1
|
Sunpuwan M, Punpuing S, Jaruruengpaisan W, Wertheim H. Understanding antibiotic use in the community setting in Thailand: Does communication matter? PLoS One 2024; 19:e0298972. [PMID: 38564533 PMCID: PMC10986969 DOI: 10.1371/journal.pone.0298972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND It is known that the misuse and overuse of antimicrobials leads to antimicrobial resistance (AMR). Effective communication between dispensers and users is thus crucial in reducing inappropriate antibiotic use. OBJECTIVE This study aims to gain a better understanding of communication around the use of antibiotics in the community and seeks potential implementation strategies to change dispenser and user practices in communication aspects. METHODS Qualitative methods were employed, including in-depth interviews with 18 drug suppliers and 16 community members, and eight focus group discussions with key informants. Data were collected in the Kanchanaburi Demographic Health Surveillance System in urban and semi-urban communities in the western region of Thailand. The thematic analysis included communication quality, communication and imbalanced power, and misconceptions and instruction. The OpenCode qualitative software program was employed. RESULTS The study revealed that the quality of communication was significantly influenced by the interaction of antibiotic dispensing with language and information. This interaction creates communication constraints between those dispensing antibiotics and the recipients, resulting in a less-than-optimal exchange of information. Consequently, users received limited information concerning the proper use of antibiotics. Furthermore, power imbalances and communication dynamics were perpetuated, mainly stemming from varying levels of access to and knowledge about antibiotics. This imbalance in power dynamics became evident between those dispensing antibiotics and the users. Users, as well as dispensers lacking proper qualifications, found themselves in a precarious position due to their inadequate knowledge of antibiotics. Moreover, it is noteworthy that misconceptions often conflicted with antibiotic instructions, leading to challenges in adhering to antibiotic regimens. These challenges primarily arose from misconceptions about antibiotics and concerns about potential side effects, particularly when users started to feel better. CONCLUSIONS The findings highlight the importance of enhancing communication between dispensers and users through future interventions. These interventions should aim to bolster user understanding of antibiotics and provide clear, trustworthy instructions for their proper usage. Investigating innovative communication methods, such as the use of QR codes, presents a promising avenue for consideration. By addressing these communication gaps, we can advocate for the appropriate utilization of antibiotics and mitigate the prevalence of AMR.
Collapse
Affiliation(s)
- Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Phutthamonthon, Thailand
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Phutthamonthon, Thailand
| | | | - Heiman Wertheim
- Department of Clinical Microbiology, Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| |
Collapse
|
2
|
Lenglet A, Contigiani O, Ariti C, Evens E, Charles K, Casimir CF, Delva RS, Badjo C, Roggeveen H, Pawulska B, Clezy K, McRae M, Wertheim H, Hopman J. Correction: Early warning for healthcare acquired infections in neonatal care units in a low-resource setting using routinely collected hospital data: The experience from Haiti, 2014-2018. PLoS One 2024; 19:e0298987. [PMID: 38346067 PMCID: PMC10861029 DOI: 10.1371/journal.pone.0298987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0269385.].
Collapse
|
3
|
Asmarawati TP, Djojodimedjo T, Andhika DP, Rusli M, Qibtiyah M, Mahdi BA, Novendrianto D, Martani OS, Paraton H, Wertheim H, Kuntaman K. The use of antibiotic prophylaxis in patients undergoing urologic procedures in an academic hospital Surabaya: A retrospective study. J Infect Dev Ctries 2023; 17:874-880. [PMID: 37406058 DOI: 10.3855/jidc.17180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/20/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Prophylactic antibiotics in urological procedures are essential to prevent postoperative infections. A different approach in selecting antibiotic prophylaxis according to the type of procedure is needed. METHODOLOGY A retrospective study was carried out at an academic hospital in Surabaya, Indonesia, by collecting medical records of patients who underwent urologic procedures within 2019- 2020, including microbiological data. RESULT One hundred seventy-nine urological procedures were assessed. Antibiotic prophylaxis was administered in the clean-contaminated and clean procedures (93.2% and 6.8%, respectively). Ceftriaxone was commonly used (69.3%), single-dose, one day before the surgery. Gram-negative bacteria were widely found in the urinary culture of patients (75.2%). E. coli, K. pneumoniae, and P. aeruginosa were dominating with low susceptibility to cephalosporins. ESBL-producing bacteria were E. coli (64%) and K. pneumoniae (89%). CONCLUSIONS The 3rd generation cephalosporins (ceftriaxone) are mostly used in urological procedures despite the low susceptibility against this antibiotic in cultured E coli, P. aeruginosa, and K. pneumonia. The aminoglycosides have relatively good activity and have been suggested in several guidelines for urologic procedures, such as prostate and urinary tract stone procedures. It is crucial to consider the incision site, type of procedure, and bacterial profile in the hospital to propose antibiotic prophylaxis guidelines.
Collapse
Affiliation(s)
- Tri Pudy Asmarawati
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Musofa Rusli
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Bagus Aulia Mahdi
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Dwiki Novendrianto
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Okla Sekar Martani
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Hari Paraton
- Department of Obstetrics and Gynecology, Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Heiman Wertheim
- Department of Microbiology, Radboud UMC, Nijmegen, Netherland
| | - Kuntaman Kuntaman
- Department of Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
4
|
Eikelenboom-Boskamp A, den Ouden M, de Groot T, Stobernack T, Wertheim H, Voss A. Evaluation of the Abbott Panbio™ COVID-19 antigen detection rapid diagnostic test among healthcare workers in elderly care. PLoS One 2023; 18:e0276244. [PMID: 36827362 PMCID: PMC9955641 DOI: 10.1371/journal.pone.0276244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/12/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been especially dangerous for elderly people. To reduce the risk of transmission from healthcare workers to elderly people, it is of utmost importance to detect possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive healthcare workers as early as possible. We aimed to determine whether the Abbott Panbio™ COVID-19 antigen detection rapid diagnostic test (Ag-RDT) could be used as an alternative to reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The second aim was to compare the cycle threshold (Ct) in RT-qPCR with the results of the Ag-RDT. METHODS A prospective diagnostic evaluation of the Abbott Panbio™ COVID-19 Ag-RDT among healthcare workers across three elderly care facilities as well as home-based elderly care workers who met clinical criteria for COVID-19 during the second wave of the COVID-19 pandemic. Per healthcare worker, the first nasopharyngeal swab was obtained to perform the Ag-RDT and the second swab for RT-qPCR. A Ct-value of < 40 was interpreted as positive, ≥ 40 as negative. RESULTS A total of 683 healthcare workers with COVID-19 symptoms were sampled for detection of SARS-CoV-2 by both Ag-RDT and RT-qPCR. Sixty-three healthcare workers (9.2%) tested positive for SARS-CoV-2 by RT-qPCR. The overall sensitivity of Ag-RDT was 81.0% sensitivity (95%CI: 69.6-88.8%) and 100% specificity (95%CI: 99.4-100%). Using a cut-off Ct-value of 32, the sensitivity increased to 92.7% (95% CI: 82.7-97.1%). Negative Ag-RDT results were moderately associated with higher Ct-values (r = 0.62) compared to positive Ag-RDT results. CONCLUSION The Panbio™ COVID-19 Ag-RDT can be used to quickly detect positive SARS-CoV-2 healthcare workers. Negative Ag-RDT should be confirmed by RT-qPCR. In case of severe understaffing and with careful consideration, fully vaccinated healthcare workers with Ag-RDT negative results could work with a mask pending PCR results.
Collapse
Affiliation(s)
- Andrea Eikelenboom-Boskamp
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- * E-mail:
| | - Martijn den Ouden
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Tim Stobernack
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
5
|
de la Court JR, Woudt SHS, Schoffelen AF, Heijmans J, de Jonge NA, van der Bruggen T, Bomers MK, Lambregts MMC, Schade RP, Sigaloff KCE, Stuart JWTC, Melles DC, van Dijk K, Alzubaidy A, Werdmuller BFM, Blaauw GJ, Diederen BMW, Alblas HJ, der Kuil WAV, Bierman SM, de Greeff SC, Groenendijk SR, Hertroys R, Kuijper EJ, Monen JC, Notermans DW, van den Reek WJ, Smilde AE, Wielders CCH, Zoetigheid RE, van den Bijllaardt W, Kraan EM, Mattsson EE, da Silva JM, de Jong E, Maraha B, van Asselt GJ, Demeulemeester A, Wintermans BB, van Trijp M, Ott A, Sinnige J, Melles DC, Silvis W, Bakker LJ, Dorigo-Zetsma JW, Waar K, Bernards AT, Hall MALV, Schaftenaar E, Nabuurs-Franssen MH, Wertheim H, Diederen BMW, Bode L, van Rijn M, Dinant S, Pontesilli O, de Man P, Wong M, Muller AE, Renders NH, Bentvelsen RG, Buiting AGM, Vlek ALM, Stam AJ, Troelstra A, Overdevest ITMA, van Meer MPA, dos Santos CO, Wolfhagen MJHM. Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy; an 11-year multi-centre retrospective study. Ann Clin Microbiol Antimicrob 2022; 21:54. [DOI: 10.1186/s12941-022-00544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
Abstract
Objectives
Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative bacteria (GNB) to third-generation cephalosporins (3GC) is increasing. In order to explore the value of using surveillance cultures to guide empirical treatment e.g. choosing between carbapenem versus ceftazidime- we aimed to assess the distribution of pathogens causing bacteraemia in patients with haematological malignancy, and the proportion of 3GC-resistant GNB (3GC-R GNB) bacteraemia that was preceded by 3GC-R GNB colonization.
Methods
Using 11 years of data (2008–2018) from the Dutch national antimicrobial resistance surveillance system, we assessed the prevalence of 3GC-R GNB in episodes of bacteraemia, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization. Colonization was defined as availability of any GNB surveillance isolate in the year before, independent of the causative micro-organism (time-paired isolates).
Results
We included 3887 patients, representing 4142 episodes of bacteraemia. GNB were identified in 715/4142 (17.3%), of which 221 (30.9%) were 3GC-R GNB. In 139 of these 221 patients a time-paired surveillance culture was available. In 76.2% (106/139) of patients these surveillance cultures already showed 3GC-R GNB isolates in the year prior to the culture date of the 3GC-R GNB positive blood isolate.
Conclusions
This multi-centre study shows that in patients with haematological malignancy, the majority of 3GC-R GNB bacteraemia is preceded by 3GC-R GNB colonization. Prospective clinical studies are needed to assess the safety and benefits of the use of surveillance-cultures to guide empirical therapy to restrict the empirical use of carbapenems in this population.
Collapse
|
6
|
Lenglet A, Contigiani O, Ariti C, Evens E, Charles K, Casimir CF, Senat Delva R, Badjo C, Roggeveen H, Pawulska B, Clezy K, McRae M, Wertheim H, Hopman J. Early warning for healthcare acquired infections in neonatal care units in a low-resource setting using routinely collected hospital data: The experience from Haiti, 2014-2018. PLoS One 2022; 17:e0269385. [PMID: 35737713 PMCID: PMC9223318 DOI: 10.1371/journal.pone.0269385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
In low-resource settings, detection of healthcare-acquired outbreaks in neonatal units relies on astute clinical staff to observe unusual morbidity or mortality from sepsis as microbiological diagnostics are often absent. We aimed to generate reliable (and automated) early warnings for potential clusters of neonatal late onset sepsis using retrospective data that could signal the start of an outbreak in an NCU in Port au Prince, Haiti, using routinely collected data on neonatal admissions. We constructed smoothed time series for late onset sepsis cases, late onset sepsis rates, neonatal care unit (NCU) mortality, maternal admissions, neonatal admissions and neonatal antibiotic consumption. An outbreak was defined as a statistical increase in any of these time series indicators. We created three outbreak alarm classes: 1) thresholds: weeks in which the late onset sepsis cases exceeded four, the late onset sepsis rates exceeded 10% of total NCU admissions and the NCU mortality exceeded 15%; 2) differential: late onset sepsis rates and NCU mortality were double the previous week; and 3) aberration: using the improved Farrington model for late onset sepsis rates and NCU mortality. We validated pairs of alarms by calculating the sensitivity and specificity of the weeks in which each alarm was launched and comparing each alarm to the weeks in which a single GNB positive blood culture was reported from a neonate. The threshold and aberration alarms were the strongest predictors for current and future NCU mortality and current LOS rates (p<0.0002). The aberration alarms were also those with the highest sensitivity, specificity, negative predictive value, and positive predictive value. Without microbiological diagnostics in NCUs in low-resource settings, applying these simple algorithms to routinely collected data show great potential to facilitate early warning for possible healthcare-acquired outbreaks of LOS in neonates. The methods used in this study require validation across other low-resource settings.
Collapse
Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Department of Medical Microbiology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Omar Contigiani
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Leiden Observatory, Leiden University, Leiden, The Netherlands
- Lorentz Institute for Theoretical Physics, Leiden University, Leiden, The Netherlands
| | - Cono Ariti
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | | | | | | | | | | | | | - Kate Clezy
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Melissa McRae
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Joost Hopman
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Department of Medical Microbiology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
- Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Veerman K, Wertheim H. Prophylactic Antibiotic Regimens in Tumor Resection Surgery Involving a Prosthesis. JAMA Oncol 2022; 8:1222. [PMID: 35737358 DOI: 10.1001/jamaoncol.2022.2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Karin Veerman
- Department of Internal Medicine-Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
| |
Collapse
|
8
|
Kurver L, van den Kieboom CH, Lanke K, Diavatopoulos DA, Overheul GJ, Netea MG, ten Oever J, van Crevel R, Mulders-Manders K, van de Veerdonk FL, Wertheim H, Schouten J, Rahamat-Langendoen J, van Rij RP, Bousema T, van Laarhoven A, de Jonge MI. SARS-CoV-2 RNA in exhaled air of hospitalized COVID-19 patients. Sci Rep 2022; 12:8991. [PMID: 35637284 PMCID: PMC9151771 DOI: 10.1038/s41598-022-13008-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/26/2022] [Indexed: 02/08/2023] Open
Abstract
Knowledge about contagiousness is key to accurate management of hospitalized COVID-19 patients. Epidemiological studies suggest that in addition to transmission through droplets, aerogenic SARS-CoV-2 transmission contributes to the spread of infection. However, the presence of virus in exhaled air has not yet been sufficiently demonstrated. In pandemic situations low tech disposable and user-friendly bedside devices are required, while commercially available samplers are unsuitable for application in patients with respiratory distress. We included 49 hospitalized COVID-19 patients and used a disposable modular breath sampler to measure SARS-CoV-2 RNA load in exhaled air samples and compared these to SARS-CoV-2 RNA load of combined nasopharyngeal throat swabs and saliva. Exhaled air sampling using the modular breath sampler has proven feasible in a clinical COVID-19 setting and demonstrated viral detection in 25% of the patients.
Collapse
|
9
|
Janssen J, Afari-Asiedu S, Monnier A, Abdulai MA, Tawiah T, Wertheim H, Baltussen R, Asante KP. Exploring the economic impact of inappropriate antibiotic use: the case of upper respiratory tract infections in Ghana. Antimicrob Resist Infect Control 2022; 11:53. [PMID: 35365210 PMCID: PMC8973739 DOI: 10.1186/s13756-022-01096-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/17/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Antibiotic consumption is increasing worldwide, particularly in low and middle-income countries (LMICs). Access to lifesaving antibiotics in LMICs is crucial while minimising inappropriate use. Studies assessing the economic impact of inappropriate antibiotic use in LMICs are lacking. We explored the economic impact of inappropriate antibiotic use using the example of upper respiratory tract infections (URIs) in Ghana, as part of the ABACUS (AntiBiotic ACcess and USe) project. METHODS A top-down, retrospective economic impact analysis of inappropriate antibiotic use for URIs was conducted. Two inappropriate antibiotic use situations were considered: (1) URIs treated with antibiotics, against recommendations from clinical guidelines; and (2) URIs that should have been treated with antibiotics according to clinical guidelines, but were not. The analysis included data collected in Ghana during the ABACUS project (household surveys and exit-interviews among consumers buying antibiotics), scientific literature and stakeholder consultations. Included cost types related to health care seeking behaviour for URIs. Additionally, cost saving projections were computed based on potential effects of future interventions that improve antibiotic use. RESULTS Health care costs related to inappropriate antibiotic use for URIs were estimated to be around 20 million (M) USD annually, including 18 M USD for situation 1 and 2 M USD for situation 2. Travel costs and lost income due to travel, together, were estimated to be around 44 M USD for situation 1 and 18 M USD for situation 2. Possible health care cost savings range from 2 to 12 M USD for situation 1 and from 0.2 to 1 M USD for situation 2. CONCLUSIONS This study indicates that inappropriate antibiotic use leads to substantial economic costs in a LMIC setting that could have been prevented. We recommend investment in novel strategies to counter these unnecessary expenditures. As the projections indicate, this may result in considerable cost reductions. By tackling inappropriate use, progress can be made in combatting antibiotic resistance.
Collapse
Affiliation(s)
- Jip Janssen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Samuel Afari-Asiedu
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Annelie Monnier
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Theresa Tawiah
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Rob Baltussen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| |
Collapse
|
10
|
Linssen J, Schapendonk C, Münster M, Daemen P, Rahamat-Langendoen J, Wertheim H. A method comparison study of the high throughput automated HISCL ® SARS-CoV-2 antigen assay using nasopharyngeal swab samples from symptomatic and asymptomatic subjects against conventional RT-PCR. J Med Virol 2022; 94:3070-3080. [PMID: 35218042 PMCID: PMC9088525 DOI: 10.1002/jmv.27679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 11/10/2022]
Abstract
Our study aim was to evaluate the performance of the automated Sysmex HISCL® severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antigen assay against reverse‐transcription polymerase chain reaction (RT‐PCR). We tested 277 remnant frozen nasopharyngeal swab samples, stored in universal transport medium (UTM), yielding a sensitivity of 94.9% against historical RT‐PCR results with cycle threshold (Ct) < 30, and a sensitivity of 76.7% for Ct < 35, and specificity of 100% (all Ct values) confirming compatibility of UTM‐diluted samples with the assay system. Thereafter, we prospectively collected 141 nasopharyngeal swab samples in UTM from healthcare workers and 1369 paired swabs (400 UTM; 969 dry) from individuals at a public health testing center, with the first swab (UTM) reserved for RT‐PCR, yielding a positivity rate of 4.6%. HISCL assay performance using UTM swabs was superior to dry swabs, with a sensitivity of 100% (95% confidence interval [CI] 71.5%–100%) at Ct < 30 versus 92.3% (95%CI 81.5%–97.9%), and a specificity of 99.3% (95% CI 98.1–99.89) against 83.3% (95%CI 80.7%–85.6%). We conclude that this antigen assay is suitable for high throughput facilities where the primary indication for testing is to rule out infection with low RT‐PCR Ct values (proxy for high viral loads) to curb viral spread.
Collapse
Affiliation(s)
- Joachim Linssen
- Sysmex Europe GMBH, Bornbarch 1, 22848, Norderstedt, Germany
| | - Claire Schapendonk
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, Internal postal code 777, 6500 HB, Nijmegen, The Netherlands.,Currently at Business Unit Microbiology, Novel Foods & Agrochains, Wageningen Food Safety Research (WFSR), Wageningen, The Netherlands
| | - Marion Münster
- Sysmex Europe GMBH, Bornbarch 1, 22848, Norderstedt, Germany
| | - Paul Daemen
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, Internal postal code 777, 6500 HB, Nijmegen, The Netherlands
| | - Janette Rahamat-Langendoen
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, Internal postal code 777, 6500 HB, Nijmegen, The Netherlands.,Currently at Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Heiman Wertheim
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, Internal postal code 777, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
11
|
Auladell M, Phuong HVM, Mai LTQ, Tseng YY, Carolan L, Wilks S, Thai PQ, Price D, Duong NT, Hang NLK, Thanh LT, Thuong NTH, Huong TTK, Diep NTN, Bich VTN, Khvorov A, Hensen L, Duong TN, Kedzierska K, Anh DD, Wertheim H, Boyd SD, Good-Jacobson KL, Smith D, Barr I, Sullivan S, van Doorn HR, Fox A. Influenza virus infection history shapes antibody responses to influenza vaccination. Nat Med 2022; 28:363-372. [PMID: 35177857 DOI: 10.1038/s41591-022-01690-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023]
Abstract
Studies of successive vaccination suggest that immunological memory against past influenza viruses may limit responses to vaccines containing current strains. The impact of memory induced by prior infection is rarely considered and is difficult to ascertain, because infections are often subclinical. This study investigated influenza vaccination among adults from the Ha Nam cohort (Vietnam), who were purposefully selected to include 72 with and 28 without documented influenza A(H3N2) infection during the preceding 9 years (Australian New Zealand Clinical Trials Registry 12621000110886). The primary outcome was the effect of prior influenza A(H3N2) infection on hemagglutinin-inhibiting antibody responses induced by a locally available influenza vaccine administered in November 2016. Baseline and postvaccination sera were titrated against 40 influenza A(H3N2) strains spanning 1968-2018. At each time point (baseline, day 14 and day 280), geometric mean antibody titers against 2008-2018 strains were higher among participants with recent infection (34 (29-40), 187 (154-227) and 86 (72-103)) than among participants without recent infection (19 (17-22), 91 (64-130) and 38 (30-49)). On days 14 and 280, mean titer rises against 2014-2018 strains were 6.1-fold (5.0- to 7.4-fold) and 2.6-fold (2.2- to 3.1-fold) for participants with recent infection versus 4.8-fold (3.5- to 6.7-fold) and 1.9-fold (1.5- to 2.3-fold) for those without. One of 72 vaccinees with recent infection versus 4 of 28 without developed symptomatic A(H3N2) infection in the season after vaccination (P = 0.021). The range of A(H3N2) viruses recognized by vaccine-induced antibodies was associated with the prior infection strain. These results suggest that recall of immunological memory induced by prior infection enhances antibody responses to inactivated influenza vaccine and is important to attain protective antibody titers.
Collapse
Affiliation(s)
- Maria Auladell
- Department of Microbiology and Immunology, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | | | - Yeu-Yang Tseng
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Louise Carolan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sam Wilks
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, UK
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - David Price
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Reference Laboratory Epidemiology Unit and The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Le Thi Thanh
- National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Nguyen Thi Hong Thuong
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, National Hospital of Tropical Diseases, Ha Noi, Vietnam
| | - Tran Thi Kieu Huong
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, National Hospital of Tropical Diseases, Ha Noi, Vietnam
| | - Nguyen Thi Ngoc Diep
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, National Hospital of Tropical Diseases, Ha Noi, Vietnam
| | - Vu Thi Ngoc Bich
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, National Hospital of Tropical Diseases, Ha Noi, Vietnam
| | - Arseniy Khvorov
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Luca Hensen
- Department of Microbiology and Immunology, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Tran Nhu Duong
- National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Heiman Wertheim
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, National Hospital of Tropical Diseases, Ha Noi, Vietnam.,Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Scott D Boyd
- Stanford University Medical Centre, Stanford University, Stanford, CA, USA
| | - Kim L Good-Jacobson
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia.,Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Derek Smith
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, UK
| | - Ian Barr
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sheena Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, National Hospital of Tropical Diseases, Ha Noi, Vietnam.,Centre of Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Annette Fox
- Department of Microbiology and Immunology, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia. .,WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia. .,Department of Infectious Diseases, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
| |
Collapse
|
12
|
Auzin A, Spits M, Tacconelli E, Rodríguez-Baño J, Hulscher M, Adang E, Voss A, Wertheim H. What is the evidence base of used aggregated antibiotic resistance percentages to change empiric antibiotic treatment? A scoping review. Clin Microbiol Infect 2021; 28:928-935. [PMID: 34906718 DOI: 10.1016/j.cmi.2021.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/08/2021] [Accepted: 12/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Antibiotic resistance requires continuous monitoring by experts to decide whether empiric antibiotic therapies (EAT) should be replaced by alternative antibiotics. The exact moment and criteria for this change is unclear and generally based on consensus between experts. OBJECTIVES This scoping review aims to identify from the literature the resistance thresholds used for a change in EAT and the criteria that they are based upon. METHODS Scoping review for which a comprehensive structured literature search was conducted. Rayyan, software for systematic reviews, was used for the screening of abstracts and titles. DATA SOURCES Pubmed and hand-searching of reference lists and grey literature. ELIGIBILITY Papers concerning any type of bacterial infectious disease and mentioning or defining antibiotic resistance thresholds for decision making purposes for EAT were included. The inclusion and analysis of articles was done by two researchers, any conflicts were resolved through discussion or by consulting a third reviewer. RESULTS We identified 3146 unique papers. Following title-abstract screening, 125 papers were comprehensively read, 16 papers included. The included papers gave thresholds for urinary tract infections, respiratory tract infections, meningitis, skin and soft tissue infections, gonorrhoea and bone and joint infections. Six criteria were found that were commonly used to base the thresholds on. These were: disease severity, efficacy of treatment, adverse drug events, risk of C. difficile infection, costs and increased resistance. The number of criteria used to define each threshold varied from 1 up to 6 criteria between papers. CONCLUSIONS The thresholds used for EATs are few, commonly based on expert opinion estimates and therefore can have broad ranges. Used criteria underlying reported thresholds are heterogenous and require standardization. Considering the rising trend in resistance there is a clear need for rigid tools to determine thresholds in order to support guideline development with the best and timely evidence.
Collapse
Affiliation(s)
- Ali Auzin
- Radboud university medical centre, Nijmegen, The Netherlands.
| | | | | | - José Rodríguez-Baño
- Infectious Diseases and Microbiology, Hospital Universitario Virgen Macarena and Medicine Department, University of Seville / Biomedicine Institute of Seville, Spain
| | - Marlies Hulscher
- Scientific Centre for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical centre, Nijmegen, The Netherlands
| | - Eddy Adang
- Radboud university medical centre, Nijmegen, The Netherlands
| | - Andreas Voss
- Canisius Wilhelmina Ziekenhuis (CWZ), Nijmegen, The Netherlands
| | - Heiman Wertheim
- Radboud university medical centre, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Ruth MM, Raaijmakers J, van den Hombergh E, Aarnoutse R, Svensson EM, Susanto BO, Simonsson USH, Wertheim H, Hoefsloot W, van Ingen J. Standard therapy of Mycobacterium avium complex pulmonary disease shows limited efficacy in an open source hollow fibre system that simulates human plasma and epithelial lining fluid pharmacokinetics. Clin Microbiol Infect 2021; 28:448.e1-448.e7. [PMID: 34332109 DOI: 10.1016/j.cmi.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Mycobacterium avium complex (MAC) bacteria can cause chronic pulmonary disease (PD). Current treatment regimens of azithromycin, ethambutol and rifampicin have culture conversion rates of around 65%. Dynamic, preclinical models to assess the efficacy of treatment regimens are important to guide clinical trial development. The hollow fibre system (HFS) has been applied but reports lack experimental details. METHODS We simulated the human pharmacokinetics of azithromycin, ethambutol and rifampicin both in plasma and epithelial lining fluid (ELF) in a HFS, exposing THP-1 cells infected with M. avium to the triple-drug regimen for 3 weeks. We accounted for drug-drug interactions and protein-binding and provide all laboratory protocols. We differentiated the effects on the intracellular and extracellular mycobacterial population. RESULTS The antibiotic concentrations in the HFS accurately reflected the time to peak concentration (Tmax), the peak concentration (Cmax) and half-life of azithromycin, rifampicin and ethambutol in plasma and ELF reported in literature. We find that plasma drug concentrations fail to hold the MAC bacterial load static (ΔLog10 CFU/mLControl:Regimen = 0.66 ± 0.76 and 0.45 ± 0.28 at 3 and 21 days); ELF concentrations do hold the bacterial load static for 3 days and inhibit bacterial growth for the duration of the experiment (ΔLog10 CFU/mLControl:Regimen = 1.1 ± 0.1 and 1.64 ± 0.59 at 3 and 21 days). DISCUSSION In our model, the current therapy against MAC is ineffective, even when accounting for antibiotic accumulation at the site of infection and intracellularly. New treatment regimens need to be developed and be compared with currently recommended regimens in dynamic models prior to clinical evaluation. With the publication of all protocols we aim to open this technology to new users.
Collapse
Affiliation(s)
- Mike Marvin Ruth
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Jelmer Raaijmakers
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Erik van den Hombergh
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rob Aarnoutse
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elin M Svensson
- Radboudumc Center for Infectious Diseases, Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pharmacy, Uppsala University, Sweden
| | - Budi O Susanto
- Department of Pharmaceutical Biosciences, Uppsala University, Sweden
| | | | - Heiman Wertheim
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wouter Hoefsloot
- Radboudumc Center for Infectious Diseases, Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jakko van Ingen
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| |
Collapse
|
14
|
Post A, Kaboré B, Bognini J, Diallo S, Lompo P, Kam B, Herssens N, van Opzeeland F, van der Gaast-de Jongh CE, Langereis JD, de Jonge MI, Rahamat-Langendoen J, Bousema T, Wertheim H, Sauerwein RW, Tinto H, Jacobs J, de Mast Q, van der Ven AJ. Infection Manager System (IMS) as a new hemocytometry-based bacteremia detection tool: A diagnostic accuracy study in a malaria-endemic area of Burkina Faso. PLoS Negl Trop Dis 2021; 15:e0009187. [PMID: 33647009 PMCID: PMC7951874 DOI: 10.1371/journal.pntd.0009187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/11/2021] [Accepted: 01/30/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND New hemocytometric parameters can be used to differentiate causes of acute febrile illness (AFI). We evaluated a software algorithm-Infection Manager System (IMS)-which uses hemocytometric data generated by Sysmex hematology analyzers, for its accuracy to detect bacteremia in AFI patients with and without malaria in Burkina Faso. Secondary aims included comparing the accuracy of IMS with C-reactive protein (CRP) and procalcitonin (PCT). METHODS In a prospective observational study, patients of ≥ three-month-old (range 3 months- 90 years) presenting with AFI were enrolled. IMS, blood culture and malaria diagnostics were done upon inclusion and additional diagnostics on clinical indication. CRP, PCT, viral multiplex PCR on nasopharyngeal swabs and bacterial- and malaria PCR were batch-tested retrospectively. Diagnostic classification was done retrospectively using all available data except IMS, CRP and PCT results. FINDINGS A diagnosis was affirmed in 549/914 (60.1%) patients and included malaria (n = 191) bacteremia (n = 69), viral infections (n = 145), and malaria-bacteremia co-infections (n = 47). The overall sensitivity, specificity, and negative predictive value (NPV) of IMS for detection of bacteremia in patients of ≥ 5 years were 97.0% (95% CI: 89.8-99.6), 68.2% (95% CI: 55.6-79.1) and 95.7% (95% CI: 85.5-99.5) respectively, compared to 93.9% (95% CI: 85.2-98.3), 39.4% (95% CI: 27.6-52.2), and 86.7% (95% CI: 69.3-96.2) for CRP at ≥20mg/L. The sensitivity, specificity and NPV of PCT at 0.5 ng/ml were lower at respectively 72.7% (95% CI: 60.4-83.0), 50.0% (95% CI: 37.4-62.6) and 64.7% (95% CI: 50.1-77.6) The diagnostic accuracy of IMS was lower among malaria cases and patients <5 years but remained equal to- or higher than the accuracy of CRP. INTERPRETATION IMS is a new diagnostic tool to differentiate causes of AFI. Its high NPV for bacteremia has the potential to improve antibiotic dispensing practices in healthcare facilities with hematology analyzers. Future studies are needed to evaluate whether IMS, combined with malaria diagnostics, may be used to rationalize antimicrobial prescription in malaria endemic areas. TRIAL REGISTRATION ClinicalTrials.gov (NCT02669823) https://clinicaltrials.gov/ct2/show/NCT02669823.
Collapse
Affiliation(s)
- Annelies Post
- Nijmegen Institute of International Health, Radboudumc, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- * E-mail: (AP); (AvV)
| | - Berenger Kaboré
- Nijmegen Institute of International Health, Radboudumc, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Joel Bognini
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Salou Diallo
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | | | - Basile Kam
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Natacha Herssens
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Fred van Opzeeland
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - Christa E. van der Gaast-de Jongh
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - Jeroen D. Langereis
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - Marien I. de Jonge
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - Janette Rahamat-Langendoen
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
| | - Teun Bousema
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
| | - Heiman Wertheim
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
| | - Robert W. Sauerwein
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
| | - Halidou Tinto
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni de Bobo-Dioulasso, Burkina Faso
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Department of Microbiology and Immunology, University of Leuven (KU Leuven), Leuven, Belgium
| | - Quirijn de Mast
- Nijmegen Institute of International Health, Radboudumc, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - Andre J. van der Ven
- Nijmegen Institute of International Health, Radboudumc, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
- * E-mail: (AP); (AvV)
| |
Collapse
|
15
|
Cremers-Pijpers S, van Rossum C, Dautzenberg M, Wertheim H, Tostmann A, Hopman J. Disinfecting handheld electronic devices with UV-C in a healthcare setting. Infect Prev Pract 2021; 3:100133. [PMID: 34368747 PMCID: PMC8336058 DOI: 10.1016/j.infpip.2021.100133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
Handheld Electronic Devices (HEDs) play a central role in the hospital environment. However, they can be a vehicle for transmitting (pathogenic) microorganisms. We studied whether disinfection with UV-C light is successful in disinfecting three different HEDs in a clinical setting. Disinfection with UV-C light was performed with the UV-Smart® D25. We took a total of 800 samples on two departments and counted colony forming units. More than half of the baseline measurements were moderately (>10CFU) or highly (>50 CFU) contaminated. Post-disinfection the CFU was 0 in 87% of measurements. We conclude that the UV-Smart® D25 can be used to disinfect non-critical HEDs in clinical healthcare.
Collapse
Affiliation(s)
- Suzan Cremers-Pijpers
- Hygiene and Infection Control, Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carsten van Rossum
- Hygiene and Infection Control, Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Heiman Wertheim
- Hygiene and Infection Control, Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Alma Tostmann
- Hygiene and Infection Control, Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Joost Hopman
- Hygiene and Infection Control, Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, the Netherlands
| |
Collapse
|
16
|
Rooijakkers MJP, Li WWL, Wollersheim LWLM, Geuzebroek GSC, Gehlmann H, van Garsse LAFM, van Wely MH, Verkroost MWA, Morshuis WJ, Wertheim H, van Royen N. Transcatheter aortic valve replacement during the COVID-19 pandemic-A Dutch single-center analysis. J Card Surg 2020; 36:48-55. [PMID: 33084121 PMCID: PMC7821107 DOI: 10.1111/jocs.15123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/27/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Background and Aim of the Study The coronavirus disease 2019 (COVID‐19) pandemic has put an enormous strain on healthcare systems and intensive care unit (ICU) capacity, leading to suspension of most elective procedures, including transcatheter aortic valve replacement (TAVR). However, deferment of TAVR is associated with significant wait‐time mortality in patients with severe aortic valve stenosis. Conversely, there is currently no data available regarding the safety and feasibility of a continued TAVR program during this unprecedented crisis. The aim of this study is to evaluate the safety and feasibility of patients undergoing TAVR during the COVID‐19 pandemic in our center, with specific emphasis on COVID‐19 related outcomes. Methods All patients who underwent TAVR in our center between February 27, 2020, and June 30, 2020, were evaluated. Clinical outcomes were described in terms of Valve Academic Research Consortium 2 definitions. Patient follow‐up was done by chart review and telephone survey. Results A total of 71 patients have undergone TAVR during the study period. Median age was 80 years, 63% were men, and 25% were inpatients. Procedural success was 99%. After TAVR, 30% involved admission to the ICU, and 94% were ultimately discharged to the cardiac care unit on the same day. Two patients (3%) had confirmed COVID‐19 a few days after TAVR, and both died of COVID‐19 pneumonia within 2 weeks after hospital discharge. Conclusions A continued TAVR program during the COVID‐19 pandemic is feasible despite limited hospital resources. However, COVID‐19 related mortality after TAVR is of concern.
Collapse
Affiliation(s)
- Maxim J P Rooijakkers
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wilson W L Li
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helmut Gehlmann
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leen A F M van Garsse
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marleen H van Wely
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel W A Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
17
|
Poole S, Townsend J, Wertheim H, Kidd SP, Welte T, Schuetz P, Luyt CE, Beishuizen A, Jensen JUS, Del Castillo JG, Plebani M, Saeed K. How are rapid diagnostic tests for infectious diseases used in clinical practice: a global survey by the International Society of Antimicrobial Chemotherapy (ISAC). Eur J Clin Microbiol Infect Dis 2020; 40:429-434. [PMID: 32902760 PMCID: PMC7478941 DOI: 10.1007/s10096-020-04031-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
Abstract
Novel rapid diagnostic tests (RDTs) offer huge potential to optimise clinical care and improve patient outcomes. In this study, we aim to assess the current patterns of use around the world, identify issues for successful implementation and suggest best practice advice on how to introduce new tests. An electronic survey was devised by the International Society of Antimicrobial Chemotherapy (ISAC) Rapid Diagnostics and Biomarkers working group focussing on the availability, structure and impact of RDTs around the world. It was circulated to ISAC members in December 2019. Results were collated according to the UN human development index (HDI). 81 responses were gathered from 31 different countries. 84% of institutions reported the availability of any test 24/7. In more developed countries, this was more for respiratory viruses, whereas in high and medium/low developed countries, it was for HIV and viral hepatitis. Only 37% of those carrying out rapid tests measured the impact. There is no 'one-size fits all' solution to RDTs: the requirements must be tailored to the healthcare setting in which they are deployed and there are many factors that should be considered prior to this.
Collapse
Affiliation(s)
- Stephen Poole
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Heiman Wertheim
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - Stephen P Kidd
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Tobias Welte
- Department of Respiratory Medicine and member of the German Centre of Lung Research, Medizinische Hochschule, Hannover, Germany
| | - Philipp Schuetz
- Internal Medicine and Emergency Medicine Endocrinology, Diabetes & Clinical Nutrition Medical University, Department Kantonsspital Aarau, Tellstrasse CH, -5001, Aarau, Switzerland
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Jens-Ulrik Stæhr Jensen
- Department of Internal Medicine, Respiratory Medicine Section, Herlev-Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | | | - Mario Plebani
- School of Medicine and Surgery, University of Padova, & Centre of Biomedical Research, Vento Region, Padova, Italy
| | - Kordo Saeed
- School of Medicine, University of Southampton, Southampton, UK. .,Microbiology Innovation and Research Unit (MIRU), Microbiology Department, Southampton University Hospitals NHS Foundation Trust, Southampton, SO16 6YD, UK.
| |
Collapse
|
18
|
Lenglet A, Schuurmans J, Ariti C, Borgundvaag E, Charles K, Badjo C, Clezy K, Evens E, Senat-Delva R, Berthet M, Lekkerkerker M, McRae M, Wertheim H, Hopman J. Rectal screening displays high negative predictive value for bloodstream infection with (ESBL-producing) Gram-negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit. J Glob Antimicrob Resist 2020; 23:102-107. [PMID: 32890840 DOI: 10.1016/j.jgar.2020.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti. METHODS We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis. RESULTS We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4-28.0%] and 20.6% (95% CI 16.0-26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%. CONCLUSIONS The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.
Collapse
Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands; Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands.
| | | | - Cono Ariti
- Centre for Medical Education, Cardiff University School of Medicine, Cardiff, UK
| | | | | | | | - Kate Clezy
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | | | | | | | - Melissa McRae
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Heiman Wertheim
- Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Joost Hopman
- Médecins Sans Frontières, Amsterdam, The Netherlands; Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Tattevin P, Levy Hara G, Toumi A, Enani M, Coombs G, Voss A, Wertheim H, Poda A, Daoud Z, Laxminarayan R, Nathwani D, Gould I. Advocacy for Increased International Efforts for Antimicrobial Stewardship Actions in Low-and Middle-Income Countries on Behalf of Alliance for the Prudent Use of Antimicrobials (APUA), Under the Auspices of the International Society of Antimicrobial Chemotherapy (ISAC). Front Med (Lausanne) 2020; 7:503. [PMID: 32984380 PMCID: PMC7479847 DOI: 10.3389/fmed.2020.00503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/21/2020] [Indexed: 01/27/2023] Open
Abstract
Antimicrobial stewardship (AMS) is a set of coordinated strategies to improve the use of antimicrobials, to enhance patient outcomes, reduce antimicrobial resistance, and decrease unnecessary costs. The pioneer years of AMS were restricted to high-income countries (HIC), where overconsumption of antibiotics was associated with emergence of multidrug-resistant (MDR) bacteria. AMS in low- and middle-income countries (LMIC) is also necessary. However, programs effective in HIC may not perform as well in LMIC, because (i) While decreased consumption of antibiotics may be an appropriate target in overconsuming HIC, this may be dangerous in LMIC, where many patients die from the lack of access to antibiotics; (ii) although AMS programs in HIC can be designed and monitored through laboratory surveillance of resistance, surveillance programs are not available in many LMIC; (iii) the heterogeneity of health care systems implies that AMS programs must be carefully contextualized. Despite the need to individually tailor AMS programs in LMIC, international collaborations remain highly valuable, through the dissemination of high-quality documents and educational material, that may be shared, adapted where needed, and adopted worldwide. This process, facilitated by modern communication tools, combines many benefits, including: (i) saving time, a precious dimension for health care workers, by avoiding the duplication of similar works in different settings; (ii) taking advantage of colleagues skills, and initiatives, through open access to the work performed in other parts of the world; (iii) sharing experiences, so that we all learn from each others' successes and failures.
Collapse
Affiliation(s)
- Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital Center, Rennes, France
| | - Gabriel Levy Hara
- Infectious Diseases Unit, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Adnene Toumi
- Infectious Diseases Department, Monastir University Hospital, Monastir, Tunisia
| | - Mushira Enani
- Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Geoffrey Coombs
- Antimicrobial Resistance and Infectious Diseases Research Laboratory, Murdoch University, Perth, WA, Australia
| | - Andreas Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands.,Radboudumc, Department of Medical Microbiology and Radboud Center for Infectious Diseases, Nijmegen, Netherlands
| | - Heiman Wertheim
- Radboudumc, Department of Medical Microbiology and Radboud Center for Infectious Diseases, Nijmegen, Netherlands
| | - Armel Poda
- Infectious Diseases Department, Sourô Sanou University Hospital, Bobo-Dioulasso, Burkina Faso
| | - Ziad Daoud
- Clinical Microbiology, Saint George Hospital-UMC and University of Balamand, Beirut, Lebanon
| | | | - Dilip Nathwani
- Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Ian Gould
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| |
Collapse
|
20
|
Cambaco O, Alonso Menendez Y, Kinsman J, Sigaúque B, Wertheim H, Do N, Gyapong M, John-Langba J, Sevene E, Munguambe K. Community knowledge and practices regarding antibiotic use in rural Mozambique: where is the starting point for prevention of antibiotic resistance? BMC Public Health 2020; 20:1183. [PMID: 32727445 PMCID: PMC7389384 DOI: 10.1186/s12889-020-09243-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Antibiotic misuse and other types of unnecessary use of antibiotics can contribute to accelerate the process of antibiotic resistance, which is considered a global concern, mostly affecting low-and middle-income countries (LMICs). In Mozambique there is limited evidence on community knowledge and practices regarding antibiotics and antibiotic resistance. As part of the ABACUS project, this paper describes knowledge and practices of antibiotic use among the general population in the semi-rural district of Manhiça to inform evidence-based communication intervention strategies for safer antibiotic use. METHODS The study was conducted in Manhiça, a semi-rural district of Southern Mozambique. Sixteen in-depth interviews and four focus group discussions (FGDs) were conducted with community members to explore lay knowledge and practices regarding antibiotics and awareness of antibiotic resistance. The qualitative data was analysed using a combination of content and thematic analysis. The SRQR guidelines for reporting qualitative studies was performed. RESULTS Although participants did not hold any consistent knowledge of antibiotics, their visual recognition of amoxicillin (distinct red yellow capsule) was acceptable, but less so for different types and brands of antibiotics. The majority of participants were aware of the term 'antibiotic', yet the definition they gave was rarely backed by biomedical knowledge. Participants associated antibiotics with certain colours, shapes and health conditions. Participants reported common habits that may contribute to resistance: not buying the full course, self-medication, sharing medicines and interruption of treatment. Most had never heard of the term 'antibiotic resistance' but were familiar with the phenomenon. They often understood the term 'resistance' as treatment failure and likened 'resistance' to non-compliance, ineffective medication, disease resistance or to an inability of the physical body to respond to it. CONCLUSION There is a broad understanding of the importance of medication compliance but not specifically of antibiotic resistance. In addition, there is a recognized gap between knowledge of responsible drug compliance and actual behaviour. Future qualitative research is required to further explore what determines this behaviour. The existing ability to visually identify amoxicillin by its distinct red and yellow appearance is informative for future awareness and behavioural change campaigns that may incorporate visual aids of antibiotics.
Collapse
Affiliation(s)
- Olga Cambaco
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | | | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
| | - Heiman Wertheim
- Department of Medical Microbiology and Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - Nga Do
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Kintampo, Ghana
| | | | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
| |
Collapse
|
21
|
Matin MA, Khan WA, Karim MM, Ahmed S, John-Langba J, Sankoh OA, Gyapong M, Kinsman J, Wertheim H. What influences antibiotic sales in rural Bangladesh? A drug dispensers' perspective. J Pharm Policy Pract 2020; 13:20. [PMID: 32514362 PMCID: PMC7268404 DOI: 10.1186/s40545-020-00212-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 04/24/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Antibiotic resistance poses a great threat to global health, especially in low- and middle-income countries with a high infectious disease burden and limited resources. In spite of regulations, antibiotics are sold in many settings as non-prescription medicines, resulting in inappropriate use and resistance. OBJECTIVE This study aimed to investigate the current status of access and use of antibiotics in rural Bangladesh, by exploring the perspectives and sales practices of antibiotic drug dispensers. METHODS We used a mixed methods approach (qualitative and quantitative). We mapped and characterized antibiotic purchasing and dispensing sites in the Matlab Health and Demographic Surveillance System catchment area. Furthermore, we investigated the volume of provision of systemic antibiotics in 10 drug outlets. We held 16 in-depth interviews with randomly selected antibiotics dispensers. Interviews explored factors associated with antibiotic selling. Responses were transcribed, coded for themes, and summarized. We used ATLAS.ti 5.2 for conducting a thematic analysis. RESULTS A total of 301 antibiotic dispensers were identified, of whom 92% (n = 278) were private and 8% (n = 23) public. 52% (n = 155) operated informally (i.e. without legal authorization). In order to promote and survive in their business, dispensers sell antibiotics for a range of conditions without a qualified physician's prescription. Factors that facilitate these inappropriate sales include lack of access to healthcare in the rural community, inadequate doctor: population ratio, limited dispenser knowledge, poor pharmacovigilance concerning safety of self medication, lack of enforcement of policies, financial benefits for both customers and dispensers, and high dependency on pharmaceutical companies' information. CONCLUSION Dispensers in rural Bangladesh sell antibiotics inappropriately by ignoring existing national regulations. They operate the antibiotic sales without facing any legal barriers and primarily with a view to sustain their business, resulting in inappropriate sales of antibiotics to the rural community. The influence of the drug industry needs to be replaced with evidence-based, not commercially driven information. Awareness programs for antibiotic providers that promote understanding of antibiotics and antibiotic resistance through tailored interventions may be helpful in changing current antibiotic sales practices.
Collapse
Affiliation(s)
- Mohammad Abdul Matin
- Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Enteric and Respiratory Infections, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Wasif Ali Khan
- Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Enteric and Respiratory Infections, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Mohammad Mahbubul Karim
- Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Enteric and Respiratory Infections, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sabeena Ahmed
- Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Enteric and Respiratory Infections, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Johannes John-Langba
- University of Kwazulu-Natal, School of Applied Sciences college of Humanities, Memorial Tower Building, Durban, F224 South Africa
| | - Osman A. Sankoh
- 6INDEPTH Network, 38 & 40 Mensah Wood Street, East Legon, P. O. Box KD 213, Kanda Accra, Ghana
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Institute for Health Research, University of Health and Allied Sciences, Ho, Volta Region Ghana
| | - John Kinsman
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Heiman Wertheim
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
22
|
Voss A, Martens L, van Mansfeld R, Hopman J, Veldkamp KE, Wertheim H, Kluytmans J. [Rational use of respiratory protective equipment: advice for health care professionals in time of COVID-19]. Ned Tijdschr Geneeskd 2020; 164:D5040. [PMID: 32395962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current COVID-19 pandemic has led to a worldwide shortage of respiratory protective equipment. In order to offer maximum protection against infection for all healthcare workers, we need to optimise our use of the available equipment. This article provides practical advice on which type of mask is indicated in what specific situation, what requirements the mask should meet and how to optimise the local workflow, including the re-use of masks after decontamination.
Collapse
Affiliation(s)
- Andreas Voss
- Canisius Wilhelmina Ziekenhuis, afd. Medische Microbiologie en Infectieziekten, Nijmegen
| | | | - Rosa van Mansfeld
- Amsterdam UMC, afd. Medische Microbiologie en Infectiepreventie, Amsterdam
| | - Joost Hopman
- Radboudumc, afd. Medische Microbiologie, Nijmegen
| | | | - Heiman Wertheim
- Radboudumc, afd. Medische Microbiologie, Nijmegen
- Contact: Heiman Wertheim
| | - Jan Kluytmans
- Amphia Ziekenhuis, afd. Kenniskern Infectiepreventie, Breda
| |
Collapse
|
23
|
Tostmann A, Bradley J, Bousema T, Yiek WK, Holwerda M, Bleeker-Rovers C, Ten Oever J, Meijer C, Rahamat-Langendoen J, Hopman J, van der Geest-Blankert N, Wertheim H. Strong associations and moderate predictive value of early symptoms for SARS-CoV-2 test positivity among healthcare workers, the Netherlands, March 2020. Euro Surveill 2020; 25:2000508. [PMID: 32347200 PMCID: PMC7189649 DOI: 10.2807/1560-7917.es.2020.25.16.2000508] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 11/21/2022] Open
Abstract
Healthcare workers (n = 803) with mild symptoms were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 90 positive) and asked to complete a symptom questionnaire. Anosmia, muscle ache, ocular pain, general malaise, headache, extreme tiredness and fever were associated with positivity. A predictive model based on these symptoms showed moderate discriminative value (sensitivity: 91.2%; specificity: 55.6%). While our models would not justify presumptive SARS-CoV-2 diagnosis without molecular confirmation, it can contribute to targeted screening strategies.
Collapse
Affiliation(s)
- Alma Tostmann
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
| | - John Bradley
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
- Department of Infection and Immunity, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wing-Kee Yiek
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
| | - Minke Holwerda
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
| | - Chantal Bleeker-Rovers
- Department of Internal Medicine, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
| | - Jaap Ten Oever
- Department of Internal Medicine, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
| | - Corianne Meijer
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
| | - Janette Rahamat-Langendoen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
| | - Joost Hopman
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
| | | | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands
| |
Collapse
|
24
|
Afari-Asiedu S, Hulscher M, Boamah-Kaali E, Abdulai M, Asante K, Wertheim H. All medicine is medicine; exploring inappropriate antibiotic use at the community level in rural Ghana. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
25
|
Anstey Watkins J, Wagner F, Xavier Gómez-Olivé F, Wertheim H, Sankoh O, Kinsman J. Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site. Am J Trop Med Hyg 2020; 100:1378-1390. [PMID: 30994091 PMCID: PMC6553901 DOI: 10.4269/ajtmh.18-0171] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Knowledge and practices of rural South African populations with regard to antibiotic access and use (ABACUS) remain understudied. By using the case of four villages in the north east of the country, our aim was to investigate popular notions and social practices related to antibiotics to inform patient-level social interventions for appropriate antibiotic use. To achieve this, we investigated where community members (village residents) were accessing and sourcing medication, and what they understood antibiotics and antibiotic resistance (ABR) to be. Embedded within the multicountry ABACUS project, this qualitative study uses interviews and focus group discussions. A sample of 60 community members was recruited from the Agincourt Health and Demographic Surveillance System, situated in Mpumalanga Province, from April to August, 2017. We used the five abilities of seek, reach, pay, perceive, and engage in access to healthcare as proposed by Levesque’s “Access to Healthcare” framework. Respondents reported accessing antibiotics prescribed from legal sources: by nurses at the government primary healthcare clinics or by private doctors dispensed by private pharmacists. No account of the illegal purchasing of antibiotics was described. There was a mix of people who finished their prescription according to the instructions and those who did not. Some people kept antibiotics for future episodes of infection. The concept of “ABR” was understood by some community members when translated into related Xitsonga words because of knowledge tuberculosis and HIV/AIDS treatment regimens. Our findings indicate that regulation around the sale of antibiotics is enforced. Safer use of antibiotics and why resistance is necessary to understand need to be instilled. Therefore, context-specific educational campaigns, drawing on people’s understandings of antibiotics and informed by the experiences of other diseases, may be an important and deployable means of promoting the safe use of antibiotics.
Collapse
Affiliation(s)
- Jocelyn Anstey Watkins
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Fezile Wagner
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Nijmegen, The Netherlands.,Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom.,Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Osman Sankoh
- Statistics Sierra Leone, Freetown, Sierra Leone.,International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) Network, Accra, Ghana.,Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - John Kinsman
- Department of Public Health Sciences, Global Health (Division of International Health - IHCAR), Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health (Umeå Centre for Global Health Research), Umeå University, Umeå, Sweden
| |
Collapse
|
26
|
Chowdhury M, Stewart Williams J, Wertheim H, Khan WA, Matin A, Kinsman J. Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh. Glob Health Action 2019; 12:1824383. [PMID: 33040695 PMCID: PMC7580843 DOI: 10.1080/16549716.2020.1824383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/11/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The use of large quantities of antimicrobial drugs for human health and agriculture is advancing the predominance of drug resistant pathogens in the environment. Antimicrobial resistance is now a major public health threat posing significant challenges for achieving the Sustainable Development Goals. In Bangladesh, where over one third of the population is below the poverty line, the achievement of safe and effective antibiotic medication use for human health is challenging. OBJECTIVE To explore factors and practices around access and use of antibiotics and understanding of antimicrobial resistance in rural communities in Bangladesh from a socio-cultural perspective. METHODS This qualitative study comprises the second phase of the multi-country ABACUS (Antibiotic Access and Use) project in Matlab, Bangladesh. Information was collected through six focus group discussions and 16 in-depth interviews. Informants were selected from ten villages in four geographic locations using the Health and Demographic Surveillance System database. The Access to Healthcare Framework guided the interpretation and framing of the findings in terms of individuals' abilities to: perceive, seek, reach, pay and engage with healthcare. RESULTS Village pharmacies were the preferred and trusted source of antibiotics for self-treatment. Cultural and religious beliefs informed the use of herbal and other complementary medicines. Advice on antibiotic use was also sourced from trusted friends and family members. Access to government-run facilities required travel on poorly maintained roads. Reports of structural corruption, stock-outs and patient safety risks eroded trust in the public sector. Some expressed a willingness to learn about antibiotic resistance. CONCLUSION Antimicrobial resistance is both a health and development issue. Social and economic contexts shape medicine seeking, use and behaviours. Multi-sectoral action is needed to confront the underlying social, economic, cultural and political drivers that impact on the access and use of antibiotic medicines in Bangladesh.
Collapse
Affiliation(s)
- Moyukh Chowdhury
- Outcomes Research Department, Reveal AB, Stockholm, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Jennifer Stewart Williams
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Callaghan, Australia
| | - Heiman Wertheim
- Clinical Research Unit, Oxford University, Hanoi, Vietnam
- Department of Medical Microbiology and Radboud Centre for Infectious Disease, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Enteric and Respiratory Infections Infectious Diseases Division, 68, Shaheed Tajuddin Ahmed Sharani, Dhaka, Bangladesh
| | - Abdul Matin
- International Centre for Diarrhoeal Disease Research, Enteric and Respiratory Infections Infectious Diseases Division, 68, Shaheed Tajuddin Ahmed Sharani, Dhaka, Bangladesh
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
27
|
Nguyen HH, Ho DP, Vu TLH, Tran KT, Tran TD, Nguyen TKC, van Doorn HR, Nadjm B, Kinsman J, Wertheim H. "I can make more from selling medicine when breaking the rules" - understanding the antibiotic supply network in a rural community in Viet Nam. BMC Public Health 2019; 19:1560. [PMID: 31771536 PMCID: PMC6880519 DOI: 10.1186/s12889-019-7812-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background As in many other low and middle income countries (LIMCs), Vietnam has experienced a major growth in the pharmaceutical industry, with large numbers of pharmacies and drug stores, and increasing drug expenditure per capita over the past decade. Despite regulatory frameworks that have been introduced to control the dispensing and use of prescription-only drugs, including antibiotics, compliance has been reported to be strikingly low particularly in rural parts of Vietnam. This qualitative study aimed to understand antibiotic access and use practices in the community from both supplier and consumer perspectives in order to support the identification and development of future interventions. Methods This qualitative study was part of a project on community antibiotic access and use (ABACUS) in six LMICs. The focus was Ba Vi district of Hanoi capital city, where we conducted 16 indepth interviews (IDIs) with drug suppliers, and 16 IDIs and 6 focus group discussions (FGDs) with community members. Drug suppliers were sampled based on mapping of all informal and formal antibiotic purchase or dispensing points in the study area. Community members were identified through local networks and relationships with the field collaborators. All IDIs and FGDs were audio-taped, transcribed and analysed using content analysis. Results We identified a large number of antibiotic suppliers in the locality with widespread infringements of regulatory requirements. Established reciprocal relationships between suppliers and consumers in drug transactions were noted, as was the consumers’ trust in the knowledge and services provided by the suppliers. In addition, antibiotic use has become a habitual choice in most illness conditions, driven by both suppliers and consumers. Conclusions This study presents an analysis of the practices of antibiotic access and use in a rural Vietnamese setting. It highlights the interactions between antibiotic suppliers and consumers in the community and identifies possible targets for interventions.
Collapse
Affiliation(s)
| | - Dang Phuc Ho
- Hanoi Medical University, Dong Da, Ha Noi, Vietnam
| | - Thi Lan Huong Vu
- Wellcome Trust Asia Programme - Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | | | | | | | - H Rogier van Doorn
- Wellcome Trust Asia Programme - Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | - Behzad Nadjm
- Wellcome Trust Asia Programme - Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | - John Kinsman
- Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden.,Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | | |
Collapse
|
28
|
Haenssgen MJ, Charoenboon N, Zanello G, Mayxay M, Reed-Tsochas F, Lubell Y, Wertheim H, Lienert J, Xayavong T, Khine Zaw Y, Thepkhamkong A, Sithongdeng N, Khamsoukthavong N, Phanthavong C, Boualaiseng S, Vongsavang S, Wibunjak K, Chai-In P, Thavethanutthanawin P, Althaus T, Greer RC, Nedsuwan S, Wangrangsimakul T, Limmathurotsakul D, Elliott E, Ariana P. Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia. BMJ Open 2019; 9:e028224. [PMID: 31434769 PMCID: PMC6707701 DOI: 10.1136/bmjopen-2018-028224] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/20/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Low-income and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains under-represented in AMR research. OBJECTIVE To (1) Describe antibiotic-related knowledge, attitudes and practices of the general population in two LMICs. (2) Assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers. DESIGN Observational study: cross-sectional rural health behaviour survey, representative of the population level. SETTING General rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018. PARTICIPANTS 2141 adult members (≥18 years) of the general rural population, representing 712 000 villagers. OUTCOME MEASURES Antibiotic-related knowledge, attitudes and practices across sites and healthcare access channels. FINDINGS Villagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p<0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p<0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like 'anti-inflammatory medicine' in Chiang Rai (87.6%; 95% CI 84.9% to 90.0%) and 'ampi' in Salavan (75.6%; 95% CI 71.4% to 79.4%). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95% CI 0.01 to 0.23) and 0.53 in Salavan (95% CI 0.16 to 0.90). CONCLUSIONS Locally specific conceptions and counterintuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming 'knowledge deficits' alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards 'AMR-sensitive interventions' that address context-specific upstream drivers of antimicrobial use (eg, unemployment insurance) and complement education and awareness campaigns. TRIAL REGISTRATION NUMBER Clinicaltrials.gov identifier NCT03241316.
Collapse
Affiliation(s)
- Marco J Haenssgen
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
- School of Cross Faculty Studies, University of Warwick, Coventry, UK
- Green Templeton College, Oxford, United Kingdom
- Said Business School, University of Oxford, Oxford, UK
| | - Nutcha Charoenboon
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Giacomo Zanello
- School of Agriculture, Policy and Development, University of Reading, Reading, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health, London, London, UK
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Laos
| | - Felix Reed-Tsochas
- Green Templeton College, Oxford, United Kingdom
- Said Business School, University of Oxford, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
| | - Yoel Lubell
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Heiman Wertheim
- Medical Microbiology Department, Radbuod University, Nijmegen, The Netherlands
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Jeffrey Lienert
- Green Templeton College, Oxford, United Kingdom
- Said Business School, University of Oxford, Oxford, UK
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thipphaphone Xayavong
- Department of Peace and Conflict Studies, University for Peace, Ciudad Colon, Costa Rica
- Department of Political Science, Ateneo de Manila University, Quezon City, Philippines
| | - Yuzana Khine Zaw
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Amphayvone Thepkhamkong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Nicksan Sithongdeng
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Nid Khamsoukthavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Chanthasone Phanthavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Somsanith Boualaiseng
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Souksakhone Vongsavang
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Kanokporn Wibunjak
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Poowadon Chai-In
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Thomas Althaus
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Rachel Claire Greer
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Chiangrai Clinical Research Unit, Chiangrai Regional Hospital, Chiang Rai, Thailand
| | - Supalert Nedsuwan
- Primary Care Department, Chiangrai Regional Hospital, Chiang Rai, Thailand
| | - Tri Wangrangsimakul
- Chiangrai Clinical Research Unit, Chiangrai Regional Hospital, Chiang Rai, Thailand
- Microbiology, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Elizabeth Elliott
- UCL Anthropology, University College London, London, UK
- Institut de recherche pour le développement, Vientiane, Laos
| | - Proochista Ariana
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
| |
Collapse
|
29
|
Bonell A, Huyen NN, Phu VD, Wertheim H, Nadjm B. Determining the predictive equation for height from ulnar length in the Vietnamese population. Asia Pac J Clin Nutr 2019; 26:982-986. [PMID: 28917221 DOI: 10.6133/apjcn.012017.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Height is an essential measurement in clinical medicine. It allows the calculation of body mass index, ideal body weight, basic energy requirements and tidal volumes. In many patient groups, such as the critically ill, height cannot be measured easily and surrogate anthropometric measures are used. Regression equations estimating height are specific to ethnicity. We aimed to develop the regression equation for Vietnamese men and women to predict height from ulna length and so improve prescription of life-saving treatment in the intensive care units. METHODS AND STUDY DESIGN A cross-sectional survey of patients and relatives at the National Hospital for Tropical Diseases was undertaken. Ulna length, standing height and weight were measured. The first two thirds of participants' data, stratified by sex and age, were allocated to a model training group, the subsequent participants entered the validation group. Linear regression equations were calculated for the model group by sex, then applied to the validation group and assessed for precision. Other international equations were also compared. RESULTS 498 males and 496 females were recruited. There was good correlation between ulna length and height in those aged 21-64, r=0.66, p<0.001 in males and females. The regression equations were: male: height = 85.61 + (3.16 x ulna length), female: height = 85.80 + (2.97 x ulna length). Equations from other populations were less accurate. CONCLUSIONS The regression equations calculated for men and women aged 21-64 showed good correlation and can be used to predict height in those where direct measurement is impossible.
Collapse
Affiliation(s)
- Ana Bonell
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Hanoi, Vietnam. ;
| | | | - Vu Dinh Phu
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Heiman Wertheim
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Hanoi, Vietnam.,Department of medical microbiology, Radboud Center of Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - Behzad Nadjm
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Hanoi, Vietnam
| |
Collapse
|
30
|
Sunpuwan M, Punpuing S, Jaruruengpaisan W, Kinsman J, Wertheim H. What is in the drug packet?: access and use of non-prescribed poly-pharmaceutical packs (Yaa Chud) in the community in Thailand. BMC Public Health 2019; 19:971. [PMID: 31331304 PMCID: PMC6647088 DOI: 10.1186/s12889-019-7300-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 'Yaa Chud' is a non-prescribed poly-pharmaceutical pack containing several types of drugs, including antibiotics and steroids, which can be purchased over the counter in Thailand for self-medication. Although it is illegal, it is still available at some community outlets. This study aimed to understand access to and use of Yaa Chud at the community level in order to raise awareness on its usage and to provide policy recommendations to address the problem. METHODS This study employed qualitative methods, including in-depth interviews with 18 drug suppliers and 16 community members, and six focus group discussions. It included inventories from 17 drug suppliers. Data were collected in selected communities of the Kanchanaburi Demographic Surveillance System, located in the western region of Thailand.Thematic analysis was based upon the Health Services Utilization Model and conducted using the Open Code qualitative software program. RESULTS Overcrowding, long waiting times, and a perceived unwelcoming environment at public health-care service outlets were identified as factors that drive people into the private sector, where loose regulation of drug laws facilitates access and use of Yaa Chud. Migrants and older people were most likely to seek and use Yaa Chud, especially for mild illness. Availability, easy access through a user's network, low cost, and perceived effectiveness were identified as factors that enable access and use of Yaa Chud. CONCLUSIONS Though illegal in Thailand, Yaa Chud is likely to remain available for self-medication by community members, due to the persisting demand by the elderly and migrant workers. There is an urgent need to replace these mixed medications with better choices. Safer Yaa Chud may be a preferred, first-line health-care option, which could help reduce congestion in the formal health-care setting. At the same time, enforcement of regulatory compliance needs to be continued in order to stop the supply of unsafe Yaa Chud.
Collapse
Affiliation(s)
- Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand.
| | - Wipaporn Jaruruengpaisan
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Heiman Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- The Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Clinical Microbiology and the Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| |
Collapse
|
31
|
Bonell A, Azarrafiy R, Huong VTL, Viet TL, Phu VD, Dat VQ, Wertheim H, van Doorn HR, Lewycka S, Nadjm B. A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology. Clin Infect Dis 2019; 68:511-518. [PMID: 29982303 PMCID: PMC6336913 DOI: 10.1093/cid/ciy543] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/29/2018] [Indexed: 01/31/2023] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia. Methods We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level. Results Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%). Conclusions VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.
Collapse
Affiliation(s)
- Ana Bonell
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | - Vu Thi Lan Huong
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Thanh Le Viet
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | | | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - H Rogier van Doorn
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Sonia Lewycka
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Behzad Nadjm
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| |
Collapse
|
32
|
Shrestha P, Cooper BS, Coast J, Oppong R, Do Thi Thuy N, Phodha T, Celhay O, Guerin PJ, Wertheim H, Lubell Y. Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use. Antimicrob Resist Infect Control 2018; 7:98. [PMID: 30116525 PMCID: PMC6085682 DOI: 10.1186/s13756-018-0384-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/19/2018] [Indexed: 01/09/2023] Open
Abstract
Background Antimicrobial resistance (AMR) poses a colossal threat to global health and incurs high economic costs to society. Economic evaluations of antimicrobials and interventions such as diagnostics and vaccines that affect their consumption rarely include the costs of AMR, resulting in sub-optimal policy recommendations. We estimate the economic cost of AMR per antibiotic consumed, stratified by drug class and national income level. Methods The model is comprised of three components: correlation coefficients between human antibiotic consumption and subsequent resistance; the economic costs of AMR for five key pathogens; and consumption data for antibiotic classes driving resistance in these organisms. These were used to calculate the economic cost of AMR per antibiotic consumed for different drug classes, using data from Thailand and the United States (US) to represent low/middle and high-income countries. Results The correlation coefficients between consumption of antibiotics that drive resistance in S. aureus, E. coli, K. pneumoniae, A. baumanii, and P. aeruginosa and resistance rates were 0.37, 0.27, 0.35, 0.45, and 0.52, respectively. The total economic cost of AMR due to resistance in these five pathogens was $0.5 billion and $2.9 billion in Thailand and the US, respectively. The cost of AMR associated with the consumption of one standard unit (SU) of antibiotics ranged from $0.1 for macrolides to $0.7 for quinolones, cephalosporins and broad-spectrum penicillins in the Thai context. In the US context, the cost of AMR per SU of antibiotic consumed ranged from $0.1 for carbapenems to $0.6 for quinolones, cephalosporins and broad spectrum penicillins. Conclusion The economic costs of AMR per antibiotic consumed were considerable, often exceeding their purchase cost. Differences between Thailand and the US were apparent, corresponding with variation in the overall burden of AMR and relative prevalence of different pathogens. Notwithstanding their limitations, use of these estimates in economic evaluations can make better-informed policy recommendations regarding interventions that affect antimicrobial consumption and those aimed specifically at reducing the burden of AMR. Electronic supplementary material The online version of this article (10.1186/s13756-018-0384-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Poojan Shrestha
- 1Infectious Diseases Data Observatory, University of Oxford, Oxford, UK.,2Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ben S Cooper
- 2Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,3Mahidol Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand
| | - Joanna Coast
- 4School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Raymond Oppong
- 5Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Nga Do Thi Thuy
- Oxford University Clinical Research Unit-Ha Noi, Ha Noi, Vietnam.,7National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | - Olivier Celhay
- 3Mahidol Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand
| | - Philippe J Guerin
- 1Infectious Diseases Data Observatory, University of Oxford, Oxford, UK.,2Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Heiman Wertheim
- Oxford University Clinical Research Unit-Ha Noi, Ha Noi, Vietnam.,9Department of Medical Microbiology, Radboud Center of Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - Yoel Lubell
- 2Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,3Mahidol Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand
| |
Collapse
|
33
|
Pulcini C, Binda F, Lamkang AS, Trett A, Charani E, Goff DA, Harbarth S, Hinrichsen SL, Levy-Hara G, Mendelson M, Nathwani D, Gunturu R, Singh S, Srinivasan A, Thamlikitkul V, Thursky K, Vlieghe E, Wertheim H, Zeng M, Gandra S, Laxminarayan R. Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach. Clin Microbiol Infect 2018; 25:20-25. [PMID: 29625170 DOI: 10.1016/j.cmi.2018.03.033] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/18/2018] [Accepted: 03/22/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES With increasing global interest in hospital antimicrobial stewardship (AMS) programmes, there is a strong demand for core elements of AMS to be clearly defined on the basis of principles of effectiveness and affordability. To date, efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for AMS programmes that should be present in all hospitals worldwide, regardless of resource availability. METHODS A literature review was performed by searching Medline and relevant websites to retrieve a list of core elements and items that could have global relevance. These core elements and items were evaluated by an international group of AMS experts using a structured modified Delphi consensus procedure, using two-phased online in-depth questionnaires. RESULTS The literature review identified seven core elements and their related 29 checklist items from 48 references. Fifteen experts from 13 countries in six continents participated in the consensus procedure. Ultimately, all seven core elements were retained, as well as 28 of the initial checklist items plus one that was newly suggested, all with ≥80% agreement; 20 elements and items were rephrased. CONCLUSIONS This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide.
Collapse
Affiliation(s)
- C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France.
| | - F Binda
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France; University of Milan, Department of Biomedical and Clinical Sciences «Luigi Sacco», Milan, Italy
| | - A S Lamkang
- Center for Disease Dynamics, Economics & Policy (CDDEP), New Delhi, India
| | - A Trett
- Center for Disease Dynamics, Economics & Policy (CDDEP), New Delhi, India
| | - E Charani
- Imperial College London, Department of Medicine, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, UK
| | - D A Goff
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - S Harbarth
- Geneva University Hospitals, Infection Control Program and WHO Collaborating Center, Faculty of Medicine, Geneva, Switzerland
| | - S L Hinrichsen
- Universidade Federal de Pernambuco (UFPE), Tropical Diseases Department, Recife, Brazil
| | - G Levy-Hara
- Hospital Carlos G Durand, Unit of Infectious Diseases, Buenos Aires, Argentina
| | - M Mendelson
- Groote Schuur Hospital, University of Cape Town, Department of Medicine, Division of Infectious Diseases & HIV Medicine, Cape Town, South Africa
| | - D Nathwani
- Ninewells Hospital and Medical School, Dundee, UK
| | - R Gunturu
- The Aga Khan University Hospital, Dept. of Pathology, Division of Clinical Microbiology, Nairobi, Kenya
| | - S Singh
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - A Srinivasan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - V Thamlikitkul
- Mahidol University, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - K Thursky
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute, Melbourne, Australia
| | - E Vlieghe
- University Hospital Antwerp, Department of General Internal Medicine, Infectious Diseases & Tropical Medicine, Antwerp, Belgium; University of Antwerp, Global Health Institute, Antwerp, Belgium; Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
| | - H Wertheim
- Radboudumc, Department of Medical Microbiology and Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
| | - M Zeng
- Children's Hospital of Fudan University, Department of Infectious Diseases, Shanghai, China
| | - S Gandra
- Center for Disease Dynamics, Economics & Policy (CDDEP), New Delhi, India
| | - R Laxminarayan
- Center for Disease Dynamics, Economics & Policy (CDDEP), New Delhi, India; Princeton University, Princeton, NJ, USA
| |
Collapse
|
34
|
Shrestha P, Cooper BS, Coast J, Oppong R, Do Thi Thuy N, Phodha T, Celhay O, Guerin PJ, Wertheim H, Lubell Y. Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use. Antimicrob Resist Infect Control 2018. [PMID: 30116525 DOI: 10.1186/s13756-019-0384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) poses a colossal threat to global health and incurs high economic costs to society. Economic evaluations of antimicrobials and interventions such as diagnostics and vaccines that affect their consumption rarely include the costs of AMR, resulting in sub-optimal policy recommendations. We estimate the economic cost of AMR per antibiotic consumed, stratified by drug class and national income level. METHODS The model is comprised of three components: correlation coefficients between human antibiotic consumption and subsequent resistance; the economic costs of AMR for five key pathogens; and consumption data for antibiotic classes driving resistance in these organisms. These were used to calculate the economic cost of AMR per antibiotic consumed for different drug classes, using data from Thailand and the United States (US) to represent low/middle and high-income countries. RESULTS The correlation coefficients between consumption of antibiotics that drive resistance in S. aureus, E. coli, K. pneumoniae, A. baumanii, and P. aeruginosa and resistance rates were 0.37, 0.27, 0.35, 0.45, and 0.52, respectively. The total economic cost of AMR due to resistance in these five pathogens was $0.5 billion and $2.9 billion in Thailand and the US, respectively. The cost of AMR associated with the consumption of one standard unit (SU) of antibiotics ranged from $0.1 for macrolides to $0.7 for quinolones, cephalosporins and broad-spectrum penicillins in the Thai context. In the US context, the cost of AMR per SU of antibiotic consumed ranged from $0.1 for carbapenems to $0.6 for quinolones, cephalosporins and broad spectrum penicillins. CONCLUSION The economic costs of AMR per antibiotic consumed were considerable, often exceeding their purchase cost. Differences between Thailand and the US were apparent, corresponding with variation in the overall burden of AMR and relative prevalence of different pathogens. Notwithstanding their limitations, use of these estimates in economic evaluations can make better-informed policy recommendations regarding interventions that affect antimicrobial consumption and those aimed specifically at reducing the burden of AMR.
Collapse
Affiliation(s)
- Poojan Shrestha
- 1Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
- 2Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ben S Cooper
- 2Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- 3Mahidol Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand
| | - Joanna Coast
- 4School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Raymond Oppong
- 5Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Nga Do Thi Thuy
- Oxford University Clinical Research Unit-Ha Noi, Ha Noi, Vietnam
- 7National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | - Olivier Celhay
- 3Mahidol Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand
| | - Philippe J Guerin
- 1Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
- 2Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Heiman Wertheim
- Oxford University Clinical Research Unit-Ha Noi, Ha Noi, Vietnam
- 9Department of Medical Microbiology, Radboud Center of Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - Yoel Lubell
- 2Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- 3Mahidol Oxford Tropical Medicine Research Unit Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400 Thailand
| |
Collapse
|
35
|
Yacoub S, Lam PK, Huynh TT, Nguyen Ho HH, Dong Thi HT, Van NT, Lien LT, Ha QNT, Le DHT, Mongkolspaya J, Culshaw A, Yeo TW, Wertheim H, Simmons C, Screaton G, Wills B. Endothelial Nitric Oxide Pathways in the Pathophysiology of Dengue: A Prospective Observational Study. Clin Infect Dis 2017; 65:1453-1461. [PMID: 28673038 PMCID: PMC5850435 DOI: 10.1093/cid/cix567] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/20/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dengue can cause increased vascular permeability that may lead to hypovolemic shock. Endothelial dysfunction may underlie this; however, the association of endothelial nitric oxide (NO) pathways with disease severity is unknown. METHODS We performed a prospective observational study in 2 Vietnamese hospitals, assessing patients presenting early (<72 hours of fever) and patients hospitalized with warning signs or severe dengue. The reactive hyperemic index (RHI), which measures endothelium-dependent vasodilation and is a surrogate marker of endothelial function and NO bioavailability, was evaluated using peripheral artery tonometry (EndoPAT), and plasma levels of l-arginine, arginase-1, and asymmetric dimethylarginine were measured at serial time-points. The main outcome of interest was plasma leakage severity. RESULTS Three hundred fourteen patients were enrolled; median age of the participants was 21(interquartile range, 13-30) years. No difference was found in the endothelial parameters between dengue and other febrile illness. Considering dengue patients, the RHI was significantly lower for patients with severe plasma leakage compared to those with no leakage (1.46 vs 2.00; P < .001), over acute time-points, apparent already in the early febrile phase (1.29 vs 1.75; P = .012). RHI correlated negatively with arginase-1 and positively with l-arginine (P = .001). CONCLUSIONS Endothelial dysfunction/NO bioavailability is associated with worse plasma leakage, occurs early in dengue illness and correlates with hypoargininemia and high arginase-1 levels.
Collapse
Affiliation(s)
- Sophie Yacoub
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi and Ho Chi Minh City, Vietnam
- Department of Medicine, Imperial College London, United Kingdom
| | - Phung Khanh Lam
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi and Ho Chi Minh City, Vietnam
| | | | | | - Hoai Tam Dong Thi
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi and Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, and
| | - Nguyen Thu Van
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi and Ho Chi Minh City, Vietnam
| | - Le Thi Lien
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Quyen Nguyen Than Ha
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi and Ho Chi Minh City, Vietnam
| | - Duyen Huynh Thi Le
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi and Ho Chi Minh City, Vietnam
| | | | - Abigail Culshaw
- Department of Medicine, Imperial College London, United Kingdom
| | - Tsin Wen Yeo
- Menzies School of Health Research, Darwin, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Heiman Wertheim
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi and Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, University of Oxford, United Kingdom; and
| | - Cameron Simmons
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi and Ho Chi Minh City, Vietnam
- Department of Microbiology and Immunology, University of Melbourne, Australia
| | - Gavin Screaton
- Department of Medicine, Imperial College London, United Kingdom
| | - Bridget Wills
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi and Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, University of Oxford, United Kingdom; and
| |
Collapse
|
36
|
Hoa LNM, Tuan NA, My PH, Huong TTK, Chi NTY, Hau Thu TT, Carrique-Mas J, Duong MT, Tho ND, Hoang ND, Thanh TL, Diep NT, van Duong N, Toan TK, Tung TS, Mai LQ, Iqbal M, Wertheim H, van Doorn HR, Bryant JE. Assessing evidence for avian-to-human transmission of influenza A/H9N2 virus in rural farming communities in northern Vietnam. J Gen Virol 2017; 98:2011-2016. [PMID: 28771136 PMCID: PMC5656782 DOI: 10.1099/jgv.0.000877] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022] Open
Abstract
Rural farming communities in northern Vietnam do not routinely practice vaccination for influenza A viruses (IAV) for either humans or poultry, which enables us to study transmission intensity via seroepidemiology. Using samples from a longitudinal cohort of farming households, we determined the number of symptomatic and asymptomatic human infections for seasonal IAV and avian A/H9 over 2 years. As expected, we detected virologically confirmed acute cases of seasonal IAV in humans, as well as large numbers of subclinical seroconversions to A/H1pdm [55/265 (21 %)], A/H3 [95/265 (36 %)] and A/H9 [24/265 (9 %)]. Five of the A/H9 human seroconverters likely represented true infections rather than heterosubtypic immunity, because the individuals seroconverted solely to A/H9. Among co-located poultry, we found significantly higher seroprevalance for A/H5 compared to A/H9 in both chickens and ducks [for northern study sites overall, 337/1105 (30.5 %) seropositive for A/H5 and 123/1105 (11.1 %) seropositive for A/H9].
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Agriculture
- Animals
- Antibodies, Viral/blood
- Chickens
- Child
- Child, Preschool
- Ducks
- Female
- Humans
- Infant
- Influenza A Virus, H9N2 Subtype/classification
- Influenza A Virus, H9N2 Subtype/genetics
- Influenza A Virus, H9N2 Subtype/immunology
- Influenza A Virus, H9N2 Subtype/isolation & purification
- Influenza in Birds/blood
- Influenza in Birds/epidemiology
- Influenza in Birds/transmission
- Influenza in Birds/virology
- Influenza, Human/blood
- Influenza, Human/epidemiology
- Influenza, Human/transmission
- Influenza, Human/virology
- Male
- Middle Aged
- Poultry Diseases/blood
- Poultry Diseases/epidemiology
- Poultry Diseases/transmission
- Poultry Diseases/virology
- Rural Population/statistics & numerical data
- Seroepidemiologic Studies
- Vietnam
- Young Adult
Collapse
Affiliation(s)
- Le Nguyen Minh Hoa
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
| | - Nguyen Anh Tuan
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
| | - Pham Ha My
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
| | - Tran Thi Kieu Huong
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
| | - Nguyen Thi Yen Chi
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
| | - Trang Thi Hau Thu
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
| | - Juan Carrique-Mas
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
| | - Mai Thuy Duong
- National Center for
Veterinary Diagnostics, Hanoi,
Vietnam
| | | | | | - To Long Thanh
- National Center for
Veterinary Diagnostics, Hanoi,
Vietnam
| | - Nguyen Thi Diep
- Department of Animal
Health, Epidemiology Division, Hanoi,
Vietnam
| | - Nguyen van Duong
- District Veterinary
Services, BaVi District, Subdepartment of Animal Health,
Hanoi province, Vietnam
| | | | - Trinh Son Tung
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
- National Institute
Hygiene and Epidemiology, Hanoi,
Vietnam
| | - Le Quynh Mai
- National Institute
Hygiene and Epidemiology, Hanoi,
Vietnam
| | | | - Heiman Wertheim
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
- Radboud
University, Nijmegen,
Netherlands
| | - H. Rogier van Doorn
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
- Nuffield Department
of Medicine, Centre for Tropical Medicine, University of
Oxford, Oxford,
UK
| | - Juliet E. Bryant
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
- Nuffield Department
of Medicine, Centre for Tropical Medicine, University of
Oxford, Oxford,
UK
| | - the VIZIONS consortium
- Oxford University
Clinical Research Unit, Hospital for Tropical Diseases,
Vietnam
- National Center for
Veterinary Diagnostics, Hanoi,
Vietnam
- Department of Animal
Health, Epidemiology Division, Hanoi,
Vietnam
- District Veterinary
Services, BaVi District, Subdepartment of Animal Health,
Hanoi province, Vietnam
- Hanoi Medical
University, Hanoi,
Vietnam
- National Institute
Hygiene and Epidemiology, Hanoi,
Vietnam
- The Pirbright
Insitute, UK
- Radboud
University, Nijmegen,
Netherlands
- Nuffield Department
of Medicine, Centre for Tropical Medicine, University of
Oxford, Oxford,
UK
| |
Collapse
|
37
|
Cox JA, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas MV, Gould I, Levy Hara G. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infect 2017; 23:812-818. [PMID: 28712667 DOI: 10.1016/j.cmi.2017.07.010] [Citation(s) in RCA: 282] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Antibiotic resistance (ABR) is a quickly worsening problem worldwide, also in low- and middle-income countries (LMICs). Appropriate antibiotic use in humans and animals, i.e. antibiotic stewardship (ABS), is one of the cornerstones of the World Health Organization's global action plan for ABR. Many LMICs are in the process of developing stewardship programs. AIMS We highlight challenges for ABS initiatives in LMICs, give an outline of (inter)national recommendations and demonstrate examples of effective, contextualized stewardship interventions. SOURCES We searched PubMed for articles on ABS interventions in humans in LMICs. Relevant websites and experts were consulted for additional sources. CONTENT Evidence on effective and feasible stewardship interventions in LMICs is limited, and challenges for implementation of interventions are numerous. Nevertheless, several initiatives at the international and local levels in Latin America, Africa and Asia have shown that ABS effective interventions are feasible in LMICs, although contextualization is essential. IMPLICATIONS Specific guidance for setting up antimicrobial stewardship programs in LMICs should be developed. Strategic points might need to be progressively addressed in LMICs, such as (a) ensuring availability of diagnostic testing, (b) providing dedicated education in ABR both for healthcare workers and the general public, (c) creating or strengthening (inter)national agencies towards better regulations and audit on production, distribution and dispensing of drugs, (d) strengthening healthcare facilities, (e) exploring a broader synergism between policy makers, academia, professional bodies and civil society and (f) designing and studying easy and scalable ABS interventions for both hospital and community settings.
Collapse
Affiliation(s)
- J A Cox
- Unit of Tropical Laboratory Medicine, Department of Clinical Sciences, Institute of Tropical Medicine, Belgium
| | - E Vlieghe
- Unit of Tropical Laboratory Medicine, Department of Clinical Sciences, Institute of Tropical Medicine, Belgium; Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp, Antwerp, Belgium.
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - H Wertheim
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Viet Nam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom; Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - L Ndegwa
- Infection Prevention Network-Kenya (IPNET-Kenya), Nairobi, Kenya
| | - M V Villegas
- Hospital Epidemiology and Bacterial Resistance Area, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali and Universidad El Bosque, Bogotá, Colombia
| | - I Gould
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - G Levy Hara
- Infectious Diseases Unit, Hospital Carlos G Durand, Buenos Aires, Argentina
| |
Collapse
|
38
|
Hopman J, Tostmann A, Wertheim H, Bos M, Kolwijck E, Akkermans R, Sturm P, Voss A, Pickkers P, Vd Hoeven H. Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of 'water-free' patient care. Antimicrob Resist Infect Control 2017; 6:59. [PMID: 28616203 PMCID: PMC5466749 DOI: 10.1186/s13756-017-0213-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Sinks in patient rooms are associated with hospital-acquired infections. The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of ‘water-free’ patient care on gram-negative bacilli colonization rates. Methods We conducted a 2-year pre/post quasi-experimental study that compared monthly gram-negative bacilli colonization rates pre- and post-intervention using segmented regression analysis of interrupted time series data. Five ICUs of a tertiary care medical center were included. Participants were all patients of 18 years and older admitted to our ICUs for at least 48 h who also received selective digestive tract decontamination during the twelve month pre-intervention or the twelve month post-intervention period. The effect of sink removal and the introduction of ‘water-free’ patient care on colonization rates with gram-negative bacilli was evaluated. The main outcome of this study was the monthly colonization rate with gram-negative bacilli (GNB). Yeast colonization rates were used as a ‘negative control’. In addition, colonization rates were calculated for first positive culture results from cultures taken ≥3, ≥5, ≥7, ≥10 and ≥14 days after ICU-admission, rate ratios (RR) were calculated and differences tested with chi-squared tests. Results In the pre-intervention period, 1496 patients (9153 admission days) and in the post-intervention period 1444 patients (9044 admission days) were included. Segmented regression analysis showed that the intervention was followed by a statistically significant immediate reduction in GNB colonization in absence of a pre or post intervention trend in GNB colonization. The overall GNB colonization rate dropped from 26.3 to 21.6 GNB/1000 ICU admission days (colonization rate ratio 0.82; 95%CI 0.67–0.99; P = 0.02). The reduction in GNB colonization rate became more pronounced in patients with a longer ICU-Length of Stay (LOS): from a 1.22-fold reduction (≥2 days), to a 1.6-fold (≥5 days; P = 0.002), 2.5-fold (for ≥10 days; P < 0.001) to a 3.6-fold (≥14 days; P < 0.001) reduction. Conclusions Removal of sinks from patient rooms and introduction of a method of ‘water-free’ patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay. Electronic supplementary material The online version of this article (doi:10.1186/s13756-017-0213-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joost Hopman
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Alma Tostmann
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Maria Bos
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Eva Kolwijck
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Patrick Sturm
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands.,Department of Medical Microbiology, Laurentius hospital, Roermond, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Hans Vd Hoeven
- Department of Intensive Care, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
39
|
Yacoub S, Lam PK, Vu LHM, Le TL, Ha NT, Toan TT, Van NT, Quyen NTH, Le Duyen HT, Van Kinh N, Fox A, Mongkolspaya J, Wolbers M, Simmons CP, Screaton GR, Wertheim H, Wills B. Association of Microvascular Function and Endothelial Biomarkers With Clinical Outcome in Dengue: An Observational Study. J Infect Dis 2016; 214:697-706. [PMID: 27230099 PMCID: PMC4978369 DOI: 10.1093/infdis/jiw220] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/18/2016] [Indexed: 12/26/2022] Open
Abstract
Background. The hallmark of severe dengue is increased microvascular permeability, but alterations in the microcirculation and their evolution over the course of dengue are unknown. Methods. We conducted a prospective observational study to evaluate the sublingual microcirculation using side-stream dark-field imaging in patients presenting early (<72 hours after fever onset) and patients hospitalized with warning signs or severe dengue in Vietnam. Clinical findings, microvascular function, global hemodynamics assessed with echocardiography, and serological markers of endothelial activation were determined at 4 time points. Results. A total of 165 patients were enrolled. No difference was found between the microcirculatory parameters comparing dengue with other febrile illnesses. The proportion of perfused vessels (PPV) and the mean flow index (MFI) were lower in patients with dengue with plasma than those without leakage (PPV, 88.1% vs 90.6% [P = .01]; MFI, 2.1 vs 2.4 [P = .007]), most markedly during the critical phase. PPV and MFI were correlated with the endothelial activation markers vascular cell adhesion molecule 1 (P < .001 for both) and angiopoietin 2 (P < .001 for both), negatively correlated. Conclusions. Modest microcirculatory alterations occur in dengue, are associated with plasma leakage, and are correlate with molecules of endothelial activation, angiopoietin 2 and vascular cell adhesion molecule 1.
Collapse
Affiliation(s)
- Sophie Yacoub
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi Department of Medicine, Imperial College London
| | - Phung Khanh Lam
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi
| | - Le Hoang Mai Vu
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi
| | - Thi Lien Le
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Ngo Thanh Ha
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Tran Thi Toan
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Nguyen Thu Van
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi
| | - Nguyen Than Ha Quyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi
| | - Huynh Thi Le Duyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi
| | | | - Annette Fox
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi
| | | | - Marcel Wolbers
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi
| | - Cameron Paul Simmons
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi Nuffield Department of Medicine, University of Oxford, United Kingdom
| | | | - Heiman Wertheim
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Bridget Wills
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Hanoi Nuffield Department of Medicine, University of Oxford, United Kingdom
| |
Collapse
|
40
|
Mendelson M, Røttingen JA, Gopinathan U, Hamer DH, Wertheim H, Basnyat B, Butler C, Tomson G, Balasegaram M. Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries. Lancet 2016; 387:188-98. [PMID: 26603919 DOI: 10.1016/s0140-6736(15)00547-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Access to quality-assured antimicrobials is regarded as part of the human right to health, yet universal access is often undermined in low-income and middle-income countries. Lack of access to the instruments necessary to make the correct diagnosis and prescribe antimicrobials appropriately, in addition to weak health systems, heightens the challenge faced by prescribers. Evidence-based interventions in community and health-care settings can increase access to appropriately prescribed antimicrobials. The key global enablers of sustainable financing, governance, and leadership will be necessary to achieve access while preventing excess antimicrobial use.
Collapse
Affiliation(s)
- Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - John-Arne Røttingen
- Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Unni Gopinathan
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Davidson H Hamer
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia; Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Heiman Wertheim
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Diseases, Oxford, UK
| | - Buddha Basnyat
- Oxford University Clinical Research Unit-Nepal, Kathmandu, Nepal
| | - Christopher Butler
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Göran Tomson
- Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | | |
Collapse
|
41
|
Carrique-Mas JJ, Tue NT, Bryant JE, Saylors K, Cuong NV, Hoa NT, An NN, Hien VB, Lao PV, Tu NC, Chuyen NK, Chuc NT, Tan DV, Duong HVV, Toan TK, Chi NT, Campbell J, Rabaa MA, Nadjm B, Woolhouse M, Wertheim H, Thwaites G, Baker S. The baseline characteristics and interim analyses of the high-risk sentinel cohort of the Vietnam Initiative on Zoonotic InfectiONS (VIZIONS). Sci Rep 2015; 5:17965. [PMID: 26659094 PMCID: PMC4674710 DOI: 10.1038/srep17965] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/26/2015] [Indexed: 11/08/2022] Open
Abstract
The Vietnam Initiative for Zoonotic Infections (VIZIONS) includes community-based 'high-risk sentinel cohort' (HRSC) studies investigating individuals at risk of zoonotic infection due to occupational or residential exposure to animals. A total of 852 HRSC members were recruited between March 2013 and August 2014 from three provinces (Ha Noi, Dak Lak, and Dong Thap). The most numerous group (72.8%) corresponded to individuals living on farms, followed by slaughterers (16.3%) and animal health workers (8.5%). Nasal/pharyngeal and rectal swabs were collected from HRSC members at recruitment and after notifying illness. Exposure to exotic animals (including wild pigs, porcupine, monkey, civet, bamboo rat and bat) was highest for the Dak Lak cohort (53.7%), followed by Ha Noi (13.7%) and Dong Thap (4.0%). A total of 26.8% of individuals reported consumption of raw blood over the previous year; 33.6% slaughterers reported no use of protective equipment at work. Over 686 person-years of observation, 213 episodes of suspect infectious disease were notified, equivalent of 0.35 reports per person-year. Responsive samples were collected from animals in the farm cohort. There was noticeable time and space clustering of disease episodes suggesting that the VIZIONS set up is also suitable for the formal epidemiological investigation of disease outbreaks.
Collapse
Affiliation(s)
- Juan J. Carrique-Mas
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7BN, United Kingdom
| | - Ngo T. Tue
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Global Viral, San Francisco, CA 94104 USA
| | - Juliet E. Bryant
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7BN, United Kingdom
- National Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | | | - Nguyen V. Cuong
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ngo T. Hoa
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7BN, United Kingdom
| | - Nguyen N. An
- Preventive Medicine Centre Dong Thap Province, Cao Lanh, Vietnam
| | - Vo B. Hien
- Sub-Department of Animal Health Dong Thap Province, Cao Lanh, Vietnam
| | - Pham V. Lao
- Preventive Medicine Centre Dak Lak Province, Buon Ma Thuot, Vietnam
| | - Nguyen C. Tu
- Regional Animal Health Laboratory 5, Buon Ma Thuot, Vietnam
| | - Nguyen K. Chuyen
- Sub-Department of Animal Health Dak Lak Province, Buon Ma Thuot, Vietnam
| | | | - Dinh V. Tan
- Ba Vi District Health Centre, Ha Noi, Vietnam
| | | | | | - Nguyen T.Y. Chi
- National Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | - James Campbell
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7BN, United Kingdom
| | - Maia A. Rabaa
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7BN, United Kingdom
| | - Behzad Nadjm
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7BN, United Kingdom
- National Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | - Mark Woolhouse
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh EH9 3FL, United Kingdom
| | - Heiman Wertheim
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7BN, United Kingdom
- National Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ha Noi, Vietnam
- Department of Medical Microbiology, Radboud University Medical Cente, Nijmegen 6500 HB, the Netherlands
| | - Guy Thwaites
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7BN, United Kingdom
| | - Stephen Baker
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7BN, United Kingdom
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| |
Collapse
|
42
|
Rabaa MA, Tue NT, Phuc TM, Carrique-Mas J, Saylors K, Cotten M, Bryant JE, Nghia HDT, Cuong NV, Pham HA, Berto A, Phat VV, Dung TTN, Bao LH, Hoa NT, Wertheim H, Nadjm B, Monagin C, van Doorn HR, Rahman M, Tra MPV, Campbell JI, Boni MF, Tam PTT, van der Hoek L, Simmonds P, Rambaut A, Toan TK, Van Vinh Chau N, Hien TT, Wolfe N, Farrar JJ, Thwaites G, Kellam P, Woolhouse MEJ, Baker S. The Vietnam Initiative on Zoonotic Infections (VIZIONS): A Strategic Approach to Studying Emerging Zoonotic Infectious Diseases. Ecohealth 2015; 12:726-35. [PMID: 26403795 PMCID: PMC4700077 DOI: 10.1007/s10393-015-1061-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/20/2015] [Accepted: 08/24/2015] [Indexed: 06/05/2023]
Abstract
The effect of newly emerging or re-emerging infectious diseases of zoonotic origin in human populations can be potentially catastrophic, and large-scale investigations of such diseases are highly challenging. The monitoring of emergence events is subject to ascertainment bias, whether at the level of species discovery, emerging disease events, or disease outbreaks in human populations. Disease surveillance is generally performed post hoc, driven by a response to recent events and by the availability of detection and identification technologies. Additionally, the inventory of pathogens that exist in mammalian and other reservoirs is incomplete, and identifying those with the potential to cause disease in humans is rarely possible in advance. A major step in understanding the burden and diversity of zoonotic infections, the local behavioral and demographic risks of infection, and the risk of emergence of these pathogens in human populations is to establish surveillance networks in populations that maintain regular contact with diverse animal populations, and to simultaneously characterize pathogen diversity in human and animal populations. Vietnam has been an epicenter of disease emergence over the last decade, and practices at the human/animal interface may facilitate the likelihood of spillover of zoonotic pathogens into humans. To tackle the scientific issues surrounding the origins and emergence of zoonotic infections in Vietnam, we have established The Vietnam Initiative on Zoonotic Infections (VIZIONS). This countrywide project, in which several international institutions collaborate with Vietnamese organizations, is combining clinical data, epidemiology, high-throughput sequencing, and social sciences to address relevant one-health questions. Here, we describe the primary aims of the project, the infrastructure established to address our scientific questions, and the current status of the project. Our principal objective is to develop an integrated approach to the surveillance of pathogens circulating in both human and animal populations and assess how frequently they are exchanged. This infrastructure will facilitate systematic investigations of pathogen ecology and evolution, enhance understanding of viral cross-species transmission events, and identify relevant risk factors and drivers of zoonotic disease emergence.
Collapse
Affiliation(s)
- Maia A Rabaa
- Centre for Immunity, Infection & Evolution, The University of Edinburgh, Edinburgh, UK
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Ngo Tri Tue
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Tran My Phuc
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Juan Carrique-Mas
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | | | | | - Juliet E Bryant
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - Ho Dang Trung Nghia
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- The Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
| | - Nguyen Van Cuong
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Hong Anh Pham
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Alessandra Berto
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Voong Vinh Phat
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Tran Thi Ngoc Dung
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Long Hoang Bao
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - Ngo Thi Hoa
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Heiman Wertheim
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - Behzad Nadjm
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | | | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Motiur Rahman
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | | | - James I Campbell
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Maciej F Boni
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Pham Thi Thanh Tam
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Lia van der Hoek
- Laboratory of Experimental Virology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Simmonds
- Centre for Immunity, Infection & Evolution, The University of Edinburgh, Edinburgh, UK
| | - Andrew Rambaut
- Centre for Immunity, Infection & Evolution, The University of Edinburgh, Edinburgh, UK
| | | | - Nguyen Van Vinh Chau
- The Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | | | - Jeremy J Farrar
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Paul Kellam
- The Wellcome Trust Sanger Institute, Cambridge, UK
| | - Mark E J Woolhouse
- Centre for Immunity, Infection & Evolution, The University of Edinburgh, Edinburgh, UK
| | - Stephen Baker
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK.
- The Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
- The London School of Hygiene and Tropical Medicine, London, UK.
| |
Collapse
|
43
|
Taylor WR, Fox A, Pham KT, Le HNM, Tran NTH, Tran GV, Nguyen BT, Nguyen MV, Nguyen LT, Yacoub S, Nguyen HTT, Nguyen HH, Nguyen HD, Wertheim H, Horby P, Farrar J, Trinh LTM, Nguyen KV. Dengue in adults admitted to a referral hospital in Hanoi, Vietnam. Am J Trop Med Hyg 2015; 92:1141-1149. [PMID: 25918201 PMCID: PMC4458817 DOI: 10.4269/ajtmh.14-0472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 01/14/2015] [Indexed: 01/11/2023] Open
Abstract
Knowledge of adult dengue virus (DENV) infection from Hanoi, Vietnam, is limited. In 2008, we prospectively studied 143 (77 male) confirmed (nonstructural 1 antigen enzyme-linked immunosorbent assay [ELISA], DENV polymerase chain reaction, paired serology) adult dengue patients of median age 23.5 (range 16-72) years. They were admitted to the National Hospital for Tropical Diseases, Hanoi, on median illness day (D) 5 (range 1-8). By D8, 141 (98.6%) were afebrile. Platelet counts and hematocrit (median, interquartile range [IQR]) nadired and peaked on D5 and D4, respectively: 40,000/μL (10,000-109,000/μL), 43.4% (34.9-49.7%). Four (2.8%) patients had severe dengue: 1) D10 shock (N = 1) and 2) aspartate aminotransferase (AST) ≥ 1,000 IU/L (N = 3, D5 and D7). Of 143 patients, 118 (82.5%) had ≥ 1 warning sign (World Health Organization [WHO] 2009 criteria): mucosal bleeding 66/143 (46.1%), soft tissue edema 54/143 (37.7%), and ultrasound detected plasma leakage (pleural effusions/ascites) 30/129 (23.25%). 138 (96.5%) patients received intravenous (IV) fluids: 3 L (IQR: 0.5-8.5 L). Most patients had non-severe dengue with warning signs. High rates of edema and plasma leakage may be explained partly by liberal use of IV fluids. Studies are needed on optimizing fluid management in non-severe adult dengue.
Collapse
Affiliation(s)
- Walter R. Taylor
- Oxford University Clinical Research Unit (OUCRU), Wellcome Trust Major Overseas Programme, Hanoi, Socialist Republic of Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, England; National Hospital for Tropical Diseases, Hanoi, Socialist Republic of Vietnam; Department of Medicine, Imperial College, Hammersmith Campus, London, England; Vietnam National Heart Institute, Bach Mai hospital, Hanoi, Socialist Republic of Vietnam; Oxford Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Socialist Republic of Vietnam
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Segura M, Zheng H, de Greeff A, Gao GF, Grenier D, Jiang Y, Lu C, Maskell D, Oishi K, Okura M, Osawa R, Schultsz C, Schwerk C, Sekizaki T, Smith H, Srimanote P, Takamatsu D, Tang J, Tenenbaum T, Tharavichitkul P, Hoa NT, Valentin-Weigand P, Wells JM, Wertheim H, Zhu B, Xu J, Gottschalk M. Latest developments on Streptococcus suis: an emerging zoonotic pathogen: part 2. Future Microbiol 2015; 9:587-91. [PMID: 24957086 DOI: 10.2217/fmb.14.15] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
First International Workshop on Streptococcus suis, Beijing, China, 12-13 August 2013. This second and final chapter of the report on the First International Workshop on Streptococcus suis follows on from Part 1, published in the April 2014, volume 9, issue 4 of Future Microbiology. S. suis is a swine pathogen and a zoonotic agent afflicting people in close contact with infected pigs or pork meat. Although sporadic cases of human infections had been reported worldwide, deadly S. suis outbreaks emerged in Asia. The severity of the disease underscores the lack of knowledge on the virulence and zoonotic evolution of this human-infecting agent. The pathogenesis of the infection, interactions with host cells and new avenues for treatments were among the topics discussed during the First International Workshop on S. suis (China 2013).
Collapse
Affiliation(s)
- Mariela Segura
- Faculty of Veterinary Medicine, University of Montreal, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
BACKGROUND Dengue infection can result in a wide spectrum of disease. The defining feature of severe disease is increased capillary permeability, which can lead to hypovolaemic shock. Microvascular and endothelial dysfunction might underlie hypovolaemic shock, but they have not been assessed clinically. We aimed to investigate the use of microvascular assessment as a prognostic method in dengue. METHODS This is an ongoing prospective observational study that aims to recruit 300 participants: children over the age of 3 years and adults presenting to two outpatient departments in Vietnam with fever of less than 72 h duration and suspected dengue, and patients admitted to hospital with warning signs or severe disease. Participants are being clinically assessed daily for 6 days, and 2 weeks later. Microvascular imaging using sublingual sidestream darkfield imaging (SDF) and endothelial function testing using peripheral artery tonometry are being performed at enrolment, defervescence, and follow-up FINDINGS To date, 167 patients have been recruited (92 outpatient arm, 75 inpatient arm, median age 27 years [IQR 21-33], 78 male [47%]). Dengue has been confirmed in 67 individuals in the outpatient arm, of whom 29 (43%) developed warning signs, three (4%) developed severe disease, and 35 had uncomplicated dengue; the other 25 outpatients (27%) were diagnosed as other febrile illness. At enrolment, the reactive hyperaemic index, a marker of endothelial function, was lowest in the patients who went on to develop severe dengue (median 1·54, IQR 1·36-1·77) followed by those who developed warning signs (1·78, 1·43-2·36) and then uncomplicated dengue (2·18, 1·65-2·24). Initial SDF results showed a lower proportion of perfused vessels and mean flow index during the febrile phase of dengue compared with follow-up, and were worst in the severe group at defervescence. INTERPRETATION This study of vascular function at serial timepoints in dengue is, to our knowledge, the first and most comprehensive. Our preliminary results suggest that microvascular and endothelial dysfunction are associated with severity of dengue, and occur before the appearance of severe clinical manifestations. These techniques might be useful in risk prediction in dengue. A limitation is that a formal sample size could not be calculated because no previous microvascular data in dengue exist. FUNDING Wellcome Trust.
Collapse
Affiliation(s)
- Sophie Yacoub
- Department of Medicine, Imperial College London, London, UK; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
| | - Heiman Wertheim
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, UK
| | - Cameron P Simmons
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; University of Melbourne, Melbourne, VIC, Australia
| | - Gavin Screaton
- Department of Medicine, Imperial College London, London, UK
| | - Bridget Wills
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Oxford, UK
| |
Collapse
|
46
|
Van TD, Dinh QD, Vu PD, Nguyen TV, Pham CV, Dao TT, Phung CD, Hoang HTT, Tang NT, Do NT, Nguyen KV, Wertheim H. Antibiotic susceptibility and molecular epidemiology of Acinetobacter calcoaceticus-baumannii complex strains isolated from a referral hospital in northern Vietnam. J Glob Antimicrob Resist 2014; 2:318-321. [PMID: 25540720 PMCID: PMC4270437 DOI: 10.1016/j.jgar.2014.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/12/2014] [Accepted: 05/15/2014] [Indexed: 10/28/2022] Open
Abstract
Acinetobacter calcoaceticus-baumannii complex is a common cause of hospital-acquired infections (HAIs) globally, remarkable for its high rate of antibiotic resistance, including to carbapenems. There are few data on the resistance of A. baumannii in Vietnam, which are essential for developing evidence-based treatment guidelines for HAIs. Antibiotic susceptibility testing was conducted by VITEK®2, and pulsed-field gel electrophoresis (PFGE) was performed on 66 clinical A. baumannii complex isolates recovered during 2009 at the National Hospital of Tropical Diseases (NHTD), a referral hospital in Hanoi, Vietnam. Basic demographic and clinical data were collected and analysed using descriptive statistics. Most isolates came from lower respiratory tract specimens (59; 89.4%) from intensive care unit (ICU) patients [64/65 (98.5%) with available data] who had been admitted to NHTD for ≥2 days [42/46 (91.3%) with available data]. More than 90% of the isolates were resistant to the tested β-lactamase/β-lactamase inhibitors, cephalosporins, carbapenems, fluoroquinolones and trimethoprim/sulfamethoxazole. Moreover, 25.4% (16/63) were resistant to all tested β-lactams, quinolones and aminoglycosides. All isolates remained sensitive to colistin and 58.7% were susceptible to tigecycline. Of the 66 isolates, 49 could be classified into eight PFGE types (A-H). Every PFGE type, except D, had cluster(s) of three or more isolates with a temporal relationship. In conclusion, these data suggest a significant rise in A. baumannii antibiotic resistance in Vietnam. Clustering within PFGE types supports cross-transmission of A. baumannii within the ICU at NHTD. Increased research and resources in optimising treatment, infection control and antibiotic stewardship are needed.
Collapse
Affiliation(s)
| | - Quynh-Dao Dinh
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Hanoi, Viet Nam
| | - Phu Dinh Vu
- National Hospital of Tropical Diseases, Hanoi, Viet Nam
| | | | - Ca Van Pham
- National Hospital of Tropical Diseases, Hanoi, Viet Nam
| | | | - Cam Dac Phung
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | | | - Nga Thi Tang
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Nga Thuy Do
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Hanoi, Viet Nam
| | | | - Heiman Wertheim
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Hanoi, Viet Nam ; Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
47
|
Day J, Imran D, Ganiem AR, Tjahjani N, Wahyuningsih R, Adawiyah R, Dance D, Mayxay M, Newton P, Phetsouvanh R, Rattanavong S, Chan AK, Heyderman R, van Oosterhout JJ, Chierakul W, Day N, Kamali A, Kibengo F, Ruzagira E, Gray A, Lalloo DG, Beardsley J, Binh TQ, Chau TTH, Chau NVV, Cuc NTK, Farrar J, Hien TT, Van Kinh N, Merson L, Phuong L, Tho LT, Thuy PT, Thwaites G, Wertheim H, Wolbers M. CryptoDex: a randomised, double-blind, placebo-controlled phase III trial of adjunctive dexamethasone in HIV-infected adults with cryptococcal meningitis: study protocol for a randomised control trial. Trials 2014; 15:441. [PMID: 25391338 PMCID: PMC4289250 DOI: 10.1186/1745-6215-15-441] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/16/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cryptococcal meningitis (CM) is a severe AIDS-defining illness with 90-day case mortality as high as 70% in sub-Saharan Africa, despite treatment. It is the leading cause of death in HIV patients in Asia and Africa.No major advance has been made in the treatment of CM since the 1970s. The mainstays of induction therapy are amphotericin B and flucytosine, but these are often poorly available where the disease burden is highest. Adjunctive treatments, such as dexamethasone, have had dramatic effects on mortality in other neurologic infections, but are untested in CM. Given the high death rates in patients receiving current optimal treatment, and the lack of new agents on the horizon, adjuvant treatments, which offer the potential to reduce mortality in CM, should be tested.The principal research question posed by this study is as follows: does adding dexamethasone to standard antifungal therapy for CM reduce mortality? Dexamethasone is a cheap, readily available, and practicable intervention. METHOD A double-blind placebo-controlled trial with parallel arms in which patients are randomised to receive either dexamethasone or placebo, in addition to local standard of care. The study recruits patients in both Asia and Africa to ensure the relevance of its results to the populations in which the disease burden is highest. The 10-week mortality risk in the control group is expected to be between 30% and 50%, depending on location, and the target hazard ratio of 0.7 corresponds to absolute risk reductions in mortality from 30% to 22%, or from 50% to 38%. Assuming an overall 10-week mortality of at least 30% in our study population, recruitment of 824 patients will be sufficient to observe the expected number of deaths. Allowing for some loss to follow-up, the total sample size for this study is 880 patients. To generate robust evidence across both continents, we aim to recruit roughly similar numbers of patients from each continent. The primary end point is 10-week mortality. Ethical approval has been obtained from Oxford University's Tropical Research Ethics Committee (OxTREC), and as locally mandated at each site. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN59144167 26-July-2012.
Collapse
Affiliation(s)
- Jeremy Day
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Darma Imran
- />Cipto Mangunkusum Hospital, Jakarta, Indonesia
| | | | | | - Retno Wahyuningsih
- />Cipto Mangunkusum Hospital, Jakarta, Indonesia
- />Department of Parasitology, Indonesia Christian University, School of Medicine, Jakarta, Indonesia
| | - Robiatul Adawiyah
- />Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - David Dance
- />Laos Oxford Mahosot Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
| | - Mayfong Mayxay
- />Laos Oxford Mahosot Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
| | - Paul Newton
- />Laos Oxford Mahosot Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
| | | | - Sayaphet Rattanavong
- />Laos Oxford Mahosot Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
| | | | - Robert Heyderman
- />Malawi-Liverpool-Wellcome Trust, Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Wirongrong Chierakul
- />Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Nick Day
- />Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Anatoli Kamali
- />MRC/UVRI Uganda Research Unit on AIDS, Entebbe/Masaka, Uganda
| | - Freddie Kibengo
- />MRC/UVRI Uganda Research Unit on AIDS, Entebbe/Masaka, Uganda
| | - Eugene Ruzagira
- />MRC/UVRI Uganda Research Unit on AIDS, Entebbe/Masaka, Uganda
| | - Alastair Gray
- />Nuffield Department of Population Health, University of Oxford Health Economics Research Centre, Oxford, UK
| | - David G Lalloo
- />Wellcome Trust Tropical Centre Liverpool, Liverpool, UK
| | - Justin Beardsley
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Tran Thi Hong Chau
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Jeremy Farrar
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Laura Merson
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Lan Phuong
- />Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Loc Truong Tho
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Guy Thwaites
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Heiman Wertheim
- />National Hospital for Tropical Diseases Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Marcel Wolbers
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| |
Collapse
|
48
|
Van Nguyen K, Zhang T, Thi Vu BN, Dao TT, Tran TK, Thi Nguyen DN, Thi Tran HK, Thi Nguyen CK, Fox A, Horby P, Wertheim H. Staphylococcus aureus nasopharyngeal carriage in rural and urban northern Vietnam. Trans R Soc Trop Med Hyg 2014; 108:783-90. [PMID: 25187670 PMCID: PMC4235569 DOI: 10.1093/trstmh/tru132] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Staphylococcus aureus is a common human pathogen that can colonise the respiratory tract and cause infection. Here we investigate the risk factors associated with nasopharyngeal carriage of S. aureus (including methicillin-resistant S. aureus [MRSA]) in Vietnam. Methods Between February and June 2012, nasal and pharyngeal swabs for S. aureus culture, and demographic and socioeconomic data were taken from 1016 participants in urban and rural northern Vietnam, who were randomly selected from pre-specified age strata. Results Overall S. aureus prevalence was 303/1016 (29.8%; adjusted for age: 33.8%). Carriage in the main cohort was found to be associated with younger age (≤5 years [OR 3.13, CI 1.62–6.03]; 6–12 [OR 6.87, CI 3.95–11.94]; 13–19 [OR 6.47, CI 3.56–11.74]; 20–29 [OR 4.73, CI 2.40–9.31]; 30–59 [OR 1.74, CI 1.04–2.92); with ≥60 as reference), living in an urban area (OR 1.36, CI 1.01–1.83) and antibiotics use (OR 0.69, CI 0.49–0.96). MRSA was detected in 80/1016 (7.9%). Being aged ≤5 years (OR 4.84, CI 1.47–15.97); 6–12 (OR 10.21, CI 3.54–29.50); 20–29 (OR 4.01, CI 1.09–14.77) and wealth (>3/5 wealth index, OR 1.63 CI 1.01–2.62) were significant risk factors for MRSA carriage. Conclusions Nasopharyngeal carriage of S. aureus is present in one-third of the Vietnamese population, and is more prevalent among children. Pharyngeal carriage is more common than nasal carriage. Risk factors for S. aureus (including MRSA) carriage are identified in the community.
Collapse
Affiliation(s)
| | - Tianying Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | | | | | | | | | | - Annette Fox
- Oxford University Clinical Research Unit, Hanoi, Vietnam Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Peter Horby
- Oxford University Clinical Research Unit, Hanoi, Vietnam Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Heiman Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
49
|
Fox A, Whitehead S, Anders KL, Hoa LNM, Mai LQ, Thai PQ, Yen NT, Duong TN, Thoang DD, Farrar J, Wertheim H, Simmons C, Hien NT, Horby P. Investigation of dengue and Japanese encephalitis virus transmission in Hanam, Viet Nam. Am J Trop Med Hyg 2014; 90:892-896. [PMID: 24615123 PMCID: PMC4015583 DOI: 10.4269/ajtmh.13-0077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 11/14/2013] [Indexed: 11/23/2022] Open
Abstract
This study investigated whether a large dengue epidemic that struck Hanoi in 2009 also affected a nearby semirural area. Seroconversion (dengue virus-reactive immunoglobulin G enzyme-linked immunosorbent assay) was high during 2009 compared with 2008, but neutralization assays showed that it was caused by both dengue virus and Japanese encephalitis virus infections. The findings highlight the importance of continued Japanese encephalitis virus vaccination and dengue surveillance.
Collapse
Affiliation(s)
- Annette Fox
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Viet Nam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam; Hanam Centre for Preventive Medicine, Hanam, Viet Nam
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Segura M, Zheng H, Greeff AD, Gao GF, Grenier D, Jiang Y, Lu C, Maskell D, Oishi K, Okura M, Osawa R, Schultsz C, Schwerk C, Sekizaki T, Smith H, Srimanote P, Takamatsu D, Tang J, Tenenbaum T, Tharavichitkul P, Hoa NT, Valentin-Weigand P, Wells JM, Wertheim H, Zhu B, Gottschalk M, Xu J. Latest developments on Streptococcus suis: an emerging zoonotic pathogen: part 1. Future Microbiol 2014; 9:441-4. [DOI: 10.2217/fmb.14.14] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
First International Workshop on Streptococcus suis, Beijing, China, 12–13 August 2013 The first international workshop on Streptococcus suis, which is an important swine pathogen and emerging zoonotic agent, took place in Beijing, jointly organized by the Faculty of Veterinary Medicine, University of Montreal, Canada and the National Institute for Communicable Disease Control and Prevention, China CDC. The aim of the meeting was to gather together, for the first time, more than 80 researchers working on S. suis, from countries including China, Canada, Japan, The Netherlands, Germany, Thailand, the UK and Vietnam. This article, the first of a two-part report on this First International Workshop, reviews current aspects of the epidemiology and population genomics of S. suis, covers public health concerns and discusses questions about S. suis serotyping and molecular diagnostics.
Collapse
Affiliation(s)
- Mariela Segura
- Faculty of Veterinary Medicine, University of Montreal, Canada
| | - Han Zheng
- State Key Laboratory for Infectious Disease Prevention & Control, National Institute for Communicable Diseases Control & Prevention, China CDC
| | | | - George F Gao
- CAS Key Laboratory of Pathogenic Microbiology & Immunology, Chinese Academy of Sciences, China
| | | | | | | | | | | | | | | | | | - Christian Schwerk
- University Children's Hospital Mannheim, Heidelberg University, Germany
| | | | - Hilde Smith
- Central Veterinary Institute, The Netherlands
| | | | | | - Jiaqi Tang
- Nanjing General Hospital of Nanjing Military Command, China
| | - Tobias Tenenbaum
- University Children's Hospital Mannheim, Heidelberg University, Germany
| | | | - Ngo Thi Hoa
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | - Baoli Zhu
- CAS Key Laboratory of Pathogenic Microbiology & Immunology, Chinese Academy of Sciences, China
| | | | - Jianguo Xu
- State Key Laboratory for Infectious Disease Prevention & Control, National Institute for Communicable Diseases Control & Prevention, China CDC
| |
Collapse
|