3^rd World Congress and Exhibition on Antibiotics and Antibiotic Resistance July 30-31, 2017 Milan, Italy

Xiaoyuan Qu is a PhD candidate of Social Medicine and Health Management at Shandong University. His research field is antibiotic use and management

Introduction: Antibiotic drug consumption is a major driver of antibiotic resistance. China has built Center for Antibacterial Surveillance (CAS) to monitor antibiotic use of hospitals in 2005. CAS currently has 192 core member institutions; all of them are tertiary hospitals. Methods: Valid data of inpatient antibiotic consumption of 183 tertiary hospitals during the period 2011-2014 have been collected using ATC/DDD and expressed in Defined Daily Dose (DDDs). We used compound annual growth rates (CAGR) to analyze the consumption sum and DDDs. Results: The CAGR of DDDs and costs of antibiotic use in 183 tertiary hospitals is -6.02% and -5.58%. The most consumed drugs were cephalosporins (an average DDDs of 46.35% a year), which also costs accounted for the most (an average of 48.38% a year). The proportion of DDDs of carbapenems has been growing from 2011 (6.99%) to 2014 (6.92%), CAGR was 4.81%, which the most used drugs were meropenem and with the DDDs growing, the proportion of costs of carbapenems increased rapidly, CAGR was 9.67%. In method of antibiotic administrator, the injection method was the most used, which average proportion of DDDs for four years was 84.55%, and the average proportion of consumption amount was 94.95%. Conclusion: Implementing of a series of antibacterial stewardship policies, had an effect to control DDDs of antibiotic consumption, but costs control was weak. Increasing use of carbapenems shows that there is a risk of bacteria resistance in tertiary hospitals in China.

Fadya Hamadani has acquired her BSc in Pharmacy and MSc in Clinical Pharmacy from College of Pharmacy, Baghdad University (1992, 1998 respectively). She is Assistant Professor in Clinical Pharmacy and since that period, she has built a variety of experience in research, evaluation, teaching in higher education institutions and providing hospital training. Currently she is a full time PhD student at the School of Pharmacy and Pharmaceutical Sciences, Cardiff University. Her PhD project involves identification of issues around safe and effective administration and management of medicines in care homes. Her research interest includes the rational use of antibiotics in care homes.

Statement of the Problem: Residents of care homes are noted for the complexity of their care needs, multiple co-morbidities and the incidence of polypharmacy. This makes them particularly susceptible to medicines related harm. Antibiotic prescribing in care homes is particularly prevalent and their inappropriate administration risks the development of antimicrobial resistance. The aim of this present study was to identify the prevalence and types of prescribing and administration errors related to antibiotics in Care Homes Methodology & Theoretical Orientation: A retrospective study was conducted in 12 Care Homes in South Wales over an eight month period (Feb-Oct 2015). Anonymised real-time data was collected from an electronic medicines management system and the prevalence of antibiotic determined. The data was also analyzed for errors related to the prescribing and administration of antibiotics. The type and frequency of medication errors were recorded in excel and selected data was transferred into SPSS for further analysis. Findings: A total of 142 (43.16%) residents received at least one antibiotic over the study period. The most commonly prescribed antibiotic was trimethoprim (24.6%). Some 9499 administrations were analyzed against pre-defined medication error categories with 2247 medication errors identified, 79.6% of residents were exposed to at least one error. The most frequent administration error type was duration error (44.5%) where the antibiotic was administered either for a period shorter or longer than the prescribed duration, followed by dose omissions errors (38.9%). The most common prescribing error type was similarly duration errors (74.3%) Conclusion & Significance: This evaluation of the management of antibiotics in care homes in South Wales has revealed that the prevalence of antibiotic prescribing along with the incidence of administration and prescribing errors related to antibiotics is significant. This may result in antimicrobial resistance in a particularly vulnerable patient cohort

Álvarez-Martínez F J is a Molecular Biology PhD student at the Universidad Miguel Hernández of Elche. The main theme of his thesis is the identification of natural compounds with antimicrobial capacity to act as antibiotics or in conjunction with those already existing in the treatment of microbial diseases, especially those resistant to traditional drugs. To reach these objectives, computational approaches and in vitro studies using reference microbial strains are used in addition to clinical isolates collected at the General University Hospital of Alicante.

The PBP2a protein is encoded by the mecA gene and confers resistance to antibiotics such as methicillin, penicillin and derivatives thereof. The main bacterium carrying this gene is methicillin-resistant Staphylococcus aureus (MRSA). The main objective of the present work is the identification of natural compounds with inhibitory capacity of the microbial protein PBP2a. Firstly, several files with the three-dimensional structure of crystallized MRSA PBP2a proteins (obtained from RCSB Protein Data Bank) were collected. Secondly, 67,408 natural inhibitor-targeting structures were obtained by entering 14 electronic chem libraries and downloading the desired files. Once the molecules were obtained, they were subjected to a filtration to eliminate those molecules that did not fulfill the common characteristics of a conventional drug. Once ligands and receptors were obtained, a docking study was performed to determine the free binding energy between the natural molecules and the target proteins. A total of 2,820 compounds with suitable pharmacological properties and interaction free energies of -9.5Kcal/mol or less were obtained, indicating a strong binding affinity. Three molecules from this set were selected based on their commercial availability, absence of previous studies and possibility of handling in the laboratory to go to the phase of in vitro tests. In silico molecular sieving is a powerful tool for the selection of compounds with specific pharmacological properties. In the absence of in vitro and in vivo assays, in silico results predict a marked therapeutic potential of the natural compounds selected for the treatment of MRSA infections and other pathogens possessing the antibiotic resistance protein PBP2a. Soon we will perform bacterial inhibition experiments using the disc-plate method to test the three compounds selected against various strains of MRSA

Jung Gi-Mo has earned his MS degree from Department ofBiochemistry at Hoseo University, Korea.He is a staff scientist at Institute of iNtRON Biotechnology,working on biocontrol for anti-biotics resistance

Statement of the Problem: A wide variety of bacteria can cause severe infections. Many of these bacteria are or have become resistant to many commonly used antibiotics. Infections due to drug-resistant bacteria require treatment with new types of antibiotics. Phage endolysins differ from standard-of-care antibiotics with regard to their potency, speed, specificity, and activity against antibiotic-resistant strains. Therefore, phage endolysins represent a promising research target for the discovery and development of novel antibacterial therapeutic agents. Materials and Method: We developed phage endolysin SAL-1 using genetic information of staphylococcal bacteriophage SAP-1. For current and future clinical studies of SAL-1, we performed the development of its efficient production process and ELISA assay method, preformulation study and its characterization. Findings:We established an efficient soluble production process for SAL-1 and ELISA assay method to be used in pharmacokinetic study. In addition, various characteristic of SAL-1 including pI, antibacterial activity were identified. Furthermore, appropriate formulation providing acceptable storage- and handling-stability was developed. Conclusion: Essential prerequisite technologies for conducting clinical studies for SAL-1-containing drug candidate were developed. We anticipate that this presentation will provide incentives for developing phage endolysin-based antibacterial agents to combat other bacterial infections.

Klebsiella pneumoniae (K. pneumonia), Staphylococcus aureus, Candida albicans and Candida tropicalis are opportunistic microbes associated with certain diseases such as diabetes, deep wounds and immunodeficiency. Those microbes have evolved their resistance to antibiotics in recent years. The aim of this study is to prepare oil extracts from the dried roots of Indian Costus and sea-Qust and test that oil's effectiveness on some bacteria and yeast. The results have recorded significantly high antimicrobial activity against K. pneumonia and C.tropicalis during treatment with Indian Costus oil, the sea-Qust oil was also very effective on C.albicans and S.aureus. Because the cell wall (SEM) of C. albicans was rough and wrinkled. Therefore, the budding of yeast became less with a treatment of Indian Costus oil. Thus, this result demonstrates that oil extract of Costus-type plants is effective that their oil extract could be considered as a natural alternative to antibiotics.

Zainab Al-Hashimy has done her Msc in Pharmacotherapy and Medicine Management, is Senior Specialized Pharmacist in Plastic and Hand surgery wards. She developed her skills in Pharmacy management since 2006 in running the OPD Pharmacies in the Tertiary care Hospital Khoula Hospital in Oman. She is Member in Education and Training in Pharmacy department. She is interest in Bacterial Resistance and antimicrobial stewardship. She is doing research in the uses of antibiotic in surgical prophylaxis. She is applying the knowledge of Pharmacokinetic/ Pharmacodynamics in antibiotics to avoid emergency resistance of bacteria.

The aim of this study was to review the changes in distribution of bacterial populations and their antibiotic sensitivity over 12 years in a tertiary care burn unit. Understanding the periodic variation of isolated microorganisms and their antibiotic sensitivity helps in selecting the appropriate antimicrobial therapy before culture and sensitivity is reported. It also aids the design of antibiotics protocols. The study was retrospective. The data were obtained from the computerized hospital medical record system and the burn unit records. Overall, Pseudomonas aeruginosa was the most commonly isolated microorganism followed by Staphylococcus aureus, Meticillin-resistant Staphylococcus aureus (MRSA), and the genus Acinetobacter. Acinetobacter isolation rose rapidly and became more prevalent than P. aeruginosa over the last three years. Other organisms became isolated more frequently, such as Klebsiella pneumoniae, but their overall prevalence was low. Pseudomonas species frequency of isolation declined. P. aeruginosa, MRSA, and other microorganisms showed increasing sensitivity to a number of antibiotics. MRSA remained highly sensitive to vancomycin. Acinetobacter showed high resistance to all antibiotics tested except colistin. K. pneumoniae was highly resistant to most of the antibiotics tested except the carbapenems, but the resistance to carbapenems increased over time

Tikam Chand Dakal has his expertise in multi-drug resistance and its mechanism. His current interest is to study the effect of genetic mutations on structure and function of multi-drug transport proteins in bacteria, yeasts and fungus. His approach includes use of in-silico (computational) tools to perform structural modeling and docking studies on various antibiotic drugs and their target transporter proteins. He believes that nanotechnology based biomedicines have emerged as an alternative next generation antimicrobial therapy against multi-drug resistant strains of bacteria, yeasts and fungus. In particular, the use of silver nanoparticles (AgNPs) as a potent antibacterial agent has received much attention in past decades. He also believes that several aspects of AgNPs-based medicines including, microbial resistance to AgNPs; cytotoxic, genotoxic and inflammatory response of AgNPs to human cells etc., need to be evaluated for successful application of AgNPs in therapeutics and targeted drug delivery platforms.

Statement of the Problem: Multidrug resistance of the pathogenic microorganisms has become a major impediment toward successful diagnosis of infectious diseases. Recent advancements in nanotechnology-based medicines have opened new horizons for combating multidrug resistance. In particular, the use of silver nanoparticles (AgNPs) as a potent antibacterial agent has received much attention. AgNPs exhibits their antimicrobial activity through multifaceted mechanisms. Figure 1 depicts the most prominent modes of antimicrobial action of AgNPs. Herein, we have summarized our endeavors that address current challenges in relation to safe use of AgNPs in therapeutics and drug delivery platforms. Methodology & Theoretical Orientation: AgNPs were synthesized using plant extract as diagrammatically represented in Figure 2. Antimicrobial activity of AgNPs was assayed using agar disc-diffusion method. Findings: In our study, biosynthesized AgNPs showed remarkable antimicrobial activity against isolated MDR strains of S. aureus & P. aeruginosa as well as against fungal strains.

Tie Teck Kim has completed his Bpharm in 2007 from Curtin University of Technology in Western Australia. He has a postgraduate master degree in Infectious Diseases from the University of Western Australia in 2014. He is currently practicing as an antimicrobial stewardship pharmacist at Changi General Hospital.

Background: Ertapenem use has been associated with central nervous system (CNS) related adverse effects (AEs) which include delirium, hallucinations, altered mental status (AMS), stroke like symptoms and seizures. We described baseline characteristics and clinical features in 4 patients who developed CNS related AEs while receiving ertapenem during a period of six consecutive months in 2016. Methods: We retrospectively reviewed patients on ertapenem and identified the ones who developed CNS related AEs attributed to ertapenem use from April till October 2016. Results: Patient 1 (no renal impairment) was prescribed ertapenem for complicated intra-abdominal infection. He was noted to be drowsy on day 12 of ertapenem. Over the next 1-2 days he developed auditory hallucinations, jerky limb movements and fluctuating level of consciousness. He was switched to aztreonam. Patient 2 (no renal impairment) has developed confusion and hallucinations (visual, auditory and tactile) on day 25 of ertapenem which was being administered for tubo-ovarian abscess. Ertapenem was substituted to meropenem. Patient 3 (known end stage renal failure) developed seizure while on day 28 of ertapenem which was prescribed for bilateral renal abscess. No further episode of seizure was observed after ertapenem was switched to piperacillin/tazobactam. Patient 4 (known chronic kidney disease) was receiving ertapenem for complicated urinary tract infection. He was noted to be delirious on day 9 of ertapenem. Patient was switched to meropenem. In these patients, average age was 65 years. Male to female ratio was 1:1. None of the patients had previous history of seizure or CNS disorders. Two patients had normal renal functions. Toxic and metabolic causes were excluded. Computed tomography (CT) of brain was normal in all cases. Dose was renally adjusted in 2 patients. Ertapenem therapeutic drug monitoring (TDM) was not locally available. Symptom improvement was noted 3-4 days after ertapenem discontinuation in all patients. Conclusions: Patients who developed these AEs can deteriorate rather unexpectedly which leads to extensive investigations and increase in health care cost. The cost can be minimized if physicians are acquainted to consider ertapenem as an offender agent. However appropriate workup to eliminate alternate etiology also needs to be considered at the same time as dictated by the clinical scenario. Ertapenem TDM might give information on CNS AEs in future studies.