ANTIMICROBIAL DRUG MISUSE IN THE EASTERN DEMOCRATIC REPUBLIC OF THE CONGO A CROSS-SECTIONAL STUDY: FACTORS INFLUENCING THE EMERGENCE OF ANTIMICROBIAL RESISTANCE

Background Antimicrobial resistance is a major global public health challenge. In sub-Saharan Africa, Plasmodium resistance to new molecules on the market continues unabated. This increase in resistance is mostly due to unhealthy community practices, and also to microbial control methods that are ineffective because of our health policies. This study aimed to analyze factors involved in the emergence of antimicrobial resistance in ancient Kivu, in the eastern part of the Democratic Republic of Congo (DRC). Materials and methods A cross-sectional study was carried out from November 2023 to February 2024 in two cities east of the Democratic Republic of the Congo, surveying pharmacies using a standardized questionnaire. We focused on four elements within the pharmacies: the nature of the provider, the way medicines are sold (consumption), the location of the pharmacies, and the nature of drugs. Results Our study included 98 (56.9%) pharmacies, 66.3% (65/98) of which were located in peripheral areas with most of the untrained providers (91.7%; 11/12; p = 0.006) and in all pharmacies, 81% (47/58; p < 0.001) of their sales were based on patients' wishes. Nursing sales are 76.9% (20/26; PR: 1.9; 95% CI: 0.5-7.4; p = 0.009) undocumented among qualified staff involved in pharmacy sales. Conclusions The risk factors for developing antimicrobial resistance in these two cities in eastern DRC are related to undocumented drug sales and qualified providers in pharmacies. This requires a high level of awareness among those involved in the sale of medicines and those who receive them. Recommendation Our proposal is for strict protection of antimicrobial resources through regulation of their sale in the region

High bacterial and viral load in the upper respiratory tract of children in the Democratic Republic of the Congo.

BackgroundRespiratory pathogens including Streptococcus pneumoniae and Haemophilus influenzae, are implicated in the pathogenicity of acute lower respiratory infection (ALRI). These are also commonly found in both healthy and sick children. In this study, we describe the first data on the most frequent bacteria and viruses detected in the nasopharynx of children from the general population in the Eastern DR Congo.MethodsFrom January 2014 to June 2015, nasopharyngeal samples from 375 children aged from 2 to 60 months attending health centres for immunisation or growth monitoring were included in the study. Multiplex real-time PCR assays were used for detection of 15 different viruses and 5 bacterial species and for determination of pneumococcal serotypes/serogroups in the nasopharyngeal secretions.ResultsHigh levels of S. pneumoniae were detected in 77% of cases, and H. influenzae in 51%. Rhinovirus and enterovirus were the most commonly found viruses, while respiratory syncytial virus (RSV) was rare (1%). Co-occurrence of both bacteria and viruses at high levels was detected in 33% of the children. The pneumococcal load was higher in those children who lived in a dwelling with an indoor kitchen area with an open fire, i.e. a kitchen with an open fire for cooking located inside the dwelling with the resultant smoke passing to the living room and/or bedrooms; this was also higher in children from rural areas as compared to children from urban areas or children not living in a dwelling with an indoor kitchen area with an open fire/not living in this type of dwelling. Immunization with 2-3 doses of PCV13 was associated with lower rates of pneumococcal detection. Half of the identified serotypes were non-PCV13 serotypes. The most common non-PCV13 serotypes/serogroups were 15BC, 10A, and 12F, while 5, 6, and 19F were the most prevalent PCV13 serotypes/serogroups.ConclusionsThe burden of respiratory pathogens including S. pneumoniae in Congolese children was high but relatively few children had RSV. Non-PCV13 serotypes/serogroups became predominant soon after PCV13 was introduced in DR Congo

HYDROPS FETALIS SECONDARY TO TOXOPLASMA GONDII AND TREPONEMA PALLIDUM COINFECTION: CASE REPORT AND BRIEF LITERATURE REVIEW: case report and brief literature review

Background Hydrops fetalis is a pathological condition in which fluid accumulates in the fetus in an extracellular environment, leading to subcutaneous edema and possible accumulation in the fetal body and abdominal cavity. The most common causes in this region are infectious, making systematic monitoring during pregnancy essential. However, it is difficult to apply this guideline in urban areas, and even more so in rural areas with few resources for investigation, as in this patient's case, monitoring was ineffective. The aim was to carry out infection studies in maternal blood samples taken after giving birth to a newborn in hydrops.  Case presentation A 36-year-old rural woman in her 6th pregnancy presented with uterine contractions in what was thought to be a full-term pregnancy. The progress of this pregnancy had not been monitored throughout the antenatal period for unknown reasons despite a clinical presentation characterized by breathlessness and generalized edema. The obstetric gynecology clinical examination revealed a mattress-like appearance suggestive of placenta previa, and a cesarean section was indicated with the extraction of a newborn with hydrops fetalis who died despite resuscitation efforts. An infectious disease investigation after delivery revealed the presence of both Treponema pallidum and Toxoplasma gondii in the maternal blood sample.  Conclusion This state of hydrops fetalis was secondary to this co-infection, which is very difficult to manage in such conditions, facilitated by the lack of systematic biological monitoring for pathogens that could harm both the fetus and the mother.  Recommendation Facilitate prenatal visits to women, especially in rural areas where access to services is limited, through home visits from health workers and community relays. During the monthly antenatal visit, pregnant women should be subjected to compulsory infectious screening to provide suitable conditions for the fetus

High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo

Abstract Background Pneumococcal conjugate vaccines have been introduced in the infant immunisation programmes in many countries to reduce the rate of fatal pneumococcal infections. In the Democratic Republic of the Congo (DR Congo) a 13-valent vaccine (PCV13) was introduced in 2013. Data on the burden of circulating pneumococci among children after this introduction are lacking. In this study, we aimed to determine the risk factors related to pneumococcal carriage in healthy Congolese children after the vaccine introduction and to assess the antibiotic resistance rates and serotype distribution among the isolated pneumococci. Methods In 2014 and 2015, 794 healthy children aged one to 60 months attending health centres in the eastern part of DR Congo for immunisation or growth monitoring were included in the study. Data on socio-demographic and medical factors were collected by interviews with the children’s caregivers. Nasopharyngeal swabs were obtained from all the children for bacterial culture, and isolated pneumococci were further tested for antimicrobial resistance using disc diffusion tests and, when indicated, minimal inhibitory concentration (MIC) determination, and for serotype/serogroup by molecular testing. Results The pneumococcal detection rate was 21%, being higher among children who had not received PCV13 vaccination, lived in rural areas, had an enclosed kitchen, were malnourished or presented with fever (p value < 0.05). The predominant serotypes were 19F, 11, 6A/B/C/D and 10A. More than 50% of the pneumococcal isolates belonged to a serotype/serogroup not included in PCV13. Eighty per cent of the isolates were not susceptible to benzylpenicillin and non-susceptibility to ampicillin and ceftriaxone was also high (42 and 37% respectively). Almost all the isolates (94%) were resistant to trimethoprim-sulphamethoxazole, while 43% of the strains were resistant to ≥3 antibiotics. Conclusions Our study shows alarmingly high levels of reduced susceptibility to commonly used antibiotics in pneumococci carried by healthy Congolese children. This highlights the importance of local antibiotic resistance surveillance and indicates the needs for the more appropriate use of antibiotics in the area. The results further indicate that improved living conditions are needed to reduce the pneumococcal burden, in addition to PCV13 vaccination