IntroductionApproximately 5-10% of the general population report an antibiotic allergy. It has been reported that labeling of medical records with antibiotic hypersensitivity are often incorrect. As a result, antibiotic treatment choice will be increasingly difficult resulting in prolonged hospital visit, increased use of broad-spectrum antibiotics, increased frequency of side effects and the development of antibiotic resistance.AimThe primary aim was to investigate to what extent medical records were labelled with antibiotic allergy and whether these labels were adequately documented. The secondary aim was to investigate the difference in the impact of the label on the doctors’ choice of antibiotics depending on whether the doctor worked at a clinic of infectious diseases or not.MethodsA retrospective cohort study based on medical records labeled with antibiotic allergy in patients admitted to the Clinic of Infectious Diseases and the Emergency Ward at the Clinic of Medicine between 1st of January to 30th of June 2018.ResultsOf the total 1720 patients there were 132 (7,7%) patients marked with antibiotic allergy. Of these, only 21 patients (15.8%) were correctly labelled. There was no significant difference in the impact of the label on the choice of prescription between the two wards.ConclusionA substantial number of medical journals have a label for antibiotic allergy and the quality of the label is often poor with only 21 (15.8%) correct documented labels. We argue the need of education on antibiotic allergy and how to label and medical records.

Indiana University-Purdue University Indianapolis (IUPUI) Endodontic Regeneration Graduate Endodontic Department / Introduction: Regenerative endodontic procedures are used to treat immature teeth with pulpal necrosis in order to control infection, enable continued root development and enhance formation of a pulp like tissue in the canal. Canal disinfection is an integral part the regenerative endodontic process. Double antibiotic paste (DAP; i.e., equal parts of ciprofloxacin and metronidazole) has been successfully used for canal disinfection in regenerative endodontics. A comparison of the residual antibacterial effect of dentin treated with various dilutions of DAP pastes on biofilm formation has not yet been investigated thoroughly. Objectives: The aims of this in-vitro study were to investigate how concentration and time of treatment affect the residual antibacterial properties of DAP in preventing E. faecalis biofilm formation on human dentin. Materials and Methods: Extracted human teeth were used to obtain 4x4mm radicular dentin specimens. Each specimen was pretreated for 1 or 4 weeks with the 77 clinically used concentration of DAP (500 mg/mL), low concentrations of DAP (1, 5 or 50 mg/mL) loaded into a methylcellulose system, calcium hydroxide (Ca(OH)2), or placebo paste. After treatment, samples were rinsed and placed in sterile phosphate buffered saline (PBS) for three weeks. Samples were then inoculated with cultured E. faecalis and incubated in anaerobic conditions for three weeks to allow mature biofilm formation. The dentin samples were rinsed and biofilms detached. The detached biofilm cells were then diluted and spirally plated for enumeration on blood agar plates. The plates were then incubated for 24 h and the number of CFUs/mL was determined using an automated colony counter. Data was analyzed using Fisher’s Exact and Wilcoxon rank sum tests were used for statistical comparisons (α=0.05). Results: Dentin pretreatment for 4 weeks with 5, 50 or 500 mg/mL of DAP demonstrated significantly higher residual antibacterial effects and complete eradication of E. faecalis biofilms in comparison to a 1 week pretreatment with similar concentrations. However, dentin pretreated with 1 mg/mL of DAP or Ca(OH)2 did not provide a substantial residual antibacterial effect regardless of the application time. Conclusion: Dentin treated with 500, 50, or 5 mg/mL of DAP for 4 weeks was able to completely prevent the colonization of bacterial biofilm. Four-week treatment of dentin with DAP offers superior residual antibacterial effect in comparison to a one-week treatment. Intracanal application of DAP for 4 weeks during endodontic regeneration may offer an extended residual antibacterial effect.

Indiana University School of Dentistry Department of Endodontics / Introduction: Triple antibiotic paste (TAP, 1000 mg/ml) is composed of equal portions of ciprofloxacin, metronidazole and minocycline and is used as an intracanal dressing to disinfect the infected immature root canal during endodontic regeneration procedures. Lower concentrations of TAP have been recommended to minimize detrimental effects on pulp stem cells. TAP can be retained within the dentin matrix and its continual release confers an antibacterial effect to the dentin. Objective: The aim of this in vitro study was to investigate the residual antibacterial effect of dentin treated with various concentrations of TAP loaded into a gel system. Materials and Methods: Radicular dentin slabs were prepared from human teeth after obtaining IRB approval. The slabs were sterilized and treated with methylcellulose-based TAP of 100 mg/mL, 10 mg/mL, 1 mg/mL, 1.5% NaOCl, placebo paste with no TAP, or a positive control group with pure 1000 mg/mL TAP. Samples in each group were treated with the assigned TAP concentration for three weeks or immersed in 1.5% NaOCl for five minutes (n =18 per group). All samples were then irrigated with sterile water followed by 17% EDTA and incubated in phosphate buffered saline for either 2 or 4 weeks. Samples were then inoculated with Enterococcus faecalis and incubated for an additional 3 weeks. Biofilm formed on each sample was then dislodged and spiral plated to evaluate the bacterial colony-forming units. Data were analyzed using Fisher’s Exact tests and Wilcoxon rank sum tests (α = 0.05). Results: Dentin treated with 10, 100, or 1000 mg/mL of TAP demonstrated significant residual antibacterial effects up to four weeks. However, only 100 mg/mL TAP was able to completely prevent bacterial colonization after four weeks. No considerable residual antibacterial effect was observed in dentin treated with placebo gel, 1 mg/ml TAP or 1.5% NaOCl. Conclusion: At least 10 mg/mL of TAP loaded into a methylcellulose system is required to achieve a substantial residual antibacterial effect for four weeks.

This study is a part of a project at Q-linea that aims to present a rapid diagnostic instrument to speed up the process of identification of pathogens and determination of MIC-values (Minimal Inhibitory Concentration) of antibiotic needed to treat patients with sepsis. Specifically, this report is aimed to describe the development and implementation of algorithms that examine susceptibility profiles ofsepsis related pathogens where the bacteria have been exposed to different antibiotics and by different lapse of concentrations. The developed algorithms are based on a clustering technique that identify inhibited growth and present the lowest concentration needed to slow down the growth of the pathogen. The implemented solution was tested on sepsis related pathogens and the determined MIC values were compared to MIC values generated with a method commonly used in healthcare today. Approximately 90% of instances were correctly classified based on data from six hours long tests which is significantly faster than the reference method which takes 16-24 hours to complete. Furthermore, each result comes with a set of quality measures for validation of the algorithm results. Although, further studies are necessary to increase the performance at the four-hour target time, and more data is needed to validate the developed quality measures.

Antimicrobial susceptibility profiles were assembled for isolates of Moraxella catarrhalis collected from the Mountain Home Veteran's Affairs Medical Center (VAMC) clinical laboratory in Johnson City, Tennessee. The goal of the study was to identify isolates for genetic characterization using comparisons of susceptibility profiles. Isolates of Moraxella catarrhalis collected from July 1984 through 1994 were analyzed for β-lactamase production using a Cefinase disk assay. A multi-drug profile consisting of 11 β-lactam antibiotics was performed on the 41 M. catarrhalis isolates. Kirby Bauer disk assays were performed for 7 cephalosporin and 4 non-cephalosporin antibiotics. In summary, 2 observations implicate more complex resistance determinants than the 2 known forms of the BRO β-lactamase. First, there was overlap in the ranges of inhibition zones. Second, several isolates had antibiotic-specific deviations from typical profiles. These data suggest either more variation in the M. catarrhalis BRO β-lactamase than described or contributions to resistance from undescribed determinants.

No description available.

The overuse and misuse of antibiotics to treat bacterial infections, the release of unmetabolized residuals into the sewer system, and the incomplete removal antibiotic residues by wastewater treatment plants (WWTPs) pose a severe threat to human health. The accumulation of antibiotic residue induces selective pressure on the bacterial population, resulting in the spread of antibiotic-resistant bacteria (ARB) and antibiotic-resistance genes (ARGs) in water. This study investigated the degradation of different types of ARGs in water matrices using a wide variety of treatment technologies. Real wastewater samples were collected from a WWTP in urban Philadelphia and the presence of single and multidrug-resistant bacteria and resistance genes were investigated using molecular-based techniques. Subsequently, an analytical method was developed and validated for the detection and quantification of the ARGs against a range of antibiotics, such as tetracycline (TCN), ciprofloxacin (CIP), and levofloxacin (LVX). Finally, to remove the ARGs from water matrices, different conventional and advanced oxidation processes were applied. At the very onset, conventional treatment processes such as chlorine treatment was used to inactivate the E.coli resistant strains. It was observed that chlorination can potentially deactivate the ARBs by applying a lower dose and contact time. However, the effectiveness of chlorine treatment in removing all types of ARGs from water matrices was limited. For instance, no significant degradation of extracellular ARGs (e-ARGs) was observed in DI water during chlorine treatment. Subsequently, a peracetic acid (PAA) based treatment process was used to degrade the genomic and plasmid-encoded ARGs from the water matrices. Similar to chlorine treatment, no significant changes were observed in the degradation of extracellular ARGs (e-ARGs) in DI and WW. Then, the degradation kinetics of ARGs across different types (gyrAR, tetAR, qnrSR) and forms (chromosomal, plasmids) were evaluated using the Ultraviolet (UV) disinfection process. Compared to chlorination and PAA, UV treatment showed better removal efficiencies for the degradation of different types of e-ARGs in DI water. The degradation profile of e-ARGs showed 1-4 log reductions at a UV fluence of 900 mj/cm2. The i-ARGs showed similar degradation rates as compared to e-ARGs in phosphate buffer saline (PBS) at the same UV dosage. On the other hand, the regrowth potential of ARBs at low UV dosage (60–180 mJ/cm2) showed the evidence of damage repairment after several hours of exposure to light (photoreactivation) and dark conditions, making it susceptible again to the resistance spread. To resolve this issue, process parameters were optimized, and no regrowth of the ARBs were found from the higher fluence from 300 to 600 mJ/ cm2. Later, UV/ H2O2 based AOP was applied to evaluate the degradation and deactivation of the same resistant genes. The addition of H2O2 during the UV treatment produces strongly reactive •OH radicals during the treatment and showed considerable improvements in e-ARGs degradation (1.2-5 logs) compared to UV treatment alone. However, this AOP showed minimal contribution to i-ARG degradation (1-2.4 logs), possibly due to the scavenging of •OH radicals by the cellular components in PBS. In contrast to PBS, the wastewater matrix moderately enhanced the gene degradation during the treatment. In terms of plasmid degradation, the conformational differences of the supercoiled structures showed 1.2-2.8 times slower degradation rates than chromosomal ARGs. In addition, the degradation kinetics of the free residual ARGs (f-ARGs) were assessed during the treatment to reduce the AMR dissemination risk from the treated sample. This study also examined the potential of ozone (O3) based oxidation process to degrade and deactivate the extracellular and intracellular ARGs, and MGE (plasmid, intl-1) from E.coli ARBs. The degradation kinetics of the ARGs across different sizes (118-454 bps) and types were evaluated in different water matrices (DI water, PBS, and WW), and showed a significantly higher removal for chromosomal, and plasmid encoded ARGs than other treatment technologies. For the e-ARGs in DI water, 3.8-5.2 logs removal was observed at ozone dosage of 2.0 × 10-2 M.s. i-ARGs in PBS and wastewater showed nearly similar degradation (3.8-5 logs) during O3, indicating the elimination of i-ARGs was not dependent on the cellular components and effluent organic matter. Moreover, an analysis of environmental DNA (eDNA) from wastewater was conducted to examine the degradation of DNA and ARGs for different storage periods and temperatures (-20°C, 0°C, 4°C, 22±0.87°C). Result indicated that water samples kept at -20°C and 0°C showed the best performance in preventing the DNA concentration and gene degradation over time. Additionally, the effectiveness of different preservatives (Longmire buffers: LB1 and LB2, benzalkonium chloride at 0.1%, 0.01%) were investigated in preserving the DNA integrity and the gene degradation at an ambient temperature. It was found that the Longmire buffer (LB1) exhibited lowest gene degradation during the three-week storage period. In summary, this research provided a comprehensive assessment on the degradation of e-ARGs, i-ARGs, and free ARGs from water using different treatment technologies (i.e., UV, UV/H2O2, O3, PAA, chlorine). Additionally, this study suggested valuable information on optimizing the process parameters of the selected methods and developed a comparative assessment of removing the ARGs from the water matrix (DI/PBS, WW). The estimation of Electrical Energy per Order (EEO, kWh/m3) during UV and ozone treatments provided a comparison of the energy consumption for ARGs degradation in the water. Overall, the findings of this study can be useful for evaluating different types and forms (chromosomal, plasmid) of ARG degradation from water matrices and can help to reduce the risk of AMR dissemination in the environment. / Civil Engineering

Objective: Currently, there does not exist a cohesive and predictive set of criteria that can be used to identify patients that are at risk of being non-adherent to antibiotic regimens. In this study, we sought to answer the question of whether patients’ knowledge of the scientific background of antibiotic resistance is related to their likelihood to adhere to antibiotic regimens. Additionally, we explored other facets of the profiles of adherent and non-adherent subjects. Methods: All responses were collected via questionnaire. Subjects were split into two groups (adherent and non-adherent) based upon four patient-behavior questions. These two groups of subjects were compared in a variety of ways to test for significant differences in categories such as science knowledge, age, and self-reported understanding of the problem of antibiotic resistance. Results: It was determined that the adherent group of subjects had significantly higher science scores (mean=5.46, n=384) than the non-adherent subjects (mean=4.99, n=460); t(842)= -2.73, p=0.0064. Subjects majoring in STEM were more likely to be adherent than biology or non-STEM majors. There were no differences in adherence or science scores across age groups. About 26% of subjects had not previously heard of the problem of antibiotic resistance. Discussion: Increasing patient education on the topic of antibiotic resistance could increase patient adherence, which could in turn lead to a reduction in the rate at which bacteria develop resistance. Initiatives to educate patients and health care professionals have the potential to increase understanding and improve rates of adherence.

No description available.

Antibiotika är ett viktigt läkemedel vid behandling av orala infektioner orsakade av bakterier. Läkemedelsverkets riktlinjer ska fungera som stöd och vägledning för tandläkare angående ordination av antibiotika. I behandlande syfte rekommenderas antibiotika till patienter med påverkat allmäntillstånd och/eller tecken på infektionsspridning. Vid dessa tillfällen ordineras främst fenoximetylpenicillin (PcV). När det gäller antibiotikaprofylax ordineras det med syfte att minska risken för fjärrinfektioner. Förstahandsvalet vid profylax är amoxicillin. Syfte: Syftet med denna studie är att kartlägga tandläkarnas antibiotikaordination för vuxna patienter vid Tandvårdshögskolan i Malmö år 2015-2017 genom att undersöka och analysera på vilka indikationer en ordination gjorts och ifall den överensstämmer med aktuella rekommendationer från Läkemedelsverket.Material och metod: Studien utfördes genom att granska patientjournaler där antibiotika har ordinerats. Journaler togs fram genom en term-sökning i journalsystemet T4. Sökningen omfattade en treårsperiod (2015-2017). Data sammanställdes och analyserades i tabeller och diagram.Resultat: Resultatet visar att majoriteten av antibiotikan ordineras i profylaktiskt syfte och främst i samband med implantatinstallationer. I behandlande syfte ordineras antibiotika till största del till patienter med svullnad, med eller utan abscess, och smärta. Under perioden 2015-2017 är resultatet med behandlande antibiotika nästan oförändrat medan profylaktisk ordination ökat med 44,5 %. Slutsats: Till största del följer Tandvårdshögskolan i Malmö Läkemedelsverkets rekommendationer gällande antibiotikaordinationer men brister när det gäller lokal infektionsbehandling i samband med antibiotikaordination. I framtiden kan det behövas liknande studie vid Tandvårdshögskolan för att undersöka om det skett någon förändring gällande antibiotikaanvändning och journalföring. / Guidelines from the Swedish Medical Products Agency serve as guidance for dental practitioners regarding prescription of antibiotics. For treatment purposes, antibiotics, mainly phenoxymethylpenicillin are recommended for patients with affected general conditions and/or signs of spreading infection. Regarding patients with a risk of remote infections, antibiotic profylaxis with amoxicillin is advised.Aim: The aim of this study is to investigate dental antibiotic prescriptions to adult patients at the Faculty of Odontology in Malmö between 2015-2017 by examining the indications behind an ordination and if it is in accordance with current guidelines.Methods: The study was performed by examining patient records where antibiotics have been prescribed by dentists. Charts between the years were obtained through a term search in the dental practice software T4, with resulting data compiled into tables and charts.Results: Results show that the majority of antibiotics prescribed, is for prophylactic purposes and mainly for implant installations. For treatment purposes, antibiotics are largely prescribed to patients with symptoms of swelling, either with or without abscess, and pain. Prescription of antibiotics with treatment purposes are consistent between 2015-2017, while prophylactic prescription has increased with 44.5 % between the years. Conclusion: The Faculty of Odontology in Malmö are most of the time following the guidelines regarding antibiotic prescriptions although inconsistent regarding local operative infection treatment in association with prescription. In the future, a similar study may be needed at Faculty of Odontology in Malmö to investigate whether difference occurs in prescription of antibiotics and in the quality of patient record documentations.