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Apr 2024 DOI 10.14302/issn.2690-4721.ijcm-24-5030
Typhoid fever, caused by the human restricted pathogen Salmonella Typhi, remains a major global public health concern. Even after successful treatment, approximately 3-5% of patients with typhoid fail to clear the bacteria within one year and become chronic carriers. Most typhoid carriers have gallstones in their gallbladder, and biofilm formation on gallstones is highly correlated with chronic carriage. This study’s goal was to identify asymptomatic typhoid carriers in an endemic setting in Kenya, and to compare acute versus chronic isolates. A cohort of typhoid fever patients identified through blood and/or stool culture, and their household contacts, were followed up after treatment to detect longitudinal S. Typhi stool shedding. An abdominal ultrasound scan was used to identify individuals with gallstones. A total of 32 index patients and 32 household contacts were successfully followed-up. Gallstones were detected in 4 cases and 1 household contact. The duration of S. Typhi shedding was significantly longer in individuals with gallstones compared to those without, P<0.001. Eighty-three (83) S. Typhi strains were tested for susceptibility to commonly used antimicrobials and examined by in vitro biofilm formation assays. Out of 37 infected individuals, 32.4% had infections caused by multidrug resistant (MDR) S. Typhi strains and only 18.9% were infected by susceptible strains. Non-MDR strains formed significantly better biofilms in vitro than the MDR strains (P<0.001). This study provides data on S. Typhi chronic carriage that will influence public health approaches aimed at reducing typhoid transmission and the burden of infection.
Jun 2021 DOI 10.14302/issn.2474-3585.jpmc-21-3851
Background The rapid and ongoing spread of antimicrobial-resistant organisms threatens the ability to successfully prevent, control, or treat a growing number of infectious diseases in developed and developing countries. This study was designed to convey more insight on the profile of antimicrobial resistance and the capacity of laboratories conducting antimicrobial susceptibility testing in Cameroon. Methods A multicentre cross-sectional study was conducted from October 2019 to March 2020 in the Deido Health District. Laboratories that carry out culture and sensitivity testing within the Deido Health District were identified and assessed to determine their capacity as well as the quality of results from microbiological investigations. Information on antimicrobial susceptibility of various isolates was collected using tablet phones in which the study questionnaires had been incorporated. Results Gaps identified in antimicrobial susceptibility testing that cut across laboratories included; insufficient standard operating procedures, inadequate records on personnel training and competency assessment, lack of safety equipment such as biosafety cabinet, stock out and non-participation in external quality assurance program. The turnaround time for antimicrobial susceptibility testing ranged from 3 – 7 days. Out of the 1797 samples cultured, 437(24.3%) had at least one isolate. A total of 15 different isolates were identified with Candida albicans being the most frequent 178 (40.7%), followed by Escherichia coli 80(18.3%). Among the 15 classes of antimicrobial drugs used in this study, the overall resistance of the isolates showed that five classes had class median resistance above 40% (Cephalosporins, Penicillins, Beta-lactam, Macrolides, and Polyenes). Conclusion This study has shown the need to develop a coordinated national approach to fight antimicrobial resistance. Scaling-up of antimicrobial susceptibility testing will, therefore, require strengthening the microbiology units of laboratory systems as well as ensuring the use of laboratory data for decision making.
Mar 2024 DOI 10.14302/issn.2640-690X.jfm-24-5016
Background Antibiotics are the most prescribed medications worldwide. Global consumption rose by 65% in 76 low and middle-income countries between the years 2000 and 2015. According to the World Health Organization, improper administration of antibiotics occurs in over 60% of people with upper respiratory tract infections. Inadvertent antibiotic use has been identified as a contributor to antimicrobial resistance. Outpatient antibiotic use accounts for around 80-90% of all antibiotic use in patients. Clinical officers are non-physician healthcare workers who have received less training, have a more restricted scope of practice than physicians. Clinical officers are key service providers in this country especially at the primary healthcare level. Objective The study assessed the factors that influence antibiotic prescribing for upper respiratory tract infections by clinical officers. Method A prospective study was carried out at 20 public hospitals in Kiambu County, on 36 clinical officers and 600 patient prescriptions. The parameters measured were patient factors, prescriber factors, institutional factors and how they affected the antibiotic prescribing practices by either being rational or irrational. Rational prescribing was identified as prescribing the right drug, at the right frequency, in the right duration, right dose for the right indication. Prescriptions were considered irrational if they did not satisfy any of the rational indices. Data was collected via a questionnaire from the clinical officers while WHO prescription checklist was used to collect data from patient encounters. Data was analyzed using Statistical Package for Social Sciences version 22.0 (SPSS v22.0) with P-value, Confidence Interval and Odds Ratio. Results A total of 600 patient encounters were recorded and 79.8% of the 479 encounters had an antibiotic prescription for URTI, 91% of the antibiotics prescribed were the right dose, 98% had the right frequency, 75% had the right duration, and only 23% had the right indication. Patients above 65 years were more likely to receive an antibiotic prescription OR 3.98 CI 0.91,17.41 P=0.17 compared to children under 12 years old. Males were more likely to receive an antibiotic, but this was not significant OR 1.06 CI 0.70, 1.59 P=0.79. A total of 28 (4.6%) patients had fever, and all received antibiotics. A total of 36 clinical officers were sampled and only 5 (13.8%) were found to have rational prescriptions (P=0.63), prescriber age (P=0.92), prescriber level of education (P=0.99) and prescriber work experience (P=0.22) were not associated with antibiotic prescription. As per institutional factors, availability of antibiotics (P=0.026) and availability of prescription guidelines (P=0.012) were associated with rational prescription of antibiotics. Conclusion The study indicated that there was a high antibiotic prescription rate deviating from the WHO standard. It demonstrated that most antibiotic prescriptions were irrational.
Aug 2020 DOI 10.14302/issn.2641-5526.jmid-20-3494
Introduction Antimicrobial stewardship (ASP) is of the utmost importance as a way to optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. So, it is worthwhile to assess the knowledge, attitude and awareness regarding antimicrobial stewardship in hospitals. Objective The aim of this study is to assess knowledge, attitudes and practices (KAP) of prescribers towards antimicrobial stewardship at hospitals in Khartoum state and to identify the associations between prescriber’s demographic information and their knowledge. Methodology This descriptive cross-sectional study multi-centered study conducted in 10 hospitals at Khartoum state -Sudan, during period from November to December 2018. Study population included all prescribers who is available at study’s hospitals during study period and willing to participate in the study. A self-administered questionnaire addressing participants’ knowledge, attitudes, and practice (KAP) regarding antibiotic resistance and ASP distributed in the selected hospitals among attending house-officers, registrars and consultants completed then analyzed. Results Of the 294 medical staff targeted, 287 responded to the survey (response rate 97.6%). Only (26.4%) were familiar with the term ASP and (31.5%) claimed that it is effective in reducing resistance. (43.0%) of respondents believe that ASP play vital role on antibiotic prescribing. Only (9.5%) had ASP in their hospital and (13.5%) having policy and team. (45.3%) of participants had good level of knowledge about antimicrobial stewardship, but majority show negative attitude (63.1%), and poor practices (92.0%) regarding ASP. There was no observed correlation between knowledge and attitude, knowledge with practice (p-value ≥ 0.05). Only attitude with practice shows significance correlation (P=0.0001), which means that prescribers with positive attitude had the better practices towards antimicrobial stewardship. Age, occupation and experience are the only significant predictors of prescriber's knowledge and attitude towards antibiotic stewardship, while no association between these factors and practice. Conclusion The present study concludes that the knowledge of prescribers regarding ASP is moderate and their attitude is negative. Unfortunately, practices regarding ASP were poor, despite, the good knowledge regarding the effects of ASP on antimicrobial resistance.
Jan 2020 DOI 10.14302/issn.2690-4721.ijcm-19-3154
Background The morbidity and mortality associated with the multi drug resistant Gram negative bacterial infections pose a significant and growing challenge to clinical practitioners. Klebsiella pneumoniae, which is a substantial nosocomial pathogen and confer high levels of resistance to broad-spectrum antibiotics including carbapenems. The aim of this study is to determine the resistance profiles of Klebsiella pneumoniae strains isolated from various clinical specimens. Material and Method In this study, the antibiotic susceptibility profiles of 2452 Klebsiella pneumoniae strains isolated from various clinical specimens between July 2015 and November 2019 were considered retrospectively. Blood culture vials were incubated in Bac T / Alert 3D automated system, other samples were cultured on blood and Eosin Methylene-blue (EMB) medium. The identification and antibiotic susceptibility tests of the isolated bacteria were performed by VITEC 2 Compact ID-AST cards (BioMérieux, Marcy l’Etoile, Fransa) and the results were evaluated according to the standards of the Europian Committee on Antimicrobial Susceptibility testing (EUCAST). The first sample of each patient was included in the study. The strains with inappropriate results were re-studied with gradient agar diffusion test (BioMérieux, Marcy l’Etoile, Fransa). Results The study included a total of 2452 Klebsiella pneumoniae strains and the distribution of samples was as follows: 894 (36, 5 %) blood, 790 (32, 2%) bronchial lavage, 211 (8,6 %) wound, 148 (6 %) drainage, 148 (6 %) peritoneal fluid, 95 (3, 9 %) tracheal aspirates, 64 (2,6%) catheter, 62 (2,5 %) urine, 40 (1,6%) other samples (pleural fluid, cerebrospinal fluid, throat ). In this study, antibiotic susceptibility test results indicated that the resistance to tigecycline was lowest (0, 3%). High colistin resistance ratio (33, 5 %) in carbapenem-resistant Klebsiella pneumoniae was considered to be of concern. Conclusion In this study, high rates of resistance to carbapenems were noteworthy. Determination of hospital antimicrobial resistance rates will be useful in developing antibiotic use policies of each hospital, in the treatment of causative agents, in selecting antibiotics according to antimicrobial susceptibility.
May 2018
Microorganisms are the main cause of food-borne illness in humans that may occur by consuming unhygienic products from poultry and other sources. With the passage of time bacterial resistance to antibiotics is ever-increasing which necessitates development of new antibiotics. One of the most obvious reasons of antimicrobial resistance in human-beings is the consumption of contaminated food with microbes. The aim of present study is to isolate, identify and characterize the food-borne pathogens from chicken eggs. For this purpose, a total of 240 egg samples were collected from eight different towns of Faisalabad. Samples were collected from egg surface, yolk, albumin and egg tray. Isolation, identification and characterization of commonly occurring egg borne pathogens including E. coli, Salmonella spp., Bacillus subtilis, Staphylococcus aureus were carried out by different cultural, morphological and biochemical tests. Antibiotic resistance pattern of recovered bacterial pathogens was determined by disk diffusion method (Kirby-Bauer). Zone of inhibition was measured through vernier calliper. The results revealed a high prevalence of Salmonella entitidis with 40.83% following Staphylococcus aureus with 22.08%, Escherichia coli with 17.92% and Bacillus subtilis in a lower ratio with 2.5%. The antibiotic sensitivity test showed different resistance patterns of the isolated microbes. For this purpose, five different drugs were used that included cefotaxime, tetracycline, gentamicin, levofloxacin and penicillin. Bacillus subtilis was highly resistant to penicillin and cefotaxime. Whereas, E. coli showed resistance to three antibiotics that were tetracycline, cefotaxime and penicillin. The only drug to which Staphylococcus aureus showed resistance was cefotaxime. Salmonella was resistant to tetracycline and gentamicin. The study concluded that chicken egg is contaminated with a number of bacteria that could be pathogenic or not. So, there is need of proper attention to cope up with possible future egg-borne illnesses.