Practice of Perioperative Rational Use of Antibacterial Drugs Based on Drug Pathway

[Objectives]To establish a new management model for rational use of perioperative antibacterial drugs in surgical departments.[Methods]Based on evidence-based medicine,the department s drug pathway was formulated,and the new mode of rational drug use control was established by using fine pharmaceutical technology intervention,and the intervention effect was evaluated by the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs.[Results]After adopting drug pathway in departments,the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs decreased significantly,and the effect of rational drug use control was remarkable.[Conclusions]The drug pathway provides a new management and control mode for the rational use of perioperative antibacterial drugs in surgical departments of hospitals.Thus,it is worthy of popularization and application.

Effects of intervention measures on irrational antibiotics/antibacterial drug use in developing countries: A systematic review

Irrational antibiotics/antibacterial (AB) drug use is a global problem, especially in developing countries. This results in an increased emergence of resistance to most common bacteria, higher cost of treatment, prolonged hospitalization and adverse drug reactions. Interventions measures have been instituted to avert the problem but it still persists. A systematic review was conducted to determine the effect of different interventions (education, managerial, diagnostic tests, regulatory, economic and multifaceted) on misuse of AB drugs in developing countries. A total of 722 articles were retrieved and 55 were reviewed. About 10.9% of the studies were from Africa, 63.6% from Asia, 9.1% from Latin America, and 16.4% from Southeastern Europe. A total of 52.7% of the studies were from hospital settings, 5.5% from outpatient departments, 21.8% were from public health care facilities, 12.7% from private pharmacies/drug stores, and 7.3% from the communities. Education intervention had 27.3% studies, managerial had 20%, managerial/education had 3.6%, regulatory had 9.1%, education/regulation had 9.1% and diagnostic had 3.6% studies. Multifaceted intervention had 27.3% studies, with 63% improvement in appropriate AB doses prescribed, 2.6% mean number of AB encounter reduction, 23% AB prescription reduction, 18.3% generic AB prescription improvement, 32.1% reduction in AB use, 89% reduction in AB use in acute respiratory infection, 82% in surgery, 62.7% mean reduction in deliveries, 39% in STDs, 36.3% mean reduction in diarrhea, 14.6% mean reduction AB use in malaria, and 6%-11% in the cost of treating bacteria-resistant organisms. Also noted was 6.3% reductions in mean AB encounters after 1 month of intervention, and then increased to 7.7% after 3 months thus lacking sustainability. Multifaceted interventions were effective in reducing irrational AB drug use in the various health facilities and communities as well as reduction in the emergence of resistance to the commonest bacteria in the developing countries though there was lack of sustainability or continuity of rational drug use over the time.

Antibacterial effect of Allium sativum cloves and Zingiber officinale rhizomes against multiple-drug resistant clinical pathogens

Objective:To evaluate the antibacterial properties ot Allium sativum(garlic) cloves and Zingiber officinale(ginger) rhizomes against multi-drug resistant clinical pathogens causing nosocomial infection.Methods:The cloves of garlic and rhizomes of ginger were extracted with 95%(v/v) ethanol.The ethanolic extracts were subjected to antibacterial sensitivity test against clinical pathogens.Results:Anti-bacterial potentials of the extracts of two crude garlic cloves and ginger rhizomes were tested against five gram negative and two gram positive multi-drug resistant bacteria isolates.All the bacterial isolates were susceptible to crude extracts of both plants extracts.Except Enterobacter sp.and Klebsiella sp.,all other isolates were susceptible when subjected to ethanolic extracts of garlic and ginger.The highest inhibition zone was observed with garlic(19.4S mm) against Pseudomonas aeruginosa(P.aeruginosa).The minimal inhibitory concentration was as low as 67.00 μg/mL against P.aeruginosa.Conclusions:Natural spices of garlic and ginger possess effective anti-bacterial activity against multi-drug clinical pathogens and can be used for prevention of drug resistant microbial diseases and further evaluation is necessary.

<i>In Vitro</i>Antibacterial Activity of Flavonoid Extracts of Two Selected Libyan Algae against Multi-Drug Resistant Bacteria Isolated from Food Products

This study aimed to evaluate the antibacterial activity of flavonoids extracted from two Libyan brown algae namely Cystoseira compressa and Padina pavonica using microwave-assisted extraction method against pathogenic bacteria isolated from meat, meat products, milk and dairy products (Staphylococcus aureus subsp. aureus (5 isolates), Bacillus cereus (3 isolates), Bacillus pumilus (1 isolate), Salmonella enterica subsp. enteric (4 isolates) and Enterohaemor-rhagic Escherichia coli O157 (EHEC O157) (4 isolates)). All of these isolates were muti-drug resistant with high MAR index. The results showed that C. compressa extract exhibited better and stronger antibacterial activities against the seventeen tested isolates with inhibition zones diameter ranged from 14 - 22 mm compared to P. pavonica extract which showed positive effect against 9 isolates with low inhibition zone ranged from 11 - 16.5 mm. Flavonoids extracted from C. compressa also displayed the best spectrum of bactericidal effect with a ratio MBC/MIC ≤ 4 obtained on all susceptible tested bacterial strains. Flavonoids and proanthocyanidins significantly contributed to the antibacterial properties. The mode of action of these active extracts is under investigation.

Comparison of Antibacterial Activities of Six Bacillus amyloliquefaciens Strains

In this study, six bacterial strains were isolated from the sediment, probiotic fermentation products, and lake sediments, they were identified as Bacillus amyloliquefaciens using genetic evolution analysis, which were named B3, B4, B5, XD3, YF6, and YF8. The comparison of the antibacterial activity, hemolytic activity, and antibiotic sensitivity of six Bacillus amyloliquefaciens strains laid a foundation for the development and application of antimicrobial peptide products. A surface activity assay was used to determine the production of biosurfactants in six Bacillus amyloliquefaciens strains. With Staphylococcus aureus and Escherichia coli as indicator bacteria, their antibacterial activity was determined using the agar diffusion method;the same diffusion method was used to determine the antibiotic susceptibility of Bacillus amyloliquefaciens. The results showed that the six Bacillus amyloliquefaciens strains had obvious biosurface activity, and the bacteria inhibited Staphylococcus aureus and Escherichia coli, from strong to weak: YF8, XD3, B3, B4, YF6, and B5. Strain YF8 had the best broad-spectrum bacteriostatic effect, followed by strain XD3. All Bacillus amyloliquefaciens strains were susceptible to 16 common drugs, except for Bacillus amyloliquefaciens strain YF8, which was intermediate to neomycin. The study shows that Bacillus amyloliquefaciens and secondary metabolites have the ability to produce a variety of active peptides, exert a certain inhibitory effect on common pathogens, and have the potential to develop as animal probiotics.

Identification and Antibacterial Activity Study of a Terrestrial Strain of Brevibacterium aureus 431

This study isolated and purified strain 431 from an animal probiotic product.Through staining and microscopic examination,colony morphology analysis,biochemical reaction tests,and 16S rDNA sequence alignment,the strain was identified and named Brevibacterium aureus 431.The study focused on the production of biosurfactants by strain 431,and antibacterial activity tests were conducted on the strain and its secondary metabolites.The results showed that strain 431 exhibited no resistance to 10 commonly used drugs,and its concentrated secondary metabolites were highly sensitive to the indicator bacterium Escherichia coli.Oral administration of strain 431 to BALB/c mice resulted in normal mental state,diet,and bowel movements,with no signs of illness or death,indicating that strain 431 is highly safe and non-pathogenic to mice.The study suggests that Brevibacterium aureus 431 has significant research value as a new source of actinomycetes and that its secondary metabolites have potential application value in the development of antibacterial drugs.

Study on Anti-diarrhea Effect of the Prescription of 4 Tibetan Veterinary Drugs

This study was conducted to investigate the effects of extracts of 4 Tibetan veterinary drugs on bacterial diarrhea, and to guide the clinical treatment of the disease. The inhibitory effects of the extracts of the 4 Tibetan veterinary drugs, Veronica ciliate Fisch, Usnea diffracta Vain, Sophoraflavescens var. flavescens, Lamiophlomis rotata （ Benth. ） Kudo on 14 common diarrheagenic bacteria were detected by K-B diffusion method and micro-broth dilution method. Optimization was performed on prescriptions of the 4 Tibetan veterinary drugs using orthogonal design software, and a mouse bacterial diarrhea model was established with a clinical isolate, Salmonella blegdam. According to the LD50 value of the optimal prescription of the 4 Tibetan veterinary drugs, the established mouse bacterial diarrhea model was treated in 3 dose groups, i. e. , the high, middle and low dose groups （0. 060, 0. 030 and 0. 020 g/ml, respectively）. The results showed that the 4 Tibetan veterinary drugs had very good inhibitory effects on most of the tested diarrheagenic bacteria, and among them, U. diffracta had better inhibitory effects on all the tested bacteria. The optimal prescription of the d Tibetan veterinary drugs （high dose, 0.06 g/ml） exhibited very good inhibitory effect on mouse diarrhea, indicating that the prescription has very good anti-diarrhea effect, which is beneficial to the clinical treatment of such disease and the development of Tibetan veterinary drugs.

Antibacterial activity of Rosmarinus officinalis L.alone and in combination with cefuroxime against methicillin-resistant Staphylococcus aureus

Objective:To determine the antimicrobial activity of rosemary(Rosmarinus of ficinalis L.) and to investigate the synergistic effects of this extract combined with ceforuxime against methicillinresistant Staphylococcus aureus(MRSA).Methods:The inhibitory and bactericidal activities of rosemary ethanol extract,alone and in combination with cefuroxime,were studied.Results:The minimum inhibitory concentrations(MICs) of the ethanol extract of rosemary were in the range of 0.39-3.13 mg/mL.The minimum bactericidal concentrations(MBCs) were usually equal to or double that MICs.The antimicrobial activity of combinations of the ethanol extract of rosemary and cefuroxime indicated their synergistic effects against all MRSAs.Conclusions:The present work clearly demonstrates that rosemary has a key role in the elevation of susceptibility toβ-lactams.

A drug-loaded flexible substrate improves the performance of conformal cortical electrodes

Cortical electrodes are a powerful tool for the stimulation and/or recording of electrical activity in the nervous system.However,the inevitable wound caused by surgical implantation of electrodes presents bacterial infection and inflammatory reaction risks associated with foreign body exposure.Moreover,inflammation of the wound area can dramatically worsen in response to bacterial infection.These consequences can not only lead to the failure of cortical electrode implantation but also threaten the lives of patients.Herein,we prepared a hydrogel made of bacterial cellulose(BC),a flexible substrate for cortical electrodes,and further loaded antibiotic tetracycline(TC)and the anti-inflammatory drug dexamethasone(DEX)onto it.The encapsulated drugs can be released from the BC hydrogel and effectively inhibit the growth of Gram-negative and Gram-positive bacteria.Next,therapeutic cortical electrodes were developed by integrating the drug-loaded BC hydrogel and nine-channel serpentine arrays;these were used to record electrocorticography(ECoG)signals in a rat model.Due to the controlled release of TC and DEX from the BC hydrogel substrate,therapeutic cortical electrodes can alleviate or prevent symptoms associated with the bacterial infection and inflammation of brain tissue.This approach facilitates the development of drug delivery electrodes for resolving complications caused by implantable electrodes.

Advances in Study of Natural Antibacterial Medicines

This paper introduce the advances in study of antibacterial effects of natural medicines in the past ten years.The antibacterial components of natural medicines mainly include flavonoids,terpenoids,alkaloids,lignans,phenols,etc..This paper is intended to provide data reference for the research and development of new natural antibacterial medicines.

Design, Synthesis and Antibacterial Activity Evaluation of 4,5-Diphenyl-1<i>H</i>-Imidazoles Derivatives

Due to the continuous emergence and rapid spread of drug-resistant strains of bacteria, there is an urgent need for the development of novel antimicrobials. Along this line, the synthesis and antibacterial activity of 4,5-diphenylimidazol-2-thiol derivatives 2a-g and 6a-e are reported. The structures of the synthesized compounds were confirmed by Nuclear Magnetic Resonance (NMR) and High Resolution Mass Spectrometry (HRMS). All compounds were screened in vitro for their antibacterial activity against Pseudomonas aeruginosa and Escherichia coli (Gram-negative bacteria) and also against Staphyloccocus aureus and Enterococcus faecalis (Gram-positive bacteria). The results showed most of the synthesized compounds have no antibacterial activity. However compound 6d was two-fold potent than ciprofloxacin against Staphylococcus aureus with Minimum Inhibitory Concentration (MIC) of 4 μg/mL and 6c showed moderate biological activity against Staphylococcus aureus (16 μg/mL) and Enterococcus faecalis (16 μg/mL).

Study on Antibacterial Effect of Single Chinese Herbs on Staphylococcus aureus

[Objectives] This study was conducted to determine in-vitro antibacterial effect of 58 Chinese herbs on Staphylococcus aureus,and screen single Chinese herbs with better in-vitro antibacterial effect for formulation of prescription. [Methods]Effective components in Chinese herbs were extracted with water,and inhibition zone diameters and minimal inhibitory concentrations of the 58 Chinese herbs against S. aureus were determined by agar plate punching method and micro two-fold method,respectively. [Results] Twenty two kinds of Chinese herbs including Terminalia chebula Retz.,Anemarrhena asphodeloides Bunge.,Prunella vulgaris L,Rheum palmatum L. and Mosla chinensis Maxim. had better antibacterial effect,among which T. chebula Retz.,A. asphodeloides Bunge.,P. vulgaris L,R. palmatum L. and C. sappan Linn showed the best antibacterial effect,with average inhibition zone over 20 mm and MIC lower than 15. 6 mg/ml.[Conclusions]Traditional Chinese herbs have certain antibacterial effect,and this study will provide important theoretical reference for clinical medication and development of prescription.

Antimicrobial activity of green tea extract against isolates of methicillin-resistant Staphylococcus aureus and multi-drug resistant Pseudomonas aeruginosa

Objective:To evaluate antibacterial activity of the Indonesian water soluble green tea extract,Camellia sinensis,against clinical isolates of methicillin-resistantStaphylococcus aureus (S.aureus)(MRSA)and multi-drug resistant Pseudomonas aeruginosa(MDR-P.aeruginosa).Methods:Antimicrobial activity of green tea extract was determined by the disc diffusion method and the minimum inhibitory concentration(MIC)was determined by the twofold serial broth dilutions method.The tested bacteria using in this study were the standard strains and multi-drug resistant clinical isolates of S.aureus and P.aeruginosa,obtained from Laboratory of Clinical Microbiology,Faculty of Medicine,University of Indonesia.Results:The results showed that the inhibition zone diameter of green tea extracts forS.aureus ATCC 25923 and MRSA were(18.970依0.287)mm,and(19.130依0.250)mm respectively.While the inhibition zone diameter forP.aeruginosa ATCC 27853 and MDR-P.aeruginosawere(17.550依0.393)mm and(17.670依0.398)mm respectively.The MIC of green tea extracts againstS.aureus ATCC 25923 and MRSA were 400μg/mL and 400μg/mL,respectively,whereas the MIC for P.aeruginosa ATCC 27853 and MDR-P.aeruginosawere 800μg/mL,and 800μg/mL,respectively.Conclusions:Camellia sinensisleaves extract could be useful in combating emerging drug-resistance caused by MRSA andP.aeruginosa.

Screening of antibacterial drugs from marine gastropod Chicoreus ramosus(Linnaeus,1758)

Objective:To screen the antibacterial drugs from different solvent extracts of tissue and egg of marine gastropods Chicoreus ramosus against clinically isolated human pathogenic bacteria.Methods:Vibrio parehaemolyticus(J13300),Aeromonus hydrophilla(IDH1585),Salmonella typhi(C6953),Salmonella paratyphi A(C6915),Vibrio cholerae(IDH5439)and Escherichia coli(H10407)using standard well diffusion method and its minimum inhibitory concentration.Results:Different solvent extracts of Chicoreus ramosus was screened for their activity against egg inhibited the growth of the tested pathogenic bacterial strains.The minimum inhibitory concentration of both the extract ranged from 4 to 12 mg/mL.The study revealed that the acetone and chloroform extract of both the tissues and Conclusions:These results suggest that marine gastropods tissue and egg extract contains comparatively good antibacterial activity.

Intercalation of Ciprofloxacin in Naturally Occurring Smectite from Bana: Potentiality as Drug Delivery System and Antimicrobial Effects on <i>Escherichia coli</i>and <i>Staphylococcus aureus</i>

Ciprofloxacin (CFX) was loaded on Bana clay (Cameroon) and CFX loaded-clays have been evaluated as drug delivery system. Raw clays and CFX loaded compounds have been characterized by some physico-chemicals methods. In vitro release studies have been done in gastric and phosphate buffer experimental mediums;bacteriological studies have been made up on Escherichia coli and Staphylococcus aureus. X-ray diffractometry patterns of loaded compounds show a basal spacing increasing due to CFX intercalation. On Fourier-Transformed Infrared spectrometry spectra, appearance of CFX characteristic bands and shifting of certain bands already presents on clay confirmed CFX intercalation. After 96 h of CFX released from release mediums, prolonged and continue profiles have been observed. Diffusion tests displayed an inhibition radius of ~2 cm on gelose seeded with Escherichia coli and Staphylococcus aureus due to CFX. The overall results show a modified release of ciprofloxacin with an effective antibacterial activity, giving the way for a new ciprofloxacin drug delivery system using Bana clay as carrier.

Distribution and drug resistance of pathogens isolated from 4142 blood cultures

Objective:To investigate the distribution and drug resistance of pathogens isolated from 4142 blood cultures, and provide a scientific foundation for guiding clinical rational use of antimicrobial agents for bloodstream infections.Methods: Blood cultures obtained from 4142 inpatients and outpatients who were hospitalized from Jan 2015 to Dec 2016. The culture was detected by automatic BACT/ALERT 3D blood culture system of biomerieux. Bacteria isolated from positive blood cultures were further identified, and the drug susceptibility tests were conducted by VITEK-2 Compact automatic microbial analysis system and ATB Expression microbial analysis system. The drug susceptibility results were evaluated according to CLSI 2014 standard. Statistical analysis was performed by using WHONET 5.6 software. Results:A total of 396 unique strains were isolated from 4142 blood cultures, and the positive rate is 9.6%. Among the positive blood cultures, 194 (49.0%) strains were identified as Gram-positive, 185 (46.7%) strains were identified as Gram-negative, and 17(4.3%) strains were identified as fungi. The coagulase-negative Staphylococcus were the most frequently detectable (29.2%), followed by Escherichia coli (18.4%), Klebsiella pneumonia (7.3%), Staphylococcus aureus (5.1%), Acinetobacter baumannii(5.1%), and Enterococcus genera (5.1%). The incidences of methicillin resistant coagulase negative staphylococcus (MRCNS) and methicillin resistant staphylococcus aureus (MRSA) were 81.9% and 50.0% respectively. However, vancomycin resistant staphylococcus and enterococcus were not detected. The prevalence of extended spectrumβ lactamases (ESBLs) in E. coli and K. pneumoniae were 56.2% and 37.9%, respectively. All the E. coli strains were sensitive to amikacin, piperacillin/tazobactam, imipenem and meropenem, and the sensitive rate of K. pneumoniae strains to imipenem and meropenem were 93.1% and 89.7%, respectively.Conclusions MRCNS stains were the most frequently detected pathogens in blood cultures in the present study. The characteristic of drug resistance for the pathogens indicated that monitoring of imipenem and meropenem resistant K. pneumoniae should be underlined to prevent nosocomial outbreak. Fungi bloodstream infections of ward such as ICU and department of hemopathology should be enhanced monitored.

Production and purification of a bioactive substance against multi-drug resistant human pathogens from the marine-sponge-derived Salinispora sp.

Objective:To isolate,purify,characterize,elucidate structure and evaluate bioactive compounds from the sponge-derived Salinispora sp.FS-0034.Methods:The symbiotic actinomycete strain FS-0034 with an interesting bioactivity profile was isolated from the Fijian marine sponge Theonella sp.Based on colony morphology and obligatory requirement of seawater for growth,and mycelia morphological characteristics the isolate FS-0034 was identified as a Salinispora sp.The bioactive compound was identified by using various spectral analysis of ultraviolet,high resolution electrospray ionization mass spectroscopy,H nuclear magnetic resonance,correlated spectroscopy and heteronuclear multiple bond coherence spectral data.A minimum inhibitory concentration assay were performed to evaluate the biological properties of the pure compound against multi-drug resistant pathogens.Results:Bioassay guided fractionation of the ethyl acetate extract of the culture of Salinispora sp.FS-0034 by different chromatographic methods yielded the isolation of an antibacterial compound,which was identified as rifamycin W(compound 1).Rifamycin W was reported for its potent antibacterial activity against methicillin-resistant Staphylococcus aureus,wild type Staphylococcus aureus and vancomycin-resistant Enterococcus faecium and displayed minimum inhibitory concentrations of 15.62,7.80 and 250.00 μg/mL,respectively.Conclusions:The present study reported the rifamycin W from sponge-associated Salinispora sp.and it exhibited appreciable antibacterial activity against multi-drug resistant human pathogens which indicated that sponge-associated Actinobacteria are significant sources of bioactive metabolites.

Drug treatment

China Medical Abstracts(Intenal Medicine) 930428 In vitro antibacterial activity and clini-cal significance of domestic fluroqinolones com-binations with other antimicrobial agenls.LI Li-jin(李立津),et al.Instit Infect Dis,2nd TeachHosp,Tianjin Med Coll,Tianjin,300211.Chin JIntern Med 1993;32(2):148—151.The minimal inhibitory concentration of nor-floxacia,pefloxacin,ciprofloxacin and other tenantimicrobial agents for 143 strains of Gram-positive cocci and 267 strains of Gram-negativebacilli of recent clinical isolates from June 1990to March 1991 was analyzed.The results showedthat ciprofloxacin and norvancomycin were moreactive than other antimicrobial agents

Drug treatment

930015 Treatment of soil-transmittedhelminth infections by helminthicides in currentuse.XU Longqi(许隆祺),et al.Instit ParasitDis,Acad Chin Pre Med,Shanghai 200025.Chin J Parasitol & Parasit Dis 1992;10(2):95—98.The efficacy of broad-spectrum helminthi-cides in current use was studied in HengshanCounty,Hunan Province.The vermicides

国内兽用抗菌药减量化使用措施

兽用抗菌药物的过度使用在中国等许多国家引发抗菌药物耐药性和卫生风险的问题。为了有效应对该挑战,国内兽用抗菌药减量化使用策略应运而生。本文论述改善兽用抗菌药物使用实践和维护公共卫生方面的重要性,并提出政策和实践建议。通过采取综合措施,可以更好地管理兽用抗菌药物的使用,降低抗菌药物滥用的风险,维护公共卫生,同时确保养殖业的可持续发展。