Staphylococcus aureus bacteraemia Audit - UK experience

Background: Staphylococcus aureus bacteraemia (SAB) causes high morbidity, mortality and healthcare costs. There are national recommendations for minimal 14 days of IV antibiotics, repeat blood cultures and screen for endocarditis. Study was conducted in University Hospital Coventry (UHC). It is a most modern healthcare facility in Europe with 1,005 beds, 26 operating theatres and specialize in cardiology, neurosurgery, stroke, joint replacements, in vitro fertilization and maternal health, diabetes and kidney transplants. Management of SAB is continuously audited in UHC since 2007. The standard treatment pathway for the trust is underway.Objectives: This is to assess the standard of care in management of SAB comparing the results of past 3-years and looking forward for further development.Methods: Retrospective study conducted between June 2016 to December 2018. Electronic patient records were used.Results: Total 153 patients were identified with SAB. Majority were >60 years. There were 25 intravenous drug users in the group and 6 presented with recurrence. There were only 2% MRSAs. In majority (28%), the source of infection was skin and soft tissue infections. Surveillance blood cultures were done in 76% patients. It is improved form 67% in last audit which was conducted betweenJune 2016 and May2018. Fifty one percent had undergone echocardiogram and 8% patients died before blood culture results are available. In 89% of patients appropriate treatment was started. More than 14 days of treatment was completed in 81% patients. Flucloxacillin, meropenem, ertapenem, daptomycin and other antibiotics were used for the completion of 14 days course. From total patients, 16% had complications and endocarditis was the commonest. The 60 days mortality rate was 21%.Conclusions: The mortality rate and complications of SAB is high disregard of the effective antibiotics and further improvement of the clinical management is essential

Service evaluation to establish the sensitivity, specificity and additional value of broad-range 16S rDNA PCR for the diagnosis of infective endocarditis from resected endocardial material in patients from eight UK and Ireland hospitals

Infective endocarditis (IE) can be diagnosed in the clinical microbiology laboratory by culturing explanted heart valve material. We present a service evaluation that examines the sensitivity and specificity of a broad-range 16S rDNA polymerase chain reaction (PCR) assay for the detection of the causative microbe in culture-proven and culture-negative cases of IE. A clinical case-note review was performed for 151 patients, from eight UK and Ireland hospitals, whose endocardial specimens were referred to the Microbiology Laboratory at Great Ormond Street Hospital (GOSH) for broad-range 16S rDNA PCR over a 12-year period. PCR detects the causative microbe in 35/47 cases of culture-proven IE and provides an aetiological agent in 43/69 cases of culture-negative IE. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the 16S rDNA PCR assay were calculated for this series of selected samples using the clinical diagnosis of IE as the reference standard. The values obtained are as follows: sensitivity = 67 %, specificity = 91 %, PPV = 96 % and NPV = 46 %. A wide range of organisms are detected by PCR, with Streptococcus spp. detected most frequently and a relatively large number of cases of Bartonella spp. and Tropheryma whipplei IE. PCR testing of explanted heart valves is recommended in addition to culture techniques to increase diagnostic yield. The data describing the aetiological agents in a large UK and Ireland series of culture-negative IE will allow future development of the diagnostic algorithm to include real-time PCR assays targeted at specific organisms

Harnessing innovation platforms for sustainable intensification R4D experiences from Kongwa and Kiteto, Tanzania

United States Agency for International Developmen

The impact of HIV on morbidity and mortality from tuberculosis in sub-Saharan Africa: a study of rural Malawi and review of the literature

Since the mid-1980s tuberculosis (TB) case numbers and HIV seroprevalence have both risen sharply in sub-Saharan Africa. Estimates for the relative risk of TB in those infected with HIV have ranged from less than five to more than 20. The proportion of TB cases attributable to HIV (the population attributable fraction) has been calculated for several populations but is difficult to interpret if no account is taken of the age and sex distribution of the cases. In a rural area of Malawi we have studied the proportion of TB attributable to HIV over time. Nearly 40 per cent of smear-positive TB cases in this rural area of Malawi can now be attributed directly to HIV. The actual effect of HIV on TB is even greater than this because increased case numbers increase transmission of tuberculosis infection to both HIV-infected and non-infected sections of the population. We compare our findings with others from sub-Saharan Africa and discuss reasons for the differences, and methodological issues in interpretatio

Aflatoxin contamination: Knowledge disparities among agriculture extension officers, frontline health workers and small holder farming households in Malawi

The aims of this study were to assess the state of knowledge and perceptions regarding aflatoxin contamination among frontline workers in direct contact with small holder farming households in Malawi as well as among the households themselves. The study first investigated and documented demographic profiles of agriculture extension workers (n = 22) and frontline health workers (n = 161) both from Ntchisi district and small holder farming households (n = 915) from Dedza, Balaka and Mzimba districts. Structured questionnaires were administered to document knowledge and perceptions. Majority of the respondents in Ntchisi were frontline nutrition and health workers as follows: care group promoters (31.7%), cluster leaders (51.9%) and health surveillance assistants (4.4%). Only 12% of the respondents were agriculture extension officers. Among frontline workers, using factor analyses, factors highly associated with the knowledge on domestic management of aflatoxin contamination and the impact of aflatoxin contamination on child linear growth and health in general were most prominent. Whereas, their knowledge of pre & post-harvest practices that pre-dispose crops to aflatoxin contamination and impact of aflatoxin contamination on trade and income losses was relatively low. On the other hand, among small holder farming households, lowest knowledge was related to occurrence of aflatoxin contamination pre and post-harvest. Highest knowledge was observed on issues around loss of income due to aflatoxin contamination. Across all districts over 50% of surveyed respondents reported that they perceived aflatoxin contamination severity as low. Majority of the households (>50%) did not perceive aflatoxin contamination as a problem that could be controlled. This is the first study to investigate knowledge, attitudes, practices and perceptions on aflatoxin contamination among a combination of agriculture extension officers and frontline health workers in parallel with the households they usually are in contact with. The current investigation is crucial because it elucidates knowledge gaps in aflatoxin critical control across agriculture extension, health workers and the small holder farming households. This is especially crucial among agriculture extension workers and frontline health workers as they have direct contact with households and therefore serve as an important source of information that could influence behavior change