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9 pages, 1906 KiB

Open AccessArticle

Antibiotic Use in a Municipal Veterinary Clinic in Ghana

by Wisdom Adeapena, Samuel Afari-Asiedu, Robinah Najjemba, Johan van Griensven, Alexandre Delamou, Kwame Ohene Buabeng and Kwaku Poku Asante

Trop. Med. Infect. Dis. 2021, 6(3), 138; https://doi.org/10.3390/tropicalmed6030138 - 20 Jul 2021

Cited by 7 | Viewed by 6118

Abstract

Antimicrobial resistance (AMR) is a threat to public health, impacting both human and animal health as well as the economy. This study sought to describe antibiotic prescription practices and use in the Kintampo North Municipal Veterinary Clinic in Ghana using routinely collected data. [...] Read more.

Antimicrobial resistance (AMR) is a threat to public health, impacting both human and animal health as well as the economy. This study sought to describe antibiotic prescription practices and use in the Kintampo North Municipal Veterinary Clinic in Ghana using routinely collected data. Of the 513 animals presented for care between 2013 and 2019, the most common animals were dogs (71.9%), goats (13.1%), and sheep (11.1%). Antibiotics were prescribed for 273/513 (53.2%) of the animals. Tetracycline was the most commonly prescribed class of antibiotics, (99.6%). Of the 273 animals that received antibiotics, the route of administration was not documented in 68.9%, and antibiotic doses were missing in the treatment records in 37.7%. Details of the antibiotic regimen and the medical conditions diagnosed were often not recorded (52.8%). This study recommends appropriate documentation to enable continuous audit of antibiotic prescription practice and to improve quality of use. There is also the need for a national survey on antibiotic prescribtion and use in animal health to support policy implementation and decision making in One-Health in Ghana. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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12 pages, 415 KiB

Open AccessArticle

Bacteria and Their Antibiotic Resistance Profiles in Ambient Air in Accra, Ghana, February 2020: A Cross-Sectional Study

by Godfred Saviour Kudjo Azaglo, Mohammed Khogali, Katrina Hann, John Alexis Pwamang, Emmanuel Appoh, Ebenezer Appah-Sampong, Meldon Ansah-Koi Agyarkwa, Carl Fiati, Jewel Kudjawu, George Kwesi Hedidor, Amos Akumwena, Collins Timire, Hannock Tweya, Japheth A. Opintan and Anthony D. Harries

Trop. Med. Infect. Dis. 2021, 6(3), 110; https://doi.org/10.3390/tropicalmed6030110 - 25 Jun 2021

Cited by 2 | Viewed by 5313

Abstract

Inappropriate use of antibiotics has led to the presence of antibiotic-resistant bacteria in ambient air. There is no published information about the presence and resistance profiles of bacteria in ambient air in Ghana. We evaluated the presence and antibiotic resistance profiles of selected [...] Read more.

Inappropriate use of antibiotics has led to the presence of antibiotic-resistant bacteria in ambient air. There is no published information about the presence and resistance profiles of bacteria in ambient air in Ghana. We evaluated the presence and antibiotic resistance profiles of selected bacterial, environmental and meteorological characteristics and airborne bacterial counts in 12 active air quality monitoring sites (seven roadside, two industrial and three residential) in Accra in February 2020. Roadside sites had the highest median temperature, relative humidity, wind speed and PM₁₀ concentrations, and median airborne bacterial counts in roadside sites (115,000 CFU/m³) were higher compared with industrial (35,150 CFU/m³) and residential sites (1210 CFU/m³). Bacillus species were isolated in all samples and none were antibiotic resistant. There were, however, Pseudomonas aeruginosa, Escherichia coli, Pseudomonas species, non-hemolytic Streptococci, Coliforms and Staphylococci species, of which six (50%) showed mono-resistance or multidrug resistance to four antibiotics (penicillin, ampicillin, ciprofloxacin and ceftriaxone). There was a positive correlation between PM₁₀ concentrations and airborne bacterial counts (r_s = 0.72), but no correlations were found between PM₁₀ concentrations and the pathogenic bacteria nor their antibiotic resistance. We call for the expansion of surveillance of ambient air to other cities of Ghana to obtain nationally representative information. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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19 pages, 3260 KiB

Open AccessArticle

Extended Spectrum Beta-Lactamase Escherichia coli in River Waters Collected from Two Cities in Ghana, 2018–2020

by Regina Ama Banu, Jorge Matheu Alvarez, Anthony J. Reid, Wendemagegn Enbiale, Appiah-Korang Labi, Ebenezer D. O. Ansa, Edith Andrews Annan, Mark Osa Akrong, Selorm Borbor, Lady A. B. Adomako, Hawa Ahmed, Mohammed Bello Mustapha, Hayk Davtyan, Phillip Owiti, George Kwesi Hedidor, Gerard Quarcoo, David Opare, Boi Kikimoto, Mike Y. Osei-Atweneboana and Heike Schmitt

Trop. Med. Infect. Dis. 2021, 6(2), 105; https://doi.org/10.3390/tropicalmed6020105 - 20 Jun 2021

Cited by 17 | Viewed by 7385

Abstract

Infections by Extended-Spectrum Beta-Lactamase producing Escherichia coli (ESBL-Ec) are on the increase in Ghana, but the level of environmental contamination with this organism, which may contribute to growing Antimicrobial Resistance (AMR), is unknown. Using the WHO OneHealth Tricycle Protocol, we investigated the contamination [...] Read more.

Infections by Extended-Spectrum Beta-Lactamase producing Escherichia coli (ESBL-Ec) are on the increase in Ghana, but the level of environmental contamination with this organism, which may contribute to growing Antimicrobial Resistance (AMR), is unknown. Using the WHO OneHealth Tricycle Protocol, we investigated the contamination of E. coli (Ec) and ESBL-Ec in two rivers in Ghana (Odaw in Accra and Okurudu in Kasoa) that receive effluents from human and animal wastewater hotspots over a 12-month period. Concentrations of Ec, ESBL-Ec and percent ESBL-Ec/Ec were determined per 100 mL sample. Of 96 samples, 94 (98%) were positive for ESBL-Ec. concentrations per 100 mL (MCs100) of ESBL-Ec and %ESBL-Ec from both rivers were 4.2 × 10⁴ (IQR, 3.1 × 10³–2.3 × 10⁵) and 2.79 (IQR, 0.96–6.03), respectively. MCs100 were significantly lower in upstream waters: 1.8 × 10⁴ (IQR, 9.0 × 10³–3.9 × 10⁴) as compared to downstream waters: 1.9 × 10⁶ (IQR, 3.7 × 10⁵–5.4 × 10⁶). Both human and animal wastewater effluents contributed to the increased contamination downstream. This study revealed high levels of ESBL-Ec in rivers flowing through two cities in Ghana. There is a need to manage the sources of contamination as they may contribute to the acquisition and spread of ESBL-Ec in humans and animals, thereby contributing to AMR. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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9 pages, 576 KiB

Open AccessArticle

High Levels of Antibiotic Resistance Patterns in Two Referral Hospitals during the Post-Ebola Era in Free-Town, Sierra Leone: 2017–2019

by Zikan Koroma, Francis Moses, Alexandre Delamou, Katrina Hann, Engy Ali, Freddy Eric Kitutu, Juliet Sanyu Namugambe, Doris Harding, Veerle Hermans, Kudakwashe Takarinda, Pruthu Thekkur and Isatta Wurie

Trop. Med. Infect. Dis. 2021, 6(2), 103; https://doi.org/10.3390/tropicalmed6020103 - 16 Jun 2021

Cited by 3 | Viewed by 5885

Abstract

The Post-Ebola era (2017–2019) presented an opportunity for laboratory investments in Sierra Leone. US CDC supported the Ministry of Health and Sanitation to establish a microbiological unit for routine antimicrobial sensitivity testing in two referral (pediatric and maternity) hospitals in Freetown. This study [...] Read more.

The Post-Ebola era (2017–2019) presented an opportunity for laboratory investments in Sierra Leone. US CDC supported the Ministry of Health and Sanitation to establish a microbiological unit for routine antimicrobial sensitivity testing in two referral (pediatric and maternity) hospitals in Freetown. This study describes resistance patterns among patients’ laboratory samples from 2017 to 2019 using routine data. Samples included urine, stool, cerebrospinal fluid, pus-wound, pleural fluid, and high vaginal swabs. Selected Gram-positive and Gram-negative bacterial isolates were tested for antimicrobial susceptibility. Of 200 samples received by the laboratory, 89 returned positive bacterial isolates with urine and pus-wound swabs accounting for 75% of positive isolates. The number of positive isolates increased annually from one in 2017 to 42 in 2018 and 46 in 2019. Resistance of the cultures to at least one antibiotic was high (91%), and even higher in the pediatric hospital (94%). Resistance was highest with penicillin (81%) for Gram-positive bacteria and lowest with nitrofurantoin (13%). Gram-negative bacteria were most resistant to ampicillin, gentamycin, streptomycin, tetracycline, cephalothin and penicillin (100%) and least resistant to novobiocin (0%). Antibiotic resistance for commonly prescribed antibiotics was high in two referral hospitals, highlighting the urgent need for antimicrobial stewardship and access to reserve antibiotics. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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14 pages, 1051 KiB

Open AccessArticle

Gaps in Infection Prevention and Control in Public Health Facilities of Sierra Leone after the 2014–2015 Ebola Outbreak

by James Sylvester Squire, Imurana Conteh, Arpine Abrahamya, Anna Maruta, Ruzanna Grigoryan, Hannock Tweya, Collins Timire, Katrina Hann, Rony Zachariah and Mohamed Alex Vandi

Trop. Med. Infect. Dis. 2021, 6(2), 89; https://doi.org/10.3390/tropicalmed6020089 - 26 May 2021

Cited by 7 | Viewed by 6007

Abstract

Background: High compliance to infection prevention and control (IPC) is vital to prevent health care-associated infections. In the worst 2014–2015 Ebola-affected district in Sierra Leone (Kenema), we assessed (a) average yearly IPC compliance (2016–2018) using a National IPC assessment tool in the district [...] Read more.

Background: High compliance to infection prevention and control (IPC) is vital to prevent health care-associated infections. In the worst 2014–2015 Ebola-affected district in Sierra Leone (Kenema), we assessed (a) average yearly IPC compliance (2016–2018) using a National IPC assessment tool in the district hospital and peripheral health units (PHUs), and (b) gaps in IPC activities, infrastructure and consumables in 2018. Methods: This was a cross-sectional study using secondary program data. Results: At the district hospital, compliance increased from 69% in 2016 to 73% in 2018 (expected minimal threshold = 70%; desired threshold ≥ 85%). Compliance for screening/isolation facilities and decontamination of medical equipment reached 100% in 2018. The two thematic areas with the lowest compliance were sanitation (44%) and sharps safety (56%). In PHUs (2018), the minimal 70% compliance threshold was not achieved in two (of 10 thematic areas) for Community Health Centers, four for Community Health Posts, and five for Maternal and Child Health Units. The lowest compliance was for screening and isolation facilities (range: 33–53%). Conclusion: This baseline assessment is an eye opener of what is working and what is not, and can be used to galvanize political, financial, and material resources to bridge the existing gaps. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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14 pages, 702 KiB

Open AccessArticle

National Antimicrobial Consumption: Analysis of Central Warehouses Supplies to In-Patient Care Health Facilities from 2017 to 2019 in Uganda

by Juliet Sanyu Namugambe, Alexandre Delamou, Francis Moses, Engy Ali, Veerle Hermans, Kudakwashe Takarinda, Pruthu Thekkur, Stella Maris Nanyonga, Zikan Koroma, Joseph Ngobi Mwoga, Harriet Akello, Monica Imi and Freddy Eric Kitutu

Trop. Med. Infect. Dis. 2021, 6(2), 83; https://doi.org/10.3390/tropicalmed6020083 - 19 May 2021

Cited by 9 | Viewed by 6583

Abstract

Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) [...] Read more.

Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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11 pages, 2391 KiB

Open AccessArticle

Increasing Antimicrobial Resistance in Surgical Wards at Mulago National Referral Hospital, Uganda, from 2014 to 2018—Cause for Concern?

by Gerald Mboowa, Dickson Aruhomukama, Ivan Sserwadda, Freddy Eric Kitutu, Hayk Davtyan, Philip Owiti, Edward Mberu Kamau, Wendemagegn Enbiale, Anthony Reid, Douglas Bulafu, Jeffrey Kisukye, Margaret Lubwama and Henry Kajumbula

Trop. Med. Infect. Dis. 2021, 6(2), 82; https://doi.org/10.3390/tropicalmed6020082 - 19 May 2021

Cited by 7 | Viewed by 7704

Abstract

Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAIs) are major global public health challenges in our time. This study provides a broader and updated overview of AMR trends in surgical wards of Mulago National Referral Hospital (MNRH) between 2014 and 2018. Laboratory data [...] Read more.

Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAIs) are major global public health challenges in our time. This study provides a broader and updated overview of AMR trends in surgical wards of Mulago National Referral Hospital (MNRH) between 2014 and 2018. Laboratory data on the antimicrobial susceptibility profiles of bacterial isolates from 428 patient samples were available. The most common samples were as follows: tracheal aspirates (36.5%), pus swabs (28.0%), and blood (20.6%). Klebsiella (21.7%), Acinetobacter (17.5%), and Staphylococcus species (12.4%) were the most common isolates. The resistance patterns for different antimicrobials were: penicillins (40–100%), cephalosporins (30–100%), β-lactamase inhibitor combinations (70–100%), carbapenems (10–100%), polymyxin E (0–7%), aminoglycosides (50–100%), sulphonamides (80–100%), fluoroquinolones (40–70%), macrolides (40–100%), lincosamides (10–45%), phenicols (40–70%), nitrofurans (0–25%), and glycopeptide (0–20%). This study demonstrated a sustained increase in resistance among the most commonly used antibiotics in Uganda over the five-year study period. It implies ongoing hospital-based monitoring and surveillance of AMR patterns are needed to inform antibiotic prescribing, and to contribute to national and global AMR profiles. It also suggests continued emphasis on infection prevention and control practices (IPC), including antibiotic stewardship. Ultimately, laboratory capacity for timely bacteriological culture and sensitivity testing will provide a rational choice of antibiotics for HAI. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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15 pages, 1186 KiB

Open AccessArticle

Wounds, Antimicrobial Resistance and Challenges of Implementing a Surveillance System in Myanmar: A Mixed-Methods Study

by Win-Pa Sandar, Saw Saw, Ajay M. V. Kumar, Bienvenu Salim Camara and Myint-Myint Sein

Trop. Med. Infect. Dis. 2021, 6(2), 80; https://doi.org/10.3390/tropicalmed6020080 - 18 May 2021

Cited by 9 | Viewed by 6244

Abstract

Wound infections with drug-resistant bacteria lead to higher mortality and morbidity and increased healthcare costs. We aimed to describe the spectrum of bacterial pathogens, isolated from wound cultures in Yangon General Hospital in 2018, and their antimicrobial resistance (AMR) patterns and to understand [...] Read more.

Wound infections with drug-resistant bacteria lead to higher mortality and morbidity and increased healthcare costs. We aimed to describe the spectrum of bacterial pathogens, isolated from wound cultures in Yangon General Hospital in 2018, and their antimicrobial resistance (AMR) patterns and to understand the challenges in implementing an AMR surveillance system in Myanmar. We conducted a concurrent mixed-methods study involving analysis of surveillance data and in-depth interviews with nine key personnel involved in AMR surveillance. Of 1418 wound specimens processed, 822 (58%) were culture-positive. The most common Gram-positive bacteria were coagulase-negative staphylococci (23.3%) and Staphylococcus aureus (15.1%). Among Gram-negative bacteria, Escherichia coli (12.5%) and Pseudomonas aeruginosa (10.1%) were common. Staphylococcus aureus isolates were resistant to penicillin (98%), oxacillin (70%) and tetracycline (66%). Escherichia coli showed resistance to ampicillin (98%). Lack of dedicated and trained staff (microbiologist, technician, data entry operator), lack of computers at sentinel sites and non-uniform and non-standardized data capture formats were the major challenges in implementing AMR surveillance. These challenges need to be addressed urgently. We also recommend periodic analysis and sharing of antibiograms at every hospital to inform the treatment regimens used in wound management. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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12 pages, 2880 KiB

Open AccessArticle

Reduced Bacterial Counts from a Sewage Treatment Plant but Increased Counts and Antibiotic Resistance in the Recipient Stream in Accra, Ghana—A Cross-Sectional Study

by Lady A. B. Adomako, Dzidzo Yirenya-Tawiah, Daniel Nukpezah, Arpine Abrahamya, Appiah-Korang Labi, Ruzanna Grigoryan, Hawa Ahmed, Josiah Owusu-Danquah, Ted Yemoh Annang, Regina A. Banu, Mike Y. Osei-Atweneboana, Collins Timire, Hanock Tweya, Stephen E. D. Ackon, Emmanuel Nartey and Rony Zachariah

Trop. Med. Infect. Dis. 2021, 6(2), 79; https://doi.org/10.3390/tropicalmed6020079 - 14 May 2021

Cited by 13 | Viewed by 7088

Abstract

Wastewater treatment plants receive sewage containing high concentrations of bacteria and antibiotics. We assessed bacterial counts and their antibiotic resistance patterns in water from (a) influents and effluents of the Legon sewage treatment plant (STP) in Accra, Ghana and (b) upstream, outfall, and [...] Read more.

Wastewater treatment plants receive sewage containing high concentrations of bacteria and antibiotics. We assessed bacterial counts and their antibiotic resistance patterns in water from (a) influents and effluents of the Legon sewage treatment plant (STP) in Accra, Ghana and (b) upstream, outfall, and downstream in the recipient Onyasia stream. We conducted a cross-sectional study of quality-controlled water testing (January–June 2018). In STP effluents, mean bacterial counts (colony-forming units/100 mL) had reduced E. coli (99.9% reduction; 102,266,667 to 710), A. hydrophila (98.8%; 376,333 to 9603), and P. aeruginosa (99.5%; 5,666,667 to 1550). Antibiotic resistance was significantly reduced for tetracycline, ciprofloxacin, cefuroxime, and ceftazidime and increased for gentamicin, amoxicillin/clavulanate, and imipenem. The highest levels were for amoxicillin/clavulanate (50–97%) and aztreonam (33%). Bacterial counts increased by 98.8% downstream compared to the sewage outfall and were predominated by E. coli, implying intense fecal contamination from other sources. There was a progressive increase in antibiotic resistance from upstream, to outfall, to downstream. The highest resistance was for amoxicillin/clavulanate (80–83%), cefuroxime (47–73%), aztreonam (53%), and ciprofloxacin (40%). The STP is efficient in reducing bacterial counts and thus reducing environmental contamination. The recipient stream is contaminated with antibiotic-resistant bacteria listed as critically important for human use, which needs addressing. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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12 pages, 233 KiB

Open AccessArticle

National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): A Cross-Sectional Study

by Joseph Sam Kanu, Mohammed Khogali, Katrina Hann, Wenjing Tao, Shuwary Barlatt, James Komeh, Joy Johnson, Mohamed Sesay, Mohamed Alex Vandi, Hannock Tweya, Collins Timire, Onome Thomas Abiri, Fawzi Thomas, Ahmed Sankoh-Hughes, Bailah Molleh, Anna Maruta and Anthony D. Harries

Trop. Med. Infect. Dis. 2021, 6(2), 77; https://doi.org/10.3390/tropicalmed6020077 - 13 May 2021

Cited by 15 | Viewed by 6251

Abstract

Monitoring antibiotic consumption is crucial to tackling antimicrobial resistance. However, currently there is no system in Sierra Leone for recording and reporting on antibiotic consumption. We therefore conducted a cross-sectional study to assess national antibiotic consumption expressed as defined daily dose (DDD) per [...] Read more.

Monitoring antibiotic consumption is crucial to tackling antimicrobial resistance. However, currently there is no system in Sierra Leone for recording and reporting on antibiotic consumption. We therefore conducted a cross-sectional study to assess national antibiotic consumption expressed as defined daily dose (DDD) per 1000 inhabitants per day using all registered and imported antibiotics (categorized under the subgroup J01 under the anatomical and therapeutic classification (ATC) system) as a proxy. Between 2017–2019, total cumulative consumption of antibiotics was 19 DDD per 1000 inhabitants per day. The vast majority consisted of oral antibiotics (98.4%), while parenteral antibiotics made up 1.6%. According to therapeutic/pharmacological subgroups (ATC level 3), beta-lactam/penicillins, quinolones, and other antibacterials (mainly oral metronidazole) comprised 65% of total consumption. According to WHO Access, Watch, and Reserve (AWaRe), 65% of antibiotics consumed were Access, 31% were Watch, and no Reserve antibiotics were reported. The top ten oral antibiotics represented 97% of total oral antibiotics consumed, with metronidazole (35%) and ciprofloxacin (15%) together constituting half of the total. Of parenteral antibiotics consumed, procaine penicillin (32%) and ceftriaxone (19%) together comprised half of the total. Policy recommendations at global and national levels have been made to improve monitoring of antibiotic consumption and antibiotic stewardship. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

9 pages, 585 KiB

Open AccessArticle

Veterinary Healthcare Provision and Quality of Reported Data on Antimicrobial Use in the Treatment of Livestock in Sierra Leone, 2016–2019

by Amara Leno, Walter Kizito, Amadu Tejan Jalloh, Mohamed Alpha Bah, Sorie Mohamed Kamara, Maria Zolfo, Amara Aidara Sheriff, Katrina Hann, Pruthu Thekkur and Ajay M. V. Kumar

Trop. Med. Infect. Dis. 2021, 6(2), 73; https://doi.org/10.3390/tropicalmed6020073 - 10 May 2021

Cited by 4 | Viewed by 5027

Abstract

Antimicrobials help in the prevention and treatment of infections and are crucial for animal production, but overuse can result in antimicrobial resistance. Hence, understanding data quality on livestock antimicrobial use is essential. We assessed frequency of reporting, completeness, and concordance of reported data [...] Read more.

Antimicrobials help in the prevention and treatment of infections and are crucial for animal production, but overuse can result in antimicrobial resistance. Hence, understanding data quality on livestock antimicrobial use is essential. We assessed frequency of reporting, completeness, and concordance of reported data and availability of human resources and infrastructure in 14 districts in Sierra Leone. This was a cross-sectional study involving a review of district and sub-district animal treatment forms submitted from January 2016 to August 2019. Out of the 14 districts, only 3 had filled forms available for review: A total of 6 (0.97% of 616 expected) district forms and 79 (1.15% of 6840 expected) sub-district forms. Data between district and sub-district treatment forms were fully discordant. Hence, completeness of data could not be assessed. All districts had livestock officers (barring one) and livestock assistants but no veterinarians. The gap in community animal health workers ranged from 14 to 100% per district. No districts had a functional computer or internet access. Reporting was non-existent in 11 districts and poor in the other 3. Resources are urgently needed to address critical gaps in human resources and capacity and computer and Internet connectivity to develop critical One Health surveillance functions at the national and sub-national levels. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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12 pages, 844 KiB

Open AccessArticle

Blood Culture Testing Outcomes among Non-Malarial Febrile Children at Antimicrobial Resistance Surveillance Sites in Uganda, 2017–2018

by Rogers Kisame, Robinah Najjemba, Johan van Griensven, Freddy Eric Kitutu, Kudakwashe Takarinda, Pruthu Thekkur, Alexandre Delamou, Richard Walwema, Francis Kakooza, Ibrahim Mugerwa, Musa Sekamatte, Kimera Robert, Thomas Katairo, Marc Sam Opollo, Morgan Otita and Mohammed Lamorde

Trop. Med. Infect. Dis. 2021, 6(2), 71; https://doi.org/10.3390/tropicalmed6020071 - 6 May 2021

Cited by 3 | Viewed by 5736

Abstract

Blood culture (BC) processes are critical to the utility of diagnostic testing, bloodstream infection (BSI) management, and antimicrobial resistance (AMR) surveillance. While Uganda has established BC guidelines, often laboratory practice does not meet the desired standards. This compromises pathogen recovery, reliability of antimicrobial [...] Read more.

Blood culture (BC) processes are critical to the utility of diagnostic testing, bloodstream infection (BSI) management, and antimicrobial resistance (AMR) surveillance. While Uganda has established BC guidelines, often laboratory practice does not meet the desired standards. This compromises pathogen recovery, reliability of antimicrobial susceptibility testing, and diagnostic test utility. This study assessed laboratory BC process outcomes among non-malarial febrile children below five years of age at five AMR surveillance sites in Uganda between 2017 and 2018. Secondary BC testing data was reviewed against established standards. Overall, 959 BC specimens were processed. Of these, 91% were from female patients, neonates, infants, and young children (1–48 months). A total of 37 AMR priority pathogens were identified; Staphylococcus aureus was predominant (54%), followed by Escherichia coli (19%). The diagnostic yield was low (4.9%). Only 6.3% of isolates were identified. AST was performed on 70% (18/26) of identified AMR priority isolates, and only 40% of these tests adhered to recommended standards. Interventions are needed to improve laboratory BC practices for effective patient management through targeted antimicrobial therapy and AMR surveillance in Uganda. Further research on process documentation, diagnostic yield, and a review of patient outcomes for all hospitalized febrile patients is needed. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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13 pages, 809 KiB

Open AccessArticle

High Prevalence of Methicillin-Resistant Staphylococcus aureus among Healthcare Facilities and Its Related Factors in Myanmar (2018–2019)

by Pan Ei Soe, Wai Wai Han, Karuna D. Sagili, Srinath Satyanarayana, Priyanka Shrestha, Thi Thi Htoon and Htay Htay Tin

Trop. Med. Infect. Dis. 2021, 6(2), 70; https://doi.org/10.3390/tropicalmed6020070 - 6 May 2021

Cited by 12 | Viewed by 5778

Abstract

Background: Antimicrobial resistance (AMR) is a growing global health problem. Staphylococcus aureus (SA) is a common bacterium associated with a variety of community and hospital infections. Methicillin-resistant Staphylococcus aureus (MRSA) accounts for most SA related morbidity and mortality. In this study, [...] Read more.

Background: Antimicrobial resistance (AMR) is a growing global health problem. Staphylococcus aureus (SA) is a common bacterium associated with a variety of community and hospital infections. Methicillin-resistant Staphylococcus aureus (MRSA) accounts for most SA related morbidity and mortality. In this study, we determined the prevalence and factors associated with SA and MRSA in Myanmar. Methods: We collected the data retrospectively by reviewing an electronic register containing the results of bacterial culture and antibiotic susceptibility testing of biological specimens received from healthcare facilities during 2018–2019. Results: Of the 37,798 biological specimens with bacterial culture growth, 22% (8244) were Gram-positive. Among the Gram-positive bacteria, 42% (2801) were SA, of which 48% (1331) were judged as MRSA by phenotypic methods. The prevalence of MRSA was higher in the older age groups, in female patients, in urine specimens and specimens received from the intensive care unit and dermatology departments. One site (Site F) had the highest MRSA prevalence of the seven AMR sentinel sites. Most SA isolates were sensitive to vancomycin (90%) by phenotypic methods. Conclusions: The high prevalence of MRSA indicates a major public health threat. There is an urgent need to strengthen the AMR surveillance and hospital infection control program in Myanmar. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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11 pages, 356 KiB

Open AccessArticle

Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done

by Marc Sam Opollo, Tom Charles Otim, Walter Kizito, Pruthu Thekkur, Ajay M. V. Kumar, Freddy Eric Kitutu, Rogers Kisame and Maria Zolfo

Trop. Med. Infect. Dis. 2021, 6(2), 69; https://doi.org/10.3390/tropicalmed6020069 - 1 May 2021

Cited by 17 | Viewed by 9580

Abstract

Globally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobial-resistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira [...] Read more.

Globally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobial-resistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, cross-sectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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16 pages, 1089 KiB

Open AccessArticle

Neonatal Sepsis, Antibiotic Susceptibility Pattern, and Treatment Outcomes among Neonates Treated in Two Tertiary Care Hospitals of Yangon, Myanmar from 2017 to 2019

by Nan Aye Thida Oo, Jeffrey K. Edwards, Prajjwal Pyakurel, Pruthu Thekkur, Thae Maung Maung, Nant San San Aye and Hla Myat Nwe

Trop. Med. Infect. Dis. 2021, 6(2), 62; https://doi.org/10.3390/tropicalmed6020062 - 28 Apr 2021

Cited by 15 | Viewed by 5427

Abstract

Neonatal sepsis is a leading cause of morbidity and mortality in developing countries. This study aimed to assess the proportion of culture-confirmed sepsis, bacteriological pathogen profile, culture report turnaround times, antibiotic susceptibility patterns, and treatment outcomes of all with neonatal sepsis admitted in [...] Read more.

Neonatal sepsis is a leading cause of morbidity and mortality in developing countries. This study aimed to assess the proportion of culture-confirmed sepsis, bacteriological pathogen profile, culture report turnaround times, antibiotic susceptibility patterns, and treatment outcomes of all with neonatal sepsis admitted in two tertiary care hospitals in Yangon, Myanmar, 2017–2019. This was a cross sectional study utilizing a standardized electronic database and paper-based records. Bacteriological profiles and associated factors were analyzed with descriptive statistics and Poisson Regression. Of those with suspected sepsis, 42% were bacteriologically confirmed and 74% of confirmed sepsis was resistant to at least first-line antibiotics. Neonates with late onset sepsis (LOS) (aPR: 1.2 (95% CI: 1.1–1.4, p = 0.008)) were more likely to have bacteriologically confirmed sepsis (45%) versus early onset sepsis (38%). Gram-negative organisms were most commonly isolated (63%), associated with multidrug-resistant organisms and with a high case-fatality rate (64%). These findings suggest that enhanced national guidance regarding infection control and prevention, antibiotic stewardship, and first-line antibiotic choices need to be provided. The link between LOS with infection and prevention protocols needs to be further explored in this context to decrease sepsis risk, neonatal mortality, and reduce further antimicrobial resistance. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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13 pages, 1462 KiB

Open AccessArticle

Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal

by Jyoti Acharya, Maria Zolfo, Wendemagegn Enbiale, Khine Wut Yee Kyaw, Meika Bhattachan, Nisha Rijal, Anjana Shrestha, Basudha Shrestha, Surendra Kumar Madhup, Bijendra Raj Raghubanshi, Hari Prasad Kattel, Piyush Rajbhandari, Parmananda Bhandari, Subhash Thakur, Saroj Sharma, Dipendra Raman Singh and Runa Jha

Trop. Med. Infect. Dis. 2021, 6(2), 60; https://doi.org/10.3390/tropicalmed6020060 - 23 Apr 2021

Cited by 6 | Viewed by 5034

Abstract

Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed [...] Read more.

Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed the quality of AMR surveillance data during 2019–2020 at nine surveillance sites in Province 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting sites. Here, we present the results of this cross-sectional descriptive study of secondary AMR data from five reporting sites and barriers identified through a structured questionnaire completed by representatives at the five reporting and four non-reporting sites. Among the 1584 records from the reporting sites assessed for consistency and completeness, 77–92% were consistent and 88–100% were complete, with inter-site variation. Data from two sites were received by the 15th day of the following month, whereas receipt was delayed by a mean of 175 days at three other sites. All four non-reporting sites lacked dedicated data personnel, and two lacked computers. The AMR surveillance data collection process needs improvement in completeness, consistency, and timeliness. Non-reporting sites need support to meet the specific requirements for data compilation and sharing. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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11 pages, 889 KiB

Open AccessArticle

High Resistance of Salmonella spp. and Shigella spp. in Blood and Stool Cultures from the Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal, 2015−2019

by Anup Bastola, Prajjwal Pyakurel, Rajan Bikram Rayamajhi, Saugat Shrestha, Pruthu Thekkur, Basudev Pandey, Parmananda Bhandari, Anu Maharjan and Jeffrey K. Edwards

Trop. Med. Infect. Dis. 2021, 6(2), 59; https://doi.org/10.3390/tropicalmed6020059 - 23 Apr 2021

Cited by 2 | Viewed by 4645

Abstract

Antimicrobial resistance (AMR) is an increasing global concern, particularly in Southeast Asian countries like Nepal. The aim of this study was to determine the proportion of Salmonella spp. and Shigella spp. among culture-positive bacterial isolates in blood and stool samples from 2015 to [...] Read more.

Antimicrobial resistance (AMR) is an increasing global concern, particularly in Southeast Asian countries like Nepal. The aim of this study was to determine the proportion of Salmonella spp. and Shigella spp. among culture-positive bacterial isolates in blood and stool samples from 2015 to 2019 and their AMR pattern. Routinely collected data were abstracted from medical records and laboratory electronic databases of the Sukraraj Tropical and Infectious Disease Hospital (STIDH), Kathmandu, Nepal. All culture-positive bacterial isolates from blood and stool samples were included in the study. Among 390 blood cultures positive for bacterial isolates, Salmonella spp. were isolated in 44%, with S. Typhi being the most frequent (34%). Antibiotic resistance was demonstrated among Salmonella spp. to ciprofloxacin (68%), ofloxacin (16%), amoxicillin (13%) and cotrimoxazole (5%). Of the 357 stool cultures positive for bacterial isolates, the proportion of Shigella spp. isolated was 31%. Antibiotic resistance among Shigella spp. was demonstrated to cotrimoxazole (59%), tetracycline (40%), amoxicillin (38%) and ciprofloxacin (25%). Salmonella spp. and Shigella spp. were the most predominant organisms among all the bacterial isolates in blood and stool cultures, respectively. Nalidixic acid was the antibiotic to which both Salmonella spp. and Shigella spp. were most resistant. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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14 pages, 4877 KiB

Open AccessArticle

Decreasing Trends in Antibiotic Consumption in Public Hospitals from 2014 to 2017 Following the Decentralization of Drug Procurement in Myanmar

by Khin Hnin Pwint, Kyaw Soe Min, Wenjing Tao, Hemant Deepak Shewade, Khin Thet Wai, Hnin Aye Kyi, Sushma Shakya, Badri Thapa, Rony Zachariah and Zaw Than Htun

Trop. Med. Infect. Dis. 2021, 6(2), 57; https://doi.org/10.3390/tropicalmed6020057 - 20 Apr 2021

Cited by 2 | Viewed by 3956

Abstract

(1) Background: In 2014, drug procurement for public hospitals in Myanmar was decentralized to a pull system. This might lead to increasing trends in the consumption of broad-spectrum and last-resort antibiotics. For fiscal years 2014-2017, we assessed annual antibiotic consumption trends and patterns [...] Read more.

(1) Background: In 2014, drug procurement for public hospitals in Myanmar was decentralized to a pull system. This might lead to increasing trends in the consumption of broad-spectrum and last-resort antibiotics. For fiscal years 2014-2017, we assessed annual antibiotic consumption trends and patterns in total defined daily doses (DDDs). (2) Methods: We followed World Health Organization (WHO) methodology for surveillance of antimicrobial consumption based on hospital antibiotic procurement records (as a proxy). (3) Results: In 32% of all public hospitals where data were retrieved, total antibiotic consumption reduced by 19% between 2014 (7,122,852 DDD) and 2017 (5,794,904 DDD). Consumption per 1000 inhabitants per day (<200 bed hospitals) also reduced from 0.6 to 0.3. Over 60% of procurement was for beta-lactam antibiotics and quinolones; quinolones decreased over time. Consumption of first-line antibiotics increased (42% in 2014 to 54% in 2017), whereas broad-spectrum antibiotics decreased (46% in 2014 to 38% in 2017). Linezolid was the only last-resort antibiotic procured. There was a progressive reduction in per capita government current health expenditure from approximately 9.2 US$ in 2014 to 8.3 US$ in 2017. (4) Conclusions: Antibiotic consumption decreased over time in public hospitals. This first study provides a baseline for developing an antibiotic consumption surveillance system in Myanmar. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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11 pages, 1219 KiB

Open AccessArticle

Antimicrobial Resistance among Neonates with Bacterial Sepsis and Their Clinical Outcomes in a Tertiary Hospital in Kathmandu Valley, Nepal

by Bijendra Raj Raghubanshi, Karuna D. Sagili, Wai Wai Han, Henish Shakya, Priyanka Shrestha, Srinath Satyanarayana and Bal Man Singh Karki

Trop. Med. Infect. Dis. 2021, 6(2), 56; https://doi.org/10.3390/tropicalmed6020056 - 20 Apr 2021

Cited by 2 | Viewed by 3824

Abstract

Globally, antibiotic resistance in bacteria isolated from neonatal sepsis is increasing. In this cross-sectional study conducted at a medical college teaching hospital in Nepal, we assessed the antibiotic resistance levels in bacteria cultured from neonates with sepsis and their in-hospital treatment outcomes. We [...] Read more.

Globally, antibiotic resistance in bacteria isolated from neonatal sepsis is increasing. In this cross-sectional study conducted at a medical college teaching hospital in Nepal, we assessed the antibiotic resistance levels in bacteria cultured from neonates with sepsis and their in-hospital treatment outcomes. We extracted data of neonates with sepsis admitted for in-patient care from June 2018 to December 2019 by reviewing hospital records of the neonatal intensive care unit and microbiology department. A total of 308 neonates with sepsis were admitted of which, blood bacterial culture antibiotic sensitivity reports were available for 298 neonates. Twenty neonates (7%) had bacteriologic culture-confirmed neonatal sepsis. The most common bacterial species isolated were Staphylococcus aureus (8), followed by coagulase-negative Staphylococcus (5). Most of these bacteria were resistant to at least one first-line antibiotic used to manage neonatal sepsis. Overall, there were 7 (2%) deaths among the 308 neonates (none of them from the bacterial culture-positive group), and 53 (17%) neonates had left the hospital against medical advice (LAMA). Improving hospital procedures to isolate bacteria in neonates with sepsis, undertaking measures to prevent the spread of antibiotic-resistant bacteria, and addressing LAMA’s reasons are urgently needed. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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11 pages, 248 KiB

Open AccessArticle

Antibiotic Use and Treatment Outcomes among Children with Community-Acquired Pneumonia Admitted to a Tertiary Care Public Hospital in Nepal

by Bhishma Pokhrel, Tapendra Koirala, Dipendra Gautam, Ajay Kumar, Bienvenu Salim Camara, Saw Saw, Sunil Kumar Daha, Sunaina Gurung, Animesh Khulal, Sonu Kumar Yadav, Pinky Baral, Meeru Gurung and Shrijana Shrestha

Trop. Med. Infect. Dis. 2021, 6(2), 55; https://doi.org/10.3390/tropicalmed6020055 - 20 Apr 2021

Cited by 1 | Viewed by 5231

Abstract

In the era of growing antimicrobial resistance, there is a concern about the effectiveness of first-line antibiotics such as ampicillin in children hospitalized with community-acquired pneumonia. In this study, we describe antibiotic use and treatment outcomes among under-five children with community-acquired pneumonia admitted [...] Read more.

In the era of growing antimicrobial resistance, there is a concern about the effectiveness of first-line antibiotics such as ampicillin in children hospitalized with community-acquired pneumonia. In this study, we describe antibiotic use and treatment outcomes among under-five children with community-acquired pneumonia admitted to a tertiary care public hospital in Nepal from 2017 to 2019. In this cross-sectional study involving secondary analysis of hospital data, there were 659 patients and 30% of them had a history of prehospital antibiotic use. Irrespective of prehospital antibiotic use, ampicillin monotherapy (70%) was the most common first-line treatment provided during hospitalization followed by ceftriaxone monotherapy (12%). The remaining children (18%) were treated with various other antibiotics alone or in combination as first-line treatment. Broad-spectrum antibiotics such as linezolid, vancomycin, and meropenem were used in less than 1% of patients. Overall, 66 (10%) children were required to switch to second-line treatment and only 7 (1%) children were required to switch to third-line treatment. Almost all (99%) children recovered without any sequelae. This study highlights the effectiveness of ampicillin monotherapy in the treatment of community-acquired pneumonia in hospitalized children in a non-intensive care unit setting. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

10 pages, 250 KiB

Open AccessArticle

Bacterial Profile and Antibiotic Resistance among Cancer Patients with Urinary Tract Infection in a National Tertiary Cancer Hospital of Nepal

by Gambhir Shrestha, Xiaolin Wei, Katrina Hann, Kyaw Thu Soe, Srinath Satyanarayana, Bhola Siwakoti, Shankar Bastakoti, Rashmi Mulmi, Kritika Rana and Nirmal Lamichhane

Trop. Med. Infect. Dis. 2021, 6(2), 49; https://doi.org/10.3390/tropicalmed6020049 - 13 Apr 2021

Cited by 15 | Viewed by 5661

Abstract

Cancer patients are at high risk of antibiotic resistant bacterial urinary tract infections (UTIs). In this study, we assessed the bacterial profile and antibiotic resistance among cancer patients suspected of UTI in B.P. Koirala Memorial Cancer Hospital in Nepal through a cross-sectional study [...] Read more.

Cancer patients are at high risk of antibiotic resistant bacterial urinary tract infections (UTIs). In this study, we assessed the bacterial profile and antibiotic resistance among cancer patients suspected of UTI in B.P. Koirala Memorial Cancer Hospital in Nepal through a cross-sectional study with routinely collected data. All cancer patients who had a recorded urine culture between July 2018–June 2019 were included in the study. Out of 308 patients who had undergone culture, 73 (24%) of samples had bacterial growth. The most common organisms isolated were E. coli (58%), Staphylococcus (11%) and Klebsiella (10%). These bacteria had undergone susceptibility testing to 27 different antibiotics in various proportions. Of the limited antibiotic testing levels, nitrofurantoin (54/66, 82%) and amikacin (30/51, 59%) were the most common. Among those tested, there were high levels of resistance to antibiotics in the “Access” and “Watch” groups of antibiotics (2019 WHO classification). In the “Reserve” group, both antibiotics showed resistance (polymyxin 15%, tigecycline 8%). Multidrug resistance was seen among 89% of the positive culture samples. This calls for urgent measures to optimize the use of antibiotics in UTI care at policy and health facility levels through stewardship to prevent further augmentation of antibiotic resistance among cancer patients. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

9 pages, 5161 KiB

Open AccessArticle

Antibiotic Use in Broiler Poultry Farms in Kathmandu Valley of Nepal: Which Antibiotics and Why?

by Ananta Koirala, Priyanka Bhandari, Hemant Deepak Shewade, Wenjing Tao, Badri Thapa, Robert Terry, Rony Zachariah and Surendra Karki

Trop. Med. Infect. Dis. 2021, 6(2), 47; https://doi.org/10.3390/tropicalmed6020047 - 5 Apr 2021

Cited by 19 | Viewed by 6791

Abstract

Inappropriate antibiotic use in food-producing animals is associated with the emergence and spread of antibiotic resistance. In industrial broiler poultry farms in three districts of Kathmandu valley, Nepal, we assessed antibiotic use prevalence, and their classes, types, and quantities. A cross-sectional questionnaire study [...] Read more.

Inappropriate antibiotic use in food-producing animals is associated with the emergence and spread of antibiotic resistance. In industrial broiler poultry farms in three districts of Kathmandu valley, Nepal, we assessed antibiotic use prevalence, and their classes, types, and quantities. A cross-sectional questionnaire study involving field visits to large poultry farms (flock size ≥ 3000) of the Kathmandu, Bhaktapur, and Lalitpur districts was conducted. Of 30 farms (total flock size 104,200; range 3000–6000), prevalence of antibiotic use was 90% (95% CI: 73–98%). Six (22%) farms used antibiotics as prophylaxis, while 21 (78%) used it for therapeutics. Seven antibiotics from six classes (including quinolones, macrolides, and polymyxins) were used. The most commonly used antibiotics were tylosin (47%), colistin (47%), and dual therapies with neomycin and doxycycline (33%). A total of 50,000 grams of antibiotics (total weight including active and inactive ingredients) were used (0.5 grams/chicken/45 days of flock life) with eight (26%) farms using more than two antibiotics. No farms had records on clinical indications for prophylaxis or treatment. No post-mortem records of sick birds were available. Prevalence of antibiotic use in broiler farms of Kathmandu valley is high and includes “highest priority critically important antibiotics” for human use, with direct implications on public health. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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9 pages, 217 KiB

Open AccessArticle

Antimicrobial Resistance in a Tertiary Care Hospital in Armenia: 2016–2019

by Hayk Davtyan, Ruzanna Grigoryan, Lyudmila Niazyan, Mher Davidyants, Tehmine Ghalechyan and Karapet Davtyan

Trop. Med. Infect. Dis. 2021, 6(1), 31; https://doi.org/10.3390/tropicalmed6010031 - 7 Mar 2021

Cited by 4 | Viewed by 3206

Abstract

Antimicrobial resistance (AMR) is the acquired ability of pathogens to withstand antimicrobial treatment. To bridge the gap in knowledge for implementing effective and targeted interventions in relation to the AMR in Armenia, we designed this study to explore the performance of AMR diagnostics [...] Read more.

Antimicrobial resistance (AMR) is the acquired ability of pathogens to withstand antimicrobial treatment. To bridge the gap in knowledge for implementing effective and targeted interventions in relation to the AMR in Armenia, we designed this study to explore the performance of AMR diagnostics and the profile of AMR in the Nork Infection Clinical Hospital (NICH) for the period of 2016–2019, particularly to (i) determine the proportions of antimicrobial resistance among all samples tested at the hospital laboratory, (ii) determine the proportion of resistance against specific antimicrobials, and (iii) identify factors associated with AMR. A cross-sectional study was conducted with a secondary data analysis that included all the patients tested for AMR in the laboratory of the NICH for the period of 2016–2019. For this period, only 107 (0.3%) patients out of 36,528 had their AMR test results available and of them, 87 (81%) had resistance at least to one tested antimicrobial. This study has provided some valuable information on the AMR situation in Armenia. The results call for immediate actions to control the access to and the use of antimicrobials, strengthen AMR surveillance, and improve laboratory capacity for the proper and fast identification of drug resistance through a comprehensive system. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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Antimicrobial Resistance Situational Analysis 2019–2020: Design and Performance for Human Health Surveillance in Uganda

by Ibrahimm Mugerwa, Susan N. Nabadda, Janet Midega, Consolata Guma, Simeon Kalyesubula and Adrian Muwonge

Trop. Med. Infect. Dis. 2021, 6(4), 178; https://doi.org/10.3390/tropicalmed6040178 - 29 Sep 2021

Cited by 10 | Viewed by 4620

Abstract

Antibiotic resistance and its mechanisms have been known for over six decades, but global efforts to characterize its routine drivers have only gained momentum in the recent past. Drivers of clinical and community resistance go beyond just clinical practice, which is why one-health [...] Read more.

Antibiotic resistance and its mechanisms have been known for over six decades, but global efforts to characterize its routine drivers have only gained momentum in the recent past. Drivers of clinical and community resistance go beyond just clinical practice, which is why one-health approaches offer the most realistic option for controlling antibiotic resistance. It is noteworthy that the emergence of resistance occurs naturally in the environment, but akin to climate change, the current accelerated emergence and spread bears hallmarks of anthropomorphic influence. If left unchecked, this can undo the medical and agricultural advancements of the last century. The WHO recommends that nations develop, adopt, and implement strategies that track the changing trends in antibiotic resistance levels to tackle this problem. This article examines efforts and progress in developing and implementing a human health antimicrobial resistance surveillance strategy in Uganda. We do so within the context of the National Action Plan for tackling antimicrobial resistance (AMR-NAP) launched in 2018. We discuss the technical milestones and progress in implementing surveillance of GLASS priority pathogens under this framework. The preliminary output of the framework examines the performance and compares AMR and AMU surveillance data to explain observed trends. We conclude that Uganda is making progress in developing and implementing a functional AMR surveillance strategy for human health. Full article

(This article belongs to the Special Issue AMR in Low and Middle Income Countries)

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