13 research outputs found
Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda
BACKGROUND: To establish the magnitude of bacteraemia in severely malnourished children, and describe the types of bacteria and antimicrobial sensitivity by HIV status. METHOD: Isolates were recovered from 76 blood specimens. Antibiotic susceptibility tests were performed using commercial antibiotic disks and demographic and clinical findings were recorded. RESULTS: Of the 450 children 63% were male; median age 17.0 months (inter quartile range, IQR 12–24) and 57% had oedema. 151 (36.7 %) of 411 tested HIV-positive; 76 (17.1%) of 445 blood specimens grew bacterial isolates; 58% were Gram negative – S. typhimurium (27.6%) and S. enteriditis (11.8%). Staph. aureus (26.3%) and Strep. pneumoniae (13.2%) were the main Gram positive organisms. There was no difference in the risk of bacteraemia by HIV status, age < 24 months, male sex, or oedema, except for oral thrush (OR 2.3 CI 1.0–5.1) and hypoalbuminaemia (OR 3.5 CI 1.0–12.1). Isolates from severely immuno-suppressed children (CD4% <15%) were more likely to grow Salmonella enteriditis (OR 5.4; CI 1.6 – 17.4). The isolates were susceptible (≥ 80%) to ciprofloxacin, ceftriaxone and gentamicin; with low susceptibility to chlorampenicol, ampicillin (< 50%) and co-trimoxazole (<25%). Suspicion of bacteraemia had 95.9% sensitivity and 99.2% specificity. Among bacteraemic children, mortality was higher (43.5% vs 20.5%) in the HIV-positive; OR 3.0 (95%CI 1.0, 8.6). CONCLUSION: Bacteraemia affects 1 in every 6 severely malnourished children and carries high mortality especially among the HIV-positive. Given the high level of resistance to common antibiotics, there is need for clinical trials to determine the best combinations of antibiotics for management of bacteraemia in severely malnourished children
“Ten Commandments” for the Appropriate use of Antibiotics by the Practicing Physician in an Outpatient Setting
A multi-national working group on antibiotic stewardship, from the International Society of Chemotherapy, put together ten recommendations to physicians prescribing antibiotics to outpatients. These recommendations are: (1) use antibiotics only when needed; teach the patient how to manage symptoms of non-bacterial infections; (2) select the adequate ATB; precise targeting is better than shotgun therapy; (3) consider pharmacokinetics and pharmacodynamics when selecting an ATB; use the shortest ATB course that has proven clinical efficacy; (4) encourage patients’ compliance; (5) use antibiotic combinations only in specific situations; (6) avoid low quality and sub-standard drugs; prevent prescription changes at the drugstore; (7) discourage self-prescription; (8) follow only evidence-based guidelines; beware those sponsored by drug companies; (9) rely (rationally) upon the clinical microbiology lab; and (10) prescribe ATB empirically – but intelligently; know local susceptibility trends, and also surveillance limitations
Role of microscopic examination of stool specimens in the diagnosis of campylobacter infection from children with acute diarrhoea in Kampala, Uganda
Campylobacter species are a frequent cause of enteritis and less
often of extraintestinal infections in humans. The diagnosis of
campylobacter infection depends mainly on culture which is difficult
and expensive to be done as routine in most clinical microbiology
laboratories in the developing countries. This study was conducted to
determine the sensitivity and specificity of Gram-stain of the stool in
diagnosis of campylobacter infection, using culture as the gold
standard. A total of 226 stool specimens were obtained from children
with acute diarrhoea, attending Mulago Hospital in Kampala, Uganda.
Stool smears were made and conventional Gram stain done using 0.3%
carbol-fuschin as counter stain for 5 minutes. Mucous part of the stool
was cultured in Charcoal Ceferaperazone Deoxycholate Agar and blood
contained selective media. A total of 21 stool samples (9.3%) were
positive by culture and 17 (7.5%) by Gram stain. Sensitivity and
specificity of Gram stain in the diagnosis of campylobacter infection
was 76% and 99.5%, respectively with positive predictive value of
94.1%. A total of 127 (56.2%) had white blood cells (WBC) in stool and
there was strong association between WBC in stool and the presence of
campylobacter infection (P=0.001). Gram stain is a good alternative in
diagnosis of campylobacter infection in place where facilities for
culture are limited
Intravascular catheter related infections in children admitted on the paediatric wards of Mulago hospital, Uganda.
Introduction: Worldwide use of intravascular catheters (IVC) has been associated with both local and systemic infections. No studies have been done in the sub-Saharan region on IVC related infections. Objective: To determine the prevalence, causative organisms and their antimicrobial susceptibility pattern and the factors associated with infections related to short term peripheral venous catheters in children admitted to the general paediatric wards in Mulago Hospital, Uganda. Methods: A cross-sectional study of 391 children aged one day to 12 years, on Jelliffe ward in Mulago Hospital, who had short
peripheral venous intravascular catheters uncoated with no antibiotic or antiseptic, was done. Social demographic characteristics, anthropometry, clinical examination including the catheter site were determined at enrollment. The children had their blood, catheter tip and hub samples taken off for culture and sensitivity as well as complete blood counts. The data collected was entered using EPIINFO and analysed with SPSS packages.
Results: Out of the 391 short term peripheral venous catheters collected, 20.7% catheter tips and 11.3% catheter hubs were colonised. Phlebitis was observed in 17.4%. Bacteria isolated from colonised catheter tips were Staphylococcus aureus (60.5%), Staphylococcus epidermidis (23.5%). The most common organism isolated from the hub was Staphylococcus aureus (56.8%) followed by Staphylococcus epidermidis (18.1%). Gram positive and negative organisms were sensitive to ciprofloxacin, gentamycin for gramnegative organisms and augmentin, cefuroxime, ceftriaxone for the gram-positive organisms. After logistic regression, factors such oedema, modified Glasgow coma score o
Campylobacter spp among Children with acute diarrhea attending Mulago hospital in Kampala - Uga
Background: Campylobacter infections occur worldwide. A recent study in Kampala, Uganda, found that 87% of broiler chickens had Campylobacter jejuni; these are potential source of human infection. Isolation rate in developing countries is between 5-35%. This study aimed at finding prevalence of children with campylobacter infection among children with acute diarrhea attending Mulago hospital. Objective: The objective was to establish the proportion of children infected with Campylobacter spp among children with acute diarrhea at Mulago hospital. Methods: A crossectional study from July to October 2005 was conducted involved 226 children with sampling was done a total of 226 stool specimens were obtained and cultured on selective media. Identification was done using biochemical test and susceptibility using standard discs diffusion method.Results: Campylobacter spp were isolated in 21 (9.3%) of 226 stool specimens analyzed. Campylobacter jejuni 17 (80.9%), Campylobacter lari 2 (9.5%), Campylobacter coli 1 (4.5%) and Campylobacter jejuni/coli 1(4.5%). All Campylobacter isolates were sensitive to erythromycin, and 20% had intermediate resistance to Ampicillin. Conclusion: Campylobacter spp are prevalent among children with acute diarrhea in Kampala- Uganda. A large multicenter study should be undertaken so that the extent of campylobacter infection in our setting can be established.Keywords: Campylobacter spp, Prevalence, Acute diarrheaAfrican Health Sciences 2009; 9(3):201-20
Campylobacter spp among Children with acute diarrhea attending Mulago hospital in Kampala - Uganda
Background: Campylobacter infections occur worldwide. A recent study
in Kampala, Uganda, found that 87% of broiler chickens had
Campylobacter jejuni ; these are potential source of human infection.
Isolation rate in developing countries is between 5-35%. This study
aimed at finding prevalence of children with campylobacter infection
among children with acute diarrhea attending Mulago hospital.
Objective: The objective was to establish the proportion of children
infected with Campylobacter spp among children with acute diarrhea at
Mulago hospital. Methods: A crossectional study from July to October
2005 was conducted involved 226 children with acute diarrhea. Serial
sampling was done a total of 226 stool specimens were obtained and
cultured on selective media. Identification was done using biochemical
test and susceptibility using standard discs diffusion method.
Results: Campylobacter spp were isolated in 21 (9.3%) of 226 stool
specimens analyzed. Campylobacter jejuni 17 (80.9%), Campylobacter lari
2 (9.5%), Campylobacter coli 1 (4.5%) and Campylobacter jejuni/coli
1(4.5%). All Campylobacter isolates were sensitive to erythromycin, and
20% had intermediate resistance to Ampicillin. Conclusion:
Campylobacter spp are prevalent among children with acute diarrhea in
Kampala- Uganda. A large multicenter study should be undertaken so that
the extent of campylobacter infection in our setting can be
established
Bacteriuria among adult non-pregnant women attending Mulago hospital assessment centre in Uganda
Background: Urinary tract infections (UTIs) in women are a common
problem in primary health care settings. Resistance of bacterial
uropathogens to commonly used antibiotics is common in many places.
Objectives: To determine the prevalence of UTI, associated uropathogens
and their antimicrobial susceptibility. Methods: A cross section study
carried out at Mulago hospital outpatients' department. Midstream urine
samples (MSU) were collected from 399 women, who gave informed consent
and fulfilled other study criteria. Quantitative culture method,
identification of uropathogens and antibiotic susceptibility testing
using the Kirby-Bauer disc diffusion technique were applied to the
isolates. Results: Out of 399 MSU samples, 40 pure significant
bacterial growths (≥ 105 colony forming units (cfu)/ml of urine)
were isolated and these included Escherichia coli , 23 (57.5%),
Staphylococcus aureus , 9 (22.5%), Enterococci spp, 6 (15%) and
Klebsiella pneumoniae , 2 (5.0%). Overall, sensitivities were:
nitrofurantoin (98.3%), cefuroxime (89.3%), and cotrimoxazole (20%) by
all uropathogens isolated. Conclusions: Culture positive UTI among
adult non-pregnant women are a common problem, occurring in 10% of the
study population. Most bacterial uropathogens showed high sensitivity
to nitrofurantoin but low sensitivity to SXT. Recommendations:
Nitrofurantoin should be considered as drug of choice for empirical
treatment of community acquired uncomplicated UTI in adult non-pregnant
women
Bacteriuria among adult non-pregnant women attending Mulago hospital assessment centre in Uganda
Background: Urinary tract infections (UTIs) in women are a common problem in primary health care settings. Resistance of bacterial uropathogens to commonly used antibiotics is common in many places.Objectives: To determine the prevalence of UTI, associated uropathogens and their antimicrobial susceptibility.Methods: A cross section study carried out at Mulago hospital outpatients’ department. Midstream urine samples (MSU) were collected from 399 women, who gave informed consent and fulfilled other study criteria. Quantitative culture method, identification of uropathogens and antibiotic susceptibility testing using the Kirby-Bauer disc diffusion technique wereapplied to the isolates.Results: Out of 399 MSU samples, 40 pure significant bacterial growths (>105 colony forming units (cfu)/ml of urine) were isolated and these included Escherichia coli, 23 (57.5%), Staphylococcus aureus, 9 (22.5%), Enterococci spp, 6 (15%) and Klebsiella pneumoniae, 2 (5.0%). Overall, sensitivities were: nitrofurantoin (98.3%), cefuroxime (89.3%), andcotrimoxazole (20%) by all uropathogens isolated.Conclusions: Culture positive UTI among adult non-pregnant women are a common problem, occurring in 10% of the study population. Most bacterial uropathogens showed high sensitivity to nitrofurantoin but low sensitivity to SXT. Recommendations: Nitrofurantoin should be considered as drug of choice for empirical treatment of community acquired uncomplicated UTI in adult non-pregnant women
Untersuchungen ueber die Lebensdauer, die Aktivitaet und den Transport von Mikroorganismen in Grundwasser und Grundwasserleitern unter besonderer Beruecksichtigung humanpathogener und potentiell pathogener Keime Abschlussdatum: 31.12.1983
TIB: RN 8908 (84-120) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman