scholarly journals Diversity and Distribution of Spa types among Methicillin Resistant Staphylococcus Aureus Isolated from Humans and Livestock in Kabale District - South Western Uganda

2021 ◽  
Author(s):  
Andrew Baguma ◽  
Benson Musinguzi ◽  
Patrick Orikiriza ◽  
Joel Bazira
Keyword(s):  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Multi Drug Resistance ◽  
Typing Method ◽  
Cross Sectional ◽  
Effective Prevention ◽  
Household Contacts ◽  
Western Uganda ◽  
Spa Types

Abstract Background: S. aureus is a skin and mucosal bacterial commensal of both humans and animals which has evolved as an important pathogen implicated to cause various infections. High levels of antibiotic use have resulted into multi-drug resistance MRSA, especially among HA-MRSA, CA-and LA - MRSA. Awareness on coexistence and diversity of MRSA clones among humans and household Livestock particularly cattle and swine in our region is limited. We used spa typing method to determine spa diversity, distribution and coexistence in outpatients, household contacts and respective livestock (cattle and swine) in Kabale region, south western Uganda. Methods: This was a cross sectional study by design consisting of outpatients, household contacts and livestock. Outpatients (n =100) colonized with MRSA were traced back to their respective homesteads where household members, domestic cattle, and, swine were tested for S. aureus and subsequently MRSA colonization. High-resolution DNA melting analysis was used to determine spa types among MRSA isolates. Overlap of MRSA isolates among humans and livestock was based on the presence of similar spa types.Results: A total of 3371 S.aureus isolates were collected from outpatients (n =376), household contacts (n = 1531), Cattle (n = 1159) and Swine (n = 305), among which 482 had mecA gene where 27% (100/376) and 8% (123/1531) were outpatients and household contacts respectively while 11% (132/1159) and 42% (127/305) were cattle and swine respectively. Twenty different spa types were identified; t034, t4677, t108, t1451, t9377, t1081, t040, t701, t041, t002, t044, t037,t121, t127, t922, t032, t019, t018, t012 and t030, among which t034 (109/482), t4677 (53/482), t9377 (63/482) and t1081 (53/482) were most prevalent and distributed among human and livestock. All the MRSA isolates were multidrug resistant to antibiotics tested. Conclusion: In Kabale region, there is high diversity of spa types among MRSA. Presence of similar spa types was found circulating among humans and their respective livestock which demonstrates a possible bidirectional transmission. Presence of MDR - MRSA highlights the need for effective prevention and control of MRSA among livestock and in the community using One Health approach.

scholarly journals Feasibility of Identifying Household Contacts of Rifampin-and Multidrug-resistant Tuberculosis Cases at High Risk of Progression to Tuberculosis Disease

2019 ◽  
Vol 70 (3) ◽  
pp. 425-435 ◽  
Author(s):  
Amita Gupta ◽  
Susan Swindells ◽  
Soyeon Kim ◽  
Michael D Hughes ◽  
Linda Naini ◽  
...  
Keyword(s):  
High Risk ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Preventive Therapy ◽  
Interferon Gamma Release Assay ◽  
Cross Sectional ◽  
Household Contacts ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background We assessed multidrug-resistant tuberculosis (MDR-TB) cases and their household contacts (HHCs) to inform the development of an interventional clinical trial. Methods We conducted a cross-sectional study of adult MDR-TB cases and their HHCs in 8 countries with high TB burdens. HHCs underwent symptom screenings, chest radiographies, sputum TB bacteriologies, TB infection (TBI) testing (tuberculin skin test [TST] and interferon gamma release assay [IGRA]), and human immunodeficiency virus (HIV) testing. Results From October 2015 to April 2016, 1016 HHCs from 284 MDR-TB cases were enrolled. At diagnosis, 69% of MDR-TB cases were positive for acid-fast bacilli sputum smears and 43% had cavitary disease; at study entry, 35% remained smear positive after a median MDR-TB treatment duration of 8.8 weeks. There were 9 HHCs that were diagnosed with TB prior to entry and excluded. Of the remaining 1007 HHCs, 41% were male and the median age was 25 years. There were 121 (12%) HHCs that had new cases of TB identified: 17 (2%) were confirmed, 33 (3%) probable, and 71 (7%) possible TB cases. The TBI prevalence (defined as either TST or IGRA positivity) was 72% and varied by age, test used, and country. Of 1007 HHCs, 775 (77%) were considered high-risk per these mutually exclusive groups: 102 (10%) were aged <5 years; 63 (6%) were aged ≥5 and were infected with HIV; and 610 (61%) were aged ≥5 years, were negative for HIV or had an unknown HIV status, and were TBI positive. Only 21 (2%) HHCs were on preventive therapy. Conclusions The majority of HHCs in these high-burden countries were at high risk of TB disease and infection, yet few were receiving routine preventive therapy. Trials of novel, preventive therapies are urgently needed to inform treatment policy and practice.

scholarly journals Willingness to Take Multidrug-resistant Tuberculosis (MDR-TB) Preventive Therapy Among Adult and Adolescent Household Contacts of MDR-TB Index Cases: An International Multisite Cross-sectional Study

2019 ◽  
Vol 70 (3) ◽  
pp. 436-445
Author(s):  
Nishi Suryavanshi ◽  
Matthew Murrill ◽  
Amita Gupta ◽  
Michael Hughes ◽  
Anneke Hesseling ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Preventive Therapy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Household Contacts ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Index Cases

Abstract Background Household contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB) are at high risk of infection and subsequent disease. There is limited evidence on the willingness of MDR-TB HHCs to take MDR-TB preventive therapy (MDR TPT) to decrease their risk of TB disease. Methods In this cross-sectional study of HHCs of MDR-TB and rifampicin-resistant tuberculosis (RR-TB) index cases from 16 clinical research sites in 8 countries, enrollees were interviewed to assess willingness to take a hypothetical, newly developed MDR TPT if offered. To identify factors associated with willingness to take MDR TPT, a marginal logistic model was fitted using generalized estimating equations to account for household-level clustering. Results From 278 MDR-TB/RR-TB index case households, 743 HHCs were enrolled; the median age of HHCs was 33 (interquartile range, 22–49) years, and 62% were women. HHC willingness to take hypothetical MDR TPT was high (79%) and remained high even with the potential for mild side effects (70%). Increased willingness was significantly associated with current employment or schooling (adjusted odds ratio [aOR], 1.83 [95% confidence interval {CI}, 1.07–3.13]), appropriate TB-related knowledge (aOR, 2.22 [95% CI, 1.23–3.99]), confidence in taking MDR TPT (aOR, 7.16 [95% CI, 3.33–15.42]), and being comfortable telling others about taking MDR TPT (aOR, 2.29 [95% CI, 1.29–4.06]). Conclusions The high percentage of HHCs of MDR-TB/RR-TB index cases willing to take hypothetical MDR TPT provides important evidence for the potential uptake of effective MDR TPT when implemented. Identified HHC-level variables associated with willingness may inform education and counseling efforts to increase HHC confidence in and uptake of MDR TPT.

scholarly journals Impact of an antibiotic stewardship programme in a surgical setting

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Muhammad A. Bashar ◽  
Jacqui Miot ◽  
Evan Shoul ◽  
Robyn L. Van Zyl
Keyword(s):  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Modern Medicine ◽  
Cross Sectional ◽  
Defined Daily Doses ◽  
Surgical Setting ◽  
Antibiotic Stewardship Programme

Background: Antibiotics are miracles of science and critical for many surgical procedures. However, the emergence of multidrug resistant pathogens resulting from inappropriate antibiotic use is a threat to modern medicine. This study aimed to determine the appropriateness of antibiotic use, cost, consumption and impact of an antibiotic stewardship intervention round in a surgical ward setting.Methods: Baseline antibiotic utilisation was determined with a retrospective cross-sectional study in two surgical wards in a tertiary academic hospital in South Africa where medical records of 264 patients who received antibiotics were reviewed. In the second stage of the study, records of 212 patients who received antibiotics were reviewed during a weekly antibiotic stewardship intervention round. The volume of antibiotics consumed was determined using defined daily doses (DDDs)/1000 patients’ days, and the appropriateness of the antibiotic prescription for treatment was also determined using a quality-of-use algorithm.Results: There was a reduction in the volume of antibiotic consumption from a total 739.30 DDDs/1000 to 564.93 DDDs/1000 patient days, with reduction in inappropriate antibiotic use from 35% to 26% from baseline to antibiotic stewardship programme stages, respectively. There was an overall increase in culture targeted therapy in both wards in the antibiotic stewardship programme stage.Conclusion: The implementation of an antibiotic stewardship programme led to a reduction in antibiotic consumption and improvement in appropriate use of antibiotics.

Implementation status of antimicrobial stewardship programs in hospitals: A quantitative analysis study in Ho Chi Minh city, Vietnam

MedPharmRes ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 34-39
Author(s):  
Thi-Hai-Yen Nguyen ◽  
Truong Van Dat ◽  
Phuong-Thao Huynh ◽  
Chi-Thuong Tang ◽  
Vinh-Chau Van Nguyen ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Health Workers ◽  
Cross Sectional Study ◽  
Ho Chi Minh City ◽  
Multi Drug Resistance ◽  
Cross Sectional ◽  
Clostridioides Difficile ◽  
The Status ◽  
Specific Assessment ◽  
Implementation Status

Vietnam has one of the highest multi drug resistance in Asia. Although, despite many efforts to implement the Antimicrobial Stewardship Programs (the ASP) since 2016, studies that on the implementation policy are very lacking of this program are limited. For that reason, we conducted this cross-sectional study to analyze the viewpoint of health workers (HWs) on the implementation of the ASP at some hospitals in Ho Chi Minh City (HCMC). An assessment of 234 HWs showed that the implementation of the ASP in HCMC hospitals was above average (62.7/100.0). A barrier to the implementation consisted of the deficiency in finances, guidelines for diagnosis, and specific interventions for some common infections, such as distributing current antibiogram and monitoring rate of Clostridioides difficile infections. These were the widely recognized problems in initially implementing the ASP. Although most HWs are aware of the importance of implementing the ASP (79.1%), the specific assessment has not been recorded clearly due to the numerous neutral responses. Despite the support of the leadership, the implementation still faces many difficulties and limitations, especially in 3rd and 4th class hospitals. Besides, there was a lack of wide dissemination of information on the ASP at each unit. To generalize the status of the ASP implementation, researchers should conduct qualitative and quantitative studies with a larger scale.

scholarly journals Assessing Knowledge and Perception Regarding Antimicrobial Stewardship and Antimicrobial Resistance in University Students of Pakistan: Findings and Implications

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 866
Author(s):  
Iltaf Hussain ◽  
Nisa Yousaf ◽  
Sana Haider ◽  
Pervisha Jalil ◽  
Muhammad Usman Saleem ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
University Students ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Dosing Regimen ◽  
Student Knowledge ◽  
Chi Square ◽  
Cross Sectional ◽  
Self Administered Questionnaire

The irrational use of antimicrobials has enormously contributed to antimicrobial resistance (AMR) globally and especially in the developing world. To assess the knowledge and perception regarding AMR and antimicrobial stewardship (AMS), a descriptive cross-sectional study was carried out in university students enrolled in pharmacy, veterinary, and biology programs by using an online self-administered questionnaire. The Chi-square and Fisher exact tests (where applicable) were performed to assess the association of the demographics with the students’ knowledge and perception regarding AMR and AMS. A total of 496 students completed the questionnaire, among which, 85.7% of the participants were familiar with the term AMR and 79.4% of the participants correctly identified a poorly designed dosing regimen as a contributing factor towards AMR. The majority of participants (57.9%) were familiar with the term AMS and 86.5% were aware of the aim of AMS. The participants showed good knowledge regarding AMR and AMS, but to further improve student knowledge and perception of AMS and AMR, it is suggested that dedicated modules on antibiotic use and AMS should be incorporated into the curricula of these undergraduate and postgraduate programs.

scholarly journals Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 601
Author(s):  
Houyu Zhao ◽  
Mei Zhang ◽  
Jiaming Bian ◽  
Siyan Zhan
Keyword(s):  
Pregnant Women ◽  
Ambulatory Care ◽  
National Level ◽  
Mainland China ◽  
Antibiotic Use ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Fetal Safety ◽  
First Trimester Of Pregnancy

Background: Antibiotic use in pregnant women at the national level has rarely been reported in China. Objectives: We aimed to investigate antibiotic prescriptions during pregnancy in ambulatory care settings in China. Methods: Data of 4,574,961 ambulatory care visits of pregnant women from October 2014 to April 2018 were analyzed. Percentages of Antibiotic prescriptions by different subgroups and various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Food and Drug Administration (FDA) pregnancy categories were used to describe the antibiotic prescription patterns. The 95% confidence intervals (CIs) were estimated using the Clopper––Pearson method or Goodman method. Results: Among the 4,574,961 outpatient visits during pregnancy, 2.0% (92,514 visits; 95% CI, 2.0–2.0%) were prescribed at least one antibiotic. The percentage of antibiotic prescriptions for pregnant women aged >40 years was 4.9% (95% CI, 4.7–5.0%), whereas that for pregnant women aged 26–30 years was 1.5% (95% CI, 1.4–1.5%). In addition, percentages of antibiotic prescriptions varied among different trimesters of pregnancy, which were 5.4% (95% CI, 5.3–5.4%) for the visits in the first trimester of pregnancy and 0.5% (95% CI, 0.4–0.5%) in the third trimester of pregnancy. Furthermore, the percentages of antibiotic prescriptions substantially varied among different diagnosis categories and nearly three-quarters of antibiotic prescriptions had no clear indications and thus might be inappropriate. In total, 130,308 individual antibiotics were prescribed; among these, 60.4% (95% CI, 60.0–60.8%) belonged to FDA category B, 2.7% (95% CI, 2.1–3.5%) were classified as FDA category D and 16.8% (95% CI, 16.2–17.4%) were not assigned any FDA pregnancy category. Conclusions: Antibiotic prescriptions in ambulatory care during pregnancy were not highly prevalent in mainland China. However, a substantial proportion of antibiotics might have been prescribed without adequate indications. Antibiotics whose fetal safety has not been sufficiently illustrated were widely used in pregnant women.

Prevalence of Enterobacteriaceae spp. and its multidrug-resistant rates in clinical isolates: A two-center cross-sectional study

2021 ◽  
Author(s):  
Bahman Mirzaei ◽  
Ryhane Babaei ◽  
Zahra Norouzi Bazgir ◽  
Hamid Reza Goli ◽  
Shima Keshavarzi ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Clinical Isolates ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Prescribers’ Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 858
Author(s):  
Reema A. Karasneh ◽  
Sayer I. Al-Azzam ◽  
Mera Ababneh ◽  
Ola Al-Azzeh ◽  
Ola B. Al-Batayneh ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Attitudes And Behaviors ◽  
And Behaviors ◽  
Ease Of Access

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.

scholarly journals Influence ofABCC2andABCC4Polymorphisms on Tenofovir Plasma Concentrations in Thai HIV-Infected Patients

2015 ◽  
Vol 59 (6) ◽  
pp. 3240-3245 ◽  
Author(s):  
Kanokrat Rungtivasuwan ◽  
Anchalee Avihingsanon ◽  
Narukjaporn Thammajaruk ◽  
Siwaporn Mitruk ◽  
David M. Burger ◽  
...  
Keyword(s):  
Body Weight ◽  
Multivariate Analysis ◽  
Plasma Concentration ◽  
Protease Inhibitors ◽  
Demographic Data ◽  
Plasma Concentrations ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Mean

ABSTRACTTenofovir (TFV) is eliminated by renal excretion, which is mediated through multidrug-resistant protein 2 (MRP2) and MRP4, encoded byABCC2andABCC4, respectively. Genetic polymorphisms of these transporters may affect the plasma concentrations of tenofovir. Therefore, the aim of this study was to investigate the influence of genetic and nongenetic factors on tenofovir plasma concentrations. A cross-sectional study was performed in Thai HIV-infected patients aged ≥18 years who had been receiving tenofovir disoproxil fumarate at 300 mg once daily for at least 6 months. A middose tenofovir plasma concentration was obtained. Multivariate analysis was performed to investigate whether there was an association between tenofovir plasma concentrations and demographic data, including age, sex, body weight, estimated glomerular filtration rate (eGFR), hepatitis B virus coinfection, hepatitis C virus coinfection, duration of tenofovir treatment, concomitant use of ritonavir-boosted protease inhibitors, and polymorphisms ofABCC2andABCC4. A total of 150 Thai HIV-infected patients were included. The mean age of the patients was 43.9 ± 7.2 years. The mean tenofovir plasma concentration was 100.3 ± 52.7 ng/ml. In multivariate analysis, a low body weight, a low eGFR, the concomitant use of ritonavir-boosted protease inhibitors, and theABCC44131T → G variation (genotype TG or GG) were independently associated with higher tenofovir plasma concentrations. After adjusting for weight, eGFR, and the concomitant use of ritonavir-boosted protease inhibitors, a 30% increase in the mean tenofovir plasma concentration was observed in patients having theABCC44131 TG or GG genotype. Both genetic and nongenetic factors affect tenofovir plasma concentrations. These factors should be considered when adjusting tenofovir dosage regimens to ensure the efficacy and safety of a drug. (This study has been registered at ClinicalTrials.gov under registration no. NCT01138241.)

The situation of antibiotic use for diarrhea treatment on pediatric inpatient at Pediatrics - Kien Giang General Hospital in 2019-2020

2020 ◽  
pp. 15-24
Author(s):  
Nhon Tran Van ◽  
Mai Do Van ◽  
Hien Ha Minh
Keyword(s):  
General Hospital ◽  
Blood Cells ◽  
Antibiotic Prescription ◽  
White Blood Cells ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Loose Stool ◽  
Cross Sectional ◽  
Watery Stool ◽  
Pediatric Inpatient

Background: To survey for evaluation the use of antibiotic for diarrhea treatment on pediatric inpatient in compliance with MOH, WHO or treatment regimen. Objectives: (1) To describe the situation of antibiotic use for diarrhea treatment and (2) to determine factors that affected on indication of antibiotic for pediatric inpatient under 15 years at Kien Giang General Hospital in 2019. Subjects and methods: A cross-sectional study on 251 medical records of pediatric inpatients who treated by one of any drug from 01/2019 to 12/2019. Results: one antibiotic was prescribed in 71.7% in comparison with 17.1% on two antibiotics. The antibiotic prescription was based on the results of blood test including examinations of white blood cells (WBC), the percentage of neutrophils (Neu%) and/or C-reactive protein (CRP) (59.4%), stool with white blood cells and/or red blood cells (1.6%), high fever without causes (27.9%), watery stool (86.3%), loose stool with blood (100%), loose stool (97.9%). The most used antibiotics are ceftriaxone (53.4%), ciprofloxacin (12.4%). Duration of antibiotic use is 5 days in median. Conclusion: The rate of antibiotic prescription that met MOH and WHO guidelines was 88.3% in comparison with 11.7% of non-conformance. The compliance prescriptions based on antibiogram were 77.8%, non-compliance were 22.5%. The compliance dosage refered to guideline was 86.4%, non-conpliance was 2.4%. The duration of hospitalization and neutrophil are factors that affected the use of antibiotics (p < 0.05). Keywords: diarrhea, pediatric inpatient, antibiotic, Pediatrics-Kien Giang General Hospital

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