Infections account for a major cause of death throughout the developing world. This is mainly due to the emergence of newer infectious agents and more specifically due to the appearance of antimicrobial resistance. With time, the bacteria have become smarter and along with it, massive imprudent usage of antibiotics in clinical practice has resulted in resistance of bacteria to antimicrobial agents. The antimicrobial resistance is recognized as a major problem in the treatment of microbial infections. The biochemical resistance mechanisms used by bacteria include the following: antibiotic inactivation, target modification, altered permeability, and “bypass” of metabolic pathway. Determination of bacterial resistance to antibiotics of all classes (phenotypes) and mutations that are responsible for bacterial resistance to antibiotics (genetic analysis) are helpful. Better understanding of the mechanisms of antibiotic resistance will help clinicians regarding usage of antibiotics in different situations. This review discusses the mechanism of action and resistance development in commonly used antimicrobials.
Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients.The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance.The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria.An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.
INTRODUCTIONMenstrual irregularities affect 2-5% of childbearing women, a number that is considerably higher among females under constant stress during a cycle [1]. A woman's menstrual cycle typically follows a 28-day cycle and ends with the shedding of uterine lining leading to bleeding. The normal menstrual cycle indicates the proper functioning of hormones, having a normal menstrual cycle signifies a healthy hypothalamo-pitutary axis with a normal uterus. However, a number of conditions such sudden weight loss, over-exercising, medical conditions and even stress can interfere with a woman's ability to experience a normal menstrual cycle. Both longer duration of menstrual bleeding and cycle irregularity are associated with major depression.Although there appears to be a relationship between the type and severity of the stress and the proportion of women who develop menstrual problems, in practice it is difficult if not impossible to identify a threshold at which stress will interfere with the normal cycle. The individual response to abnormality in body function is heightened due to psychobiological characteristics [2][3]. This study was planned to establish a correlation between the levels of perceived stress and its effect on the menstrual cycle. MATERIALS AND METHODSThis cross-sectional study was conducted in the undergraduate girl's hostel of a medical college. Hundred female students aged above 18 years were the target population of the study. The students with current medical, psychiatric or gynaecological problems like pregnancy and amenorrhea were excluded from the study.The participants were given liberal verbal explanations plus description letters about the topic and the aim of the study with attached consent forms. After the students had duly signed the consent form, a questionnaire along with the PSS (available freely online) [4] and PBAC (prior permission taken) [5] was provided to them.The questionnaire dealt with anthropometric data, lifestyle, menstrual history, and menstrual health status. Body Mass Index (BMI) was calculated using self-reported data on height and weight. The students were then asked to record their menstrual pattern on the PBAC for the next menstrual cycle and fill the PSS for the month. Based on the answers, PSS was calculated for each participant.The PSS is the most widely used psychological instrument for measuring the perception of stress [4]. It is a measure of the degree to which situations in one's life are appraised as stressful. Items were designed to tap how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale also includes a number of direct queries about current levels of experienced stress. The questions in the PSS ask about feelings and thoughts during the last month. In each case, respondents are asked how often they felt a certain way. 5, 7, & 8) and then summing across all scale items. The subjects who scored ≤20 on the PSS were categorized to have low stress levels, while subjects with score >20 were categorized to have hig...
BackgroundAntimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world.MethodsA cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery.ResultsThe response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4–6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%).ConclusionThe survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-017-0145-2) contains supplementary material, which is available to authorized users.
This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages.
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