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The Economic Burden of Chronic Obstructive Pulmonary Disease and Comparative Effectiveness of Maintenance Inhaler Medications in the United States

Immunomodulatory nanoparticles as a multimodal approach to attenuate immune dysregulation in severe inflammation and sepsis, conversion of small-molecule inhibitors into heterobifunctional compounds in the discovery of novel chemotherapeutics, utilizing pharmacometrics to facilitate generic drug development of orally inhaled products and optimize pharmacotherapy of antifibrinolytics.

Development of Mass Spectrometric Methods for Analysis of Sphingolipids and Oligonucleotides

Integration of Quantitative and Qualitative Mass Spectrometric Workflows to Evaluate the Role of Plasmalogen Glycerophosphoethanolamine in Disease Progression

HDX-MS, Molecular Dynamics, and Modeling: An Integrative Approach to Model Solution Structural Ensembles

PTGFRN as a Target for Antibody-Drug Conjugate (ADC) Development in Mesothelioma and Medulloblastoma

Development of an In-Cell Footprinting Method Coupled with MS for the Study of Proteins in Three-Dimensional Cancer Models

The Effect of Medication Information Delivery Format on Cognitive Load and Knowledge Retention of Informal Caregivers

The Effects of Graded Versus Ungraded Individual Readiness Assurance Tests on Pharmacy Students’ Assessment Performance and Achievement Goals in a Team-Based Learning Classroom

Under-ascertainment and underreporting of adverse events in clinical trials

Determination of Harmful and Potentially Harmful Constituents in E-cigarettes, E-liquids, and Generated Aerosols

A Cost-Effectiveness Analysis Model Framework For Treatments Of Early-Stage Huntington’s Disease Patients In The United States

Evaluation of Evidence in Economic Models Used for Decision-Making: Development of the Data Inputs in Value Economic Evaluations (DIVEE) Checklist

Regulation of retinoid homeostasis by cellular retinol-binding protein, type 1

Method Optimization of a New Automated Platform for Proteome-Wide Structural Biology

Effect of Excipients on the Performance of Spray-dried Amorphous Solid Dispersion (ASD) in Tablets

The Regulatory Role of the Cytoplasmic Heme Binding Protein PhuS in Pseudomonas aeruginosa

Development of the Lennard-Jones Parameters for the Polarizable Classical Drude Oscillator Force Field

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An Evaluation of Antibiotic Resistance: Structure-Activity Relationship Studies of Tetracyclic Indolines as A Novel Class of Resistance-Modifying Agents for MRSA & Analysis of Recent FDA Regulations on Antibiotic Use in Livestock Public Deposited

While the rate at which resistance develops against antimicrobials rises, research and development for new antimicrobials declines. By placing selective pressure on bacteria we are inadvertently forcing bacteria into expressing and propagating genes conferring high levels of resistance. Continued misuse and overuse of antibiotics, in light of the evident problem developing, must be resolved. To find a resolve, a multidisciplinary and multifaceted approach must be taken which involves 1) research and development of novel antimicrobial agents and 2) governmental regulation.

Strides in new antimicrobial drug development largely revolve around making old antibiotics usable again. Resistance-Modifying Agents (RMAs) act to re-sensitize resistant bacteria to antibiotics through a variety of mechanisms, although currently most target bacterial resistance mechanisms themselves, such as β - lactamases. Foreseeably, while these compounds have shown efficacy and certainly are of value in the present crisis, it is a short-term solution in light of the evidently rapid and dynamic capability of bacteria to respond evolutionarily. Nonetheless, a new class of RMAs, currently being researched and developed at Wang lab, hope to extend RMA lifespan through a model of synthetic compound development that targets gene expression.

Both clinically and community-acquired resistance contribute to the demolishment of a critical building block (antibiotics) of modern medicine. Arguably the most nonsensical piece of the puzzle is subtherapeutic antibiotic use in livestock, which accounts for 80% of all antibiotic use in the United States 12 . FDA regulations are seemingly the only feasible way to fix the problem, and yet their efforts in recent regulatory measures not only contain major loopholes, but seem altogether to be largely barren of any significant resolutions.

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UKnowledge > College of Pharmacy > Theses & Dissertations

Theses and Dissertations--Pharmacy

Theses/dissertations from 2024 2024.

Design of Kappa Opioid Receptor Agonists for Potential Treatment of Multiple Sclerosis , Lindsay Kornberger

Theses/Dissertations from 2023 2023

Self-Assembled Ternary Polypeptide Nanoparticles With Improved Biostability For Drug Delivery In Cancer Therapy , Preye Mike Agbana

Investigation of Folate-Poly(Glutamic Acid)/Polyethylenimine/DNA Complexes for in vitro Gene Delivery , Caleb Akers

POPULATION-BASED EVALUATION OF TREATMENT PATTERNS, DRUG-DRUG INTERACTIONS, AND CARDIOVASCULAR RISK IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER , Yue Cheng

An Epidemiological and Pharmacokinetic-pharmacodynamic Investigation into the Impact of Carbapenem-resistant Enterobacterales , Justin Clark

STRIVING FOR APPROPRIATE ANTIBIOTIC USE: A BIOMARKER INITIATIVE, AND OUTCOMES ASSOCIATED WITH AZITHROMYCIN EXPOSURE , Amanda Gusovsky

New Tools for Biocatalysis: Studies on the Carminomycin 4-O-Methyltransferase DnrK , Elnaz Jalali

Optimization of Orally Bioavailable Inhibitors of Defective in Cullin Neddylation 1 (DCN-1) , Leah Kovalic

Genetic and Pharmacogenetics Associations of Cancer Disparities in Appalachia , Nan Lin

Design and Synthesis of Small Molecular Inhibitors of DCN1-UBE2M Interaction , Tucker J. Moseley

Effectiveness of a long-acting cocaine hydrolase in metabolizing cocaine and its physiologically active metabolites , Linyue Shang

Anti-Inflammatory and Analgesic Effects of Highly Selective Microsomal Prostaglandin E2 Synthase-1 (mPGES-1) Inhibitors , Madeline Stewart

INVESTIGATING THE USE OF mPGES-1 INHIBITORS FOR THE TREATMENT OF ABDOMINAL AORTIC ANEURYSMS , Lauren M. Weaver

DEVELOPING A BIOCATALYTIC TOOLBOX TO AID IN UNDERSTANDING NUCLEOSIDE ANTIBIOTICS , Jasmine Brianna Woods

BIOINFORMATIC ANALYSIS OF PROTEOMIC AND GENOMIC DATA FROM NSCLC TUMORS ON PROGNOSTIC AND PREDICTIVE FACTORS OF IMMUNOTHERAPY TREATMENT , Mark Wuenschel

Theses/Dissertations from 2022 2022

Response of Dopaminergic System to Cocaine Exposure, Recovery after Cocaine Abstinence, and Impact of a Long-acting Cocaine Hydrolase , Jing Deng

ANALYSIS OF POTENTIAL FACILITATORS TO USE OF HIV PRE-EXPOSURE PROPHYLAXIS (PrEP) IN A YOUNG TRANSGENDER POPULATION , Noah Dixon

Studies Toward the Development of an Improved Countermeasure for Synthetic Opioid Overdose , Sidnee L. Hedrick

Development of zafirlukast derivatives active against Porphyromonas gingivalis , Kaitlind C. Howard

Investigating the Physical Stability of Amorphous Pharmaceutical Formulations , Travis W. Jarrells

THE RELATIVE CONTRIBUTION OF LIVER AND INTESTINE IN REVERSE CHOLESTEROL TRANSPORT , Rupinder Kaur

LIPOSOMAL TECHNOLOGIES TO IMPROVE GENE DELIVERY , David Nardo Padron

DEVELOPMENT OF ACCURATE AND EFFICIENT COMPUTATIONAL METHODOLOGIES FOR PREDICTING PROTEIN-LIGAND AND PROTEIN-PROTEIN BINDING FREE ENERGIES , Alexander Hamilton Williams

BUILDING TOOLS FOR IMPROVED MODULATION OF THE HUMAN GABAA RECEPTOR, A CENTRAL NERVOUS SYSTEM TARGET FOR THE TREATMENT OF ANXIETY , Garrett Edward Zinck

Theses/Dissertations from 2021 2021

UNDERSTANDING ABSORPTION, SUPERSATURATION, AND DRUG ACTIVITY IN SOLUTION: WORKING TOWARDS DEVELOPING A MORE BIORELEVANT MEDIA , Freddy Arce

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Home » Blog » Dissertation » Topics » Biology » Microbiology » 99 Microbiology Dissertation Topics | Research Ideas

99 Microbiology Dissertation Topics | Research Ideas

By Liam Dec 7, 2023 in Biology , Microbiology | No Comments

Exploring the vast realm of Microbiology for your dissertation can be both exciting and overwhelming. Whether you’re an undergraduate, master’s, or doctoral student, selecting the right Microbiology dissertation topic is crucial to your academic success. This blog post aims to simplify this journey for you, offering a curated list of intriguing and relevant Microbiology dissertation […]

Exploring the vast realm of Microbiology for your dissertation can be both exciting and overwhelming. Whether you’re an undergraduate, master’s, or doctoral student, selecting the right Microbiology dissertation topic is crucial to your academic success. This blog post aims to simplify this journey for you, offering a curated list of intriguing and relevant Microbiology dissertation topics. From the intricate world of bacteriology to the expansive field of virology, we understand the importance of choosing a topic that not only aligns with your academic level but also fuels your passion for Microbiology. Dive into our comprehensive guide to discover a range of dissertation topics tailored to inspire and challenge students at every stage of their Microbiology studies.

In conclusion, the journey of selecting the perfect Microbiology dissertation topic is a pivotal step in your academic career. We hope our diverse list of Microbiology dissertation topics has provided you with the inspiration and direction needed for your undergraduate, master’s, or doctoral research. Remember, a well-chosen dissertation topic in Microbiology not only contributes to the scientific community but also shapes your academic and professional path. As you embark on this exciting research venture, let your curiosity and passion for Microbiology guide you towards making a significant impact in the field.

Download Microbiology Dissertation Sample

A list of Microbiology Dissertation Topics:

Understanding the impact of COVID-19 on diagnostic laboratories and the challenges faced.

Multi-center evaluation of commercial SARS-CoV-2 rapid antigen tests in Ecuador.

Understanding the molecular mechanisms of microbial pathogenesis.

Impacts of glucose on the longevity of cut flowers.

Studying the role of microorganisms in the carbon cycle.

Exploring the interactions between microorganisms and nanoparticles.

Exploring the potential of microbial biotechnology in carbon sequestration.

Diagnostic performance of commercially available serological assays for seroprevalence studies in South America.

Evaluating the effectiveness of microbial interventions in allergy prevention.

Investigating the potential of extremophilic enzymes in industrial processes.

Analyzing the impact of antibiotic use in livestock on human health.

Developments in cloning research.

Analyzing the role of microbial metabolism in climate change.

Large-scale molecular testing and whole genome sequencing for SARS-CoV-2 surveillance.

Evaluating the role of microbes in the degradation of hazardous waste.

Research on evidence of extraterrestrial life.

Potential of phage therapy for antibiotic-resistant respiratory tract infections.

Studying the role of microbes in the biogeochemical cycling of nutrients.

Investigating the genetic basis of microbial tolerance to extreme conditions.

Studying the microbial ecology of urban environments.

Recent discoveries in antibacterial products affecting the immune system.

Investigating the microbial basis of biogeochemical sulfur cycling.

Exploring the potential of microbial processes in enhancing cryptocurrency mining efficiency through advanced bioinformatics techniques.

Analyzing the host immune response to SARS-CoV-2 infection.

Studying the effects of microwave radiation on different organisms.

Studying the role of extremophiles in understanding life’s boundaries.

Exploring microbial strategies for survival in hostile environments.

Investigating the potential of microbes in the synthesis of novel biomaterials.

Role of genomics in controlling healthcare-associated infections in the UK.

Microbiota-gut-brain axis in neurodegenerative diseases.

Investigating the molecular basis of antibiotic resistance transfer between bacteria.

Investigating the role of microbial communication in environmental adaptation.

Studying the potential of bacteriocins in food preservation.

Future of microbiology research: technological and theoretical developments.

Analyzing the impact of environmental factors on microbial community structure.

Exploring the microbial etiology of emerging infectious diseases.

Investigating the role of quorum sensing in microbial communities.

Exploring the potential of bacteriophages in treating bacterial infections.

Exploring the role of viruses in genetic exchange among microorganisms.

Comprehensive review of nucleic acid amplification tests for COVID-19 diagnosis.

Investigating the role of microorganisms in bioremediation of polluted environments.

Expert consensus on SARS-CoV-2 nucleic acid point-of-care testing in China.

Exploring the role of microorganisms in coral reef ecosystems.

Investigating the role of microbial interactions in botanical growth and development for sustainable agricultural advancements.

Studying the role of microorganisms in the decomposition of organic matter.

Studying the impact of global warming on pathogen virulence and spread.

Investigating the role of microbes in the stabilization of soil structure.

Understanding the transmission dynamics of zoonotic diseases.

Exploring the potential of microbial sensors in environmental monitoring.

Gut-brain axis impact on neurological disorders and microbiota-based interventions.

Exploring early and accurate diagnosis of SARS-CoV-2 and differentiating it from other respiratory pathogens.

Evaluating the potential of microbial enzymes in industrial applications.

Investigating antibiotic resistance mechanisms in pathogenic bacteria.

Assessing the potential of probiotics in the treatment of gastrointestinal diseases.

Microbial transmission dynamics within households post-COVID-19.

Impact of microbiota on vaccine response in pediatric populations.

Evaluating the role of microbiome in plant resistance to pests and diseases.

Studying the interactions between human microbiome and chronic diseases.

Analyzing the impact of climate change on microbial diversity in various ecosystems.

Studying the genetic evolution of viruses in response to host immune defenses.

Analyzing the potential of synthetic biology in microbial research.

Evaluating the effectiveness of new disinfection methods in controlling hospital-acquired infections.

Investigating the role of microbes in sustainable agriculture and soil health.

Evaluating the role of microbial biofilms in industrial and medical settings.

Investigating the isolation of SARS-CoV-2 in culture in immunocompromised patients.

Investigating the interactions between antibiotics and microbial communities.

Analyzing the role of viruses in marine ecosystems.

Examining the integration of microbial technologies in textile production to develop innovative, sustainable fabrics with enhanced properties.

Evaluating the impact of microplastics on marine microbial communities.

Exploring the role of microbiota in the development of autoimmune diseases.

Investigating the role of microbial secondary metabolites in pharmaceutical development.

Solutions and control measures for diseases.

Investigating the potential of microbial consortia in waste management.

Evaluating the impact of nanotechnology on microbial life.

Exploring the use of CRISPR technology in microbial genome editing.

Investigating the dynamics of microbial communities in aquatic systems.

Influence of the gut microbiome on metabolic syndrome and obesity.

Exploring the gut-liver axis in liver diseases and microbial changes.

Evaluating the role of gut microbiota in mental health disorders.

Analyzing the effectiveness of vaccination strategies against emerging infectious diseases.

Analyzing the impact of climate change on pathogen-host interactions.

Analyzing the microbial degradation of synthetic polymers.

Exploring the role of gut microbiota in obesity and metabolic disorders.

Impact of gut dysbiosis on treatment outcomes in inflammatory arthritis patients.

Exploring the microbial ecology of extreme environments and its biotechnological applications.

Modern food preservation techniques and their impact on food conservation.

Evaluating the impact of post-COVID microbial dysbiosis on host immune response.

Investigating the interactions between human pathogens and environmental reservoirs.

Evaluating the efficacy of new antimicrobial agents against multi-drug resistant organisms.

Studying the role of microbial symbionts in animal health and development.

Studying the interactions between microbes and plants in phytoremediation.

Analyzing the dynamics of microbial populations in fermentation processes.

Investigating the role of fungi in forest ecosystem dynamics.

Investigating the role of endophytic bacteria in plant growth and health.

Investigating microbial contributions to biofuel production.

Evaluating the efficiency of SARS-CoV-2 inactivation methods for operator safety during testing.

Evaluating the impact of genetically modified organisms on soil microbial communities.

Analyzing the role of microbiota in the detoxification of xenobiotics.

There you go. Use the list of Microbiology dissertation topics well and let us know if you have any comments or suggestions for topics-related blog posts for the future or want help with dissertation writing; send us an email at [email protected] .

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• v.3(3); 2021 Sep

Antibiotic prescribing practices in general surgery: a mixed methods quality improvement project

Georgia lamb.

a Imperial College Healthcare NHS Trust, London, UK

Georgina Phillips

Esmita charani.

b NIHR Health Protection Research Unit in Healthcare Associated Infections and AMR and Centre for Antimicrobial Optimisation, Imperial College London, London, UK

Alison Holmes

Giovanni satta.

A single pre-operative antibiotic dose provides optimal prophylaxis against surgical site infection (SSI), but significant variability persists in adherence to prophylaxis guidelines. We describe a quality improvement project aiming to improve guideline-driven antibiotic prescribing within surgical teams at a tertiary hospital.

Face-to-face interviews with surgical teams and anonymous surveys of senior surgeons and anaesthetists were used to collect qualitative data on the perceptions and attitudes of prescribers. This informed intervention development, including a daily ward-round checklist using the acronymous ‘ABBDDOMM’, from A (antibiotics) to M (microbiology), combined with education and heightened guideline accessibility. A first audit cycle was performed for patients undergoing intra-abdominal surgery during a two-month period (cycle one). Post-implementation data were collected 12 months later (cycle two).

Interviews provided insight into common themes and barriers surrounding antibiotic prescribing, whilst surveys explored future solutions to these barriers. In cycle one, 100/205 (48.8%) patients received extended antibiotics beyond the single-dose prophylaxis. Following intervention, only 41/138 (29.7%) patients received extended antibiotic courses, demonstrating a 21.5% reduction in prolonged antibiotics (P<0.0005). In cycle one, 107/205 patients (52.2%) received antibiotics compliant with Trust Guidelines, compared to 80/138 (58.0%) in cycle two.

Our proposed checklist, alongside antimicrobial stewardship education, prompts daily review of important patient parameters and results to significantly reduce inappropriate post-operative antibiotic prescribing. Promoting the sustained use of similar checklists by junior doctors and focusing on measures to improve uptake of pre-operative induction antibiotic guidelines is required to achieve further benefits.

Introduction

Antibiotics have revolutionised the reach of surgical intervention, both by treating and preventing infection-related complications. However, inappropriate antibiotic use is increasingly leading to healthcare associated multi-drug resistant (MDR) infections. MDR infections cause 25,000 deaths per year in Europe and are associated with greater mortality and economic burden [ 1 , 2 ]. Inappropriate antibiotic prescribing is a key driver of antimicrobial resistance, which presents one of the most pressing global health challenges [ 1 ].

The World Health Organisation recommends a single dose of pre-operative antibiotic as optimal prophylaxis to reduce surgical site infection (SSI), whilst causing the least possible impact on patient microbiota and antimicrobial resistance [ 3 ]. Existing antibiotic prescribing guidelines aim to ensure a standardised approach to effective antibiotic choice according to local resistance patterns. However, significant variability in adherence to surgical prophylaxis guidelines exists globally [ 4 ], with concerns this poor compliance is mirrored locally. Surveillance in Northern Ireland suggests a large proportion of antibiotic prescribing in hospitals is inappropriate, highlighting prolonged surgical prophylaxis as a particular issue [ 5 ]. Possible reasons for poor compliance include poor awareness of guidelines and practising habitual prescribing based on previous clinical experiences [ 6 ].

Without consistent and sustained antimicrobial stewardship, we face losing the ability to practice safe surgery. Antimicrobial stewardship interventions, particularly those providing direct feedback and education for prescribers, have been shown to increase compliance with antibiotic guidelines and reduce hospital length of stay [ 6 ]. The success of ward-round checklists in quality improvement has been increasingly recognised, ensuring daily review of key post-operative measures [ 7 ] and reduced risk of iatrogenic infections following procedures [ 8 ].

We evaluated the baseline adherence to surgical antibiotic guidelines in a tertiary hospital and explored the attitudes of healthcare professionals underpinning poor prescribing practices. Based on findings, a three-pronged quality improvement intervention comprising 1) education, 2) ward-round checklist and 3) heightened guideline accessibility was implemented to successfully improve antimicrobial prescribing.

This mixed-methods study was conducted at a single National Health Service hospital between 2018-2020.

Qualitative data

Face-to-face interviews were conducted between 2018 -2019 by EC with fourteen members of the general surgery multi-disciplinary team [ 9 , 10 ]. Using open-ended questions, interviews explored participants' views and experiences of antibiotic prescribing in surgery and the key factors that influence decision-making. Interviews were recorded, anonymised and transcribed verbatim. A thematic analysis was conducted manually. Findings were organised into broad analytical, intermediate descriptive and detailed coded sub-themes of perceptions surrounding antibiotic use and the influence of team dynamics.

Pre-intervention anonymous online surveys assessed surgeons' prescribing practices and understanding of antibiotic guidelines. Questions were developed based on contextual information from face-to-face interviews and piloted with two junior doctors. Survey invitation was sent via email and responses were collected over six weeks. A similar anonymous survey for anaesthetists was developed based on responses from surgeons and piloted with two junior doctors. Survey participation occurred at an anaesthetic departmental meeting.

The intervention ( Figure 1 )

Descriptive infographic of the three-stage intervention, detailing the daily ward-round checklist ‘ABBDDOMM’.

Four educational sessions were delivered throughout the two-year period to three different staff groups. Each session was delivered as a PowerPoint presentation, using interactive questions to the audience, followed by discussion to gain feedback from general surgeons, anesthetists and junior doctors on perceived barriers to good antimicrobial prescribing and suggestions for improvement. All sessions included evidence on antimicrobial resistance and addressed knowledge gaps identified in the anonymous surveys, for example the impact of antibiotics on SSI risk. Sessions also covered the initial results of the QI project, an introduction to the ABBDDOMM checklist, and guidance on access to the Trust antibiotic guidelines via the mobile application.

Sessions one and two were delivered after cycle one. Session one was presented at a general surgery morbidity and mortality meeting to around 50 members of the general surgery department including consultants, registrars, junior doctors and nurse practitioners. Session two was presented at a departmental anaesthetist meeting, to around 30 anaesthetic consultants and registrars. Anaesthetist survey responses were collected during this session. Session three was delivered prior to checklist implementation at an induction session for new junior doctors in general surgery (seven doctors), focusing on the introduction and use of the checklist in ward round documentation. Session four occurred following cycle two at another general surgery morbidity and mortality meeting, with an audience of around 50 general surgeons and junior doctors.

The ‘ABBDDOMM’ checklist

Knowledge from interview s provided contextual information and formed a thematic basis for the fundamentals of a simple, user-friendly intervention. Daily ward rounds were observed to assess the frequency of review of patient parameters. The acronymous ward round checklist ‘ABBDDOMM’ was developed to include parameters most commonly assessed by surgeons, alongside microbiological parameters: A (Antibiotics), B (Blood results), B (Bowels), D (Drain output), D (Diet), O (Observations), M (Mobility) and M (Microbiology results). The checklist is displayed in Appendix 1 . Various iterations were piloted by one junior doctor (GP) during ward rounds, with input from senior surgeons. Checklist usability was piloted with four junior doctors for two weeks before implementation.

Promotion of trust antimicrobial guidelines

General surgeons, anaesthetists and junior doctors received an education session on how to access the Trust antimicrobial guidelines. Based on anaesthetist feedback, QR codes (easily scanned by mobile phone devices with cameras) for point-of-care guideline reference will be implemented in cycle three of this project.

Quantitative data

Cycle one reviewed surgeries undertaken between 1 st January and 28 th February 2019. Cycle two reviewed surgeries undertaken between 1 st January and 28 th February 2020, following intervention. All patients over 18-years-old who had intra-abdominal surgery during this period were included. The setting was a specialist tertiary centre for bariatric surgery with independent guidelines, therefore bariatric surgeries were excluded due to comparison limitations with the local Trust and national surgical standards. There is no existing guideline for antibiotic prophylaxis in diagnostic laparoscopy, therefore diagnostic laparoscopies were also excluded from analysis. In cycle one, 205 surgeries were included for analysis and 138 in cycle two.

Data collection

Patients were identified using theatre lists. Retrospective data was collected using online patient notes and prescription charts. Information on the choice and duration of antibiotics prescribed at anaesthetic induction and the surgery characteristics were collected. Data on SSI was collected for 30 days post-operatively. SSIs were graded according to the ASEPSIS score as mild, moderate or severe [ 11 ]. Microbiology, culture and sensitivity (MCS) results were correlated with any antibiotic used for treatment. Identical data was collected 12 months apart, with additional data on the utilisation of the checklist in ward round notes during cycle two.

Data analysis

Antibiotic choice and duration used at induction was compared to the Trust antibiotic guidelines to assess compliance. Continued prescriptions of antibiotics on the ward, and any documented indications, were analysed.

Data was stored and analysed using Microsoft Excel. P -values and confidence intervals were calculated using the Chi-squared test, using Medcalc Statistical Software Version 19.8.

Surgery characteristics

Surgery characteristics are detailed in Table I .

Table I

Characteristics of surgical procedures performed in Cycles One and Two

Antibiotic choice: prescription at anaesthetic induction

The choice of antibiotic regimen used for all surgeries, in comparison to the Trust guideline, are listed in Table II .

Table II

The choice of antibiotic regimens used for different categories of surgery during Cycle One and Cycle Two. ∗For patients with penicillin-allergy, gentamicin is substituted for cefuroxime in all guidelines recommending cefuroxime

Bold text identifies the number of procedures performed using Trust recommended antibiotics.

Cycle one: In 107/205 operations (52.2%), the correct choice of antibiotics according to Trust guidelines was used. In two of these operations, a non-adherent antibiotic had been advised by a microbiologist, therefore were considered compliant. In 98/205 procedures (47.8%), the antibiotics used were non-compliant with Trust guidelines.

Cycle two: In 80/138 operations (58%), the correct choice of antibiotics according to Trust guidelines was used. In 58/138 procedures (42%), the antibiotics used were non-compliant with Trust guidelines.

This demonstrates an increase in uptake of Trust guidelines by 5.8% (CI -4.9%–16.2%, p-value 0.29), see Figure 2 .

Comparison of compliance to Trust antibiotic guidelines for antibiotic choice and duration between Cycles One and Two.

Antibiotic duration: post-operative prescriptions

Cycle one: 100/205 patients (48.8%) received an extended course of antibiotics (>one dose at induction or >two doses for operations four hours or longer). In 60 of these patients (60%) there was a clear indication for prolonged antibiotic use. Forty (66.7%) of given indications were for intra-operative findings including purulent fluid, abscess or perforated viscus. Eight (13.3%) were prophylaxis for contaminated wounds or foreign bodies. Twelve (20%) were for intercurrent active infection: eight patients had intra-abdominal sepsis on admission requiring emergency surgery, two patients had elective surgeries but became febrile and septic post-operatively and two elective patients were being treated for intercurrent infection (cellulitis and urinary tract infection). In 40 (40%) of the 100 patients receiving prolonged antibiotics there was no apparent or documented indication. In seven of these cases (17.5%), antibiotics were not discontinued despite explicit instruction to in the operation note.

Cycle two: 41/138 patients (29.7%) received extended antibiotics. In 16 of these patients (39%) there was a clear indication documented for a prolonged duration of antibiotics; ten (62.5%) for intra-operative findings, four (25%) for prophylaxis of contaminated wounds and two (12.5%) for intercurrent infection (emergency procedures for patients with intra-abdominal sepsis). In cycle two, 70.3% of patients received the correct duration of antibiotics compared to 48.8% in cycle one, demonstrating an increase in compliance by 21.5% (CI 10.9%–31.2%, p-value 0.0001).

Surgical site infections

Cycle one: 18/205 operations (8.8%) were complicated by SSI, of which seven (38.9%) were elective and 11 (61.1%) were emergency procedures. Twelve (66.7%) occurred following open surgery and six (33.3%) occurred at sites of laparoscopic surgery. Two patients developed a collection in addition to wound infection. Eleven infections were classified as mild, five as moderate and two as severe.

Eleven patients (61.1%) were started on antibiotics. Nine of those started on antibiotics (81.8%) had swabs taken for MCS. Antibiotics were appropriate following MCS results in three patients (33.3%): in one patient antibiotics were changed based on resistance, and in two patients there was no need to change antibiotics. In six patients (66.6%), antibiotics were not appropriately changed following MCS results that demonstrated resistance to the prescribed antibiotic.

Cycle two: eight of 138 operations (5.8%) were complicated by SSI, of which four (50%) were elective and four (50%) were emergency procedures. Six (75%) occurred following open surgery and two (25%) occurred at sites of laparoscopic surgery. Three patients developed wound infections, four developed collections and one patient developed both. Of the four wound infections, one was classified as a “disturbance of wound healing”, one as a minor SSI and two as moderate. Following intervention there was a reduction in SSI rate of 3.0% (CI -3.1%–8.5%), p-value 0.30.

One patient remained in intensive care post-operatively, under the care of multiple teams. Given inability to access intensive care online patient notes, conclusions could not be accurately drawn on the management of the SSI, therefore this patient was excluded from further analysis of SSI data. All seven other patients had swabs or cultures taken for MCS. Six patients (85.7%) were treated with antibiotics for SSI. Antibiotics were appropriate following MCS results in six patients (85.7%); in five patients antibiotics were changed based on resistance, and in one patient there was no need to change antibiotics. In one patient, antibiotics were not thought clinically indicated but the subsequent wound swab grew klebsiella with resistance; there is no documented evidence of this result being reviewed by the surgical team. Table III summarises the positive microbiology, culture and sensitivity results for patients with SSI.

Table III

Summary of positive microbiology, culture and sensitivity results for patients with surgical site infection (SSI)

Use of the ABBDDOMM checklist

During cycle two, 103 patients were admitted to the surgical ward post-operatively. 76 of these patients (74%) had the ABBDDOMM checklist used in the ward round documentation at least once during their inpatient stay, and 38 patients (37%) had the checklist used in the ward round documentation every day. Antibiotics were reviewed daily 100% of the time when ABBDDOMM was used, and 30% of the time when not used.

Surgical team perceptions of antibiotic use

Face-to-face interviews.

Fourteen face-to-face interviews were conducted with multidisciplinary healthcare professionals within the general surgery team (two consultant surgeons, one consultant physician, six specialty registrars, two foundation doctors, one pharmacist and two advanced nurse practitioners). For complete thematic analysis results, with analytical, descriptive and sub-themes, see Table IV .

Table IV

Overarching analytical themes, descriptive themes and detailed sub-themes describing current barriers to surgical team antibiotic prescribing

Anonymous survey findings

Thirteen responses were collected from the surgical team (seven consultants, four registrars, and two junior doctors). Cited reasons for not using the guidelines were they are “not easily accessible” and “vague and non-specific”. One surgeon was not aware of the Trust guidelines. Eleven surgeons stated the correct number of doses of induction antibiotic prophylaxis was one. Seven out of 13 surgeons either did not agree that prolonged antibiotic use does not reduce the risk of SSI, or did not know: one did not agree, and six did not know, whilst six surgeons did understand that prolonged antibiotic use does not reduce SSI risk. When asked to cite indications for prolonged antibiotics post-operatively, surgeons gave examples of intra-operative findings such as perforation, collection, contaminated wounds, concurrent sepsis and patient factors including diabetes and smoking status.

Twenty-five anaesthetic responses were collected (thirteen consultants, eight specialty registrars, four junior doctors). Twenty-one reported anaesthetists prescribed the prophylactic antibiotics at induction, whilst four reported the surgeons did. Twenty-three were unsure who should actually be responsible for prescribing the prophylactic antibiotics. All anaesthetists were aware of Trust guidelines for antibiotic prescribing in surgery prophylaxis. None of the anaesthetists had used the Trust antibiotic prescribing app that is available on their phones. Eighteen anaesthetists reported one antibiotic dose should be given at surgery induction, depending on the surgery duration, whilst seven thought multiple doses should be given. Suggestions for interventions to improve adherence included posters of the guidelines displayed in induction rooms and availability of a point-of-care guideline reference on mobile phones.

Discussion and recommendations

This study highlights two crucial time-points where antibiotic prescribing practices can be targeted in general surgery: 1) at pre-operative induction and 2) post-operative prescribing of antibiotics on the ward. A small improvement in the compliance to guidelines for choice of antibiotics at induction was observed between cycles one and two, and a significant improvement was seen in prolonged post-operative prescribing of antibiotics. There was no significant change in SSI rates post-intervention, as expected in line with extensive evidence in this area, [ 3 , 12 ] and incidence remained around the national average for small bowel and colorectal surgery of 6.6% and 8.3% respectively [ 12 ]. Finally, this project furthers understanding of cultural and physical barriers to appropriate antibiotic prescribing at a tertiary NHS hospital, and investigates end-user intervention suggestions to promote future antimicrobial stewardship.

Despite improvement in guideline compliant pre-operative antibiotic choice, the overall compliance rate in cycle two remained poor. A similar audit, communicated locally, of antibiotic prescribing by counterpart medical teams demonstrated 100% of prescribed antibiotics were adherent to Trust guidelines, exposing disparity between medical and surgical practices. In contrast, inappropriate post-operative antibiotic prescribing by surgeons is mirrored in international studies; for example, Vessal found only 8 of 106 patients at an Iranian hospital received the recommended pre-operative prophylactic antibiotic regimen, and antibiotic treatment was extended in 83% of cases despite only being indicated in 37% [ 13 , 14 ].

Most surgeons acknowledged the need for rapidly changing antibiotic guidelines according to resistance patterns, yet poor surgical adherence to guidelines implies decision-making is influenced by other factors. An interesting observation during interviews was the ambiguity between surgeons and anaesthetists regarding who takes responsibility for pre-operative antibiotic prescribing decisions at induction, which may stem from observed reluctance to challenge inappropriate behaviour within the hierarchical dynamics of an operating team [ 15 ]. Moreover, some surgeons admitted prescribing was driven by consideration for short-term individual patient outcomes rather than the negative consequences of extended antibiotic use. The McDonnel group theorise two explanations for this attitude; 1) the action and consequence are so widely separated in time that the relationship goes unrecognised, and 2) surgeons acting in “rational self-interest” feel their individual contribution to antimicrobial resistance is insignificant [ 16 ]. Troughton et al. identified that surgeons' fear of adverse patient outcomes, including SSI, negatively impacting on their professional reputation is a salient influence as surgeons feel “personal accountability” for SSI rates, despite a consensus that SSI prevention is a team responsibility [ 15 ]. Similarly, Charani describes a “defensive antibiotic decision-making” pattern seen in surgical antibiotic prescribing, which is primarily driven by surgical outcome data and the short-term procedure success [ 10 ]. Understanding the cultures underpinning poor prescribing is essential to facilitating sustainable change; our exploration of local attitudes and perceptions to target intervention may in part explain the project's success. Based on conflicting perceptions of prescribing responsibility for infection-related complications, we recommend clinical accountability for pre-operative prescribing should be defined and agreed between general surgeons and anaesthetists.

Consistent uptake of the ‘ABBDDOMM’ checklist suggests it plays an important role in reducing inappropriate post-operative antibiotic prescribing, particularly given the much greater improvement observed in duration of antibiotics compared to pre-operative choice of antibiotic. Microbiology results were reviewed and appropriately acted upon more frequently in cycle two. Implementation of the ABBDDOMM checklist may have contributed to this improvement, but it is difficult to determine causation in this small cohort, particularly as several patients with complex SSIs in cycle two had extensive microbiology team involvement in their care. Wider literature demonstrates the potential for point-of-care reference applications to improve guideline-driven prescribing, with Yoon et al. finding an 8% increase in adherence to guidelines for treating urinary tract infections following introduction of a smartphone application [ 17 ]. Whilst a smartphone application exists within this Trust, our interviews revealed limited usage, suggesting poor awareness or barriers to application accessibility. Influenced by feedback from anaesthetists, cycle three of this project will introduce QR codes into anaesthetic induction rooms to provide instant access to the Trust guidelines, potentially overcoming any accessibility problems and focusing on increasing uptake of pre-operative antibiotic guidelines.

Study limitations

This is a single-centre study focusing on one surgical department, therefore data may not be representative of other surgical departments within the Trust or nationally.

Given that there were multiple interventions implemented at the same time, it is difficult to ascertain the relative impact of any one of these on the observed outcomes. Since the checklist targeted antibiotic prescribing on wards post-operatively, whereas education should additionally target prescribing at induction, it can be inferred that the checklist led to the greatest benefit seen in prolonged antibiotic prescribing. Alternative factors contributing to the observed improvements in compliance rates and post-operative antibiotic prescribing should also be considered, such as increased media coverage of antibiotic resistance, and the Trust switching to an entirely computerised prescribing system.

SSIs were only included if they aligned with the WHO definition [ 18 ], and if patients remained an inpatient or re-presented to hospital with SSI symptomology within 30-days post-operatively. The true SSI rate in our population may therefore be under-estimated, as we were unable to capture patients presenting to Primary Care. Online notes were reviewed retrospectively, and so interpretation of SSI severity and management is limited by the quality of the documentation. Furthermore, larger sample sizes are needed to assess the impact of this intervention on SSI rate.

Conclusions

Improved adherence to surgical prophylaxis antibiotic guidelines and reduced post-operative antibiotic use was observed following introduction of the ‘ABBDDOMM’ checklist, alongside education. This checklist could be easily replicated as a simple and cost-effective antimicrobial stewardship intervention, specifically focusing on the decision-making dynamics of surgical teams. Further work is needed to establish interventions that target pre-operative antibiotic choice, which was less impacted by our intervention; specifically the benefit of QR codes as a tool for point-of-care access to guidelines to improve guideline-driven antibiotic prescribing for surgical prophylaxis.

Acknowledgements

We would like to thank the Trust general surgery and anaesthetic departments for their open and willing contribution to this study through participation in interviews and surveys.

Conflict of interest statement

The authors declare that there is no conflict of interest.

Funding sources

Charani and Holmes acknowledge funding from the National Institute for Health Research, UK Department of Health [HPRU-2012-10047] in partnership with Public Health England.

Appendix 1. 

The checklist “ABBDDOMM”, as presented to junior doctors for use in daily ward-round documentation:

A – Antibiotics

• - Review the type, route, dose, indication and intended duration for any prescribed antibiotics

B –Blood results

• - Review most recent full blood count (FBC), C-reactive protein (CRP), renal function and liver function. Review dose levels for monitored antibiotics.

B – Bowels

• - Review patient bowel frequency and form; assess for signs of post-operative ileus

D –Drains

• - Clinically review any post-operative drains or indwelling urinary catheters, and review output over 24 hours.

D – Diet

• - Review permitted diet and oral intake

O – Observations

• - Review trends in vital signs over the past 24 hours

M –Mobility

• - Review post-operative mobility and recovery

M – Microbiology Results

• - Review any microbiology, culture and sensitivity (MCS) results for blood cultures, wound cultures and intra-operative samples. This section also provided an opportunity to flag up any ‘sent’ samples that require chasing.

Antimicrobial Resistance

Research projects.

The Bristol AMR interdisciplinary research community is focusing on three main research areas to address the global challenge of antimicrobial resistance: 1) Antimicrobial resistance discovery science; 2) AMR research applications and 3) AMR in a global context

Antimicrobial resistance discovery science

Antibiotic drug discovery.

Our research to find new antibiotics derived from natural products.

Understanding and blocking resistance

Identifying what makes bacteria resistant to antibiotics and how it may be reversed or blocked.

Development of novel resistance diagnostics

Novel AMR diagnostics to assist with more effective antibiotic prescribing.

AMR research applications

New approaches to infection prevention and treatment.

How using antimicrobial materials in wound care, medical devices and implants are offering potential solutions.

Antibiotic usage and behaviour change in human and veterinary medicine

Identifying the behaviours surrounding antibiotic use in healthcare systems and in veterinary medicine

Data linkage for antibiotic stewardship and reduced AMR in healthcare

Improving the use of antibiotics in primary care to preserve the efficacy of current antibiotics.

AMR in a global context, regulation and policy

Understanding the drivers of amr in a one health context.

Determining the drivers of AMR in human and veterinary healthcare in global contexts.

Surveillance of AMR and antimicrobial usage in farming

Establishing surveillance systems of AMR and antimicrobial usage in global farming systems

Understanding regulatory systems relevant to drivers of AMR

How different regulatory systems in human and animal healthcare drive global AMR.

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Journal articles on the topic "Antibiotics":

Hochvaldová, Lucie, Renata Večeřová, Milan Kolář, Robert Prucek, Libor Kvítek, Lubomír Lapčík, and Aleš Panáček. "Antibacterial nanomaterials: Upcoming hope to overcome antibiotic resistance crisis." Nanotechnology Reviews 11, no. 1 (January 1, 2022): 1115–42. http://dx.doi.org/10.1515/ntrev-2022-0059.

Sembiring, Pintata, Masria Sianipar, Sri Sudewi Pratiwi Sitio, Yunita Syahputri Damanik, and Efrata Sembiring. "EDUKASI PENGGUNAAN ANTIBIOTIK PADA SISWA/SISWI SMA NEGERI 1 STM HILIR, JLN. PENDIDIKAN DUSUN I TALUN KENAS, KEC. SINEMBAH TANJUNG MUDA HILIR, KAB. DELI SERDANG, SUMATERA UTARA." Jurnal Pengabdian Masyarakat Putri Hijau 3, no. 3 (July 2, 2023): 29–31. http://dx.doi.org/10.36656/jpmph.v3i3.1342.

Danielewski, Maciej, Dorota Ksiądzyna, and Adam Szeląg. "NON-ANTIBIOTIC USE OF ANTIBIOTICS." Postępy Mikrobiologii - Advancements of Microbiology 57, no. 4 (2019): 301–12. http://dx.doi.org/10.21307/pm-2018.57.4.301.

Simonson, William. "Antibiotic stewardship: Revisiting quinolone antibiotics." Geriatric Nursing 38, no. 2 (March 2017): 152–53. http://dx.doi.org/10.1016/j.gerinurse.2017.03.008.

Heinemann, Jack A. "How antibiotics cause antibiotic resistance." Drug Discovery Today 4, no. 2 (February 1999): 72–79. http://dx.doi.org/10.1016/s1359-6446(98)01294-x.

Heinemann, Jack A., Robert G. Ankenbauer, and Carlos F. Amábile-Cuevas. "Do antibiotics maintain antibiotic resistance?" Drug Discovery Today 5, no. 5 (May 2000): 195–204. http://dx.doi.org/10.1016/s1359-6446(00)01483-5.

Sterling, Stephanie, Arnold Decano, and Evelyn Fabian. "1098. Perioperative Antibiotic Stewardship for Interventional Radiology Cases Improves Antibiotic Decision-Making." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S390. http://dx.doi.org/10.1093/ofid/ofz360.962.

Patel, Payal K., Naoyuki Satoh, Masashi Narita, Yoshiaki Cho, Yusuke Oshiro, Tomoharu Suzuki, Karen E. Fowler, M. Todd Greene, Yasuharu Tokuda, and Keith S. Kaye. "172. Inpatient Antibiotic Prescribing Patterns Using the WHO Access Watch and Reserve (AWaRe) Classification in Okinawa, Japan: A Point Prevalence Survey." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S195—S196. http://dx.doi.org/10.1093/ofid/ofab466.374.

Miller, Benjamin, Kathryn Carson, Sujay Pathak, and Sara C. Keller. "1978. Statements about Antibiotic Side-Effects and Patient Desire for Unnecessary Antibiotics." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S662. http://dx.doi.org/10.1093/ofid/ofz360.1658.

Ahmed, Iftekhar, Md Bodiuzzaman Rabbi, Marufa Rahman, Rehnuma Tanjin, Sharmin Jahan, Md Abu Adnan Khan, and Sakina Sultana. "Knowledge of antibiotics and antibiotic usage behavior among the people of Dhaka, Bangladesh." Asian Journal of Medical and Biological Research 6, no. 3 (October 17, 2020): 519–24. http://dx.doi.org/10.3329/ajmbr.v6i3.49803.

Dissertations / Theses on the topic "Antibiotics":

Dodgen, Taylor L. "Escherichia coli and Antibiotic Resistance to Tetracycline Antibiotics." Lynchburg, Va. : Liberty University, 2008. http://digitalcommons.liberty.edu.

Lee, Henry Hung-Yi. "A systems approach to the evolution of antibiotic resistance." Thesis, Boston University, 2012. https://hdl.handle.net/2144/31582.

Meng, Li. "Development of one-step strip test for rapid detection of antibiotic residues in animal body fluid and food animal products /." View abstract or full-text, 2006. http://library.ust.hk/cgi/db/thesis.pl?BIEN%202006%20MENG.

Millar, Michael. "Antibiotics and antibiotic resistance : what do we owe to each other?" Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/4780/.

Wolken, Kathryn, and Velliyur Viswesh. "The Appropriateness of Antibiotic Therapy in Patients Initiated on Meropenem in a University-Affiliated Hospital." The University of Arizona, 2011. http://hdl.handle.net/10150/623557.

Silva, Niléia Cristina da [UNESP]. "Remoção de antibióticos da água por meio do processo de adsorção em carvão ativado." Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/97882.

Batista, Ana Paula dos Santos [UNESP]. "Degradação de antibióticos sulfonamidas por processo foto-Feton: identificação de intermediários." Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/105698.

Fisher, Morgane, (Dennison) Jaime Thomas, and Danielle Weimann. "Effects of an Educational Intervention on Parental Knowledge Regarding Antibiotic Resistance." The University of Arizona, 2008. http://hdl.handle.net/10150/624276.

Starosta, Agata Lucyna. "Antibiotics and translation." Diss., Ludwig-Maximilians-Universität München, 2012. http://nbn-resolving.de/urn:nbn:de:bvb:19-170210.

Tangeman, Lorraine Susan. "Can Antibiotics From Recently Discovered Marine Actinobacteria Slow the Tide of Antibiotic Resistance?" Wright State University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=wright1377522942.

Books on the topic "Antibiotics":

Sköld, Ola. Antibiotics and Antibiotic Resistance . Hoboken, NJ, USA: John Wiley & Sons, Inc., 2011. http://dx.doi.org/10.1002/9781118075609.

Sköld, Ola. Antibiotics and antibiotic resistance . Hoboken, N.J: Wiley, 2011.

Sadao, Teshiba, ed. Antibiotics.: Antibiotics by fermentation . Yverdon, Switzerland: Gordon and Breach Science Publishers, 1993.

Hays, Virgil W. Antibiotics for animals: The antibiotic-resistance issue . Ames, Iowa: Council for Agricultural Science and Technology, 1989.

Sass, Peter, ed. Antibiotics . New York, NY: Springer New York, 2017. http://dx.doi.org/10.1007/978-1-4939-6634-9.

Walsh, Christopher. Antibiotics . Edited by Timothy Wencewicz. Washington, DC, USA: ASM Press, 2016. http://dx.doi.org/10.1128/9781555819316.

Gualerzi, Claudio O., Letizia Brandi, Attilio Fabbretti, and Cynthia L. Pon, eds. Antibiotics . Weinheim, Germany: Wiley-VCH Verlag GmbH & Co. KGaA, 2013. http://dx.doi.org/10.1002/9783527659685.

Shlaes, David M. Antibiotics . Dordrecht: Springer Netherlands, 2010. http://dx.doi.org/10.1007/978-90-481-9057-7.

Lancini, Giancarlo, Francesco Parenti, and Gian Gualberto Gallo. Antibiotics . Boston, MA: Springer US, 1995. http://dx.doi.org/10.1007/978-1-4757-9200-3.

Sass, Peter, ed. Antibiotics . New York, NY: Springer US, 2023. http://dx.doi.org/10.1007/978-1-0716-2855-3.

Book chapters on the topic "Antibiotics":

Jeske, Arthur H. "Antibiotics and Antibiotic Prophylaxis." In Contemporary Dental Pharmacology , 39–46. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-99852-7_5.

Millar, Michael. "A Capability Perspective on Antibiotic Resistance, Inequality, and Child Development." In Ethics and Drug Resistance: Collective Responsibility for Global Public Health , 225–42. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-27874-8_14.

Özcan, Özal. "Antibiotics." In Musculoskeletal Research and Basic Science , 651–63. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-20777-3_38.

Surivet, Jean-Philippe, and Philippe Panchaud. "Antibiotics." In Methods and Principles in Medicinal Chemistry , 433–75. Weinheim, Germany: Wiley-VCH Verlag GmbH & Co. KGaA, 2017. http://dx.doi.org/10.1002/9783527674381.ch15.

Mehlhorn, Heinz. "Antibiotics." In Encyclopedia of Parasitology , 1. Berlin, Heidelberg: Springer Berlin Heidelberg, 2016. http://dx.doi.org/10.1007/978-3-642-27769-6_217-2.

Phan, Yih Chyn, and Bob Yang. "Antibiotics." In Female Urinary Tract Infections in Clinical Practice , 29–38. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-27909-7_4.

Popella, Peter. "Antibiotics." In The Palgrave Encyclopedia of Global Security Studies , 1–5. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-74336-3_516-1.

Schaub, Günter. "Antibiotics." In Encyclopedia of Parasitology , 157–60. Berlin, Heidelberg: Springer Berlin Heidelberg, 2016. http://dx.doi.org/10.1007/978-3-662-43978-4_217.

Marik, Paul Ellis. "Antibiotics." In Handbook of Evidence-Based Critical Care , 123–31. New York, NY: Springer New York, 2010. http://dx.doi.org/10.1007/978-1-4419-5923-2_12.

Tramper, Johannes, and Yang Zhu. "Antibiotics." In Modern Biotechnology , 153–70. Wageningen: Wageningen Academic Publishers, 2011. http://dx.doi.org/10.3920/978-90-8686-725-7_9.

Reports on the topic "Antibiotics":

Lilley, Laura Margaret. Radiopharmaceutical Antibiotics . Office of Scientific and Technical Information (OSTI), July 2018. http://dx.doi.org/10.2172/1458965.

Peñaloza, Blanca. Which interventions can improve antibiotic prescription in ambulatory setting? SUPPORT, 2011. http://dx.doi.org/10.30846/11080608.

Naegeli, Hanspeter, Noémie Boillat Blanco, Benedikt Huttner, Mireille Meylan, and Vivianne Visschers. Optimized use of antibiotics and behavior changes . Swiss National Science Foundation SNSF, November 2022. http://dx.doi.org/10.46446/publication_nrp72.2022.4.en.

Lopez Bautista, Cesar Augusto, and Sandrasegaram Gnanakaran. Permeation profiles of Antibiotics . Office of Scientific and Technical Information (OSTI), October 2017. http://dx.doi.org/10.2172/1398894.

Wierup, Martin, Helene Wahlström, and Björn Bengtsson. How disease control and animal health services can impact antimicrobial resistance. A retrospective country case study of Sweden . O.I.E (World Organisation for Animal Health), April 2021. http://dx.doi.org/10.20506/bull.2021.nf.3167.

Monteiro, Alvaro N. Restoring BRCA1 Function With Antibiotics . Fort Belvoir, VA: Defense Technical Information Center, August 2002. http://dx.doi.org/10.21236/ada410655.

Bienkowski, P. R., C. H. Byers, and D. D. Lee. Expedient antibiotics production: Final report . Office of Scientific and Technical Information (OSTI), May 1988. http://dx.doi.org/10.2172/6917476.

Monteiro, Alvaro N. Restoring BRCA1 Function With Antibiotics . Fort Belvoir, VA: Defense Technical Information Center, September 2003. http://dx.doi.org/10.21236/ada420394.

Nelson, Daniel C. Resensitizing Resistant Bacteria to Antibiotics . Fort Belvoir, VA: Defense Technical Information Center, April 2011. http://dx.doi.org/10.21236/ada554271.

Cash, Brooks D. Non-absorbed Antibiotics for IBS . Fort Belvoir, VA: Defense Technical Information Center, March 2012. http://dx.doi.org/10.21236/ada559010.

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• A study of complementary feeding practices amongst mothers of children aged six months to two years attending an immunisation clinic.
• A study of factors associated with health seeking behavior of elderly in rural community
• Knowledge,attitude,practice and toxicity symptoms asssociated with pesticide use among farm workers in a rural area.
• A community based study of prevalence of selected risk factors of osteoporosis in adult male population in an organized sector. Study of quality of life in hiv/aids patients in a tertiary care center.
• Knowledge and practices regarding injection procedures among injection providers in a tertiary care hospital.
• A comparative study of prevalence of hypertension,and its association with bmi and waist circumference,among adolescent school children in urban and rural area.
• A study of family planning practices in an urban slum.
• A cross sectional study of susceptibility to rubella among college students.
• A study of morbidity profile of middle,secondary and higher secondary school children in an urban area.
• A study of newborn care practices in the filed practice area of urban health center, sulthan palya.
• Socio-demograhic and reproductive variables in relation to female reproductive tract malignancies: hospital based case-control study.
• Clinico -epidemiological profile and risk factors of hypertension among the bank employees in western maharastra-a cross sectional study.
• An epidemiological study of overweight and obesity and its risk factors among adults in an adopted urban slum area.
• To study the prevalence and risk factors of obesity in bank employees in the city.
• Quality of life,stress and depression in geriatric population residing in field practice area of urban health training centre-a cross sectional study.
• Study of anaemia in adolescent girls and its co-relation with dietary intake.
• Assesment of effect of early childhood development interventions on child feeding practices including responsive feeding and nutrition status of 6 to 23 months old children.
• Awareness and health care seeking behaviour for newborn danger signs among mothers in rural area.
• Process evaluation of implementation of rashtriya bal swasthya karyakram in a District in central india.
• Status and effectiveness of implementation of weekly iron and folic acid supplementation Scheme in schools.
• Assessment of effect of a school-based behavior modification strategy on improvement in physical activity among school children.
• Prevalence of primary infertility among reproductive age group women.
• Menstrual morbidities in adolescent girls and their health seeking behavior in rural area.
• A study of health profile of juveniles placed in remand home.
• Cross sectional study of patients attending diabetic clinic in a tertiary care hospital.
• Epidemiological study of ischemic heart disease in patients admitted in intensive care unit in the tertiary care hospital.
• Study of contraceptive use and unmet need for contraception in married women of reproductive age group in urban slum area.
• Study of some epidemiological determinants of road traffic accidents.
• A study of morbidity associated with biomass fuel combustion among women in rural field practice area of a medical college.
• Profile of multimorbidity and associated socio-demographic factors:a hospital based study.
• A cross sectional study of health profile of bus drivers with special focus on mental health.
• Evaluation of the quality of pulmonary tuberculosis management among private practitioners in an urban area with special reference to rntcp guidelines/dots Strategy.
• A study to determine the prevalence of diabetes mellitus in tuberculosis patients registered for treatment under rntcp.
• Study of health profile of hiv positive
• Orphans in selected orphanages and challenges faced by their caregivers.
• Assessment of knowledge and practices regarding menstruation in school going Adolescent girls who attained menarche.
• Prevalence of sharps injuries among health care workers and assessment of their knowledge,attitude and practice regarding post-exposure prophylaxis for hiv in a tertiary care hospital.
• Morbidity pattern among geriatric population in field practice area of urban health centre.
• Prevalence of high risk pregnancy and its outcome in rural area.
• Health status of bank employees with special reference to musculoskeletal disorders.
• Risk factors for oral cancer : a case control study.
• Prevalence and determinants of caesarean section in an urban slum.
• To study to determine the prevalence of diabetes mellitus and it’s associated risk factors in class iv employess of tertiary care hospital and their family members residing in the hospital campus.
• Assessment of vitamin d status among the geriatric population in a tertiary care hospital of a metropolitan city.
• Prevalence of anemia morbidity school absenteeism and examination performance among lower primary school children.
• Coronary heart disease at the tertiary care hospital – a 5 years retrospective analysis.
• Assessment of the functionality status of the health facilities,according to the iphs guidelines.
• An epidemiological study of health hazards in sawmill workers.
• Study of prevalence & risk factors of metabolic syndrome in teaching staff of Engineering college.
• An epidemiological study of road traffic accident cases admitted in tertiary care Hospital from central india.
• Immunization coverage and its associated factors among children aged 12-23 months in rural area of a district.
• Evaluation of janani suraksha yojana in rural area of a district.
• Nutritional status of adolescent girls in rural area of a district.
• Study of factors associated with delay in diagnosis and treatment initiation in pulmonary tuberculosis.
• Cross sectional study of health status of geriatric population in urban and rural field practice area under community medicine department.
• Monitoring and surveillance of hypertension control in urban slum through community ownership programme.
• An epidemiological study of acute malnutrition in children six months to five years of age in an urban slum.
• Study of health care seeking behaviour and reasons for patient and health system delay in diagnosis of tuberculosis patients
• A cross sectional study to assess the antenatal utilization and factors affecting them in a tribal area.
• A cross-sectional review of issues and challenges in immunization services of under-five children amongst brick-kiln workers settlements.
• A cross-sectional epidemiological study of assessment of health needs and awareness regarding reproductive health in adolescent girls in rural area.
• An epidemiological study of health needs assessment and health seeking behavior Among geriatric population of and urban slum in a metro city
• A cross sectional epidemiological study of morbidity profile and assessment of health needs among workers of municipal water treatment plant.
• Clinical evaluation of safety and immunogenicity of indirab and verorab using simulated updated thai red cross regimen in healthy volunteers phase iii randomized controlled trial.
• A study of health problems lifestyle and behaviour of college youths in an urban area.
• Occupational health and safety measures among the health care workers in ancillary departments of a private tertiary care hospital.
• An epidemiological study of morbidity profile and health seeking behavior amongst brick workers in a rural field area of tertiary care hospital.
• A cross sectional epidemiological study of morbidity pattern and factors influencing mental health status with special focus on depression in geriatric population in field practice area of unban an health centre.
• A cross-sectional study to determine occupational determinants influencing health status & morbidity profile of traffic police in a metropolitan city.
• An epidemiological study to evaluate determinants influencing health status amongst married working women in the administrative departments of a medical college and a tertiary care hospital attached to it.
• An epidemiological mapping of growth and development in children below 3 years of age in a rural area.
• A cross-sectional study to evaluate the epidemiological determinants influencing the health status of meat handlers in the field practice area of an urban health centre in a metropolitan city.
• A study of knowledge attitudes and practices of private general practitioners in davangere city regarding tuberculosis and its control.
• Study of profile of the burns cases admitted to the a tertiary care hospital.
• Study of acute respiratory infections among pre-school children in rural field practice area.
• A prospective study to know the type of tuberculosis treatment outcome and reason for default among pediatric tuberculosis cases.
• Study of gaps between precepts and practices of preventive measures and pre hospital care among injury cases.
• A study to assess the outcome with particular reference to institutional deliveries after interventions under janani suraksh yojana in a primary health center area.
• Prevalence of bronchial asthma in adult population in rural field practice area.
• Knowledge attitude and practice of first aid in rural women
• To determine measles vaccination coverage and the socio-cultural factors associated with partial immunization among children of aged between 9-24 months in the urban slums.
• Nutritional status of adolescent girls residing in an urban slum of bagalkot city – a cross sectional study.
• A study on risk factors of type-2 diabetes mellitus – a case control study.
• Acute respiratory infections in under five children in urban slums.
• To estimate the proportion of substance use and socio-demographic factors among street children.
• Epidemiological determinants among the suspects of multidrug resistance tuberculosis.
• Occupational safety and health risks in selected estates of a tea planting company.
• A comparative study of prevelence and needs of persons with disability in selected rural areas.
• Health scenario and service utilization in urban slums of Surat city: Perspectives among young girls.
• Assessment of the Factors Related to the Development of Drug Resistant Tuberculosis in Category IV Eligible Patients.
• A study on life style risk factors on prevalence of hypertension among college going students.
• Situational analysis of NICU of tertiary health care, public health sector of western India.
• Diagnosis, Compliance & Treatment Outcome Among Public & Private Sector- A Retrospective Cohort Study.
• Undernutrition Among Three to Five Years Old Children Attending Anganwadi Centers in a City.
• Study of health profile and lifestyle disorder pattern among medical students.
• A Study Of Knowledge, Attitude and Practice Of Universal Precautions and Post Exposure Prophylaxis for HIV Among Resident doctors.
• An interventional study regarding reproductive health among adolescent girls in the rural field practice area.
• Evalution of Treatment outcome of tuberculosis patients in the urban filed practice area.
• Rural Prevalence of type 2 diabets mellitus :A Cross sectional study
• Occupational Stress among staff nurses: Controlling the risk to health.

Disclaimer!

There are many methods of sample size determination. It is one of the first hurdle when someone starts writing a thesis. I have tried to give simplest way of determination of sample size. You need to show the method to your PG teacher before you include this method in your thesis. First confirm from your PG teacher and then only proceed.

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Generative AI develops potential new drugs for antibiotic-resistant bacteria

Stanford Medicine researchers devise a new artificial intelligence model, SyntheMol, which creates recipes for chemists to synthesize the drugs in the lab.

March 28, 2024 - By Rachel Tompa

Acinetobacter baumannii infection is a leading cause of death related to antibiotic resistance. Stanford Medicine researchers employed artificial intelligence to provide recipes for drugs that can treat it.  Kateryna Kon /Shutterstock.com

With nearly 5 million deaths linked to antibiotic resistance globally every year, new ways to combat resistant bacterial strains are urgently needed.

Researchers at Stanford Medicine and McMaster University are tackling this problem with generative artificial intelligence. A new model, dubbed SyntheMol (for synthesizing molecules), created structures and chemical recipes for six novel drugs aimed at killing resistant strains of Acinetobacter baumannii, one of the leading pathogens responsible for antibacterial resistance-related deaths.

The researchers described their model and experimental validation of these new compounds in a study published March 22 in the journal Nature Machine Intelligence .

“There’s a huge public health need to develop new antibiotics quickly,” said James Zou , PhD, an associate professor of biomedical data science and co-senior author on the study. “Our hypothesis was that there are a lot of potential molecules out there that could be effective drugs, but we haven’t made or tested them yet. That’s why we wanted to use AI to design entirely new molecules that have never been seen in nature.”

Before the advent of generative AI, the same type of artificial intelligence technology that underlies large language models like ChatGPT, researchers had taken different computational approaches to antibiotic development. They used algorithms to scroll through existing drug libraries, identifying those compounds most likely to act against a given pathogen. This technique, which sifted through 100 million known compounds , yielded results but just scratched the surface in finding all the chemical compounds that could have antibacterial properties.

Kyle Swanson

“Chemical space is gigantic,” said Kyle Swanson , a Stanford computational science doctoral student and co-lead author on the study. “People have estimated that there are close to 10 60 possible drug-like molecules. So, 100 million is nowhere close to covering that entire space.”

Hallucinating for drug development

Generative AI’s tendency to “hallucinate,” or make up responses out of whole cloth, could be a boon when it comes to drug discovery, but previous attempts to generate new drugs with this kind of AI resulted in compounds that would be impossible to make in the real world, Swanson said. The researchers needed to put guardrails around SyntheMol’s activity — namely, to ensure that any molecules the model dreamed up could be synthesized in a lab.

“We’ve approached this problem by trying to bridge that gap between computational work and wet lab validation,” Swanson said.

The model was trained to construct potential drugs using a library of more than 130,000 molecular building blocks and a set of validated chemical reactions. It generated not only the final compound but also the steps it took with those building blocks, giving the researchers a set of recipes to produce the drugs.

The researchers also trained the model on existing data of different chemicals’ antibacterial activity against A. baumannii . With these guidelines and its building block starting set, SyntheMol generated around 25,000 possible antibiotics and the recipes to make them in less than nine hours. To prevent the bacteria from quickly developing resistance to the new compounds, researchers then filtered the generated compounds to only those that were dissimilar from existing compounds.

“Now we have not just entirely new molecules but also explicit instructions for how to make those molecules,” Zou said.

A new chemical space

The researchers chose the 70 compounds with the highest potential to kill the bacterium and worked with the Ukrainian chemical company Enamine to synthesize them. The company was able to efficiently generate 58 of these compounds, six of which killed a resistant strain of A. baumannii when researchers tested them in the lab. These new compounds also showed antibacterial activity against other kinds of infectious bacteria prone to antibiotic resistance, including E. coli, Klebsiella pneumoniae and MRSA.

The scientists were able to further test two of the six compounds for toxicity in mice, as the other four didn’t dissolve in water. The two they tested seemed safe; the next step is to test the drugs in mice infected with A. baumannii to see if they work in a living body, Zou said.

The six compounds are vastly different from each other and from existing antibiotics. The researchers don’t know how their antibacterial properties work at the molecular level, but exploring those details could yield general principles relevant to other antibiotic development.

“This AI is really designing and teaching us about this entirely new part of the chemical space that humans just haven’t explored before,” Zou said.

Zou and Swanson are also refining SyntheMol and broadening its reach. They’re collaborating with other research groups to use the model for drug discovery for heart disease and to create new fluorescent molecules for laboratory research.

The study was funded by the Weston Family Foundation, the David Braley Centre for Antibiotic Discovery, the Canadian Institutes of Health Research, M. and M. Heersink, the Chan-Zuckerberg Biohub, and the Knight-Hennessy scholarship.

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• Rachel Tompa Rachel Tompa is a freelance science writer.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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Chick-fil-A will soon allow some antibiotics in its chicken. Here's when and why.

Chick-fil-A will shift to allow some antibiotics in its chicken starting this spring, overturning a 2014 commitment to use only antibiotic-free chicken.

"To maintain supply of the high-quality chicken you expect from us, Chick-fil-A will shift from No Antibiotics Ever (NAE) to No Antibiotics Important To Human Medicine (NAIHM) starting in the Spring of 2024," an update on the restaurant chain's website on Thursday said.

According to the announcement, chicken antibiotics will only be used "if the animal and those around it were to become sick."

The antibiotics used to treat the poultry are not intended for humans.

"In accordance with FDA requirements, all antibiotics must be cleared from the chicken’s system before it is considered available for the chicken supply.  The United States Department of Agriculture audits and verifies that suppliers are meeting the requirements of the Chick-fil-A NAIHM commitment." the statement said.

Switch comes decade after antibiotic-free promise

In 2014, the fast-food chain announced that it planned only to sell chicken raised without antibiotics at all its stores within five years. By 2019, all Chick-fil-A restaurants were serving 100% antibiotic-free ch icken .

“As we looked to the future, the availability of high-quality chicken that meets our rigid standards became a concern. This change enables us to not only ensure we can continue to serve high-quality chicken, but also chicken that still meets the expectations our customers count on us to deliver," Chick-fil-A told USA TODAY in a statement.

The move follows announcements made by several other companies. In 2023, Tyson Foods, the largest chicken producer in the United States, also moved away from its 2015 pledge of "no antibiotics ever."