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Martin LB, Tack B, Marchello CS, Sikorski MJ, Owusu-Dabo E, Nyirenda T, Mogasale V, Crump JA. Vaccine value profile for invasive non-typhoidal Salmonella disease. Vaccine 2024; 42:S101-S124. [PMID: 39003017 DOI: 10.1016/j.vaccine.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 07/15/2024]
Abstract
Invasive non-typhoidal Salmonella (iNTS) disease is an under-recognized high-burden disease causing major health and socioeconomic issues in sub-Saharan Africa (sSA), predominantly among immune-naïve infants and young children, including those with recognized comorbidities such as HIV infection. iNTS disease is primarily caused by Salmonella enterica serovar Typhimurium sequence type (ST) 313 and 'African-restricted clades' of Salmonella Enteritidis ST11 that have emerged across the African continent as a series of epidemics associated with acquisition of new antimicrobial resistance. Due to genotypes with a high prevalence of antimicrobial resistance and scarcity of therapeutic options, these NTS serovars are designated by the World Health Organization as a priority pathogen for research and development of interventions, including vaccines, to address and reduce NTS associated bacteremia and meningitis in sSA. Novel and traditional vaccine technologies are being applied to develop vaccines against iNTS disease, and the results of the first clinical trials in the infant target population should become available in the near future. The "Vaccine Value Profile" (VVP) addresses information related predominantly to invasive disease caused by Salmonella Enteritidis and Salmonella Typhimurium prevalent in sSA. Information is included on stand-alone iNTS disease candidate vaccines and candidate vaccines targeting iNTS disease combined with another invasive serotype, Salmonella Typhi, that is also common across sSA. Out of scope for the first version of this VVP is a wider discussion on either diarrheagenic NTS disease (dNTS) also associated with Salmonella Enteritidis and Salmonella Typhimurium or the development of a multivalent Salmonella vaccines targeting key serovars for use globally. This VVP for vaccines to prevent iNTS disease is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic, and societal value of pipeline vaccines and vaccine-like products. Future versions of this VVP will be updated to reflect ongoing activities such as vaccine development strategies and a "Full Vaccine Value Assessment" that will inform the value proposition of an iNTS disease vaccine. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships, and multi-lateral organizations, and in collaboration with stakeholders from the World Health Organization African Region. All contributors have extensive expertise on various elements of the iNTS disease VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
| | - Bieke Tack
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Belgium and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium.
| | | | - Michael J Sikorski
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | | | | | - John A Crump
- Centre for International Health, University of Otago, New Zealand.
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Robbins SN, Goggs R, Kraus‐Malett S, Goodman L. Effect of institutional antimicrobial stewardship guidelines on prescription of critically important antimicrobials for dogs and cats. J Vet Intern Med 2024; 38:1706-1717. [PMID: 38465850 PMCID: PMC11099728 DOI: 10.1111/jvim.17043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Veterinary hospital antimicrobial stewardship (AMS) guidelines might help combat antimicrobial resistance (AMR). OBJECTIVES Determine the conditions and types of infection for which antimicrobial drugs (AMDs) deemed critically important (CIA) by the World Health Organization (WHO) were prescribed and assess the effect of hospital AMS guidelines on adherence to International Society for Companion Animal Infectious Diseases published guidelines for the treatment of superficial bacterial folliculitis, respiratory tract disease and urinary tract infection in these cases. ANIMALS Dogs and cats managed at an academic veterinary hospital from 1/21 to 6/21 and 9/21 to 6/22. METHODS Prescriptions of cephalosporins (third or fourth generation), glycopeptides, macrolides/ketolides, polymyxins, and quinolones were identified. Data on culture and susceptibility (C/S) testing and previous AMD exposure were collected. Frequencies were compared between time periods using Fisher's exact test with Bonferroni corrections. RESULTS In animals prescribed ≥1 WHO-CIA AMD, fluoroquinolones were the most frequently prescribed WHO-CIA class in dogs (567/1724, 32.9%) and cats (192/450, 42.7%). No animals were prescribed carbapenems, dihydrofolate reductase inhibitors/sulfonamides, or polymyxins. No cats were prescribed aminoglycosides or amphenicols. Institutional guidelines were followed in 57.8% (324/561) cases. The most frequent causes of nonadherence were failure to perform C/S testing 46.0% (109/237) and unnecessary use of a higher-tier AMD 43.0% (102/237). Bacterial C/S testing was more frequently performed after AMS guideline institution (59.7% vs. 46.8%, P = 0.0006). CONCLUSIONS AND CLINICAL IMPORTANCE Adherence to published guidelines remained poor despite an increase in C/S testing. There were no changes in the frequencies of confirmed infections, positive cultures or AMD resistance between time periods.
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Affiliation(s)
- Sarah N. Robbins
- College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Robert Goggs
- College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | | | - Laura Goodman
- College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
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Koudokpon H, Legba BB, Dougnon V, Mero S, Bankole H, Haukka K. Strengthening clinical bacteriology laboratory diagnostics to combat sepsis and antimicrobial resistance in Benin: a train-the-trainer approach. Front Med (Lausanne) 2024; 11:1281418. [PMID: 38707185 PMCID: PMC11066218 DOI: 10.3389/fmed.2024.1281418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Improved laboratory diagnostics is needed to support sepsis diagnosis and combat increasing antibiotic resistance in Benin. We trained clinical laboratory experts and technicians to improve their skills in accurate and up-to-date diagnostics. Methods A Train-the-Trainer (TtT) approach was used to design the course that combines theoretical and practical laboratory skills, specifically addressing the knowledge gaps we had previously identified in our national survey. Pedagogical methods were student-centered, including peer learning, use of online materials, practical laboratory work and pre-and post-course tests. Results We first trained 10 trainers who in turn trained 40 laboratory technicians from across the country, from both public and private clinical and veterinary laboratories. The trainers also prepared standard operation procedures for blood culture and antibiotic susceptibility testing based on international standards. Three months after the training, follow-up visits were made to the laboratories where the implementation of the new skills was evaluated. The progress of the participants observed during the course and the implementation of the new skills afterwards proved the training to be effective. Discussion The professional networks created during the training, the empowerment that utilizes local knowledge resources, and the government support for our initiative can be expected to bring sustainability to the initiative and support the participation of Beninese laboratories in international surveillance programs in the future.
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Affiliation(s)
- Hornel Koudokpon
- Research Unit in Applied Microbiology and Pharmacology of natural substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Brice Boris Legba
- Research Unit in Applied Microbiology and Pharmacology of natural substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Victorien Dougnon
- Research Unit in Applied Microbiology and Pharmacology of natural substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Sointu Mero
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Physicians for Social Responsibility, Helsinki, Finland
| | - Honoré Bankole
- Research Unit in Applied Microbiology and Pharmacology of natural substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Kaisa Haukka
- Physicians for Social Responsibility, Helsinki, Finland
- Department of Microbiology, University of Helsinki, Helsinki, Finland
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Kang Y, Wang J, Li Z. Meta-analysis addressing the characterization of antibiotic resistome in global hospital wastewater. JOURNAL OF HAZARDOUS MATERIALS 2024; 466:133577. [PMID: 38281357 DOI: 10.1016/j.jhazmat.2024.133577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/07/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Abstract
Hospital wastewater (HWW) is a significant environmental reservoir of antibiotic resistance genes (ARGs). However, currently, no comprehensive understanding exists of the antibiotic resistome in global HWW. In this study, we attempted to address this knowledge gap through an in silico reanalysis of publicly accessible global HWW metagenomic data. We reanalyzed ARGs in 338 HWW samples from 13 countries in Africa, Asia, and Europe. In total, 2420 ARG subtypes belonging to 30 ARG types were detected, dominated by multidrug, beta-lactam, and aminoglycoside resistance genes. ARG composition in Europe differed from that in Asia and Africa. Notably, the ARGs presented co-occurrence with mobile genetic elements (MGEs), metal resistance genes (MRGs), and human bacterial pathogens (HBP), indicating a potential dissemination risk of ARGs in the HWW. Multidrug resistance genes presented co-occurrence with MGEs, MRGs, and HBP, is particularly pronounced. The abundance of contigs that contained ARG, contigs that contained ARG and HBP, contigs that contained ARG and MGE, contigs that contained ARG and MRG were used for health and transmission risk assessment of antibiotic resistome and screened out 40 high risk ARGs in the global HWW. This study first provides a comprehensive characterization and risk of the antibiotic resistome in global HWW.
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Affiliation(s)
- Yutong Kang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102200, China
| | - Jie Wang
- Beijing Key Laboratory of Farmland Soil Pollution Prevention and Remediation, College of Resources and Environmental Sciences, China Agricultural University, Beijing 100193, China
| | - Zhenjun Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102200, China.
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5
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Otaigbe II. Policy entrepreneurs are integral in efforts to curb antimicrobial resistance in low and middle income countries. Front Public Health 2024; 12:1292660. [PMID: 38532974 PMCID: PMC10963478 DOI: 10.3389/fpubh.2024.1292660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Idemudia Imonikhe Otaigbe
- Department of Medical Microbiology, School of Basic Clinical Sciences, Benjamin Carson (Snr) College of Health and Medical Sciences, Babcock University/Babcock University Teaching Hospital, Ilishan Remo, Ogun State, Nigeria
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Foxlee ND, Taleo SA, Mathias A, Townell N, McIver L, Lau CL. The Impact of COVID-19 on Knowledge, Beliefs, and Practices of Ni-Vanuatu Health Workers Regarding Antibiotic Prescribing and Antibiotic Resistance, 2018 and 2022: A Mixed Methods Study. Trop Med Infect Dis 2023; 8:477. [PMID: 37888605 PMCID: PMC10611053 DOI: 10.3390/tropicalmed8100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Antimicrobial resistance (AMR) is included in the ten most urgent global public health threats. Global evidence suggests that antibiotics were over prescribed during the early waves of the COVID-19 pandemic, particularly in low- and middle-income countries. Inappropriate use of antibiotics drives the emergence and spread of antibiotic resistance. This study aimed to examine the impact of COVID-19 on Ni-Vanuatu health worker knowledge, beliefs, and practices (KBP) regarding antibiotic prescribing and awareness of antibacterial AMR. A mixed methods study was conducted using questionnaires and in-depth interviews in 2018 and 2022. A total of 49 respondents completed both baseline (2018) and follow-up (2022) questionnaires. Knowledge scores about prescribing improved between surveys, although health workers were less confident about some prescribing activities. Respondents identified barriers to optimal hand hygiene performance. More than three-quarters of respondents reported that COVID-19 influenced their prescribing practice and heightened their awareness of ABR: "more careful", "more aware", "stricter", and "need more community awareness". Recommendations include providing ongoing continuing professional development to improve knowledge, enhance skills, and maintain prescribing competency; formalising antibiotic stewardship and infection, prevention, and control (IPC) programmes to optimise prescribing and IPC practices; and raising community awareness about ABR to support more effective use of medications.
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Affiliation(s)
- Nicola D. Foxlee
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 2600, Australia
| | - Siti Aishah Taleo
- Dispensary, Vila Central Hospital, Ministry of Health, Private Mail Bag, Port Vila 9009, Vanuatu
| | - Agnes Mathias
- Curative Services, Ministry of Health, Private Mail Bag, Port Vila 9009, Vanuatu
| | - Nicola Townell
- Pacific Region Infectious Diseases Association, Kenmore Hills, QLD 4069, Australia
| | | | - Colleen L. Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia;
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Boakye-Yiadom E, Najjemba R, Thekkur P, Labi AK, Gil-Cuesta J, Asafo-Adjei K, Mensah P, van Boetzelaer E, Jessani NS, Orish VN. Use and Quality of Blood Cultures for the Diagnosis of Bloodstream Infections: A Cross-Sectional Study in the Ho Teaching Hospital, Ghana, 2019-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6631. [PMID: 37681771 PMCID: PMC10487590 DOI: 10.3390/ijerph20176631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/22/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Blood Culture and Drug Susceptibility Testing (CDST) remains vital for the diagnosis and management of bloodstream infections (BSIs). While the Ghana National Standard Treatment Guidelines require CDST to be performed in each case of suspected or clinically diagnosed BSI, these are poorly adhered to in the Ho Teaching Hospital (HTH). This study used secondary medical and laboratory records to describe blood CDST requests by clinicians and the quality of CDST processes for the diagnosis of BSI among patients admitted to HTH from 2019 to 2021. Of 4278 patients, 33% were infants. Pneumonia and neonatal sepsis cases were 40% and 22%, respectively. Only 8% (351/4278) had blood CDST requested. Of 94% (329/351) blood CDST processed and reported, only 7% (22/329) were culture-positive, with likely contaminants being recovered from 16% (52/329) of the specimens. The duration from admission to request was 2 days (IQR: 0-5), and Further qualitative studies must be conducted to understand the reasons for low blood CDST utilisation among clinicians and the patient outcomes. Targeted interventions are required to enhance the utilisation of blood CDST by clinicians and the quality of laboratory processes.
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Affiliation(s)
- Emily Boakye-Yiadom
- Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho PMB 31, Volta Region, Ghana;
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | | | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France;
| | - Appiah-Korang Labi
- Ghana Country Office, World Health Organization, 7 Ameda Street, Roman Ridge, Accra P.O. Box MB 142, Ghana;
| | - Julita Gil-Cuesta
- Luxembourg Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières, Rue Arbre Benit 46, 1050 Brussels, Belgium;
| | - Karikari Asafo-Adjei
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | - Prosper Mensah
- Laboratory Department, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana; (K.A.-A.); (P.M.)
| | - Elburg van Boetzelaer
- Luxembourg Operational Research Unit, Médecins Sans Frontières, 68 Rue de Gasperich, L-1617 Luxembourg, Luxembourg;
| | - Nasreen S. Jessani
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Tygerburg 7505, South Africa;
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Verner Ndudri Orish
- Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho PMB 31, Volta Region, Ghana;
- Sickle Cell Disease Unit, Department of Internal Medicine, Ho Teaching Hospital, Ho P.O. Box MA 374, Volta Region, Ghana
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Jung L, Kiwanuka J, Mbabazi L, Nakate V, Musaazi J, Nabajja H, Kajumbula H, Lübbert C, Mwaka E, Nsibirwa S, von Braun A. A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001880. [PMID: 37582103 PMCID: PMC10427013 DOI: 10.1371/journal.pgph.0001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
The global spread of antimicrobial resistance (AMR) poses an increasing challenge for clinicians in Uganda, where microbiological diagnostics are not routinely available or accessible. The aim of this study was to determine pathogen prevalence and antibiotic resistance patterns in patients with wound infections following trauma at a national referral hospital in Kampala, Uganda. In addition, the suitability of currently used empirical treatment options in this setting was evaluated. This prospective, observational study analysed antimicrobial prescriptions, culture results and antimicrobial sensitivity testing (AST) of wound swabs and blood samples from patients with clinical signs of wound infections on the trauma ward. A total of 124 patients (n = 99, 79.8% male) with a median age of 30 years (IQR 23-39) were enrolled between October 2021 and January 2022. Wound infections were classified as nosocomial in 69% of the cases. Pathogens were isolated from 122 wound swabs, yielding 238 bacterial isolates. The most prevalent pathogens were gram-negative bacteria including Escherichia coli (n = 48, 20.2%) and Acinetobacter spp. (n = 43, 18.1%). Empiric treatment consisted of ceftriaxone and gentamicin which was administered to 67.2% (n = 78) and 62.1% (n = 72) of patients, respectively. High rates of antimicrobial resistance could be demonstrated across gram-negative and gram-positive species towards the most common empiric antibiotics. Following the AST results, over 95% (n = 111) of patients required a change of treatment. Our findings demonstrate that current empiric treatment for wound infections is missing its target in hospitalized patients in Kampala. To address the growing problem of AMR in Uganda, there is a pressing need to enhance diagnostic capacity and implement structured antimicrobial stewardship programs.
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Affiliation(s)
- Laura Jung
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany
| | - James Kiwanuka
- Department of Orthopedics/Trauma, Mulago National Referral Hospital, Kampala, Uganda
| | - Leah Mbabazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vivian Nakate
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hawah Nabajja
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Kajumbula
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Christoph Lübbert
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany
| | - Erisa Mwaka
- Department of Orthopedics/Trauma, Mulago National Referral Hospital, Kampala, Uganda
| | - Sara Nsibirwa
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Amrei von Braun
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany
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Lompo P, Heroes AS, Agbobli E, Kazienga A, Peeters M, Tinto H, Lagrou K, Sangaré L, Affolabi D, Jacobs J. Growth of Gram-Negative Bacteria in Antiseptics, Disinfectants and Hand Hygiene Products in Two Tertiary Care Hospitals in West Africa-A Cross-Sectional Survey. Pathogens 2023; 12:917. [PMID: 37513763 PMCID: PMC10384974 DOI: 10.3390/pathogens12070917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Antiseptics, disinfectants, and hand hygiene products can act as reservoirs of Gram-negative bacteria causing healthcare-associated infections. This problem is rarely documented in low- and middle-income countries, particularly in sub-Saharan Africa. In a cross-sectional survey, we assessed the bacterial contamination of antiseptics, disinfectants, and hand hygiene products in two university hospitals in Burkina Faso and Benin. During ward visits and staff interviews, in-use products were cultured for the presence of Gram-negative bacteria. The growth of Gram-negative bacteria was absent or rare in alcohol-based products, povidone iodine, and Dakin solution. Contamination was highest (73.9% (51/69)) for liquid soap products (versus antiseptic/disinfectants (4.5%, 7/157) (p < 0.0001)), mostly used in high-risk areas and associated with high total bacterial counts (>10,000 colony-forming units/mL). Contaminating flora (105 isolates) included Enterobacterales and the Vibrio non-cholerae/Aeromonas group (17.1%) and non-fermentative Gram-negative rods (82.8%). Multidrug resistance was present among 9/16 Enterobacterales (Klebsiella and Enterobacter spp.) and 3/12 Acinetobacter spp., including carbapenem resistance (Acinetobacter baumannii: NDM, Pseudomonas stutzeri: VIM). The risk factors for contamination included the type of product (cleaning grade and in-house prepared liquid soap), use of recycled disposable containers and soft drink bottles, absence of labeling, topping-up of containers, dilution with tap water (pharmacy and ward), and poor-quality management (procurement, stock management, expiry dates, and period after opening).
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Affiliation(s)
- Palpouguini Lompo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Nanoro, Ouagadougou 11 BP 218, Burkina Faso
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22 Box 5401, 3000 Leuven, Belgium
| | - Anne-Sophie Heroes
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22 Box 5401, 3000 Leuven, Belgium
| | - Esenam Agbobli
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou 01 BP 386, Benin
| | - Adama Kazienga
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Nanoro, Ouagadougou 11 BP 218, Burkina Faso
| | - Marjan Peeters
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Nanoro, Ouagadougou 11 BP 218, Burkina Faso
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22 Box 5401, 3000 Leuven, Belgium
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou 03 BP 7022, Burkina Faso
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou 01 BP 386, Benin
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22 Box 5401, 3000 Leuven, Belgium
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Otaigbe II, Elikwu CJ. Drivers of inappropriate antibiotic use in low- and middle-income countries. JAC Antimicrob Resist 2023; 5:dlad062. [PMID: 37265987 PMCID: PMC10230568 DOI: 10.1093/jacamr/dlad062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Antimicrobial resistance (AMR) is a global security threat that accounts for about 700 000 deaths annually. Studies have shown that antimicrobial resistance could result in a 2% to 3.5% reduction in global Gross Domestic Product by 2050 and a loss of between 60 and 100 trillion US dollars, worth of economic output resulting in significant and widespread human suffering. Low- and middle-income countries (LMICs) will be worse hit by an unchecked rise of AMR. For example, it is predicted that AMR could kill about 4.1 million people in Africa by 2050 if it is not curbed. Similarly rising rates of AMR will lead to increased treatment costs and an inability to attain universal health coverage, in LMICs with fragile health systems. Sadly, AMR is driven by the inappropriate use of antimicrobials, especially antibiotics. Inappropriate antibiotic use is a pertinent problem in LMICs where regulatory frame works are weak. Inappropriate antibiotic use in LMICs is a multifaceted problem that cuts across clinical and veterinary medicine and agriculture. Therefore, efforts geared at curbing inappropriate antibiotic use in LMICs must identify the factors that drive this problem (i.e. inappropriate antibiotic use) in these countries. A clear knowledge of these factors will guide effective policy and decision making to curb inappropriate antibiotic use and ultimately AMR. The focus of this review is to discuss the factors that drive inappropriate antibiotic use in LMICs.
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Affiliation(s)
| | - Charles John Elikwu
- Department of Medical Microbiology, School of Basic Clinical Sciences, Benjamin Carson (Snr.) College of Health & Medical Sciences, Babcock University, Ilishan Remo, Ogun State, Nigeria
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11
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Sagar P, Aseem A, Banjara SK, Veleri S. The role of food chain in antimicrobial resistance spread and One Health approach to reduce risks. Int J Food Microbiol 2023; 391-393:110148. [PMID: 36868045 DOI: 10.1016/j.ijfoodmicro.2023.110148] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/14/2023] [Accepted: 02/18/2023] [Indexed: 02/26/2023]
Abstract
The incidence of antimicrobial resistance (AMR) is rapidly spreading worldwide. It is depleting the repertoire of antibiotics in use but the pace of development of new antibiotics is stagnant for decades. Annually, millions of people are killed by AMR. This alarming situation urged both scientific and civil bodies to take steps to curb AMR as a top priority. Here we review the various sources of AMR in the environment, especially focusing on the food chain. Food chain inculcates pathogens with AMR genes and serves as a conduit for its transmission. In certain countries, the antibiotics are more used in livestock than in humans. It is also used in agriculture crops of high value products. The indiscriminate use of antibiotics in livestock and agriculture increased rapid emergence of AMR pathogens. In addition, in many countries nosocomial settings are spewing AMR pathogens, which is a serious health hazard. Both the developed and low and middle income countries (LMIC) face the phenomenon of AMR. Therefore, a comprehensive approach for monitoring all sectors of life is required to identify the emerging trend of AMR in environment. AMR genes' mode of action must be understood to develop strategies to reduce risk. The new generation sequencing technologies, metagenomics and bioinformatics capabilities can be resorted to quickly identify and characterize AMR genes. The sampling for AMR monitoring can be done from multiples nodes of the food chain as envisioned and promoted by the WHO, FAO, OIE and UNEP under the One Health approach to overcome threat of AMR pathogens.
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Affiliation(s)
- Prarthi Sagar
- Drug Safety Division, ICMR-National Institute of Nutrition, Hyderabad 500007, India
| | - Ajmal Aseem
- Drug Safety Division, ICMR-National Institute of Nutrition, Hyderabad 500007, India
| | | | - Shobi Veleri
- Drug Safety Division, ICMR-National Institute of Nutrition, Hyderabad 500007, India.
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Laboratory-on-a-ship: a microbiology culture media production facility in a sea container for local production in low-resource settings. THE LANCET. MICROBE 2023:S2666-5247(23)00070-8. [PMID: 36907195 DOI: 10.1016/s2666-5247(23)00070-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
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Metagenomic Analysis of the Abundance and Composition of Antibiotic Resistance Genes in Hospital Wastewater in Benin, Burkina Faso, and Finland. mSphere 2023; 8:e0053822. [PMID: 36728456 PMCID: PMC9942590 DOI: 10.1128/msphere.00538-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Antibiotic resistance is a global threat to human health, with the most severe effect in low- and middle-income countries. We explored the presence of antibiotic resistance genes (ARGs) in the hospital wastewater (HWW) of nine hospitals in Benin and Burkina Faso, two low-income countries in West Africa, with shotgun metagenomic sequencing. For comparison, we also studied six hospitals in Finland. The highest sum of the relative abundance of ARGs in the 68 HWW samples was detected in Benin and the lowest in Finland. HWW resistomes and mobilomes in Benin and Burkina Faso resembled each other more than those in Finland. Many carbapenemase genes were detected at various abundances, especially in HWW from Burkina Faso and Finland. The blaGES genes, the most widespread carbapenemase gene in the Beninese HWW, were also found in water intended for hand washing and in a puddle at a hospital yard in Benin. mcr genes were detected in the HWW of all three countries, with mcr-5 being the most common mcr gene. These and other mcr genes were observed in very high relative abundances, even in treated wastewater in Burkina Faso and a street gutter in Benin. The results highlight the importance of wastewater treatment, with particular attention to HWW. IMPORTANCE The global emergence and increased spread of antibiotic resistance threaten the effectiveness of antibiotics and, thus, the health of the entire population. Therefore, understanding the resistomes in different geographical locations is crucial in the global fight against the antibiotic resistance crisis. However, this information is scarce in many low- and middle-income countries (LMICs), such as those in West Africa. In this study, we describe the resistomes of hospital wastewater in Benin and Burkina Faso and, as a comparison, Finland. Our results help to understand the hitherto unrevealed resistance in Beninese and Burkinabe hospitals. Furthermore, the results emphasize the importance of wastewater management infrastructure design to minimize exposure events between humans, HWW, and the environment, preventing the circulation of resistant bacteria and ARGs between humans (hospitals and community) and the environment.
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Legba BB, Dougnon V, Koudokpon H, Mero S, Elovainio R, Parry M, Bankole H, Haukka K. Assessment of blood cultures and antibiotic susceptibility testing for bacterial sepsis diagnosis and utilization of results by clinicians in Benin: A qualitative study. Front Public Health 2023; 10:1088590. [PMID: 36726632 PMCID: PMC9885088 DOI: 10.3389/fpubh.2022.1088590] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives We assessed the current status of blood culture and antibiotic susceptibility testing (AST) practices in clinical laboratories in Benin, and how the laboratory results are used by physicians to prescribe antibiotics. Methods The qualitative study covered twenty-five clinical laboratories with a bacteriology unit and associated hospitals and pharmacies. Altogether 159 laboratory staff, physicians and pharmacists were interviewed about their perceptions of the state of laboratory diagnostics related to sepsis and the use of antibiotics. Face-to-face interviews based on structured questionnaires were supported by direct observations when visiting five laboratories in across the country. Results Only 6 laboratories (24%) conducted blood cultures, half of them with a maximum of 10 samples per month. The most common gram-negative bacteria isolated from blood cultures were: Escherichia coli, Salmonella spp. and Salmonella enterica serovar Typhi while the most common gram-positives were Enterococcus spp. and Staphylococcus aureus. None of the laboratories listed Klebsiella pneumoniae among the three most common bacteria isolated from blood cultures, although other evidence indicates that it is the most common cause of sepsis in Benin. Due to limited testing capacity, physicians most commonly use empirical antibiotic therapy. Conclusions More resources are needed to develop laboratory testing capacity, technical skills in bacterial identification, AST, quality assurance, and communication of results must be strengthened.
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Affiliation(s)
- Brice Boris Legba
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Victorien Dougnon
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Hornel Koudokpon
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Sointu Mero
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Physicians for Social Responsibility, Helsinki, Finland
| | - Riku Elovainio
- Physicians for Social Responsibility, Helsinki, Finland
- Tampere Center for Child, Adolescent, and Maternal Health Research (TAMCAM): Global Health Group, University of Tampere, Tampere, Finland
| | - Matti Parry
- Physicians for Social Responsibility, Helsinki, Finland
- New Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Honoré Bankole
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Kaisa Haukka
- Physicians for Social Responsibility, Helsinki, Finland
- Department of Microbiology, University of Helsinki, Helsinki, Finland
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Pharmacokinetics of Antimicrobials in Children with Emphasis on Challenges Faced by Low and Middle Income Countries, a Clinical Review. Antibiotics (Basel) 2022; 12:antibiotics12010017. [PMID: 36671218 PMCID: PMC9854442 DOI: 10.3390/antibiotics12010017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022] Open
Abstract
Effective antimicrobial exposure is essential to treat infections and prevent antimicrobial resistance, both being major public health problems in low and middle income countries (LMIC). Delivery of drug concentrations to the target site is governed by dose and pharmacokinetic processes (absorption, distribution, metabolism and excretion). However, specific data on the pharmacokinetics of antimicrobials in children living in LMIC settings are scarce. Additionally, there are significant logistical constraints to therapeutic drug monitoring that further emphasize the importance of understanding pharmacokinetics and dosing in LMIC. Both malnutrition and diarrheal disease reduce the extent of enteral absorption. Multiple antiretrovirals and antimycobacterial agents, commonly used by children in low resource settings, have potential interactions with other antimicrobials. Hypoalbuminemia, which may be the result of malnutrition, nephrotic syndrome or liver failure, increases the unbound concentrations of protein bound drugs that may therefore be eliminated faster. Kidney function develops rapidly during the first years of life and different inflammatory processes commonly augment renal clearance in febrile children, potentially resulting in subtherapeutic drug concentrations if doses are not adapted. Using a narrative review approach, we outline the effects of growth, maturation and comorbidities on maturational and disease specific effects on pharmacokinetics in children in LMIC.
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Abstract
BACKGROUND Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. METHODS We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. FINDINGS From an estimated 13·7 million (95% UI 10·9-17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7-10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2-18·1) of all global deaths and 56·2% (52·1-60·1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54·9% (52·9-56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4-71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. INTERPRETATION The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund.
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Moirongo RM, Aglanu LM, Lamshöft M, Adero BO, Yator S, Anyona S, May J, Lorenz E, Eibach D. Laboratory-based surveillance of antimicrobial resistance in regions of Kenya: An assessment of capacities, practices, and barriers by means of multi-facility survey. Front Public Health 2022; 10:1003178. [PMID: 36518572 PMCID: PMC9742437 DOI: 10.3389/fpubh.2022.1003178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adequate laboratory capacity is critical in the implementation of coherent surveillance for antimicrobial resistance (AMR). We describe capacities and deficiencies in laboratory infrastructure and AMR surveillance practices among health facilities in Kenya to support progress toward broader sustainable laboratory-based AMR surveillance. Methods A convenience sample of health facilities from both public and private sectors across the country were selected. Information was obtained cross-sectionally between 5th October and 8th December 2020 through online surveys of laboratory managers. The assessment covered quality assurance, management and dissemination of AMR data, material and equipment, staffing, microbiology competency, biosafety and certification. A scoring scheme was developed for the evaluation and interpreted as (80% and above) facility is adequate (60-79%) requires some strengthening and (<60%) needing significant strengthening. Average scores were compared across facilities in public and private sectors, rural and urban settings, as well as national, county, and community levels. Results Among the participating facilities (n = 219), the majority (n = 135, 61.6%) did not offer bacterial culture testing, 47 (21.5%) offered culture services only and 37 (16.9%) performed antimicrobial susceptibility testing (AST). The major gaps identified among AST facilities were poor access to laboratory information management technology (LIMT) (score: 45.9%) and low uptake of external quality assessment (EQA) programs for cultures (score 67.7%). Access to laboratory technology was more than two-fold higher in facilities in urban (58.6%) relative to rural (25.0%) areas. Whilst laboratories that lacked culture services were found to have significant infrastructural gaps (average score 59.4%), facilities that performed cultures only (average score: 83.6%) and AST (average score: 82.9%) recorded significantly high scores that were very similar across areas assessed. Lack of equipment was identified as the leading challenge to the implementation of susceptibility testing among 46.8% of laboratories. Conclusions We identified key gaps in laboratory information management technology, external quality assurance and material and equipment among the surveyed health facilities in Kenya. Our findings suggest that by investing in equipment, facilities performing cultures can be successfully upgraded to provide additional antimicrobial susceptibility testing, presenting a chance for a major leap toward improved AMR diagnostics and surveillance in the country.
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Affiliation(s)
- Rehema Moraa Moirongo
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,*Correspondence: Rehema Moraa Moirongo
| | - Leslie Mawuli Aglanu
- Global Health and Infectious Diseases Research Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana,Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Maike Lamshöft
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany
| | | | - Solomon Yator
- Department of Biochemistry and Molecular Biology, University of Bremen, Bremen, Germany
| | - Stephen Anyona
- Centre for Microbiology Research (KEMRI-CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany,Department of Tropical Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany,Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
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Otaigbe I. Scaling up artificial intelligence to curb infectious diseases in Africa. Front Digit Health 2022; 4:1030427. [PMID: 36339519 PMCID: PMC9634158 DOI: 10.3389/fdgth.2022.1030427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022] Open
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Omenako KA, Enimil A, Marfo AFA, Timire C, Chinnakali P, Fenny AP, Jeyashree K, Buabeng KO. Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12968. [PMID: 36232262 PMCID: PMC9566692 DOI: 10.3390/ijerph191912968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Neonatal sepsis is a life-threatening emergency, and empirical antimicrobial prescription is common. In this cross-sectional study of neonates admitted with suspected sepsis in a teaching hospital in Ghana from January-December 2021, we described antimicrobial prescription patterns, compliance with national standard treatment guidelines (STG), blood culture testing, antimicrobial resistance patterns and treatment outcomes. Of the 549 neonates admitted with suspected sepsis, 283 (52%) were males. Overall, 529 (96%) received empirical antimicrobials. Most neonates (n = 407, 76.9%) were treated empirically with cefuroxime + gentamicin, while cefotaxime was started as a modified treatment in the majority of neonates (46/68, 67.6%). Only one prescription complied with national STGs. Samples of 257 (47%) neonates underwent blood culture testing, of which 70 (27%) were positive. Isolates were predominantly Gram-positive bacteria, with coagulase-negative Staphylococcus and Staphylococcus aureus accounting for 79% of the isolates. Isolates showed high resistance to most penicillins, while resistance to aminoglycosides and quinolones was relatively low. The majority of neonates (n = 497, 90.5%) were discharged after successfully completing treatment, while 50 (9%) neonates died during treatment. Strengthening of antimicrobial stewardship programmes, periodic review of STGs and increased uptake of culture and sensitivity testing are needed to improve management of sepsis.
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Affiliation(s)
- Kwaku Anim Omenako
- Eastern Regional Hospital, Ghana Health Service, Koforidua P.O. Box KF 201, Ghana
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Anthony Enimil
- Komfo Anokye Teaching Hospital (KATH), Kumasi P.O. Box KS 1934, Ghana
- School of Medicine and Dentistry (SMD), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Collins Timire
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry 605006, India
| | - Ama Pokuaa Fenny
- Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra P.O. Box LG 25, Ghana
| | - Kathiresan Jeyashree
- Department of Epidemiology and Biostatistics, National Institute of Epidemiology, Chennai 600077, India
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
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Ezzat S, Biga R, Kozlakidis Z. Biobanking in LMIC settings for infectious diseases: Challenges and enablers. BIOSAFETY AND HEALTH 2022; 4:290-292. [PMID: 35910333 PMCID: PMC9310343 DOI: 10.1016/j.bsheal.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022] Open
Abstract
Biobanking facilities are well established in high-income settings, where substantial funding has been invested in infrastructure. In contrast, such facilities are much less developed in resource-restricted settings. However, low-and middle-income countries (LMICs) still face a disproportionately high infectious diseases burden. Thus, the further development of infrastructure facilities, including biobanks is warranted as an important component of this unfolding clinical research environment. This perspective manuscript summarises the challenges and enablers for biobanking in LMICs, with a particular focus on infectious diseases, incorporating some of the lessons learned from the recent coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Sameera Ezzat
- National Liver Institute, Menoufia University, Shibin el Kom 32511, Egypt
- Mounir Armanious Research Center (MARC), Giza 12561, Egypt
| | | | - Zisis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, Lyon 69372, France
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Fileccia L, Wood T, Guthrie A, Ronoh C, Sleeth C, Kamath-Rayne BD, Liu C, Schaffzin JK, Rule AR. Comparison of Early-Onset Sepsis Risk-Stratification Algorithms in Neonates in a Kenyan Nursery. Hosp Pediatr 2022; 12:876-884. [PMID: 36127311 DOI: 10.1542/hpeds.2021-006228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Risk stratification algorithms (RSAs) can reduce antibiotic duration (AD) and length of stay (LOS) for early-onset sepsis (EOS). Because of higher EOS and antibiotic resistance rates and limited laboratory capacity, RSA implementation may benefit low- and middle-income countries (LMIC). Our objective was to compare the impact of 4 RSAs on AD and LOS in an LMIC nursery. METHOD Neonates <5 days of age admitted for presumed sepsis to a Kenyan referral hospital in 2019 (n = 262) were evaluated by using 4 RSAs, including the current local sepsis protocol ("local RSA"), a simplified local protocol ("simple RSA"), an existing categorical RSA that uses infant clinical examination and maternal risk factors (CE-M RSA) clinical assessment, and the World Health Organization's Integrated Management of Childhood Illness guideline. For each RSA, a neonate was classified as at high, moderate, or low EOS risk. We used к coefficients to evaluate the agreement between RSAs and McNemar's test for the direction of disagreement. We used the Wilcoxon rank test for differences in observed and predicted median AD and LOS. RESULTS Local and simple RSAs overestimated EOS risk compared with CE-M RSA and the Integrated Management of Childhood Illness guideline. Compared with the observed value, CE-M RSA shortened AD by 2 days and simple RSA lengthened AD by 2 days. LOS was shortened by 4 days by using CE-M RSA and by 2 days by using the local RSA. CONCLUSIONS The local RSA overestimated EOS risk compared with CE-M RSA. If implemented fully, the local RSA may reduce LOS. Future studies will evaluate the prospective use of RSAs in LMICs with other interventions such as observation off antibiotics, biomarkers, and bundled implementation.
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Affiliation(s)
| | - Tristan Wood
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alyssa Guthrie
- Division of Infectious Disease.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Beena D Kamath-Rayne
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, Illinois; and
| | | | - Joshua K Schaffzin
- Division of Infectious Disease.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Rl Rule
- Perinatal Institute and Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
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Post AS, Guiraud I, Peeters M, Lompo P, Ombelet S, Karama I, Yougbaré S, Garba Z, Rouamba E, Tinto H, Jacobs J. Escherichia coli from urine samples of pregnant women as an indicator for antimicrobial resistance in the community: a field study from rural Burkina Faso. Antimicrob Resist Infect Control 2022; 11:112. [PMID: 36064435 PMCID: PMC9446845 DOI: 10.1186/s13756-022-01142-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In low- and middle-income countries, surveillance of antimicrobial resistance (AMR) is mostly hospital-based and, in view of poor access to clinical microbiology, biased to more resistant pathogens. We aimed to assess AMR among Escherichia coli isolates obtained from urine cultures of pregnant women as an indicator for community AMR and compared the AMR results with those from E. coli isolates obtained from febrile patients in previously published clinical surveillance studies conducted within the same population in Nanoro, rural Burkina Faso. We furthermore explored feasibility of adding urine culture to standard antenatal care in a rural sub-Saharan African setting.
Methods
Between October 2016–September 2018, midstream urine samples collected as part of routine antenatal care in Nanoro district were cultured by a dipslide method and screened for antibiotic residues. Significant growth was defined as a pure culture of Enterobacterales at counts of ≥ 104 colony forming units/ml.
Results
Significant growth was observed in 202/5934 (3.4%) cultures; E. coli represented 155 (76.7%) of isolates. Among E. coli isolates, resistance rates to ampicillin, cotrimoxazole and ciprofloxacin were respectively 65.8%, 64.4% 16.2%, compared to 89.5%, 89.5% and 62.5% among E. coli from clinical isolates (n = 48 of which 45 from blood cultures). Proportions of extended spectrum beta-lactamase producers and multidrug resistance were 3.2% and 5.2% among E. coli isolates from urine in pregnant women versus 35.4%, and 60.4% respectively among clinical isolates.
Conclusions
The E. coli isolates obtained from healthy pregnant women had significantly lower AMR rates compared to clinical E. coli isolates, probably reflecting the lower antibiotic pressure in the pregnant women population. Adding urine culture to the routine urine analysis (dipstick) of antenatal care was feasible. The dipslide culture method was affordable and user-friendly and allowed on-site inoculation and easy transport; challenges were contamination (midstream urine sampling) and the semi-quantitative reading. Provided confirmation of the present findings in other settings, E. coli from urine samples in pregnant women may be a potential indicator for benchmarking, comparing, and monitoring community AMR rates across populations over different countries and regions.
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Validation of Three MicroScan® Antimicrobial Susceptibility Testing Plates Designed for Low-Resource Settings. Diagnostics (Basel) 2022; 12:diagnostics12092106. [PMID: 36140507 PMCID: PMC9497938 DOI: 10.3390/diagnostics12092106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Easy and robust antimicrobial susceptibility testing (AST) methods are essential in clinical bacteriology laboratories (CBL) in low-resource settings (LRS). We evaluated the Beckman Coulter MicroScan lyophilized broth microdilution panel designed to support Médecins Sans Frontières (MSF) CBL activity in difficult settings, in particular with the Mini-Lab. We evaluated the custom-designed MSF MicroScan Gram-pos microplate (MICPOS1) for Staphylococcus and Enterococcus species, MSF MicroScan Gram-neg microplate (MICNEG1) for Gram-negative bacilli, and MSF MicroScan Fastidious microplate (MICFAST1) for Streptococci and Haemophilus species using 387 isolates from routine CBLs from LRS against the reference methods. Results showed that, for all selected antibiotics on the three panels, the proportion of the category agreement was above 90% and the proportion of major and very major errors was below 3%, as per ISO standards. The use of the Prompt inoculation system was found to increase the MIC and the major error rate for some antibiotics when testing Staphylococci. The readability of the manufacturer’s user manual was considered challenging for low-skilled staff. The inoculations and readings of the panels were estimated as easy to use. In conclusion, the three MSF MicroScan MIC panels performed well against clinical isolates from LRS and provided a convenient, robust, and standardized AST method for use in CBL in LRS.
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Tsere DB, Shirima GM, Grundy BS, Heysell SK, Mpagama SG, Mziray SR, Mbelele PM. Multiple pathogens contribute to human immunodeficiency virus-related sepsis in addition to Mycobacterium tuberculosis: A prospective cohort in Tanzania. Int J Mycobacteriol 2022; 11:241-248. [PMID: 36260441 PMCID: PMC9582297 DOI: 10.4103/ijmy.ijmy_80_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Mortality from tuberculosis (TB) sepsis is common among patients living with human immunodeficiency virus (PLHIV). We aimed to detect M. tuberculosis (MTB) and additional sepsis etiologies, and mortality determinants in PLHIV. Methods This prospective cohort study consented and followed-up PLHIV for 28 days in northern Tanzania. From May through December 2021, patients provided urine and sputum for TB testing in lateral-flow lipoarabinomannan (LF-LAM) and Xpert® MTB/RIF. Bacterial blood culture, cryptococcal antigen, malaria rapid diagnostic, C-reactive-protein (CRP), and international normalized ratio (INR) tests were also performed. Sepsis severity was clinically measured by Karnofsky and modified early warning signs (MEWS) scores. Anti-TB, broad-spectrum antibiotics, and antimalarial and antifungal agents were prescribed in accordance with Tanzania treatment guideline. An independent t-test and Chi-square or Fisher's exact tests compared means and proportions, respectively. P < 0.05 was statistically significant. Results Among 98 patients, 59 (60.2%) were female. Their mean (standard deviation) age was 44 (12.9) years. TB detection increased from 24 (24.5%) by Xpert® MTB/RIF to 36 (36.7%) when LF-LAM was added. In total, 23 (23.5%) patients had other than TB etiologies of sepsis, including Staphylococcus aureus, Streptococcus pneumoniae, Cryptococcus spp., and Plasmodium spp. Twenty-four (94.4%) of 36 patients with TB had higher CRP (≥10 mg/l) compared to 25 (40.3%) non-TB patients (P < 0.001). Nine (9.2%) patients died and almost all had INR ≥1.8 (n = 8), Karnofsky score <50% (n = 9), MEWS score >6 (n = 8), and malnutrition (n = 9). Conclusions MTB and other microbes contributed to sepsis in PLHIV. Adding non-TB tests informed clinical decisions. Mortality was predicted by conventional sepsis and severity scoring, malnutrition, and elevated INR.
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Affiliation(s)
- Donatus Bonphace Tsere
- Department of medical services, Kibong’oto Infectious Diseases Hospital, Siha, Tanzania
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Gabriel Mkilema Shirima
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Brian S. Grundy
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Stellah G. Mpagama
- Department of medical services, Kibong’oto Infectious Diseases Hospital, Siha, Tanzania
| | - Shabani Ramadhani Mziray
- Department of medical services, Kibong’oto Infectious Diseases Hospital, Siha, Tanzania
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Peter M. Mbelele
- Department of medical services, Kibong’oto Infectious Diseases Hospital, Siha, Tanzania
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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Mukwege D, Mitangala P, Byabene A, Busha E, Van Laethem Y, Vandenberg O. Global burden of antimicrobial resistance: essential pieces of a global puzzle. Lancet 2022; 399:2348. [PMID: 35753337 DOI: 10.1016/s0140-6736(22)00944-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Denis Mukwege
- Department of Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo; Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
| | - Prudence Mitangala
- Laboratoire Provincial du Nord-Kivu, Goma, Democratic Republic of the Congo; Faculty of Medicine, Université Officielle de Ruwenzori, Goma, Democratic Republic of the Congo
| | - Aline Byabene
- Department of Internal Medicine, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
| | - Emmanuel Busha
- Faculty of Medicine, Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of the Congo; Samaritan Paediatric Centre/Samaritan Doctors, Goma, Democratic Republic of the Congo
| | - Yves Van Laethem
- Department of Infectiology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Vandenberg
- Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium; Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, UK; Innovation and Business Development Unit, Laboratoire Hospitalier Universtaire de Bruxelles- Universitair Laboratorium Brussel, Université Libre de Bruxelles, 1000 Brussels, Belgium.
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Trollip A, Gadde R, Datema T, Gatwechi K, Oskam L, Katz Z, Whitelaw A, Kinyanjui P, Njukeng P, Wendifraw DA, Mugerwa I, Najjuka G, Dayie N, Opintan JA, Albert H. Implementation of a customised antimicrobial resistance laboratory scorecard in Cameroon, Ethiopia and Kenya. Afr J Lab Med 2022; 11:1476. [PMID: 35811751 PMCID: PMC9257829 DOI: 10.4102/ajlm.v11i1.1476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/11/2022] [Indexed: 11/08/2022] Open
Abstract
Background In low-resource settings, antimicrobial resistance (AMR) is detected by traditional culture-based methods and ensuring the quality of such services is a challenge. The AMR Scorecard provides laboratories with a technical assessment tool for strengthening the quality of bacterial culture, identification, and antimicrobial testing procedures. Objective To evaluate the performance of the AMR Scorecard in 11 pilot laboratory evaluations in three countries also assessed with the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. Methods Pilot laboratory evaluations were conducted in Cameroon, Ethiopia and Kenya between February 2019 and March 2019. Assessors with previous SLIPTA and microbiology experience were trained. Assessors performed the laboratory assessments using the SLIPTA and AMR Scorecard tools. Results Weaknesses in technical procedures and the quality management systems were identified in all areas and all laboratories. Safety had the highest mean performance score (SLIPTA: 68%; AMR Scorecard: 73%) while management review had the lowest (SLIPTA: 32%; AMR Scorecard: 8%) across all laboratories. The AMR Scorecard scores were generally consistent with SLIPTA scores. The AMR Scorecard identified technical weaknesses in AMR testing, and SLIPTA identified weaknesses in the quality management systems in the laboratories. Conclusion Since the AMR Scorecard identified important gaps in AMR testing not detected by SLIPTA, it is recommended that microbiology laboratories use SLIPTA and the AMR Scorecard in parallel when preparing for accreditation. Expanding the use of the AMR Scorecard is a priority to address the need for quality clinical microbiology laboratory services in support of optimal patient care and AMR surveillance.
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Affiliation(s)
- André Trollip
- Foundation for Innovative New Diagnostics (FIND) South Africa, Cape Town, South Africa
| | - Renuka Gadde
- Becton, Dickinson & Company, Franklin Lakes, New Jersey, United States
| | | | | | | | - Zachary Katz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Andrew Whitelaw
- Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Peter Kinyanjui
- National Public Health Laboratory, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Dawit A. Wendifraw
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ibrahimm Mugerwa
- Ministry of Health, National Health Laboratories and Diagnostic Services-AMR-National Coordination Centre, Kampala, Uganda
| | - Grace Najjuka
- National Health Laboratories and Diagnostic Services, Kampala, Uganda
| | - Nicholas Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Japheth A. Opintan
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Heidi Albert
- Foundation for Innovative New Diagnostics (FIND) South Africa, Cape Town, South Africa
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Ombelet S, Natale A, Ronat JB, Vandenberg O, Jacobs J, Hardy L. Considerations in evaluating equipment-free blood culture bottles: A short protocol for use in low-resource settings. PLoS One 2022; 17:e0267491. [PMID: 35468169 PMCID: PMC9037908 DOI: 10.1371/journal.pone.0267491] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/07/2022] [Indexed: 12/21/2022] Open
Abstract
Use of equipment-free, “manual” blood cultures is still widespread in low-resource settings, as requirements for implementation of automated systems are often not met. Quality of manual blood culture bottles currently on the market, however, is usually unknown. An acceptable quality in terms of yield and speed of growth can be ensured by evaluating the bottles using simulated blood cultures. In these experiments, bottles from different systems are inoculated in parallel with blood and a known quantity of bacteria. Based on literature review and personal experiences, we propose a short and practical protocol for an efficient evaluation of manual blood culture bottles, aimed at research or reference laboratories in low-resource settings. Recommendations include: (1) practical equivalence of horse blood and human blood; (2) a diverse selection of 10 to 20 micro-organisms to be tested (both slow- and fast-growing reference organisms); (3) evaluation of both adult and pediatric bottle formulations and blood volumes; (4) a minimum sample size of 120 bottles per bottle type; (5) a formal assessment of usability. Different testing scenarios for increasing levels of reliability are provided, along with practical tools such as worksheets and surveys that can be used by laboratories wishing to evaluate manual blood culture bottles.
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Affiliation(s)
- Sien Ombelet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Immunology & Microbiology Department, KU Leuven, Leuven, Belgium
| | | | - Jean-Baptiste Ronat
- Médecins Sans Frontières, Paris, France
- Team ReSIST, INSERM U1184, School of Medicine University Paris-Saclay, Paris, France
- Bacteriology-Hygiene Unit, Assistance Publique – Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Olivier Vandenberg
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Innovation and Business Development Unit, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), ULB, Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Immunology & Microbiology Department, KU Leuven, Leuven, Belgium
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
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Gulleen EA, Lubwama M, Komakech A, Krantz EM, Liu C, Phipps W. Knowledge and perceptions of antimicrobial resistance and antimicrobial stewardship among staff at a national cancer referral center in Uganda. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e54. [PMID: 36483337 PMCID: PMC9726558 DOI: 10.1017/ash.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES As access to cancer care has improved throughout sub-Saharan Africa, treatment-associated infections have increased. Assessing healthcare worker knowledge of antimicrobial stewardship and identifying the barriers to infection management will inform the development of contextually appropriate antimicrobial stewardship programs, improving cancer outcomes in sub-Saharan Africa. DESIGN Cross-sectional survey. SETTING The Uganda Cancer Institute (UCI), a national cancer referral center in Kampala, Uganda. PARTICIPANTS We surveyed 61 UCI staff: 29 nurses, 7 pharmacists, and 25 physicians. METHODS The survey contained 25 questions and 1 ranking exercise. We examined differences in responses by staff role. RESULTS All 60 respondents who answered the question had heard the term "antimicrobial resistance." Only 44 (73%) had heard the term "antimicrobial stewardship." Nurses were less likely than pharmacists or physicians to be familiar with either term. Also, 41 respondents (68%) felt that loss of antibiotic susceptibility is a major issue at UCI. Regarding barriers to diagnosing infections, 54 (93%) of 58 thought that it was difficult to obtain blood cultures and 48 (86%) of 56 thought that it was difficult to regularly measure temperatures. CONCLUSIONS Although most recognized the term "antimicrobial resistance," fewer were familiar with the term "antimicrobial stewardship." Inappropriate antibiotic use was recognized as a contributor to antimicrobial resistance, but hand hygiene was underrecognized as a contributing factor. We identified numerous barriers to diagnosing infections, including the ability to obtain blood cultures and consistently monitor temperatures. Educating staff regarding antimicrobial selection, allocating resources for blood cultures, and implementing strategies to enhance fever detection will improve infection management.
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Affiliation(s)
- Elizabeth A. Gulleen
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
- Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, United States
- Seattle Cancer Care Alliance, Seattle, Washington, United States
| | - Margaret Lubwama
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Alfred Komakech
- Department of Pharmacy, Uganda Cancer Institute, Kampala, Uganda
| | - Elizabeth M. Krantz
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Catherine Liu
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
- Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, United States
- Seattle Cancer Care Alliance, Seattle, Washington, United States
| | - Warren Phipps
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
- Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, United States
- Seattle Cancer Care Alliance, Seattle, Washington, United States
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Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda. Antibiotics (Basel) 2022; 11:antibiotics11020199. [PMID: 35203802 PMCID: PMC8868487 DOI: 10.3390/antibiotics11020199] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.
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Ombelet S, Kpossou G, Kotchare C, Agbobli E, Sogbo F, Massou F, Lagrou K, Barbé B, Affolabi D, Jacobs J. Blood culture surveillance in a secondary care hospital in Benin: epidemiology of bloodstream infection pathogens and antimicrobial resistance. BMC Infect Dis 2022; 22:119. [PMID: 35114948 PMCID: PMC8812239 DOI: 10.1186/s12879-022-07077-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although global surveillance of antimicrobial resistance (AMR) is considered key in the containment of AMR, data from low- and middle-income countries, especially from sub-Saharan Africa, are scarce. This study describes epidemiology of bloodstream infections and antimicrobial resistance rates in a secondary care hospital in Benin. METHODS Blood cultures were sampled, according to predefined indications, in BacT/ALERT FA Plus and PF Plus (bioMérieux, Marcy-l'Etoile, France) blood culture bottles (BCB) in a district hospital (Boko hospital) and to a lesser extent in the University hospital of Parakou. These BCB were incubated for 7 days in a standard incubator and twice daily inspected for visual signs of growth. Isolates retrieved from the BCB were processed locally and later shipped to Belgium for reference identification [matrix-assisted laser desorption/ionization time-of-flight spectrometry (MALDI-TOF)] and antibiotic susceptibility testing (disk diffusion and E-tests). RESULTS From October 2017 to February 2020, 3353 BCB were sampled, corresponding to 3140 blood cultures (212 cultures consisting of > 1 BCB) and 3082 suspected bloodstream infection (BSI) episodes. Most of these cultures (n = 2471; 78.7%) were sampled in children < 15 years of age. Pathogens were recovered from 383 (12.4%) cultures, corresponding to 381 confirmed BSI. 340 of these pathogens were available and confirmed by reference identification. The most common pathogens were Klebsiella pneumoniae (n = 53; 15.6%), Salmonella Typhi (n = 52; 15.3%) and Staphylococcus aureus (n = 46; 13.5%). AMR rates were high among Enterobacterales, with resistance to third-generation cephalosporins in 77.6% of K. pneumoniae isolates (n = 58), 12.8% of Escherichia coli isolates (n = 49) and 70.5% of Enterobacter cloacae isolates (n = 44). Carbapenemase production was detected in 2 Escherichia coli and 2 Enterobacter cloacae isolates, all of which were of the New Delhi metallo-beta lactamase type. Methicillin resistance was present in 22.4% of S. aureus isolates (n = 49). CONCLUSION Blood cultures were successfully implemented in a district hospital in Benin, especially among the pediatric patient population. Unexpectedly high rates of AMR among Gram-negative bacteria against commonly used antibiotics were found, demonstrating the clinical and scientific importance of clinical bacteriology laboratories at this level of care.
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Affiliation(s)
- Sien Ombelet
- Institute of Tropical Medicine, Antwerp, Belgium.
- Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium.
| | | | | | - Esenam Agbobli
- Centre National Hospitalier Universitaire Hubert Koutougou MAGA de Cotonou (CNHU-HKM), Cotonou, Benin
- National Reference Laboratory for Mycobacteria, Cotonou, Benin
| | - Frédéric Sogbo
- Centre National Hospitalier Universitaire Hubert Koutougou MAGA de Cotonou (CNHU-HKM), Cotonou, Benin
- National Reference Laboratory for Mycobacteria, Cotonou, Benin
| | - Faridath Massou
- Centre National Hospitalier Universitaire Hubert Koutougou MAGA de Cotonou (CNHU-HKM), Cotonou, Benin
- National Reference Laboratory for Mycobacteria, Cotonou, Benin
| | - Katrien Lagrou
- Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Dissou Affolabi
- Centre National Hospitalier Universitaire Hubert Koutougou MAGA de Cotonou (CNHU-HKM), Cotonou, Benin
- National Reference Laboratory for Mycobacteria, Cotonou, Benin
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium
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Krapp F, Rondon C, Amaro C, Barco-Yaipén E, Valera-Krumdieck M, Vásquez R, Briones A, Casapia M, Burgos A, Sarmiento López F, Vilcapoma P, Díaz Sipión R, Villegas-Chiroque M, Castillo K, Pino-Dueñas J, Cuaresma Cuadros E, Alpaca-Salvador H, Campana R, Peralta Córdova T, Sierra Chavez E, Aguado Ventura C, Peeters M, Jacobs J, Garcia C. Underutilization and Quality Gaps in Blood Culture Processing in Public Hospitals of Peru. Am J Trop Med Hyg 2022; 106:432-440. [PMID: 34872054 PMCID: PMC8832895 DOI: 10.4269/ajtmh.21-0770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023] Open
Abstract
Correct processing of blood cultures may impact individual patient management, antibiotic stewardship, and scaling up of antimicrobial resistance surveillance. To assess the quality of blood culture processing, we conducted four assessments at 16 public hospitals across different regions of Peru. We assessed the following standardized quality indicators: 1) positivity and contamination rates, 2) compliance with recommended number of bottles/sets and volume of blood sampled, 3) blood culture utilization, and 4) possible barriers for compliance with recommendations. Suboptimal performance was found, with a median contamination rate of 4.2% (range 0-15.1%), with only one third of the participating hospitals meeting the target value of < 3%; and a median positivity rate of 4.9% (range 1-8.1%), with only 6 out of the 15 surveilled hospitals meeting the target of 6-12%. None of the assessed hospitals met both targets. The median frequency of solitary blood cultures was 71.9% and only 8.9% (N = 59) of the surveyed adult bottles met the target blood volume of 8 - 12 mL, whereas 90.5% (N = 602) were underfilled. A high frequency of missed opportunities for ordering blood cultures was found (69.9%, 221/316) among patients with clinical indications for blood culture sampling. This multicenter study demonstrates important shortcomings in the quality of blood culture processing in public hospitals of Peru. It provides a national benchmark of blood culture utilization and quality indicators that can be used to monitor future quality improvement studies and diagnostic stewardship policies.
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Affiliation(s)
- Fiorella Krapp
- Universidad Peruana Cayetano Heredia, Lima, Peru;,Address correspondence to Fiorella Krapp, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres 15102, Lima, Peru. E-mail:
| | | | | | | | | | | | - Alexander Briones
- Hospital Regional de Loreto Felipe Santiago Arriola Iglesias Loreto, Peru
| | - Martin Casapia
- Hospital Regional de Loreto Felipe Santiago Arriola Iglesias Loreto, Peru
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jan Jacobs
- Institute of Tropical Medicine Antwerp, Belgium;,Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Coralith Garcia
- Universidad Peruana Cayetano Heredia, Lima, Peru;,Hospital Cayetano Heredia, Lima, Peru
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Roberts T, Silisouk J, Sengdatka D, Sibounheuang B, Seljuk R, Vang X, Sengduangphachanh A, Davong V, Vongsouvath M, Malou N, Ferreyra C, Ashley EA, Simpson AJH. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac006. [PMID: 35146428 PMCID: PMC8826549 DOI: 10.1093/jacamr/dlac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Abstract
Background There is a need for simple microbiology diagnostics to enable antimicrobial resistance surveillance in low- and middle-income countries. Objectives To investigate the field utility of InTray COLOREX plates for urine culture and ESBL detection. Methods Clinical urine samples from Mahosot Hospital, Vientiane, Lao PDR were inoculated onto chromogenic media and InTray COLOREX Screen plates between June and August 2020. Urine and isolates from other clinical specimens were inoculated onto COLOREX ESBL plates. A simulated field study investigating the field utility of the InTray COLOREX plates was also completed. Results In total, 355 urine samples were inoculated onto standard chromogenic agar and InTray COLOREX Screen plates, and 154 urine samples and 54 isolates from other clinical specimens on the COLOREX ESBL plates. Growth was similar for the two methods (COLOREX Screen 41%, standard method 38%) with 20% discordant results, mainly due to differences in colony counts or colonial appearance. Contamination occurred in 13% of samples, with the COLOREX Screen plates showing increased contamination rates, potentially due to condensation. ESBL producers were confirmed from 80% of isolates from the COLOREX ESBL plates, and direct plating provided rapid detection of presumptive ESBL producers. Burkholderia pseudomallei also grew well on the ESBL plates, a relevant finding in this melioidosis-endemic area. Conclusions The InTray COLOREX Screen and ESBL plates were simple to use and interpret, permitting rapid detection of uropathogens and ESBLs, and have the potential for easy transport and storage from field sites and use in laboratories with low capacity.
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Affiliation(s)
- Tamalee Roberts
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Corresponding author. E-mail:
| | - Joy Silisouk
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Davanh Sengdatka
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Bountoy Sibounheuang
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Ranoy Seljuk
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Xao Vang
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Amphonesavanh Sengduangphachanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Viengmon Davong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | | | | | - Elizabeth A. Ashley
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew J. H. Simpson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Dramowski A, Aucamp M, Beales E, Bekker A, Cotton MF, Fitzgerald FC, Labi AK, Russell N, Strysko J, Whitelaw A, Coffin S. Healthcare-Associated Infection Prevention Interventions for Neonates in Resource-Limited Settings. Front Pediatr 2022; 10:919403. [PMID: 35874586 PMCID: PMC9301049 DOI: 10.3389/fped.2022.919403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Healthcare-associated infections (HAIs) and antimicrobial-resistant (AMR) infections are leading causes of neonatal morbidity and mortality, contributing to an extended hospital stay and increased healthcare costs. Although the burden and impact of HAI/AMR in resource-limited neonatal units are substantial, there are few HAI/AMR prevention studies in these settings. We reviewed the mechanism of action and evidence supporting HAI/AMR prevention interventions, including care bundles, for hospitalized neonates in low- and middle-income countries (LMIC).
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Affiliation(s)
- Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marina Aucamp
- Infection Prevention and Control Service, Mowbray Maternity Hospital, Cape Town, South Africa
| | - Emily Beales
- Center for Neonatal and Pediatric Infection, St George's University of London, London, United Kingdom
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mark Frederic Cotton
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Felicity C Fitzgerald
- Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Appiah-Korang Labi
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Neal Russell
- Center for Neonatal and Pediatric Infection, St George's University of London, London, United Kingdom
| | - Jonathan Strysko
- Department of Paediatric and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana.,Department of Global Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Andrew Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Susan Coffin
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Verna R, Alallon W, Murakami M, Hayward CPM, Harrath AH, Alwasel SH, Sumita NM, Alatas O, Fedeli V, Sharma P, Fuso A, Capuano DM, Capalbo M, Angeloni A, Bizzarri M. Analytical Performance of COVID-19 Detection Methods (RT-PCR): Scientific and Societal Concerns. Life (Basel) 2021; 11:660. [PMID: 34357032 PMCID: PMC8305061 DOI: 10.3390/life11070660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022] Open
Abstract
Background. Health and social management of the SARS-CoV-2 epidemic, responsible for the COVID-19 disease, requires both screening tools and diagnostic procedures. Reliable screening tests aim at identifying (truely) infectious individuals that can spread the viral infection and therefore are essential for tracing and harnessing the epidemic diffusion. Instead, diagnostic tests should supplement clinical and radiological findings, thus helping in establishing the diagnosis. Several analytical assays, mostly using RT-PCR-based technologies, have become commercially available for healthcare workers and clinical laboratories. However, such tests showed some critical limitations, given that a relevant number of both false-positive and false-negative cases have been so far reported. Moreover, those analytical techniques demonstrated to be significantly influenced by pre-analytical biases, while the sensitivity showed a dramatic time dependency. Aim. Herein, we critically investigate limits and perspectives of currently available RT-PCR techniques, especially when referring to the required performances in providing reliable epidemiological and clinical information. Key Concepts. Current data cast doubt on the use of RT-PCR swabs as a screening procedure for tracing the evolution of the current SARS-COV-2 pandemic. Indeed, the huge number of both false-positive and false-negative results deprives the trustworthiness of decision making based on those data. Therefore, we should refine current available analytical tests to quickly identify individuals able to really transmit the virus, with the aim to control and prevent large outbreaks.
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Affiliation(s)
- Roberto Verna
- In Unam Sapientiam, 00185 Rome, Italy;
- WASPaLM, CT Corporation, P.O. Box 4349, Carol Stream, IL 60197-4349, USA;
- Academy for Health and Clinical Research, 00185 Rome, Italy
| | - Walter Alallon
- Department of Clinical Laboratory, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo 11000, Uruguay;
| | - Masami Murakami
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan;
| | - Catherine P. M. Hayward
- Health Science Center, Departments of Pathology and Molecular Medicine, and Medicine, Room 2N29A, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada;
| | - Abdel Halim Harrath
- Department of Zoology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (A.H.H.); (S.H.A.)
| | - Saleh H. Alwasel
- Department of Zoology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (A.H.H.); (S.H.A.)
| | - Nairo M. Sumita
- Grupo Fleury, Central Laboratory Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05508, Brazil;
| | - Ozkan Alatas
- Department of Medical Biochemistry, Eskisehir Osmangazi University Medical School, Eskisehir 33400, Turkey;
| | - Valeria Fedeli
- Department of Experimental Medicine, Sapienza University, 00160 Rome, Italy; (V.F.); (A.F.); (A.A.)
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur 342005, India;
| | - Andrea Fuso
- Department of Experimental Medicine, Sapienza University, 00160 Rome, Italy; (V.F.); (A.F.); (A.A.)
| | - Daniela Maria Capuano
- WASPaLM, CT Corporation, P.O. Box 4349, Carol Stream, IL 60197-4349, USA;
- Academy for Health and Clinical Research, 00185 Rome, Italy
| | - Maria Capalbo
- Azienda Ospedaliera Ospedali Riuniti Marche Nord (DG), 61121 Pesaro, Italy;
| | - Antonio Angeloni
- Department of Experimental Medicine, Sapienza University, 00160 Rome, Italy; (V.F.); (A.F.); (A.A.)
| | - Mariano Bizzarri
- Department of Experimental Medicine, Sapienza University, 00160 Rome, Italy; (V.F.); (A.F.); (A.A.)
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35
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Malania L, Wagenaar I, Karatuna O, Tambic Andrasevic A, Tsereteli D, Baidauri M, Imnadze P, Nahrgang S, Ruesen C. Setting up laboratory-based antimicrobial resistance surveillance in low- and middle-income countries: lessons learned from Georgia. Clin Microbiol Infect 2021; 27:1409-1413. [PMID: 34044149 DOI: 10.1016/j.cmi.2021.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/08/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a growing problem worldwide, with an estimated high burden in low- and middle-income countries (LMICs). In these settings, tackling the problem of AMR is often constrained by a lack of reliable surveillance data due to limited use of microbiological diagnostics in clinical practice. OBJECTIVES The aim of this article is to present an overview of essential elements for setting up an AMR surveillance system in LMICs, to summarize the steps taken to develop such a system in the country of Georgia, and to describe its impact on microbiology laboratories. SOURCES A literature review of published papers using PubMed and experiences of experts involved in setting up AMR surveillance in Georgia. CONTENT Basic requirements for implementing a laboratory-based surveillance system in LMICs can be captured under four pillars: (a) governmental support, (b) laboratory capacity and quality management, (c) materials and supplies, and (d) sample collection, data management, analysis and reporting. In Georgia, the World Health Organization Proof-of-Principle project helped to start the collection of AMR surveillance data on a small scale by promoting the use of microbiological diagnostics in clinics, and by providing training and materials for laboratories. Thanks to governmental support and a strong lead by the national reference laboratory, the AMR surveillance network was sustained and expanded after the project ended. IMPLICATIONS This review describes the Georgian approach in building and expanding a functional AMR surveillance system, considering the elements identified from the literature. The introduction of quality management systems, standardization of guidelines and training paired with targeted capacity building led to improved laboratory standards and management of patients with bloodstream infections. Reliable AMR surveillance data may inform and facilitate policy-making on AMR control. The Georgian experience can guide other countries in the process of building up their national AMR surveillance system.
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Affiliation(s)
- Lile Malania
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | - Inge Wagenaar
- Centre for Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Onur Karatuna
- EUCAST Development Laboratory, Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Arjana Tambic Andrasevic
- University Hospital for Infectious Diseases, Zagreb, University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - David Tsereteli
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | - Marine Baidauri
- Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia, Georgia
| | - Paata Imnadze
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Carolien Ruesen
- Centre for Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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von Laer A, N'Guessan MA, Touré FS, Nowak K, Groeschner K, Ignatius R, Friesen J, Tomczyk S, Leendertz FH, Eckmanns T, Akoua-Koffi C. Implementation of Automated Blood Culture With Quality Assurance in a Resource-Limited Setting. Front Med (Lausanne) 2021; 8:627513. [PMID: 34095162 PMCID: PMC8176090 DOI: 10.3389/fmed.2021.627513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Blood cultures (BC) have a high clinical relevance and are a priority specimen for surveillance of antimicrobial resistance. Manual BC are still most frequently used in resource-limited settings. Data on automated BC performance in Africa are scarce. We implemented automated BC at a surveillance site of the African Network for improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA). Methods: Between June 2017 and January 2018, pairs of automated BC (BacT/ALERT®FA Plus) and manual BC (brain-heart infusion broth) were compared at a University hospital in Bouaké, Côte d'Ivoire. BC were inoculated each with a target blood volume of 10 ml from the same venipuncture. Automated BC were incubated for up to 5 days, manual BC for up to 10 days. Terminal subcultures were performed for manual BC only. The two systems were compared regarding yield, contamination, and turnaround time. For quality assurance, isolates were retested in a German routine microbiological laboratory. Results: BC sampling was increased from on average 24 BC to 63 BC per month. A total of 337 matched pairs of BC were included. Automated BC was positive in 36.5%, manual BC in 24.0% (p-value < 0.01), proportion of contamination was 47.9 and 43.8%, respectively (p-value = 1.0). Turnaround time of positive BC was shortened by 2.5 days with automated compared to manual BC (p < 0.01). Most common detected pathogens in both systems were Klebsiella spp. (26.0%) and Staphylococcus aureus (18.2%). Most contaminants were members of the skin flora. Retesting of 162 isolates was concordant in 79.6% on family level. Conclusions: Implementing automated BC in a resource-limited setting is possible and improves microbiological diagnostic performance. Automated BC increased yield and shortened turnaround times. Regular training and mentorship of clinicians has to be intensified to increase number and quality of BC. Pre-analytical training to improve diagnostic stewardship is essential when implementing a new microbiological method. Retesting highlighted that manual identification and antimicrobial susceptibility testing can be of good quality and sustainable. The implementation of automated tools should be decided individually according to economic considerations, number of samples, stable supply chain of consumables, and technical sustainability.
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Affiliation(s)
- Anja von Laer
- Postgraduate Training for Applied Epidemiology, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Fidèle Sounan Touré
- Laboratoire Central, Centre Hospitalier et Universitaire de Bouaké, Bouaké, Côte d'Ivoire
| | - Kathrin Nowak
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Karin Groeschner
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ralf Ignatius
- Department of Microbiology, Medical Care Unit Labor 28 GmbH, Berlin, Germany
| | - Johannes Friesen
- Department of Microbiology, Medical Care Unit Labor 28 GmbH, Berlin, Germany
| | - Sara Tomczyk
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Fabian H Leendertz
- Research Group Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Chantal Akoua-Koffi
- Laboratoire Central, Centre Hospitalier et Universitaire de Bouaké, Bouaké, Côte d'Ivoire
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Orekan J, Barbé B, Oeng S, Ronat JB, Letchford J, Jacobs J, Affolabi D, Hardy L. Culture media for clinical bacteriology in low- and middle-income countries: challenges, best practices for preparation and recommendations for improved access. Clin Microbiol Infect 2021; 27:1400-1408. [PMID: 34015533 DOI: 10.1016/j.cmi.2021.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Culture media are fundamental in clinical microbiology. In laboratories in low- and middle-income countries (LMICs), they are mostly prepared in-house, which is challenging. OBJECTIVES This narrative review describes challenges related to culture media in LMICs, compiles best practices for in-house media preparation, gives recommendations to improve access to quality-assured culture media products in LMICs and formulates outstanding questions for further research. SOURCES Scientific literature was searched using PubMed and predefined MeSH terms. In addition, grey literature was screened, including manufacturer's websites and manuals as well as microbiology textbooks. CONTENT Bacteriology laboratories in LMICs often face challenges at multiple levels: lack of clean water and uninterrupted power supply, high environmental temperatures and humidity, dust, inexperienced and poorly trained staff, and a variable supply of consumables (often of poor quality). To deal with this at a base level, one should be very careful in selecting culture media. It is recommended to look for products supported by the national reference laboratory that are being distributed by an in-country supplier. Correct storage is key, as is appropriate preparation and waste management. Centralized media acquisition has been advocated for LMICs, a role that can be taken up by the national reference laboratories, next to guidance and support of the local laboratories. In addition, there is an important role in tropicalization and customization of culture media formulations for private in vitro diagnostic manufacturers, who are often still unfamiliar with the LMIC market and the plethora of bacteriology products. IMPLICATION The present narrative review will assist clinical microbiology laboratories in LMICs to establish best practices for handling culture media by defining quality, regulatory and research paths.
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Affiliation(s)
- Jeanne Orekan
- Clinical Microbiology, Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, Benin
| | - Barbara Barbé
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Sopheap Oeng
- Laboratory Department, Diagnostic Microbiology Development Program, Phnom Penh, Cambodia
| | - Jean-Baptiste Ronat
- Mini-Lab Project, Médecins Sans Frontières, Paris, France; Team ReSIST, INSERM U1184, School of Medicine University Paris-Saclay, France; Bacteriology-Hygiene Unit, Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Joanne Letchford
- Laboratory Department, Diagnostic Microbiology Development Program, Phnom Penh, Cambodia
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Dissou Affolabi
- Clinical Microbiology, Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, Benin
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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38
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Asif M, Awan FR, Khan QM, Ngamsom B, Pamme N. Paper-based analytical devices for colorimetric detection of S. aureus and E. coli and their antibiotic resistant strains in milk. Analyst 2021; 145:7320-7329. [PMID: 32902519 DOI: 10.1039/d0an01075h] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Animal derived milk which is an important part of human diet due to its high nutritional value not only supports humans but also presents a growth environment for pathogenic bacteria. Milk may become contaminated with bacteria through udder infections or through contact within the dairy farm environment. Infections are treated with antibiotics, with β-lactams most commonly used in veterinary medicine. However, their frequent use leads to the emergence of β-lactam resistant bacterial strains, which causes difficulties in the treatment of infections in both humans and animals. Detection of pathogens as well as their antibiotic sensitivity is a pre-requisite for successful treatment and this is generally achieved with laboratory-based techniques such as growth inhibition assays, enzyme-linked immunosorbent assays (ELISA) or polymerase chain reactions (PCRs), which are unavailable in resource-limited settings. Here, we investigated paper-based analytical devices (μPADs) for the presumptive detection of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) and their antibiotic resistant bacterial strains in milk samples. The μPADs were fabricated on filter paper using wax printing, and then impregnated with chromogenic substrates, which reacted with bacterial enzymes to form coloured products. Limits of detection of S. aureus and E. coli and their antibiotic resistant strains in milk samples were found to be 106 cfu mL-1. Enrichment of milk samples in a selective medium for 12 h enabled detection as low as 10 cfu mL-1. The paper devices tested on a set of 640 milk samples collected from dairy animals in Pakistan demonstrated more than 90% sensitivity and 100% selectivity compared to PCR, showing promise to provide inexpensive and portable diagnostic solutions for the detection of pathogenic bacteria in resource-limited settings.
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Affiliation(s)
- Muhammad Asif
- National Institute for Biotechnology and Genetic Engineering (NIBGE), Jhang Road, Faisalabad, Punjab 44000, Pakistan
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39
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Gomez-Marquez J, Hamad-Schifferli K. Local development of nanotechnology-based diagnostics. NATURE NANOTECHNOLOGY 2021; 16:484-486. [PMID: 33846590 DOI: 10.1038/s41565-021-00907-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Affiliation(s)
- Jose Gomez-Marquez
- Little Devices Lab, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Kimberly Hamad-Schifferli
- Department of Engineering, School for the Environment, University of Massachusetts Boston, Boston, MA, USA.
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40
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Vandenberg O, Martiny D, Rochas O, van Belkum A, Kozlakidis Z. Considerations for diagnostic COVID-19 tests. Nat Rev Microbiol 2021; 19:171-183. [PMID: 33057203 PMCID: PMC7556561 DOI: 10.1038/s41579-020-00461-z] [Citation(s) in RCA: 447] [Impact Index Per Article: 149.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
During the early phase of the coronavirus disease 2019 (COVID-19) pandemic, design, development, validation, verification and implementation of diagnostic tests were actively addressed by a large number of diagnostic test manufacturers. Hundreds of molecular tests and immunoassays were rapidly developed, albeit many still await clinical validation and formal approval. In this Review, we summarize the crucial role of diagnostic tests during the first global wave of COVID-19. We explore the technical and implementation problems encountered during this early phase in the pandemic, and try to define future directions for the progressive and better use of (syndromic) diagnostics during a possible resurgence of COVID-19 in future global waves or regional outbreaks. Continuous global improvement in diagnostic test preparedness is essential for more rapid detection of patients, possibly at the point of care, and for optimized prevention and treatment, in both industrialized countries and low-resource settings.
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Affiliation(s)
- Olivier Vandenberg
- Innovation and Business Development Unit, Laboratoire Hospitalier Universtaire de Bruxelles - Universitair Laboratorium Brussel, Université Libre de Bruxelles, Brussels, Belgium.
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, UK.
| | - Delphine Martiny
- Department of Microbiology, Laboratoire Hospitalier Universtaire de Bruxelles - Universitair Laboratorium Brussel, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Rochas
- Strategic Intelligence, Corporate Business Development, bioMérieux, Chemin de L'Orme, France
| | - Alex van Belkum
- Open Innovation and Partnerships, bioMérieux, La Balme Les Grottes, France.
| | - Zisis Kozlakidis
- Laboratory Services and Biobank Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
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Ombelet S, Natale A, Ronat JB, Vandenberg O, Hardy L, Jacobs J. Evaluation of MicroScan Bacterial Identification Panels for Low-Resource Settings. Diagnostics (Basel) 2021; 11:349. [PMID: 33669829 PMCID: PMC7922174 DOI: 10.3390/diagnostics11020349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
Bacterial identification is challenging in low-resource settings (LRS). We evaluated the MicroScan identification panels (Beckman Coulter, Brea, CA, USA) as part of Médecins Sans Frontières' Mini-lab Project. The MicroScan Dried Overnight Positive ID Type 3 (PID3) panels for Gram-positive organisms and Dried Overnight Negative ID Type 2 (NID2) panels for Gram-negative organisms were assessed with 367 clinical isolates from LRS. Robustness was studied by inoculating Gram-negative species on the Gram-positive panel and vice versa. The ease of use of the panels and readability of the instructions for use (IFU) were evaluated. Of species represented in the MicroScan database, 94.6% (185/195) of Gram-negative and 85.9% (110/128) of Gram-positive isolates were correctly identified up to species level. Of species not represented in the database (e.g., Streptococcus suis and Bacillus spp.), 53.1% out of 49 isolates were incorrectly identified as non-related bacterial species. Testing of Gram-positive isolates on Gram-negative panels and vice versa (n = 144) resulted in incorrect identifications for 38.2% of tested isolates. The readability level of the IFU was considered too high for LRS. Inoculation of the panels was favorably evaluated, whereas the visual reading of the panels was considered error-prone. In conclusion, the accuracy of the MicroScan identification panels was excellent for Gram-negative species and good for Gram-positive species. Improvements in stability, robustness, and ease of use have been identified to assure adaptation to LRS constraints.
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Affiliation(s)
- Sien Ombelet
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (L.H.); (J.J.)
- Immunology & Microbiology Department, KU Leuven, 3000 Leuven, Belgium
| | - Alessandra Natale
- Médecins Sans Frontières, Operational Center Paris, 75019 Paris, France; (A.N.); (J.-B.R.)
| | - Jean-Baptiste Ronat
- Médecins Sans Frontières, Operational Center Paris, 75019 Paris, France; (A.N.); (J.-B.R.)
- Team ReSIST, INSERM U1184, School of Medicine, University Paris-Saclay, 94807 Villejuif, France
- Bacteriology-Hygiene Unit, Assistance Publique—Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Olivier Vandenberg
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium;
- Innovation and Business Development Unit, Laboratoire Hospitalier Universitaire de Bruxelles—Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London WC1E 6BT, UK
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (L.H.); (J.J.)
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (L.H.); (J.J.)
- Immunology & Microbiology Department, KU Leuven, 3000 Leuven, Belgium
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42
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Jacobs J, Kühne V, Lunguya O, Affolabi D, Hardy L, Vandenberg O. Implementing COVID-19 (SARS-CoV-2) Rapid Diagnostic Tests in Sub-Saharan Africa: A Review. Front Med (Lausanne) 2020; 7:557797. [PMID: 33195307 PMCID: PMC7662157 DOI: 10.3389/fmed.2020.557797] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/15/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction: For the COVID-19 (SARS-CoV-2) response, COVID-19 antigen (Ag), and antibody (Ab) rapid diagnostic tests (RDTs) are expected to complement central molecular testing particularly in low-resource settings. The present review assesses requirements for implementation of COVID-19 RDTs in sub-Saharan Africa. Methods: Review of PubMed-published articles assessing COVID-19 RDTs complemented with Instructions for Use (IFU) of products. Results: In total 47 articles on two COVID-19 Ag RDTs and 54 COVID-19 Ab RDTs and IFUs of 20 COVID-19 Ab RDTs were retrieved. Only five COVID-19 Ab RDTs (9.3%) were assessed with capillary blood sampling at the point-of-care; none of the studies were conducted in sub-Saharan Africa. Sampling: Challenges for COVID-19 Ag RDTs include nasopharyngeal sampling (technique, biosafety) and sample stability; for COVID-19 Ab RDTs equivalence of whole blood vs. plasma/serum needs further validation (assessed for only eight (14.8%) products). Sensitivity-Specificity: sensitivity of COVID-19 Ag and Ab RDTs depend on viral load (antigen) and timeframe (antibody), respectively; COVID-19 Ab tests have lower sensitivity compared to laboratory test platforms and the kinetics of IgM and IgG are very similar. Reported specificity was high but has not yet been assessed against tropical pathogens. Kit configuration: For COVID-19 Ag RDTs, flocked swabs should be added to the kit; for COVID-19 Ab RDTs, finger prick sampling materials, transfer devices, and controls should be added (currently only supplied in 15, 5, and 1/20 products). Usability and Robustness: some COVID-19 Ab RDTs showed high proportions of faint lines (>40%) or invalid results (>20%). Shortcomings were reported for buffer vials (spills, air bubbles) and their instructions for use. Stability: storage temperature was ≤ 30°C for all but one RDT, in-use and result stability were maximal at 1 h and 30 min, respectively. Integration in the healthcare setting requires a target product profile, landscape overview of technologies, certified manufacturing capacity, a sustainable market, and a stringent but timely regulation. In-country deployment depends on integration in the national laboratory network. Discussion/Conclusion: Despite these limitations, successful implementation models in triage, contact tracing, and surveillance have been proposed, in particular for COVID-19 Ab RDTs. Valuable experience is available from implementation of other disease-specific RDTs in sub-Saharan Africa.
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Affiliation(s)
- Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Vera Kühne
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Octavie Lunguya
- Department of Clinical Microbiology, National Institute of Biomedical Research, Kinshasa, Democratic Republic of Congo
- Microbiology Unit, Department of Clinical Biology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dissou Affolabi
- Clinical Microbiology, Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Olivier Vandenberg
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Innovation and Business Development Unit, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), ULB, Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
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Jayatilleke K. Challenges in Implementing Surveillance Tools of High-Income Countries (HICs) in Low Middle Income Countries (LMICs ). CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020; 12:191-201. [PMID: 32874140 PMCID: PMC7453076 DOI: 10.1007/s40506-020-00229-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose of Review Surveillance of communicable diseases is essential in all countries to prevent and control infections, to detect outbreaks and also to see the effects of interventions. The data should be reliable, and collection, analysis and feedback as well as the action based on this data should be fast. In this article, author discusses the limitations the Low Middle income Countries (LMICs) have in implementing disease surveillance and some suggestions for improvement. Recent Findings Integrated Disease Surveillance and Response (IDSR) has been implemented successfully through most of the countries in Africa though they belong to low or LMIC. Major barriers for surveillance of Healthcare Associated Infections in LMICs are non-availability of adequate number of healthcare personnel such as infection control personnel as well as not having an integrated healthcare system with an effective data flow. For some infections, not having proper diagnostic facilities is a major obstacle. An important capacity limitation in clinical laboratories of LMICs is identification of antimicrobial resistant organisms as well as other pathogens to species level. This affects the surveillance of infections and antimicrobial resistance. Summary Use of modern technology, capacity building including the human resources as well as the laboratory capacity in healthcare setting, improving data communication methods, are the main recommendations made. Education and training of healthcare staff as well as educating the general public to change the attitudes of people is another aspect that we need to concentrate.
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Semret M, Abebe W, Kong LY, Alemayehu T, Beyene T, Libman MD, Amogne W, Johannsen ØH, Gebretekle GB, Seifu D, Yansouni CP. Prolonged empirical antibiotic therapy is correlated with bloodstream infections and increased mortality in a tertiary care hospital in Ethiopia: bacteriology testing matters. JAC Antimicrob Resist 2020; 2:dlaa039. [PMID: 34240055 DOI: 10.1093/jacamr/dlaa039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/25/2020] [Accepted: 04/05/2020] [Indexed: 12/31/2022] Open
Abstract
Background Hospital-associated infection (HAI) and antimicrobial resistance (AMR) are major health threats in low- and middle-income countries (LMICs). Because diagnostic capacity is lacking throughout most of Africa, patients are commonly managed with prolonged empirical antibiotic therapy. Our goal was to assess mortality in relation to HAI and empirical therapy in Ethiopia's largest referral hospital. Methods Cohort study of patients with suspected HAI at Tikur Anbessa Specialized Hospital from October 2016 to October 2018. Blood culture testing was performed on an automated platform. Primary outcomes were proportion of patients with bloodstream infection (BSI), antibiotic resistance patterns and 14 day mortality. We also assessed days of therapy (DOT) pre- and post-blood culture testing. Results Of 978 enrolled patients, 777 had blood culture testing; 237 (30%) had a BSI. Enterobacteriaceae were isolated in 49%; 81% of these were cephalosporin resistant and 23% were also carbapenem resistant. Mortality at 14 days was 31% and 21% in those with and without BSI, respectively. Ceftriaxone resistance was strongly correlated with mortality. Patients with BSI had longer DOT pre-blood culture testing compared with those without BSI (median DOT 12 versus 3 days, respectively, P < 0.0001). After testing, DOT were comparable between the two groups (20 versus 18 days, respectively). Conclusions BSI are frequent and fatal among patients with suspected HAI in Ethiopia. Highly resistant blood isolates are alarmingly common. This study provides evidence that investing in systematic blood culture testing in LMICs identifies patients at highest risk of death and that empirical management is frequently inappropriate. Major investments in laboratory development are critical to achieve better outcomes.
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Affiliation(s)
- Makeda Semret
- Department of Medicine and JD MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | - Workeabeba Abebe
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ling Yuan Kong
- Department of Medicine and JD MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tinsae Alemayehu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Temesgen Beyene
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael D Libman
- Department of Medicine and JD MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | - Daniel Seifu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Cedric P Yansouni
- Department of Medicine and JD MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada
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Natale A, Ronat JB, Mazoyer A, Rochard A, Boillot B, Hubert J, Baillet B, Ducasse M, Mantelet F, Oueslati S, Ombelet S, Langendorf C, Naas T, Vandenberg O, Jacobs J. The Mini-Lab: accessible clinical bacteriology for low-resource settings. LANCET MICROBE 2020; 1:e56-e58. [DOI: 10.1016/s2666-5247(20)30012-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/15/2022]
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Resman F. Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program. Ther Adv Infect Dis 2020; 7:2049936120933187. [PMID: 32612826 PMCID: PMC7307277 DOI: 10.1177/2049936120933187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022] Open
Abstract
Regardless of one's opinion of antimicrobial stewardship programs (ASPs), it is hardly possible to work in hospital care and not be exposed to the term or its practical effects. Despite the term being relatively new, the number of publications in the field is vast, including several excellent reviews of general and specific aspects. Work in antimicrobial stewardship is complex, and includes not only aspects of infectious disease and microbiology, but also of epidemiology, genetics, behavioural psychology, systems science, economics and ethics, to name a few. This review aims to take several of these aspects and the scientific evidence of antimicrobial stewardship studies and merge them into two questions: How should we design ASPs based on what we know today? And which are the most essential unanswered questions regarding antimicrobial stewardship on a broader scale? This narrative review is written in two separate parts aiming to provide answers to the two questions. This first part is written as a step-wise approach to designing a stewardship intervention based on the pillars of unmet need, feasibility, scientific evidence and necessary core elements. It is written mainly as a guide to someone new to the field. It is sorted into five distinct steps: (a) focusing on designing aims; (b) assessing performance and local barriers to rational antimicrobial use; (c) deciding on intervention technique; (d) practical, tailored design including core element inclusion; and (e) evaluation and sustainability. The second part, published separately, formulates ten critical questions on controversies in the field of antimicrobial stewardship. It is aimed at clinicians and researchers with stewardship experience and strives to promote discussion, not to provide answers.
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Affiliation(s)
- Fredrik Resman
- Department of Translational Medicine, Clinical
Infection Medicine, Lund University, Rut Lundskogs Gata 3, Plan 6, Malmö, 20502,
Sweden
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