Suchergebnisse

Background: Bloodstream infections (BSIs) are a leading cause of sepsis-related morbidity and mortality globally. We present the pathogenic agents of bloodstream infections, their antimicrobial susceptibilities, and associated outcomes, with a focus on drug-resistant cases.Methods: We included all adult patients admitted to B.P. Koirala Institute of Health Sciences with blood culture-positive sepsis from July 2019 to June 2020. Blood cultures and antimicrobial susceptibility tests followed standard methods. Demographic, clinical, and microbiological data, including clinical outcomes, were documented. Patients were categorized into non-multidrug resistant (non-MDR), multidrug resistant (MDR), and extensively drug resistant (XDR) groups for analysis of clinical outcomes. Results: Of 5372 adult patients with suspected bloodstream infections, 475 (9%) had culture-positive infections with 536 organisms cultured. The median age of the patients was 42 (25-60) years, and 47% of the patients were women. There were 146 (31%) non-MDR, 220 (46%) MDR and 109 (23%) XDR cases. Common pathogens were Staphylococcus aureus (27%), Acinetobacter spp (20%), and Klebsiella spp (15%). The overall in-hospital mortality rate was 8% (38/475). Mortality was highest among XDR patients (53%), compared to MDR (29%) and non-MDR patients (18%) (p < 0.001). Patients in XDR group had longer hospital stays compared to MDR-BSI and non-MDR BSI patients (p=<0.001). After adjusting for risk factors, the odds ratio for in-hospital mortality in XDR patients was 2.52 (CI 1.11–5.72, p = 0.02). Conclusions: Drug-resistant pathogens are prevalent in our setting, causing bloodstream infection. Extensively drug-resistant bacteria in the blood are independently and significantly linked to increased mortality. Keywords: Bloodstream infections; clinical outcome; drug resistance.

Background: Infections of the sterile body sites, when occurs typically have greater clinical urgency and these infections could be life threatening. For the appropriate management of patient, early detection and identification of organism is crucial. Hence, the present study was designed to evaluate the prevalence, organism profile and antimicrobial susceptibility pattern of isolates obtained from infection of body fluids.Methods: Laboratory and clinical records of all the sterile body fluid except blood and cerebrospinal fluid submitted to the Department of Microbiology, B. P. Koirala Institute of Health Sciences during the period of 5 years (January 2012 to December 2016) were analyzed.Results: Among 1835 samples, 196 fluids samples showed growth of organisms with an isolation rate of 10.68%. Escherichia coli (E. coli) was the most common organism followed by Staphylococcus aureus (S. aureus) and Acinetobacter calcoaceticus-baumannii complex. Antimicrobial susceptibility testing showed variable degree of resistance. Thirty percentage of organisms were multi-drug resistant, 10% were extensively-drug resistant, none was pan-drug resistant, 35% of E. coli and K. pneumoniae were extended spectrum ?-lactamase producer and 30% of S. aureus were methicillin-resistant S. aureus. The study showed increasing trends of multi-drug resistant, extensively-drug resistant, methicillin-resistant S. aureus and extended spectrum ?-lactamase over the years. Conclusions: The study showed infection rate of 10% among normally sterile body fluids. E.coli, S. aureus and Acinetobacter calcoaceticus-baumannii complex are the common organisms. The infections are associated with multi drug resistant organisms. Routine surveillance of multi-drug resistant in infection of body fluids is necessary to guide treatment. Keywords: Extensively-drug resistant; methicillin-resistant S. aureus; multi-drug resistant; sterile body fluid.

Background: Antiretroviral drugs are lifeline for patients living with HIV. Adverse drug reactions can compromise the compliance to antiretroviral therapy. The objectives of the study were to estimate the prevalence of adverse drug reactions and to assess its risk factors in patients living with HIV and receiving antiretroviral therapy.Methods: A prospective cohort study was conducted among 496 patients living with HIV at B.P. Koirala Institute of Health Sciences for a period of one year. Adverse drug reactions were evaluated based upon clinical history, clinical examination and investigations. Results: Majority of patients were of 31-45 year age group (58.1%) and on first-line antiretroviral therapy regimen (94.3%). Total of 240 adverse drug reactions were documented. Prevalence of adverse drug reaction was 34.7%. Skin rash, anemia and nausea and vomiting were the three most common adverse drug reactions. The adverse drug reactions were more common in patients having non-communicable diseases, chronic co-infections, taking more than 3 non-HIV drugs, second and third-line antiretroviral regimen and it was statistically significant (P-value < 0.05). Conclusions: Prevalence of adverse drug reaction was high in the patients living with HIV. Age, gender, co-infections, non-communicable diseases, taking more than three non-HIV drugs and second and third-line antiretroviral regimen were identified as possible risk factor for occurrence of adverse drug reactions and their prior identification is important to optimize the best suited antiretroviral regimen.Keywords: Adverse drug reactions; antiretroviral therapy; pharmacovigilance

In a recent paper, Nagpal et al. voiced concerns about the limited or biased use of scientific evidence to support public health interventions to control neglected tropical diseases (NTDs). Visceral leishmaniasis (VL), also known as kala-azar, is one of the major NTDs and does not escape this problem. Transmission is vector-borne and the Indian subcontinent is the region reporting most of the VL cases worldwide. In this region, the main causative species is Leishmania donovani and Phlebotomus argentipes is the vector. Transmission is considered anthroponotic and peridomestic—occurring at night when female sand flies bite people sleeping inside their house. The World Health Organization and the governments of India, Nepal, and Bangladesh set out in 2005 to eliminate VL from the region by 2015 through a combination of early treatment of cases and vector control. However, while recent advances in diagnostic tools and drugs have significantly improved case management strategies, the available vector control tools against P. argentipes remain limited. The elimination initiative promotes the use of indoor residual spraying (IRS) of households and cattle sheds to reduce vector density, but the evidence underpinning the effectiveness of IRS in this region is scanty. Historical observations show that L. donovani transmission declined concomitantly with dichlorodiphenyltrichloroethane (DDT) spraying during the 1950s–60s to eradicate malaria. In the aftermath of this malaria eradication campaign, very few VL cases were observed in endemic regions until the mid-seventies, when there was resurgence of a VL epidemic in India. To date, there are no randomized trials showing the effect of IRS on the incidence of clinical VL, though some studies showed a reduction in vector density. When the VL elimination initiative was launched in 2005, there were no clear alternatives for IRS as a vector control strategy. Insecticide treated nets (ITNs) were proposed as an alternative or complement to IRS on the basis of analogy arguments regarding their given efficacy against malaria or on data from observational studies suggesting ITNs reduce the risk of VL; but as for IRS, there were no randomized trials evaluating the effect of ITNs on L. donovani transmission. In this context, a number of field studies were conducted in the Indian subcontinent in the past decade to evaluate the effectiveness and impact of ITNs and other vector control tools on VL. Most of these studies have been reviewed in detail in two recent papers. The only two studies evaluating the impact of vector control interventions on clinical outcomes found conflicting results. First, the KALANET project, a cluster randomised controlled trial (CRT) in India and Nepal, showed that mass-distribution of ITNs did not reduce the risk of L. donovani infection or clinical VL. Then, an intervention trial in Bangladesh suggested that widespread bed net impregnation with slow-release insecticide may reduce the frequency of VL. Technical (e.g., type of nets and insecticides, lack of replicas and randomisation in Bangladesh) and biological factors (e.g., insecticide susceptibility and sand fly behaviour) may explain the different results observed. This apparent contradiction raises the question about the role that ITN may play in controlling VL in the Indian subcontinent but has also triggered a lot of discussion on methodology and evidence levels required when evaluating vector control tools for VL. In this paper, we would like to summarise the lessons learned from the KALANET CRT in terms of methodology to inform the generation of future evidence and discuss interpretation of findings against this background.

Background: Persistent fever, defined as fever lasting for 7 days or more at first medical evaluation, has been hardly investigated as a separate clinical entity in the tropics. This study aimed at exploring the frequencies and diagnostic predictors of the ubiquitous priority (i.e., severe and treatable) infections causing persistent fever in the tropics.Methods: In six different health settings across four countries in Africa and Asia (Sudan, Democratic Republic of Congo [DRC], Nepal, and Cambodia), consecutive patients aged 5 years or older with persistent fever were prospectively recruited from January 2013 to October 2014. Participants underwent a reference diagnostic workup targeting a pre-established list of 12 epidemiologically relevant priority infections (i.e., malaria, tuberculosis, HIV, enteric fever, leptospirosis, rickettsiosis, brucellosis, melioidosis, relapsing fever, visceral leishmaniasis, human African trypanosomiasis, amebic liver abscess). The likelihood ratios (LRs) of clinical and basic laboratory features were determined by pooling all cases of each identified ubiquitous infection (i.e., found in all countries). In addition, we assessed the diagnostic accuracy of five antibody-based rapid diagnostic tests (RDTs): Typhidot Rapid IgM, Test-itTM Typhoid IgM Lateral Flow Assay, and SD Bioline Salmonella typhi IgG/IgM for Salmonella Typhi infection, and Test-itTM Leptospira IgM Lateral Flow Assay and SD Bioline Leptospira IgG/IgM for leptospirosis.Results: A total of 1922 patients (median age: 35 years; female: 51%) were enrolled (Sudan, n = 667; DRC, n = 300; Nepal, n = 577; Cambodia, n = 378). Ubiquitous priority infections were diagnosed in 452 (23.5%) participants and included malaria 8.0% (n = 154), tuberculosis 6.7% (n = 129), leptospirosis 4.0% (n = 77), rickettsiosis 2.3% (n = 44), enteric fever 1.8% (n = 34), and new HIV diagnosis 0.7% (n = 14). The other priority infections were limited to one or two countries. The only features with a positive LR ≥ 3 were diarrhea for enteric fever ...

BACKGROUND: Persistent fever, defined as fever lasting for 7 days or more at first medical evaluation, has been hardly investigated as a separate clinical entity in the tropics. This study aimed at exploring the frequencies and diagnostic predictors of the ubiquitous priority (i.e., severe and treatable) infections causing persistent fever in the tropics. METHODS: In six different health settings across four countries in Africa and Asia (Sudan, Democratic Republic of Congo [DRC], Nepal, and Cambodia), consecutive patients aged 5 years or older with persistent fever were prospectively recruited from January 2013 to October 2014. Participants underwent a reference diagnostic workup targeting a pre-established list of 12 epidemiologically relevant priority infections (i.e., malaria, tuberculosis, HIV, enteric fever, leptospirosis, rickettsiosis, brucellosis, melioidosis, relapsing fever, visceral leishmaniasis, human African trypanosomiasis, amebic liver abscess). The likelihood ratios (LRs) of clinical and basic laboratory features were determined by pooling all cases of each identified ubiquitous infection (i.e., found in all countries). In addition, we assessed the diagnostic accuracy of five antibody-based rapid diagnostic tests (RDTs): Typhidot Rapid IgM, Test-it(TM) Typhoid IgM Lateral Flow Assay, and SD Bioline Salmonella typhi IgG/IgM for Salmonella Typhi infection, and Test-it(TM) Leptospira IgM Lateral Flow Assay and SD Bioline Leptospira IgG/IgM for leptospirosis. RESULTS: A total of 1922 patients (median age: 35 years; female: 51%) were enrolled (Sudan, n = 667; DRC, n = 300; Nepal, n = 577; Cambodia, n = 378). Ubiquitous priority infections were diagnosed in 452 (23.5%) participants and included malaria 8.0% (n = 154), tuberculosis 6.7% (n = 129), leptospirosis 4.0% (n = 77), rickettsiosis 2.3% (n = 44), enteric fever 1.8% (n = 34), and new HIV diagnosis 0.7% (n = 14). The other priority infections were limited to one or two countries. The only features with a positive LR ≥ 3 were diarrhea for enteric ...