African Journal of Laboratory Medicine最新文献

Background: Urinary tract infections are among the most common infections affecting the general population. Their high incidence, as well as frequent antimicrobial use, contribute significantly to the development of antimicrobial resistance (AMR).

Objective: To determine the profile and prevalence of uropathogens isolated from urine specimens at a regional hospital and assess susceptibility patterns to commonly used antimicrobials recommended by the National Essential Medicines List (NEML).

Methods: This was a retrospective evaluation of laboratory reports for all urine specimens submitted between 01 January 2020 and 31 December 2023.

Results: The most frequently cultured organisms were Escherichia coli (n = 1481; 42%); Klebsiella pneumoniae (n = 568; 16%); Enterococcus faecalis (n = 249; 7%); Proteus mirabilis (n = 229; 7%), Enterobacter cloacae (n = 137; 4%), and Candida albicans (n = 119; 3%). Escherichia coli maintained high sensitivity to antimicrobials such as nitrofurantoin (92.2%) and gentamicin (90.6%), whilst K. pneumoniae had decreased sensitivities of 40% and 77%, respectively. Cumulative sensitivities of commonly used first-line antimicrobials showed low rates of susceptibility to ciprofloxacin (77%), nitrofurantoin (67%), and amoxicillin/clavulanate (68.7%).

Conclusion: Escherichia coli was the most commonly identified isolate and remains sensitive to nitrofurantoin. It was, however, resistant to ciprofloxacin, amoxicillin/clavulanate, and trimethoprim sulfamethoxazole, as were all the other Gram-negative organisms. These sensitivity patterns do not align with the antimicrobials recommended in the current NEML guidelines, and highlight the need for targeted therapy and interventions.

What this study adds: This retrospective analysis identifies predominant uropathogens' updated antimicrobial susceptibility profiles, some of which misalign with NEML guidelines. Insights will guide targeted antimicrobial stewardship, empiric therapy, and local surveillance to curb AMR.

Background: Glucose-6-phosphate dehydrogenase deficiency (G6PDD), a common inherited enzyme defect, associated with severe neonatal anaemia and hyperbilirubinaemia, can result in permanent neurologic damage or death. Prevalence of G6PDD-induced anaemia in vulnerable groups, like children, is not known in our setting.

Objective: This study was aimed at determining the prevalence of erythrocyte G6PDD-induced anaemia among children aged 0-5 years old seen at Jos University Teaching Hospital, North-Central Nigeria.

Methods: This was a hospital-based cross-sectional study conducted from February to June 2023. Glucose-6-phosphate dehydrogenase and haemoglobin levels were analysed colourimetrically. Data were analysed; p < 0.05 was considered significant.

Results: Out of 100 children aged 0-5 years (54 male, 46 female), 40 (40%) were G6PD deficient. Nineteen (35.2%) of the G6PD-deficient children were male and 21 (45.7%) were female. Fifty-one (51%) children were anaemic, 23 (57.5%) were G6PDD-induced; 85 (85%) of the parents had no knowledge of G6PD and its deficiency.

Conclusion: This study showed a high prevalence of G6PDD-induced anaemia among children in Jos. This suggests that there may be a need for early routine G6PD screening in children for early detection and proper intervention in those with the deficiency.

What this study adds: This study has objectively established high prevalence of anaemia, G6PDD and G6PDD-induced anaemia in children aged 0-5 years in Jos, Nigeria, highlighting the importance of G6PD screening in children.

Background: Despite the widespread acceptability of glucometers as a blood glucose self-monitoring and point-of-care device, their usage is confronted with operational, technical, regulatory, and quality control concerns.

Objective: This study assessed knowledge, estimated competence, and measured experience of healthcare practitioners using glucometers for patient care in two states of Northern Nigeria.

Methods: This cross-sectional, descriptive study used a total population sampling strategy and self-completed questionnaires. A total of 768 questionnaires were distributed to hospitals in Jigawa and Kogi States, Nigeria, from December 2019 to April 2022. The questionnaire had three sections: collecting details about type of healthcare facility, sociodemographic characteristics and educational qualifications of participants, and assessment of knowledge, competence and practice. Data were analysed and results expressed as frequencies and percentages.

Results: Overall, 570 questionnaires were filled and retrieved, giving a response rate of 74.2%. Most of the participants were male (312; 54.7%); female participants totalled 258 (45.3%). Most participants were aged < 50 years (25-40 years, 215 [37.7%]; 41-50 years, 246 [43.2%]). The majority of participants were Medical Laboratory Scientists (124, 21.8%]), Technicians (151, 26.5%), or Nurses (132, 23.2%). Most participants (284, 49.8%) reported having no formal training prior to first use of glucometers in patient care. Many participants (379, 66.5%) knew about glucometer calibrators; 235 (41.2%) did not know what specific purpose calibrators served.

Conclusion: This study found a lack of knowledge, competence and experience among healthcare practitioners, especially for hands-on use of glucometer calibrators and standard operating procedures for blood glucose testing using glucometers.

What this study adds: The study brings to fore the need for training and retraining of healthcare practitioners on the theoretical and practical skills required for operating glucometers. Periodic calibration of glucometers and provision of quality control materials should be incorporated into standard operating procedures at point-of-care testing workstations in health facilities.

Background: Newer equations, which are more accurate than the Friedewald formula (FF), have been published for the calculation of low-density lipoprotein (LDL) cholesterol. The impact of their adoption on decision-making has not been examined in Nigerian laboratories.

Objective: This study examined the clinical implications of differences in estimating LDL cholesterol by the FF, Martin-Hopkins (MH), and Sampson-National Institutes of Health (NIH) equations.

Methods: Between 01 January 2019 and 31 December 2023, lipid profile data, and the associated gender, were retrieved from the laboratory information system of Synlab Nigeria for persons aged 18-75 years. Differences in LDL cholesterol estimates from the three equations, and agreement with category assignments that determine clinical decisions, were examined.

Results: Lipid profile data from 19 126 records were retrieved. This included data from 8234 (43.1%) women. The difference between FF estimates of LDL cholesterol and the other two equations was less than 10% for over 96% of the data. This difference increased with triglyceride levels. There was at least substantial agreement in the clinical category assignment of the equations, (ĸ > 0.715, p < 0.001). However, when triglycerides were > 1.69 mmol/L, the FF classification of < 1.81 mmol/L was classified as > 1.81 mmol/L in 43.3% and 25.1% of cases by MH and Sampson-NIH, respectively. For triglycerides > 4.51 mmol/L, there was constant bias, with MH higher than Sampson-NIH.

Conclusion: Using the FF formula may significantly impact primary prevention of atherosclerotic cardiovascular disease. Switching to the MH or Sampson-NIH equation is advisable.

What this study adds: This study provides a basis for Nigerian laboratories to switch from the Friedewald formula to one of the newer equations for the calculation of LDL cholesterol.

Background: Parathyroid hormone (PTH) measurement is key for diagnosing parathyroid disorders, and for management of chronic kidney disease. Available PTH assays include second (intact PTH) and third (PTH 1-84) generations. Data comparing interchangeable use are insufficient.

Objective: The objective of this study was to compare intact and 1-84 PTH assays to determine the difference in analytical performance and impact on clinical interpretation.

Methods: A method comparison was done on residual samples with PTH requests (06 April 2022 - 21 September 2022) from a tertiary hospital in South Africa. Parathyroid hormone was measured using both intact PTH and 1-84 PTH assays. Clinical performance was compared in the diagnosis of hypo- and hyperparathyroidism, and in pre-dialysis and dialysis chronic kidney disease patients.

Results: Among 481 samples, intact PTH had a higher median concentration than PTH 1-84 (9.85 pmol/L vs. 8.51 pmol/L, p < 0.0001), but the two showed good correlation (r = 0.994, p < 0.0001). Regression analysis revealed systematic (intercept = 0.887 pmol/L [95% confidence interval: 0.788 - 1.005]) and proportional differences (slope = 0.713 pmol/L, [95% confidence interval: 0.703 - 0.723]), with increased deviations at higher concentrations. The average bias was 18.5%, exceeding allowable limits. Among the 276 patients (170 women, 106 men, age range: 18-89 years) included in the clinical study, interpretation was unchanged.

Conclusion: A bias was observed between the PTH assays, indicating that they should not be used interchangeably. However, no changes in clinical interpretation were observed when one assay was used over the other.

What this study adds: The study confirms the recommendation by Kidney Disease: Improving Global Outcomes for the use of assay-specific upper limit of normal instead of generic cut-off in dialysis patients. This study further highlights the need for standardisation of PTH assays.

Background: Febrile neutropaenia (FN) is an oncology emergency, but there is a paucity of data on it in Africa.

Aim: This study aimed to review and aggregate data on FN in the context of antibiotic resistance.

Methods: Published original articles between 1991 and 2024 were systematically searched in Google Scholar, PubMed, and African Journals Online databases (grey literature excluded). 'Febrile neutropenia' was combined by Boolean terms 'OR' and 'AND' with individual countries for the searched terms. Data aggregation on bacteria isolates and antibiotics was done using Microsoft Excel.

Results: Of 16 637 articles retrieved, 15 (from nine countries) with 1216 non-duplicate isolates were included in the analyses after exclusion of irrelevant and duplicate articles. There were 57.0% (698/1225) Gram-positive and 43.3% (527/1225) Gram-negative bacteria. Aggregated resistance to antibiotics for Gram-positive bacteria was 71.8% (163/227), for ampicillin, 74.3% (226/304), for cefoxitin, 64.1% (25/39), and 54.0% (47/87) for oxacillin, while that of Gram-negative bacteria was 35.5% (184/519) for ciprofloxacin, 60.6% (168/277) for ceftriaxone, 65.9% (89/135) for cefuroxime, and 38.2% (153/401) for imipenem. Staphylococcus aureus had 68.8% (22/32) resistance to oxacillin/methicillin and 10% (1/10) resistance to vancomycin. Klebsiella spp. was 50% (9/18) resistant to quinolones, 75.9% (22/29) resistant to third-generation cephalosporins, and 25.0% (4/16) resistant to carbapenems, while Acinetobacter spp. was 85.7% (6/7) resistant to gentamycin.

Conclusion: This review highlighted the paucity of data and the emergence of multidrug resistance in FN in Africa. There is a need for antibiotic-resistance surveillance and antibiotic stewardship to optimise therapy in FN in Africa.

What this study adds: To the best of our knowledge, this is the first systematic review of FN in Africa in the context of available laboratory resources across the African regions.