Opportunities to improve antibiotic prescribing for adults with acute sinusitis, United States, 2016–2020

BACKGROUND: Better understanding differences associated with antibiotic prescribing for acute sinusitis can help inform antibiotic stewardship strategies. We characterized antibiotic prescribing patterns for acute sinusitis among commercially insured adults and explored differences by patient- and prescriber-level factors. METHODS: Outpatient encounters among adults aged 18 to 64 years diagnosed with sinusitis between 2016 and 2020 were identified by national administrative claims data. We classified antibiotic agents-first-line (amoxicillin-clavulanate or amoxicillin) and second-line (doxycycline, levofloxacin, or moxifloxacin)-and ≤7-day durations as guideline concordant based on clinical practice guidelines. Modified Poisson regression was used to examine the association between patient- and prescriber-level factors and guideline-concordant antibiotic prescribing. RESULTS: Among 4 689 850 sinusitis encounters, 53% resulted in a guideline-concordant agent, 30% in a guideline-discordant agent, and 17% in no antibiotic prescription. About 75% of first-line agents and 63% of second-line agents were prescribed for \u3e7 days, exceeding the length of therapy recommended by clinical guidelines. Adults with sinusitis living in a rural area were less likely to receive a prescription with guideline-concordant antibiotic selection (adjusted risk ratio [aRR], 0.92; 95% CI, .92-.92) and duration (aRR, 0.77; 95% CI, .76-.77). When compared with encounters in an office setting, urgent care encounters were less likely to result in a prescription with a guideline-concordant duration (aRR, 0.76; 95% CI, .75-.76). CONCLUSIONS: Opportunities still exist to optimize antibiotic agent selection and treatment duration for adults with acute sinusitis, especially in rural areas and urgent care settings. Recognizing specific patient- and prescriber-level factors associated with antibiotic prescribing can help inform antibiotic stewardship interventions

Assessment of the Environmental Impact of Discharges from Fishmeal Factories Located in Levrier Bay, Nouadhibou-Mauritania

Levrier Bay, located in the western part of Mauritanian Cost, has a strategic position in Mauritania’s fish economy and reproduction environment. Recently, fishmeal factories have multiplied in the bay. This study was carried out in Levrier Bay. It is the first one in this area which is interested in assessing the environmental impact of fishmeal factory discharges by measuring several parameters such as suspended matter, chemical oxygen demand (COD), biological oxygen demand (BOD), conductivity, turbidity, and salinity. A total of 27 samples were collected at 9 sites distributed on the link between effluents from factories and the Atlantic Ocean (discharge site). Results show that some parameters are over permissible values, like suspended matter content (SS), which reached 2020 mg. L.-1 level. The turbidity measure shows excessively high values (50 to 961 mg.L.-1); impacted by effluents at the reject point, the seawater conductivity and salinity are particularly low (4.53 to 188.2 and 13 to 56.4, respectively). The total organic carbon (TOC) values ranged from 200 to 780 mg/L, whereas the highest measured level of chemical oxygen demand was 4010 mg.L.-1 Biochemical oxygen demand content ranged from 685 to 961 mg/L. The biodegradability index (COD/BOD) shows that these effluents are not easily biodegradable because the index > 3

Assessment of drug resistance associated genetic diversity in Mauritanian isolates of Plasmodium vivax reveals limited polymorphism

BackgroundPlasmodium vivax is the predominant malaria species in northern Mauritania. Molecular data on P. vivax isolates circulating in West Africa are scarce. The present study analysed molecular markers associated with resistance to antifolates (Pvdhfr and Pvdhps), chloroquine (Pvmdr1), and artemisinin (Pvk12) in P. vivax isolates collected in two cities located in the Saharan zone of Mauritania.MethodsBlood samples were obtained from P. vivax-infected patients recruited for chloroquine therapeutic efficacy study in 2013 and febrile patients spontaneously consulting health facilities in Nouakchott and Atar in 2015-2016. Fragments of Pvdhfr (codons 13, 33, 57, 58, 61, 117, and 174), Pvdhps (codons 382, 383, 512, 553, and 585), Pvmdr1 (codons 976 and 1076) and Pvk12 (codon 552) genes were amplified by PCR and sequenced.ResultsMost of the isolates in Nouakchott (126/154, 81.8%) and Atar (44/45, 97.8%) carried the wild-type Pvdhfr allelic variant (IPFSTSI). In Nouakchott, all mutants (28/154; 18.2%) had double Pvdhfr mutations in positions 58 and 61 (allelic variant IPFRMSI), whereas in Atar only 1 isolate was mutant (S117N, allelic variant IPFSTNI). The wild-type Pvdhps allelic variant (SAKAV) was found in all tested isolates (Nouakchott, n=93; Atar, n=37). Few isolates in Nouakchott (5/115, 4.3%) and Atar (3/79, 3.8%) had the mutant Pvmdr1 allele 976F or 1076L, but not both, including in pre-treatment isolates obtained from patients treated successfully with chloroquine. All isolates (59 in Nouakchott and 48 in Atar) carried the wild-type V552 allele in Pvk12.ConclusionsPolymorphisms in Pvdhfr, Pvdhps, Pvmdr1, and Pvk12 were limited in P. vivax isolates collected recently in Nouakchott and Atar. Compared to the isolates collected in Nouakchott in 2007-2009, there was no evidence for selection of mutants. The presence of one, but not both, of the two potential markers of chloroquine resistance in Pvmdr1 in pre-treatment isolates did not influence the clinical outcome, putting into question the role of Pvmdr1 mutant alleles 976F and 1076L in treatment failure. Molecular surveillance is an important component of P. vivax malaria control programme in the Saharan zone of Mauritania to predict possible emergence of drug-resistant parasites

Comparative post-rainy season surveys of malaria-associated morbidity among febrile pediatric patients in Nouakchott, Mauritania

International audienc

Increasing prevalence of Plasmodium vivax among febrile patients in Nouakchott, Mauritania

The occurrence of Plasmodium vivax malaria was reported in Nouakchott, Mauritania in the 1990s. Several studies have suggested the frequent occurrence of P. vivax malaria among Nouakchott residents, including those without recent travel history to the southern part of the country where malaria is known to be endemic. To further consolidate the evidence for P. vivax endemicity and the extent of malaria burden in one district in the city of Nouakchott, febrile illnesses were monitored in 2012-2013 in the Teyarett health center. The number of laboratory-confirmed P. vivax cases has attained more than 2,000 cases in 2013. Malaria transmission occurs locally, and P. vivax is diagnosed throughout the year. Plasmodium vivax malaria is endemic in Nouakchott and largely predominates over Plasmodium falciparum

Retrospective overview of a COVID-19 outbreak in Mauritania

International audienc

Assessment of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Plasmodium vivax malaria endemic setting in Mauritania

International audienc

Distribution of Duffy blood group (FY) phenotypes among Plasmodium vivax-infected patients in Nouakchott, Mauritania

International audienc