Antimicrobial storage and antibiotic knowledge in the community: a cross-sectional pilot study in north-western Angola

Background - Antimicrobials are drugs that were once lifesavers and mainly curative. Nowadays their value is increasingly under pressure because of the fast and worldwide emergence of antimicrobial resistance, which, in low resources settings, frequently occurs in microorganisms that are likely to be transmitted in the community. Methods - A cross-sectional pilot study including 102 households within the 10th HDSS round in Dande, Bengo Province, Angola. Results - From the total 102 households piloted, 77.45% were urban (n = 79); the respondents were females in 56.44% (n = 57) and mean age was 39.70 (SD 15.35). Overall storage of antimicrobials was found in 55/102 (53.92%) of the households. More than 66% of the antimicrobials stored were prescribed by a health professional and the majority of antimicrobials were bought at pharmacies and at a street market. Penicillin and its derivates, antimalarial drugs and metronidazole are the most frequently antimicrobials stored. Households with female respondents reported to store more frequently any drugs at home (82.50%) (p = 0.002) and also more antimicrobials (64.91%; p = 0.016) as compared to households with male respondents. Reported use of antimicrobials was significantly higher in urban 60.76% (48/79) as compared to rural households 30.43% (7/23), (p = 0.010). Overall, 74/101 (73.26%) of respondents reported to have already heard about antibiotics. Among them, the common reasons for its use were cough and other respiratory symptoms, wounds, flu and body muscle pain, fever, bladder complaints, diarrhea and/or presumed typhoid fever. Nearly 40% (28/74) of the respondents thought that antibiotics should be stopped as soon as people dońt feel sick anymore. Conclusions - Community interventions for appropriate use of antibiotics should be designed with a special focus in women; through public awareness campaigns and improving access to reliable medical services. Drug prescribers are a keystone not only in adequate antimicrobial prescription but also adequate dispensing and strong advocates for the possible misconceptions on antimicrobial usage by laypeople.info:eu-repo/semantics/publishedVersio

Time between symptom onset, hospitalisation and recovery or death : statistical analysis of Belgian COVID-19 patients

There are different patterns in the COVID-19 outbreak in the general population and amongst nursing home patients. We investigate the time from symptom onset to diagnosis and hospitalization or the length of stay (LoS) in the hospital, and whether there are differences in the population. Sciensano collected information on 14,618 hospitalized patients with COVID-19 admissions from 114 Belgian hospitals between 14 March and 12 June 2020. The distributions of different event times for different patient groups are estimated accounting for interval censoring and right truncation of the time intervals. The time between symptom onset and hospitalization or diagnosis are similar, with median length between symptom onset and hospitalization ranging between 3 and 10.4 days, depending on the age of the patient (longest delay in age group 20-60 years) and whether or not the patient lives in a nursing home (additional 2 days for patients from nursing home). The median LoS in hospital varies between 3 and 10.4 days, with the LoS increasing with age. The hospital LoS for patients that recover is shorter for patients living in a nursing home, but the time to death is longer for these patients. Over the course of the first wave, the LoS has decreased

A retrospective observational study on the efficacy of colistin by inhalation as compared to parenteral administration for the treatment of nosocomial pneumonia associated with multidrug-resistant Pseudomonas aeruginosa

<p>Abstract</p> <p>Background</p> <p>Colistin is used as last treatment option for pneumonia associated with multidrug-resistant (MDR) <it>Pseudomonas </it>spp.. Literature about the best administration mode (inhalation versus parenteral treatment) is lacking.</p> <p>Methods</p> <p>A retrospective study of 20 intensive care patients with a pneumonia associated with MDR <it>P. aeruginosa </it>receiving colistin sulphomethate sodium (Colistineb^®) between 2007 and 2009 was performed. A strain was considered multidrug-resistant if it was resistant to at least 6 of the following antibiotics: piperacillin-tazobactam, ceftazidime, cefepime, meropenem, aztreonam, ciprofloxacin, and amikacin. The administration mode, predicted mortality based on the SAPS3 score, SOFA score at onset of the colistin treatment, clinical and microbiological response, and mortality during the episode of the infection were analysed. The non parametric Kruskal-Wallis and Fisher's Exact test were used for statistical analysis of respectively the predicted mortality/SOFA score and mortality rate.</p> <p>Results</p> <p>Six patients received colistin by inhalation only, 5 were treated only parenterally, and 9 by a combination of both administration modes. All patients received concomitant beta-lactam therapy. The mean predicted mortalities were respectively 72%, 68%, and 69% (p = 0.91). SOFA scores at the onset of the treatment were also comparable (p = 0.87). Clinical response was favorable in all patients receiving colistin by inhalation (6/6) and in 40% (2/5) of the patients receiving colistin parenterally (p = 0.06). In the patients with colistin administered both via inhalation and parenterally, clinical response was favorable in 78% of the patients (7/9) (p = 0.27 as compared to the treatment group receiving colistin only parenterally). When all patients with inhalation therapy were compared to the group without inhalation therapy, a favorable clinical response was present in respectively 87% and 40% (p = 0.06). In none of the patients, the <it>Pseudomonas </it>spp. was eradicated from the follow-up cultures.</p> <p>All patients in the parenterally treated group died. None of the patients receiving colistin by inhalation, and 3 of 9 patients of the combination group eventually died (p = 0.002 and p = 0.03 respectively as compared to the group receiving colistin only parenterally).</p> <p>Conclusions</p> <p>Aerosolized colistin could be beneficial as adjunctive treatment for the management of pneumonia due to MDR <it>P. aeruginosa</it>.</p

The microbiological spectrum of invasive bacterial infections in Cambodian adults and implications for standard treatment guidelines.

Invasive bacterial infections, including bloodstream infections, are a major cause of morbidity and mortality around the world. In order to choose the most adequate empiric antibiotic, clinicians require information on the most frequent bacteria causing invasive infections. This information can be obtained by culturing blood from patients suspect of invasive bacterial infections (i.e. blood cultures). Given the worldwide spread of antibiotic resistance, invasive bacterial infections have become more difficult-to-treat with commonly available antibiotics. Therefore it is also important to measure resistance rates among invasive bacteria. In addition, studying the (genetic) mechanisms behind antibiotic resistance and the genetic relations between bacteria can contribute to a better understanding of how bacteria become resistant and spread among people and in the environment. In high-income settings with a sufficient number of high-quality microbiological laboratories such as Europe and Northern America, information on the presence of (resistant) bacteria is widely available through surveillance systems, based on nationwide networks of quality-assured laboratories. In low- and middle income countries such as Cambodia, well-functioning laboratories are very scarce, and essential information on the causes and resistance patterns of invasive bacterial infections is often not available.In 2007, the Institute of Tropical Medicine, Antwerp (ITM) and Sihanouk Hospital Centre of HOPE (SHCH), Phnom Penh, Cambodia, started a joint study of blood cultures taken from all adult patients who presented with fever in the hospital between 2007 and 2010. During this study period, 5714 blood culture samples were taken from 4833 patients; in 8.8 % (n = 445) of these samples we detected pathogenic bacteria. Nearly one out of four patients with a bloodstream infection died. The most common and remarkable bacteria were Escherichia coli and other Enterobacteriaceae, Salmonella enterica, Burkholderia pseudomallei, Staphylococcus aureus and Streptococcus suis; for all of which we found high resistance rates to several commonly used antibiotics. Burkholderia pseudomallei is a bacterium living in soil and water, mainly in Southeast Asia and northern Australia. It is the cause of the disease melioidosis, which presents in many different ways such as a skin, lung, bone or bloodstream infection. The bacterium has intrinsic resistance against many commonly used antibiotics and requires treatment with expensive, broad spectrum antibiotics. We described 58 patients with melioidosis in Cambodia. The disease was mainly seen in patients with diabetes mellitus and during the rainy season. More than half of the patients died, especially those with a severe condition such as a bloodstream infection (RR 6.8 (1.82-25.5) and those who received inappropriate antibiotic treatment (RR 3.5 (2.07-5.90), p < 0.001). An earlier diagnosis and the availability of effective antibiotics would be a step forward in better outcomes for these patients.Salmonella bloodstream infections can be caused by Salmonella types which infect only humans (Salmonella Typhi and Salmonella Paratyphi which cause enteric fever), or by non-typhoid Salmonella types which cause illness in animals and only occasionally in humans. Between 2007-2010 we described 72 patients with Salmonella bloodstream infections. These were caused by Salmonella types of the first group Salmonella Typhi (20 cases) and Salmonella Paratyphi (2 cases) and by non-typhoid Salmonella types, most commonly Salmonella Choleraesuis (50 cases). This bacterium causes fever in pigs and occasionally in humans with very low immunity. In patients with HIV/AIDS, Salmonella Choleraesuis caused multiple episodes of fever. All Salmonella presented with high resistance rates, especially for ciprofloxacin (in Salmonella Typhi) and azithromycin (in Salmonella Choleraesuis), two important antibiotics for the treatment of enteric fever. Therefore, a review of the guidelines for enteric fever treatment is warranted.Surprisingly, between 2011 and 2013, we observed a sudden and very sharp rise in the number of infections with Salmonella Paratyphi A, mostly in the capital Phnom Penh. As this coincides with an increased number of European travelers returning from Cambodia with enteric fever, we presume a local outbreak is ongoing which warrants prompt investigation and control measures.Escherichia coli is the most common cause of (complicated) intra-abdominal and genito-urinary infections. In our study, about 50% of these bacteria were highly resistant for a combination of first and second line antibiotics, mostly due to the presence of extended spectrum beta-lactamases (ESBL). Most of these highly resistant bacteria with ESBL carried a common mechanism (i.e. CTX-M) which is spreading quickly around the world, including in Cambodia. In our study, people who had recent exposure to antibiotics were at higher risk of having a ESBL-positive Escherichia coli bloodstream infection (RR 1.46 (1.03-2.09), p = 0.035). About 30% of all patients with Escherichia coli bloodstream infection died, especially those who suffered from many other illnesses (RR 2.75 (1.11-6.81), p = 0.028) such as chronic liver disease. Remarkably, inappropriate antibiotic choices did not increase mortality significantly (RR 1.16 ( 0.66-2.06), p = 0.669), in contrast with melioidosis patients.Staphylocccus aureus is the most common cause of skin infections worldwide. Its most famous resistance type is methicillin resistance ( MRSA ), known as a typical nosocomial pathogen, but now frequently associated with community-acquired infections as well. In our study, 23% of invasive Staphylococcus aureus infections was of the MRSA-type. Older age, superficial skin infections and recent hospital contact were risk factors for infection with MRSA. About 15% of all patients died, especially those older than 50 years of age (RR 4.27 (1.14-15.9), p = 0.044). We observed a wide variety of genetic Staphylococcus aureus-types, but five main clones dominated, including 2 types which have been found in animals as well (i.e. ST 398 and ST 9).During the study period, we observed also 13 patients with invasive Streptococcus suis infection. Streptococcus suis usually infects pigs; people can acquire the pathogen through close contact with pigs or undercooked food. These 13 patients presented with meningitis with or without bloodstream infection and often required antibiotic treatment during several weeks. All patients survived, but one third had complications such as deafness. Interestingly, we noted important similarities with Streptococcus suis isolates circulating in southern Vietnam and found resistance problems associated with antibiotic use in animals.We conclude that bloodstream infections in Cambodian adults are often associated with high mortality and high levels of complex antibiotic resistance. Therefore, several urgent measures are to be taken. To contain antibiotic resistance we suggest a wide range of actions, from an improved availability of necessary drugs, adapted treatment guidelines and hand hygiene to updated education and international collaboration.status: publishe

Trends of norfloxacin and erythromycin resistance of Campylobacter jejuni/Campylobacter coli isolates recovered from international travelers, 1994 to 2006.

BACKGROUND: Campylobacter sp. is a major cause of bacterial enterocolitis and travelers' diarrhea. Empiric treatment regimens include fluoroquinolones and macrolides. METHODS: Over the period 1994 to 2006, 724 Campylobacter jejuni/Campylobacter coli isolates recovered from international travelers at the outpatient clinic of the Institute of Tropical Medicine, Antwerp, Belgium, were reviewed for their susceptibility to norfloxacin and erythromycin. RESULTS: Norfloxacin resistance increased significantly over time in isolates from travelers returning from Asia, Africa, and Latin America. For the years 2001 to 2006, norfloxacin resistance rates were 67 (70.5%) of 95 for Asia, 20 (60.6%) of 33 for Latin America, and 36 (30.6%) of 114 for Africa. The sharpest increase was noted for India, with no resistance in 1994, but 41 (78.8%) of 52 resistant isolates found during 2001 to 2006. Erythromycin resistance was demonstrated in 20 (2.7%) isolates, with a mean annual resistance of 3.1% +/- 2.8%; resistance increased over time, with up to 3(7.5%) of 40 and 3 (8.6%) of 35 resistant isolates in 2004 and 2006, respectively (p < 0.05); there was no apparent geographic association. Combined resistance to norfloxacin and erythromycin was observed in five isolates. CONCLUSIONS: The high resistance rates to fluoroquinolones warrant reconsideration of their use as drugs of choice in patients with severe gastroenteritis when Campylobacter is the presumed cause. Continued monitoring of the incidence and the spread of resistant Campylobacter isolates is warranted