Saudi Cultural Missions Theses & Dissertations
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Item Restricted Educational Provision in antimicrobial stewardship for Healthcare Professionals in NHS Wales(swansea, 2024) Alhazmi, Nawaf; Davies, AngharadBackground: Antimicrobial stewardship (AMS) initiatives are specialized programs designed to lower the incidence and development of antimicrobial resistance. Educational provisions impose direct and successful impact over the implementation of antibiotic resistance stewardship practices. The current study aims to take into account, or capture the amount and nature of education and training taking place in NHS Wales. Through AWARE interprofessional community members in Wales. The specific study objectives include assessment of the participation ratio of different types of healthcare professionals of NHS Wales, mode and duration of learning, and examination of challenges faced by NHS Wales healthcare personnel in AMS program across the health boards. Methods: Reliable datasets from five different Health Boards in Wales namely, Betsi Cadwaladr University Health Board's (BCUHB), Cwm Taf Morgannwg University Health Board (CTMUHB), Hywel Dda University Health Board (HDUHB), Swansea Bay University Health Board (SBUHB), and Aneurin Bevan University Health Board (ABUHB) were included. A survey was executed via Microsoft Forms, followed by statistical analysis utilising SPSS software, with data displayed as counts and frequencies. Results: Studies showed 2735 members received education and training. Mixed audiences of doctors, nurses, pharmacists, and allied healthcare practitioners were most numerous, followed by doctors and students (medical and pharmacy). Fewer nurses and pharmacists participated. Face-to-face sessions had the most participants, followed by virtual and hybrid sessions. Hybrid sessions lasted 60 minutes across all health boards, virtual sessions 20–120 minutes, and face-to-face sessions 20–300 minutes. The study documented participants' AMS program problems.. Conclusions: Antimicrobial stewardship education interventions have great impact in addressing the challenging issue of antimicrobial resistance, however for effective outcomes it is imperative to motivate participation of multi-functional healthcare professionals including nurses and pharmacists.22 0Item Restricted Understanding the effect of silver exposure on P. aeruginosa biofilms(The University of Manchester, 2025) Almuzaini, Osama; Humphreys, Gavin; Mcbain , AndrewBackground. The longstanding belief of the rarity of silver resistance development has facilitated the widespread use of silver in wound dressings. However, studies have shown that the prolonged exposure of clinical samples under laboratory investigation can result in reduced silver susceptibility. Most of these prolonged exposures have been conducted on planktonic isolates, whereas biofilms are the predominant state in chronic wounds. This PhD thesis aims to assess the bacteriological effects of repeated passaging of bacterial biofilm to ionic silver. Methods. Monospecies biofilms of Pseudomonas aeruginosa (WIBG 2.2) were grown in MBEC devices and repeatedly passaged under two distinct silver nitrate concentrations setting: (i) a constant ionic silver concentration and (ii) dynamic concentrations, where the exposure concentration was determined before each passage. After the fifth passage, biofilm variants were extracted, cultured on agar and compared morphologically. New morphological variants were limited to biofilms exposed to dynamic concentrations. MICs and MBECs were performed to assess the silver sensitivity of these variants, as well as cross-resistance to antimicrobials utilizing the EUCAST zone of inhibition protocol. Biofilm biomass of P. aeruginosa silver-treated variants grown in an MBEC device was determined using crystal violet staining. Extracellular DNA (eDNA) within the biofilm was visualized and quantified utilizing confocal laser scanning microscopy. eDNA was further digested by Deoxyribonuclease-I to evaluate its role in silver recalcitrance and biofilm integrity. Given the generation of mucoid biofilm, alginate production was measured using a carbazole assay. Following the phenotypic changes, all variants underwent whole genome sequencing to detect associated mutations. Bacterial competitive fitness was assessed using a broth co-culture assay, and bacterial-host virulence was determined using Galleria mellonella survival model. Finally, the morphological changes of the biofilm-derived variants were monitored through planktonic passaging in the absence of silver exposure, with growth kinetics determined using a plate reader. Results. Following dynamic exposure to ionic silver, mucoid biofilms were generated after the fifth passage, exhibiting distinct colony morphology named SV, BV, and BWV. Control biofilms passaged in LB broth resulted in two distinct colony morphologies named SC and BC. The treated biofilm variants (SV and BV) and one of the control variants (SC) exhibited reduced colony morphology. SV and BV showed the highest MBEC values, 2227- fold greater than the parent strain and 32-fold greater than the control passage. Compared to the baseline (P0), SV and SC exhibited a highly significant increase in biofilm biomass (P<0.0001), while BV, BWV, and BC exhibited no significant changes. Increased eDNA disposition was observed exclusively within the SV biofilm architecture. Alginate production was highest in BV, followed by BWV and SV, while control biofilm variants (SC and BC) exhibited no significant increases compared to the parent strain. Silver sensitivity was restored by treating biofilms with DNAse I, although this treatment also significantly reduced the biofilm biomass. None of the bacterial variants showed altered virulence compared to the parent strain, although BV exhibited a reduced growth rate. Both SV and BV demonstrated higher competitive fitness than the parent strain. The adapted colony morphology was transient upon subsequent planktonic passage in the absence of ionic silver. SV's colony morphology remained stable until the 11th passage, after which it started to resemble the parent strain. Similarly, BV reverted to the parent morphology by the 10th passage, and BWV began reverting by the 5th passage. In controls, BC began reverting by the 3rd passage, while SC started reverting by the 9th passage. Conclusion: Silver-adapted strains gained resistance through various mechanisms within their sessile phenotype embedded in the complex and heterogenous biofilm ecosystem, including eDNA deposition and alginate production, accompanied by several mutations. These mutations were associated with transport activity, virulence, metabolism, transcription and regulatory functions.12 0Item Restricted Antimicrobial resistance susceptibility in microbial isolates from hospital vs community wastewater sources(Newcastle University, 2024-09) Alsubhi, Raghad; Jobling, KellyThis study investigates the antimicrobial resistance (AMR) patterns in bacterial isolates from hospital and community wastewater sources in North-East England. The research aims to compare the prevalence and severity of AMR in these two environments, with a particular focus on carbapenem-resistant Klebsiella. Samples were collected from Darlington Memorial Hospital, Queen Elizabeth Hospital Gateshead, and their respective community wastewater systems. The study utilized selective agars, disc diffusion, and Minimum Inhibitory Concentration (MIC) methods to determine resistance levels. Additionally, multiplex PCR was employed to identify specific carbapenemase genes. Results indicate a higher prevalence of carbapenem-resistant isolates in hospital settings, with notable regional differences in resistance patterns. The findings underscore the critical role of hospitals as reservoirs for multidrug-resistant pathogens and highlight the need for targeted interventions to mitigate the spread of AMR in the environment10 0Item Restricted Antimicrobial Effects of Cold Atmospheric Plasma on Oral Biofilm Compared With No Treatment(Saudi Digital Library, 2023-08-07) Alshammari, Fahad Hashim; Ramage, GordonThis systematic review aimed to integrate existing knowledge regarding the antimicrobial potential of cold atmospheric plasma (CAP) in the context of oral biofilms, the cause of various oral infections. To achieve this, several databases, namely, MEDLINE, Embase, and Web of Science, were comprehensively searched for studies analysing the effects of CAP on oral biofilms. 11 studies are included to this review, and the outcomes of these studies were analysed and summarised using a modified version of the MINORS assessment tool because of the lack of a more suitable tool for in vitro studies. The findings of this review highlighted the remarkable antimicrobial potential of CAP against oral biofilms; however, considerable variation as noted in some specific parameters such as the type of gas, biofilm species, treatment duration, and voltage. Prior studies have suggested a 2-min threshold for efficacy; however, according to the findings of this review, this most studies indicated that CAP displayed efficient antimicrobial in less than 2 min. Additionally, the review indicated that CAP was adaptable and safe and has a minimal detrimental impact on nontarget tissues and oral materials. The review validated the antimicrobial effectiveness of CAP against oral biofilms, presenting it as a promising alternative to conventional techniques such as, mechanical debridement and antibiotics. Future in vivo and in vitro studies are warranted to validate these findings, create specific quality assessment tools for in vitro research, and explore the effects of CAP on nontarget tissues and common oral surfaces. These measures may help promote the use of CAP as an effective antimicrobial strategy in dentistry.6 0