Healthcare Infection Society

Knowledge of local antibiotic susceptibility rates is essential to strengthen antimicrobial stewardship programs. DASH to Protect Antibiotics (https://dashuti.com/), promotes the dissemination of focused local antibiograms in community urinary tract infection (UTI). This study mapped the susceptibility profile of Klebsiella pneumoniae from 18 Indian centers. The centers spanned nine Indian States and three Union Territories. Urinary K. pneumoniae antibiograms from the outpatient clinic were collated and analyzed. Standardization was achieved through online training. For epidemiological purposes, five centers tested fosfomycin. Overall, low susceptibility (<60%) was observed for the standard oral antibiotics prescribed for cystitis: co-trimoxazole, 54% (36-68%); ciprofloxacin, 52% (29-55%); amoxicillin-clavulanic acid, 46%, (35-82%); nitrofurantoin, 39% (19-78%); and cefuroxime, 30% (15-62%). The rates for third- and fourth-generation cephalosporins were 49% (45-52%) and 60% (36-76%), respectively. Extended-spectrum beta-lactamases ranged from 36-61% in India. Piperacillin-tazobactam 74% (65-87%), amikacin 76% (45-91%), and meropenem 81% (61-87%) exhibited higher activity. Fosfomycin was the most active antimicrobial, with 89% (92-97%) susceptibility. K. pneumoniae susceptibility was directly linked to geographic region, log gross domestic product (P <0.001), and humidity, and low and high temperatures (P <0.05). Oral treatment options for K. pneumoniae cystitis are rapidly decreasing. Northern and southern India showed significant differences in antimicrobial susceptibility, highlighting the importance of local antibiograms for promoting antimicrobial stewardship. For uncomplicated cystitis, co-trimoxazole (54%) may be the empirical choice. Good susceptibility to fosfomycin was observed (89%). The empirical use of fluoroquinolones, cephalosporins, and amoxicillin-clavulanic acid has been discouraged. Piperacillin-tazobactam and aminoglycosides are carbapenem-sparing agents.

ABSTRACTBackgroundHypovitaminosis-D has been linked to neuropsychiatric conditions, but little is known about vitamin D status in individuals with chronic tic disorders (CTD). This study sought to determine whether vitamin D levels are associated with the severity of tics and presence and severity of comorbid obsessive-compulsive disorder (OCD) and/ or attention-deficit/hyperactivity disorder (ADHD).MethodsThis is a cross-sectional sub-study of the European Multicentre Tics in Children Studies (EMTICS). Vitamin D [25(OH)D] levels (ng/ml) were obtained for 327 participants with CTD at study entry and tic severity was measured using the Yale Global Tic Severity Scale (YGTSS). An association between tic severity and presence and severity of comorbid OCD and/or ADHD symptoms was analysed using multilevel models controlling for season, site, sex, age and presence of comorbid OCD and/or ADHD.ResultsThe participants comprised 247 boys and 80 girls (4-16 years, mean [SD], 10.9 [2.72]). Hypovitaminosis-D ([25(OH)D] &lt; 20ng/ml) was present in 33% of participants with CTD and/ or comorbid OCD and/ or ADHD. The authors found no association between 25(OH)D levels and tic severity or OCD symptom severity. However, lower 25(OH)D levels were significantly associated with increased severity of ADHD symptoms in participants with CTD (β = -0.25, s.e. = 0.08, 95% CI, -0.42 to -0.09; p &lt; 0.01).ConclusionAdditional research is needed to confirm these findings and assess whether hypovitaminosis-D may represent an underlying biological vulnerability for comorbid ADHD symptoms in CTD as it may signpost novel strategies for prevention and treatment.

Interest in the therapeutic potential of faecal microbiota transplant (FMT) has been increasing globally in recent years, particularly as a result of randomised studies in which it has been used as an intervention. The main focus of these studies has been the treatment of recurrent or refractory Clostridium difficile infection (CDI), but there is also an emerging evidence base regarding potential applications in non-CDI settings. The key clinical stakeholders for the provision and governance of FMT services in the UK have tended to be in two major specialty areas: gastroenterology and microbiology/infectious diseases. While the National Institute for Health and Care Excellence (NICE) guidance (2014) for use of FMT for recurrent or refractory CDI has become accepted in the UK, clear evidence-based UK guidelines for FMT have been lacking. This resulted in discussions between the British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS), and a joint BSG/HIS FMT working group was established. This guideline document is the culmination of that joint dialogue.