High Rates Of Bacterial Resistance Research Articles

Pattern of Primary Resistance of Helicobacter pylori to Clarithromycin among Pediatric Patients from North-Eastern Romania.

Helicobacter pylori antibiotic resistance has increased worldwide and affects the effectiveness of current therapies. The recommended first-line empiric treatment should be tailored to the local clarithromycin resistance rate. This study aimed to determine the pediatric patient profile and rate of clarithromycin resistance for patients diagnosed with Helicobacter pylori by gastric biopsy. We studied 84 positive gastric samples for Helicobacter pylori. Positive results were confirmed by a rapid urease test and histopathological examination, with the type of gastritis established according to the Sydney System. Gastric biopsy samples were stored in RNA saver. Clarithromycin resistance was determined by a real-time polymerase chain reaction-based molecular assay after RNA-DNA extraction. Of the 84 biopsy samples analyzed, 35 (41.6%) were resistant to clarithromycin. Clarithromycin resistance was found mainly in girls (80%) with a mean age of 15 years (range 6-17 years). The history of prior exposure to clarithromycin was 91.6%. The concordance between the histopathological examination and the PCR test was 100%. One in 2.4 children infected with Helicobacter pylori had a strain resistant to clarithromycin. This resistant strain may be a reason for treatment failure in Romanian children, yet this is uninvestigated. The high rate of bacterial resistance to this antibiotic among children indicates the need for susceptibility testing before therapy.

Bacterial respiratory infections in patients with COVID-19: A retrospective study from a tertiary care center in Lebanon

BackgroundDespite multiple reports of increased incidence of bacterial respiratory tract infections following COVID-19 globally, the microbiology is not yet fully elucidated. In this study, we describe the microbiology of bacterial infections and the prevalence of multidrug resistant organisms (MDROs) in hospitalized COVID-19 patients with community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP) which includes both non-ventilated hospital acquired pneumonia (NVHAP) and ventilator-associated pneumonia (VAP). To our knowledge, this is the first study that compares the microbiology of VAP and NVHAP in COVID-19 patients. MethodsThis is a longitudinal retrospective cohort study conducted at the American University of Beirut Medical Center (AUBMC), a tertiary-care centre in Lebanon. Adult patients with confirmed COVID-19 and concurrent bacterial respiratory infections with an identifiable causative organism who were hospitalized between March 2020 and September 2021 were included. Bacterial isolates identified in hospital-acquired pneumonia (HAP) were divided into 3 groups based on the time of acquisition of pneumonia after admission: hospital day 3–14, 15–28 and 29–42. ResultsOut of 1674 patients admitted with COVID-19, 159 (9.5%) developed one or more respiratory infections with an identifiable causative organism. Overall, Gram-negative bacteria were predominant (84%) and Stenotrophomonas maltophilia was the most common pathogen, particularly in HAP. Among 231 obtained isolates, 59 (26%) were MDROs, seen in higher proportion in HAP, especially among patients with prolonged hospital stay (> 4 weeks). Non-fermenter Gram-negative bacilli (NFGNB) (OR = 3.52, p-value<0.001), particularly S. maltophilia (OR = 3.24, p-value = 0.02), were significantly more implicated in VAP compared to NVHAP. ConclusionsNFGNB particularly S. maltophilia were significantly associated with COVID-19 VAP. A high rate of bacterial resistance (25%), especially among Gram-negative bacteria, was found which may compromise patients’ outcomes and has important implications in guiding therapeutic decisions in COVID-19 patients who acquire bacterial respiratory infections.

Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated Factors of Community- and Hospital-Acquired Urinary Tract Infection at Dessie Referral Hospital, Dessie, Northeast Ethiopia.

Background Bacterial urinary tract infection is among the most common community and hospital-acquired infections. Therefore, to know the status of the community and hospital-acquired urinary tract infection, antimicrobial susceptibility patterns, and associated factors among urinary tract infection profiles are essential to physicians and health workers to implement appropriate intervention. Methods An institution-based cross-sectional study was conducted among 422 urinary tract infection suspected patients. All isolates were identified by standard microbiological techniques, and their antibiotic susceptibility was done by the Kirby–Bauer disc diffusion method. Data were entered using EpiData version 3.1 and analyzed by SPSS software version 20. P value < 0.05 at 95% CI was considered statistically significant. Result Of 422 urine samples processed, 100 (23.7%) yielded bacterial isolates. About 50(30.7%) and 50(19.3%) were bacterial isolates from the community and hospitalized patients, respectively. E. coli 44/103(42.7%) predominated across the two groups, followed by S. aureus 25/103(24.3%), CONs, 14/103(13.5%), Klebsiella spp. 7/103(6.78), Proteus spp. 3/103(2.91), and Enterococcus spp. 3/103 (2.91%). Pseudomonas spp. 3/103 (2.91), Citrobacter spp. 2/103(1.94%), and Acinetobacter spp. 1/103(0.999), which were isolated from only the hospitalized patients. Meropenem susceptibly was 100% in both study groups and Ampicillin resistance was documented as 83.3% to 100% and 76.9% to 100% in hospitalized and community-acquired samples, respectively. Conclusion This study found a high prevalence of bacterial urinary tract infection in the study area and a high rate of bacterial resistance was observed to most antimicrobial drugs tested. Meropenem and nitrofurantoin were the most active drugs for urinary tract infections. Therefore, expanding routine bacterial culture and identification with antimicrobial susceptibility testing and strengthening regular surveillance systems are essential for appropriate patient care.

Multiresistant Bacterial Pathogens Causing Bacterial Pneumonia and Analyses of Potential Risk Factors from Northeast Ethiopia.

Background Pneumonia is the most common cause of morbidity and mortality in developing countries, mostly caused by different species of bacterial pathogens. Hence, patient management needs awareness of the pathogens and antimicrobial susceptibility testing (AST). This study was aimed to assess the type of bacterial isolates and their antimicrobial susceptibility patterns among pneumonia suspected patients at Dessie Referral Hospital, Northeast Ethiopia. Potential risk factors were also assessed to apply preventive measures accordingly. Materials and Methods A cross-sectional study design was employed among pneumonia suspected patients from February to April 2020 at Dessie Referral Hospital. Sociodemographic characteristics and associated risk factors were collected using a pretested questionnaire, and clinical data were extracted by reviewing medical records. Sputum specimens were collected and inoculated into chocolate agar, blood agar, mannitol salt agar, and MacConkey agar which are then incubated at 35°C or 37°C for 24–48 hours. Bacterial species were identified based on Gram stain, colony characteristics, and biochemical techniques. The data were entered in to Epi-Info version 7.1.5 and analyzed with SPSS software version 20. p value <0.05 at 95% CI was considered as statistically significant. Results A total of 406 sputum specimens were collected and cultured, among which 157 (38.7%) were positive for different bacterial pathogens. The predominant pathogens were Klebsiella pneumoniae (28.0%), Streptococcus pneumoniae (24.8%), Staphylococcus aureus (18.5%), and Pseudomonas aeruginosa (14.0%). Majority of the isolates exhibited resistance to ampicillin with 81.5% followed by penicillin with 75.9% and amoxicillin-clavulanate with 61.2%. Multivariable logistic regression showed a significant association of culture positivity with older age (AOR = 2.43, CI: 1.12–5.28, p value = 0.025), cigarette smoking (AOR = 4.67, CI: 2.39–9.20, p value <0.001), and alcohol use (AOR = 5.58, CI: 3.14–9.92, p value <0.001). Resistance to ampicillin and penicillin was associated with repeated prescription and use. Conclusions This study found high prevalence of bacterial pneumonia in the study area, and high rate of bacterial resistance was observed in ampicillin, penicillin, and amoxicillin-clavulanate. Repeated prescriptions and use of antimicrobials were significantly independent factors of bacterial resistance. Therefore, patient management needs identification of bacteria by routine culture with antimicrobial susceptibility testing.

Bactericidal Properties of Bacillus Subtilis Nanoparticles Against Selected Human Pathogens

The use of biologically synthesized nanoparticles has been an area of research interest in recent times. Due to the high rate of bacterial resistance to antibiotics, there is a need to search for a more potent alternative to ineffective antibiotics. This study aims to evaluate the antibacterial effects of silver nanoparticles synthesized by Bacillus subtilis against Pseudomonas aeruginosa and Staphylococcus aureus. Silver nanoparticles were obtained by dissolving 0.842 gram of AgNO3 silver nitrate into 100ml of B. subtilis in Mueller Hinton broth. The antibacterial susceptibility of the nanoparticles formed was carried out using standard methods. Comparative antibacterial test was also carried out using standard antibiotics The multiple antibiotic resistance index were also determined. The zones of inhibition were 29 and 12 mm against Staphylococcus aureus and Pseudomonas aeruginosa respectively after 8 hrs of nanoparticle synthesis. The antibiotic susceptibility test using standard antibiotics revealed that S. aureus was sensitive to only Erythromycin and ofloxacin with a zone of inhibition of 15mm and 9mm respectively while P. aeruginosa was sensitive only to ofloxacin. The Multiple resistance index (MARi) shows P aeruginosa to have MARi of 0.9 while S, aureus has MARi of 0.82. The result indicated that B. subtilis nanoparticles presented better antibacterial properties than standard antibiotic and can be explored as a candidate for drug production to fight bacterial resistance to antibiotics.

Prevalence of Carbapenem-Resistance among Enterobacteriaceae Isolated from Patients Attending Uduth Sokoto, North West Nigeria

The major problem threatening the continued success of antimicrobial drugs is the development of resistant organisms. This study was designed to determine the occurrence and prevalence of carbapenem resistance among enterobacteriaceae isolated from in-patients attending Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, and also to determine the antimicrobial susceptibility patterns of the organisms isolated. The Methodology involves the use of trypticase soy broth containing 10 μg of carbapenem (imipenem) for primary isolation. The secondary isolation involves the use of MacConkey agar and biochemical (Simmon citrate Agar) for identification, and then antimicrobial susceptibility testing by the disk diffusion method. A total of 191 stool samples from male and female in-patients within the range of 2-60 years were screened for the gastrointestinal colonization of Carbapenem Resistance Enterobacteriacea (CRE). Data were analysed using Statistical Package for Social Sciences (SPSS) windows version 21. The overall prevalence was 15.7% The prevalence rate was found exclusively in males. The highest prevalence was found within the age group of 30-40 years. Escherichia coli, Klebsiella species, Pseudomonas species and salmonella species were the bacteria isolated. The most predominant bacteria isolated were Escherichia coli, accounting for 85 (9.4%) resistant strains, Klebsiella species accounting for 50 (8%) resistant strain, Pseudomonas aeruginosa 21% and Salmonella species accounting for 42 (0%) no resistant strain isolated. The misuse of antibiotics is a major factor responsible for the high rate of bacterial resistance. Improvement on the management and personal hygiene, as well as the appropriate use of antibiotics would reduce the prevalence of Nosocomial Carbapenem Resistance (NCR) especially among prolonged hospitalized patients.

HAEMATOLOGICAL EVALUATION OF SPRAGUE-DAWLEY RATS INFECTED WITH PASTEURELLA MULTOCIDA AND ADMINISTERED BDELLOVIBRIO BACTERIOVORUS (ATCC™ 1534) AS THERAPY

The effects on haematological parameters of Sprague-Dawley rats infected (challenged) by the injection of pathogenic Pasteurella multocida and the administration of Bdellovibrio bacteriovorus (ATCC™ 1534) as therapy, occasioned by the consideration of its use as an alternative to antibiotics, due to the high rate of bacterial resistance to current clinically used antibiotics was investigated. A total of 60 rats, divided into 5 groups (4 experimental groups and 1 control group) of 12 rats each were used in this study. The first group of 12 rats were injected subcutaneously with one millilitre of 1 x 108/ml B. bacteriovorus (ATCC™ 1534). The second group of 12 rats were injected with one millilitre 108/ml of P. multocida in saline. One millilitre each of 108/ml of both P. multocida and B. bacteriovorus (ATCC™ 1534) were injected into another set of 12 rats in the third group. The third group of 12 rats were injected once intra-muscularly, in the hind flank muscle, with 2 mg/kg of Ketamine Hydrochloride. And lastly, one set of 12 rats were not injected with any bacteria served as control. In all cases, observed haematological data were analysed from the experimental rats after 168 hours (except rats which were injected with 2mg/kg ketamine hydrochloride, used as anaesthetic, (at sacrifice), and compared with the haematological profiles of the 12 control rats. Results shows a reduction of mortality from 9 to 1 (88.8%) of rats challenged with P. multocida over those inoculated with B. bacteriovorus and P. multocida was observed. WBC counts were higher (4.12 x 103/µL) in B. bacteriovorus and P. multocida over WBC counts in control rats which served as WBC reference values. Though, not statistically significant (ANOVA = p &gt;0.05). In a similar comparison, RBC counts (6.5 x 103/µL) were lower than observed in control rats, while platelet counts (1138 x 103/µL) were higher than values in controls, however, this was statistically significant. Moreover, haemoglobin concentrations were lower (11.7 g/dL) than in control rats. Though there were slight variations in haematological profiles from reference values, it was concluded that B. bacteriovorus seems to have no life-threatening effect on haematology of rats. However, evaluations such as observed platelet increases on inoculations of B. bacteriovorus, need to be addressed before the promise of its in vivo use in controlling Gram-negative infection in animals and humans can be tapped.&#x0D; Sar, T. T. | Department of Biological Sciences, University of Agriculture, Makurdi, Benue State, Nigeria

Current Challenges in Antibiotic Stewardship in Low- and Middle-Income Countries

ASPs are key tools in the time where an increase in the rates of bacterial resistance and cases of Clostridium difficile disease is observed worldwide, forcing a more efficient use of antibiotic therapy. We review some examples of the actual state of bacterial resistance in low- and middle-income countries (LMIC), as well as some of the proposed strategies for the establishment of ASPs in resource-constrained environments. In LMIC, there are important challenges in antimicrobial prescription; although not all inhabitants have access to adequate antibiotic therapy, the consumption of these drugs is high, and is reflected in high rates of bacterial resistance. The implementation of the strategic tools within ASP is promising and good results have been achieved, with a decrease in antimicrobial consumption. The establishment of ASP is a worldwide need, and there are currently international initiatives for its development and implementation. LMIC deal with special challenges, as they need to guarantee the access to their population, but the use must be made in an appropriate manner. Currently, high rates of resistance are reported in hospital services, but in some countries, the implementation of ASP begins to yield results. Antibiotics are drugs that have a special place in the armamentarium of modern medicine. Since their introduction, they were one of the first drugs that changed the therapeutics, with the medical practice focused on symptom control to one of curative intent. In addition to the direct positive impact they have had on the morbidity and mortality associated with infectious diseases (ID), they have allowed the development of other areas, such as intensive care, neonatal care, complex surgery, and transplants, to the extent that we know them today. Unfortunately, these wonderful drugs are threatened by the emergence of bacterial resistance (BR). Although this phenomenon is characteristic of the nature of the infectious agents, exposure to antimicrobials favors and accelerates the natural selection of microorganisms better adapted to an environment in which these molecules are found. Hence, the use of antibiotics, whether for the treatment or prevention of ID in humans or animals, or with other industrial purposes in food production, is one of the activities that currently require the establishment of measures for a rational use. If we look at the use we have given to antibiotics in the previous decades, we must recognize that we have abused them, and it is in this context that antibiotic stewardship programs (ASPs) have been developed. We understand ASP as the set of measures that can be developed for the use of antibiotics in conditions in which they are really required (in a prophylactic or therapeutic way), aiming for the use of the molecules with the narrowest antibacterial spectrum, but with activity on the causative organisms of the infection, with a duration long enough to achieve their objective, but as short as possible to minimize selective pressure. The final goal of ASP is to reduce morbidity and mortality, and preserving antibiotic utility. Challenges for ASP in LMIC: 1. A high proportion of infections are caused by multidrug-resistant (MDR) microorganisms, not only in the hospital, but also in the community 2. Limitations on the diagnostic capacity for the detection of MDR microorganisms 3. Lax regulation on antibiotic use in both humans and animals 4. Deficient regulation in the food industry 5. Lack of clinician training and administration will in these issues However, proposals that try to bring together isolated efforts, such as the one set forth by the World Health Organization (WHO), have emerged in recent years. Some countries have reported their experience in the successful implementation of some of the components of ASPs, and can serve as a guide for its adaptation to local conditions. This is the basis for the protection of antibiotics, for present and future use.

Prevalence of infective organisms of infections of urinary tract in a sample of Arab infants and children

Background: Infections of urinary tract were considered as the most common hospital-acquired infections in hospitalized patients. Area-specific monitoring studies aimed to assess the prevalence of causative organisms of urinary tract infections (UTIs) and their responsiveness to different available antimicrobials in a sample of Arab children, which may help the clinician to choose the correct empirical treatment. We aimed to study the type of urinary pathogens isolated from hospitalized patients with first-episode UTI in our locality and its antibiotic susceptibility pattern. Materials and Methods: Urine samples were collected from 320 clinically suspected cases of UTI from inpatient wards and outpatient clinic of Pediatric Department of Tanta University Hospital during the period from June 2016 to June 2017. The samples were tested microbiologically by standard procedures. Antibiotic susceptibility of the isolated pathogens was tested for commonly used antibiotics by disc diffusion method according to hospital policy. Results: Significant bacteriuria was present in 75% of the samples, 16.25% were sterile, and 8.75% showed insignificant bacteriuria. The most common pathogens were Escherichia coli (55%), Klebsiella spp. (26.6%), and Proteus mirabilis (14.2%). The mean susceptibility was high for amikacin (85%), ceftriaxone (82%), cefotaxime (80%), nitrofurantoin (80%), and nalidixic acid (78%) but low for ampicillin (21%), cephalexin (30%), and sulfamethoxazole + trimethoprim (37%). Conclusions: The antibiotics which are commonely used in UTIs such as trimethoprim/sulphamethoxazole,ampicillin and cephalexin are not appropriate for embrical treatment of common UTIs.This may be attributed to high rate of bacterial resistance .Regular monitering of these patients is recommended to establish reliable information about patterns of urinary pathogens aiming optimal embrical therapy for children with UTI.

Vigilancia del consumo de antimicrobianos en hospitales de México: situación actual y guía práctica para su implementación

Antibiotic use in Mexico is characterized by high levels of consumption, irrational use in primary care services, and high rates of bacterial resistance that cause hospital infections. Changes are needed in the recommended method for reporting antimicrobial drug use, so that quantification can be carried out through drug utilization studies. Such studies, which make it possible to know which drugs are used in hospitals, require an accessible source of data on antimicrobial drug use with the least risk of biases, a single drug identification system, and the adoption of units of measure that can be extrapolated. The methodology developed by the WHO Collaborating Centre for Drug Statistics Methodology, based on the anatomical, therapeutic, and chemical classification (ATC) system and the daily defined dosage (DDD), is proposed. Despite its limitations, employing this methodology to monitor local antimicrobial drug use will make it possible to detect differences in usage patterns among institutions, and, especially, trends within a given institution. This would facilitate timely alerts about potential problems related to the use of antimicrobial drugs and the need for specific interventions.

Activity of a novel combination against multidrug-resistant nonfermenters: ceftazidime plus NXL104

Evaluation of: Mushtaq S, Warner M, Livermore DM. In vitro activity of ceftazidime+NXL104 against Pseudomonas aeruginosa and other non-fermenters. J. Antimicrob. Chemother. 65, 2376–2381 (2010).AmpC overexpression appears to be a significant mechanism of β-lactam resistance in Pseudomonas aeruginosa and other nonfermenter Gram-negatives. The article under review describes the in vitro activity of a novel combination ceftazidime plus NXL104, against ceftazidime-resistant Pseudomonas aeruginosa, Burkholderia cepacia complex and OXA carbapenemase-producing Acinetobacter baumannii. The study results show that NXL104 overcomes the ceftazidime resistance engendered by AmpC enzymes, even when these are completely derepressed. NXL104 has shown good activity against ESBL PER-1 in P. aeruginosa, as well as against most of the B. cepacia complex isolates from patients with cystic fibrosis. Nevertheless, NXL104 does not inhibit metallo-carbapenemases, which were excluded from this investigation, nor does it reverse resistance associated with oxacillin-type extended-spectrum β-lactamases in P. aeruginosa or with oxacillin-type carbapenemases in Acinetobacter spp. In the worldwide context of high rates of bacterial resistance, the combination of NXL104 with ceftazidime could represent a promising therapeutic strategy to treat infections due to AmpC-mediated resistance in P. aeruginosa, among other multidrug-resistant pathogens.

Resistência antimicrobiana dos uropatógenos em pacientes ambulatoriais, 2000-2004

A retrospective study based on the electronic database of a university hospital was carried out to investigate the prevalence of etiological agents and their susceptibilities to antibiotics, among adult outpatients (> 18 years old) with urinary tract infections. Nine hundred and fifty-seven positive urine cultures were identified between January 2000 and December 2004. Escherichia coli, Proteus mirabilis and Klebsiella sp were the three principal bacterial etiological agents. Trimethoprim-sulfamethoxazole presented the highest prevalence of bacterial resistance (46.9%), followed by cefalotin (46.7%), nalidixic acid (27.6%) and nitrofurantoin (22.3%). Over the study period, nalidixic acid presented annual increases of 5.9% in the rate of bacterial resistance (p = 0.02). Ciprofloxacin also showed an increasing trend, of 3.3% per year (p = 0.07). This study demonstrated that the antibiotics that are widely recommended for empirical treatment of urinary tract infection in adults presented high rates of bacterial resistance among the population studied.

Cotrimoxazole Prophylaxis in HIV‐Infected Pregnant Women: Only a First Step

Received 2 August 2006; accepted 2 August 2006; electronically published 19 October 2006. Potential conflicts of interest: none reported. Reprints or correspondence: Dr. D. Heather Watts, Pediatric, Adolescent, and Maternal AIDS Branch, CRMC/NICHD/NIH, Rm. 4B11, 6100 Executive Blvd., MSC 7510, Bethesda, MD 20892 (hw59i@nih.gov). The Journal of Infectious Diseases 2006;194:1478–80 This article is in the public domain, and no copyright is claimed. 0022-1899/2006/19411-0003 In resource-rich countries, during the era before the availability of highly active antiretroviral therapy (HAART), prophylaxis with cotrimoxazole (CTX) was one of the first interventions shown to reduce morbidity and mortality among HIV-infected individuals by reducing the incidence of Pneumocystis jiroveci pneumonia [1]. Prophylaxis with CTX is still recommended for persons with CD4 cell counts!200 cells/ mL, even for those receiving HAART [2]. In resource-limited settings, CTX prophylaxis has also been shown to reduce morbidity and delay death, probably because of the effect that it has on multiple coinfections besides P. jiroveci pneumonia [3, 4]. CTX is inexpensive and is generally well tolerated. However, despite studies demonstrating efficacy in multiple settings, implementation of CTX prophylaxis in resource-limited countries has been slow [5], possibly resulting from perceived differences in the etiology and burden of opportunistic pathogens between resourcelimited and -rich countries, concerns related to the use of CTX prophylaxis in settings with high background malarial and bacterial infections and high rates of bacterial resistance to CTX, and concerns that widespread use of CTX prophylaxis could increase resistance to sulfadoxinepyrimethamine in Plasmodium falciparum. Studies have now demonstrated the efficacy of CTX prophylaxis in multiple settings with a variety of different patterns of bacterial CTX resistance, and, to date, studies have not found that CTX prophylaxis impairs the efficacy of sulfadoxinepyrimethamine in the treatment of malaria [6, 7]. There have been additional barriers to the use of CTX prophylaxis in pregnant women, including concerns about the potential teratogenicity of CTX [8, 9] and the possible effects that CTX may have on folate metabolism that may contribute to low birth weight [10]. In this issue of the Journal of Infectious Diseases, Walter et al. [11] report the results of an opportunistic study of the changes in pregnancy and neonatal outcome after implementation of CTX prophylaxis for pregnant women with CD4 cell counts !200 cells/mL within a larger trial of mother-to-child transmission. The rates of preterm birth, clinical chorioamnionitis, and neonatal mortality were significantly reduced after implementation of CTX prophylaxis, with the benefits being most marked among women with CD4 cell counts !100 cells/mL. No changes in the rates of these outcomes were seen among pregnant women with CD4 cell counts 200 cells/mL over the course of the study. Preterm birth rates remained at 20%–21% in women with CD4 cell counts 200 cells/mL, whereas the rate among women with CD4 cell counts !200 decreased from 31% before to 18% after CTX prophylaxis became available. These results are exciting, because an intervention known to be of benefit for maternal health appears to benefit infant outcomes as well. Earlier concerns regarding the potential toxicity of CTX during pregnancy were not confirmed, although, because of the sample size in Walter et al.’s study, an increase in toxicities such as neonatal jaundice cannot be ruled out. The concern regarding the potential teratogenicity of CTX was addressed by not beginning CTX until 14 weeks of gestation, although the World Health Organization (WHO) recommends the use of CTX throughout pregnancy, because the risk of life-threatening infection among women with low CD4 cell counts or symptomatic HIV infection is felt to outweigh the potential risk of congenital abnormalities [5]. A recent review of the use of CTX during pregnancy did not find evidence to substantiate an increased risk of neonatal jaundice or kernicterus with the use of CTX and found the data on the risk of birth defects to be inconclusive [12]. Conat N aonal Initutes of H ealth L irary on O cber 1, 2013 http://jidrdjournals.org/ D ow nladed from

Serendipity and Co-trimoxazole Aid HIV-Infected Children in Africa

Clinical Pharmacology & Therapeutics| March 01 2005 Serendipity and Co-trimoxazole Aid HIV-Infected Children in Africa AAP Grand Rounds (2005) 13 (3): 25–26. https://doi.org/10.1542/gr.13-3-25 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Serendipity and Co-trimoxazole Aid HIV-Infected Children in Africa. AAP Grand Rounds March 2005; 13 (3): 25–26. https://doi.org/10.1542/gr.13-3-25 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: africa, hiv infections, trimethoprim-sulfamethoxazole combination Source: Chintu C, Bhat GJ, Walker AS, et al. Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): a double-blind randomized placebo-controlled trial. Lancet. 2004;364:1865–1871. Because anti-retroviral therapy is available to less than 5% of HIV-infected children in sub-Saharan Africa, other methods of therapy have been sought to help reduce the impact of the epidemic.1 Several groups, including the Centers for Disease Control and Prevention and the World Health Organization, have recommended the use of co-trimoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in all children born to HIV-infected women and in HIV-infected children after infancy if CD4 counts are less than 15% of the total lymphocyte count.1,2 Data from studies in HIV-infected adults and children have indicated that the benefit from this prophylaxis extends beyond prophylaxis for P carinii and includes reductions in bacterial infections, malaria, and pulmonary tuberculosis.3 However, concern has been raised that the prophylaxis may not be of great benefit in areas where there is a high rate of bacterial resistance to co-trimoxazole. This study, carried out by investigators from the Medical Research Council of Great Britain and the University of Lusaka, Zambia, is the first to explore the role of co-trimoxazole prophylaxis in HIV-infected children in an area with a high rate (60–80%) of resistance to common bacteria. The investigators randomized 534 HIV-infected Zambian children aged 1 to 15 years to receive either co-trimoxazole or placebo. The median follow-up was 19 months. The study was stopped early because of the significant decrease in mortality (28% vs 42%, P=.0002) and hospitalization rate per child-year of follow-up (0.48 vs 0.63, P=.01) in the children receiving co-trimoxazole. These reductions were seen across all age groups and all levels of CD4 counts. Pneumonia was the only cause of death that was more frequent in the placebo group but P carinii was found in only 1 of 73 nasopharyngeal aspirate samples, indicating that this opportunistic infection did not play an important role in the outcomes. These data provide further proof that the benefit from co-trimoxazole extends beyond prophylaxis for P carinii They also indicate that the use of co-trimoxazole has an important role in the reduction of mortality and hospitalizations in HIV-infected children in an area with a high rate of bacterial resistance to the drug. Dr. Snyder has disclosed no financial relationships relevant to this commentary. The grim truth is that the HIV epidemic continues to rage in sub-Saharan Africa where nearly 75% of worldwide HIV/AIDS-related deaths occur and where anti-retroviral therapy is practically unavailable.4 The encouraging results of this well-designed study underline several serendipitous factors, which provide short-term encouragement while the affected population awaits greater access to anti-retroviral therapy. One is that the use of an inexpensive, widely available therapy can have benefits beyond its theoretical impact. Although the mechanism of action of co-trimoxazole prophylaxis is not clear, the therapy was clearly beneficial. Another factor is that objective measurements like drug resistance data may... You do not currently have access to this content.

Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda

Prophylaxis with co-trimoxazole (trimethoprim-sulphamethoxazole) is recommended for people with HIV infection or AIDS but is rarely used in Africa. We assessed the effect of such prophylaxis on morbidity, mortality, CD4-cell count, and viral load among people with HIV infection living in rural Uganda, an area with high rates of bacterial resistance to co-trimoxazole. Between April, 2001, and March, 2003, we enrolled, and followed up with weekly home visits, 509 individuals with HIV-1 infection and their 1522 HIV-negative household members. After 5 months of follow-up, HIV-positive participants were offered daily co-trimoxazole prophylaxis (800 mg trimethoprim, 160 mg sulphamethoxazole) and followed up for a further 1.5 years. We assessed rates of malaria, diarrhoea, hospital admission, and death. Co-trimoxazole was well tolerated with rare (<2% per person-year) adverse reactions. Even though rates of resistance in diarrhoeal pathogens were high (76%), co-trimoxazole prophylaxis was associated with a 46% reduction in mortality (hazard ratio 0.54 [95% CI 0.35-0.84], p=0.006) and lower rates of malaria (multivariate incidence rate ratio 0.28 [0.19-0.40], p<0.0001), diarrhoea (0.65 [0.53-0.81], p<0.0001), and hospital admission (0.69 [0.48-0.98], p=0.04). The annual rate of decline in CD4-cell count was less during prophylaxis than before (77 vs 203 cells per microL, p<0.0001), and the annual rate of increase in viral load was lower (0.08 vs 0.90 log(10) copies per mL, p=0.01). Daily co-trimoxazole prophylaxis was associated with reduced morbidity and mortality and had beneficial effects on CD4-cell count and viral load. Co-trimoxazole prophylaxis is a readily available, effective intervention for people with HIV infection in Africa.

Consumo de antibióticos y su posible relación con la resistencia bacteriana en la región sanitaria Costa de Ponent: análisis evolutivo durante los períodos inicial y final de la última década

To analyse antibiotic consumption (ABC) and its trend in primary care in an area with a high rate of bacterial resistance during the periods 1993-96 and 2000-02. Comparative, retrospective analysis. Costa de Ponent Health Region. Population in 1993-96 period was 1,158,098 inhabitants; in 2000-02 period, 1,188,007 inhabitants. Those patients in the Area who took AB during the periods under study. Data obtained from the appropriate records of the Catalan Health Service. Measurement of ABC was the Defined Daily Dose (DDD)/1000 inhabitants/day (DID) [criteria of the WHO Collaborating Centre for Drugs Statistics Methodology]. Trends were quantified as percentage increase or drop, comparing the 1993-96 and 2000-02 periods. The U Mann-Whitney test was used. Overall consumption was high, with a light fall from 17.049 DID during the first period to 15.826 DID in the second (-7.1%). Amoxycillin increased from 4.878 DID (57.6%) to 6.19 DID (67.6%) (+26.8%), but amoxycillin-clavulanic did not rise. The percentages of macrolides, quinolones, cephalosporins, sulphonamides, and tetracyclines were higher in the first period. The variations in the consumption of clarithromycin, azithromycin, cefuroxime, cefixime, and ciprofloxacin between the two periods was the most notable point. Although overall ABC was high and in accord with the high rate of bacterial resistance in our area, a satisfactory evolutionary trend was found. The fall in consumption in the second period was not significant, but an appropriate modification in its profile was noted: domination of aminopenicillins and drop in macrolides, cephalosporins and fluorquinolones.