Public Health Action最新文献_第10页

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

Public Health Action 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

{"title":"High antibiotic resistance and mortality with Acinetobacter species in a tertiary hospital, Nepal.","authors":"M Mahto, M Chaudhary, A Shah, K L Show, F L Moses, A G Stewart","doi":"10.5588/pha.21.0036","DOIUrl":"https://doi.org/10.5588/pha.21.0036","url":null,"abstract":"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.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"13-17"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575387/pdf/i2220-8372-11-s1-13.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732093","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

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

Public Health Action 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

{"title":"High drug resistance among Gram-negative bacteria in sputum samples from an intensive care unit in Nepal.","authors":"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","doi":"10.5588/pha.21.0034","DOIUrl":"https://doi.org/10.5588/pha.21.0034","url":null,"abstract":"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.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"64-69"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623771","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

Surgical antibiotic prophylaxis administration practices. 外科抗生素预防管理实践。

IF 1.4

Public Health Action Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0027

S Shrestha, K Hann, K W Y Kyaw, P Koju, M Khogali

{"title":"Surgical antibiotic prophylaxis administration practices.","authors":"S Shrestha, K Hann, K W Y Kyaw, P Koju, M Khogali","doi":"10.5588/pha.21.0027","DOIUrl":"10.5588/pha.21.0027","url":null,"abstract":"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.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"18-23"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623764","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: 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

Public Health Action 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

{"title":"High success and low recurrence with shorter treatment regimen for multidrug-resistant TB in Nepal.","authors":"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","doi":"10.5588/pha.21.0041","DOIUrl":"10.5588/pha.21.0041","url":null,"abstract":"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.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"38-45"},"PeriodicalIF":1.3,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623767","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

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

Public Health Action 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

{"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":"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.","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

Public Health Action 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

{"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":"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.","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

Public Health Action 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

{"title":"Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal.","authors":"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","doi":"10.5588/pha.21.0029","DOIUrl":"10.5588/pha.21.0029","url":null,"abstract":"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.","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

Public Health Action 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

{"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":"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.","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

Public Health Action Pub Date : 2021-11-01 DOI: 10.5588/pha.21.0048

M Mahto, A Shah, K L Show, F L Moses, A G Stewart

{"title":"Pseudomonas aeruginosa in Nepali hospitals: poor outcomes amid 10 years of increasing antimicrobial resistance.","authors":"M Mahto, A Shah, K L Show, F L Moses, A G Stewart","doi":"10.5588/pha.21.0048","DOIUrl":"https://doi.org/10.5588/pha.21.0048","url":null,"abstract":"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.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"58-63"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575381/pdf/i2220-8372-11-s1-58.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623770","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: 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

Public Health Action 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

{"title":"Challenges in LTBI care in the United States identified using a nationwide TB medical consultation database.","authors":"N T Agathis, R Bhavaraju, V Shah, L Chen, C A Haley, N D Goswami, A Patrawalla","doi":"10.5588/pha.21.0026","DOIUrl":"https://doi.org/10.5588/pha.21.0026","url":null,"abstract":"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.","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}

引用次数: 0