Misuse of prophylactic antibiotics and prevalence of postoperative wound infection in obstetrics and gynecology department in a Sudanese hospital

Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751;of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR 2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions’ parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription’s parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.

Urinary Tract Infections Identified in the Preoperative and Their Sensitivities to Antibiotics

Introduction: Urinary tract infection is a public health problem. Patients who have to undergo urology surgery are exposed to infectious complications if there is an untreated urinary tract infection. The objective of our study is to identify all the germs responsible for urinary tract infections discovered in the preoperative assessment of hospitalized patients with their susceptibility and antibiotic resistance profiles. Patients and Methods: This is a retrospective and descriptive study of 124 cases of cytobacteriological examination of urine collected over 2 years from January 1st, 2016 to December 31st, 2017, performed in the urology department of the University Hospital of Bocar S. Sall of Kati. The parameters studied were: age, sex, reason for admission, the diagnosis chosen, the result of the cytobacteriological examination of urine and the antibiogram. Results: We collected 124 cases of cytobacteriological examination of urine during this period. The average age of our patients was 58 years old with extremes ranging from 3 years to 84 years. The sex ratio was 6 in favor of men. 86 patients, or 69%, were admitted for micturition disorders. In 53.2%, the diagnosis was BPH followed by urolithiasis 22.6%. Cytobacteriological examination of urine identified 55 cases of urinary infection, 44%. In 34 cases or 60%, the germ responsible was an E. coli. Two germs were sensitive only to one antibiotic. Conclusion: This study made it possible to have an idea about the antibiotic susceptibility of germs involved in urinary tract infections. Awareness-raising for the proper use of antibiotics needs to be strengthened to minimize the risk of increasing antibiotic resistance.

Efficacy of Some Antibiotics in Curing Resistant <i>Escherichia coli</i>Infection

There is growing interest in re-evaluation of older antibiotics with the wide spread of pathogen resistance, especially gram negative bacteria, which impair treatment of some infections. In contrast various studies have reported that some antibiotics have efficacy in clearing resistant bacterial infections. On account of that it was interesting to evaluate the efficacy of erythromycin, chloramphenicol and/or tenoxicam in curing and/or relieving wound infection of highly resistant Escherichia coli and investigate the possible mechanisms beyond their antibacterial activity. This was achieved through evaluating highly resistant E. coli strains in vitro using agar dilution and in vivo rat models of E. coli infected wound and acute inflammation by carrageenin, where possible mechanisms were evaluated through measuring immunological mediators and histopathological examination. This study revealed that in vivo, erythromycin alone or in combination with tenoxicam significantly improved the healing of infected skin wounds with E. coli irresspective of resistancy in vitro. In addition to the improvement of immunological mediators involved in inflammatory reaction, oxidative stress and in cytokines expression as response to the bacterial infection in vivo. On the other hand chloramphenicol neither alone nor in combination with tenoxicam, achieved any significant effect. Tenoxicam didn’t show antimicrobial activity alone nor in combination with tested antibiotics in vitro, but it has shown synergestic activity in combination with tested antibiotics in vivo. Thus we concluded that immunomodulatory activity of erythromycin through anti-inflammatory and antioxidant effects was the possible mechanisms by which this antibiotic had healed infection with resistant E. coli in vivo, despite its resistancy to this antibiotic in vitro.

Recurrence of urinary tract infections in postmenopausal diabetic women using different antibiotics

Objectives: Postmenopausal women with diabetes mellitus (DM) have an increased incidence of urinary tract infections (UTI) compared to women without DM. The aim of this study is to compare recurrence rates of UTI in postmenopausal women with DM after treatment with nitrofurantoin, the agent of first choice following the Dutch guidelines, with two other common prescribed antibiotics trimethoprim and norfloxacin. Methods: We used a PHARMO database with pharmacy dispensing data. A total of 8534 postmenopausal (>55 years) women with DM who received a first course of nitrofurantoin, trimethoprim or norfloxacin were included. The UTI recurrence rates after treatment with these three different antimicrobial agents were compared. Recurrence was defined as a second prescription for nitrofurantoin, trimethoprim or norfloxacin or a first with fosfomycin, amoxicillin, fluoroquinolones, or trimethoprim/sulfamethoxazole between 6 and 30 days after inclusion. Results: Postmenopausal women with DM had significantly more UTI recurrences when they were treated with nitrofurantoin (22.7%) compared to trimethoprim (17.7%) or norfloxacin (14.2%) irrespective of the treatment duration. There was a trend that longer treatment duration was associated with higher recurrence rates. Conclusions: Postmenopausal women with DM had more UTI recurrences when they are treated with nitrofurantoin, agent of first choice, compared to trimethoprim or norfloxacin.

Antibiotics for complicated urinary tract infection and acute pyelonephritis: A systematic review

BACKGROUND The increasing rates of antibiotic-resistance in the recent years has caused the emergence of multiple drug-resistant bacteria.Therefore,antibiotics that are recommended by the current clinical guidelines may not be effective for the treatment of complicated urinary tract infection(UTI)and acute pyelonephritis.AIM To determine the clinical efficacy and safety of antibiotics for the treatment of complicated urinary tract infection and acute pyelonephritis.METHODS A search of three medical databases(PubMed,EMBASE and Google Scholar)were conducted for eligible articles describing the use of antibiotics in managing complicated UTI and acute pyelonephritis.The following keywords were used to perform the literature search:“urinary tract infection”,“complicated UTI”,“pyelonephritis”,“treatment”and“antibiotics”.Additional articles of interest were retrieved from the reference list of selected papers.Eligibility criteria for this systematic review were diagnosis of either complicated urinary tract infection or acute pyelonephritis and the use of antibiotics in management.Clinical trials and observational studies were included in this review while case reports and reviews were excluded.The methodological quality of clinical trials and observational studies was assessed.A descriptive approach was adopted to analyze the data due to the variation of methodology and interventions.RESULTS A total of 183 studies were screened;eight studies that matched all the eligibility criteria were included in this review.The antibiotics included in this systematic review were ceftazidime-avibactam,doripenem,levofloxacin,meropenemvaborbactam,piperacillin-tazobactam,plazomicin,tazobactam-ceftolozane and gentamicin.Two clinical trials reported that shorter duration of levofloxacin or non-fluoroquinolone antibiotics treatment was as effective as the duration of antibiotic therapy recommended by the current guidelines in treating complicated UTI and pyelonephritis.Besides that,ceftazidime-avibactam,piperacillintazobactam and tazobactam-ceftolozane can be used as an alternative to carbapenem in treating extended-spectrumβ-lactamase-producing Escherichia coli.In the included studies,the cure rates of the complicated UTI and pyelonephritis by meropenem-vaborbactam,piperacillin-tazobactam and tazobactam-ceftolozane was comparable at between 95.6%and 98.4%.Furthermore,the clinical trials showed that levofloxacin had a relatively high rate of adverse events(33.1%and 47.7%in two clinical trials)while tazobactamceftolozane had a relatively low rate of adverse events(17.5%).All studies have limitations and a potential for bias.CONCLUSION The use of novel antibiotics and combination antibiotic therapy can be considered in treating complicated UTI and acute pyelonephritis when resistance to recommended antibiotics occurs.

Effects of glucocorticoid combined with antibiotics on serum infection indexes, acute phase proteins and stress hormones in patients with severe pneumonia

Objective: To study the effects of glucocorticoid combined with antibiotics on serum infection indexes, acute phase proteins and stress hormones in patients with severe pneumonia. Methods: a total of 80 patients with severe pneumonia who were hospitalized between August 2014 and January 2017 were retrospectively analyzed and divided into the routine treatment group (n=46) who received conventional antibiotic therapy and the combined treatment group (n=34) who received glucocorticoid combined with antibiotic therapy, and the differences in infection indexes, acute proteins and stress hormones were compared between the two groups of patients before and after treatment. Results: The differences in serum levels of infection indexes, acute phase proteins and stress hormones were not statistically significant between the two groups before treatment. After 1 week of treatment, serum infection indexes CRP and PCT levels of observation group were lower than those of control group;serum acute phase proteins α1-AT, α1-AG and CER levels were lower than those of control group;serum stress hormones Cor, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion:Glucocorticoid combined with antibiotics can effectively inhibit systemic infection and stress and optimize the illness in patients with severe pneumonia.

Targeted montoring to surgical site infection and investigation of standard application of antibiotics during perioperative period

Objective To investigate current surgical site infection and perioperative antibiotics in inpatients and explore the controlling aim and methods. Methods The infection rates of surgical sites of 287 operated cases from May to Dec 31,2007 were studied and compared with

Oxazolidinones Antibiotics, Chemistry, Applications and Role in COVID-19 Treatment

Oxazolidinones are groups of synthetic antimicrobial agents, which have a novel chemical structure. Their mechanism of antimicrobial mainly bacteriostatic via inhibition of protein synthesis. Oxazolidinones are used in serious cases of bacterial infections. Their spectrum of action against a lot of microbes, which often infect humans vigorously, like penicillin and cephalosporin-resistant Streptococcus pneumonia, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci. Oxazolidinones chemical structure possesses a ring called oxazolidone, which is characterized by the S configuration of the substituent at C5, the acyl-amino-methyl group connected to C5 and the N-aryl substituent. Some oxazolidinones like linezolid were believed to have a role in COVID-19 treatment. It is also noticed that oxazolidinones have a role in improving clinical status of patients with COVID-19 and in decreasing the risk of mortality caused by co-infections. This review was conducted to discuss the chemistry, mechanism, applications and role of oxazolidinones in the treatment of COVID-19.

The Burns Menace: Antibiotics for the Fight against Burns Bacterial Infection, a Systemic Review

Burn wound infection delays wound healing, leading to varying degrees of morbidity and mortality. Various antibiotics are administered to burn patients in burn wound management. The emergence of antibiotic resistance is a menace that costs families and the country. This review seeks to expound on infections related to burn wounds, common bacteria of burn wound infections and choice of antibiotics in burns treatment. Words such as burns, wound infection, burns injury and antibiotics were put into the Google search engine. Only articles related to the subject of burns, burn wound infection and antibiotics were used to write the review. Articles obtained included case reports on burns, research articles, review articles, short notes, briefs, literatures and other articles relating to burns. We found that the choice of antibiotics in the management of burns is an issue of major concern due to the evolution of pathogens causing these infections. The challenge of antibiotic resistance still persists in burns wound management. The commonly used topical antimicrobials included silver sulphadiazine, silver nitrate solution, silver impregnated dressings and mafenide acetate. Mafenide acetate has a wide antibacterial activity and also acts against the usual wound pathogens that were identified: Pseudomonas aeruginosa and Staphylococcus aureus. The role of antibiotic resistance is of major concern. Antibiotics must be administered after culture evidence in order to reduce the chance of increasing evolution of resistant strains of bacteria.

Prophylactic antibiotics for variceal hemorrhage: Clostridium difficile infection still can be a risk

Bron et al presented a retrospective study regarding the prophylactic use of antibiotics for variceal hemorrhage. Antibiotics appeared to improve the survival rate of patients without increasing clostridium difficile infection (CDI). We argue against the conclusion of the authors and consider that this result may be simply due to concurrent use of metronidazole, a therapeutic agent against CDI.

Challenges and recommendations when selecting empirical antibiotics in patients with cirrhosis

There is abundant evidence that bacterial infections are severe complications in patients with cirrhosis,being the most frequent trigger of acute-on-chronic liver failure and causing death in one of every four patients during hospitalization.For these reasons,early diagnosis and effective treatment of infections are mandatory to improve patient outcomes.However,treating physicians are challenged in daily practice since diagnosing bacterial infections is not always straightforward.This situation might lead to delayed antibiotic initiation or prescription of ineffective regimens,which are associated with poor outcomes.On the other hand,prescribing broad-spectrum antibiotics to all patients suspected of bacterial infections might favor bacterial resistance development.This is a significant concern given the alarming number of infections caused by multidrug-resistant microorganisms worldwide.Therefore,it is paramount to know the local epidemiology to propose tailored guidelines for empirical antibiotic selection in patients with cirrhosis in whom bacterial infections are suspected or confirmed.In this article,we will revise current knowledge in this area and highlight the importance of surveillance programs.

A clinical observation of early short-term use of potent antibiotics in severely burned patients

Objective:To evaluatetheeffectof earlyandshort-termuseof potentantibioticsfollowingextensivesevere burninjury.Methods:Seventeenseverelyburnedpatientshospitalizedin thesameperiod(Nov.,1998to Oct.,2000)were dividedinto2groups.PatientsinGroup1(n=9)receivedearlytreatmentwithimipenumandamikacinfor5d,andthe sametreatmentin Group2(n=8)was discontinueduntilday15postburn.Thesurvivalrate,bloodbacterialculture,body temperatureand whitebloodcellandplateletcountswerecomparedbetweenthe2groups.Results:Allthe17patients survivedandallbloodbacterialcultureswerenegative.No significantdifferenceof bodytemperatureandwhitebloodcell andplateletcountsbetweenthe2groupswasobserved(P>0.05).Conclusion:Earlyuseof high-potencyantibioticsatshort treatmentcourseafterextensivesevereburniseffectiveto preventinfectionandreducethecost.

Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding

Bacterial infections are common in cirrhotic patients with acute variceal bleeding,occurring in 20%within48 h.Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection.However,mortality from variceal bleeding is largely determined by the severity of liver disease.Besides a higher Child-Pugh score,patients with hepatocellular carcinoma are particularly susceptible to infections.Despite several hypotheses that include increased use of instruments,greater risk of aspiration pneumonia and higher bacterial translocation,it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis.Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures,but more recently,gram positives and quinolone-resistant organisms are increasingly seen,even though their clinical significance is unclear.Fluoroquinolones(including ciprofloxacin and norfloxacin)used for short term(7 d)have the most robust evidence and are recommended in most expert guidelines.Short term intravenous cephalosporin(especially ceftriaxone),given in a hospital setting with prevalent quinolone-resistant organisms,has been shown in studies to be beneficial,particularly in high risk patients with advanced cirrhosis.

Effect of Ilizarov external fixation combined with negative pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion

Objective:Observation on the effect of Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion.Methods:79 patients with tibial infective nonunion who were treated in our hospital from August 2016 to August 2018 were divided into two groups according to random number table,with 39 patients in the control group treated with Ilizarov external fixation technology and 40 patients in the study group treated with vacuum pressure sealing drainage and antibiotics on the basis of the control group.Bone healing time and daily walking were recorded.Rasmussen score,serum intercellular adhesion molecule-1(ICAM-1)and IL-6 levels,lower limb Fugl-Meyer motor function score and lower limb BI index score were compared at different time.Results:The daily walking condition of the study group was significantly better than that of the control group(P<0.05),and the healing time of bone was significantly shorter than that of the control group(P<0.05);the Rasmussen score of the study group was higher than that of the control group at 1 month,6 months and 12 months after treatment(P<0.05);the levels of serum ICAM-1 and IL-6 in the two groups after treatment were lower than those before treatment(P<0.05),and the levels of serum ICAM-1 and IL-6 in the study group were lower than those in the control group after treatment(P<0.05).The lower limb Fugl-Meyer motor function score and lower limb BI index score of the two groups after treatment were higher than those before treatment(P<0.05),and the lower limb Fugl-Meyer motor function score and lower limb BI index score of the study group after treatment were higher than those of the control group(P<0.05).Conclusions:Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics can promote the bone healing of patients with infective tibial nonunion,significantly improving their daily walking condition,alleviating inflammation,and recovering the knee joint function and lower limb function well.

Antibiotics for eradicating meningococcal carriages:Network meta-analysis and investigation of evidence inconsistency

AIM To compare different antibiotics for eradicating the carriage of Neisseria meningitidis(N.meningitidis),and to investigate heterogeneity and evidence inconsistency.METHODS From a search of Pub Med and published systematic reviews,we identified 23 trials evaluating 15 antibiotics that could be connected in a trial network.The outcome of interest is the eradication of N.meningitidis.We used Win BUGS to conduct random-effects,mixed treatment comparisons.Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and interventions evaluated.RESULTS Rifampin,ciprofloxacin,minocycline,ceftriaxone,and azythromycin were statistically significantly(P<0.05)more effective than placebo.The probability of being the best was 67.0%for a combination of rifampin and minocycline,25.0%for ceftriaxone,1.7%for azythromycin,and below 1%for the remaining regimens.Significant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofloxacin(P<0.01),which may becaused by different types of carriers and different doses of ciprofloxacin.CONCLUSION A range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages,and treatment choice will depend on the individual priorities of the patients and physicians.In clinical situations where complete eradication is considered to be of the utmost importance,a combination of rifampin and minocycline seems to offer the highest likelihood of success.Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics(ciprofloxacin or rifampin)recommended by the current guidelines.

A prospective randomized study to define the role of low dose continuous prophylactic antibiotics and anti-adherence agents in altering the microbial colonization related to indwelling double‐J stents

Objective:Despite conflicting evidence,it is common practice to use continuous antibiotic prophylaxis(CAP)in patients with indwelling double-J(DJ)stents.Cranberry extracts and d-mannose have been shown to prevent colonization of the urinary tract.We evaluated their role in this setting.Methods:We conducted a prospective randomized study to evaluate patients with indwelling DJ stents following urological procedures.They were randomized into three groups.Group A(n=46)received CAP(nitrofurantoin 100 mg once daily[OD]).Group B(n=48)received cranberry extract 300 mg and d-mannose 600 mg twice daily(BD).Group C(n=40)received no prophylaxis.The stents were removed between 15 days and 45 days after surgery.Three groups were compared in terms of colonization of stent and urine,stent related symptoms and febrile urinary tract infections(UTIs)during the period of indwelling stent and until 1 week after removal.Results:In Group A,9(19.5%)patients had significant bacterial growth on the stents.This was 8(16.7%)in the Group B and 5(12.5%)in Group C(p-value:0.743).However,the culture positivity rate of urine specimens showed a significant difference(p-value:0.023)with Group B showing least colonization of urine compared to groups A and C.There was no statistically significant difference in the frequency of stent related symptoms(p-value:0.242)or febrile UTIs(p-value:0.399)among the groups.Conclusion:Prophylactic agents have no role in altering bacterial growth on temporary indwelling DJ stent,stent related symptoms or febrile UTIs.Cranberry extract may reduce the colonization of urinary tract,but its clinical significance needs further evaluation.

Antibiotics and near-patient testing: Differences in habits between physicians completing or discontinuing a medical audit

Background and Aim: Respiratory tract infection (RTI) is a common reason for consulting primary health care. Antibiotic prescribing for RTIs varies among physicians indicating that national guidelines are not always adhered to. The aim was to study if antibiotic prescribing and use of near-patient tests were different among physicians who complete an audit registration and those who discontinue their participation. Method: A prospective cohort study where physicians participated in an APO (Audit Project Odense) process, making an audit registration for every appointment with a patient who had a respiratory tract infection during 4 weeks in 2008 and 4 weeks in 2009. Between the registrations, a limited educationally oriented intervention was made. 18 Primary Health Care Centres located in three counties in southern of Sweden with 77 primary health care physicians participated. When comparing proportions the Chisquare test was used. Mann Whitney U-test was used when comparing independent groups and Wilcoxon’s signed-rank test was used when comparing dependent groups. Results: Of the 77 physicians, 38 participated only at baseline (group 1) and 39 participated in both registrations (group 2). The overall use of CRP near-patient tests was 37% in group 1 and 28% in group 2 (Chisquare p < 0.001), and the overall use of Strep-A near-patient tests was 31% and 20%, respectively (Chisquare p < 0.001). When the Strep-A near-patient test was negative in pharyngitis/tonsillitis, antibiotics were prescribed to 45% in group 1 and to 12% by group 2 (Chisquare 0.003). Conclusion: In conclusion, this study showed that physicians, who were more inclined to complete audit participation, used near-patient tests and prescribed antibiotics more correctly, according to the national guidelines for respiratory tract infections, than physicians who discontinued the participation. To achieve a rational use of antibiotics, near-patient tests and prescription of antibiotics must be used according to guidelines.

Analysis of the Clinical Characteristics and Antibiotics Resistance of Community-acquired Methicillin-resistant Staphylococcus aureus

The purpose of this investigation is to study the clinical characteristics of infections by community-acquired methicillin-resistant Staphylococcus aureus (MRSA) and the condition of antibiotics resistance of the clinical isolates in order to guide for the rational use of antibiotics. With the clinical isolates from cases of hospital-acquired MRSA at the same period as controls, the clinical characteristics of infections by community-acquired MRSA in Hangzhou area and the pattern of non-β-lactamase antibiotics resistance were determined in this study. It was found that the average age of patients with community-acquired MRSA infections was 30.89±13.3, in comparison with those of the hospital-acquired patients of 56.0±11.8, appearing to be younger than those of the latter, and the former showing no any basic illness. Both of the former and the latter were sensitive to vancomycin (100% vs 100%), and they had the same degrees of sensitivity to rifampicin, fosfomycin, and STM/TMP (86.8% vs 88.1%, P >0.05; 81.6% vs 82.9%, P >0.05; and 52.6% vs 61.9%, P >0.05, respectively). The former was more sensitive to netimycin, clindamycin, erythromycin and minocycline than those of the latter (73.7% vs 50.5%, P <0.01; 60.5% vs 45.7%, P <0.05; 28.9% vs 11.4%, P <0.01; and 81.6% vs 58.6%, P <0.01 respectively). Meanwhile, the incidence of multi-resistant strain of isolates in the former was significantly lower than that of the latter (31.6% vs 81.0%, P <0.01). In conclusion, it appears that the strains of clinical isolates isolated from patients with the community-acquired MRSA infections show different clinical characteristics and antimicrobial susceptibility in comparison with those of the hospital-acquired cases of infection, and this necessitates an alteration in the chemotherapy of infections suspected to be caused by community-acquired MRSA.

Urinary Tract Infection in Pediatric Emergency Department of Mohamed VI Hospital in Marrakech: Epidemiological Profile and Antibiotic Resistance

Background: Urinary tract infection (UTI) is one of the most frequent bacterial infections in pediatrics. The aim of our work was to establish the epidemiological and bacteriological profile of UTIs in children and then to study the sensitivity of the bacterial strains isolated to antibiotics. Materials and methods: This is a retrospective descriptive study over 3 years (2019-2022), including all cytobacteriological examination of urine (CBEU), performed in children aged 3 months to 14 years, admitted and treated for UTI, in the pediatric emergency department of Mohamed VI University Hospital. Results: A total of 239 children were included in our study. The mean age was 26 months. The sex ratio was 1.08. Escherichia coli was the most isolated bacterial strain in 79% of samples. The tested strains showed a high level of sensitivity to susceptibility rate toward amikacin (91%) and ciprofloxacin (100%) and whereas the level of resistance was high to the most current recommended antibiotics, mainly beta-lactams. Management was based, in severe forms of pyelonephritis, dual antibiotic therapy based on Third-generation cephalosporins combined with gentamycin. Favorable outcome was noted in 94% of children. Conclusion: Awareness-raising on the proper use of antibiotics, issuing national recommendations for the treatment of urinary tract infections in order to standardize therapeutic regimens is strongly recommended. Effective control of these infections requires a global prevention strategy that implies close collaboration between epidemiologists, clinicians, bacteriologists, hygienists and the health care team.

Effect of weight-adjusted antimicrobial antibiotic prophylaxis on postoperative dosage and surgical site infection incidence in total joint arthroplasty

Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.