Multidrug-resistant tuberculosis treatment adherence in migrants: a systematic review and meta-analysis.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In high-income low-TB-incidence countries, a disproportionate number of MDR-TB cases occur in migrant (foreign-born) populations, with concerns about low adherence rates in these patients compared to the host non-migrant population. Tackling MDR-TB in this context may, therefore, require unique approaches. We conducted a systematic review and meta-analysis to identify and synthesise data on MDR-TB treatment adherence in migrant patients to inform evidence-based strategies to improve care pathways and health outcomes in this group. METHODS: This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO 42017070756). The databases Embase, MEDLINE, Global Health and PubMed were searched to 24 May 2017 for primary research reporting MDR-TB treatment adherence and outcomes in migrant populations, with no restrictions on dates or language. A meta-analysis was conducted using random-effects models. RESULTS: From 413 papers identified in the database search, 15 studies reporting on MDR-TB treatment outcomes for 258 migrants and 174 non-migrants were included in the systematic review and meta-analysis. The estimated rate of adherence to MDR-TB treatment across migrant patients was 71% [95% confidence interval (CI) = 58-84%], with non-adherence reported among 20% (95% CI = 4-37%) of migrant patients. A key finding was that there were no differences in estimated rates of adherence [risk ratio (RR) = 1.05; 95% CI = 0.82-1.34] or non-adherence (RR = 0.97; 95% CI = 0.79-1.36) between migrants and non-migrants. CONCLUSIONS: MDR-TB treatment adherence rates among migrants in high-income low-TB-incidence countries are approaching global targets for treatment success (75%), and are comparable to rates in non-migrants. The findings highlight that only just over 70% of migrant and non-migrant patients adhere to MDR-TB treatment. The results point to the importance of increasing adherence in all patient groups, including migrants, with an emphasis on tailoring care based on social risk factors for poor adherence. We believe that MDR-TB treatment targets are not ambitious enough

Antibiotic resistance profile of Escherichia coli isolated from five major geopolitical zones of Nigeria

Information on the resistance profiles of clinical and non clinical human bacteria isolates in the developing countries can serve as important means of understanding the human pathogens drug resistance interactions in the zone. Escherichia coli isolated from five geopolitical zones of Nigeria were screened for anti-microbial resistance profile against 14 antibiotics using the disc diffusion method. Overall, the 89 isolates tested, were 94,4% that showed resistance to Ampicillin; 85.5% to Cotrimaoxazole, 92.1% to Cephalothin; 78.7% to Streptomycin, 70.8% to Nitrofurantoin; 79.8 to Tetracycline; 67.4% to Chloramphenicol; 74.2% to Amoxicillin clavulanic acid; 61.8 to Cefpirome; 52.8% to Cefpodoxime; 46.1 % to Cefotaxine; 46.1% to Ceftriaxone; 31.5% to Cefoxitin; 38.2% to Nalidixic acid and 24.7% to Gentamycin. These isolates showed a total of 42 different antibiotics resistance profiles, with all the isolates showing resistance to at least four or more of the drugs tested. Statistical analysis showed there was no statistical difference in the proportion of isolates that were resistant to >1 antibiotic for human clinical (84.6%) and non-clinical (91.7%) isolates. This results indicates that antimicrobial use in humans has driven the emergence of multi-drug resistant clones in developing countries such as Nigeria that has resulted in an increasingly high prevalence of multiple resistance

Pyrex Journals Whole Genome Sequencing: Bacterial Typing Revolutionized

Bacterial genotyping, or identifying bacteria at the genetic level, is particularly important for diagnosis, treatment, and epidemiological surveillance of bacterial infections. This is especially the case for bacteria exhibiting high levels of antibiotic resistance or virulence, and those involved in nosocomial or pandemic infections. Genotyping also has applications in studying bacterial population dynamics. Over the last two decades, molecular methods have progressively replaced phenotypic assays to type bacterial strains. Whole-genome sequencing of bacteria has recently emerged as a cost-effective and convenient approach for addressing many microbiological questions. Here, we briefly review the state of the art within this field and provide a step-by-step introduction to the workflow involved in genome sequencing, assembly and annotation. We also discussed the application of this technique in a clinical microbiology laboratory, focusing on three essential tasks: (1) identifying the species of an isolate, (2) testing its properties, such as resistance to antibiotics and virulence, and (3) monitoring the emergence and spread of bacterial pathogens. We predict that the application of whole generations sequencing will soon be sufficiently fast, accurate and cheap to be used in routine clinical microbiology practice, where it could replace many complex current techniques with a single, more efficient workflow