Antibiotic resistance and Molecular characterization of Salmonella in diarrhoeal patients’ faeces in south-western Nigeria

The study reports the prevalence of multiple antibiotic resistance (MAR) and molecular chacterization of resistance (BlaCTX and GyrA) genes in Salmonella recovered from stool samples of diarrhoeal patients in Ile-Ife, Osun state, Nigeria. Salmonella was cultured on molten Salmonella and Shigella agar (Oxoid, Ltd, Bashingstoke, Hampshire, England) plate at 370C. Susceptibility of isolates to antibiotics was done on Mueller Hinton (Himedia lab Ltd, Vadhani) by disk diffusion technique. Detection of plasmid DNA in multiple antibiotic resistant isolates was carried out by alkali lysis (TENS) method and resistance genes (BlaCTX and GyrA) were detected by the polymerase chain reaction. A total of 69 Salmonella (S.Typhimurium(82.6 %), S.Typhi(10.1 %) and S.ParatyphiA (7.3 %)) were cultured from 187 diarrhoeal stool samples analysed. Resistance was mostly to nitrofurantoin (100%), ceftriazone (97.2 %), and gentamicin (94.2 %) among others.  Sixty seven (97.1 %) of the Salmonella isolates were resistant to at least two different classes of antibiotics with 32 antibiotypes. Multiple plasmids of molecular weights (1.46 - 23.13 kbp) and resistance genes (GyrA-282 bp, blaCTX-480 bp) were detected in the representative MAR isolates. The prevalence of MAR Salmonella in diarrhoeal patients’ stool samples is high in the study area with attendant public health and economic loss consequences. Keywords:Salmonella, diarrhoea, antibiotic resistance, plasmid, resistance gene

Anthrax disease burden: Impact on animal and human health

Anthrax is a zoonotic infectious disease caused by Bacillus anthracis. According to current knowledge, the disease originates in sub-Saharan Africa, especially Egypt and Mesopotamia. Laboratory tests involving direct staining or culture of samples taken from malignant pustules, sputum, blood, or patient discharge must be performed to establish a diagnosis. B. anthracis infection can enter the body through the skin, mouth, or nose. Human infection is usually caused by contact with infected animals or animal products. Anthrax causes a reduction in resource efficiency and decreases livestock productivity. B. anthracis spores are resistant to extreme temperatures, pressure, pH, drying, solvents, and ultraviolet light. The biological weapon of this disease may be fatal if it is designed to spread B. anthracis spores by aerosols. In the past, the treatment of human anthrax with penicillin at a high dose was the preferred method. The public can take several measures to prevent anthrax infection, such as purchasing and consuming meat that has been legally certified to have been slaughtered in a slaughterhouse, consuming healthy and properly cooked animal meat, and washing hands with antiseptic soap after handling, processing, and cooking animal products. This review aimed to describe the etiology, pathogenesis, mechanism of infection, epidemiology, diagnosis, clinical symptoms, transmission, risk factors, public health importance, economic impact, potential as a bio-warfare agent, treatment, and control of anthrax

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Human Colonization and Infection by <i>Staphylococcus pseudintermedius</i>: An Emerging and Underestimated Zoonotic Pathogen

S. pseudintermedius is a known resident of the skin and mucous membranes and a constituent of the normal microbiota of dogs. It has also been recognized as an opportunistic and zoonotic pathogen that is able to colonize humans and cause severe diseases, especially in immunocompromised hosts. Most importantly, methicillin-resistant S. pseudintermedius (MRSP), which is intrinsically multidrug-resistant, has emerged with serious public health consequences. The epidemiological situation is further exacerbated with reports of its zoonotic transmission and human infections which have been mostly attributed to the increasing frequency of dog ownership and close contact between dogs and humans. Evidence on the zoonotic transmission of MRSP from pet dogs to humans (such as dog owners, small-animal veterinarians, and other people in close proximity to dogs) is limited, especially due to the misidentification of S. pseudintermedius as S. aureus. Despite this fact, reports on the increasing emergence and spread of MRSP in humans have been increasing steadily over the years since its first documented report in 2006 in Belgium. The emergence of MRSP strains has further compromised treatment outcomes in both veterinary and human medicine as these strains are resistant to beta-lactam antimicrobials usually prescribed as first line treatment. Frustratingly, the limited awareness and surveillance of the zoonotic transmission of S. pseudintermedius have underestimated their extent of transmission, prevalence, epidemiology, and public health significance. In order to fill this gap of information, this review focused on detailed reports on zoonotic transmission, human colonization, and infections by S. pseudintermedius, their pathogenic features, antimicrobial resistance profiles, epidemiology, risk factors, and treatment. In writing this review, we searched Web of Science, PubMed, and SCOPUS databases using the keyword “Staphylococcus pseudintermedius AND humans”. A phylogenetic tree to determine the genetic relatedness/diversity of publicly available genomes of S. pseudintermedius was also constructed

Detection of Genes on Eschericia coli Producing Extended Spectrum β-lactamase Isolated from the Small Intestine of Ducks in Traditional Markets Surabaya City, Indonesia

This research aimed to focus on the presence of ESBL-producing E. coli isolated from the small intestine of ducks in several traditional markets in Surabaya as there is still little information regarding cases of ESBL-producing E. coli in ducks in Indonesia. Samples from the small intestine of ducks were kept on Buffer Peptone Water (BPW) media and then streaked on Eosin Methylene Blue Agar (EMBA) media for isolation testing, while Gram staining and IMViC tests were used to continue the identification test. Kirby-bauer diffusion test for determining antibiotic sensitivity and confirmation of ESBL producing E. coli using the double disc synergy test (DDST). Molecular detection of TEM and CTX-M genes was carried out using Polymerase Chain Reaction (PCR). Based on morphological culture characteristics, Gram staining, and biochemical testing, the sample analysis results revealed that 32 samples (32%) of the 100 samples that were isolated were confirmed to be positive for E. coli. 10 from 32 E. coli isolates (31.25%) were confirmed to be multidrug resistance (MDR) because they were resistant to 3 to 4 antibiotic classes. Two out of ten E. coli isolates reported to be multidrug resistant were discovered to have positive DDST test findings after the ESBL identification of those isolates. Based on molecular examination, one isolate of E. coli was found containing TEM and CTX-M genes. Giving antibiotics to ducks must be considered in the dose or level so as not to cause antibiotic residues in the digestive tract of ducks. More farmer awareness of and public concern for the safety of food of animal origin is required, as is the use of antibiotics in poultry under the supervision of a veterinarian.

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways