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Bullens M, de Cerqueira Melo A, Raziq S, Lee J, Khalid GG, Khan SN, Zada A, Atta-Ur-Rehman, Wailly Y, Zeshan SM, Saad NJ, Gil-Cuesta J, Williams A. Antibiotic resistance in patients with urinary tract infections in Pakistan. Public Health Action 2022; 12:48-52. [DOI: 10.5588/pha.21.0071] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The level of antibiotic resistance of pathogens causing uncomplicated urinary tract infections (UTIs) is increasing. The 2017–2018 GLASS (Global Antimicrobial Resistance and Use Surveillance System) report indicated >70% resistance to ceftriaxone and ciprofloxacin
in Escherichia coli in Pakistan.METHODS: A prospective study was conducted in the Médecins Sans Frontières (MSF) supported Timurgara District Hospital, Timurgara, Pakistan, from September 2017 to December 2018. Women aged 18–65 years presenting to the
Emergency Department with symptoms of uncomplicated UTI (cystitis/pyelonephritis) were invited to participate. We conducted microbiological culture and sensitivity testing for samples with positive dipstick or nitrite test.RESULTS: Of the 200 patients who participated, 109 (54.5%)
were diagnosed with pyelonephritis and 91 (45.5%) with cystitis. Forty-three samples (21.5%) were culture-positive: E. coli was isolated in 27 samples, Enterococcus spp. in 7 and Klebsiella pneumoniae in 6. Overall resistance to ciprofloxacin was observed in 51.8% of E.
coli isolates, and ceftriaxone resistance in 66.7% of E. coli isolates and in 33.3% of K. pneumoniae. Resistance to fosfomycin was low (one E. coli isolate).CONCLUSIONS: This study found resistance to first- and second-line antibiotics for treating UTIs
as per the MSF protocol. Heightened awareness and potential changes to local prescription practices are necessary to curb the spread of antimicrobial resistance pathogens causing UTIs.
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Affiliation(s)
- M. Bullens
- Timurgara District Hospital Project, Médecins Sans Frontières Operational Centre Brussels (MSF OCB), Timurgara, Pakistan
| | - A. de Cerqueira Melo
- Timurgara District Hospital Project, Médecins Sans Frontières Operational Centre Brussels (MSF OCB), Timurgara, Pakistan
| | - S. Raziq
- Timurgara District Hospital Project, Médecins Sans Frontières Operational Centre Brussels (MSF OCB), Timurgara, Pakistan
| | - J. Lee
- Timurgara District Hospital Project, Médecins Sans Frontières Operational Centre Brussels (MSF OCB), Timurgara, Pakistan, MSF OCB, Medical Department, Brussels, Belgium
| | - G. G. Khalid
- MSF OCB, Islamabad Mission Coordination, Islamabad, Pakistan
| | - S. N. Khan
- Timurgara District Hospital Project, Médecins Sans Frontières Operational Centre Brussels (MSF OCB), Timurgara, Pakistan
| | - A. Zada
- Timurgara District Hospital Project, Médecins Sans Frontières Operational Centre Brussels (MSF OCB), Timurgara, Pakistan
| | - Atta-Ur-Rehman
- Timurgara District Hospital, Pakistan Ministry of Health (MoH), Timurgara, Pakistan
| | - Y. Wailly
- Operations Department, MSF OCB, Brussels, Belgium
| | | | - N. J. Saad
- Operations Department, MSF OCB, Brussels, Belgium
| | - J. Gil-Cuesta
- MSF OCB, Medical Department, Brussels, Belgium, Luxembourg Operational Research (LuxOR) Unit, MSF OCB, Luxembourg
| | - A. Williams
- Luxembourg Operational Research (LuxOR) Unit, MSF OCB, Luxembourg, Middle East Medical Unit (MEMU), MSF Lebanon, Beirut, Lebanon
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Mafirakureva N, Lim AG, Khalid GG, Aslam K, Campbell L, Zahid H, Van den Bergh R, Falq G, Fortas C, Wailly Y, Auat R, Donchuk D, Loarec A, Coast J, Vickerman P, Walker JG. Cost-effectiveness of screening and treatment using direct-acting antivirals for chronic Hepatitis C virus in a primary care setting in Karachi, Pakistan. J Viral Hepat 2021; 28:268-278. [PMID: 33051950 PMCID: PMC7821258 DOI: 10.1111/jvh.13422] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
Despite the availability of effective direct-acting antiviral (DAA) treatments for Hepatitis C virus (HCV) infection, many people remain undiagnosed and untreated. We assessed the cost-effectiveness of a Médecins Sans Frontières (MSF) HCV screening and treatment programme within a primary health clinic in Karachi, Pakistan. A health state transition Markov model was developed to estimate the cost-effectiveness of the MSF programme. Programme cost and outcome data were analysed retrospectively. The incremental cost-effectiveness ratio (ICER) was calculated in terms of incremental cost (2016 US$) per disability-adjusted life year (DALY) averted from the provider's perspective over a lifetime horizon. The robustness of the model was evaluated using deterministic and probabilistic sensitivity analyses (PSA). The ICER for implementing testing and treatment compared to no programme was US$450/DALY averted, with 100% of PSA runs falling below the per capita Gross Domestic Product threshold for cost-effective interventions for Pakistan (US$1,422). The ICER increased to US$532/DALY averted assuming national HCV seroprevalence (5.5% versus 33% observed in the intervention). If the cost of liver disease care was included (adapted from resource use data from Cambodia which has similar GDP to Pakistan), the ICER dropped to US$148/DALY, while it became cost-saving if a recently negotiated reduced drug cost of $75/treatment course was assumed (versus $282 in base-case) in addition to cost of liver disease care. In conclusion, screening and DAA treatment for HCV infection are expected to be highly cost-effective in Pakistan, supporting the expansion of similar screening and treatment programmes across Pakistan.
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Affiliation(s)
| | - Aaron G. Lim
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | | | - Khawar Aslam
- Operational Center BrusselsMédecins Sans FrontièresIslamabadPakistan
| | - Linda Campbell
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Hassaan Zahid
- Operational Center BrusselsMédecins Sans FrontièresIslamabadPakistan
| | | | | | | | - Yves Wailly
- Operational Center BrusselsMédecins Sans FrontièresBrusselsBelgium
| | - Rosa Auat
- Operational Center BrusselsMédecins Sans FrontièresBrusselsBelgium
| | - Dmytro Donchuk
- Operational Center BrusselsMédecins Sans FrontièresBrusselsBelgium
| | | | - Joanna Coast
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Peter Vickerman
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK,NIHR Health Protection Research Unit in Behavioural Science and EvaluationUniversity of BristolBristolUK
| | - Josephine G. Walker
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
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