Bacteremia in critical care units at Bugando Medical Centre, Mwanza, Tanzania: the role of colonization and contaminated cots and mothers’ hands in cross-transmission of multidrug resistant Gram-negative bacteria

Background: Multidrug resistance (MDR) is a major clinical problem in tertiary hospitals in Tanzania and jeopardizes the life of neonates in critical care units (CCUs). To better understand methods for prevention of MDR infections, this study aimed to determine, among other factors, the role of MDR-Gram-negative bacteria (GNB) contaminating neonatal cots and hands of mothers as possible role in transmission of bacteremia at Bugando Medical Centre (BMC), Mwanza, Tanzania. Methods: This cross-sectional, hospital-based study was conducted among neonates and their mothers in a neonatal intensive care unit and a neonatology unit at BMC from December 2018 to April 2019. Blood specimens (n = 200) were sub-cultured on 5% sheep blood agar (SBA) and MacConkey agar (MCA) plates. Other specimens (200 neonatal rectal swabs, 200 maternal hand swabs and 200 neonatal cot swabs) were directly inoculated on MCA plates supplemented with 2 μg/ml cefotaxime (MCA-C) for screening of GNB resistant to third generation cephalosporins, r-3GCs. Conventional biochemical tests, Kirby-Bauer technique and resistance to cefoxitin 30 μg were used for identification of bacteria, antibiotic susceptibility testing and detection of MDR-GNB and screening of potential Amp-C beta lactamase producing GNB, respectively. Results: The prevalence of culture confirmed bacteremia was 34.5% of which 85.5% were GNB. Fifty-five (93.2%) of GNB isolated from neonatal blood specimens were r-3GCs. On the other hand; 43% of neonates were colonized with GNB r-3GCs, 32% of cots were contaminated with GNB r-3GCs and 18.5% of hands of neonates’ mothers were contaminated with GNB r-3GCs. The prevalences of MDR-GNB isolated from blood culture and GNB r-3GCs isolated from neonatal colonization, cots and mothers’ hands were 96.6, 100, 100 and 94.6%, respectively. Significantly, cyanosis (OR[95%CI]: 3.13[1.51–6.51], p = 0.002), jaundice (OR[95%CI]: 2.10[1.07–4.14], p = 0.031), number of invasive devices (OR[95%CI]: 2.52[1.08–5.85], p = 0.031) and contaminated cot (OR[95%CI]: 2.39[1.26–4.55], p = 0.008) were associated with bacteremia due to GNB. Use of tap water only (OR[95%CI]: 2.12[0.88–5.09], p = 0.040) was protective for bacteremia due to GNB. Conclusion: High prevalence of MDR-GNB bacteremia and intestinal colonization, and MDR-GNB contaminating cots and mothers’ hands was observed. Improved cots decontamination strategies is crucial to limit the spread of MDR-GNB. Further, clinical presentations and water use should be considered in administration of empirical therapy whilst awaiting culture results

The hospital environment versus carriage: transmission pathways for third-generation cephalosporin-resistant bacteria in blood in neonates in a low-resource country healthcare setting

Neonatal bloodstream infections (BSI) can lead to sepsis, with high morbidity and mortality, particularly in low-income settings. The high prevalence of third-generation cephalosporin-resistant organisms (3GC-RO) complicates the management of BSI. Whether BSI is linked to carriage of 3GC-RO, or to acquisition from the hospital environment is important for infection prevention and control, but the relationship remains unclear, especially in low-income settings. At a tertiary hospital in Mwanza, Tanzania, we screened neonatal blood and rectal samples from 200 neonates, and 400 (hospital) environmental samples. We used logistic regression to identify risk factors, and Kolmogorov–Smirnov tests and randomisation analyses to compare distributions of species and resistance patterns to assess potential routes of transmission. We found that BSIs caused by 3GC-RO were frequent (of 59 cases of BSI, 55 were caused by 3GC-RO), as was carriage of 3GC-RO, particularly Escherichia coli, Klebsiella pneumoniae, and Acinetobacter species. In the 28 infants with both a carriage and blood isolate, there were more (4 of 28) isolate pairs of the same species and susceptibility profile than expected by chance (p < 0.05), but most pairs were discordant (24 of 28). Logistic regression models found no association between BSI and carriage with either 3GC-RO or only 3GC-R K. pneumoniae. These analyses suggest that carriage of 3GC-RO is not a major driver of BSI caused by 3GC-RO in this setting. Comparison with environmental isolates showed very similar distributions of species and resistance patterns in the carriage, BSI, and the environment. These similar distributions, a high frequency of Acinetobacter spp. isolations, the lack of strong association between carriage and BSI, together with the high proportion of 3GC-RO in BSI all suggest that these neonates acquire multidrug-resistant carriage and blood isolates directly from the hospital environment

A systematic review of the effects of prolonged cow-calf contact on behavior, welfare, and productivity

Separation of calves from cows within hours or days of birth is common on dairy farms. Stakeholders have conflicting perspectives on whether this is harmful or beneficial for the animals’ welfare and production. Our objective was to critically evaluate the scientific evidence for both acute and long-term effects of early separation versus an extended period of cow-calf contact. The outcomes investigated were the behavior, welfare (excluding physical health) and performance (milk yield and growth, respectively) of dairy cows and calves. Primary research papers were found through targeted Web of Science searches, the reference lists of recent reviews for each topic, and the reference lists of papers identified from these sources. Studies were included if they were published in English, the full text was accessible, and they compared treatments with and without contact between dairy cows and calves for a specified period. Early separation (within 24 h post-partum) was found to reduce acute distress responses of cows and calves. However, longer cow-calf contact typically had positive longer-term effects on calves, promoting more normal social behavior, reducing abnormal behavior and sometimes reducing responses to stressors. In terms of productivity, allowing cows to nurse calves generally decreased the volume of milk available for sale during the nursing period, but there was no consistent evidence of reduced milk production over a longer period. Allowing a prolonged period of nursing increased calf weight gains during the milk-feeding period. In summary, extended cow-calf contact aggravates the acute distress responses and reduces the amount of saleable milk while the calves are suckling, but can have positive effects on behaviors relevant to welfare in the longer term and benefit calf growth. The strength of these conclusions is limited, however, given that relatively few studies address most of these effects and that experimental design including timing of contact and observations are often inconsistent across studies. Few studies presented indicators of long-term welfare effects other than abnormal and social behavior of the calves

Changing trends in mastitis

<p>Abstract</p> <p>The global dairy industry, the predominant pathogens causing mastitis, our understanding of mastitis pathogens and the host response to intramammary infection are changing rapidly. This paper aims to discuss changes in each of these aspects. Globalisation, energy demands, human population growth and climate change all affect the dairy industry. In many western countries, control programs for contagious mastitis have been in place for decades, resulting in a decrease in occurrence of <it>Streptococcus agalactiae </it>and <it>Staphylococcus aureus </it>mastitis and an increase in the relative impact of <it>Streptococcus uberis </it>and <it>Escherichia coli </it>mastitis. In some countries, <it>Klebsiella </it>spp. or <it>Streptococcus dysgalactiae </it>are appearing as important causes of mastitis. Differences between countries in legislation, veterinary and laboratory services and farmers' management practices affect the distribution and impact of mastitis pathogens. For pathogens that have traditionally been categorised as contagious, strain adaptation to human and bovine hosts has been recognised. For pathogens that are often categorised as environmental, strains causing transient and chronic infections are distinguished. The genetic basis underlying host adaptation and mechanisms of infection is being unravelled. Genomic information on pathogens and their hosts and improved knowledge of the host's innate and acquired immune responses to intramammary infections provide opportunities to expand our understanding of bovine mastitis. These developments will undoubtedly contribute to novel approaches to mastitis diagnostics and control.</p

The smallholder dairying in northeast coastal Tanzania Productivity of crossbred cattle and calf rearing systems

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN012302 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Effect of Procurement Procedures on Performance of Public Projects: The Case of Road Construction in Temeke Municipality in Tanzania.

The study examined effects of procurement procedures on performance of public projects; study focused on the road constructed in Mbagala ward, Temeke municipality specifically the study aimed at identifying effects of procurement procedures on cost performance of public project, examined effects of procurement procedures on quality performance of public project and determining effects of procurement procedures on time performance of public project. Data were obtained from the procurement officers, road construction and Mbagala residence. Descriptive and regression analysis were performed in order to determine strength of the study variables. The study findings reveled that; procurement procedures ware highly effective on cost performance of public projects, while regression analysis confirmed that the procurement procedures had moderate correlation with cost performance in road construction project. Also it was revealed that procurement procedure highly contributed to quality performance of public projects. Further regression analysis revealed that the procurement procedures used had very strong correlation with quality performance and finally it was realized that procurement procedures very highly leads to time performance Finally the study concludes that performance of public project in Temeke municipality was highly facilitated due to the contribution of procurement procedures on cost performance, quality performance and time performance. Keywords: Procurement procedures, Quality performance, Cost performance and Time performanc