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Patel PK, Mehrotra P, Ladines-Lim JB. An opportunity for global antimicrobial stewardship research: Refugee populations. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e23. [PMID: 36310775 PMCID: PMC9614941 DOI: 10.1017/ash.2022.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 01/03/2023]
Abstract
Antimicrobial resistance is a well-known global health threat that has higher prevalence in the refugee population. Although guidance has been provided by the World Health Organization and Centers for Disease Control and Prevention on implementing antimicrobial stewardship in lower- and middle-income countries, as well as by the United Nations Refugee Agency on other infection prevention and control efforts, no specific guidance exists for implementation of stewardship in this population. We highlight challenges specific to this population, review recent studies of interest within this space, and propose a research agenda to help move stewardship forward in the refugee population. We advocate for the importance of this issue, particularly given recent current events of geopolitical volatility that render this population more vulnerable, in the setting of its already well-known numerous health challenges.
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Affiliation(s)
- Payal K. Patel
- Division of Infectious Diseases, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Preeti Mehrotra
- Silverman Institute for Health Care Quality and Safety, Boston, Massachusetts
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joseph B. Ladines-Lim
- Departments of Internal Medicine and Pediatrics, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
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Randell EW, Thakur V. Leading POCT Networks: Operating POCT Programs Across Multiple Sites Involving Vast Geographical Areas and Rural Communities. EJIFCC 2021; 32:179-189. [PMID: 34421486 PMCID: PMC8343053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Few peer-reviewed publications provide laboratory leaders with useful strategies on which to develop and implement point of care testing (POCT) programs to support delivery of acute care services to remote rural communities, with or without trained laboratory staff on site. This mini review discusses common challenges faced by laboratory leaders poised to implement and operate POCT programs at multiple remote and rural sites. It identifies areas for consideration during the initial program planning phases and provides areas for focus during evaluation and for continued improvement of POCT services at remote locations. Finally, it discusses a potential oversight framework for governance and leadership of multisite POCT programs servicing remote and rural communities.
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Affiliation(s)
- Edward W. Randell
- Laboratory Medicine, Eastern Health Authority, St. John’s, Newfoundland and Labrador, Canada, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada,Corresponding author: Prof. Edward W. Randell Lab. Medicine, Eastern Health Authority & Faculty of Medicine, Memorial University Rm 1J442 Laboratory Medicine Eastern Health St. John’s, NL Canada Phone: 709-777-6375 Fax: 709-777-2442 E-mail:
| | - Vinita Thakur
- Laboratory Medicine, Eastern Health Authority, St. John’s, Newfoundland and Labrador, Canada, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
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Wong HY, Marcu LG, Bezak E, Parange NA. Review of Health Economics of Point-of-Care Testing Worldwide and Its Efficacy of Implementation in the Primary Health Care Setting in Remote Australia. Risk Manag Healthc Policy 2020; 13:379-386. [PMID: 32440241 PMCID: PMC7212773 DOI: 10.2147/rmhp.s247774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
There are important differences concerning health outcomes between the Australian population living in rural/remote regions and the urban population. Health care provision in remote areas, particularly in regions with a low number of inhabitants, is not without challenges. Aboriginal, rural and remote communities are therefore affected, as they face various obstacles in accessing health services, owing to geographical settings, difficulties in transportation to nearby hospitals, limited or inexistent local qualified personnel. The implementation of point-of-care testing could be a plausible solution to these challenges, as various point-of-care services that have been successfully put into action worldwide indicate towards positive clinical outcomes. Point-of-care units have a real potential in reducing morbidity and mortality in all population groups. This article aims to review the published literature on point-of-care testing around the world, with a focus on health economics and the feasibility of its implementation in Australian rural and remote regions.
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Affiliation(s)
- Hoi Yan Wong
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Loredana G Marcu
- Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Eva Bezak
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.,Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia
| | - Nayana Anupam Parange
- Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.,Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
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Malchione MD, Torres LM, Hartley DM, Koch M, Goodman JL. Carbapenem and colistin resistance in Enterobacteriaceae in Southeast Asia: Review and mapping of emerging and overlapping challenges. Int J Antimicrob Agents 2019; 54:381-399. [DOI: 10.1016/j.ijantimicag.2019.07.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 01/21/2023]
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Beyer AK, Currea GCC, Holm A. Validity of microscopy for diagnosing urinary tract infection in general practice - a systematic review. Scand J Prim Health Care 2019; 37:373-379. [PMID: 31304845 PMCID: PMC6713105 DOI: 10.1080/02813432.2019.1639935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To investigate the validity of microscopy as a diagnostic tool for urinary tract infection in general practice. Methods: (Design/setting) A systematic review was conducted by searching Medline for clinical studies made in general practice, outpatient clinics or similar settings in which the accuracy/validity of microscopy was evaluated with urine culture as the reference standard. Results: Our search resulted in 108 titles. 28 potentially eligible studies were retrieved for full-text reading. We included eight studies involving 4582 patients in this review. The quality of the studies was moderate to high. Specificity ranged from 27% to 100%, sensitivity from 47% to 97%. The variation between studies did not allow for meta-analysis. Conclusion: We did not find substantial evidence to determine the clinical validity of microscopy performed in general practice on urine samples from patients with symptoms of UTI. Key points Urinary tract infection is common in general practice. Methods for precise diagnosis are needed in order to avoid inappropriate treatment. Currently no evidence-based consensus exists regarding the use of urinary microscopy in general practice. We did not find substantial evidence to determine the overall clinical validity of microscopy performed in general practice on urine samples from patients with symptoms of UTI. Light microscopy with oil immersion had high sensitivity and specificity but is time-consuming. Phase-contrast microscopy is quick and had high specificity but lower sensitivity.
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Affiliation(s)
- Anja Kofod Beyer
- Research Unit for General practice and Department of General Practice, University of Copenhagen, København, Denmark
- CONTACT Anja Kofod Beyer Bachelor of medicine, Copenhagen University, Nørregade 10, 1165 København, Denmark
| | | | - Anne Holm
- Research Unit for General practice and Department of General Practice, University of Copenhagen, København, Denmark
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Ginting F, Sugianli AK, Kusumawati RL, Parwati I, de Jong MD, Schultsz C, van Leth F. Predictive value of the urinary dipstick test in the management of patients with urinary tract infection-associated symptoms in primary care in Indonesia: a cross-sectional study. BMJ Open 2018; 8:e023051. [PMID: 30158234 PMCID: PMC6119407 DOI: 10.1136/bmjopen-2018-023051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/16/2018] [Accepted: 07/10/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the test characteristics of a urine dipstick test in predicting a positive urine culture in an outpatient setting in Indonesia. DESIGN Cross-sectional study. SETTING Two outpatient clinics in Medan, Indonesia. PARTICIPANTS 616 consecutively enrolled participants suspected of having a urinary tract infection. OUTCOME MEASURES The primary outcome is the estimates of accuracy (sensitivity, specificity, predictive values) where urine culture is the reference test. The secondary outcome is the post-test probability of a positive urine culture. RESULTS The optimal test characteristics were obtained when index test positivity was defined as any leucocyte esterase reaction and/or a nitrite reaction and reference test positivity was defined as a urine culture with a growth of at least 103 colony-forming units/mL (sensitivity: 88.2% (95% CI 81.6 to 93.1), negative predictive value: 93.0% (95% CI 88.9 to 95.9)). The post-test probability of a positive urine culture after a negative urinary dipstick test was 7% in the obstetric/gynaecology clinic and 8% in the internal medicine clinic. CONCLUSION The use of a urine dipstick test in a rule-out strategy can reduce the need for urine culture and avoid the prescription of (ineffective) antibiotics in a non-urology outpatient setting.
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Affiliation(s)
- Franciscus Ginting
- Department of Internal Medicine, Faculty of Medicine, University of Sumatera Utara, H Adam Malik Hospital, Medan, Indonesia
| | - Adhi Kristianto Sugianli
- Department of Clinical Pathology, Faculty of Medicine Universitas Padjadjaran, Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R Lia Kusumawati
- Department of Microbiology, Faculty of Medicine, University of Sumatera Utara, H Adam Malik Hospital, Medan, Indonesia
| | - Ida Parwati
- Department of Clinical Pathology, Faculty of Medicine Universitas Padjadjaran, Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Menno D de Jong
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Constance Schultsz
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Zellweger RM, Carrique-Mas J, Limmathurotsakul D, Day NPJ, Thwaites GE, Baker S. A current perspective on antimicrobial resistance in Southeast Asia. J Antimicrob Chemother 2017; 72:2963-2972. [PMID: 28961709 PMCID: PMC5890732 DOI: 10.1093/jac/dkx260] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Southeast Asia, a vibrant region that has recently undergone unprecedented economic development, is regarded as a global hotspot for the emergence and spread of antimicrobial resistance (AMR). Understanding AMR in Southeast Asia is crucial for assessing how to control AMR on an international scale. Here we (i) describe the current AMR situation in Southeast Asia, (ii) explore the mechanisms that make Southeast Asia a focal region for the emergence of AMR, and (iii) propose ways in which Southeast Asia could contribute to a global solution.
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Affiliation(s)
- Raphaël M Zellweger
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Juan Carrique-Mas
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas P. J Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Guy E Thwaites
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
- The London School of Hygiene and Tropical Medicine, London, UK
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