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Elfving K, Shakely D, Andersson M, Baltzell K, Ali AS, Bachelard M, Falk KI, Ljung A, Msellem MI, Omar RS, Parola P, Xu W, Petzold M, Trollfors B, Björkman A, Lindh M, Mårtensson A. Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar - Aetiologies, Antibiotic Treatment and Outcome. PLoS One 2016; 11:e0146054. [PMID: 26821179 PMCID: PMC4731140 DOI: 10.1371/journal.pone.0146054] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/11/2015] [Indexed: 12/29/2022] Open
Abstract
Background Despite the fact that a large proportion of children with fever in Africa present at primary health care facilities, few studies have been designed to specifically study the causes of uncomplicated childhood febrile illness at this level of care, especially in areas like Zanzibar that has recently undergone a dramatic change from high to low malaria transmission. Methods We prospectively studied the aetiology of febrile illness in 677 children aged 2–59 months with acute uncomplicated fever managed by IMCI (Integrated Management of Childhood Illness) guidelines in Zanzibar, using point-of-care tests, urine culture, blood-PCR, chest X-ray (CXR) of IMCI-pneumonia classified patients, and multiple quantitative (q)PCR investigations of nasopharyngeal (NPH) (all patients) and rectal (GE) swabs (diarrhoea patients). For comparison, we also performed NPH and GE qPCR analyses in 167 healthy community controls. Final fever diagnoses were retrospectively established based on all clinical and laboratory data. Clinical outcome was assessed during a 14-day follow-up. The utility of IMCI for identifying infections presumed to require antibiotics was evaluated. Findings NPH-qPCR and GE-qPCR detected ≥1 pathogen in 657/672 (98%) and 153/164 (93%) of patients and 158/166 (95%) and 144/165 (87%) of controls, respectively. Overall, 57% (387/677) had IMCI-pneumonia, but only 12% (42/342) had CXR-confirmed pneumonia. Two patients were positive for Plasmodium falciparum. Respiratory syncytial virus (24.5%), influenza A/B (22.3%), rhinovirus (10.5%) and group-A streptococci (6.4%), CXR-confirmed pneumonia (6.2%), Shigella (4.3%) were the most common viral and bacterial fever diagnoses, respectively. Blood-PCR conducted in a sub-group of patients (n = 83) without defined fever diagnosis was negative for rickettsiae, chikungunya, dengue, Rift Valley fever and West Nile viruses. Antibiotics were prescribed to 500 (74%) patients, but only 152 (22%) had an infection retrospectively considered to require antibiotics. Clinical outcome was generally good. However, two children died. Only 68 (11%) patients remained febrile on day 3 and three of them had verified fever on day 14. An additional 29 (4.5%) children had fever relapse on day 14. Regression analysis determined C-reactive Protein (CRP) as the only independent variable significantly associated with CXR-confirmed pneumonia. Conclusions This is the first study on uncomplicated febrile illness in African children that both applied a comprehensive laboratory panel and a healthy control group. A majority of patients had viral respiratory tract infection. Pathogens were frequently detected by qPCR also in asymptomatic children, demonstrating the importance of incorporating controls in fever aetiology studies. The precision of IMCI for identifying infections requiring antibiotics was low.
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Affiliation(s)
- Kristina Elfving
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Deler Shakely
- Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Kungälv Hospital, Kungälv, Sweden
| | - Maria Andersson
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, United States of America
| | - Abdullah S. Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Marc Bachelard
- Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin I. Falk
- Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Stockholm, Sweden
| | - Annika Ljung
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Mwinyi I. Msellem
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Rahila S. Omar
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Philippe Parola
- Aix Marseille University, UM63, WHO collaborative centre for rickettsioses and other arthropod borne bacterial diseases, Faculté de Médecine, Marseille, France
| | - Weiping Xu
- Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden
| | - Max Petzold
- Akademistatistik, Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Birger Trollfors
- Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden
| | - Anders Björkman
- Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Mårtensson
- Malaria Research, Department of Microbiology, Tumour and Cell biology, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Women’s and Children’s Health, International Maternal and Child Health Unit (IMCH), Uppsala University, Uppsala, Sweden
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252
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Dar OA, Hasan R, Schlundt J, Harbarth S, Caleo G, Dar FK, Littmann J, Rweyemamu M, Buckley EJ, Shahid M, Kock R, Li HL, Giha H, Khan M, So AD, Bindayna KM, Kessel A, Pedersen HB, Permanand G, Zumla A, Røttingen JA, Heymann DL. Exploring the evidence base for national and regional policy interventions to combat resistance. Lancet 2016; 387:285-95. [PMID: 26603921 DOI: 10.1016/s0140-6736(15)00520-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains-responsible use, surveillance, and infection prevention and control-and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions.
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Affiliation(s)
- Osman A Dar
- Public Health England, London, UK; Chatham House Centre on Global Health Security, London, UK.
| | | | - Jørgen Schlundt
- School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore
| | - Stephan Harbarth
- University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | | | | | - Mark Rweyemamu
- Southern African Centre for Infectious Disease Surveillance, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | - Mohammed Shahid
- Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India
| | | | - Henry Lishi Li
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mishal Khan
- London School of Hygiene & Tropical Medicine, London, UK; Research Alliance for Advocacy and Development, Karachi, Pakistan
| | - Anthony D So
- Sanford School of Public Policy and Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Anthony Kessel
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Alimuddin Zumla
- University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College Hospitals NHS Trust, London, UK
| | - John-Arne Røttingen
- Norwegian Institute of Public Health, Oslo, Norway; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - David L Heymann
- Public Health England, London, UK; Chatham House Centre on Global Health Security, London, UK; London School of Hygiene & Tropical Medicine, London, UK
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253
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Maraghehpour B, Khayamzadeh M, Najafi S, Kharazifard M. Traditionally used herbal medicines with antibacterial effect on Aggegatibacter actinomycetemcomitans: Boswellia serrata and Nigella sativa. J Indian Soc Periodontol 2016; 20:603-607. [PMID: 29238140 PMCID: PMC5713083 DOI: 10.4103/jisp.jisp_12_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Since bacterial strains developed resistance against commonly used antibiotics and side effects became more serious, other alternatives have been postulated. There is an answer for this issue in ancient medicine. Many plants have been proved to provide antibacterial effect. In this study, Boswellia serrata (BS) and Nigella sativa (NS) were assessed to evaluate the antibacterial effect on Aggregatibacter actinomycetemcomitans (A.a) known as main pathogen of aggressive periodontitis. Materials and Methods: Broth microdilution method was used to obtain minimum inhibitory concentration (MIC) of crude extract of BS and NS. Furthermore, the logarithm of colony forming units grown in fresh brain heart infusion bacterial culture was assessed. Three groups including BS+ (containing only BS), NS+ (containing only NS), and BS-NS− (control group) were defined. For each group, the experiment was repeated 12 times. Results: MIC of BS and NS were 512 μg/mL and 128 μg/mL, respectively. No growth was observed in our negative control group. The mean ± standard deviation of logarithm of CFU/mL for BS, NS, and control group was 4.32 ± 0.36, 3.61 ± 0.3, and 5.57 ± 0.19, respectively. ANOVA test revealed significant difference (P values < 0.0001) of these groups which was later confirmed using the post hoc test of Tukey's honest significant difference (all P < 0.0001). Conclusions: Both BS and NS are effective against A.a which should be taken into account as appropriate ingredient for oral hygiene products.
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Affiliation(s)
- Bita Maraghehpour
- Department of Oral Medicine, International Campus, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Khayamzadeh
- Department of Oral Medicine, International Campus, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Shamsoulmolouk Najafi
- Department of Oral Medicine, International Campus, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,Department of Oral Medicine, Dental Research Center, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadjavad Kharazifard
- Department of Oral Medicine, International Campus, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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254
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Martins IJ. Magnesium Therapy Prevents Senescence with the Reversal of Diabetes and Alzheimer’s Disease. Health (London) 2016. [DOI: 10.4236/health.2016.87073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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255
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Ghanshani R, Gupta R, Gupta BS, Kalra S, Khedar RS, Sood S. Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India. Lung India 2015; 32:441-8. [PMID: 26628756 PMCID: PMC4586996 DOI: 10.4103/0970-2113.164155] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the prevalence of infections, risk factors, and outcomes in a medical intensive care unit (ICU), we performed a hospital-based study. MATERIALS AND METHODS Consecutive patients were enrolled and details of risk factors and bacteriological data were obtained. Outcomes were death/transfer to palliative care or recovery. Statistical analyses were performed. RESULTS Four hundred and eighty-seven patients were admitted during the study period (age 55.6 ± 19 yr, men 68%). Diseases responsible were respiratory (37%), gastrointestinal/liver (22%), neurological (20%), renal (8%), and trauma (6%) related. Majority of admissions were direct (45%) or transfers from other hospitals (41%). Most important comorbidities were hypertension (41%), diabetes (31%), and chronic obstructive pulmonary disease (15%). Median APACHE-2 score was 13.0 (IQR 1-25). Antibiotics were administered in 98%. Bacteriological cultures were positive in 28% (n = 623). Respiratory infections were the most common (45.5%) followed by blood (23.3%) and urinary (16.1%). Gram-negative bacteria were common-Acinetobacter baumannii (20.9%), Klebsiella pneumoniae (19.7%), Escherichia coli (18.3%), and Pseudomonas aeruginosa (14.0%). There a high prevalence of resistance to common antibiotics. Patients with positive cultures were older, transferees (46 vs 37%, P = 0.07), with respiratory disease (48 vs. 33%, P = 0.003), with more than two comorbidities (33 vs 21%, P = 0.009), and higher APACHE-2 score (17.7 ± 8 vs. 13.3 ± 8, P = 0.07). Three hundred and fifty-two (72.3%) recovered, 68 (13.9%) died, and 67 (13.8%) were transferred to palliative care. Survival was associated with younger age, lower APACHE-2 score, negative cultures, and shorter duration in ICU (P < 0.05). Mortality was greater in patients with Acinetobacter (OR 2.36, 1.17-4.73), Klebsiella (OR 2.81, 1.33-5.92), Pseudomonas (OR 8.03, 2.83-22.76), or Enterobacter (OR 6.73, 1.29-35.12) infection. CONCLUSIONS There is high prevalence of infections in patients in a medical ICU in India. Gram-negative bacteria are the most prevalent and resistance to antibiotics is high. Risk factors are age, hospital transfers, APACHE-2 score, and multiple comorbidities.
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Affiliation(s)
- Rajesh Ghanshani
- Department of Internal Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Rajeev Gupta
- Department of Internal Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Bhagwan Swarup Gupta
- Department of Internal Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Sushil Kalra
- Department of Internal Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | | | - Smita Sood
- Department of Laboratory Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
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256
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Alcaine SD, Molla L, Nugen SR, Kruse H. Results of a pilot antibiotic resistance survey of Albanian poultry farms. J Glob Antimicrob Resist 2015; 4:60-64. [PMID: 27436396 DOI: 10.1016/j.jgar.2015.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/04/2015] [Accepted: 11/10/2015] [Indexed: 11/24/2022] Open
Abstract
Global dissemination of antibiotic-resistant bacteria in food animals is a major public health concern. Whilst many countries have implemented prudent antibiotic use policies and surveillance systems both in clinical and veterinary settings, there are no such systems in place in Albania and little is known about the levels of antibiotic-resistant bacteria in food animals within the country. A total of 172 poultry samples were taken from six Albanian farms over a 3-month period and were tested for the presence of Enterobacteriaceae. In total, 91 bacterial isolates were obtained and were characterised by species (Escherichia coli, Salmonella spp. or other Enterobacteriaceae) and by susceptibility to 11 antibiotics. Resistance rates of E. coli and Salmonella isolates were, respectively: amoxicillin (86%, 64%); chloramphenicol (77%, 82%); ciprofloxacin (93%, 73%); cefotaxime (14%, 0%); gentamicin (12%, 0%); kanamycin (30%, 18%); nalidixic acid (91%, 73%); streptomycin (70%, 55%); sulphonamides (91%, 73%); tetracycline (95%, 73%); and trimethoprim (79%, 64%). Multidrug resistance to at least four antibiotics was observed in 95% of E. coli isolates and 82% of Salmonella. In conclusion, these data indicate that: (i) Salmonella and E. coli isolates from Albanian poultry farms exhibit high to extremely high levels of antibiotic resistance; (ii) Salmonella and E. coli isolates exhibit resistance to multiple antibiotics; and (iii) multidrug resistance profiles among Enterobacteriaceae are geographically widespread. Implementation of prudent antibiotic use policies in food animals and related surveillance will be necessary to reduce the emergence, spread and establishment of highly resistant strains across poultry farms in Albania.
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Affiliation(s)
- S D Alcaine
- Department of Food Science, University of Massachusetts, Amherst, MA, USA.
| | - L Molla
- Health & Environment Department, Food Safety & Nutrition Section, Institute of Public Health, Tirana, Albania
| | - S R Nugen
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
| | - H Kruse
- Food Safety, Division of Communicable Diseases, Health Security, and the Environment, WHO Regional Office for Europe, Copenhagen, Denmark
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257
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Bischel HN, Özel Duygan BD, Strande L, McArdell CS, Udert KM, Kohn T. Pathogens and pharmaceuticals in source-separated urine in eThekwini, South Africa. WATER RESEARCH 2015; 85:57-65. [PMID: 26302215 DOI: 10.1016/j.watres.2015.08.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 05/12/2023]
Abstract
In eThekwini, South Africa, the production of agricultural fertilizers from human urine collected from urine-diverting dry toilets is being evaluated at a municipality scale as a way to help finance a decentralized, dry sanitation system. The present study aimed to assess a range of human and environmental health hazards in source-separated urine, which was presumed to be contaminated with feces, by evaluating the presence of human pathogens, pharmaceuticals, and an antibiotic resistance gene. Composite urine samples from households enrolled in a urine collection trial were obtained from urine storage tanks installed in three regions of eThekwini. Polymerase chain reaction (PCR) assays targeted 9 viral and 10 bacterial human pathogens transmitted by the fecal-oral route. The most frequently detected viral pathogens were JC polyomavirus, rotavirus, and human adenovirus in 100%, 34% and 31% of samples, respectively. Aeromonas spp. and Shigella spp. were frequently detected gram negative bacteria, in 94% and 61% of samples, respectively. The gram positive bacterium, Clostridium perfringens, which is known to survive for extended times in urine, was found in 72% of samples. A screening of 41 trace organic compounds in the urine facilitated selection of 12 priority pharmaceuticals for further evaluation. The antibiotics sulfamethoxazole and trimethoprim, which are frequently prescribed as prophylaxis for HIV-positive patients, were detected in 95% and 85% of samples, reaching maximum concentrations of 6800 μg/L and 1280 μg/L, respectively. The antiretroviral drug emtricitabine was also detected in 40% of urine samples. A sulfonamide antibiotic resistance gene (sul1) was detected in 100% of urine samples. By coupling analysis of pathogens and pharmaceuticals in geographically dispersed samples in eThekwini, this study reveals a range of human and environmental health hazards in urine intended for fertilizer production. Collection of urine offers the benefit of sequestering contaminants from environmental release and allows for targeted treatment of potential health hazards prior to agricultural application. The efficacy of pathogen and pharmaceutical inactivation, transformation or removal during urine nutrient recovery processes is thus briefly reviewed.
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Affiliation(s)
- Heather N Bischel
- Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland.
| | - Birge D Özel Duygan
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, CH-8600 Dübendorf, Switzerland
| | - Linda Strande
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, CH-8600 Dübendorf, Switzerland
| | - Christa S McArdell
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, CH-8600 Dübendorf, Switzerland
| | - Kai M Udert
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, CH-8600 Dübendorf, Switzerland
| | - Tamar Kohn
- Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
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258
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Lubell Y, Blacksell SD, Dunachie S, Tanganuchitcharnchai A, Althaus T, Watthanaworawit W, Paris DH, Mayxay M, Peto TJ, Dondorp AM, White NJ, Day NPJ, Nosten F, Newton PN, Turner P. Performance of C-reactive protein and procalcitonin to distinguish viral from bacterial and malarial causes of fever in Southeast Asia. BMC Infect Dis 2015; 15:511. [PMID: 26558692 PMCID: PMC4642613 DOI: 10.1186/s12879-015-1272-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/05/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Poor targeting of antimicrobial drugs contributes to the millions of deaths each year from malaria, pneumonia, and other tropical infectious diseases. While malaria rapid diagnostic tests have improved use of antimalarial drugs, there are no similar tests to guide the use of antibiotics in undifferentiated fevers. In this study we estimate the diagnostic accuracy of two well established biomarkers of bacterial infection, procalcitonin and C-reactive protein (CRP) in discriminating between common viral and bacterial infections in malaria endemic settings of Southeast Asia. METHODS Serum procalcitonin and CRP levels were measured in stored serum samples from febrile patients enrolled in three prospective studies conducted in Cambodia, Laos and, Thailand. Of the 1372 patients with a microbiologically confirmed diagnosis, 1105 had a single viral, bacterial or malarial infection. Procalcitonin and CRP levels were compared amongst these aetiological groups and their sensitivity and specificity in distinguishing bacterial infections and bacteraemias from viral infections were estimated using standard thresholds. RESULTS Serum concentrations of both biomarkers were significantly higher in bacterial infections and malaria than in viral infections. The AUROC for CRP in discriminating between bacterial and viral infections was 0.83 (0.81-0.86) compared with 0.74 (0.71-0.77) for procalcitonin (p < 0.0001). This relative advantage was evident in all sites and when stratifying patients by age and admission status. For CRP at a threshold of 10 mg/L, the sensitivity of detecting bacterial infections was 95% with a specificity of 49%. At a threshold of 20 mg/L sensitivity was 86% with a specificity of 67%. For procalcitonin at a low threshold of 0.1 ng/mL the sensitivity was 90% with a specificity of 39%. At a higher threshold of 0.5 ng/ul sensitivity was 60% with a specificity of 76%. CONCLUSION In samples from febrile patients with mono-infections from rural settings in Southeast Asia, CRP was a highly sensitive and moderately specific biomarker for discriminating between viral and bacterial infections. Use of a CRP rapid test in peripheral health settings could potentially be a simple and affordable measure to better identify patients in need of antibacterial treatment and part of a global strategy to combat the emergence of antibiotic resistance.
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Affiliation(s)
- Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Stuart D Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Susanna Dunachie
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Ampai Tanganuchitcharnchai
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Thomas Althaus
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Wanitda Watthanaworawit
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Daniel H Paris
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Laos. .,Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos.
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - François Nosten
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Paul N Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Laos.
| | - Paul Turner
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
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259
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Streptanoate, a new anticancer butanoate from Streptomyces sp. DC3. J Antibiot (Tokyo) 2015; 69:124-7. [PMID: 26374563 DOI: 10.1038/ja.2015.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 11/08/2022]
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260
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Labena A, Kabel KI, Farag RK. One-pot synthesize of dendritic hyperbranched PAMAM and assessment as a broad spectrum antimicrobial agent and anti-biofilm. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 58:1150-9. [PMID: 26478415 DOI: 10.1016/j.msec.2015.09.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 08/13/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
Hyperbranched poly(amidoamine) (h-PAMAM) compound was synthesized from diethylene triamine and different moles percent of methyl acrylate using simple one-pot and commercial synthesis method. The synthesized h-PAMAM was provided with ester and amine terminations. Chemical structure of the synthesized h-PAMAM, with different terminations, was confirmed by Fourier Transform Infrared (FTIR) spectroscopy. In addition, the size and the distribution of the synthesized h-PAMAM were evaluated using Dynamic Light Scattering (DLS) analysis. The molecular weights of the synthesized modified hyperbranched polymer, with different terminations, were measured using Gel-permeation chromatograph. The ill-structure of the h-PAMAM with different molar feed methyl acrylate:diethylene triamine (MA:DETA) ratios was designed as h-PAMAM-amine, h-PAMAM-ester and h-PAMAM-amine plus (sharing similar chemical and physical properties with well-defined poly(amidoamine) (PAMAM) dendrimers in generation 2, 2.5 or 3, respectively). Moreover, the synthesized compound expressed broad spectrum antimicrobial and anti-biofilms activity.
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Affiliation(s)
- A Labena
- Egyptian Petroleum Research Institute (EPRI), Processes Development Department, Biotechnology Laboratory, Nasr City, Cairo, Egypt.
| | - K I Kabel
- Egyptian Petroleum Research Institute (EPRI), Petroleum Applications Department, Nasr City, Cairo, Egypt
| | - R K Farag
- Egyptian Petroleum Research Institute (EPRI), Petroleum Applications Department, Nasr City, Cairo, Egypt
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261
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Aryee A, Price N. Antimicrobial stewardship - can we afford to do without it? Br J Clin Pharmacol 2015; 79:173-81. [PMID: 24803175 DOI: 10.1111/bcp.12417] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/29/2014] [Indexed: 11/30/2022] Open
Abstract
Antimicrobial resistance (AMR) is a rapidly developing and alarming global threat which has been highlighted by national governments and public health bodies including the World Health Organization. The spectre of a 'post-antibiotic era' is a real possibility unless curtailing the development and spread of these organisms is given high priority. Numerous studies have shown that AMR is associated with worse outcomes for patients and higher healthcare costs. While clinical data from low and middle income countries is lacking, there is increasing evidence that the problem in these areas is as great, or even greater, than in high income nations. Of the many drivers behind the development of AMR, the most significant is selection pressure caused by antibiotic use. Antimicrobial stewardship programmes are a set of interventions that aim to ensure the judicious use of antimicrobials by preventing their unnecessary use, and by providing targeted and limited therapy in situations where they are warranted. The ultimate goal of these programmes is to provide effective antimicrobial therapy whilst safeguarding their effectiveness for future generations. Whilst they do require an initial investment, they have been shown to be an effective way of controlling antimicrobial use, and have been associated with improved patient outcomes and reduced healthcare costs.
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Affiliation(s)
- Anna Aryee
- Department of Infection, Guy's & St Thomas' NHS Trust, St Thomas' Hospital, London; Centre for Clinical Infection and Diagnostics Research, King's College London, St Thomas' Hospital, London, UK
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262
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Dominey-Howes D, Bajorek B, Michael CA, Betteridge B, Iredell J, Labbate M. Applying the emergency risk management process to tackle the crisis of antibiotic resistance. Front Microbiol 2015; 6:927. [PMID: 26388864 PMCID: PMC4559638 DOI: 10.3389/fmicb.2015.00927] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 08/21/2015] [Indexed: 01/21/2023] Open
Abstract
We advocate that antibiotic resistance be reframed as a disaster risk management problem. Antibiotic-resistant infections represent a risk to life as significant as other commonly occurring natural disasters (e.g., earthquakes). Despite efforts by global health authorities, antibiotic resistance continues to escalate. Therefore, new approaches and expertise are needed to manage the issue. In this perspective we: (1) make a call for the emergency management community to recognize the antibiotic resistance risk and join in addressing this problem; (2) suggest using the risk management process to help tackle antibiotic resistance; (3) show why this approach has value and why it is different to existing approaches; and (4) identify public perception of antibiotic resistance as an important issue that warrants exploration.
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Affiliation(s)
- Dale Dominey-Howes
- Asia - Pacific Natural Hazards and Disaster Risk Research Group, The School of Geosciences, The University of Sydney Sydney, NSW, Australia
| | - Beata Bajorek
- The UTS Graduate School of Health, University of Technology Sydney Sydney, NSW, Australia
| | - Carolyn A Michael
- The School of Life Sciences, University of Technology Sydney Sydney, NSW, Australia
| | - Brittany Betteridge
- Asia - Pacific Natural Hazards and Disaster Risk Research Group, The School of Geosciences, The University of Sydney Sydney, NSW, Australia
| | - Jonathan Iredell
- Westmead Millennium Institute for Medical Research and The Marie Bashir Institute, University of Sydney Sydney, NSW, Australia
| | - Maurizio Labbate
- The School of Life Sciences, University of Technology Sydney Sydney, NSW, Australia ; The ithree Institute, University of Technology Sydney Sydney, NSW, Australia
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263
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Njeru SN, Obonyo MA, Nyambati SO, Ngari SM. Antimicrobial and cytotoxicity properties of the crude extracts and fractions of Premna resinosa (Hochst.) Schauer (Compositae): Kenyan traditional medicinal plant. Altern Ther Health Med 2015; 15:295. [PMID: 26303771 PMCID: PMC4548455 DOI: 10.1186/s12906-015-0811-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 08/07/2015] [Indexed: 11/22/2022]
Abstract
Background Premna resinosa (Hochst.) Schauer also called “mukarakara” in Mbeere community of Kenya is used in the management of respiratory illness. In this study we investigated antituberculous, antifungal, antibacterial activities including cytotoxicity and phytochemical constituents of this plant. Methods Antibacterial and antifungal activities were investigated by disc diffusion and micro dilution techniques. Antituberculous activity was investigated using BACTEC MGIT 960 system while cytotoxicity was analyzed by MTT assay on Vero cells (Methanolic crude extract) and HEp-2 cells (fractions). Finally, phytochemicals were profiled using standard procedures. Results P. resinosa had high antituberculous activity with a MIC of <6.25 μg/ml in ethyl acetate fraction. The antibacterial activity was high and broad spectrum, inhibiting both Gram positive and Gram negative bacteria. Dichloromethane fraction had the best antibacterial MIC of 31.25 μg/ml against Methicillin-resistant S. aureus while Ethyl acetate fraction had the highest zone of inhibition of 22.3 ± 0.3 against S. aureus. Its effects on tested fungi were moderate with petro ether fraction giving an inhibition of 10.3 ± 0.3 on C. albicans. The crude extract and two fractions (petro ether and methanol) were not within the acceptable toxicity limits, however dichloromethane and ethyl acetate fractions that exhibited higher activity were within the acceptable toxicity limit (CC50 < 90). The activity can to some extent be associated to alkaloids, flavonoids, terpenoids, anthraquinones and phenols detected in this plant extracts. Conclusion Our findings demonstrate that P. resinosa has high selective potential as a source of novel lead for antituberculous, antibacterial and antifungal drugs. Of particular relevance is high activity against MRSA, S. aureus, C. albicans and MTB which are great public health challenge due to drug resistance development and as major sources of community and hospital based infections.
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264
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Abera B, Kibret M. Azithromycin, fluoroquinolone and chloramphenicol resistance of non-chlamydia conjunctival bacteria in rural community of Ethiopia. Indian J Ophthalmol 2015; 62:236-9. [PMID: 23571246 PMCID: PMC4005243 DOI: 10.4103/0301-4738.99974] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim: To determine profiles of non-chlamydia conjunctival bacteria and their antimicrobial susceptibility from adults who underwent trachomatous trichiasis surgery in rural areas of Ethiopia. Materials and Methods: A cross-sectional study was conducted in rural districts in West Gojjam administrative zone. Conjunctival swabs were collected during surgery and transported using Stuart transport broth (Oxoid, UK). Antibiotic susceptibility of conjunctival isolates was determined using the Kirby-Bauer disc-diffusion method. Results: Non-chlamydia pathogenic bacteria were recovered from conjunctiva of 438 (31%) participants before treatment. The isolated conjunctival bacteria were Staphylococcus aureus, coagulase-negative Staphylococci, Streptococcus group (A, C, F and G), Enterococci, Streptococcus pneumoniae, Moraxella spp., Escherichia coli, Citrobacter spp., Proteus spp., Klebsiella spp., Pseudomonas spp. and Enterobacter spp. Overall, resistance rates of 57.8% to azithromycin and 68.5% to chloramphenicol were found. However, 86-94.4% sensitivity was demonstrated to ciprofloxacin and norfloxacin. Moderate sensitivity rates (61.8-78.4%) were observed to ceftriaxone, tetracycline and cotrimoxazole. Conclusion: Fluoroquinolones that have activity against the majority of bacterial isolates were potent at in vitro. However, unacceptably high levels of resistance to azithromycin and chloramphenicol in rural community indicated a need for further study and antimicrobial resistance surveillance.
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Affiliation(s)
- Bayeh Abera
- Department of Medical Microbiology, College of Medicine and Health Sciences, Ethiopia
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265
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Figueiredo R, Card R, Nunes C, AbuOun M, Bagnall MC, Nunez J, Mendonça N, Anjum MF, da Silva GJ. Virulence Characterization of Salmonella enterica by a New Microarray: Detection and Evaluation of the Cytolethal Distending Toxin Gene Activity in the Unusual Host S. Typhimurium. PLoS One 2015; 10:e0135010. [PMID: 26244504 PMCID: PMC4526557 DOI: 10.1371/journal.pone.0135010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/16/2015] [Indexed: 11/19/2022] Open
Abstract
Salmonella enterica is a zoonotic foodborne pathogen that causes acute gastroenteritis in humans. We assessed the virulence potential of one-hundred and six Salmonella strains isolated from food animals and products. A high through-put virulence genes microarray demonstrated Salmonella Pathogenicity Islands (SPI) and adherence genes were highly conserved, while prophages and virulence plasmid genes were variably present. Isolates were grouped by serotype, and virulence plasmids separated S. Typhimurium in two clusters. Atypical microarray results lead to whole genome sequencing (WGS) of S. Infantis Sal147, which identified deletion of thirty-eight SPI-1 genes. Sal147 was unable to invade HeLa cells and showed reduced mortality in Galleria mellonella infection model, in comparison to a SPI-1 harbouring S. Infantis. Microarray and WGS of S. Typhimurium Sal199, established for the first time in S. Typhimurium presence of cdtB and other Typhi-related genes. Characterization of Sal199 showed cdtB genes were upstream of transposase IS911, and co-expressed with other Typhi-related genes. Cell cycle arrest, cytoplasmic distension, and nuclear enlargement were detected in HeLa cells infected by Sal199, but not with S. Typhimurium LT2. Increased mortality of Galleria was detected on infection with Sal199 compared to LT2. Thus, Salmonella isolates were rapidly characterized using a high through-put microarray; helping to identify unusual virulence features which were corroborated by further characterisation. This work demonstrates that the use of suitable screening methods for Salmonella virulence can help assess the potential risk associated with certain Salmonella to humans. Incorporation of such methodology into surveillance could help reduce the risk of emergence of epidemic Salmonella strains.
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Affiliation(s)
- Rui Figueiredo
- Faculty of Pharmacy and Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, New Haw, Addlestone, Surrey, KT15 3NB, United Kingdom
| | - Roderick Card
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, New Haw, Addlestone, Surrey, KT15 3NB, United Kingdom
| | - Carla Nunes
- Faculty of Pharmacy and Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Manal AbuOun
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, New Haw, Addlestone, Surrey, KT15 3NB, United Kingdom
| | - Mary C. Bagnall
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, New Haw, Addlestone, Surrey, KT15 3NB, United Kingdom
| | - Javier Nunez
- Specialist Scientific Support, Animal and Plant Health Agency, Weybridge, New Haw, Addlestone, Surrey, KT15 3NB, United Kingdom
| | - Nuno Mendonça
- Faculty of Pharmacy and Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Muna F. Anjum
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, New Haw, Addlestone, Surrey, KT15 3NB, United Kingdom
| | - Gabriela Jorge da Silva
- Faculty of Pharmacy and Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
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266
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Ahmed I, Sajed M, Sultan A, Murtaza I, Yousaf S, Maqsood B, Vanhara P, Anees M. The erratic antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections. EXCLI JOURNAL 2015; 14:916-25. [PMID: 26648826 PMCID: PMC4669912 DOI: 10.17179/excli2015-207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/17/2015] [Indexed: 11/21/2022]
Abstract
Increasing trend of antibiotic resistance and expression of Extended Spectrum Beta Lactamases (ESBLs) are serious threats for public health as they render the treatment ineffective. Present study was designed to elucidate the antibiotic-susceptibility patterns of ESBL and non-ESBL producing E. coli and K. pneumoniae causing urinary tract infections so that the ineffective antibiotics could be removed from the line of treatment. The bacterial isolates obtained from the urine of patients visiting a tertiary health care facility were cultured for strain identification using API20E. Antimicrobial susceptibility and ESBL detection were done by Kirby-bauer diffusion technique. Almost 53.4 % isolates of E. coli and 24.5 % isolates of K. pneumoniae were found to be ESBL producers. The ESBL producing bacteria were found to be more resistant towards various antibiotics. The most effective drugs against E. coli ESBL isolates were imipenem (99.54 %), ampicillin-sulbactam (97.48 %), piperacillin-tazobactam (96.86 %), fosfomycin (94.51 %), amikacin (92.26 %) and nitrofurantoin (90.68 %). The most effective drugs against K. pneumoniae ESBL isolates were imipenem (97.62 %), piperacillin-tazobactam (95.35 %), ampicillin-sulbactam (90.48 %) and amikacin (88.37 %). The antibiotics having the highest resistance, particularly by the ESBL producers were amoxicillin clavulanic acid, sulphamethoxalzole/ trimethoprim, cefuroxime, cefpirome, ceftriaxone and ciprofloxacin. Most of the isolates showed multi drug resistance (MDR). High frequency of ESBL producing E. coli and K. pneumoniae were observed as compared to previous data. Penicillins, cephalosporins and some representatives of fluoroquinolones were least effective against the common UTIs and are recommended to be removed from the line of treatment.
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Affiliation(s)
- Iftkhar Ahmed
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Sajed
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Aneesa Sultan
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Iram Murtaza
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Sohail Yousaf
- Department of Environmental Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Bushra Maqsood
- Department of Medicine Unit 2, Holy Family Hospital, Rawalpindi, Pakistan
| | - Petr Vanhara
- Department of Histology and Embryology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Mariam Anees
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan ; Institute of Health and Management Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
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267
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Mohammadinejad P, Ataeinia B, Kaynejad K, Zeinoddini A, Sadeghi B, Hosseini M, Rezaei N, Aghamohammadi A. Antibiotic resistance in patients with primary immunodeficiency disorders versus immunocompetent patients. Expert Rev Clin Immunol 2015; 11:1163-72. [PMID: 26289374 DOI: 10.1586/1744666x.2015.1075396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We aimed to investigate the antimicrobial susceptibility among bacterial isolates of patients with primary immunodeficiency disorders (PID) in comparison with immunocompetent patients. METHODS Patients' antibiotic sensitivity profiles were extracted from their medical records. In order to compare the antibiotic sensitivity profiles of PID patients with immunocompetent patients, the results of antibiograms of patients who did not have a known or suspected immunodeficiency and were hospitalized during the same period were obtained and used as control subjects. RESULTS A total number of 257 isolates were obtained from 86 PID patients. Antimicrobial susceptibilities of several organisms isolated from PID patients were significantly lower compared to that of immunocompetent patients. CONCLUSION Antibiotic resistance seems to be higher among PID patients compared to immunocompetent patients. This indicates a need for further investigations for the possible factors responsible for antibiotic resistance in PID patients.
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Affiliation(s)
- Payam Mohammadinejad
- a 1 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Ataeinia
- a 1 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kimia Kaynejad
- a 1 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Zeinoddini
- a 1 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bamdad Sadeghi
- a 1 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hosseini
- a 1 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- a 1 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,b 2 Molecular Immunology Research Center and Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Asghar Aghamohammadi
- a 1 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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268
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Thirty-minute screening of antibiotic resistance genes in bacterial isolates with minimal sample preparation in static self-dispensing 64 and 384 assay cards. Appl Microbiol Biotechnol 2015; 99:7711-22. [PMID: 26227406 PMCID: PMC4543423 DOI: 10.1007/s00253-015-6774-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 06/04/2015] [Accepted: 06/17/2015] [Indexed: 01/23/2023]
Abstract
In a clinical setting, molecular assays such as polymerase chain reaction offer a rapid means to infer or confirm identity and therapeutic decisions. Accordingly, a number of molecular assays targeting identity and antibiotic resistance (AR) genes have been developed; however, these methods can be technically complex and relatively expensive. Herein, we describe a diagnostic concept utilizing isothermal amplification technology with non-purified heat-lysed cells and self-dispensing cards for testing multiple primers in parallel. This proof-of-concept study, performed with Staphylococcus aureus isolates and associated AR genes, was compared with culture-based susceptibility and quantitative PCR (qPCR). Results demonstrate reduced sample processing steps resulting in a turnaround time (starting from bacterial culture to ending in the antibiotic resistance gene profile) in less than 30 min. For antibiotics tested in which an associated AR gene was targeted on the Gene-Z card, 69 % (18/26) of culture-based resistance events were positive for related AR genes. A comparison of loop-mediated isothermal amplification (LAMP) and qPCR assays targeting the same antibiotic resistance genes showed a 98.2 % agreement in terms of presence and absence calls. Identity-based discrepancies between conventional (phenotypic) and molecular (genotypic) results were further resolved, and we were able to demonstrate higher accuracy in identification with the molecular analysis.
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269
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Mainda G, Bessell PR, Bessell PB, Muma JB, McAteer SP, Chase-Topping ME, Gibbons J, Stevens MP, Gally DL, deC Bronsvoort BM. Prevalence and patterns of antimicrobial resistance among Escherichia coli isolated from Zambian dairy cattle across different production systems. Sci Rep 2015. [PMID: 26211388 PMCID: PMC4515737 DOI: 10.1038/srep12439] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study focused on the use of antibiotics on small, medium and commercial-sized dairy farms in the central region of Zambia and its relationship to antibiotic resistance in Escherichia coli. A stratified random sample of 104 farms was studied, representing approximately 20% of all dairy farms in the region. On each farm, faecal samples were collected from a random sample of animals and a standardised questionnaire on the usage of antibiotics was completed. An E. coli isolate was obtained from 98.67% (371/376) of the sampled animals and tested for resistance to six classes of antibiotics. The estimated prevalence of resistance across the different farming systems was: tetracycline (10.61; 95%CI: 7.40–13.82), ampicillin (6.02; 95%CI: 3.31–8.73), sulfamethoxazole/ trimethoprim (4.49; 95%CI: 2.42–6.56), cefpodoxime (1.91; 95%CI: 0.46–3.36), gentamicin (0.89; 95%CI: 0.06–1.84) and ciprofloxacin (0%). Univariate analyses indicated certain diseases, exotic breeds, location, farm size and certain management practices as risk factors for detection of resistance, whereas multivariate analyses showed an association with lumpy skin disease and a protective effect for older animals (>25 months). This study has provided novel insights into the drivers of antibiotic use and their association with antibiotic resistance in an under-studied region of Southern Africa.
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Affiliation(s)
- Geoffrey Mainda
- 1] Divisions of Immunity and Infection, Veterinary Clinical Sciences [2] District Veterinary Office, Ministry of Agriculture and Livestock, P.O. Box 80285, Kabwe, Zambia
| | - Paul R Bessell
- Genetics and Genomics, The Roslin Institute and The Royal (Dick) School of Veterinary Sciences, The University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, United Kingdom
| | | | - John B Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Zambia
| | - Sean P McAteer
- Divisions of Immunity and Infection, Veterinary Clinical Sciences
| | - Margo E Chase-Topping
- Centre for Immunity, Infection and Evolution, Kings Buildings, University of Edinburgh, Charlotte Auerbach Road, Edinburgh, EH9 3FL, United Kingdom
| | - James Gibbons
- School of Veterinary Medicine, Veterinary Science Centre, Belfield, Dublin 4, Eire
| | - Mark P Stevens
- Divisions of Immunity and Infection, Veterinary Clinical Sciences
| | - David L Gally
- Divisions of Immunity and Infection, Veterinary Clinical Sciences
| | - Barend M deC Bronsvoort
- 1] Divisions of Immunity and Infection, Veterinary Clinical Sciences [2] Genetics and Genomics, The Roslin Institute and The Royal (Dick) School of Veterinary Sciences, The University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, United Kingdom
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270
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Gap analysis of infection control practices in low- and middle-income countries. Infect Control Hosp Epidemiol 2015. [PMID: 26198467 DOI: 10.1017/ice.2015.160] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Healthcare-associated infection rates are higher in low- and middle-income countries compared with high-income countries, resulting in relatively larger incidence of patient mortality and disability and additional healthcare costs. OBJECTIVE To use the Infection Control Assessment Tool to assess gaps in infection control (IC) practices in the participating countries. METHODS Six international sites located in Argentina, Greece, Hungary, India, Nepal, and South Africa provided information on the health facility and the surgical modules relating to IC programs, surgical antibiotic use and surgical equipment procedures, surgical area practices, sterilization and disinfection of equipment and intravenous fluid, and hand hygiene. Modules were scored for each country. RESULTS The 6 international sites completed 5 modules. Of 121 completed sections, scores of less than 50% of the recommended IC practices were received in 23 (19%) and scores from 50% to 75% were received in 43 (36%). IC programs had various limitations in many sites and surveillance of healthcare-associated infections was not consistently performed. Lack of administration of perioperative antibiotics, inadequate sterilization and disinfection of equipment, and paucity of hand hygiene were found even in a high-income country. There was also a lack of clearly written defined policies and procedures across many facilities. CONCLUSIONS Our results indicate that adherence to recommended IC practices is suboptimal. Opportunities for improvement of IC practices exist in several areas, including hospital-wide IC programs and surveillance, antibiotic stewardship, written and posted guidelines and policies across a range of topics, surgical instrument sterilization procedures, and improved hand hygiene.
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271
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Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: an economic analysis. THE LANCET. INFECTIOUS DISEASES 2015; 15:1203-1210. [PMID: 26164481 PMCID: PMC4609169 DOI: 10.1016/s1473-3099(15)00149-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/23/2015] [Accepted: 03/31/2015] [Indexed: 01/21/2023]
Abstract
Background The decreasing effectiveness of antimicrobial agents is a growing global public health concern. Low- and middle-income countries (LMIC) are vulnerable to the loss of antimicrobial efficacy given their high burden of infectious disease and the cost of treating resistant organisms. Methods We analyzed data from the World Health Organization’s Antibacterial Resistance Global Surveillance Report. We investigated the importance of out-of-pocket spending and copayment requirements for public sector medications on the level of bacterial resistance among LMIC, adjusting for environmental factors purported to be predictors of resistance, such as sanitation, animal husbandry and poverty as well as other structural components of the health sector. Findings Out-of-pocket health expenditures were the only factor demonstrating a statistically significant relationship with antimicrobial resistance. A ten point increase in the percentage of health expenditures that were out-of-pocket was associated with a 3·2 percentage point increase in resistant isolates [95% CI, 1·17 to 5·15, p-value=0·002]. This relationship was driven by countries requiring copayments for medications in the public health sector. Among these countries, moving from the 20th to 80th percentile of out-of-pocket health expenditures was associated with an increase in resistant bacterial isolates from 17·76 [95%CI 12·54 to 22·97] to 36·27 percentage points [95% CI 31·16 to 41·38]. Interpretation Out-of-pocket health expenditures were strongly correlated with antimicrobial resistance among LMIC. This relationship was driven by countries that require copayments on medications in the public sector. Our findings suggest cost-sharing of antimicrobials in the public sector may drive demand to the private sector where supply-side incentives to overprescribe are likely heightened and quality assurance less standardized.
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272
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Fitchett JR. Antibiotics, copayments, and antimicrobial resistance: investment matters. THE LANCET. INFECTIOUS DISEASES 2015; 15:1125-1127. [PMID: 26164480 DOI: 10.1016/s1473-3099(15)00057-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Joseph R Fitchett
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Department of Global Health and Population, Harvard University, Boston, MA 02115, USA.
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273
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Titilawo Y, Sibanda T, Obi L, Okoh A. Multiple antibiotic resistance indexing of Escherichia coli to identify high-risk sources of faecal contamination of water. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:10969-10980. [PMID: 25779106 DOI: 10.1007/s11356-014-3887-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/18/2014] [Indexed: 06/04/2023]
Abstract
We evaluated the antibiogram profile of Escherichia coli (n = 300) isolated from selected rivers in Osun State, Nigeria. The identities of the E. coli isolates were confirmed by polymerase chain reaction (PCR) technique. Susceptibility of the isolates to 20 antibiotics conventionally used in clinical cases was assessed in vitro by the standardized agar disc-diffusion method. All the isolates were susceptible to imipenem, meropenem, amikacin and gatilofloxacin. The isolates were variously susceptible to the other antibiotics as follows: ciprofloxacin (96 %), kanamycin (95 %), neomycin (92 %), streptomycin (84 %), chloramphenicol (73 %), nalidixic acid (66 %), nitrofurantoin (64 %), gentamycin (63 %), doxycycline (58 %), cefepime (57 %), tetracycline (49 %) and cephalothin (42 %). The multiple antibiotic resistance indexing ranged from 0.50 to 0.80 for all the sampling locations and exceeded the threshold value of 0.2, suggesting the origin of the isolates to be of high antimicrobial usage. Our findings signify an increase in the incidence of antimicrobial resistance of E. coli towards conventionally used antibiotics necessitating proper surveillance programmes towards the monitoring of antimicrobial resistance determinants in water bodies.
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Affiliation(s)
- Yinka Titilawo
- Applied and Environmental Microbiology Research Group, Department of Biochemistry and Microbiology, University of Fort Hare, Alice, 5700, South Africa,
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274
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Abstract
OBJECTIVE To test the in vitro antimicrobial efficacy of water and methanol extracts of 23 plant species that are commonly used in Libyan folk medicine. METHODS The antimicrobial activity was determined using the well-diffusion method. Four test microorganisms were used namely, Escherichia coli, Salmonella species, Staphylococcus aureus and Bacillus subtilis. The minimum inhibitory concentration (MIC) was determined for the high biologically active crude plant extracts. RESULTS Among 23 medicinal plants used in the study, only 5 methanolic extracts [Rosmarinus offcinalis L., Carduus marianium L., Lantana camara L., Rhus tripartite (ueria) Grande, and Thymus capitatus (L.) Hoffm (link)] showed the highest antimicrobial activity against Staphylococcus aureus, Bacillus subtilis and Salmonella species, while 22 methanolic and aqueous extracts showed moderate to weak antimicrobial activity on all tested organisms. However 19 of the extracts showed no activity at all against Gram-ve and Gram +ve microorganisms. MIC was found to be 1.25 mg/mL (Thymus capitatus), 3 mg/mL (Rhus tripartite), 4 mg/mL (Carduus marianium), 5 mg/mL (Rosamarinus officinalis) and 5 mg/mL (Lantana camara), respectively. CONCLUSIONS The present results revealed that, crude methanolic extracts of the investigated Libyan folk medicinal plants exhibited mild to high in vitro antibacterial activities against Gram-positive and Gram-negative microorganisms.
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275
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Yong YL, Plançon A, Lau YH, Hostetler DM, Fernández FM, Green MD, Sounvoravong S, Nara S, Boravann M, Dumrong T, Bangsawan N, Low MY, Lim CC, Ai RLC, Newton PN. Collaborative health and enforcement operations on the quality of antimalarials and antibiotics in southeast Asia. Am J Trop Med Hyg 2015; 92:105-112. [PMID: 25897069 PMCID: PMC4455084 DOI: 10.4269/ajtmh.14-0574] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/05/2015] [Indexed: 11/23/2022] Open
Abstract
Counterfeit (or falsified) and substandard medicines pose a major public health risk. We describe the findings of Operation Storm I and II conducted in 2008–2009 to combat counterfeit medicines through partnership between national customs, Drug Regulatory Agencies (DRAs), and police in Cambodia, Indonesia, Laos, Myanmar, Singapore, Thailand, and Vietnam. Samples were obtained from seizures and market surveillance by national DRAs. Laboratory analysis using spectroscopic and chromatographic techniques and examination of packaging were performed. Ninety-three suspect antibiotics and 95 antimalarial samples were collected. Of the 93 antibiotics, 29 (31%) had % active pharmaceutical ingredient content (%API) < 85% or > 115% (including one counterfeit). Of the 95 antimalarials, 30 (32%) had %API < 85 > 115% API (including one counterfeit). A significant minority of samples, antimalarials (13%) and antibiotics (15%), were collected in plastic bags with minimal or no labeling. Of 20 ampicillin samples, 13 (65%) contained < 85% API (with one counterfeit containing additional amoxicillin). Of 34 oral artesunate samples, 7 (21%) contained %API out of the 85–115% range. Coordinated and synergistic partnership adopted by the participating countries, International Criminal Police Organization (INTERPOL), World Health Organization (WHO), and laboratories facilitated a platform for discussions and intelligence sharing, helping to improve each participating country's capacity to combat poor-quality medicines.
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Affiliation(s)
| | - Aline Plançon
- *Address correspondence to Paul N. Newton, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR, E-mail: or Aline Plançon, Medical Product Counterfeiting and Pharmaceutical Crime Sub-Directorate, INTERPOL, Lyon, France, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | - Paul N. Newton
- *Address correspondence to Paul N. Newton, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR, E-mail: or Aline Plançon, Medical Product Counterfeiting and Pharmaceutical Crime Sub-Directorate, INTERPOL, Lyon, France, E-mail:
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276
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Noor R, Zerin N, Das KK. Microbiological quality of pharmaceutical products in Bangladesh: current research perspective. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(14)60781-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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277
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Enteric bacterial pathogens in children with diarrhea in Niger: diversity and antimicrobial resistance. PLoS One 2015; 10:e0120275. [PMID: 25799400 PMCID: PMC4370739 DOI: 10.1371/journal.pone.0120275] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/23/2015] [Indexed: 01/21/2023] Open
Abstract
Background Although rotavirus is the leading cause of severe diarrhea among children in sub-Saharan Africa, better knowledge of circulating enteric pathogenic bacteria and their antimicrobial resistance is crucial for prevention and treatment strategies. Methodology/Principal Findings As a part of rotavirus gastroenteritis surveillance in Maradi, Niger, we performed stool culture on a sub-population of children under 5 with moderate-to-severe diarrhea between April 2010 and March 2012. Campylobacter, Shigella and Salmonella were sought with conventional culture and biochemical methods. Shigella and Salmonella were serotyped by slide agglutination. Enteropathogenic Escherichia coli (EPEC) were screened by slide agglutination with EPEC O-typing antisera and confirmed by detection of virulence genes. Antimicrobial susceptibility was determined by disk diffusion. We enrolled 4020 children, including 230 with bloody diarrhea. At least one pathogenic bacterium was found in 28.0% of children with watery diarrhea and 42.2% with bloody diarrhea. Mixed infections were found in 10.3% of children. EPEC, Salmonella and Campylobacter spp. were similarly frequent in children with watery diarrhea (11.1%, 9.2% and 11.4% respectively) and Shigella spp. were the most frequent among children with bloody diarrhea (22.1%). The most frequent Shigella serogroup was S. flexneri (69/122, 56.5%). The most frequent Salmonella serotypes were Typhimurimum (71/355, 20.0%), Enteritidis (56/355, 15.8%) and Corvallis (46/355, 13.0%). The majority of putative EPEC isolates was confirmed to be EPEC (90/111, 81.1%). More than half of all Enterobacteriaceae were resistant to amoxicillin and co-trimoxazole. Around 13% (46/360) Salmonella exhibited an extended-spectrum beta-lactamase phenotype. Conclusions This study provides updated information on enteric bacteria diversity and antibiotic resistance in the Sahel region, where such data are scarce. Whether they are or not the causative agent of diarrhea, bacterial infections and their antibiotic resistance profiles should be closely monitored in countries like Niger where childhood malnutrition pre-disposes to severe and invasive infections.
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278
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Gangcuangco LM, Alejandria M, Henson KE, Alfaraz L, Ata RM, Lopez M, Saniel M. Prevalence and risk factors for trimethoprim-sulfamethoxazole-resistant Escherichia coli among women with acute uncomplicated urinary tract infection in a developing country. Int J Infect Dis 2015; 34:55-60. [PMID: 25748571 DOI: 10.1016/j.ijid.2015.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prospective studies from developing countries that have investigated risk factors for trimethoprim-sulfamethoxazole (TMP-SMX)-resistant Escherichia coli in women with uncomplicated urinary tract infection (UTI) remain scarce. METHODS Women with acute uncomplicated UTI were enrolled prospectively. Urine was sent for antimicrobial susceptibility testing. Logistic regression analysis was used to identify risk factors for TMP-SMX resistance. RESULTS Of 405 participants, 229 (56.5%) had bacteriuria (mean age 31.9 ± 9.5 years). In the previous 12 months, 77 (33.6%) had experienced at least one UTI episode and 106 (46.3%) reported antimicrobial use. The most common uropathogens were E. coli (75.8%) and Staphylococcus saprophyticus (8.9%). For the 179 E. coli, resistance rates were highest for ampicillin (64.3%) and TMP-SMX (41.3%). Resistance to cephalosporins, nitrofurantoin, and fluoroquinolones was much lower compared with the hospital laboratory-based surveillance data. Risk factors for TMP-SMX resistance were UTI in the last 6 months (odds ratio 2.22; p = 0.04) and the number of UTI episodes in the past year (odds ratio 2.06; p = 0.004). The number of UTI episodes (adjusted odds ratio 2.21; p = 0.02) remained significant on multivariate analysis. CONCLUSIONS TMP-SMX resistance was high. Number of previous UTI episodes was associated with increased risk of resistance; prior antimicrobial use was not. Hospital antibiograms should be used with caution when treating uncomplicated UTI.
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Affiliation(s)
- Louie Mar Gangcuangco
- Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines; Infectious Disease Practice and Innovations, The Medical City, Ortigas Ave., Pasig, Metro Manila, Philippines.
| | - Marissa Alejandria
- Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines; Infectious Disease Practice and Innovations, The Medical City, Ortigas Ave., Pasig, Metro Manila, Philippines; Section of Infectious Diseases, Department of Medicine, University of the Philippines College of Medicine, Pedro Gil, Manila, Philippines
| | - Karl Evans Henson
- Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines; Section of Infectious Diseases, Department of Medicine, University of the Philippines College of Medicine, Pedro Gil, Manila, Philippines
| | - Liezel Alfaraz
- Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines
| | - Rona Marie Ata
- Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines
| | - Maritess Lopez
- Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines
| | - Mediadora Saniel
- Department of Medicine, The Medical City, Pasig, Metro Manila, Philippines; Infectious Disease Practice and Innovations, The Medical City, Ortigas Ave., Pasig, Metro Manila, Philippines; Section of Infectious Diseases, Department of Medicine, University of the Philippines College of Medicine, Pedro Gil, Manila, Philippines
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279
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Resistance to Cotrimoxazole and Other Antimicrobials among Isolates from HIV/AIDS and Non-HIV/AIDS Patients at Bugando Medical Centre, Mwanza, Tanzania. AIDS Res Treat 2015; 2015:103874. [PMID: 25793123 PMCID: PMC4352486 DOI: 10.1155/2015/103874] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/20/2015] [Accepted: 01/31/2015] [Indexed: 11/17/2022] Open
Abstract
Bacterial resistance has increased in the AIDS era and is attributed to the widespread use of cotrimoxazole prophylaxis against opportunistic infections in HIV/AIDS patients. In Tanzania, cotrimoxazole prophylaxis has been used for more than ten years. Little is known, however, about its impact on the spread of antibiotic resistance in HIV positive patients. This cross-sectional study was done to compare magnitude of bacterial resistance to cotrimoxazole and other antimicrobials among isolates from HIV infected patients on cotrimoxazole prophylaxis and those not on prophylaxis and non-HIV patients attending Bugando Medical Centre (BMC). Susceptibility testing on obtained urine and swab specimens followed Clinical Laboratory Standard Institute, 2010, Guidelines. Of 945 samples collected, 155 had positive bacterial growth after 24 hours of incubation. Of the positive samples (72), 46.4% were from HIV positive patients. The common isolates were E. coli 41.3% (64/155), Klebsiella pneumoniae 17.5% (27/155), and Staphylococcus aureus 16.1% (25/155). Overall, bacterial resistance to cotrimoxazole was 118 (76.1%); among isolates from HIV patients bacterial resistance was 54 (75%), and for isolates from HIV patients on prophylaxis bacterial resistance was 36 (81.3%). HIV seropositivity and cotrimoxazole prophylaxis are not associated with antibiotic resistance observed in bacteria infecting patients attending BMC, Mwanza, Tanzania.
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280
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Figueiredo R, Henriques A, Sereno R, Mendonça N, da Silva GJ. Antimicrobial Resistance and Extended-Spectrum β-Lactamases of Salmonella enterica Serotypes Isolated from Livestock and Processed Food in Portugal: An Update. Foodborne Pathog Dis 2015; 12:110-7. [DOI: 10.1089/fpd.2014.1836] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Rui Figueiredo
- Faculty of Pharmacy and Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | | | | | - Nuno Mendonça
- Faculty of Pharmacy and Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Gabriela Jorge da Silva
- Faculty of Pharmacy and Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
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281
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BHATTACHARYA D, BHATTACHARYA H, SAYI DS, BHARADWAJ AP, SINGHANIA M, SUGUNAN AP, ROY S. Changing patterns and widening of antibiotic resistance in Shigella spp. over a decade (2000-2011), Andaman Islands, India. Epidemiol Infect 2015; 143:470-7. [PMID: 24763083 PMCID: PMC9507051 DOI: 10.1017/s0950268814000958] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/08/2014] [Accepted: 03/26/2014] [Indexed: 11/07/2022] Open
Abstract
This study is a part of the surveillance study on childhood diarrhoea in the Andaman and Nicobar Islands; here we report the drug resistance pattern of recent isolates of Shigella spp. (2006-2011) obtained as part of that study and compare it with that of Shigella isolates obtained earlier during 2000-2005. During 2006-2011, stool samples from paediatric diarrhoea patients were collected and processed for isolation and identification of Shigella spp. Susceptibility to 22 antimicrobial drugs was tested and minimum inhibitory concentrations were determined for third-generation cephalosporins, quinolones, amoxicillin-clavulanic acid combinations and gentamicin. A wide spectrum of antibiotic resistance was observed in the Shigella strains obtained during 2006-2011. The proportions of resistant strains showed an increase from 2000-2005 to 2006-2011 in 20/22 antibiotics tested. The number of drug resistance patterns increased from 13 in 2000-2005 to 43 in 2006-2011. Resistance to newer generation fluoroquinolones, third-generation cephalosporins and augmentin, which was not observed during 2000-2005, appeared during 2006-2011. The frequency of resistance in Shigella isolates has increased substantially between 2000-2006 and 2006-2011, with a wide spectrum of resistance. At present, the option for antimicrobial therapy in shigellosis in Andaman is limited to a small number of drugs.
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Affiliation(s)
- D. BHATTACHARYA
- Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Government of India, Port Blair, Andaman & Nicobar Islands, India
- Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Government of India, opposite KLES Hospital, Nehru Nagar, Belgaum, Karnataka, India
| | - H. BHATTACHARYA
- Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Government of India, Port Blair, Andaman & Nicobar Islands, India
- KLE Dr. Prabhakar Kore Basic Science Research Centre, KLE University, Belgaum, India
| | - D. S. SAYI
- Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Government of India, Port Blair, Andaman & Nicobar Islands, India
| | - A. P. BHARADWAJ
- Chirayu Child Care Centre, Port Blair, Andaman & Nicobar Islands, India
| | - M. SINGHANIA
- G.B. Pant Hospital, Directorate of Health Service, Port Blair, Andaman & Nicobar Islands, India
| | - A. P. SUGUNAN
- Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Government of India, Port Blair, Andaman & Nicobar Islands, India
| | - S. ROY
- Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Government of India, Port Blair, Andaman & Nicobar Islands, India
- Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Government of India, opposite KLES Hospital, Nehru Nagar, Belgaum, Karnataka, India
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282
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Casey CL, Hernandez SM, Yabsley MJ, Smith KF, Sanchez S. The carriage of antibiotic resistance by enteric bacteria from imported tokay geckos (Gekko gecko) destined for the pet trade. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 505:299-305. [PMID: 25461031 DOI: 10.1016/j.scitotenv.2014.09.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 06/04/2023]
Abstract
The emergence of antibiotic-resistant bacteria is a growing public health concern and has serious implications for both human and veterinary medicine. The nature of the global economy encourages the movement of humans, livestock, produce, and wildlife, as well as their potentially antibiotic-resistant bacteria, across international borders. Humans and livestock can be reservoirs for antibiotic-resistant bacteria; however, little is known about the prevalence of antibiotic-resistant bacteria harbored by wildlife and, to our knowledge, limited data has been reported for wild-caught reptiles that were specifically collected for the pet trade. In the current study, we examined the antibiotic resistance of lactose-positive Enterobacteriaceae isolates from wild-caught Tokay geckos (Gekko gecko) imported from Indonesia for use in the pet trade. In addition, we proposed that the conditions under which wild animals are captured, transported, and handled might affect the shedding or fecal prevalence of antibiotic resistance. In particular we were interested in the effects of density; to address this, we experimentally modified densities of geckos after import and documented changes in antibiotic resistance patterns. The commensal enteric bacteria from Tokay geckos (G. gecko) imported for the pet trade displayed resistance against some antibiotics including: ampicillin, amoxicillin/clavulanic acid, cefoxitin, chloramphenicol, kanamycin and tetracycline. There was no significant difference in the prevalence of antibiotic-resistant bacteria after experimentally mimicking potentially stressful transportation conditions reptiles experience prior to purchase. There were, however, some interesting trends observed when comparing Tokay geckos housed individually and those housed in groups. Understanding the prevalence of antibiotic resistant commensal enteric flora from common pet reptiles is paramount because of the potential for humans exposed to these animals to acquire antibiotic-resistant bacteria and the potential for released pets to disseminate these bacteria to native wildlife.
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Affiliation(s)
- Christine L Casey
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, United States
| | - Sonia M Hernandez
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, United States; Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA 30602, United States.
| | - Michael J Yabsley
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, United States; Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA 30602, United States
| | - Katherine F Smith
- Department of Ecology and Evolutionary Biology, Brown University, Providence, RI 02912, United States
| | - Susan Sanchez
- The Athens Veterinary Diagnostic Laboratory, Athens, GA 30602, United States; The Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, United States
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283
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Kouegnigan Rerambiah L, Ndong JC, Medzegue S, Elisee-Ndam M, Djoba Siawaya JF. Genital Mycoplasma infections and their resistance phenotypes in an African setting. Eur J Clin Microbiol Infect Dis 2015; 34:1087-90. [PMID: 25630539 DOI: 10.1007/s10096-015-2326-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 01/12/2015] [Indexed: 11/24/2022]
Abstract
We investigated the antimicrobial susceptibilities of mycoplasmas in Gabonese men and women. A total of 1,332 men and women were included in the study. Sperm, urine, ureteral or vaginal swabs were collected from the subjects. Mycoplasmas identification and antimicrobial susceptibility to azithromycin, clarithromycin, erythromycin, josamycin, pristinamycin, doxycycline, tetracycline, ofloxacin and ciprofloxacin were tested using the Mycoplasma IST 2 kit. 794 subjects were positive for Mycoplasma. Respectively, 1.6 % and 82.24 % of subjects were singly infected with M. hominis and Ureaplasma urealyticum and 15.87 % had a mixed infection. M. hominis isolates were resistant to erythromycin and had an intermediate (I) to resistant (R) profile to azithromycin and clarithromycin. 84.6 % of M. hominis strains were sensitive (S) to josamycin and pristinamycin. 30.8 % and 92.3 % of M. hominis strains were sensitive to tetracycline and doxycycline, respectively. 76.9 and 84.6 % of M. hominis isolates were sensitive to ciprofloxacin and ofloxacin, respectively. The sensitivity rates of U. urealyticum strains were 45.23 %, 47.7 %, 63.84 %, 90.8 % and 92 % for azithromycin, erythromycin, clarithromycin, pristinamycin and josamycin, respectively. U. urealyticum strains showed 62.2 % and 79.7 % sensitivity to tetracycline and doxycycline, respectively. The resistance rates to azithromycin, clarithromycin and erythromycin for samples with mixed infection were 72.8 %, 84.7 % and 85.6 %, respectively. Josamycin and pristinamycin were 81.5 % effective on samples with mixed infection. The sensitivity rates of samples with mixed infection to tetracycline, doxycycline, ciprofloxacin and ofloxacin were 32 %, 69.6 %, 8.9 % and 18.5 %, respectively. Sub-Saharan Africa needs to use antibiotics rationally, as falling to do so would compromise the management of infectious diseases.
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Affiliation(s)
- L Kouegnigan Rerambiah
- Unité des Recherche et de Diagnostic Spécialisé, Laboratoire National de Santé Publique, Avenue Felix Eboué, BP 10736, Libreville, Gabon
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Nakayama T, Ueda S, Huong BTM, Tuyen LD, Komalamisra C, Kusolsuk T, Hirai I, Yamamoto Y. Wide dissemination of extended-spectrum β-lactamase-producing Escherichia coli in community residents in the Indochinese peninsula. Infect Drug Resist 2015; 8:1-5. [PMID: 25670909 PMCID: PMC4315533 DOI: 10.2147/idr.s74934] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recent studies have reported a widespread distribution of extended-spectrum β-lactamase (ESBL)-producing bacteria, not only in the nosocomial setting, but also in the community; some local communities in Southeast Asia have been reported to show a high prevalence of ESBL-producing bacteria. However, the details regarding the quantitative/qualitative state of ESBL-producing bacterial spread in Southeast Asia are currently unclear. Thus, the aim of this study was to assess the state of ESBL-producing bacterial spread in community residents from the Indochinese peninsula, as a representative region of Southeast Asia. In order to achieve this aim, local community residents in Laos and Vietnam were examined for fecal carriage of ESBL-producing Enterobacteriaceae, and the findings were compared with data from a previous study in Thailand which was conducted in the same manner as this study. Between 47.0%–70.2% of the Laotian and Vietnamese residents carried ESBL-producing CTX-M genotype Enterobacteriaceae. The most common sub-genotypes of CTX-M were CTX-M-1 (33.0%–47.5%) and CTX-M-9 (47.5%–64.1%), and these rates were similar among all three countries. Taken together, these results confirmed that ESBL-producing Enterobacteriaceae are widely disseminated in Indochinese countries, such as Thailand, Laos, and Vietnam.
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Affiliation(s)
| | - Shuhei Ueda
- Faculty of Medicine, University of The Ryukyus, Okinawa, Japan
| | | | | | | | - Teera Kusolsuk
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Itaru Hirai
- Faculty of Medicine, University of The Ryukyus, Okinawa, Japan
| | - Yoshimasa Yamamoto
- Global Collaboration Center, Osaka University, Osaka, Japan ; Osaka Prefectural Institute of Public Health, Osaka, Japan
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285
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Ngadimon IW, Islahudin F, Hatah E, Mohamed Shah N, Makmor-Bakry M. Antibiotic and shared decision-making preferences among adolescents in Malaysia. Patient Prefer Adherence 2015; 9:665-73. [PMID: 25999702 PMCID: PMC4437597 DOI: 10.2147/ppa.s82844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to establish baseline information on the current level of knowledge about, attitude toward, and experience with antibiotic usage, and preferences for shared decision making among adolescents in Malaysia. METHODS A cross-sectional survey, involving 1,105 respondents who were aged between 13 and 17 years and who lived in Malaysia, was conducted using a validated questionnaire. The survey assessed knowledge, attitude, and experience with regard to antibiotic usage, and adolescents' preferences for the style of shared decision-making process. RESULTS The majority (n=786 [71.13%]) of the respondents had a low level of knowledge, 296 (26.79%) had a moderate level of knowledge, and 23 (2.08%) had a high level of knowledge. Further, they demonstrated a slightly negative attitude mean score of 3.30±0.05 (range: 0-8 points) but a positive experience mean score of 2.90±0.029 (range: 0-4 points). There was a positive correlation between knowledge and attitude scores, with a higher knowledge level associated with a more positive attitude toward antibiotic usage (r=0.257, P<0.001). Higher knowledge scores were associated with a more negative experience with antibiotic usage (r=-0.83, P=0.006). When assessing preference in shared decision making, more adolescents preferred an active role (n=408 [37%]) compared with collaborative (n=360 [32.6%]) or passive (n=337 [30.5%]) (P=0.028) roles. CONCLUSION Current health care settings should involve adolescents in the decision-making process. Education packages can be introduced to improve adolescents' knowledge of and practice of taking antibiotics, as well as to encourage their participation in decision making, in an attempt to reduce misuse of antibiotics.
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Affiliation(s)
- Irma Wati Ngadimon
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Correspondence: Farida Islahudin, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia, Tel +603 9289 7689, Email
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Suleman N, Kalhapure RS, Mocktar C, Rambharose S, Singh M, Govender T. Silver salts of carboxylic acid terminated generation 1 poly (propyl ether imine) (PETIM) dendron and dendrimers as antimicrobial agents against S. aureus and MRSA. RSC Adv 2015. [DOI: 10.1039/c5ra03179f] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In this study the newly synthesised PETIM silver salts displayed a low toxicity level and showed significant antimicrobial activity against both sensitive (S. aureus) and resistant (MRSA) bacterial strains.
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Affiliation(s)
- Nadia Suleman
- Discipline of Pharmaceutical Sciences
- University of KwaZulu-Natal
- Durban 4000
- South Africa
| | - Rahul S. Kalhapure
- Discipline of Pharmaceutical Sciences
- University of KwaZulu-Natal
- Durban 4000
- South Africa
| | - Chunderika Mocktar
- Discipline of Pharmaceutical Sciences
- University of KwaZulu-Natal
- Durban 4000
- South Africa
| | - Sanjeev Rambharose
- Discipline of Pharmaceutical Sciences
- University of KwaZulu-Natal
- Durban 4000
- South Africa
| | - Moganavelli Singh
- Discipline of Biochemistry
- School of Life Sciences
- University of KwaZulu-Natal
- Durban 4000
- South Africa
| | - Thirumala Govender
- Discipline of Pharmaceutical Sciences
- University of KwaZulu-Natal
- Durban 4000
- South Africa
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287
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Daulaire N, Bang A, Tomson G, Kalyango JN, Cars O. Universal Access to Effective Antibiotics is Essential for Tackling Antibiotic Resistance. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43 Suppl 3:17-21. [PMID: 26243238 DOI: 10.1111/jlme.12269] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Universal access to effective antimicrobials is essential to the realization of the right to health. At present, 5.7 million people die from treatable infections each year because they lack this access. Yet, community-based diagnosis and appropriate treatment for many of the leading causes of avoidable infectious deaths has been shown to be feasible and effective, demonstrating that strategies to reach the under-served need to receive high priority. This is a necessary part of a broad strategy to assure the long-term benefits of antimicrobials and to combat antimicrobial resistance, both because the lack of systematic and rigorous efforts to assure effective coverage increases the likelihood of antimicrobial resistance, and because global efforts aimed at antimicrobial stewardship and innovation cannot succeed without explicitly addressing the needs of the under-served. Elements of this strategy will include clear evidence-based treatment protocols, a robust international framework and locally tailored regulations, active engagement with communities and local health providers, strong attention to program management and cost considerations, a focus on the end user, and robust surveillance and response to emerging resistance patterns. Only by balancing the needs of universal access with stewardship and innovation, and assuring that they are mutually reinforcing can a global strategy hope to effectively address antimicrobial resistance.
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Affiliation(s)
- Nils Daulaire
- Senior Visiting Scholar on Global Health Security at the Norwegian Institute of Public Health in Oslo, Norway
| | | | - Göran Tomson
- Senior Professor of International Health Systems Research at the Departments of Learning, Informatics, Management and Ethics and Public Health Sciences at Karolinska Institutet in Stockholm, Sweden
| | - Joan N Kalyango
- Associate Professor of Pharmacy at Makerere University College of Health Sciences in Kampala, Uganda
| | - Otto Cars
- Senior Professor of Infectious Diseases at the Department of Medical Sciences at Uppsala University, Sweden and Founder of Re-Act: Action in Antibiotic Resistance
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288
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Rutebemberwa E, Mpeka B, Pariyo G, Peterson S, Mworozi E, Bwanga F, Källander K. High prevalence of antibiotic resistance in nasopharyngeal bacterial isolates from healthy children in rural Uganda: A cross-sectional study. Ups J Med Sci 2015; 120:249-56. [PMID: 26305429 PMCID: PMC4816885 DOI: 10.3109/03009734.2015.1072606] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia--often due to delayed diagnosis and treatment. In preparation for a community case management intervention for pneumonia and malaria, the bacterial composition of the nasopharyngeal flora and its in vitro resistance were determined in children aged five or under to establish baseline resistance to commonly used antibiotics. METHODS In a population-based survey in April 2008, nasopharyngeal specimens were collected from 152 randomly selected healthy children under 5 years of age in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS). Medical history and prior treatment were recorded. Demographic characteristics and risk factors for carriage of resistant strains were obtained from the HDSS census. Bacteria were isolated and analysed for antibiotic susceptibility using disk diffusion and E test. RESULTS Streptococcus pneumoniae (S. pneumoniae) carriage was 58.6%, and, while most (80.9%) isolates had intermediate resistance to penicillin, none was highly resistant. Whereas no isolate was resistant to erythromycin, 98.9% were resistant to trimethoprim-sulphamethoxazole (co-trimoxazole). CONCLUSIONS In vitro resistance in S. pneumoniae to co-trimoxazole treatment was high, and the majority of isolates had intermediate resistance to penicillin. To inform treatment policies on the clinical efficacy of current treatment protocols for pneumonia in health facilities and at the community level, routine surveillance of resistance in pneumonia pathogens is needed as well as research on treatment efficacy in cases with resistant strains. Improved clinical algorithms and diagnostics for pneumonia should be developed.
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Affiliation(s)
| | | | - George Pariyo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Edison Mworozi
- Department of Paediatrics and Child Health, Makerere University Medical School, Kampala, Uganda
| | - Freddie Bwanga
- Department of Microbiology, Makerere University Faculty of Medicine, Kampala, Uganda, and
| | - Karin Källander
- Correspondence: Karin Källander, Division of Global Health, Tomteboda vägen 18A, Karolinska Institutet, SE-171 77 Stockholm, Sweden. E-mail:
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289
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Dozois A, Thomsen I, Jimenez-Truque N, Soper N, Pearson A, Mohamed-Rambaran P, Dettorre KB, Creech CB, Wright SW. Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus among skin and soft tissue infections in an emergency department in Guyana. Emerg Med J 2014; 32:800-3. [PMID: 25552545 DOI: 10.1136/emermed-2013-203373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 12/11/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The characteristics of staphylococcal skin and soft tissue infections (SSTIs) are poorly understood in northern South America and the Caribbean. The objectives of this study were to determine the frequency of methicillin resistance among Staphylococcus aureus isolates in an emergency department (ED) in Guyana and to identify specific molecular characteristics of these methicillin-resistant Staphylococcus aureus (MRSA) strains. METHODS This was a cross-sectional study conducted at the main teaching hospital in Georgetown, Guyana. Eligible subjects included patients of all ages with SSTIs with obtainable purulent material. Purulent material was cultured, and S. aureus isolates were evaluated for antibiotic susceptibilities by disc diffusion. Molecular characterisation of MRSA isolates included identification of SCCmec type, assignment of genetic relatedness by rep-PCR and determination of the presence of two exotoxins, Panton-Valentine Leukocidin (PVL) and LukAB. RESULTS Eighty-five samples were collected; of these, 47 grew S. aureus. 24 of the 47 S. aureus samples were MRSA (51%; 95% CI 37% to 65%), representing 28% of all samples. All MRSA isolates were SCCmec type IV, PVL positive, LukAB positive and were highly related to the current epidemic clone in the USA, USA300. CONCLUSIONS Here, we demonstrate a clinically significant proportion of methicillin resistance in SSTI-associated staphylococcal isolates. Guyanese isolates were highly related to the most common community-associated strain seen in the USA, USA300. These results have important implications for empiric antibiotic therapy and infection control policies in Guyana and similar settings.
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Affiliation(s)
- Adeline Dozois
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Isaac Thomsen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| | - Natalia Jimenez-Truque
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| | - Nicole Soper
- Department of Laboratory Services, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Alexis Pearson
- Department of Laboratory Services, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Pheona Mohamed-Rambaran
- Department of Laboratory Services, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Kristen B Dettorre
- Division of International Health, Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| | - Seth W Wright
- Division of International Health, Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA
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290
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Albrechtova K, Papousek I, De Nys H, Pauly M, Anoh E, Mossoun A, Dolejska M, Masarikova M, Metzger S, Couacy-Hymann E, Akoua-Koffi C, Wittig RM, Klimes J, Cizek A, Leendertz FH, Literak I. Low rates of antimicrobial-resistant Enterobacteriaceae in wildlife in Taï National Park, Côte d'Ivoire, surrounded by villages with high prevalence of multiresistant ESBL-producing Escherichia coli in people and domestic animals. PLoS One 2014; 9:e113548. [PMID: 25474243 PMCID: PMC4256204 DOI: 10.1371/journal.pone.0113548] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial resistance genes can be found in all ecosystems, including those where antibiotic selective pressure has never been exerted. We investigated resistance genes in a collection of faecal samples of wildlife (non-human primates, mice), people and domestic animals (dogs, cats) in Côte d’Ivoire; in the chimpanzee research area of Taï National Park (TNP) and adjacent villages. Single bacteria isolates were collected from antibiotic-containing agar plates and subjected to molecular analysis to detect Enterobacteriaceae isolates with plasmid-mediated genes of extended-spectrum beta-lactamases (ESBLs) and plasmid-mediated quinolone resistance (PMQR). While the prevalence of ESBL-producing E. coli in the villages was 27% in people (n = 77) and 32% in dogs (n = 38), no ESBL-producer was found in wildlife of TNP (n = 75). PMQR genes, mainly represented by qnrS1, were also present in human- and dog-originating isolates from the villages (36% and 42% in people and dogs, respectively), but no qnrS has been found in the park. In TNP, different variants of qnrB were detected in Citrobacter freundii isolates originating non-human primates and mice. In conclusion, ESBL and PMQR genes frequently found in humans and domestic animals in the villages were rather exceptional in wildlife living in the protected area. Although people enter the park, the strict biosecurity levels they are obliged to follow probably impede transmission of bacteria between them and wildlife.
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Affiliation(s)
- Katerina Albrechtova
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
- * E-mail: (KA); (FHL)
| | - Ivo Papousek
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Helene De Nys
- Project Group “Epidemiology of Highly Pathogenic Microorganisms”, Robert Koch Institute, Berlin, Germany
- Department of Primatology, Max-Planck-Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Maude Pauly
- Department of Primatology, Max-Planck-Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Etile Anoh
- Research Center for Development -Alassane Ouattara University, University Teaching Hospital Bouaké, Bouaké, Côte d’Ivoire
| | - Arsene Mossoun
- LANADA, Laboratoire Nationale de la Pathologie Animale, Bingerville, Côte d’Ivoire
| | - Monika Dolejska
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
- CEITEC VFU, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Martina Masarikova
- CEITEC VFU, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
- Institute of Microbiology and Infectious Diseases, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Sonya Metzger
- Project Group “Epidemiology of Highly Pathogenic Microorganisms”, Robert Koch Institute, Berlin, Germany
- Department of Primatology, Max-Planck-Institute for Evolutionary Anthropology, Leipzig, Germany
| | | | - Chantal Akoua-Koffi
- Research Center for Development -Alassane Ouattara University, University Teaching Hospital Bouaké, Bouaké, Côte d’Ivoire
| | - Roman M. Wittig
- Department of Primatology, Max-Planck-Institute for Evolutionary Anthropology, Leipzig, Germany
- Centre Suisse de Recherches Scientifiques, Abidjan, Côte d’Ivoire
| | - Jiri Klimes
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Alois Cizek
- CEITEC VFU, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
- Institute of Microbiology and Infectious Diseases, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Fabian H. Leendertz
- Project Group “Epidemiology of Highly Pathogenic Microorganisms”, Robert Koch Institute, Berlin, Germany
- * E-mail: (KA); (FHL)
| | - Ivan Literak
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
- CEITEC VFU, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
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291
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Gwee PS, Khoo KS, Ong HC, Sit NW. Bioactivity-guided isolation and structural characterization of the antifungal compound, plumbagin, from Nepenthes gracilis. PHARMACEUTICAL BIOLOGY 2014; 52:1526-31. [PMID: 25026359 DOI: 10.3109/13880209.2014.902083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
CONTEXT Despite several phytochemical studies of Nepenthes gracilis Korth (Nepenthaceae), the biological activities of this pitcher plant remain to be explored. OBJECTIVE This study evaluates the antifungal activity of N. gracilis extracts, isolates, and characterizes its bioactive compound and evaluates the cytotoxicity of the isolated compound. MATERIALS AND METHODS Fresh leaves of N. gracilis were sequentially extracted. The fungistatic and fungicidal activities of the extracts were evaluated against six species of fungi of medical importance using a colorimetric broth microdilution method. The most active extract was fractionated by liquid-liquid partitioning and further purified by a preparative thin layer chromatography. Structural elucidation was carried out using FT-IR, GC-MS, and NMR. Cytotoxicity testing against rhesus monkey kidney epithelial cells (LLC-MK2) was assessed by a neutral red uptake (NRU) assay. RESULTS The hexane extract, which showed the lowest minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC), both at 20 μg/mL against Candida albicans, Issatchenkia orientalis, and Trichophyton mentagrophytes, was subjected to bioactivity-guided fractionation. The isolated compound exhibited potent activity with the MIC values ranging from 2 to 31 μg/mL against all the fungi. The active compound was identified as plumbagin (5-hydroxy-2-methyl-naphthalene-1,4-dione). The 50% cytotoxicity concentration (CC50) of plumbagin was 0.60 μg/mL. DISCUSSION AND CONCLUSION The selectivity indices of plumbagin against all the fungi were less than 1.0, indicating that plumbagin is more toxic to mammalian than fungal cells. This study provides information on the antifungal properties of N. gracilis leaf extracts, as well as the antifungal and cytotoxicity properties of plumbagin.
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292
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Profitós JMH, Mouhaman A, Lee S, Garabed R, Moritz M, Piperata B, Tien J, Bisesi M, Lee J. Muddying the waters: a new area of concern for drinking water contamination in Cameroon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12454-72. [PMID: 25464137 PMCID: PMC4276624 DOI: 10.3390/ijerph111212454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/05/2014] [Accepted: 11/14/2014] [Indexed: 11/28/2022]
Abstract
In urban Maroua, Cameroon, improved drinking water sources are available to a large majority of the population, yet this water is frequently distributed through informal distribution systems and stored in home containers (canaries), leaving it vulnerable to contamination. We assessed where contamination occurs within the distribution system, determined potential sources of environmental contamination, and investigated potential pathogens. Gastrointestinal health status (785 individuals) was collected via health surveys. Drinking water samples were collected from drinking water sources and canaries. Escherichia coli and total coliform levels were evaluated and molecular detection was performed to measure human-associated faecal marker, HF183; tetracycline-resistance gene, tetQ; Campylobacter spp.; and Staphylococcus aureus. Statistical analyses were performed to evaluate the relationship between microbial contamination and gastrointestinal illness. Canari samples had higher levels of contamination than source samples. HF183 and tetQ were detected in home and source samples. An inverse relationship was found between tetQ and E. coli. Presence of tetQ with lower E. coli levels increased the odds of reported diarrhoeal illness than E. coli levels alone. Further work is warranted to better assess the relationship between antimicrobial-resistant bacteria and other pathogens in micro-ecosystems within canaries and this relationship’s impact on drinking water quality.
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Affiliation(s)
| | - Arabi Mouhaman
- Department of Environmental Sciences, University of Maroua, Maroua BP 46, Far North Region, Cameroon.
| | - Seungjun Lee
- Department of Food Science and Technology, the Ohio State University, Columbus, OH 43210, USA.
| | - Rebecca Garabed
- Department of Veterinary Preventive Medicine, the Ohio State University, Columbus, OH 43210, USA.
| | - Mark Moritz
- Department of Anthropology, the Ohio State University, Columbus, OH 43210, USA.
| | - Barbara Piperata
- Department of Anthropology, the Ohio State University, Columbus, OH 43210, USA.
| | - Joe Tien
- Department of Mathematics, the Ohio State University, Columbus, OH 43210, USA.
| | - Michael Bisesi
- Division of Environmental Health Sciences, the Ohio State University, Columbus, OH 43210, USA.
| | - Jiyoung Lee
- Division of Environmental Health Sciences, the Ohio State University, Columbus, OH 43210, USA.
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Al-Badaii F, Shuhaimi-Othman M. Water Pollution and its Impact on the Prevalence of Antibiotic-Resistant E. coli and Total Coliform Bacteria: A Study of the Semenyih River, Peninsular Malaysia. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s12403-014-0151-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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294
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Kandeel A, El-Shoubary W, Hicks LA, Fattah MA, Dooling KL, Lohiniva AL, Ragab O, Galal R, Talaat M. Patient Attitudes and Beliefs and Provider Practices Regarding Antibiotic Use for Acute Respiratory Tract Infections in Minya, Egypt. Antibiotics (Basel) 2014; 3:632-44. [PMID: 27025759 PMCID: PMC4790377 DOI: 10.3390/antibiotics3040632] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/24/2014] [Accepted: 10/24/2014] [Indexed: 11/16/2022] Open
Abstract
The inappropriate use of antibiotics in the community is one of the major causes of antimicrobial resistance. This study aimed to explore the physician prescribing pattern of antibiotics for acute respiratory infections (ARIs) and to explore the knowledge, attitudes, and practices of patients regarding antibiotic use for ARIs. The study was conducted in Upper Egypt and used quantitative and qualitative research techniques. Eligible patients exiting outpatient clinics with ARIs were invited to participate in the study. A qualitative study was conducted through 20 focus group discussions. Out of 350 encounters for patients with various ARIs, 292 (83%) had been prescribed at least one antibiotic. Factors significantly associated with antibiotic prescribing for adults included patient preference that an antibiotic be prescribed. For children younger than 18, presentation with fever, cough, loss of appetite, and sore throat, along with the caregiver’s antibiotic preference, were associated with an antibiotic prescription. Several misconceptions regarding antibiotic use among community members were stated, such as the strong belief of the curing and prophylactic power of antibiotics for the common cold. Interventions to promote proper antibiotic use for ARIs need to be piloted, targeting both physicians and the public. Educational programs for physicians and campaigns to raise public awareness regarding proper antibiotic use for ARIs need to be developed.
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Affiliation(s)
- Amr Kandeel
- Ministry of Health and Population, Cairo 11516, Egypt.
| | | | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | - Omnia Ragab
- Ministry of Health and Population, Cairo 11516, Egypt.
| | - Ramy Galal
- Ministry of Health and Population, Cairo 11516, Egypt.
| | - Maha Talaat
- Naval Medical Research Unit, No.3, Cairo 11517, Egypt.
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295
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Kouegnigan Rerambiah L, Ndong JC, Mbakob Mengue Massoua P, Medzegue S, Elisee-Ndam M, Mintsa-Ndong A, Djoba Siawaya JF. Antimicrobial profiles of bacterial clinical isolates from the Gabonese National Laboratory of Public Health: data from routine activity. Int J Infect Dis 2014; 29:48-53. [PMID: 25449235 DOI: 10.1016/j.ijid.2014.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 01/07/2014] [Accepted: 01/13/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The present study is one of the first to provide a picture of antimicrobial resistance for a range of bacteria and antimicrobial classes in Gabon, Central Africa. METHODS During the year 2010, 146 urine cytology, 143 blood cultures, 107 vaginal swabs, 23 urethral swabs, and 18 other culture examinations were positives. All isolates were tested for antibiotic sensitivity. RESULTS Four hundred thirty-seven microorganisms were isolated: 210 enterobacteria, 166 staphylococci, 38 streptococci, 14 Acinetobacter, and nine Stenotrophomonas. Of the Klebsiella isolates, 18% and 30% were found to be resistant to selected third-generation cephalosporins (3CG) and fourth-generation cephalosporins (4CG), respectively. Sixty-seven percent of Escherichia coli isolates were resistant to amoxicillin with clavulanic acid. Between 3% and 30% of E. coli isolates were resistant to selected 3CG. All Enterobacter cloacae isolates were sensitive to imipenem. Resistance to quinolones/fluoroquinolones was seen in 21-50% of E. coli isolates. Twenty-six percent of E. cloacae showed resistance to ceftazidime and 37% to cefotaxime. The resistance rate to quinolones ranged between 58% and 78%. Thirty-two percent of Staphylococcus isolates were resistant to gentamicin. Low resistance rates to teicoplanin (2-4%) were observed. Thirty-seven percent of isolated Staphylococcus aureus and 61% of isolated Staphylococcus saprophyticus were resistant to both penicillin G and oxacillin. Streptococcus isolates had low resistance rates to erythromycin, ceftriaxone, and ciprofloxacin (5%, 7%, and 14%, respectively) and were highly resistant to tetracycline, gentamicin, and sulfamethoxazole-trimethoprim (92%, 91%, and 62%, respectively). CONCLUSIONS The antimicrobial resistance profiles seen here are of concern. To control the spread of drug-resistant bacteria, clinicians should be cognizant of their local antimicrobial resistance patterns.
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Affiliation(s)
- Léonard Kouegnigan Rerambiah
- Unité des Recherche et de Diagnostic Spécialisé, Laboratoire National de Santé Publique, Avenue felix Eboué, Libreville, BP 10736, Gabon
| | - Jean-Charles Ndong
- Unité des Recherche et de Diagnostic Spécialisé, Laboratoire National de Santé Publique, Avenue felix Eboué, Libreville, BP 10736, Gabon; Service de Bactériologie, Laboratoire National de Santé Publique, Libreville, Gabon
| | - Pauline Mbakob Mengue Massoua
- Unité des Recherche et de Diagnostic Spécialisé, Laboratoire National de Santé Publique, Avenue felix Eboué, Libreville, BP 10736, Gabon
| | - Severin Medzegue
- Service de Bactériologie, Laboratoire National de Santé Publique, Libreville, Gabon
| | - Médard Elisee-Ndam
- Service de Bactériologie, Laboratoire National de Santé Publique, Libreville, Gabon
| | - Armel Mintsa-Ndong
- Unité des Recherche et de Diagnostic Spécialisé, Laboratoire National de Santé Publique, Avenue felix Eboué, Libreville, BP 10736, Gabon
| | - Joel Fleury Djoba Siawaya
- Unité des Recherche et de Diagnostic Spécialisé, Laboratoire National de Santé Publique, Avenue felix Eboué, Libreville, BP 10736, Gabon.
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Gowraiah V, Awasthi S, Kapoor R, Sahana D, Venkatesh P, Gangadhar B, Awasthi A, Verma A, Pai N, Seear M. Can we distinguish pneumonia from wheezy diseases in tachypnoeic children under low-resource conditions? A prospective observational study in four Indian hospitals. Arch Dis Child 2014; 99:899-906. [PMID: 24925892 DOI: 10.1136/archdischild-2013-305740] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute respiratory infections are the commonest cause of mortality and morbidity in children worldwide. A quarter of all deaths occur in India alone. In order to reduce this disease burden, there is a need for better diagnostic criteria, particularly ones allowing early detection of high-risk children. METHODS We enrolled 516 under 5 year olds, in four Indian hospitals, who met WHO age-dependent tachypnoea criteria for pneumonia at presentation. Patients underwent a protocolised examination assessing 29 items, including history, examination, O2 saturation, plus scores for chest X-ray, auscultation and conscious level. Treatment was determined by the emergency room (ER) physician. All children were reviewed at day 4 by a paediatrician and placed into four diagnostic categories: pneumonia, wheezy disease, mixed and non-respiratory. RESULTS The majority had wheezy diseases (42.8%). The remainder had pneumonia (35.9%), mixed disease (18.6%) and non-respiratory (2.7%). Best diagnostic predictors for wheezy disease were (auscultation/previous similar episodes) and for pneumonia (auscultation/CXR score). Mortality was 1.6%. Best disease severity predictors were conscious level, weight/age z score and respiratory/pulse rates. INTERPRETATION Current tachypnoea-based algorithms significantly overdiagnose pneumonia in children and underdiagnose wheezy diseases. Diagnostic accuracy can be improved by various combinations of clinical variables, but the best single diagnostic predictor is auscultation. Simple criteria can also be defined that reliably detect which tachypnoeic children are at high risk of death or deterioration. Management plans based on these protocols could reduce unnecessary antibiotic use, improve the management of wheezy diseases and reduce mortality by earlier identification of high-risk children.
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Affiliation(s)
- Vishwanath Gowraiah
- Divisions of Respiratory Medicine, BC's Children's Hospital, Vancouver, Canada
| | - Shally Awasthi
- Department of Paediatrics, King George Medical University, Lucknow, India
| | - Rashmi Kapoor
- Department of Pediatrics, Regency Hospital, Kanpur, India
| | - Devdas Sahana
- Department of Paediatrics, Vanivilas Hospital, Bangalore Medical College & Research Centre, Bangalore, India
| | - Pushpalatha Venkatesh
- Department of Paediatrics, Bowring and Lady Curzon Hospital, Bangalore Medical College & Research Centre, Bangalore, India
| | - Belvadi Gangadhar
- Department of Paediatrics, Vanivilas Hospital, Bangalore Medical College & Research Centre, Bangalore, India
| | | | - Anilkumar Verma
- Department of Paediatrics, King George Medical University, Lucknow, India
| | - Nanditha Pai
- Department of Paediatrics, Vanivilas Hospital, Bangalore Medical College & Research Centre, Bangalore, India
| | - Michael Seear
- Divisions of Respiratory Medicine, BC's Children's Hospital, Vancouver, Canada
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Srivastava J, Chandra H, Nautiyal AR, Kalra SJS. Antimicrobial resistance (AMR) and plant-derived antimicrobials (PDA ms) as an alternative drug line to control infections. 3 Biotech 2014; 4:451-460. [PMID: 28324380 PMCID: PMC4162903 DOI: 10.1007/s13205-013-0180-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/07/2013] [Indexed: 12/26/2022] Open
Abstract
Infectious diseases caused by antimicrobial-resistant microbes (ARMs) and the treatment are the serious problems in the field of medical science today world over. The development of alternative drug line to treat such infectious diseases is urgently required. Researches on ARMs revealed the presence of membrane proteins responsible for effusing the antibiotics from the bacterial cells. Such proteins have successfully been treated by plant-derived antimicrobials (PDAms) synergistically along with the commercially available antibiotics. Such synergistic action usually inhibits the efflux pump. The enhanced activity of plant-derived antimicrobials is being researched and is considered as the future treatment strategy to cure the incurable infections. The present paper reviews the advancement made in the researches on antimicrobial resistance along with the discovery and the development of more active PDAms.
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Affiliation(s)
- Jatin Srivastava
- Department of Applied Sciences, Faculty of Environmental Science, Himalayan Institute of Technology and Management, BKT, NH 24, Lucknow, 227005, UP, India.
| | - Harish Chandra
- Department of Medicinal and Aromatic Plants, School of Agriculture and Allied Sciences, High Altitude Plant Physiology Research Center, H.N.B. Garhwal University, Srinagar, Uttrakhand, India
| | - Anant R Nautiyal
- Department of Medicinal and Aromatic Plants, School of Agriculture and Allied Sciences, High Altitude Plant Physiology Research Center, H.N.B. Garhwal University, Srinagar, Uttrakhand, India
| | - Swinder J S Kalra
- Department of Chemistry, Dayanand Anglo Vedic College, Civil Lines, Kanpur, UP, India
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298
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Manenzhe RI, Zar HJ, Nicol MP, Kaba M. The spread of carbapenemase-producing bacteria in Africa: a systematic review. J Antimicrob Chemother 2014; 70:23-40. [PMID: 25261423 DOI: 10.1093/jac/dku356] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Carbapenems are the last line of defence against ever more prevalent MDR Gram-negative bacteria, but their efficacy is threatened worldwide by bacteria that produce carbapenemase enzymes. The epidemiology of bacteria producing carbapenemases has been described in considerable detail in Europe, North America and Asia; however, little is known about their spread and clinical relevance in Africa. METHODS We systematically searched in PubMed, EBSCOhost, Web of Science, Scopus, Elsevier Masson Consulte and African Journals Online, international conference proceedings, published theses and dissertations for studies reporting on carbapenemase-producing bacteria in Africa. We included articles published in English or French up to 28 February 2014. We calculated the prevalence of carbapenemase producers only including studies where the total number of isolates tested was at least 30. RESULTS Eighty-three studies were included and analysed. Most studies were conducted in North Africa (74%, 61/83), followed by Southern Africa (12%, 10/83), especially South Africa (90%, 9/10), West Africa (8%, 7/83) and East Africa (6%, 6/83). Carbapenemase-producing bacteria were isolated from humans, the hospital environment and community environmental water samples, but not from animals. The prevalence of carbapenemase-producing isolates in hospital settings ranged from 2.3% to 67.7% in North Africa and from 9% to 60% in sub-Saharan Africa. CONCLUSIONS Carbapenemase-producing bacteria have been described in many African countries; however, their prevalence is poorly defined and has not been systematically studied. Antibiotic stewardship and surveillance systems, including molecular detection and genotyping of resistant isolates, should be implemented to monitor and reduce the spread of carbapenemase-producing bacteria.
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Affiliation(s)
- Rendani I Manenzhe
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Mark P Nicol
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Mamadou Kaba
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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299
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Bebell LM, Muiru AN. Antibiotic use and emerging resistance: how can resource-limited countries turn the tide? Glob Heart 2014; 9:347-58. [PMID: 25667187 PMCID: PMC4369554 DOI: 10.1016/j.gheart.2014.08.009] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/14/2014] [Accepted: 08/22/2014] [Indexed: 12/20/2022] Open
Abstract
Antibiotic resistance is a global crisis driven by appropriate and inappropriate antibiotic use to treat human illness and promote animal growth. The antimicrobial resistance epidemic continues to spread due to the triple threat of unfettered access, minimal product regulation and oversight of antibiotic prescription, and lack of clinical diagnostic tools to support antibiotic de-escalation in low-resource settings. In high-resource settings, evidence-based strategies have improved the appropriateness of antibiotic use, limiting the spread of drug-resistant organisms and reducing hospital-associated infections, strategies which may also be effective to stop the spread of resistance in resource-poor countries. Current research and surveillance efforts on antimicrobial resistance and hospital-associated infections in low-resource settings are extremely limited and largely focused on intensive care units. Many challenges exist to improving antibiotic use and infection control in resource-limited settings, and turning the tide requires intensifying research and surveillance, antimicrobial stewardship, and developing new bedside diagnostic tools for bacterial infections and antimicrobial susceptibility.
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Affiliation(s)
- Lisa M Bebell
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Center for Global Health, Boston, MA, USA.
| | - Anthony N Muiru
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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300
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Biswas M, Roy MN, Manik MIN, Hossain MS, Tapu SMTA, Moniruzzaman M, Sultana S. Self medicated antibiotics in Bangladesh: a cross-sectional health survey conducted in the Rajshahi City. BMC Public Health 2014; 14:847. [PMID: 25124712 PMCID: PMC4150958 DOI: 10.1186/1471-2458-14-847] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Antibiotic self medication is highly prevalent in the developing countries due to easy availability and poor regulatory controls for selling these drugs. The purpose of this study was to evaluate the prevalence of self-medication with antibiotics for the treatment of various diseases by the peoples of Rajshahi city in Bangladesh. METHODS A cross-sectional survey was conducted to the patient's (n = 1300) at eight locations of Rajshahi city in Bangladesh from March to April, 2014. The locations were selected by convenience and the study population within each study area was randomly selected. The survey was self-administered and included questions pertaining to self medicated drugs and antibiotic usage patterns as well. Data were analyzed using descriptive statistics. RESULTS It was found that 347 (26.69%) out of 1300 participants experienced self medication with antibiotics. Over fifty percent of the patients studied were between the ages of 21-30 years with 83.57% of them being males and 16.43% females. The highest percentage of self medicated antibiotics was metronidazole (50.43%) followed by azithromycin (20.75%), ciprofloxacin (11.53%), amoxicillin (10.37%) and tetracycline (7.49%) respectively. The key reasons for the self medication of antibiotics was the pre-experience (45.82%), suggestions from others (28.24%) and knowledgeable of the antibiotics (16.14%). The perceived symptoms to purchase the antibiotics independently was dysentery, diarrhea and food poisoning (36.02%), cold, cough and fever (28.24%), infection (12.97%), dental carries and toothache (9.22%), irritable bowel syndrome (3.46%), acne (4.32%), ear and throat pain (2.31%). The duration of maximum antibiotics usage was ranges between 0-10 years. Only 4.32% patient's used self medicated antibiotics longer than 10 years. The patient's compliance for self medication of antibiotics varies from excellent to no comments whereas only 6.92% patients reported side effects for the self medication of antibiotics. CONCLUSIONS The results of this study confirm that antibiotic self-medication is a relatively frequent problem in Bangladesh. Drug Administration of Bangladesh should implement the regulatory controls immediately on the distribution and selling of antibiotics in order to reduce the frequency of antibiotic misuse.
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Affiliation(s)
- Mohitosh Biswas
- Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh
| | | | | | - Md Shahid Hossain
- Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh
| | | | - Md Moniruzzaman
- Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh
| | - Sharmin Sultana
- Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh
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