Point prevalence survey of antimicrobial consumption and resistance: 2015-2018 longitudinal survey results from Nigeria

Background: Nigeria joined the global community in monitoring antimicrobial prescribing practices since 2015. Results of individual hospital Global Point Prevalence Survey (Global-PPS) have stimulated efforts at instituting hospital-based antimicrobial stewardship (AMS) programmes. We report the trends of antimicrobial prescribing rates and quality indicators for 3 surveillance periods; 2015, 2017 and 2018.Methodology: The web-based Global-PPS for surveillance of antimicrobial use in hospitals (www.globalpps.com) was completed by each participating hospital site for all inpatients receiving antimicrobials on a selected day in 2015, 2017 and 2018. Data included details on antimicrobial agents, reasons and indications for treatment and a set of quality prescribing indicators. Data were validated by the web-based data management system of University of Antwerp, exported into Microsoft Excel and analyzed with EPI INFO version 7.2.Results: Thirteen hospitals participated in the survey involving a total of 5,174 inpatients. Mean weighted overall antimicrobial prescribing prevalence was 70.7% which declined over the years from 71.7% in 2015 to 59.1% in 2018 (p<0.001). The rate of documentation of date for post prescription review improved from 27.9% in 2015 to 48.5% in 2018 (p<0.001) while the rates of targeted treatment declined from 12.0% in 2015 to 5.2% in 2018 (p<0.001). There was no significant change in the choice of parenteral drug administration (64.5% in 2015, 65.1% in 2017 and 62.6% in 2018; p=0.6803), and but there was significant increase in documentation of reasons for prescription in case notes (62.2% in 2015, 74.5% in 2017, and 70.9% in 2018; p=0.008). Overall, the main indications for therapeutic prescribing were skin and soft tissue infections (20.8%), sepsis (15.9%) and pneumonia (11.6%). The top three antibiotics for therapeutic use were ceftriaxone (18.2%), metronidazole (15.3%) and ciprofloxacin (10.4%).Conclusions: The survey showed reduction in the overall antimicrobial prescribing rate especially in hospitals that had introduced AMS programmes. Among the quality prescribing indicators, documentation of post prescription review date showed improvement. The Global-PPS serves as a cost effective, flexible and userfriendly tool in instituting AMS programmes in hospitals. Keywords: antimicrobial prescribing, hospital, global-point prevalence survey, quality indicator

Persistence of Ebola virus RNA in some body fluids of Ebola virus disease (EVD) survivors – the Nigerian experience

Introduction: Ebola virus (EBOV) has been shown to persist in some body fluids of Ebola Virus Disease (EVD) survivors with implication for future transmission particularly in Nigeria where EVD was experienced for the first time in 2014. Thus, this paper was aimed at providing information on the duration of persistence of EBOV in Nigeria. Materials and Methods: Ten consenting EVD survivors were enrolled. Baseline specimens; urine and semen (males), urine and high vaginal swab (HVS) (females) were obtained within one month after discharge from the Ebola Treatment Centre (ETC) and subsequently every fortnight. Samples were analyzed using quantitative Real-Star Filovirus Screen RT-PCR kit 1.0 at the National Reference Laboratory in Lagos.Results: Ten EVD survivors comprising 4 (40%) males and 6 (60%) females with age ranges of 28 to >33 years (mean age: 33.0 ± 6.9 years) were evaluated. EBOV RNA was not detected in the urine of all the participants and HVS from the females. However, EBOV RNA was detected in the semen of all 4 (100%) male participants at baseline, and at 2 months after discharge from the ETC. Two men were still positive for EBOV RNA 4 months after discharge from the ETC despite persistent negative vireamia. Conclusions: Our data confirm that a negative viremia in the convalescent period is not predictive of the absence of the virus in semen. Despite an early clearance of the virus from the urine and HVS, there was persistence of EBOV RNA in semen of male survivors 4 months after recovery

Prevalence of Carbapenem resistant Klebsiella pneumoniae infections in a Nigerian Teaching Hospital

Background: The emergence of carbapenem resistant Klebsiella pneumoniae (CRKP) is of great concern because of the limited options for treatment. While carbapenem resistant Klebsiella pneumoniae is increasingly identified worldwide, limited data is available in Africa. This study was undertaken to determine the prevalence of CRKP in LUTH and to provide phenotypic characterisation of the resistancemechanisms. Methods: Across sectional study with 153 isolates of Klebsiella pneumoniae obtained from clinical cultures of inpatients identified using Microbact 12A and 12B. All isolates were subjected to antimicrobial susceptibility testing using the Modified Kirby Bauer method and interpreted according to the CLSI guidelines. The modified Hodge test was used to detect carbapenemase production. Results: The prevalence of carbapenem resisant Klebsiella pneumoniae was 5.2% and carbapenamase producing K. pneumoniae was2.6%. Most of the K. pneumoniae isolates had high rates of antibiotic resistance to Cefotaxime 78.4%, Ceftazidime 67.3%, Genticin 71.9%, Ciprofloxacin 59.5%, Cefepime 10.5% and Amikacin 13.7%. Conclusion: There was a high rate of carbapenem resistance in Klebsiella pneumoniae. The K. pneumoniae isolates were also multi- drug resistant. There is need for antibiotic stewardship. Keywords: Carbapenem resistance, Kelbsiella pneumoniae, prevalenc

A ten year retrospective study of mycological infections at a tertiary hospital in Lagos, Nigeria

Background: Mycoses have increased in importance largely due to medical progress and the increase in the population at risk. The HIV epidemic is one of the major factors that has contributed to the dramatic increase in the prevalence of invasive fungal infections.Objectives: To identify the types of fungi isolated, determine the pattern of requests to the laboratory and possible barriers to mycology diagnosis.Methods: This is a retrospective study. Data of all samples sent to the mycology laboratory from 2000–2010 were retrieved manually from the laboratory registers and entered into Microsoft excel spreadsheet. A total of 403 single samples were sent, no patient had multiple samples.Results: 207 of the samples were culture positive. The patients age range was from 5 weeks to 78 years, majority (86.1%) of them were out-patients and most (79.4%) of the samples taken from them were skin scrapings. The isolated organisms were Dermatophytes (43%), Candida spp (41.5%), Malassezia furfur (7.7%) and Aspergillus spp (5.3%). Higher proportion of the in-patients had Candida spp (66.7%) and Aspergillus spp (14.8%) , while more of the out-patients had dermatophytes isolated (42.3%). There was a progressive increase in number of isolates from 2001-2005. The most commonly isolated organisms were dermatophytes; commonly T. mentagrophyte (31.4%) and Candida spp (41.5%); commonly C. albicans  (27.1%).There were no samples from critically ill patients or from patients normally considered at risk of invasive fungal infections.Conclusion: Superficial mycosis was the major diagnosis. There is an urgent need to drive the awareness of invasive fungal infections in our environment and introduction of serological and molecular diagnostic techniques.Keywords: Mycoses, Lagos, retrospective study, dermatophytes, Candida sp

Behavioral Outcomes and Neurodevelopmental Disorders Among Children of Women With Epilepsy

IMPORTANCE The association of fetal exposure to antiseizure medications (ASMs) with outcomes in childhood are not well delineated. OBJECTIVE To examine the association of fetal ASM exposure with subsequent adaptive, behavioral or emotional, and neurodevelopmental disorder outcomes at 2, 3, and 4.5 years of age. DESIGN, SETTING, AND PARTICIPANTS The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a prospective, observational cohort study conducted at 20 epilepsy centers in the US. A total of 456 pregnant women with epilepsy or without epilepsy were enrolled from December 19, 2012, to January 13, 2016. Children of enrolled women were followed up with formal assessments at 2, 3, 4.5, and 6 years of age. Statistical analysis took place from August 2022 to May 2023. EXPOSURES Exposures included mother’s epilepsy status as well as mother’s ASM blood concentration in the third trimester (for children of women with epilepsy). Women with epilepsy were enrolled regardless of ASM regimen. MAIN OUTCOMES AND MEASURES The primary outcome was the Adaptive Behavior Assessment System, Third Edition (ABAS-3) General Adaptive Composite (GAC) score among children at 4.5 years of age. Children of women with epilepsy and children of women without epilepsy were compared, and the associations of ASM exposures with outcomes among exposed children were assessed. Secondary outcomes involved similar analyses of other related measures. RESULTS Primary analysis included 302 children of women with epilepsy (143 boys [47.4%]) and 84 children of women without epilepsy (45 boys [53.6%]). Overall adaptive functioning (ABAS-3 GAC score at 4.5 years) did not significantly differ between children of women with epilepsy and children of women without epilepsy (parameter estimate [PE], 0.4 [95% CI, −2.5 to 3.4]; P = .77). However, in adjusted analyses, a significant decrease in functioning was seen with increasing third-trimester maximum ASM blood concentrations (PE, −7.8 [95% CI, −12.6 to −3.1]; P = .001). This decrease in functioning was evident for levetiracetam (PE, −18.9 [95% CI, −26.8 to −10.9]; P < .001) and lamotrigine (PE, −12.0 [95% CI, −23.7 to −0.3]; P = .04), the ASMs with sample sizes large enough for analysis. Results were similar with third-trimester maximum daily dose. CONCLUSIONS AND RELEVANCE This study suggests that adaptive functioning of children of women with epilepsy taking commonly used ASMs did not significantly differ from that of children of women without epilepsy, but there was an exposure-dependent association of ASMs with functioning. Thus, psychiatric or psychological screening and referral of women with epilepsy and their offspring are recommended when appropriate. Additional research is needed to confirm these findings. © 2023 American Medical Association. All rights reserved.12 month embargo; first published 20 November 2023This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]