scholarly journals 1270. Molecular Characterization of Carbapenemase Producing Enterobacterales, Acinetobacter spp. and Pseudomonas spp. in Nosocomial and Community-acquired Clinical Isolates in Bogota, Colombia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S723-S724
Author(s):  
Luis F Reyes ◽  
Ingrid G Bustos-Moya ◽  
Diego Josa ◽  
Enrique Gamboa-Silva ◽  
Elsa Daniela Ibañez-Prada ◽  
...  
Keyword(s):  
Molecular Characterization ◽  
Low Income ◽  
Public Health Problem ◽  
Carbapenem Resistance ◽  
Retrospective Chart Review ◽  
Molecular Characteristics ◽  
Middle Income ◽  
Middle Income Countries ◽  
Carbapenem Resistant ◽  
Acinetobacter Spp

Abstract Background Antimicrobial resistance (AMR) in low-income and middle-income countries (LMICs) is a public health problem. AMR is a concerning problem in Gram-negative bacteria such are Enterobacterales, which are frequently carbapenem-resistant pathogens (CRP), and few therapeutic options are available. However, scarce data is known regarding the clinical, molecular characteristics, and clinical outcomes of patients infected with carbapenem-resistant pathogens in LMICs. Thus, this study will attempt to bring novel data in these regards. Methods This is a retrospective cohort study conducted in two reference hospitals in Colombia, South America. All consecutive patients infected with CRPs between 2017 and 2021 were included. Clinical data were gathered by retrospective chart review. Bacterial pathogens and antibiotic susceptibility were prospectively identified and stored by each hospital. Molecular characterization was performed by PCR in isolated bacteria. Results A total of 220 patients were included. The mean (SD) age was 60.6 (18.4) years, and 32% (71/220) were female. The most frequently identified CRPs were Pseudomonas aeruginosa (85/220, 39%) and Klebsiella pneumoniae (81/220, 37%). CRPs were most frequently identified in urine, blood, and respiratory samples (Figure 1). Community-acquired infections were frequently diagnosed in patients infected with CRPs in our study (73% [161/220]), and most of the patients were admitted to the ICU (163/220, 74%). The in-hospital mortality rate was 28% (62/220) and 38% (62/163) in ICU admitted patients. PCR was carried out in 105 CRP; KPC (69%, 73/105) and VIM (37%, 39/105) were the most frequently identified mechanisms. Of the K. pneumoniae isolates with PCR assessment, 94% (33/35) had KPC and 3% (1/35) had VIM. In contrast, in P. aeruginosa isolates with PCR assessment, 53% (29/54) had KPC and 59% (32/54) had VIM. Seven (13%) patients infected with P. aeruginosa had both KPC and VIM genes identified. Conclusion The most frequently identified carbapenem-resistant pathogens in these two Colombian reference hospitals were P. aeruginosa and K. pneumoniae, with high mortality rates. KPC was the most commonly identified mechanism of carbapenem resistance in our cohort. Disclosures All Authors: No reported disclosures

scholarly journals Antiparasitic phytotherapy perspectives, scope and current development

Infectio ◽  
2019 ◽  
Vol 23 (2) ◽  
pp. 189 ◽  
Author(s):  
Jhon Carlos Castaño Osorio ◽  
Alejandra María Giraldo García
Keyword(s):  
Low Income ◽  
Public Health Problem ◽  
Cost Effective ◽  
Prolonged Treatment ◽  
Major Public Health Problem ◽  
Middle Income ◽  
Middle Income Countries ◽  
Commercial Markets ◽  
Health And Economic Development ◽  
New Treatments

Tropical protozoan diseases are currently a major public health problem throughout the world and are strongly linked with poverty, this combined with a lack of commercial markets for potential drugs has created a large burden on the health and economic development of low-income and middle-income countries in Africa, Asia, and the Americas. Due to the low research interest and the high increase of resistance against the existing treatments, as well as increasing inefficiency, toxicity, prolonged treatment schedules and costs, there is an urgent need for cost-effective, safe and easy-to-administer, new effective compounds with novel mechanisms of action. Several studies of crude plant extracts have already identified potential compounds to treat Chagas’ disease, Leishmaniasis, Toxoplasmosis, Giardiasis, and Malaria among other protozoan parasites. Natural compounds of medicinal plants have shown lower toxicity together with higher specificity, creating an optimistic view of new treatments for diseases. Out of 1010 new active substances approved as drugs for medical conditions by regulatory agencies during the past 25 years, 490(48.5%) were from a natural origin.

scholarly journals Population genomics of Cryptosporidium hominis across five continents identifies two subspecies that have diverged and recombined during 500 years of evolution

2021 ◽  
Author(s):  
Swapnil Tichkule ◽  
Simone M. Cacciò ◽  
Guy Robinson ◽  
Rachel M. Chalmers ◽  
Ivo Mueller ◽  
...  
Keyword(s):  
Gene Flow ◽  
Low Income ◽  
Population Genomics ◽  
Balancing Selection ◽  
Public Health Problem ◽  
High Income ◽  
Secondary Contact ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractCryptosporidium is a significant public health problem and one of the primary causes of diarrhoea in humans, particularly in very young children living in low- and middle-income countries. While the zoonotic Cryptosporidium parvum and anthroponotic C. hominis species collectively account for most cases globally, the latter is predominant in low- and middle-income countries. Here, we present a comprehensive whole genome study of C. hominis, comprising 114 isolates from 16 countries within five continents. We detect two highly diverged lineages with a distinct biology and demography that have diverged circa 500 years ago. We consider these lineages as two subspecies, and provisionally propose the names C. hominis hominis (clade 1) and C. hominis aquapotentis (clade 2 or gp60 subtype IbA10G2). C. h. hominis is mostly found in low-income countries in Africa and Asia, and it appears to have recently undergone population contraction. In marked contrast, C. h. aquapotentis was found in high-income countries, mainly in Europe, North America and Oceania, and we reveal a signature of population expansion. Moreover, we detected genomic regions of introgression representing gene flow after a secondary contact between the subspecies from low- and high-income countries. We demonstrate that this gene flow resulted in genomic island of high diversity and divergence, and that this diversity at potential virulence genes is maintained by balancing selection, suggesting that they are involved in a coevolutionary arms race.

scholarly journals Predominance of Acinetobacter spp., Harboring the blaIMP Gene, Contaminating the Hospital Environment in a Tertiary Hospital in Mwanza, Tanzania: A Cross-Sectional Laboratory-Based Study

Pathogens ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 63
Author(s):  
Vitus Silago ◽  
Eveline C. Mruma ◽  
Betrand Msemwa ◽  
Conjester I. Mtemisika ◽  
Shukurani Phillip ◽  
...  
Keyword(s):  
Carbapenem Resistance ◽  
Tertiary Hospital ◽  
Hospital Environment ◽  
Pcr Assay ◽  
Cross Sectional ◽  
Middle Income ◽  
Carbapenem Resistant ◽  
Multiplex Pcr Assay ◽  
Genes Encoding ◽  
Acinetobacter Spp

Data on colonization and hospital contamination of carbapenem-resistant Gram-negative bacteria (CR-GNB) are limited in low- and middle-income countries. We designed this study to determine the prevalence and co-existence of carbapenemase genes among CR-GNB isolated from clinical, colonization, and hospital environmental samples at a tertiary hospital in Mwanza, Tanzania. The modified Hodge test (MHT), the combined disk test (CDT), and the double-disk synergy test (DDST) were used for the phenotypic detection of carbapenemases. A multiplex PCR assay was used to detect blaIMP and blaKPC, and a singleplex PCR assay was used to detect blaOXA-48. Data were analyzed by STATA version 13.0. Overall, 68.8% (44/64) of the CR-GNB had at least one phenotype by phenotypic methods, whereby 60.9% (39/64) were both CDT and DDST positive and 31.3% (20/64) were MHT positive. A total of 23/64 (35.9%) had at least one of the genes tested with the predominance of blaIMP (91.3%; 21/23). In addition, 47.7% (21/44) of the CR-GNB phenotypes had at least one gene. Around 47.8% (11/23) of the CR-GNB carried multiple genes encoding for carbapenem resistance, with the maximum co-existence of blaIMP/blaKPC/blaOXA-48 (45.5%; 5/11). The majority of carbapenem-resistant genes were detected in Acinetobacter spp. (82.6%; 19/23) and isolated from bed swabs (69.6%; 16/23). Acinetobacter spp. carrying the blaIMP gene predominantly contaminated the hospital environment. Therefore, we recommend routine decontamination of inanimate hospital surfaces, including patient beds.

scholarly journals Establishment of a road traffic trauma registry for northern Sri Lanka

2020 ◽  
Vol 5 (1) ◽  
pp. e001818 ◽  
Author(s):  
Thayasivam Gobyshanger ◽  
Alison M Bales ◽  
Claire Hardman ◽  
Mary McCarthy
Keyword(s):  
Sri Lanka ◽  
Low Income ◽  
Trauma Registry ◽  
Road Traffic ◽  
Prehospital Care ◽  
Public Health Problem ◽  
Global Public Health ◽  
Middle Income ◽  
Road Traffic Crashes ◽  
Middle Income Countries

Road traffic injuries are a neglected global public health problem. Over 1.25 million people are killed each year, and middle-income countries, which are motorising rapidly, are the hardest hit. Sri Lanka is dealing with an injury-related healthcare crisis, with a recent 85% increase in road traffic fatality rates. Road traffic crashes now account for 25 000 injuries annually and 10 deaths daily. Development of a trauma registry is the foundation for injury control, care and prevention. Five northern Sri Lankan provinces collaborated with Jaffna Teaching Hospital to develop a local electronic registry. The Centre for Clinical Excellence and Research was established to provide organisational leadership, hardware and software were purchased, and data collectors trained. Initial data collection was modified after implementation challenges were resolved. Between 1 June 2017 and 30 September 2017, 1708 injured patients were entered into the registry. Among these patients, 62% were male, 76% were aged 21–50, 71.3% were motorcyclists and 34% were in a collision with another motorcyclist. There were frequent collisions with uncontrolled livestock (12%) and with fixed objects (14%), and most patients were transported by private vehicles without prehospital care. Head (n=315) and lower extremity (n=497) injuries predominated. Establishment of a trauma registry in low-income and middle-income countries is a significant challenge and requires invested local leadership; the most challenging issue is ongoing funding. However, this pilot registry provides a valuable foundation, identifying unique injury mechanisms, establishing priorities for prevention and patient care, and introducing the concept of an organised system to this region.

scholarly journals Weak surveillance and policy attention to cancer in global health: the example of Mozambique

2018 ◽  
Vol 3 (2) ◽  
pp. e000654 ◽  
Author(s):  
Cesaltina Lorenzoni ◽  
Laura Oliveras ◽  
Alba Vilajeliu ◽  
Carla Carrilho ◽  
Mamudo R Ismail ◽  
...  
Keyword(s):  
Low Income ◽  
Urban Areas ◽  
Public Health Problem ◽  
Cancer Surveillance ◽  
Sub Saharan Africa ◽  
High Morbidity ◽  
Middle Income ◽  
Cancer Burden ◽  
Middle Income Countries ◽  
Policy Attention

Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. The increasing burden of cancer calls for urgent policy attention to develop cancer prevention and control programmes. Cancer surveillance is an essential prerequisite. Only one in five low-income and middle-income countries have the necessary data to drive policy and reduce the cancer burden. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income and middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. Like many low-income and middle-income countries, Mozambique faces the dual challenge of a still high morbidity and mortality due to infectious diseases in rural areas and increased incidence of cancers associated with westernisation of lifestyles in urban areas, as well as a rise of cancers related to the HIV epidemic. An increase in cancer burden and changes in the cancer profile should be expected in coming years. The Mozambican healthcare and health-information systems, like in many other low-income and middle-income countries, are not prepared to face this epidemiological transition, which deserves increasing policy attention.

scholarly journals Neonatal Sepsis: The Impact of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae

2021 ◽  
Vol 8 ◽  
Author(s):  
Subhankar Mukherjee ◽  
Shravani Mitra ◽  
Shanta Dutta ◽  
Sulagna Basu
Keyword(s):  
Klebsiella Pneumoniae ◽  
Low Income ◽  
Neonatal Sepsis ◽  
Carbapenem Resistance ◽  
Opportunistic Pathogen ◽  
Low Income Countries ◽  
Middle Income ◽  
Susceptible Population ◽  
Carbapenem Resistant ◽  
The Impact

The convergence of a vulnerable population and a notorious pathogen is devastating, as seen in the case of sepsis occurring during the first 28 days of life (neonatal period). Sepsis leads to mortality, particularly in low-income countries (LICs) and lower-middle-income countries (LMICs). Klebsiella pneumoniae, an opportunistic pathogen is a leading cause of neonatal sepsis. The success of K. pneumoniae as a pathogen can be attributed to its multidrug-resistance and hypervirulent-pathotype. Though the WHO still recommends ampicillin and gentamicin for the treatment of neonatal sepsis, K. pneumoniae is rapidly becoming untreatable in this susceptible population. With escalating rates of cephalosporin use in health-care settings, the increasing dependency on carbapenems, a “last resort antibiotic,” has led to the emergence of carbapenem-resistant K. pneumoniae (CRKP). CRKP is reported from around the world causing outbreaks of neonatal infections. Carbapenem resistance in CRKP is largely mediated by highly transmissible plasmid-encoded carbapenemase enzymes, including KPC, NDM, and OXA-48-like enzymes. Further, the emergence of a more invasive and highly pathogenic hypervirulent K. pneumoniae (hvKP) pathotype in the clinical context poses an additional challenge to the clinicians. The deadly package of resistance and virulence has already limited therapeutic options in neonates with a compromised defense system. Although there are reports of CRKP infections, a review on neonatal sepsis due to CRKP/ hvKP is scarce. Here, we discuss the current understanding of neonatal sepsis with a focus on the global impact of the CRKP, provide a perspective regarding the possible acquisition and transmission of the CRKP and/or hvKP in neonates, and present strategies to effectively identify and combat these organisms.

scholarly journals Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study

2021 ◽  
Vol 6 (1) ◽  
pp. e000698
Author(s):  
Simon Arunga ◽  
Tumu Mbarak ◽  
Abel Ebong ◽  
James Mwesigye ◽  
Dan Kuguminkiriza ◽  
...  
Keyword(s):  
Low Income ◽  
Public Health Problem ◽  
Fungal Keratitis ◽  
Additional Treatment ◽  
Eye Drops ◽  
Middle Income ◽  
Corneal Scarring ◽  
Middle Income Countries ◽  
Large Cohort Study

ObjectiveFungal keratitis is a major ophthalmic public health problem, particularly in low-income and middle-income countries. The options for treating fungal keratitis are limited. Our study aimed to describe the outcomes of using chlorhexidine 0.2% eye-drops as additional treatment in the management of patients with recalcitrant fungal keratitis.MethodsThis study was nested within a large cohort study of people presenting with microbial keratitis in Uganda. We enrolled patients with recalcitrant fungal keratitis not improving with topical natamycin 5% and commenced chlorhexidine 0.2%. Follow-up was scheduled for 3 months and 1 year. The main outcome measures were healing, visual acuity and scar size at final follow-up.ResultsThirteen patients were followed in this substudy. The patients were aged 27–73 years (median 43 years). Filamentous fungi were identified by microscopy of corneal scrape samples in all cases. Isolated organisms included Aspergillus spp, Fusarium spp, Candida spp, Bipolaris spp and Acremoninum spp. At the final follow-up, nine patients (75%) had healed; three had vision of better than 6/18. Three patients lost their eyes due to infection. In the remaining nine cases, corneal scarring was variable ranging from 4.6 to 9.4 mm (median 6.6 mm, IQR 5.9–8.0 mm); of these five had dense scars, three had moderate scars and one had a mild scar. None of the patients demonstrated signs of chlorhexidine toxicity during the follow-up.ConclusionChlorhexidine 0.2% was found to be a useful sequential adjunctive topical antifungal in cases of fungal keratitis not responding to natamycin 5%, which warrants further evaluation.

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