Susceptibility of common urinary isolates to the commonly used antibiotics in a tertiary hospital in southern Nigeria

Antimicrobial resistance in the treatment of urinary tract infections is a major health problem. This study evaluates the pattern of susceptibility of pathogens commonly responsible for urinary tract infections (UTIs) to commonly used antimicrobial agents in Benin City. Midstream urine samples of 700 patients (300 males and 400 females), who were attending clinics in a 550-bed University of Benin Teaching Hospital, Benin City, between April 2003 to March 2004 were examined. Susceptibility of the urine bacteria isolates to twelve commonly used antibiotics was investigated. Eight bacteria isolates were recovered from 49.5% of the patients (18.1% of males and 31.4% of females). These wereEscherichia coli (19.7%), Klebsiella aerogenes (15.1%), Proteus mirabilis (6.7%), Acinetobacter calcoaceticus (2.3%), Pseudomonas aeruginosa (2.3%), Streptococcus faecalis (1.3%), Providence stuartii (1%), and Alkaligenes faecalis (1%). All the isolates exhibited a significantly high resistance to tetracycline, co-trimoxazole, amoxycillin and cefuroxime but were either moderately or highly sensitive to the quinolones and nitrofurantoin. We conclude that majority of the antimicrobial agents that are commonly used to treat UTIs in the hospitals are no longer effective. Therefore, the development and strict management of antimicrobial policy, and surveillance for resistant organisms should be given priority in Nigeri

A study of blood and gastro-intestinal parasites in Edo state

A four-year study to determine the prevalence of both blood and gastro-intestinal parasites of man was done in all the eighteen local government areas of Edo State, Nigeria. The study, which commenced in January of 2000, ended in December of 2004. Of the 136,360 samples examined, 1000 that is 0.7% had parasites. A total of eleven parasites species were identified. A seasonal pattern of parasitic infection was noted with a high prevalence in the rainy (wet) season months of April to November and a low prevalence in the dry season months of December to March. The prevalence was significantly higher in September, October and November at 22, 10 and 10% respectively (

Incidence of Proteus species in wound infections and their sensitivity pattern in the University of Benin Teaching Hospital

Proteus species are frequently recovered from infected wounds. They contaminate wounds and thus cause infections. This study was carried out at the University of Benin Teaching Hospital (UBTH) to determine the involvement of Proteus species as one of the major causative organisms in wound infections. The study also determined the sensitivity pattern of the Proteus isolates. This was a prospective and cross-sectional study. Wound swabs and aspirates from various parts of the body and consisting of accidental, pathological and post-operative wounds were collected from patients who attended the clinics at the UBTH and examined by standard bacteriological methods. All isolates were tested for sensitivity against ciprofloxacin 5 µg, gentamycin 10 µg, streptomycin 10 µg, ofloxacin 5 mg/µg, chloramohenicol 10 µg, erythromycin 10 µg and tetracycline 10 µg. Of the 400 wound samples from various parts of the body 390 (97.5%) yielded growths and produced 560 isolates. Ten samples (2.5%) yielded no growths. Proteus species accounted for 150 (26.8%) of the isolates. Proteus mirabilis was the Proteus species most commonly isolated, 97 (17.3%), Proteus vulgaris 40 (7.1%), Proteus rettgeri 8 (1.40%), and Proteus morgagni 5 (0.9%). All the isolates were sensitive to ciprofoxacin, ofloxacin and gentamycin while all were resistant to tetracycline and erythromycin. Knowledge of the microbial flora of an environment and the sensitivity pattern are important tools in the management of wound infections especially those caused by Proteus species, and are also useful in formulating rational antibiotic policy

A five year study on the susceptibility of isolates from various parts of the body

In Nigeria, like most developing countries, there is little or complete lack of antibiotic prescribing policy. This results in a situation where antimicrobial agents are bought and consumed indiscriminately, thus leading to drug abuse. The ugly consequence is the development of resistance by microorganisms to these antimicrobial agents. This study seeks to determine the antibiogram of common isolates from swabs and aspirates in the University of Benin Teaching Hospital, Nigeria, in thelast half a decade. The design was prospective and cross sectional. Patients attending the University of Benin Teaching Hospital clinics were used for the study. The various antimicrobial agents used in thisstudy were amoxicillin clavulanate 30 ìg, cefuroxime 30 ìg, ceftazidime 5 ìg, ofloxacin 5 ìg gentamicin 10 ìg, amoxicillin 25 ìg, erythromycin 5 ìg, cloxacillin 5 ìg, cotrimoxazole 5 ìg, tetracycline 10 ìg, andchloramphenicol 30 ìg. Cultures were prepared using standard methods and incubated aerobically and anaerobically at 37°C for 48 h. Identification was by morphological characteristics and biochemicaltests. The various isolates for the five-year period were Staphylococcus aureus 1000, Klebsiella pneumoniae 340, Proteus mirabilis 38 Escherichia coli 295, Pseudomonas aeroginosa 240, Alcaligenesfaecalis 200, Enterobacter aerogenes 175, Acinetobacter baumannii 150, Proteus vulgaris 110, Providencia stuartii 101, Streptococcus pneumoniae 16, Citrobacter freundii 51. The isolates variedwidely in their susceptibility pattern. Almost all the isolates were about 100% resistant to cloxacillin, tetracycline and cotrimoxazole. The analysis of variance (ANOVA) showed no difference in thesusceptibility pattern of the isolates in the five years. However there was significant difference in the efficacy of the various antimicrobial agents and the number of isolates. This study achieved its aim ofdetermining the microbial flora and their sensitivity pattern at the University of Benin Teaching Hospital in the last half a decade. The increasing rate of drug resistance demonstrated by the isolatesparticularly to cheap and frequently used antimicrobial agents raises serious concern

Frequency of Isolation of Enterobacter Species from a Variety of Clinical Specimens in a Teaching Hospital in Nigeria

Purpose: To determine the frequency of occurrence of Enterobacter species and their antibiogram from clinical specimens of blood, cerebrospinal fluid, urine and wound obtained from University of Benin Teaching Hospital, Benin City, Nigeria.Methods: Specimens were obtained from patients who were seen at the various units of the hospital during the period January 2008 to June 2010. The total number of specimens was 6632, and were obtained from 1678 adult males, 2010 adult females and 2944 children. The specimens were collected prior to commencement of antibiotic therapy, and cultured immediately using standard bacteriological methods. Growths were identified by colonial morphology and characteristics, and biochemical reactions. Antimicrobial sensitivity test was performed according to Kirby-Bauer disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) recommendation. The control organism was a sensitive strain of Eschrichia coli (NCTC 10418).Results: Two species of Enterobacter, namely, E. aerogenes (104; 97.2 %) and E. sakazakii (3; 2.8 %) were isolated from the four types of clinical specimens, accounting for 1.6 % of all the samples. Sensitivity to antibacterials was as follows: ceftazidime (55.0 %), ofloxacin (53.3 %) and amoxicillin clavulanate (48.3 %). They were strongly resistant to the other antibiotics used in the study, especially the cephalosporins. There was no significant difference in infection rate among the age groups (p > 0.05). However, there was significant difference (p < 0.05) between isolates from cerebrospinal fluid, on the one hand, and those from wound, urine and blood, on the other hand. Conclusion: The rate of isolation of Enterobacter species in the health facility was low. Remarkable drug resistance of the organisms make them clinically significant pathogens.Keywords: β-Lactam antibiotics, Opportunistic infections, Bacterial resistance, Enterobacter species

Research into the effect Of SGLT2 inhibition on left ventricular remodelling in patients with heart failure and diabetes mellitus (REFORM) trial rationale and design

Background Heart failure (HF) and diabetes (DM) are a lethal combination. The current armamentarium of anti-diabetic agents has been shown to be less efficacious and sometimes even harmful in diabetic patients with concomitant cardiovascular disease, especially HF. Sodium glucose linked co-transporter type 2 (SGLT2) inhibitors are a new class of anti-diabetic agent that has shown potentially beneficial cardiovascular effects such as pre-load and after load reduction through osmotic diuresis, blood pressure reduction, reduced arterial stiffness and weight loss. This has been supported by the recently published EMPA-REG trial which showed a striking 38 and 35 % reduction in cardiovascular death and HF hospitalisation respectively. Methods The REFORM trial is a novel, phase IV randomised, double blind, placebo controlled clinical trial that has been ongoing since March 2015. It is designed specifically to test the safety and efficacy of the SLGT2 inhibitor, dapagliflozin, on diabetic patients with known HF. We utilise cardiac-MRI, cardio-pulmonary exercise testing, body composition analysis and other tests to quantify the cardiovascular and systemic effects of dapagliflozin 10 mg once daily against standard of care over a 1 year observation period. The primary outcome is to detect the change in left ventricular (LV) end systolic and LV end diastolic volumes. The secondary outcome measures include LV ejection fraction, LV mass index, exercise tolerance, fluid status, quality of life measures and others. Conclusions This trial will be able to determine if SGLT2 inhibitor therapy produces potentially beneficial effects in patients with DM and HF, thereby replacing current medications as the drug of choice when treating patients with both DM and HF

Placental transfusion: a review

Recently there have been a number of studies and presentations on the importance of providing a placental transfusion to the newborn. Early cord clamping is an avoidable, unphysiologic intervention that prevents the natural process of placental transfusion. However, placental transfusion, although simple in concept, is affected by multiple factors, is not always straightforward to implement, and can be performed using different methods, making this basic procedure important to discuss. Here, we review three placental transfusion techniques: delayed cord clamping, intact umbilical cord milking and cut-umbilical cord milking, and the evidence in term and preterm newborns supporting this practice. We will also review several factors that influence placental transfusion, and discuss perceived risks versus benefits of this procedure. Finally, we will provide key straightforward concepts and implementation strategies to ensure that placental-to-newborn transfusion can become routine practice at any institution

Associations of Polymorphisms in the Peroxisome Proliferator-Activated Receptor Gamma Coactivator-1 Alpha Gene With Subsequent Coronary Heart Disease: An Individual-Level Meta-Analysis

Background: The knowledge of factors influencing disease progression in patients with established coronary heart disease (CHD) is still relatively limited. One potential pathway is related to peroxisome proliferator–activated receptor gamma coactivator-1 alpha (PPARGC1A), a transcription factor linked to energy metabolism which may play a role in the heart function. Thus, its associations with subsequent CHD events remain unclear. We aimed to investigate the effect of three different SNPs in the PPARGC1A gene on the risk of subsequent CHD in a population with established CHD. Methods: We employed an individual-level meta-analysis using 23 studies from the GENetIcs of sUbSequent Coronary Heart Disease (GENIUS-CHD) consortium, which included participants (n = 80,900) with either acute coronary syndrome, stable CHD, or a mixture of both at baseline. Three variants in the PPARGC1A gene (rs8192678, G482S; rs7672915, intron 2; and rs3755863, T528T) were tested for their associations with subsequent events during the follow-up using a Cox proportional hazards model adjusted for age and sex. The primary outcome was subsequent CHD death or myocardial infarction (CHD death/myocardial infarction). Stratified analyses of the participant or study characteristics as well as additional analyses for secondary outcomes of specific cardiovascular disease diagnoses and all-cause death were also performed. Results: Meta-analysis revealed no significant association between any of the three variants in the PPARGC1A gene and the primary outcome of CHD death/myocardial infarction among those with established CHD at baseline: rs8192678, hazard ratio (HR): 1.01, 95% confidence interval (CI) 0.98–1.05 and rs7672915, HR: 0.97, 95% CI 0.94–1.00; rs3755863, HR: 1.02, 95% CI 0.99–1.06. Similarly, no significant associations were observed for any of the secondary outcomes. The results from stratified analyses showed null results, except for significant inverse associations between rs7672915 (intron 2) and the primary outcome among 1) individuals aged ≥65, 2) individuals with renal impairment, and 3) antiplatelet users. Conclusion: We found no clear associations between polymorphisms in the PPARGC1A gene and subsequent CHD events in patients with established CHD at baseline

Association of Chromosome 9p21 with Subsequent Coronary Heart Disease events:A GENIUS-CHD study of individual participant data

BACKGROUND:Genetic variation at chromosome 9p21 is a recognized risk factor for coronary heart disease (CHD). However, its effect on disease progression and subsequent events is unclear, raising questions about its value for stratification of residual risk. METHODS:A variant at chromosome 9p21 (rs1333049) was tested for association with subsequent events during follow-up in 103,357 Europeans with established CHD at baseline from the GENIUS-CHD Consortium (73.1% male, mean age 62.9 years). The primary outcome, subsequent CHD death or myocardial infarction (CHD death/MI), occurred in 13,040 of the 93,115 participants with available outcome data. Effect estimates were compared to case/control risk obtained from CARDIoGRAMPlusC4D including 47,222 CHD cases and 122,264 controls free of CHD. RESULTS:Meta-analyses revealed no significant association between chromosome 9p21 and the primary outcome of CHD death/MI among those with established CHD at baseline (GENIUS-CHD OR 1.02; 95% CI 0.99-1.05). This contrasted with a strong association in CARDIoGRAMPlusC4D OR 1.20; 95% CI 1.18-1.22; p for interaction Conclusions: In contrast to studies comparing individuals with CHD to disease free controls, we found no clear association between genetic variation at chromosome 9p21 and risk of subsequent acute CHD events when all individuals had CHD at baseline. However, the association with subsequent revascularization may support the postulated mechanism of chromosome 9p21 for promoting atheroma development