Identification of Proteus Mirabilis on Banknotes Using 16s rRNA gene in Khartoum State

Background: The presence of pathogenic bacteria in circulated currency was recorded as a public health hazard. In this study, all examined Sudanese banknotes (100%) were found to be contaminated by gram-negative bacteria. Proteus mirabilis were recovered from 10 examined notes (22.2%, f = 10), E. coli (13.3%, f = 6) and Klebsiella spp. (8.9%, f = 4) were also identified. Only the most resistant P. mirabilis isolate was identified using culture-based and 16S rRNA gene sequencing techniques. Methods: Proteus isolates were identified phenotypically and tested for their susceptibility to 16 of commonly used antibiotics, then most resistant isolate was confirmed genotypically via 16S rRNA gene amplification and sequencing. Bioinformatics analysis using BLAST for sequence similarity search, Clustal W program for multiple sequence alignment, MEGA7 software for phylogenetic analysis. Tree was constructed to show the evolutionary relationships of the obtained sequencewith similar sequences in the databases using. Results: The obtained sequence was found to be 100% identical to P. mirabilis 16S rRNA gene using BLAST. The phylogenetic tree was constructed to show the evolutionary relationships of the obtained sequence with similar sequences in the databases using MEGA7 software, and the closest strain was found to be P. mirabilis strain from India (EU411047) Conclusion: This study has shown that some currency notes circulated at Khartoum transportation are carriers of antimicrobial-resistant P. mirabilis that could be potential source for their transmission in public

Frequency of Methicillin Resistance among Staphylococcus aureus Clinical Isolates in Khartoum State, Sudan

Background: Methicillin-resistant Staphylococcus aureus (MRSA) have emerged as an important cause of nosocomial and community-acquired infections ranging from mild to severe life-threatening infections. Therefore, a reliable detection of such strains is required for effective treatment. Objectives: To determine the frequency and the antibiogram of MRSA among different clinical isolates. Study Design: A cross-sectional, descriptive study. Materials and Methods: Standard bacteriological methods, disk diffusion and PCRwere performed to determine the frequency of MRSA among different clinical isolates. Results: The overall results showed 96/210 (45.7%) of isolates were MRSA mostly recovered from wounds and blood stream. High percentage was detected in hospitalassociated (HA) strains (64.2%) rather than community (CA) (37.1%) (P-value < 0.001). From the generated Antibiogram, Co-trimoxazole was the most active (80.2%), while Penicillin was the least one (6.2%). Conclusion: As MRSA strains were mostly isolated from Hospitals, clinicians should beaware of such burden strains. Local frequency investigation of MRSA is recommended for perfect diagnosis and treatment

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely