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.

scholarly journals Do doctors in north-western Somalia follow the national guidelines for tuberculosis management?

2003 ◽  
Vol 9 (4) ◽  
pp. 789-795
Author(s):  
B. A. Suleiman ◽  
A. I. Houssein ◽  
F. Mehta ◽  
S. G. Hinderaker
Keyword(s):  
Treatment Guidelines ◽  
Cross Sectional Study ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Sputum Smear Microscopy ◽  
National Guidelines ◽  
National Treatment ◽  
Cross Sectional ◽  
Tb Control ◽  
North Western

A cross-sectional study assessed the knowledge and practices of registered practitioners in management of tuberculosis [TB] in north-western Somalia. Of 100 registered doctors, 53 were interviewed. Of these, 32 [64%] had treated TB patients during the previous year, but only 1 had notified the authorities, 33 [66%] knew the most important symptoms and 32 [64%] identified sputum smear microscopy as the most important diagnostic test. Only 4 doctors prescribed the correct regimen and only 7 advocated direct observation. Suboptimal knowledge was more common among doctors working in private practice [relative risk: 2.1; 95% CI: 1.1-4.3]. Patients are being treated in the private sector, but few doctors follow national treatment guidelines. Training in diagnosis and case management is needed to improve TB control in Somalia

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 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 Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009–2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aliaksandra Aniskevich ◽  
Iryna Shimanskaya ◽  
Iryna Boiko ◽  
Tatyana Golubovskaya ◽  
Daniel Golparian ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Eastern Europe ◽  
Treatment Guidelines ◽  
Statistical Significance ◽  
Antimicrobial Treatment ◽  
National Guidelines ◽  
First Line ◽  
Exact Test ◽  
The Republic

Abstract Background Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR in N. gonorrhoeae isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea. Methods N. gonorrhoeae isolates (n = 522) cultured in three regions of Belarus in 2009–2019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified β-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher’s exact test, or Mann-Whitney U test with p-values of < 0.05 indicating significance. Results In total, 27.8% of the N. gonorrhoeae isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125 mg/L, exactly at the resistance breakpoint (MIC > 0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n = 1), 2012 (n = 1), and 2018–2019 (n = 2). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) were given non-recommended treatment. Conclusions The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1 g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.

scholarly journals Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza- Tanzania

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Neema Kayange ◽  
Erasmus Kamugisha ◽  
Damas L Mwizamholya ◽  
Seni Jeremiah ◽  
Stephen E Mshana
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Neonatal Sepsis ◽  
Tertiary Hospital

scholarly journals Improvement of Antibiotics Susceptibility of Escherichia coli in a Tertiary Hospital in Japan

2019 ◽  
pp. 1-5
Author(s):  
Yuji Watanabe ◽  
Masafumi Seki
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Tertiary Hospital ◽  
Clinical Settings ◽  
Infection Control Team ◽  
Beta Lactamases ◽  
E Coli ◽  
Control Team ◽  
Extended Spectrum Beta Lactamases ◽  
Antibiotics Susceptibility

Antimicrobial stewardship team (AST) and Infection Control Team (ICT) have recently been linked Infectious diseases (ID) physicians, and implemented in clinical settings in Japan. The microbiological effects of an AST and ICT, in addition to Diagnostic stewardship team (DST) supported by ID physicians in our tertiary hospital were shown in significant reduction of antibiotic resistance of Escherichia coli (E coli) including extended spectrum beta-lactamases (ESBL)-producing E coli.

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