<b>Background</b> Antibiotic resistance is an important societal health issue. The greatest risk factor for developing a resistant infection is antibiotic use. Almost 75% of all antibiotics in the UK are prescribed in the community, and mostly for acute respiratory tract infections (RTIs). Yet, the majority of RTIs are self-limiting, viral and do not need antibiotic treatment, especially in young children. While the effects of antibiotic-resistant infections have been widely studied in hospitals (e.g. the MRSA 'superbug'), we know less about how antibiotic-resistant infections affect people in the community, even though this is where most antibiotics are prescribed. There is also widespread public misconception about antibiotic use and resistance despite several high-profile, multimillion antibiotic awareness campaigns. This is important to address because consultation behaviour and expectations for antibiotics are a significant determinant of antibiotic use in the community. <b>Methods</b> Three studies were conducted for this thesis. First, a systematic review and meta-analysis to assess the evidence of the impact of antibiotic resistance for patients with common infections in the community; second, a retrospective analysis of routinely collected primary care data to examine the relationship between antibiotic exposure and antibiotic 'response failure' in preschool children presenting with acute RTIs; third, a qualitative interview study to explore parents' perceptions and understanding of antibiotic use and resistance when they consider consulting in the community with their preschool child who has a respiratory tract infection. <b>Results</b> Antibiotic resistance significantly impacts on patients' illness burden for common infections in the community. Patients who presented in community health care settings with antibiotic-resistant E. coli urinary tract infections and S. pneumoniae respiratory tract infections were more likely to experience delays in recovery after antibiotic treatment. From routinely collected primary data (2009-2016), preschool children receiving two or more antibiotic courses in the previous year for acute RTIs had greater likelihood of antibiotic 'response failure' to treatment for subsequent acute RTIs compared to children that had received no previous antibiotics. When interviewing parents of young children, most parents were quite reticent about antibiotics for their children. However, very few considered antibiotic resistance as a possible harm of antibiotics. Parents thought their families were at low risk of antibiotic resistance because their families were 'low users' of antibiotics and did not perceive any association between their individual consumption of antibiotics and the development and spread of antibiotic-resistant bacteria in the community. They wanted future antibiotic awareness campaigns to have a universal message relevant to their families that fit into their daily lives. <b>Conclusions</b> The findings challenge the perception that antibiotic prescribing and resistance in the community poses little or no additional risk to patients in the community, or is remote from everyday prescribing decisions. Rapid diagnostic tests and other prognostic tools need to be promoted and evaluated to better identify patients who might need an antibiotic, and reduce the risk antibiotic response failures. Clinicians and parents should exercise caution about whether further antibiotics for acute RTIs are likely to be beneficial in those children who have received two or more antibiotic prescriptions for acute RTIs during the previous 12 months. Incorporating this into clinical practice guidelines and decision-support systems will help clinicians and parents consider a non-antibiotic strategy for acute RTIs. Future guidelines, campaigns and interventions around antibiotic resistance should tailor initiatives to outcomes that patients and clinicians in the community can relate to and slot into their daily lives. More research is needed to evaluate the impact of other common infections in primary care, and determine the relative contribution of antibiotic resistance to patients not responding to antibiotic treatment for common infections.

Orientador: Fernando Leite Hoffmann / Banca: Vanildo Luiz Del Bianchi / Banca: Maria Luiza Silva Fazio / Resumo: A coleta da alface (Lactuca sativa) e da água de manejo foi realizada no local de cultivo, tanto pelo método de hidroponia (CH) como pelo tradicional no solo (CT) em estabelecimentos hortifrutigranjeiros e restaurante (R) localizados em cidades da região noroeste paulista. As vinte e cinco amostras analisadas foram coletadas em dias alternados, sendo cinco amostras de cada local. As análises foram realizadas com objetivo de verificar se a origem das toxinfecções alimentares envolvendo pratos que contenham alface é proveniente de microrganismos do local de produção das hortaliças. Os resultados obtidos possibilitaram analisar a ocorrência de contaminação cruzada com outras hortaliças enxaguadas no mesmo tonel e comparar o índice de contaminação dos dois tipos de sistema de cultivo. As análises microbiológicas seguiram as metodologias tradicionais descritas por Silva; Junqueira e Silveira (2001), de acordo com a American Public Health Association. Os resultados das análises mostraram grande variação na contagem dos microrganismos. Nas amostras de alface 92% (23) apresentaram crescimento de coliformes totais variando entre 0,4 a ≥240 NMP/g dos quais 40% (10) CT, 32% (8) CH, 20% (5) R; 32% (8) apresentaram coliformes termotolerantes variando entre 0,9 a 46 NMP/g, sendo 24% (6) CT e 8% (2) R; 36% (9) apresentaram Staphylococcus coagulase positiva, onde 12% (3) apresentaram crescimento acima dos parâmetros estabelecidos 5x103 UFC/g, sendo 4% (1) CT e 8% (2) CH. Todas as amostras positivas para coliformes termotolerantes estão dentro dos limites estabelecidos pela ANVISA (BRASL, 2001) de 102 UFC/g. Nenhuma amostra foi positiva para Salmonella spp, atendendo os parâmetros estabelecidos pela ANVISA (BRASIL, 2001) de ausência em 25g do produto. Os resultados obtidos nas análises da água foram de 95% (19) apresentando coliformes totais variando... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The collect of lettuce (Lactuca sativa) and the water used to grow it was made in the local of its cultivation through both hydroponics (CH) and the traditional in the soil (CT) methods in fruit/vegetable/poultry stores and restaurants (R) localized in the cities of the Paulista northwest region. The twenty-five samples analyzed were collected in alternate days, being five samples from each place. The analyses were carried out with the target to check if the origin of food toxinfection involving dishes that have lettuce is from microorganisms of the local where the vegetables are cultivated. The results obtained enabled to analyze the occurrence of contamination crossed with other vegetables rinsed in the same cask. Besides, to compare the rate of contamination of the two kinds of cultivation. The microbiological analyses followed the traditional methodologies written by Silva; Junqueira e Silveira, (2001), according to the American Public Health Association. The results of the analyses showed a great variation on the count of the microorganisms. In the lettuce samples 92% (23) presented growing of total coliforms varying between 0, 4 to ≥ 240 NMP/g from which 40% (10) CT, 32% (8) CH, 20% (5) R; 32% (8) presented thermotolerant coliforms varying between 0,9 to 46 NMPg, being 24% (6) CT and 8% (2) R. 36% (9) presented coagulase-positive Staphylococcus, where 12% (3) presented growing over the parameters established 5x103 UFC/g, being 4% (1) CT and 8% (2) CH. All the positive samples for thermotolerant coliforms are inside the limits established by ANVISA (BRASIL, 2001) of 102 UFC/g. No sample was positive for Salmonella spp, attending the parameters established by ANVISA (BRASIL, 2001) of absence in 15g of the product. The results obtained from the analyses of the water were from 95% (19) presented total coliforms varying between... (Complete abstract click electronic access below) / Mestre

Made available in DSpace on 2014-06-11T19:27:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-04-28Bitstream added on 2014-06-13T18:31:22Z : No. of bitstreams: 1 paiva_jl_me_sjrp_parcial.pdf: 70455 bytes, checksum: 14560d3db04a25d7bf0ff4362ac391b4 (MD5) Bitstreams deleted on 2015-08-28T16:08:50Z: paiva_jl_me_sjrp_parcial.pdf,. Added 1 bitstream(s) on 2015-08-28T16:09:56Z : No. of bitstreams: 1 000642743.pdf: 1481069 bytes, checksum: 9eadf983610de6546b09d759783f8618 (MD5) / A coleta da alface (Lactuca sativa) e da água de manejo foi realizada no local de cultivo, tanto pelo método de hidroponia (CH) como pelo tradicional no solo (CT) em estabelecimentos hortifrutigranjeiros e restaurante (R) localizados em cidades da região noroeste paulista. As vinte e cinco amostras analisadas foram coletadas em dias alternados, sendo cinco amostras de cada local. As análises foram realizadas com objetivo de verificar se a origem das toxinfecções alimentares envolvendo pratos que contenham alface é proveniente de microrganismos do local de produção das hortaliças. Os resultados obtidos possibilitaram analisar a ocorrência de contaminação cruzada com outras hortaliças enxaguadas no mesmo tonel e comparar o índice de contaminação dos dois tipos de sistema de cultivo. As análises microbiológicas seguiram as metodologias tradicionais descritas por Silva; Junqueira e Silveira (2001), de acordo com a American Public Health Association. Os resultados das análises mostraram grande variação na contagem dos microrganismos. Nas amostras de alface 92% (23) apresentaram crescimento de coliformes totais variando entre 0,4 a ≥240 NMP/g dos quais 40% (10) CT, 32% (8) CH, 20% (5) R; 32% (8) apresentaram coliformes termotolerantes variando entre 0,9 a 46 NMP/g, sendo 24% (6) CT e 8% (2) R; 36% (9) apresentaram Staphylococcus coagulase positiva, onde 12% (3) apresentaram crescimento acima dos parâmetros estabelecidos 5x103 UFC/g, sendo 4% (1) CT e 8% (2) CH. Todas as amostras positivas para coliformes termotolerantes estão dentro dos limites estabelecidos pela ANVISA (BRASL, 2001) de 102 UFC/g. Nenhuma amostra foi positiva para Salmonella spp, atendendo os parâmetros estabelecidos pela ANVISA (BRASIL, 2001) de ausência em 25g do produto. Os resultados obtidos nas análises da água foram de 95% (19) apresentando coliformes totais variando... / The collect of lettuce (Lactuca sativa) and the water used to grow it was made in the local of its cultivation through both hydroponics (CH) and the traditional in the soil (CT) methods in fruit/vegetable/poultry stores and restaurants (R) localized in the cities of the Paulista northwest region. The twenty-five samples analyzed were collected in alternate days, being five samples from each place. The analyses were carried out with the target to check if the origin of food toxinfection involving dishes that have lettuce is from microorganisms of the local where the vegetables are cultivated. The results obtained enabled to analyze the occurrence of contamination crossed with other vegetables rinsed in the same cask. Besides, to compare the rate of contamination of the two kinds of cultivation. The microbiological analyses followed the traditional methodologies written by Silva; Junqueira e Silveira, (2001), according to the American Public Health Association. The results of the analyses showed a great variation on the count of the microorganisms. In the lettuce samples 92% (23) presented growing of total coliforms varying between 0, 4 to ≥ 240 NMP/g from which 40% (10) CT, 32% (8) CH, 20% (5) R; 32% (8) presented thermotolerant coliforms varying between 0,9 to 46 NMPg, being 24% (6) CT and 8% (2) R. 36% (9) presented coagulase-positive Staphylococcus, where 12% (3) presented growing over the parameters established 5x103 UFC/g, being 4% (1) CT and 8% (2) CH. All the positive samples for thermotolerant coliforms are inside the limits established by ANVISA (BRASIL, 2001) of 102 UFC/g. No sample was positive for Salmonella spp, attending the parameters established by ANVISA (BRASIL, 2001) of absence in 15g of the product. The results obtained from the analyses of the water were from 95% (19) presented total coliforms varying between... (Complete abstract click electronic access below)