scholarly journals Ceftriaxone Prescription at Muhimbili National Hospital

2020 ◽  
Vol 21 (2) ◽  
pp. 1-13
Author(s):  
Philip Galula Sasi
Keyword(s):  
Bacterial Infections ◽  
Treatment Guidelines ◽  
Tertiary Hospital ◽  
Resistance Rate ◽  
Coagulase Negative Staphylococcus ◽  
National Treatment ◽  
Klebsiella Species ◽  
Inappropriate Use ◽  
Klebsiella Spp ◽  
Dramatic Fall

S Background: Since their discovery, antibiotics have contributed to a dramatic fall in morbidity and mortality from bacterial infections. However, the emergence and spread of antibiotic resistance continues to threaten the effectiveness of these agents. Ceftriaxone is one of the most important medications needed in a basic health system. Yet high levels of inappropriate use have been reported increasing the likelihood of emergence and spread of resistance. Methods: We conducted a descriptive study to characterize ceftriaxone prescription and resistance at a tertiary hospital. Results: Three hundred and sixty prescriptions were observed and 194 (54 %) deviated from the National Treatment guidelines with regards to indication. For patients with conditions for which ceftriaxone is recommended, 93 % (154 out of 166) prescriptions deviated from the guideline with regard to dosing frequency and 67 % deviated with regards to the duration of administration. Coagulase Negative Staphylococcus (CoNS), Escherichia coli, Klebsiella spp, and Pseudomonas aeruginosa were the most common isolates and with the highest ceftriaxone resistance rate (up to 80%). Conclusions: At MNH, ceftriaxone is commonly inappropriately prescribed and the risk of emergence and spread of ceftriaxone resistant isolates may be high.  The majority of CoNS and Klebsiella species are resistant, thus cautious ceftriaxone prescription is needed.

scholarly journals Early Onset and Late Onset of Neonatal Sepsis in a Tertiary Hospital, South-South, Nigeria

2020 ◽  
pp. 19-29
Author(s):  
A. A. Adedokun ◽  
E. O. Onosakponome ◽  
C. U. Nyenke
Keyword(s):  
Staphylococcus Aureus ◽  
Clavulanic Acid ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Tertiary Hospital ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococcus ◽  
Therapeutic Success ◽  
Klebsiella Spp

Aims: The study was carried out to determine organisms present during early onset of neonatal sepsis (EONNS), late onset of neonatal sepsis (LONNS) and their antimicrobial susceptibility pattern. Methodology: This study is a retrospective evaluation of 453 neonatal blood cultures. Two (2) ml of blood from these neonates was cultured in thioglycollate broth and tryptone soya broth. This was carried out in the Department of Microbiology and Parasitology of the University of Port Harcourt Teaching Hospital, Nigeria between January-December 2007. Results: Out of 453, 272(60.0%) neonates showed negative blood cultures, while 181(40.0%) neonates had positive bacterial cultures and 2 neonates (0.4%) were positive for Candida albicans. Overall, Klebsiella spp. was the most common pathogen, accounting for (37.8%) of the total isolates. Others were as follows; Staphylococcus aureus (28.4%), Escherichia coli (11.8%), unclassified coliforms 8.3%, Pseudomonas spp. 4.9%, Enterococcus spp. (2.9%), coagulase-negative Staphylococcus (CONS) (2.5%) and Proteus spp. (3.4%). Early onset neonatal sepsis (EONNS) and late onset neonatal sepsis (LONNS) had Klebsiella spp and Staphylococcus aureus as their common causes of neonatal sepsis respectively. Klebsiella spp. was susceptible to spafloxacin (87.0%) followed by ofloxacin (82.0%), amoxycillin-clavulanic acid (79.0%) and ceftazidime (65.0%) among the Gram-negative organisms. In the category of Gram-positive organisms, Staphylococcus aureus is highly sensitive to ofloxacin (81.0%) followed by spafloxacin (79.0%) and amoxicillin-clavulanic acid (71.0%). Conclusion: A viable antibiotic susceptibility surveillance programme coupled with good infection control practices and rational antibiotics use will reduce infection rate, ensure better therapeutic success and prolong the efficacy of available antimicrobials.

scholarly journals The use of antibiotics in the intensive care unit of a tertiary hospital in Malawi

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Raphael Kazidule Kayambankadzanja ◽  
Moses Lihaka ◽  
Andreas Barratt-Due ◽  
Mtisunge Kachingwe ◽  
Wezzie Kumwenda ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Blood Culture ◽  
Treatment Guidelines ◽  
Tertiary Hospital ◽  
National Guidelines ◽  
National Treatment ◽  
Icu Discharge ◽  
Different Types ◽  
Common Combination ◽  
Queen Elizabeth Central Hospital

Abstract Background Antibiotic resistance is on the rise. A contributing factor to antibiotic resistance is the misuse of antibiotics in hospitals. The current use of antibiotics in ICUs in Malawi is not well documented and there are no national guidelines for the use of antibiotics in ICUs. The aim of the study was to describe the use of antibiotics in a Malawian ICU. Methods A retrospective review of medical records of all admissions to the main ICU in Queen Elizabeth Central Hospital in Blantyre, Malawi, between January 2017 and April 2019. Data were extracted from the ICU patient register on clinical parameters on admission, diagnoses, demographics and antibiotics both prescribed and given for all patients admitted to the ICU. Usage of antibiotics in the ICU and bacterial culture results from samples taken in the ICU and in the peri-ICU period, (from 5 days before ICU admission to 5 days after ICU discharge), were described. Results Six hundred-and-forty patients had data available on prescribed and received medications and were included in the analyses. Of these, 577 (90.2%) were prescribed, and 522 (81.6%) received an antibiotic in ICU. The most commonly used antibiotics were ceftriaxone, given to 470 (73.4%) of the patients and metronidazole to 354 (55.3%). Three-hundred-and-thirty-three (52.0%) of the patients received more than one type of antibiotic concurrently – ceftriaxone and metronidazole was the most common combination, given to 317 patients. Forty five patients (7.0%) were given different antibiotics sequentially. One-hundred-and-thirty-seven patients (21.4%) had a blood culture done in the peri-ICU period, of which 70 (11.0% of the patients) were done in the ICU. Twenty-five (18.3%) of the peri-ICU cultures were positive and eleven different types of bacteria were grown in the cultures, of which 17.2% were sensitive to ceftriaxone. Conclusion We have found a substantial usage of antibiotics in an ICU in Malawi. Ceftriaxone, the last-line antibiotic in the national treatment guidelines, is commonly used, and bacteria appear to show high levels of resistance to it, although blood culture testing is infrequently used. Structured antibiotic stewardship programs may be useful in all ICUs.

Microbiological characteristics of peritoneal dialysis-related peritonitis in an Asian tertiary hospital 2011–2014

2019 ◽  
pp. 5-10
Author(s):  
Mui Hian Sim
Keyword(s):  
Escherichia Coli ◽  
Peritoneal Dialysis ◽  
Tertiary Hospital ◽  
Coagulase Negative Staphylococcus ◽  
Gram Positive ◽  
Gram Negative ◽  
Singapore General Hospital ◽  
Microbiological Characteristics ◽  
Micro Organisms ◽  
Klebsiella Spp

Background Peritonitis is the leading cause of technique failure among peritoneal dialysis (PD) patients. The study aimed to examine the microbiological characteristics of PD-related peritonitis in a tertiary hospital in Singapore. Methods A retrospective, cross-sectional study was performed at Singapore General Hospital (SGH). Data of patients diagnosed with PD-related peritonitis from January 2011 to December 2014 were collected. Microbiological characteristics of PD-related peritonitis were reported using descriptive statistics. Results A total of 377 episodes of peritonitis occurred in 247 patients. The average peritonitis rate in the centre was 0.23 episodes per patient year. There were 118 (31.2%) Gram-positive, 98 (26.0%) Gram-negative, 58 (15.4%) polymicrobial, 16 (4.2%) fungal, 2 (0.5%) mycobacterium and 85 (22.6%) culture-negative, PD-related peritonitis episodes. The three main Gram-positive micro-organisms isolated from peritoneal fluid cultures were Coagulase-negative Staphylococcus aureus (CoNS) (n=70, 17.6%), Streptococcus spp. (n=52, 13.1%) and Enterococcus spp. (n=28, 7.1%), while the three main Gram-negative isolates were Escherichia coli (n=50, 12.6%), Klebsiella spp. (n=46, 11.6%) and Enterobacter spp. (n=27, 6.8%). Candida parapsilosis (n=9, 1.9%) was the commonest fungus identified. Only 33 (47.1%) CoNS strains were sensitive to cefazolin, which was used in the institution for empiric coverage of Gram-positive micro-organisms in PD-peritonitis. All Streptococcus strains were sensitive to cefazolin (n=52). The majority of Escherichia coli (n=38, 76%), Klebsiella spp. (n=37, 80.4%) and Enterobacter spp. (n=18, 66.7%) strains were sensitive to gentamicin, the empiric antibiotic used for coverage of Gram-negative micro-organisms. Conclusions Our findings highlight the importance of regular monitoring of micro-organisms and their antimicrobial sensitivities in determining appropriate, centre-specific empirical antibiotics.

Distribution of Common Pathogens and Bacterial Resistance in A Tertiary Hospital in China

2021 ◽  
Vol 7 (5) ◽  
pp. 1736-1745
Author(s):  
Jing Ping ◽  
Naiwei Li ◽  
Le Huang ◽  
Zhaohua Zhou ◽  
Xihong Zhang ◽  
...  
Keyword(s):  
Bacterial Resistance ◽  
Tertiary Hospital ◽  
Drug Susceptibility ◽  
Resistance Rate ◽  
Coagulase Negative Staphylococcus ◽  
Detection Rates ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Resistant Strains ◽  
Resistance Rates

We aimed to explore the distribution of common pathogens and bacterial resistance in our hospital from 2017 to 2020, and to standardize clinical medication guidance. The pathogens isolated from the submitted specimens were identified, and drug susceptibility results were interpreted according to the Clinical and Laboratory Standards Institute guidelines (2017-2020). A total of 43,588 specimens were collected from patients treatedfrom 2017 to 2020, and 6,285 strains of pathogens were isolated. The most common pathogens were Escherichia coli, Haemophilus influenzae and Klebsiella pneumoniae.Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 32.85%, and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) accounted for 78.79%. The resistance rates of MRSA and MRCNS to ciprofloxacin, levofloxacin, erythromycin, clindamycin and trimethoprim-sulfamethoxazole were significantly higher than those of methicillin-sensitive S. aureus and methicillin-sensitive coagulase-negative Staphylococcus. The resistance rate of Streptococcus pneumoniae to erythromycin, tetracycline and clindamycin was higher than 80%. The detection rates of E. coli and K. pneumoniae producing ESBL strains were 62.2% and 25.6%, respectively. Totally, 769 carbapenem-resistant strains were detected, of which carbapenem-resistant Acinetobacter baumannii (CRAB) accounted for 66.6%, followed by carbapenem-resistant K. pneumoniae (CRKP) and carbapenem-resistant Pseudomonas aeruginosa (CRPA). A total of 202 CRE strains were detected, which were mainly isolated from respiratory tract and urine specimens. CRAB, CRKP and CRPA had higher resistance rates to antibacterial drugs. Gram-negative bacilli are the most common pathogens from 2017 to 2020. Considering that pathogens have high drug resistance, it is recommended to strengthen clinical management and rational application of antibiotics, thus reducing the risk of nosocomial infections.

The Characterization of Antibiotic Resistance of Bacterial Isolates from Intensive Care Unit Patient Samples in a University Affiliated Hospital in Romania

2019 ◽  
Vol 70 (5) ◽  
pp. 1778-1783
Author(s):  
Andreea-Loredana Golli ◽  
Floarea Mimi Nitu ◽  
Maria Balasoiu ◽  
Marina Alina Lungu ◽  
Cristiana Cerasella Dragomirescu ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antibiotic Resistance ◽  
Bacterial Pathogens ◽  
Resistance Rate ◽  
Resistance Pattern ◽  
Bacterial Isolates ◽  
E Coli ◽  
Acinetobacter Spp ◽  
Almost All ◽  
Klebsiella Spp

To determine the resistance pattern of bacterial pathogens involved in infections of the patients aged between 18-64 years, admitted in a ICU from a 1518-bed university-affiliated hospital. A retrospective study of bacterial pathogens was carried out on 351 patients aged between 18-64 years admitted to the ICU, from January to December 2017. In this study there were analysed 469 samples from 351 patients (18-64 years). A total of 566 bacterial isolates were obtained, of which 120 strains of Klebsiella spp. (35.39%%), followed by Nonfermenting Gram negative bacilli, other than Pseudomonas and Acinetobacter (NFB) (75- 22.12%), Acinetobacter spp. (53 - 15.63%), Pseudomonas aeruginosa and Proteus (51 - 15.04%), and Escherichia coli (49 - 14.45%). The most common isolates were from respiratory tract (394 isolates � 69.61%). High rates of MDR were found for Pseudomonas aeruginosa (64.70%), MRSA (62.65%) and Klebsiella spp. (53.33%), while almost all of the isolated NFB strains were MDR (97.33%). There was statistic difference between the drug resistance rate of Klebsiella and E. coli strains to ceftazidime and ceftriaxone (p[0.001), cefuroxime (p[0.01) and to cefepime (p[0.01). The study revealed an alarming pattern of antibiotic resistance in the majority of ICU isolates.

scholarly journals Bloodstream infection with Acinetobacter baumanii in a Plasmodium falciparum positive infant: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Charity Wiafe Akenten ◽  
Kennedy Gyau Boahen ◽  
Kwadwo Sarfo Marfo ◽  
Nimako Sarpong ◽  
Denise Dekker ◽  
...  
Keyword(s):  
Case Report ◽  
Bacterial Infections ◽  
Treatment Options ◽  
Female Child ◽  
Correct Choice ◽  
Blood Cultures ◽  
Microbial Culture ◽  
Acinetobacter Baumanii ◽  
Inappropriate Use ◽  
History Of

Abstract Background The increasing incidence of multi-antibiotic-resistant bacterial infections, coupled with the risk of co-infections in malaria-endemic regions, complicates accurate diagnosis and prolongs hospitalization, thereby increasing the total cost of illness. Further, there are challenges in making the correct choice of antibiotic treatment and duration, precipitated by a lack of access to microbial culture facilities in many hospitals in Ghana. The aim of this case report is to highlight the need for blood cultures or alternative rapid tests to be performed routinely in malaria patients, to diagnose co-infections with bacteria, especially when symptoms persist after antimalarial treatment. Case presentation A 6-month old black female child presented to the Agogo Presbyterian Hospital with fever, diarrhea, and a 3-day history of cough. A rapid diagnostic test for malaria and Malaria microscopy was positive for P. falciparum with a parasitemia of 224 parasites/μl. The patient was treated with Intravenous Artesunate, parental antibiotics (cefuroxime and gentamicin) and oral dispersible zinc tablets in addition to intravenous fluids. Blood culture yielded Acinetobacter baumanii, which was resistant to all of the third-generation antibiotics included in the susceptibility test conducted, but sensitive to ciprofloxacin and gentamicin. After augmenting treatment with intravenous ciprofloxacin, all symptoms resolved. Conclusion Even though this study cannot confirm whether the bacterial infection was nosocomial or otherwise, the case highlights the necessity to test malaria patients for possible co-infections, especially when fever persists after parasites have been cleared from the bloodstream. Bacterial blood cultures and antimicrobial susceptibility testing should be routinely performed to guide treatment options for febril illnesses in Ghana in order to reduce inappropriate use of broad-spectrum antibiotics and limit the development of antimicrobial resistance.

scholarly journals The effect of eligibility for antiretroviral therapy on body mass index and blood pressure in KwaZulu-Natal, South Africa

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aditi Kuber ◽  
Anna Reuter ◽  
Pascal Geldsetzer ◽  
Natsayi Chimbindi ◽  
Mosa Moshabela ◽  
...  
Keyword(s):  
South Africa ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Antiretroviral Therapy ◽  
Body Mass ◽  
Treatment Guidelines ◽  
Causal Effect ◽  
Regression Discontinuity Design ◽  
National Treatment ◽  
Kwazulu Natal

AbstractWe use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical data on ART. We find that early ART eligibility significantly reduces systolic and diastolic blood pressure. We do not find any significant effects on BMI. The effect on blood pressure can be detected up to three years after becoming eligible for ART.

scholarly journals Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children’s Urine Cultures in an Italian Metropolitan Area

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 597
Author(s):  
Luca Pierantoni ◽  
Laura Andreozzi ◽  
Simone Ambretti ◽  
Arianna Dondi ◽  
Carlotta Biagi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Metropolitan Area ◽  
Bacterial Infections ◽  
Asymptomatic Bacteriuria ◽  
Multidrug Resistant ◽  
Resistance Rate ◽  
First Line ◽  
E Coli ◽  
First Line Therapy ◽  
Tract Infections

Urinary tract infections (UTIs) are among the most common bacterial infections in children, and Escherichia coli is the main pathogen responsible. Several guidelines, including the recently updated Italian guidelines, recommend amoxicillin-clavulanic acid (AMC) as a first-line antibiotic therapy in children with febrile UTIs. Given the current increasing rates of antibiotic resistance worldwide, this study aimed to investigate the three-year trend in the resistance rate of E. coli isolated from pediatric urine cultures (UCs) in a metropolitan area of northern Italy. We conducted a retrospective review of E. coli-positive, non-repetitive UCs collected in children aged from 1 month to 14 years, regardless of a diagnosis of UTI, catheter colonization, urine contamination, or asymptomatic bacteriuria. During the study period, the rate of resistance to AMC significantly increased from 17.6% to 40.2% (p < 0.001). Ciprofloxacin doubled its resistance rate from 9.1% to 16.3% (p = 0.007). The prevalence of multidrug-resistant E. coli rose from 3.9% to 9.2% (p = 0.015). The rate of resistance to other considered antibiotics remained stable, as did the prevalence of extended spectrum beta-lactamases and extensively resistant E. coli among isolates. These findings call into question the use of AMC as a first-line therapy for pediatric UTIs in our population, despite the indications of recent Italian guidelines.

scholarly journals Prevalence, distribution and antimicrobial susceptibility pattern of bacterial isolates from a tertiary Hospital in Malawi

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pizga Kumwenda ◽  
Emmanuel C. Adukwu ◽  
Ebot S. Tabe ◽  
Victor. C. Ujor ◽  
Pocha S. Kamudumuli ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Bacterial Infections ◽  
Blood Stream ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
Bacterial Isolates ◽  
Susceptibility Pattern ◽  
Management Options ◽  
Subsequent Increase ◽  
Antimicrobial Susceptibility Pattern

Abstract Background Bacterial infections are a significant cause of sickness and death in sub-Saharan Africa. This study aimed at establishing the prevalence, distribution and antimicrobial susceptibility pattern of major bacterial isolates from patients accessing medical care at a tertiary hospital in Malawi. Methods We retrospectively reviewed bacteria culture and antimicrobial susceptibility records for 4617 patients from 2002 to 2014 at Mzuzu Central Hospital (MCH). No inclusion and exclusion criteria were followed. Data was analysed using excel (Microsoft office, USA) and GraphPad prism 7 software programs. Results The most prevalent isolates were S. aureus (34.7%, n = 783), Klebsiella species (17.4%, n = 393) and Proteus species (11.4%, n = 256). Most microorganisms were isolated from adults (88.3%, n = 3889) and pus was the main source (69.3%, n = 1224). S. pneumoniae was predominantly isolated from cerebrospinal fluid (60.3%, n = 44) largely collected from children (88.2%, n = 64). Overall, most bacteria exhibited high resistance to all regularly used antimicrobials excluding ciprofloxacin. Conclusions Our report demonstrates an increase in bacterial infection burden in sites other than blood stream and subsequent increase in prevalence of antimicrobial resistance for all major isolates. Creating an epidemiological survey unit at MCH will be essential to help inform better treatment and management options for patients with bacterial infections.

scholarly journals Recent Development of Rapid Antimicrobial Susceptibility Testing Methods through Metabolic Profiling of Bacteria

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 311
Author(s):  
Chen Chen ◽  
Weili Hong
Keyword(s):  
Antimicrobial Susceptibility ◽  
Metabolic Profiling ◽  
Bacterial Infections ◽  
Susceptibility Testing ◽  
Antimicrobial Susceptibility Testing ◽  
Bacterial Metabolism ◽  
Resistant Bacteria ◽  
Bacterial Cells ◽  
Inappropriate Use ◽  
Key Factor

Due to the inappropriate use and overuse of antibiotics, the emergence and spread of antibiotic-resistant bacteria are increasing and have become a major threat to human health. A key factor in the treatment of bacterial infections and slowing down the emergence of antibiotic resistance is to perform antimicrobial susceptibility testing (AST) of infecting bacteria rapidly to prescribe appropriate drugs and reduce the use of broad-spectrum antibiotics. Current phenotypic AST methods based on the detection of bacterial growth are generally reliable but are too slow. There is an urgent need for new methods that can perform AST rapidly. Bacterial metabolism is a fast process, as bacterial cells double about every 20 to 30 min for fast-growing species. Moreover, bacterial metabolism has shown to be related to drug resistance, so a comparison of differences in microbial metabolic processes in the presence or absence of antimicrobials provides an alternative approach to traditional culture for faster AST. In this review, we summarize recent developments in rapid AST methods through metabolic profiling of bacteria under antibiotic treatment.

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