Ceylon Medical Journal最新文献

{"title":"Antimicrobial resistance in Staphylococcus aureus, Enterobacterales, and Pseudomonas spp. clinical isolates at a Teaching Hospital in Sri Lanka.","authors":"Nilanthi Senanayake, Gangani Sathsarani, Palinda Assella, Harshi Abeygoonawardena, Nelun De Silva","doi":"10.4038/cmj.v69iSI3.9963","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9963","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a signifi-cant global health issue in the 21st century, posing a serious threat to human health.</p><p><strong>Objectives: </strong>This study was to determine the burden and predictors of AMR and multidrug resistance (MDR) among bacterial pathogens isolated from specimens submitted to the diagnostic laboratory of a hospital in Sri Lanka.</p><p><strong>Methodology: </strong>This retrospective study used laboratory records of 1,204 clinical specimens submitted for bacterial culture submitted to the diagnostic laboratory of Neville Fernando Teaching Hospital in Sri Lanka for bacterial culture and sensitivity testing between October 2021 and May 2024. Records from specimens positive for Enterobacteriaceae, Staphylococcus aureus, or Pseudomonas spp. isolates were included for analysis.</p><p><strong>Results: </strong>Number of samples which yielded Gram negative Enterobacterales was 758 (62.95%). Of these 499 (65.83%) were ESBL and 59 (7.78%) were carba-penemase producers. Among the 214 participants, Staphylococcus aureus was isolated from 206 (96.26%) participants. This included 74 (35.92%) participants who were colonized with Methicillin Resistant Staphylococcus aureus (MRSA) isolates and Methicillin Sensitive Staphylococcus aureus (MSSA) 132 (64.07%). Among Pseudomonas spp. isolates, 29.48% were resistant to one or more aminoglycosides, 29.48% were resistant to a fluoroquinolone and only 8.54% were resistant to carbapenems.</p><p><strong>Conclusion: </strong>  This study shows that there is a high level of microbial resistance in Sri Lanka. The high levels of extended-spectrum cephalosporin resistance and multi-drug resistance (MDR) among Enterobacterales observed in this study are of concern. However, the relatively low levels of methicillin-resistant Staphylococcus aureus (MRSA) and MDR S. aureus, as well as the very low levels of carbapenem resistance among Pseudomonas spp. isolates, are encouraging.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"37-46"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combating Antimicrobial Resistance: A Global Imperative and a Shared Responsibility.","authors":"Lakshman Samaranayake","doi":"10.4038/cmj.v69iSI3.10029","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.10029","url":null,"abstract":"","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"1-2"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic prescription in critical care units in Sri Lanka: a prospective multi-centre survey.","authors":"Dilshan Priyankara, Anushka Mudalige, Manik Lokuge, Waruni Samaranayake, Eranda Sanjeeva, Makarim Mohomed, Rasanee Wanigasuriya, Dinesha Punchihewa, Lilanthi Subasinghe, Anthony Mendis, Navaneedan Muthulingam, Supun Manathunga, Ishanya Abeyagunawardena","doi":"10.4038/cmj.v69iSI3.9984","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9984","url":null,"abstract":"<p><strong>Introduction: </strong>Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed. We conducted a survey of antibiotics prescribed in critical care (CC) units in Sri Lanka to identify areas for improvement.</p><p><strong>Methods: </strong>Data was collected using a questionnaire from selected CC units in six tertiary care hospitals across Sri Lanka over six months. Data was collected on one particular day in every 2nd and 4th week of the month. Data was compiled using a google sheet and it was analyzed using R language.</p><p><strong>Results: </strong>Data from 237 adult patients was analyzed. Antibiotics were commenced according to microbiology advice (39%), local guidelines (14%), culture results (5.9%), a combination of above (27.1%) and in 14%, none of the above. A majority (39%) were prescribed two antimicrobials, whereas 35%, 18% and 5.9% were on one, three and four antibiotics respectively. The most common indication was hospital acquired pneumonia (HAP)(29.1%), followed by community acquired pneumonia (20%). In 25% of patients, no specific indication for antibiotics was noted. Only 47% of patients had all their antibiotics reviewed and updated, whereas antibiotics were not reviewed at all in 43%. The most frequently prescribed antibiotic was meropenem (32.9%) followed by piperacillin-tazobactam (22.3%) and ceftriaxone (20.6%).</p><p><strong>Conclusion: </strong>HAP was the main indication for antibiotics in critical care. Compliance on antibiotic prescription and documentation is inadequate and the extensive use of meropenem remains a cause for concern. Therefore, strict antibiotic stewardship guidelines and regular review of antibiotics are indicated in critical care units.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"79-82"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of an antimicrobial stewardship programme in a tertiary care hospital in Sri Lanka.","authors":"Wathudurage Himali Sureshika De Silva, Sashika Kushlani Jayatilleke, Mithilie Pramidika Kananke Gamage, Dona Tharangani Kuruppumudalige","doi":"10.4038/cmj.v69iSI3.9983","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9983","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital-based antibiotic stewardship programmes are helpful to optimise the treatment of infectious diseases and to prevent the development of antibiotic resistance. The rise in multi-drug resistance in Sri Lankan hospitals including carbapenem-resistant organisms emphasises the need for implementation of effective AMS programmes and planned in national strategic plan to combat antimicrobial resistance. A sustainable approach towards an effective AMS pro-gramme is continuously needed. The data on experience in implementing AMS programmes in Sri Lanka is scares.</p><p><strong>Objective: </strong>To share the experiences and challenges faced while implementing an AMS programme in a hospital. Guidelines on empirical and prophylactic use of anti-microbials and common infections were distributed to each unit. A list of antimicrobials prepared according to WHO AwaRe classification and drug chart designed for documentation of optimal prescribing.</p><p><strong>Results: </strong>There was a 27.3% reduction in mean carba-penem consumption after initial implementation and the consumption is gradually rising. 36% decrease in carbapenem resistance rate in Acinetobacter species, 33% reduction in carbapenem-resistant Pseudomonas species was observed. The point prevalence of anti-microbial use was found to be 45.5% and 49% in 2023 and 2024 respectively. The commonest indication for antimicrobial use in prescriptions was community-acquired infections. There was a reduction in continuing antibiotics for surgical prophylaxis after implementation of AMS programme.</p><p><strong>Conclusion: </strong>For successful implementation of an AMS programme in community acquired drug resistance also should be addressed. In hospital setting continuation of surgical prophylaxis is an area which can be improved easily. Adequate staff and time allocated for AMS activities will be beneficial for sustainable programmes.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"71-78"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Special issue on antimicrobial resistance.","authors":"Athula Sumathipala, Senaka Rajapakse, A Pathmeswaran, Ajith Nagahawatte","doi":"10.4038/cmj.v69iSI3.10030","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.10030","url":null,"abstract":"","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"7"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the efficacy of empiric antibiotic therapy for selected infections in patients with and without malignancy.","authors":"Gayashan Chathuranga, Thushari Dissanayake, Neluka Fernando, Chandanie Amila Wanigatunge","doi":"10.4038/cmj.v69iSI3.9975","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9975","url":null,"abstract":"<p><strong>Introduction: </strong>Guidelines for the selection of empirical antibiotics aim to improve patient outcomes, reduce unnecessary antibiotic use and reduce development of antimicrobial resistance.</p><p><strong>Objectives: </strong>To assess the adherence to guidelines for the selection of parenteral empirical antibiotics for three infections in patients with and without malignancies, to determine whether the national guidelines reflect the current bacterial susceptibility patterns of selected infections, and to determine the appropriateness of the selected parenteral empirical antibiotics for the selected infections.</p><p><strong>Methods: </strong>The study included bacterial isolates from adults with and without malignancy who had a positive culture for lower respiratory tract infection, skin and soft tissue infection, or urinary tract infection, and who were prescribed parenteral empirical antibiotic. Antibiotic susceptibility was determined by standard micro-biological methods. Adherence to guidelines was defined as prescribing the empiric antibiotic concordant with national guidelines.</p><p><strong>Results: </strong>The analysis included 155 bacterial isolates from each population. The selection of empirical antibiotics was guideline-concordant in 92.4% without and 67.5% with cancers. Resistance to recommended empirical antibiotics was seen in 29.5% and 41.2% of the bacterial isolates in those without and with cancers respectively. Only 47.5% and 20.6% of isolates from those without and with cancers respectively were sensitive to the empirical antibiotic prescribed and therefore considered as appropriate antibiotic prescriptions.</p><p><strong>Conclusions: </strong>Empirical antibiotic guidelines should be updated to reflect the prevailing bacterial sensitivity patterns to ensure optimum outcomes. Prescribing pat-terns and guideline concordance should be periodically evaluated to ensure that the antimicrobial stewardship programs are moving in the right direction.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"54-60"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A policy response to antimicrobial resistance in the South-East Asian Countries: Implications for Sri Lanka's Health Policy Reforms.","authors":"Bassem Zayed, Thiraj Haputhanthri, Suman Rijal, Alaka Singh","doi":"10.4038/cmj.v69iSI3.10026","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.10026","url":null,"abstract":"","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"3-6"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking antibiotic misuse in healthcare: the need to address the person and wider determinants.","authors":"Veranja Liyanapathirana","doi":"10.4038/cmj.v69iSI3.9943","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9943","url":null,"abstract":"","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"14-15"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotypic antimicrobial resistance associated with different bla genotypes and their combinations in Enterobacterales.","authors":"Vindya Perera, Harsha Samarasekara, Upamali Herath, Jayanthi Elvitigala, Shirani Chandrasiri, Enoka Corea","doi":"10.4038/cmj.v69iSI3.9953","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9953","url":null,"abstract":"<p><strong>Introduction: </strong>Varying combinations of β-lactamase genes (bla) in Enterobacterales manifest different resistant phenotypes.</p><p><strong>Objectives: </strong>This study aimed to identify bla gene types and combinations resulting in variations in phenotypic antimicrobial resistance.</p><p><strong>Methods: </strong>Minimum inhibitory concentrations (MICs) of 75 extended spectrum β-lactamase (ESBL), AmpC β-lactamase and carbapenemase-producing Entero-bacterales isolates from a variety of clinical specimens were determined by Vitek micro-broth dilution. Bla genes were detected by 16-plex tandem PCR panel and Xpert Carba-R assay. BlaCTX-M group-1 and blaOXA-48 were the most common ESBL and carbapenemase genes, respectively.</p><p><strong>Results: </strong>Majority of the isolates (92%, 69/75) had bla gene combinations. Thirty-eight isolates (51%) carried ESBL, AmpC genes and/or narrow spectrum bla genes without any carbapenemase genes. The common bla gene combination in these isolates was blaCTX-M group-1 + blaOXA1 which is known to confer decreased susce-ptibility to piperacillin-tazobactam. Antibiotics with potential activity against ESBL-producing bacteria such as fourth generation cephalosporins, β-lactam/β-lactam-inhibitor combinations, quinolones and gentamicin also showed low rates of susceptibility. Highest susceptibility rates were to meropenem (92%) and amikacin (92%). Thirty-seven isolates (49%) carried carbapenemase genes as well. These isolates showed even higher resistance rates to all antibiotics, except amikacin (92%susceptible). Significantly higher MIC values for cefoxitin, ceftazidime, ceftriaxone, cefepime, meropenem, amikacin, tobramycin and trimethoprim-sulfamethoxazole were seen in isolates carrying blaNDM than blaOXA-48. However, a higher MIC for norfloxacin was seen in isolates with blaOXA-48.</p><p><strong>Conclusions: </strong>In conclusion, this study showed that Enterobacterales with different bla gene combinations manifest variations in phenotypic resistance to both β-lactam and non-β-lactam antibiotics.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"23-36"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotypic and genotypic detection of carbapenem resistance and carbapenemase production in Enterobacterales isolates from cancer patients at the National Cancer Institute, Sri Lanka.","authors":"Menu Niluthpala Pitagampola, Samanmalee Priyantha Gunasekara, Kapuwella Gamaralalage Ariyatilaka Kapuwella, Jananie Kottahachchi","doi":"10.4038/cmj.v69iSI3.9951","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9951","url":null,"abstract":"<p><strong>Introduction: </strong>The emergence of pathogens that are resistant to most of the antibiotics including carba-penems are alarmingly increasing and becoming a major global threat, especially among immunocompromised patients. Presently it has become a major health chal-lenge to treat these patients as carbapenems are one of the last resort antibiotics. The main aim of this study was to detect carbapenemase production and its prevalence among Enterobacterales isolates from clinical samples of cancer patients.</p><p><strong>Methodology: </strong>Enterobacterales isolates from clinical samples received to Laboratory of Microbiology in National Cancer Institute, Sri Lanka were subjected to antibiotic sensitivity testing according to CLSI method. CarbaNP test was carried out on carbapenem non susceptible and intermediate susceptible isolates. Pathogen identification up to species level was done using the VITEK® 2 Compact system. The genotypic detection on selected isolates was carried out using the Xpert Carba-R assay.</p><p><strong>Results: </strong>The prevalence of carbapenem resistant Enterobacterales among the study isolates was 46.1%(n=48). Isolates that showed either carbapenem resistance or intermediate susceptibility (n=58) on initial testing were subjected to Carba NP test. Out of 58 carbapenem non susceptible isolates 63.8% (n=37) were positive for CarbaNP test indicating carbapenemase production. Among carbapenemase producing isolates, Klebsiella pneumoniae spp pneumoniae was found to be the most prevalent pathogen. Genetic testing on randomly selected samples showed most of them were co-harboring both blaOXA-48 and blaNDM.</p><p><strong>Conclusions: </strong>The prevalence of carbapenem resistance is notably high among cancer patients in Sri Lanka. Therefore, detecting carbapenemase-producing genes is crucial for optimizing antibiotic management. Addi-tionally, reinforcing antibiotic stewardship is necessary. Given the already high levels of carbapenem resistance, exploring and ensuring the availability of alternative treatment options within the country is essential.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"16-22"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}