Lunginflammation drabbar ungefär 1 % av Sveriges befolkning varje år. Med lunginflammation menas att lungvävnaden är inflammerad och en infektion är orsaken. Detta arbete fokuserar på Samhällsförvärvad Lunginflammation (CAP) orsakad av den grampositiva bakterien Streptococcus pneumoniae som är den vanligaste orsaken till CAP. Resistensutveckling hos bakterier gör det svårare att välja antibiotika för behandling och även att framställa effektiva nya antibiotika. Vid behandling av CAP rekommenderas i Sverige penicillin V i första hand och när infektionen är orsakad av bakterier med nedsatt känslighet rekommenderas i stället amoxicillin. Syftet med detta arbete var att undersöka vilken behandling som är mest effektiv mot resistenta stammar av S.pneumoniae. Metoden som användes var en litteraturstudie som omfattade 8 studier, om CAP och dess behandling, vilka hämtades från databasen PubMed. Totalt utrotade moxifloxacin, telitromycin, amoxicillin/klavulansyra (2000/125 mg), och ceftriaxone, 100 %, 100 %, 97,8 % och 66,7 % respektive av de isolat med penicillinresistenta S.pneumoniae som behandlades. Av de makrolidresistenta S.pneumoniae isolaten utrotades 96,2 % av de som behandlades med moxifloxacin och 95,5 % av de som behandlades med telitromycin. Alla antibiotika i arbetet har gett en god effekt mot resistenta stammar av S.pneumoniae vid CAP. De behandlingar som utmärkt sig mest är moxifloxacin och telitromycin men även den förbättrade formuleringen av amoxicillin/klavulansyra (2000/125 mg) har visat sig vara effektiv. Dock behövs fler studier som enbart inriktar sig på CAP där orsaken är resistenta stammar av S.pneumoniae och hur man på bästa sätt skall behandla dessa infektioner.

Introduktion När barn och vuxna blir sjuka och behöver antibiotikabehandling finns det ett antal beredningsformer att välja mellan. Antibiotika kan ges i tablettform, flytande och injektioner. Det finns dock ingen suppositorieberedning för systemiskt bruk, som kan användas om barn skulle ha svårt att svälja tabletter eller inte vill få i sig medicinen flytande av olika skäl. Det finns ett antibiotikum som funnits i suppositorieform och det är ampicillin (läkemedelsnamn Doktacillin). Det är ett penicillin med utvidgat spektrum och används vid bland annat akut öroninflammation. Rektum är den sista delen av vår magtarmkanal och kan via den mellersta och nedre venen undgå första passagemetabolismen i levern. Men om suppositorien skulle lösas upp i den övre delen av rektum så tas läkemedlet med stor sannolikhet upp av den övre venen och genomgår då första passagemetabolismen i levern innan läkemedlet når systemkretsloppet. Syfte Syftet är att undersöka varför det inte finns antibiotika i suppositorier tillgängligt på läkemedelsmarknaden, när småbarns föräldrar efterfrågar det. Syftet med litteraturstudien är också att undersöka om rektal administrering av antibiotika kan ge ökad följsamhet hos barn vid till exempel öroninflammation. Metod Litteraturstudien består av sju originalartiklar och studier publicerade mellan 1988-2012 har inkluderats. Ingen begränsning är gjord till enbart människostudier, utan denna litteraturstudie innehåller in vivo studier på djur och människa, in vitro studier på tarmepitel och caco-2 studie. Sökningar efter artiklar har gjorts via PubMed och till introduktionen har både böcker och Fass använts. Resultat I studierna med ampicillin-suppositorier sågs en ökning av biotillgängligheten när absorptionsförbättraren natriumkaprat tillsattes och suppositorien hade en fettlösligbas. I studierna med azithromycin i suppositorieform sågs det att en vattenlösligbas var att föredra, då en fettlöslig bas smälter fortare i tropiskt klimat, vilket studien undersökte. I in vitro studien med amoxicillin och flera olika fettlösligabaser kom man fram till att Novata baser hade de bästa frisättningsegenskaperna. Caco-2 studien visar att natriumkaprat ökar biotillgängligheten hos läkemedel med en molekylvikt upptill 1200 G/mol. Diskussion Varför Doktacillin-suppositorier drogs tillbaka har jag inte fått svar på. Det kan ha varit tillverknings problem eller att biotillgängligheten varit otillräcklig. Utifrån studierna så har jag kommit framtill att antibiotika i suppositorieform kan vara ett alternativ om terapisvikt med oral administrering uppstår. Dock behövs fler studier på barn för att få fram optimala suppositorier. Slutsats Suppositorier kan användas som alternativ till flytande och oral administrering av antibiotika, men vidare studier på vilka antibiotika som är bäst lämpade krävs på människa.

8 Abstract Analysis of antibiotic administration in prophylaxis I Author: Petr Domecký Tutor: PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Lucie Hauschke, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Antibiotic prophylaxis (AP) plays an important role in reduction of surgical site infection (SSI). It is the administration of an eligible antibiotic or chemotherapeutic (ATB) in a single dose, usually 30 minutes before surgery, followed by two to three doses during or after the surgery, regarding the selected ATB and the surgical procedure. The aim of this work was to analyse the AP in surgical procedures at the Masaryk Hospital in Ústí nad Labem (MNUL) in the context of the MNUL guideline (DP) and the research on available AP work. Methods: A cross-sectional observational study ran from January 2018 to March 2018 in surgical departments at MNUL. The study included patients aged ≥ 18 years who underwent surgery in a defined period (5 February 2018 to 9 February 2018) and gave their consent to the study. The practicability of the study was verified by a pilot part. Initially, a research of published studies concerning AP was carried out which provided outputs for AP establishment (PPA). Subsequently, a form for...

Analysis of antibiotic administration in prophylaxis II Author: Martina Bobčíková Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Anna Patková, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: The term antibacterial prophylaxis (AP) refers to antibiotic (ATB) administration in prevention of surgical site infection (SSI). There are many factors in population which can potentially raise the risk of the incidence of SSI. The maintenance of basic rules of the AP and knowledge, influence and timely elimination of risk factors of SSI are the most important measures which can reduce a number of postoperative SSI. The aim of this study was to analyze antibiotic administration in prophylaxis in the local hospital in the Czech Republic and compare the results to well known international guidelines (ASHP-G) and latest scientific knowledge (LSK). Methods: The cross-sectional study was conducted in October 2019. During the period from 2nd to 23rd October, the data of surgeries and used AP were collected. The patients who passed the entry criteria have been included in this study. Into prepared form, patient's identification, agreement, diagnosis, surgery type, operation date, the beginning and the end of surgery,...

Analysis of antibiotic prophylaxis in patients with osteosynthesis of the proximal femur Author: Anna Baťková Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: Mgr. Markéta Dlouhá Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: This work is part of the continuous monitoring of antibiotic prophylaxis (AP) at the Department of Traumatology, University Hospital. The aim was to analyze and compare key parameters of AP in osteosynthesis of pertrochanteric fractures with the previous investigation and the methodological guidelines of the University Hospital. Methods: This retrospective cross-sectional study took place from 1st April 2019 to 31st March 2020 at the Department of Traumatology at the University Hospital. AP was analyzed in 50 patients above 18 years of age and who underwent a pertrochanteric fracture of the proximal femur. Data was collected with a form, prepared in cooperation with the Department of Medical Microbiology, physicians and clinical pharmacists of the University Hospital. Information on the patient, surgery, indication of AP, selected antibiotic/chemotherapeutic (ATB) and its dose, time, route of administration, as well as the size, number and interval of administered postoperative doses and...

Analysis of infection therapy in paediatric department I Author: Tomáš Trávníček Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: MUDr. Magdalena Rohanová, Mgr. Petr Domecký Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Infections in newborns are one of the most frequent causes of death. The aim of this work was the retrospective analysis of bacterial infection in newborns with a birth weight ≤ 1500 g hospitalized in Paediatric Intensive Care Unit (ICU) and compare it with the latest findings published in the expect literature. Methods: The retrospective cross-sectional study took place in Paediatric ICU. The data were gathered between 07/29 and 08/10 2020. The study included patients in neonatal age with a birth weight ≤ 1500 g hospitalized in the Paediatric ICU in 2018 and 2019 with bacterial infection. The infection was proved by a positive cultivation, increased C-reactive protein and increased or reduced number of white blood cells. Information on the patient, infectious agent, laboratory tests, occurrence of risk factors for sepsis, selection of antibiotics, its susceptibility, dose, dosing interval and duration of administration, as well as the result of therapy were collected to a prepared form. The data were...

The presence of infections caused by Staphylococcus aureus (S. aureus) and its resistant form - methicillin-resistant S. aureus (MRSA) - are more frequent and treatment with increasing resistance becomes increasingly complicated. Early identification of microbiome in the infectious wounds leads to implementation of the correct treatment and thereby saving the patient from the formation of abscesses, amputation of limbs or even death. Presented thesis entitled Progressive tools for the identification of Staphylococcus aureus is focused on the study of the occurrence of these bacteria in clinical samples, design and construction of new detection methods based on magnetic separation and evaluation of the effects of antibiotics and metal nanoparticles on growth and biofilm formation, gene expression and protein composition in S. aureus and MRSA. The most abundant microorganism in microbiome of infections is S. aureus and in our studies was used as model bacteria for the design of fast, accurate and sensitive detection techniques utilizing indirect detection such as: i) detection of product of biochemical reaction between bacterial enzymes and matrix, ii) detection of the amplified gene using gold nanoparticles as an indicator probe, iii) determination of the detection oligonucleotides after sandwich capture of bacteria between micro and nanoparticles, and iv) a multiplex detection of quantum dots using sandwich capture of specific gene from selected bacteria. Subsequently, an influence effect of beta-lactam antibiotics and their complexes with selenium nanoparticles to non-resistant and resistant form of S. aureus was investigated. The significant inhibition of bacterial growth and biofilm formation as well as changes in gene expression and protein composition were achieved in MRSA by using the complexes of antibiotics and selenium nanoparticles.

Bakgrund: Antibiotikabehandling kan medföra gastrointestinala besvär hos patienter. En vanlig orsak till detta är bakterien Clostridium difficile som normalt kan återfinnas i tarmfloran. Vid antibiotikabehandling kan flera av tarmflorans goda bakterier slås ut vilket kan resultera i att C. difficile växer till sig och genom toxiner ge gastrointestinala besvär. Detta kan orsaka patienter onödigt lidande och kostar hälso- och sjukvården mycket pengar årligen. Probiotika består av levande mikroorganismer och det finns teorier om att dessa kan ha en positiv inverkan på tarmfloran genom stabilisering av den samt förhindrar överväxt av C. difficile i floran.   Syfte: Syftet var att undersöka om behandling med probiotika kan förebygga C. difficile infektion och/eller lindra gastrointestinala besvär orsakade av C. difficile i samband med antibiotikabehandling.  Metod: Beskrivande litteraturöversikt. Litteratursökning gjordes i CINAHL och PubMed. Elva randomiserade kontrollerade studier utgjorde resultatet i litteraturöversikten efter att ha genomgått en kvalitetsgranskning. Resultat: En statistisk signifikant skillnad gällande förebyggande av C. difficile fanns i tre av de elva inkluderade studierna. Probiotika som symtomlindring mot C. difficile visade på en signifikant skillnad avseende diarré och lösa avföringar i fyra studier med signifikant fler fall i kontroll- än interventionsgrupperna. Andra symtom som undersöktes i sammanlagt sju studier var utspänd buk, buksmärta, illamående, kräkning och flatulens. Slutsats: Litteraturöversikten påvisade att probiotika i vissa fall kan ha effekt mot infektion orsakad av C. difficile i samband med antibiotikabehandling. Effekten visar sig i form av lindrande effekt på vissa gastrointestinala besvär. Litteraturöversikten kunde dock inte påvisa tillräcklig evidens på grund av varierande resultat i de inkluderade artiklarna. Det gör att probiotika i nuläget inte är aktuellt för implementering inom sjukvården i samband med antibiotikabehandling för att förebygga eller lindra infektion av C. difficile. / Background: Patients treated with antibiotics can experience gastrointestinal side effects. A common cause of the side effects is the bacterium Clostridium difficile. C. difficile can normally be found in the intestinal human flora. Antibiotic treatment can cause imbalance in the intestinal flora because antibiotics sometimes eliminate several of the good bacteria in the gastrointestinal microbiome. This can cause an overgrowth of C. difficile and through its toxins cause gastrointestinal side effects for the individual. The side effects of antibiotics and C. difficile can cause individual suffering and cost healthcare a lot of money annually. Probiotics contain living microorganisms and there are theories that these microorganisms can have a positive effect on the intestinal human flora by stabilizing the gastrointestinal microbiome and preventing overgrowth of C. difficile in the human flora.   Aim: The aim was to investigate if treatment with probiotics could prevent C. difficile infection and/or relieve the occurrence of gastrointestinal side effects caused by C. difficile in patients treated with antibiotics.    Method: A descriptive literature review. Data collection was made in CINAHL and PubMed. Eleven randomized controlled trials were included in this literature review after a quality review.   Results: A statistically significant difference in the prevention of C. difficile was found in three of the included articles. Probiotics used for relief of symptoms caused by C. difficile showed a significant difference in four studies that examined loose stools and diarrhea with more cases in the control group than the intervention group. Other symptoms examined in a total of seven articles were distended abdomen, abdominal pain, nausea, vomiting and flatulence.  Conclusion: This literature review proved that probiotics in some cases may have an effect on infections caused by C. difficile during treatment with antibiotics. The literature review could not prove sufficient evidence due to varying results in the included studies. That makes probiotics at the present time not relevant for implementation in healthcare services during treatment with antibiotics for prevention of C. difficile.

The Most Common Infections and Their Treatments in Oncology Patients at Uppsala University Hospital Year 2020-2022 - a Retrospective Registry Study  Background: There are two types of infections of interest to this study, these are healthcareassociated infections and community-acquired infections. It is common for oncology patients to suffer from various difficult-to-treat infections caused by bacteria, viruses, and fungi. Death due to infections is the second most common cause in oncology patients. Antibiotics are a drug class of the type of antibacterial drugs that are widely used today.   Aim: The purpose of this study is to describe the frequency of an antibiotic use with a focus on the substance selection and indications as well as the resistance patterns in oncology patients at Akademiska hospital between the years 2020 and 2022.   Methods: The study was designed as a descriptive registry study, where different data sources were used as a method. Methods used to analyze the data were quantitative methods, providing a quantifiable answer to the sub-questions using numbers and structured data.    Results: The study indicated that the most common infections in oncology patients during these years were other community-acquired infection, urinary tract infection without fever, other skin/soft tissue/skeletal infections, and pneumonia. The most common treatment differed depending on which database the information was taken from. According to the first database, the most common preparations were Piperacillin/Tazobactam, Ciprofloxacin and Pivmecillinam. According to the other database, the most common preparations were Sulfamethoxazole/Trimethoprim, Ciprofloxacin and Piperacillin/Tazobactam. Of oncology patients treated with cancer drugs, 53% needed antibiotic treatment in hospital and 93% either administered in hospital or prescribed at home.   Conclusions: Many oncology patients suffer from infections that require treatment. This entails a high risk of antibiotic resistance. More study is needed for this patient group to optimize treatment and reduce relapse.

8 Abstract Analysis of antibiotic administration in prophylaxis I Author: Petr Domecký Tutor: PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Lucie Hauschke, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Antibiotic prophylaxis (AP) plays an important role in reduction of surgical site infection (SSI). It is the administration of an eligible antibiotic or chemotherapeutic (ATB) in a single dose, usually 30 minutes before surgery, followed by two to three doses during or after the surgery, regarding the selected ATB and the surgical procedure. The aim of this work was to analyse the AP in surgical procedures at the Masaryk Hospital in Ústí nad Labem (MNUL) in the context of the MNUL guideline (DP) and the research on available AP work. Methods: A cross-sectional observational study ran from January 2018 to March 2018 in surgical departments at MNUL. The study included patients aged ≥ 18 years who underwent surgery in a defined period (5 February 2018 to 9 February 2018) and gave their consent to the study. The practicability of the study was verified by a pilot part. Initially, a research of published studies concerning AP was carried out which provided outputs for AP establishment (PPA). Subsequently, a form for...