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High antibiotic resistance and mortality with Acinetobacter species in a tertiary hospital, Nepal. 尼泊尔一家三级医院中不动杆菌种类的高抗生素耐药性和死亡率。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0036
M Mahto, M Chaudhary, A Shah, K L Show, F L Moses, A G Stewart

Setting: Nepal Mediciti Hospital, Bhainsepati, Lalitpur, Nepal.

Objectives: To determine antimicrobial resistance patterns, and the number and proportion of multidrug-resistant (MDR-) and extensively drug-resistant (XDR-) cases among all patients with Acinetobacter isolates between September 2018 and September 2019.

Design: This was a hospital laboratory-based, cross-sectional study.

Results: Acinetobacter spp. (n = 364) were more common in respiratory (n = 172, 47.3%) and invasive samples such as blood, body fluids (n = 95, 26.1%). Sensitivity to AWaRe (Access, Watch and Reserve) Group antibiotics (tigecycline, polymyxin B, colistin) remained high. MDR (resistance to at least three classes of antimicrobial agents) (n = 110, 30.2%) and XDR (MDR plus carbapenem) (n = 87, 23.9%) isolates were most common in the Watch Group of antibiotics and found in respectively 99 (31.0%) and 78 (24.5%) patients (n = 319). Infected patients were more likely to be aged >40 years (n = 196, 61.4%) or inpatients (n = 191, 59.9%); 76 (23.8%) patients had an unfavourable outcome, including death (n = 59, 18.5%).

Conclusion: A significant proportion of MDR and XDR isolates was found; nearly one patient in five died. Robust hospital infection prevention and control measures (particularly for respiratory and invasive procedures) and routine surveillance are needed to reduce infections and decrease the mortality rate. Tigecycline, polymyxin B and colistin should be cautiously used only in MDR and XDR cases.

地点:尼泊尔拉利特普尔Bhainsepati尼泊尔Mediciti医院。目的:了解2018年9月至2019年9月所有不动杆菌分离患者的耐药模式,以及多重耐药(MDR-)和广泛耐药(XDR-)病例的数量和比例。设计:这是一项以医院实验室为基础的横断面研究。结果:不动杆菌以呼吸道(172例,47.3%)和血液、体液等侵入性标本(95例,26.1%)多见(n = 364)。对AWaRe (Access, Watch and Reserve)类抗生素(替加环素、多粘菌素B、粘菌素)的敏感性仍然较高。MDR(对至少3类抗菌药物耐药)(n = 110, 30.2%)和XDR (MDR加碳青霉烯)(n = 87, 23.9%)菌株在抗生素观察组中最为常见,分别在99例(31.0%)和78例(24.5%)患者中发现(n = 319)。感染患者以年龄>40岁(n = 196, 61.4%)和住院患者(n = 191, 59.9%)居多;76例(23.8%)患者出现不良结局,包括死亡(n = 59, 18.5%)。结论:MDR和XDR分离株比例显著;近五分之一的患者死亡。需要强有力的医院感染预防和控制措施(特别是呼吸道和侵入性手术)和常规监测,以减少感染和降低死亡率。替加环素、多粘菌素B和粘菌素仅在耐多药和广泛耐药病例中谨慎使用。
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引用次数: 0
High drug resistance among Gram-negative bacteria in sputum samples from an intensive care unit in Nepal. 尼泊尔重症监护病房痰样本中革兰氏阴性菌的高耐药性
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0034
R Ghimire, H A Gupte, S Shrestha, P Thekkur, S Kharel, H P Kattel, P S Shrestha, N Poudel, S Shakya, S Parajuli, A Mudvari, J Edwards

Setting: Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Objectives: 1) To report the number and proportion of Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas (PABS) species among intensive care unit (ICU) patients with sputum culture; and 2) to assess antimicrobial resistance patterns, demographic and clinical characteristics associated with resistance to at least one antibiotic and ICU discharge outcomes among those patients with PABS species admitted to hospital between 14 April 2018 and 13 April 2019.

Design: This was a hospital-based, cross-sectional study using secondary data.

Results: Of 166 who underwent sputum culture, 104 (63%) had bacterial growth, of which, 67 (64%) showed PABS species. Of the positive cultures, Pseudomonas, Acinetobacter, Burkholderia and Stenotrophomonas were present in respectively 32 (30.7%), 31 (29.8%), 1 (1%) and 3 (2.8%). Pseudomonas showed a high level of resistance to levofloxacin (61%), cefepime (50%) and amikacin (50%). Acinetobacter was largely resistant to cefepime (95%), imipenem (92%) and levofloxacin (86%). Of the 67 with PABS infection, 32 (48%) died.

Conclusion: The study showed a high prevalence of Pseudomonas and Acinetobacter and the emergence of Stenotrophomonas in sputum culture samples of ICU patients. This highlights the need for monitoring PABS and associated resistance patterns to reduce mortality in ICU patients.

地点:尼泊尔加德满都特里布万大学教学医院。目的:1)了解重症监护病房(ICU)患者痰培养中假单胞菌、不动杆菌、伯克霍尔德菌、窄养单胞菌(PABS)的数量和比例;2)评估2018年4月14日至2019年4月13日住院的PABS患者的抗微生物药物耐药性模式、与至少一种抗生素耐药性相关的人口统计学和临床特征以及ICU出院结局。设计:这是一项基于医院的横断面研究,使用二手数据。结果:痰培养166例,细菌生长104例(63%),其中PABS菌67例(64%)。阳性培养菌中假单胞菌32例(30.7%),不动杆菌31例(29.8%),伯克霍尔德菌1例(1%),窄养单胞菌3例(2.8%)。假单胞菌对左氧氟沙星(61%)、头孢吡肟(50%)和阿米卡星(50%)的耐药程度较高。不动杆菌对头孢吡肟(95%)、亚胺培南(92%)和左氧氟沙星(86%)主要耐药。67例PABS感染中,32例(48%)死亡。结论:ICU患者痰培养标本中假单胞菌和不动杆菌感染率较高,出现窄养单胞菌。这突出了监测PABS和相关耐药模式以降低ICU患者死亡率的必要性。
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引用次数: 0
Surgical antibiotic prophylaxis administration practices. 外科抗生素预防管理实践。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0027
S Shrestha, K Hann, K W Y Kyaw, P Koju, M Khogali

Setting: A referral hospital in Kavre, Nepal.

Objectives: To assess 1) compliance with National Antibiotic Treatment Guidelines (NATG), specifically, whether the administration of surgical antibiotic prophylaxis (SAP) (initial dosing and redosing) was in compliance with NATG for patients who were and were not eligible, and 2) development of surgical site infections (SSIs) among patients who underwent surgery in the Department of General Surgery (July-December 2019).

Design: This was a retrospective cohort analysis.

Results: The analysis included 846 patients, of which 717 (85%) patients were eligible for SAP and 129 (15%) were ineligible. Of those eligible, 708 (99%) received the initial dose; while 65 (50%) of the ineligible did not receive any dose. Of those who received the initial dose, 164 (23%) were eligible for redosing. Of these, only 23 (14%) received at least one redosing and 141 (86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23 (3%) patients, 8 (35%) of whom did not have SAP administered according to NATG.

Conclusion: A relatively high overall compliance with NATG for SAP administration was reported. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.

背景:尼泊尔Kavre的一家转诊医院。目的:评估1)符合国家抗生素治疗指南(NATG)的情况,特别是符合和不符合条件的患者的外科抗生素预防(SAP)(首次给药和重新给药)是否符合NATG,和2)在普通外科接受手术的患者中手术部位感染(SSIs)的发展(2019年7月至12月)。设计:这是一项回顾性队列分析。结果:分析包括846名患者,其中717名(85%)患者符合SAP条件,129名(15%)患者不符合SAP条件。在符合条件的人群中,708人(99%)接受了初始剂量;而65名(50%)不合格者没有接受任何剂量。在接受初始剂量的患者中,有164人(23%)有资格再次服用。在这些患者中,只有23人(14%)接受了至少一次重做,141人(86%)没有接受。75%(632/846)的患者达到了NATG的总体依从性。SSIs发生在23名(3%)患者中,其中8名(35%)患者没有按照NATG给药SAP。结论:据报道,SAP给药对NATG的总体依从性相对较高。提出了一些建议,以提高那些不符合SAP条件的人和那些有资格重做的人的合规性。
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引用次数: 2
High success and low recurrence with shorter treatment regimen for multidrug-resistant TB in Nepal. 尼泊尔耐多药肺结核患者采用较短疗程治疗的成功率高、复发率低。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0041
S Koirala, N P Shah, P Pyakurel, M Khanal, S K Rajbhandari, T Pun, B Shrestha, B Maharjan, S Karki, S Koirala, K B Tamang, A Roggi, A M V Kumar, N Ortuño-Gutiérrez

Setting: Nine drug-resistant TB centres, some of them supported by Damien Foundation in Nepal where >80% of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) patients are treated.

Objective: To assess the uptake, effectiveness and safety of the 9-12-month shorter treatment regimen (STR) in MDR/RR-TB patients registered from January 2018 to December 2019.

Design: This was a cohort study involving secondary programme data.

Results: Of 631 patients, 301 (48.0%) started and continued STR. Key reasons for ineligibility to start/continue STR were baseline resistance or exposure to second-line drugs (62.0%), contact with extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (7.0%) patients and unavailability of STR drugs (6.0%). Treatment success was 79.6%; unsuccessful outcomes were death (12.0%), lost to follow-up (5.3%), failure (2.7%) and not evaluated (0.7%). Unsuccessful outcomes were significantly associated with HIV positivity and patient age ⩾55 years, with adjusted relative risk of respectively 2.39 (95% CI 1.52-3.77) and 3.86 (95% CI 2.30-6.46). Post-treatment recurrence at 6 and 12 months was respectively 0.5% and 2.4%. Serious adverse events (SAEs) were seen in 15.3% patients - hepatotoxicity and ototoxicity were most common.

Conclusion: STR had a modest uptake, high treatment success and low post-treatment recurrence. For proper detection and management of SAEs, improving pharmacovigilance might be considered. Availability of rapid diagnostic test for second-line drugs is crucial for correct patient management.

环境:九个耐药结核病中心,其中一些得到了尼泊尔达米安基金会的支持,超过80%的耐多药/耐利福平结核病(MDR/RR-TB)患者在这些中心接受治疗:评估2018年1月至2019年12月登记的MDR/RR-TB患者对9-12个月短期治疗方案(STR)的接受情况、有效性和安全性:这是一项涉及二级计划数据的队列研究:在 631 名患者中,301 人(48.0%)开始并继续接受 STR 治疗。不符合开始/继续 STR 的主要原因是基线耐药或接触过二线药物(62.0%)、接触过广泛耐药结核病(XDR-TB)或前 XDR-TB 患者(7.0%)以及无法获得 STR 药物(6.0%)。治疗成功率为 79.6%;失败率为死亡(12.0%)、失去随访(5.3%)、失败(2.7%)和未评估(0.7%)。不成功的结果与 HIV 阳性和患者年龄 ⩾55 岁明显相关,调整后的相对风险分别为 2.39 (95% CI 1.52-3.77) 和 3.86 (95% CI 2.30-6.46)。治疗后6个月和12个月的复发率分别为0.5%和2.4%。15.3%的患者出现了严重不良事件(SAE)--肝毒性和耳毒性最为常见:结论:STR 的使用率不高,治疗成功率高,治疗后复发率低。为了正确检测和处理 SAE,可以考虑改进药物警戒。提供二线药物的快速诊断测试对于正确管理患者至关重要。
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引用次数: 0
Antimicrobial resistance in neonates with suspected sepsis. 疑似败血症新生儿的抗菌药耐药性。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0038
S K Yadav, S K Agrawal, S K Singh, A Giri, G K Singh, R Ghimire, A G Stewart, K L Show, F L Moses

Setting: Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.

Objective: To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary neonatal intensive care unit (NICU).

Design: This hospital-based cohort study was conducted to follow patients from January to December 2019. All identified cases of suspected sepsis were enlisted from hospital records.

Results: Sepsis was suspected in 177 (88%) of the 200 cases admitted in the NICU; 52 (29%) were culture-positive. Pseudomonas was the predominant organism isolated (n = 40; 78%), followed by coagulase negative staphylococcus (n = 12, 23%). Nine (17%) of the 52 isolates were resistant to the Access and Watch group of antibiotics, including some resistance to Reserve group drugs such as imipenem and linezolid. Most treated cases (n = 170, 96%) improved, although 7 (4%) left against medical advice.

Conclusion: Most of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed to Reserve group drugs. Most sepsis was caused by Gram-negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care testing, and a greater yield of culture-positive results are needed to enhance the management of neonatal sepsis.

地点:尼泊尔比拉德讷格尔诺贝尔医学院和教学医院尼泊尔比拉德讷格尔诺贝尔医学院和教学医院:确定三级新生儿重症监护病房(NICU)中疑似败血症新生儿的抗菌药耐药性模式和出院结果:这项基于医院的队列研究对2019年1月至12月的患者进行了追踪。所有疑似败血症病例均来自医院病历:在新生儿重症监护室收治的 200 例病例中,177 例(88%)疑似败血症;52 例(29%)培养阳性。假单胞菌是最主要的分离菌(n = 40;78%),其次是凝固酶阴性葡萄球菌(n = 12,23%)。52 个分离株中有 9 个(17%)对 Access 和 Watch 类抗生素产生耐药性,包括对亚胺培南和利奈唑胺等 Reserve 类药物产生耐药性。大多数接受治疗的病例(n = 170,96%)病情有所好转,但有 7 例(4%)病例不听医嘱离开了医院:结论:大多数病原体对世界卫生组织准入抗生素和观察抗生素具有耐药性,偶尔发现对储备类药物具有耐药性。大多数败血症是由革兰氏阴性杆菌引起的。要加强对新生儿败血症的管理,就需要利用护理点检测改善抗生素敏感性检测的周转时间,并提高培养阳性结果的产量。
{"title":"Antimicrobial resistance in neonates with suspected sepsis.","authors":"S K Yadav, S K Agrawal, S K Singh, A Giri, G K Singh, R Ghimire, A G Stewart, K L Show, F L Moses","doi":"10.5588/pha.21.0038","DOIUrl":"10.5588/pha.21.0038","url":null,"abstract":"<p><strong>Setting: </strong>Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.</p><p><strong>Objective: </strong>To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary neonatal intensive care unit (NICU).</p><p><strong>Design: </strong>This hospital-based cohort study was conducted to follow patients from January to December 2019. All identified cases of suspected sepsis were enlisted from hospital records.</p><p><strong>Results: </strong>Sepsis was suspected in 177 (88%) of the 200 cases admitted in the NICU; 52 (29%) were culture-positive. <i>Pseudomonas</i> was the predominant organism isolated (<i>n</i> = 40; 78%), followed by coagulase negative <i>staphylococcus</i> (<i>n</i> = 12, 23%). Nine (17%) of the 52 isolates were resistant to the Access and Watch group of antibiotics, including some resistance to Reserve group drugs such as imipenem and linezolid. Most treated cases (<i>n</i> = 170, 96%) improved, although 7 (4%) left against medical advice.</p><p><strong>Conclusion: </strong>Most of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed to Reserve group drugs. Most sepsis was caused by Gram-negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care testing, and a greater yield of culture-positive results are needed to enhance the management of neonatal sepsis.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"6-12"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal. 尼泊尔侵入性设备和外科手术中与医疗保健相关的感染发生率。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0039
P Koju, X Liu, R Zachariah, M Bhattachan, B Maharjan, S Madhup, H D Shewade, A Abrahamyan, P Shah, S Shrestha, H Li, R Shrestha

Setting: Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal.

Objectives: 1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures.

Design: This was a cohort study using secondary data (December 2017 to April 2018).

Results: Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, P = 0.02). The most common HAI bacteria (n = 70) were Escherichia coli (44.3%), Enterococcus spp. (22.9%) and Klebsiella spp. (11.4%). Of 98 CAIs with 41 isolates, E. coli (36.6%), Staphylococcus aureus (22.0%) and methicillin-resistant S. aureus (14.6%) were common.

Conclusion: We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.

地点:尼泊尔加德满都加德满都大学医院 Dhulikhel 医院尼泊尔加德满都加德满都大学医院 Dhulikhel 医院:1)报告医疗相关感染(HAIs)的发生率;2)比较有HAIs和无HAIs患者的人口统计学、临床特征和住院结果;3)验证有侵入性设备和/或外科手术的住院患者中HAI和社区获得性感染(CAIs)的细菌类型:这是一项使用二手数据(2017 年 12 月至 2018 年 4 月)进行的队列研究:在1310名住院患者中,908人(69.3%)进行了外科手术,125人(9.5%)使用了侵入性设备,277人(21.1%)同时使用了侵入性设备和/或外科手术。其中 66 人发生了 HAI(发生率 = 5/100,95% CI 3.9-6.3)。与外科病房相比,发生 HAI 的患者住院时间延长(⩾7 天)的风险高出 5.5 倍,入住重症监护室的风险高出 6.9 倍。出现 HAI 的患者(4.5%)的出院不良后果高于未出现 HAI 的患者(0.9%,P = 0.02)。最常见的 HAI 细菌(n = 70)为大肠埃希菌(44.3%)、肠球菌属(22.9%)和克雷伯菌属(11.4%)。在 98 例 CAI 中的 41 个分离株中,大肠杆菌(36.6%)、金黄色葡萄球菌(22.0%)和耐甲氧西林金黄色葡萄球菌(14.6%)很常见:我们发现 HAIs 的发生率相对较低,这反映了良好的感染预防和控制标准。这项研究为今后的监测和行动提供了基线。
{"title":"Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal.","authors":"P Koju, X Liu, R Zachariah, M Bhattachan, B Maharjan, S Madhup, H D Shewade, A Abrahamyan, P Shah, S Shrestha, H Li, R Shrestha","doi":"10.5588/pha.21.0039","DOIUrl":"10.5588/pha.21.0039","url":null,"abstract":"<p><strong>Setting: </strong>Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal.</p><p><strong>Objectives: </strong>1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures.</p><p><strong>Design: </strong>This was a cohort study using secondary data (December 2017 to April 2018).</p><p><strong>Results: </strong>Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, <i>P</i> = 0.02). The most common HAI bacteria (<i>n</i> = 70) were <i>Escherichia coli</i> (44.3%), <i>Enterococcus</i> spp. (22.9%) and <i>Klebsiella</i> spp. (11.4%). Of 98 CAIs with 41 isolates, <i>E. coli</i> (36.6%), <i>Staphylococcus aureus</i> (22.0%) and methicillin-resistant <i>S. aureus</i> (14.6%) were common.</p><p><strong>Conclusion: </strong>We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"32-37"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal. 尼泊尔等待手术的慢性耳部分泌物患者的抗生素耐药性。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0029
R R Karn, R Acharya, A K Rajbanshi, S K Singh, S K Thakur, S K Shah, A K Singh, R Shah, S Upadhya Kafle, M Bhattachan, A Abrahamyan, H D Shewade, R Zachariah

Setting: Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).

Objective: In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.

Design: A cohort study using hospital data, January 2018-January 2020.

Results: Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery.

Conclusion: Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.

地点:尼泊尔比拉特纳加比拉特纳格尔眼科医院,该医院为慢性化脓性中耳炎(CSOM)提供耳朵手术。目的:在等待手术的CSOM患者中,确定1)社会人口学特征2)细菌分离株及其抗生素耐药性模式,3)拒绝手术的患者的特征,包括抗生素耐药性。设计:一项使用医院数据的队列研究,2018年1月至2020年1月。结果:在117名等待手术的CSOM患者中,64%在18-35岁年龄组,79%来自印度。在118个细菌分离株中,80%为铜绿假单胞菌,16%为金黄色葡萄球菌。所有分离株对所测试的12种抗生素中的9种表现出多药耐药性。铜绿假单胞菌对万古霉素(29%)和莫西沙星(36%)的耐药性最低,对金黄色葡萄球菌的耐药性最低的是万古霉素(9%)和阿米卡星(17%)。14名(12%)患者接受了手术:鼓膜成形术(n=7,50%)、皮质乳突切除术伴鼓室造瘘术(n=4.29%)和改良乳突根治术(n=3.21%)。那些感染铜绿假单胞菌并对六种以上抗生素产生耐药性的患者更容易被拒绝接受手术。结论:等待耳部手术的患者主要感染耐多药铜绿假单胞菌,因此拒绝手术。这项研究有助于为提高手术接受率和引入跨境抗菌药物耐药性监测提供信息。
{"title":"Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal.","authors":"R R Karn,&nbsp;R Acharya,&nbsp;A K Rajbanshi,&nbsp;S K Singh,&nbsp;S K Thakur,&nbsp;S K Shah,&nbsp;A K Singh,&nbsp;R Shah,&nbsp;S Upadhya Kafle,&nbsp;M Bhattachan,&nbsp;A Abrahamyan,&nbsp;H D Shewade,&nbsp;R Zachariah","doi":"10.5588/pha.21.0029","DOIUrl":"10.5588/pha.21.0029","url":null,"abstract":"<p><strong>Setting: </strong>Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).</p><p><strong>Objective: </strong>In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.</p><p><strong>Design: </strong>A cohort study using hospital data, January 2018-January 2020.</p><p><strong>Results: </strong>Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had <i>Pseudomonas aeruginosa</i> and 16% had <i>Staphylococcus aureus</i>. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in <i>P. aeruginosa</i> was for vancomycin (29%) and moxifloxacin (36%), and for <i>S. aureus</i>, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (<i>n</i> = 7, 50%), cortical mastoidectomy with tympanostomy (<i>n</i> = 4, 29%) and modified radical mastoidectomy (<i>n</i> = 3, 21%). Those infected with <i>P. aeruginosa</i> and with resistance to over six antibiotics were significantly more likely to be refused for surgery.</p><p><strong>Conclusion: </strong>Patients awaiting ear surgery were predominantly infected with multidrug-resistant <i>P. aeruginosa</i> and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"1-5"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study. 2017-2019年尼泊尔一家三级医院肠外抗生素的年消耗量:一项横断面研究。
IF 1.3 Q4 RESPIRATORY SYSTEM Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0043
P Baral, K Hann, B Pokhrel, T Koirala, R Thapa, S M Bijukchhe, M Khogali

Setting: Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal.

Objectives: To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019.

Design: This was a cross-sectional study.

Results: Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories.

Conclusion: We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.

地点:帕坦医院帕坦医院是尼泊尔拉利特普尔县的一家三级医院:描述以下方面的年度肠外抗生素消耗情况:1)定义的日剂量(DDD)和每100例住院的DDD;2)计算每100例住院的DDD以及按药物亚组、化学亚组和AWaRe类别划分的比例;3)描述2017年至2019年期间患者在肠外抗生素方面的支出占患者在药物和耗材方面总支出的比例:这是一项横断面研究:肠外抗生素的总DDD从2017年的39639.7增加到2019年的48947.7,增加了23%。每 100 例住院患者的 DDD 从 2017 年的 172.1 增加到 2019 年的 190.2,增加了 10%。其他β-内酰胺类抗菌药物是最常消费的药物亚类。最常消耗的化学物质是头孢曲松,万古霉素和美罗培南的消耗量呈上升趋势。在研究期间,"观察 "类肠道外抗生素的消费量最大,而 "使用 "类抗生素的消费量呈下降趋势,"储备 "类抗生素的消费量呈上升趋势:我们旨在了解一家三级甲等医院肠外抗生素的消耗情况,结果发现 "观察 "类抗生素占抗生素消耗量的绝大部分。过度使用 "观察 "类和 "储备 "类抗生素会导致抗菌药耐药性,因此建议合理使用这些抗生素。
{"title":"Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study.","authors":"P Baral, K Hann, B Pokhrel, T Koirala, R Thapa, S M Bijukchhe, M Khogali","doi":"10.5588/pha.21.0043","DOIUrl":"10.5588/pha.21.0043","url":null,"abstract":"<p><strong>Setting: </strong>Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal.</p><p><strong>Objectives: </strong>To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019.</p><p><strong>Design: </strong>This was a cross-sectional study.</p><p><strong>Results: </strong>Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories.</p><p><strong>Conclusion: </strong>We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"52-57"},"PeriodicalIF":1.3,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pseudomonas aeruginosa in Nepali hospitals: poor outcomes amid 10 years of increasing antimicrobial resistance. 尼泊尔医院的铜绿假单胞菌:10年来抗菌素耐药性增加的不良结果
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0048
M Mahto, A Shah, K L Show, F L Moses, A G Stewart

Objective: To determine antimicrobial resistance patterns and prevalence of multi- (MDR, i.e., resistant to ⩾3 classes of antimicrobial agents) and extensively (XDR, i.e., resistant to ⩾3, susceptible to ⩽2 groups of antibiotics) drug-resistant strains of Pseudomonas aeruginosa.

Methods: This was a cross-sectional study conducted in Nepal Mediciti Hospital, Lalitpur, Nepal, using standard microbiological methods with Kirby Bauer disc diffusion to identify antimicrobial susceptibility.

Results: P. aeruginosa (n = 447) were most frequently isolated in respiratory (n = 203, 45.4%) and urinary samples (n = 120, 26.8%). AWaRe Access antibiotics showed 25-30% resistance, Watch antibiotics 30-55%. Susceptibility to AWaRe Reserve antibiotics remains high; however, 32.8% were resistant to aztreonam. Overall, 190 (42.5%) were MDR and 99 (22.1%) XDR (first Nepali report) based on mainly non-respiratory samples. The majority of infected patients were >40 years (n = 229, 63.2%) or inpatients (n = 181, 50.0%); 36 (15.2%) had an unfavourable outcome, including death (n = 25, 10.5%). Our larger study showed a failure of improvement over eight previous studies covering 10 years.

Conclusion: Antibiotic resistance in P. aeruginosa occurred to all 19 AWaRe group antibiotics tested. Vulnerable patients are at significant risk from such resistant strains, with a high death rate. Sustainable and acceptable antibiotic surveillance and control are urgently needed across Nepal, as antimicrobial resistance has deteriorated over the last decade.

目的:确定铜绿假单胞菌耐药模式和多重(MDR,即对大于或小于3类抗菌剂耐药)和广泛(XDR,即对大于或小于2组抗生素敏感)耐药菌株的流行。方法:这是一项在尼泊尔拉利特普尔的尼泊尔梅迪奇蒂医院进行的横断面研究,使用标准微生物学方法与Kirby Bauer圆盘扩散来鉴定抗菌药物敏感性。结果:铜绿假单胞菌(P. aeruginosa)以呼吸道(n = 203, 45.4%)和尿液(n = 120, 26.8%)分离最多。AWaRe Access抗生素耐药25-30%,Watch抗生素耐药30-55%。对AWaRe储备抗生素的敏感性仍然很高;32.8%对氨曲南耐药。总体而言,190例(42.5%)为耐多药耐药,99例(22.1%)为广泛耐药(尼泊尔首次报告),主要基于非呼吸道样本。大多数感染患者为>40岁(n = 229, 63.2%)或住院患者(n = 181, 50.0%);36例(15.2%)出现不良结局,包括死亡(n = 25, 10.5%)。我们更大的研究表明,在过去10年的8项研究中,这种改善是失败的。结论:铜绿假单胞菌对AWaRe组19种抗生素均有耐药性。易受感染的患者面临这种耐药菌株的重大风险,死亡率很高。尼泊尔各地迫切需要可持续和可接受的抗生素监测和控制,因为在过去十年中抗菌素耐药性已经恶化。
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引用次数: 1
Challenges in LTBI care in the United States identified using a nationwide TB medical consultation database. 使用全国结核病医疗咨询数据库确定美国LTBI护理面临的挑战。
IF 1.4 Q4 RESPIRATORY SYSTEM Pub Date : 2021-09-21 DOI: 10.5588/pha.21.0026
N T Agathis, R Bhavaraju, V Shah, L Chen, C A Haley, N D Goswami, A Patrawalla

Background: Identifying and treating individuals with latent TB infection (LTBI) represents a critical and challenging component of national TB elimination. Medical consultations by the Centers for Disease Control and Prevention (CDC) funded TB Centers of Excellence (COEs) are an important resource for healthcare professionals (HCPs) caring for individuals with LTBI. This study aimed to identify the most common clinical concerns regarding LTBI care and to describe epidemiologic and clinical features of patients discussed in these consultations.

Methods: This mixed-methods study randomly sampled 125 consultation inquiries related to LTBI from the COEs' medical consultation database in 2018. Text from consultation records were reviewed and coded to identify reasons for the inquiries and common epidemiologic and clinical patient characteristics.

Results: The most common topics of inquiry for consultation included accurate LTBI diagnosis (36%), management of LTBI treatment-related issues (22%), and choice of appropriate LTBI treatment regimen (17%). Patients for whom consultations were requested commonly had another medical condition (34%), were non-U.S. born (31%), were children (25%), and had a history of travel to TB-endemic areas (18%).

Conclusion: Our findings emphasize the challenge of managing patients with either suspected or confirmed LTBI, highlighting the need for ongoing medical consultation support for nuanced clinical and epidemiologic scenarios.

背景:识别和治疗潜伏性结核感染(LTBI)个体是国家消除结核病的关键和具有挑战性的组成部分。由疾病控制和预防中心(CDC)资助的结核病卓越中心(coe)提供的医疗咨询是照顾LTBI患者的医疗保健专业人员(hcp)的重要资源。本研究旨在确定LTBI护理中最常见的临床问题,并描述这些咨询中讨论的患者的流行病学和临床特征。方法:混合方法研究随机抽取2018年COEs医疗咨询数据库中125份与LTBI相关的咨询问询。对会诊记录中的文本进行审查和编码,以确定问诊的原因以及常见的流行病学和临床患者特征。结果:咨询最常见的问题包括准确的LTBI诊断(36%)、LTBI治疗相关问题的管理(22%)和选择合适的LTBI治疗方案(17%)。被要求咨询的患者通常有其他疾病(34%),非美国人。出生(31%),是儿童(25%),有结核病流行地区旅行史(18%)。结论:我们的研究结果强调了管理疑似或确诊LTBI患者的挑战,强调了对细微的临床和流行病学情况进行持续医疗咨询支持的必要性。
{"title":"Challenges in LTBI care in the United States identified using a nationwide TB medical consultation database.","authors":"N T Agathis,&nbsp;R Bhavaraju,&nbsp;V Shah,&nbsp;L Chen,&nbsp;C A Haley,&nbsp;N D Goswami,&nbsp;A Patrawalla","doi":"10.5588/pha.21.0026","DOIUrl":"https://doi.org/10.5588/pha.21.0026","url":null,"abstract":"<p><strong>Background: </strong>Identifying and treating individuals with latent TB infection (LTBI) represents a critical and challenging component of national TB elimination. Medical consultations by the Centers for Disease Control and Prevention (CDC) funded TB Centers of Excellence (COEs) are an important resource for healthcare professionals (HCPs) caring for individuals with LTBI. This study aimed to identify the most common clinical concerns regarding LTBI care and to describe epidemiologic and clinical features of patients discussed in these consultations.</p><p><strong>Methods: </strong>This mixed-methods study randomly sampled 125 consultation inquiries related to LTBI from the COEs' medical consultation database in 2018. Text from consultation records were reviewed and coded to identify reasons for the inquiries and common epidemiologic and clinical patient characteristics.</p><p><strong>Results: </strong>The most common topics of inquiry for consultation included accurate LTBI diagnosis (36%), management of LTBI treatment-related issues (22%), and choice of appropriate LTBI treatment regimen (17%). Patients for whom consultations were requested commonly had another medical condition (34%), were non-U.S. born (31%), were children (25%), and had a history of travel to TB-endemic areas (18%).</p><p><strong>Conclusion: </strong>Our findings emphasize the challenge of managing patients with either suspected or confirmed LTBI, highlighting the need for ongoing medical consultation support for nuanced clinical and epidemiologic scenarios.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 3","pages":"162-166"},"PeriodicalIF":1.4,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455022/pdf/i2220-8372-11-3-162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39452645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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