nine Rank I ARG subtypes, sixteen Rank II ARG subtypes were found to differ significantly between the two groups. Five types of MGEs (128 subtypes) were found in Himalayan vultures. Plasmids (62 subtypes) and transposases (44 subtypes) were found to be the main MGE types. Efflux pump and antibiotic deactivation were the main resistance mechanisms of ARGs in Himalayan vultures. Decreases in the abundance of cellular protection were identified in wild Himalayan vultures compared with the captive Himalayan vultures. Procrustes analysis and the co-occurrence networks analysis revealed different patterns of correlations among gut microbes, ARGs, and MGEs in wild and captive Himalayan vultures. This study is the first step in describing the characterization of the ARGs in the gut of Himalayan vultures and highlights the need to pay more attention to scavenging birds.

Background. Various mechanisms may contribute to and direct the progression of antibiotic resistance. A prominent driver associated with antibiotic resistance is inappropriate use or consumption. The sudden emergence of coronavirus disease 2019 (COVID-19 ) changed the conventional practices related to antibiotic utilisation through repurposing the use of antibiotics. Apart from the implementation of antibiotic stewardship programmes, the pressure COVID-19 placed on healthcare systems resulted in poor prescribing and medication review practices, potentially exacerbating antibiotic resistance. Furthermore, the public health system has issues that make it difficult to routinely monitor, quantify antibiotic consumption, and offer evaluation, feedback and intervention, particularly in low- and middle- income countries such as South Africa (SA). Therefore, this study aimed to determine antibiotic utilisation before and during the COVID-19 pandemic in a Gauteng provincial tertiary hospital (GPTH) in SA. Objective. To determine, examine, and compare antibiotic consumption among intensive care unit (ICU) patients admitted to a GPTH during the pre-COVID-19 period and during the COVID-19 pandemic, in addition to determining the prevalence of the World Health Organisation (WHO) ‘watch’ category antibiotics before and following the emergence of COVID-19 . Methods. A retrospective cross-sectional data analysis was undertaken of 335 medical files of ICU patients hospitalised in a GPTH between January 2017 and December 2021. Descriptive statistics were used to examine patient characteristics and antibiotic prescribing variables (antibiotic selection, dosage, route of administration, frequency, duration of course and indication for which antibiotic was prescribed). Results. The study found that the most frequently prescribed antibiotics were amoxicillin in combination with clavulanate (pre-pandemic 31.99%; amid-COVID-19 38.43%), followed by ceftriaxone (pre-pandemic 15.44%; amid-COVID-19 14.55%), piperacillin in combination with tazobactam (pre-pandemic 11.40%; amid-COVID-19 8.58%) and azithromycin (pre-pandemic 7.725%; amid-COVID-19 19.78%). Conclusion. The macrolide and penicillin (in combination with a beta-lactamase inhibitor) classes demonstrated an increase in consumption from the pre-pandemic period moving into the COVID-19 pandemic. This highlights the need for improved antibiotic stewardship programmes and policies to combat inappropriate and unnecessary antibiotic usage.

Brevibacillus laterosporus, an endospore-forming, aerobic, Gram-positive bacillus, is not only a potential biocontrol agent against plant pathogens but also a rare cause of human infection. Its pathogenicity in humans, especially in immunocompetent individuals, is still not fully understood. Skin infections caused by B. laterosporus are typically opportunistic, entering the skin through cuts, wounds, or other breaches in the skin’s protective barrier, as in the case presented here.