Phenotypic characterization of carbapenem non-susceptible gram-negative bacilli isolated from clinical specimens

Background Multidrug resistant, extremely drug-resistant, pan-drug resistant, carbapenem-resistant, and carbapenemase-producing gram-negative bacteria are becoming more common in health care settings and are posing a growing threat to public health. Objective The study was aimed to detect and phenotypically characterize carbapenem no- susceptible gram-negative bacilli at the Ethiopian Public Health Institute. Materials and methods A prospective cross-sectional study was conducted from June 30, 2019, to May 30, 2020, at the national reference laboratory of the Ethiopian Public Health Institute. Clinical samples were collected, inoculated, and incubated for each sample in accordance with standard protocol. Antimicrobial susceptibility testing was conducted using Kirby-Bauer disk diffusion method. Identification was done using the traditional biochemical method. Multidrug-resistant and extensively drug-resistant isolates were classified using a standardized definition established by the European Centre for Disease Prevention and Control and the United States Centers for Disease Prevention and Control. Gram-negative organisms with reduced susceptibility to carbapenem antibiotics were considered candidate carbapenemase producers and subjected to modified carbapenem inactivation and simplified carbapenem inactivation methods. Meropenem with EDTA was used to differentiate metallo-β-lactamase (MBL) from serine carbapenemase. Meropenem (MRP)/meropenem + phenylboronic acid (MBO) were used to differentiate Klebsiella pneumoniae carbapenemase (KPC) from other serine carbapenemase producing gram-negative organisms. Results A total of 1,337 clinical specimens were analyzed, of which 429 gram-negative bacterial isolates were recovered. Out of 429 isolates, 319, 74, and 36 were Enterobacterales, Acinetobacter species, and Pseudomonas aeruginosa respectively. In our study, the prevalence of multidrug-resistant, extensively drug-resistant, carbapenemase-producing, and carbapenem nonsusceptible gram-negative bacilli were 45.2%, 7.7%, 5.4%, and 15.4% respectively. Out of 429 isolates, 66 demonstrated reduced susceptibility to the antibiotics meropenem and imipenem. These isolates were tested for carbapenemase production of which 34.8% (23/66) were carbapenemase producers. Out of 23 carbapenemase positive gram-negative bacteria, ten (10) and thirteen (13) were metallo-beta-lactamase and serine carbapenemase respectively. Three of 13 serine carbapenemase positive organisms were Klebsiella pneumoniae carbapenemase. Conclusion This study revealed an alarming level of antimicrobial resistance (AMR), with a high prevalence of multidrug-resistant (MDR) and extremely drug-resistant, carbapenemase-producing gram-negative bacteria, particularly among intensive care unit patients at the health facility level. These findings point to a scenario in which clinical management of infected patients becomes increasingly difficult and necessitates the use of “last-resort” antimicrobials likely exacerbating the magnitude of the global AMR crisis. This mandates robust AMR monitoring and an infection prevention and control program.

COVID-19 In-Hospital Mortality in People with Diabetes Is Driven by Comorbidities and Age—Propensity Score-Matched Analysis of Austrian National Public Health Institute Data

Background: It is a matter of debate whether diabetes alone or its associated comorbidities are responsible for severe COVID-19 outcomes. This study assessed the impact of diabetes on intensive care unit (ICU) admission and in-hospital mortality in hospitalized COVID-19 patients. Methods: A retrospective analysis was performed on a countrywide cohort of 40,632 COVID-19 patients hospitalized between March 2020 and March 2021. Data were provided by the Austrian data platform. The association of diabetes with outcomes was assessed using unmatched and propensity-score matched (PSM) logistic regression. Results: 12.2% of patients had diabetes, 14.5% were admitted to the ICU, and 16.2% died in the hospital. Unmatched logistic regression analysis showed a significant association of diabetes (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.15–1.34, p < 0.001) with in-hospital mortality, whereas PSM analysis showed no significant association of diabetes with in-hospital mortality (OR: 1.08, 95%CI: 0.97–1.19, p = 0.146). Diabetes was associated with higher odds of ICU admissions in both unmatched (OR: 1.36, 95%CI: 1.25–1.47, p < 0.001) and PSM analysis (OR: 1.15, 95%CI: 1.04–1.28, p = 0.009). Conclusions: People with diabetes were more likely to be admitted to ICU compared to those without diabetes. However, advanced age and comorbidities rather than diabetes itself were associated with increased in-hospital mortality in COVID-19 patients.

Early Post-Acute Myocardial Infarction: Psychosocial and Financial Concerns

Purpose: Acute myocardial infarction (AMI) is a major cardiovascular event that has significant psycho-social-physical and lifestyle consequences. This study assessed the feelings of patients within days following an AMI in a public health institute in Trinidad and Tobago. Results: Of the 150 AMI patients, 134 (89.3%), were included in the study. Sixteen (10.7%) patients were not included due to inadequate information. Among the post-AMI patients, common negative feelings experienced include fear of another heart attack (n = 74, 55.2%), fear of death (n = 40, 29.9%), and fear of the future (n = 29, 21.6%). However, the positive thoughts of the AMI patients predominated: intentions to improve eating habits (n = 97, 73.5%), and increased spirituality (n = 82, 62.1%). Changes in feelings from pre to post AMI were most pronounced for positive feelings such as improved eating habits, regular exercise, and improved goals. In general, among the post-AMI patients, there were no significant associations between age and sex. However, significant associations were found between selected lifestyles variables (exercise, alcohol, eating habits, employment status, hypertension, and obesity) and psychological issues such as fear of another heart attack, improved relationships, or turning to God. Conclusions: Post-AMI patients experienced major psychosocial issues in the early post-AMI period. Though negative feelings were common, most of the patients resolved to make positive lifestyle changes.

Early Post-Acute Myocardial Infarction: Psychosocial and Financial Concerns

Purpose: Acute myocardial infarction (AMI) is a major cardiovascular event that has significant psycho-social-physical and lifestyle consequences. This study assessed the feelings of patients within days following an AMI in a public health institute in Trinidad and Tobago. Results: Of the 150 AMI patients, 134 (89.3%), were included in the study. Sixteen (10.7%) patients were not included due to inadequate information. Among the post-AMI patients, common negative feelings experienced include fear of another heart attack (n = 74, 55.2%), fear of death (n = 40, 29.9%), and fear of the future (n = 29, 21.6%). However, the positive thoughts of the AMI patients predominated: intentions to improve eating habits (n = 97, 73.5%), and increased spirituality (n = 82, 62.1%). Changes in feelings from pre to post AMI were most pronounced for positive feelings such as improved eating habits, regular exercise, and improved goals. In general, among the post-AMI patients, there were no significant associations between age and sex. However, significant associations were found between selected lifestyles variables (exercise, alcohol, eating habits, employment status, hypertension, and obesity) and psychological issues such as fear of another heart attack, improved relationships, or turning to God. Conclusions: Post-AMI patients experienced major psychosocial issues in the early post-AMI period. Though negative feelings were common, most of the patients resolved to make positive lifestyle changes.

Social Media Platforms to Combat COVID-19 Pandemic in Ethiopia

The aim of this study was to assess social media platforms to combat coronavirus pandemic in Ethiopia for need-based communication to address COVID-19 information and to control infodemic information. A mixed research design was used. Self-administered questionnaires, interviews and document analyses were used to gather relevant data from active social media users and healthcare workers that were selected by a simple random sampling technique. The social media integrated theory model to evaluate social media platforms were used.Ministry of Health and Ethiopian Public Health Institute addressed need-based information for 46.75 million people in SMS in 3-6 days intervals, 22 million virtual societies and 7 million social media platform users. The study revealed that the participants used social media platforms: Facebook (83.1%), telegram (59.3%), YouTube (33.9%), web (13.6%), Twitter (11.9%) actively in a moderate way to grasp and share information related to COVID-19. Ministry of Health and Ethiopian Public Health Institute used as a center of COVID-19 information, and it helps to control the infodemic information that arises with the de-central source of information. They were using the World Health Organization communication protocol and strategies to combat the pandemic. Ministry of Health (MOH) and Ethiopian Public Health Institute (EPHI) used social media platforms actively to combat the pandemic. The platforms enabled the public to express their feelings, needs and develop their awareness about COVID-19. The health institutions established the pandemic communication units from the federal to woreda level to disseminate the information and the materials to combat the virus. Yet, the health communication units were politicized.

Detection and phenotypic characterization of carbapenem non susceptible gram-negative bacilli isolated from clinical specimens

Background Multi-drug resistant, extremely drug-resistant, pan-drug resistant, carbapenem-resistant, and carbapenemase-producing gram-negative bacteria are becoming more common in health care settings and are posing a growing threat to public health. Objective The study was aimed to determine the magnitude of multi-drug resistant, extremely drug-resistant, carbapenem non-susceptible, and carbapenemase-producing gram-negative bacilli at Ethiopian Public Health Institute. Materials and methods Prospective cross-sectional study was conducted from June 30, 2019, to May 30, 2020, at the national reference laboratory of the Ethiopian Public Health Institute. Clinical samples were collected, inoculated, and incubated in accordance to standard protocol for each sample. Antimicrobial susceptibility testing was done using Kirby Bauer disk diffusion. Identification was done using the traditional biochemical method. Multidrug-resistant and extensively drug-resistant were classified using a standardized definition established by European Centers for Disease prevention and control and the United States Centers for Disease prevention and control experts. Carbapenemase production was confirmed by modified carbapenem inactivation and a simplified carbapenem inactivation method. Meropenem with EDTA was used to differentiate serine carbapenemase and Metallo β-lactamase. Results A total of 1337 clinical specimens were analyzed, of which 429-gram negative bacilli isolates were recovered. Out of 429 isolates 319, 74, and 36 were Enterobacterales, Acinetobacter species, and P. aeruginosa respectively. In our study, the prevalence of Multidrug-resistant, extensively drug-resistant, Carbapenemase-producing, and carbapenem non-susceptible Gram-negative bacilli were, 45.2%, 7.7%, 5.4%, and 15.4% respectively. Out of 66 isolates screened for Carbapenemase, 34.8% (23/66) were Carbapenemase enzyme producers. Ten out of twenty-three Carbapenemase-positive organisms were Metallo-beta-lactamase producers. Thirteen out of twenty-three isolates were serine carbapenemase producers. Three out of 13 serine Carbapenemase positive organisms were Klebsiella pneumoniae Carbapenemase. Conclusion The finding from this study revealed a high prevalence of Multidrug-resistant, extremely drug-resistant, carbapenemase-producing gram-negative bacteria, particularly among Intensive care unit patients at the health facility level, this necessitates a robust laboratory-based antimicrobial resistance monitoring and infection prevention and control program.