Continuous Surveillance System Research Articles

The netball injury evidence base: a scoping review of methodologies and recommendations for future approaches

BackgroundNetball is a sport with a large participation base and a high risk of injuries. Effective injury prevention strategies are dependent upon a clear understanding of injury issues, aetiology and mechanisms, requiring robust research methodologies to ensure a reliable evidence base. This scoping review aims to identify the characteristics and range of netball injury research methodologies, to inform recommendations for future research.MethodsA systematic search of SPORTDiscus, MEDLINE, CINAHL and Academic Search Complete, PubMed, Scopus and Web of Science, from 1985 to May 2023 identified relevant studies. Inclusion criteria included peer-reviewed studies assessing injury incidence, aetiology and mechanisms in netball.ResultsFollowing screening, 65 studies were included (68% descriptive epidemiology, 32% analytic epidemiology). Descriptive epidemiology reported data from hospital/clinic and insurance databases (57%) and netball competitions (43%). Only two studies used ongoing, systematic injury surveillance in netball cohorts, and significant heterogeneity existed in study designs, data collection methods, injury definitions and injury incidence rates calculations. Studies assessed a limited number of risk factors (descriptive competition studies: median: n = 4; analytic studies median: n = 6), with 76% using a simplistic reductionist approach to determine causality. Basic descriptions and retrospective recall of injury mechanisms reduced accuracy. Only two studies conducted comprehensive assessments of injury mechanisms using video-based methods.ConclusionTo establish an accurate netball injury evidence base, future research should prioritise the development of reliable, continuous surveillance systems. The International Olympic Committee (IOC) consensus statement guidelines are recommended for accurate injury data collection and reporting. A multifactorial approach should be adopted to assess the complex interaction between multiple risk factors, player load and the injury inciting event. Comprehensive descriptions of injury mechanisms using video methods, alongside descriptions from medical staff are recommended. This information is crucial for developing targeted prevention strategies.

Rotavirus genotype dynamics in Pakistan: G9 and G12 emerging as dominant strains in vaccinated children (2019)

Rotavirus A (RVA) is a leading cause of severe gastroenteritis in children worldwide, and vaccination has become a pivotal strategy to reduce the associated morbidity and mortality. This study presents a molecular characterization of RVA genotypes circulating among vaccinated children in Pakistan during the year 2019. A total of 510 stool samples were collected from children of up to five years of age presenting with acute gastroenteritis symptoms in Rawalpindi, Islamabad regions of Pakistan. The RVA antigen was detected using ELISA on these samples. RVA G/P genotyping was performed on ELISA positive samples using Multiplex semi-nested reverse transcriptase PCR. RVA was found in 130 fecal samples, with an overall prevalence of 25.4 %. G9P[8] (20 %) is the most prevalent genotype, followed by G12P[6] (17 %), G3P[8] (14 %), G1P[8] (12 %), G2P[4] (10 %), G12P[8] (7 %), G9P[6] (7 %), G3P[6] (6 %), G3P[4] (4 %) and G1P[6] (3 %) respectively. There is a statistically significant difference (p < 0.05) found in the group age (in months) of RVA gastroenteritis cases as detected by RT-PCR. The highest number of positive cases was found in the age range from 0 to 6 months, followed by 7–12 months, 13–24 months, and 25–60 months, respectively. Dehydration is statistically significantly associated (p˂ 0.05) in RVA gastroenteritis cases compared to those who tested negative. This study emphasizes the significance of maintaining a continuous surveillance system and conducting genomic analysis of RVA genotypes in children upto the age of 5 years. This is essential for tracking the circulation of RVA genotypes. The results from this research enhance our comprehension of how RVA genotypes are changing over time in Pakistan, underscoring the ongoing necessity for improving vaccine coverage and effectiveness. This, in turn, can help reduce the impact of RVA-related illnesses in children.

SARS-CoV-2 Wastewater Surveillance in Ten Cities from Mexico

We aimed to estimate the lead time and infection prevalence from SARS-CoV-2 wastewater (WW) monitoring compared with clinical surveillance data in Mexico to generate evidence about the feasibility of a large-scale WW surveillance system. We selected 10 WW treatment plants (WWTP) and 5 COVID-19 hospitals in major urban conglomerates in Mexico and collected biweekly 24-h flow-adjusted composite samples during October–November 2020. We concentrated WW samples by polyethylene glycol precipitation and employed quantitative PCR (RT-qPCR) assays, targeting the nucleoprotein (N1 and N2) genes. We detected and quantified SARS-CoV-2 RNA in 88% and 58% of the raw WW samples from WWTPs and COVID-19 hospitals, respectively. The WW RNA daily loads lead the active cases by more than one month in large and medium WWTP sites. WW estimated that cases were 2 to 20-fold higher than registered active cases. Developing a continuous monitoring surveillance system for SARS-CoV-2 community transmission through WW is feasible, informative, and recognizes three main challenges: (1) WW system data (catchment area, population served), (2) capacity to maintain the cold-chain and process samples, and (3) supplies and personnel to ensure standardized procedures.

Total Excess Mortality Surveillance for Real-Time Decision-Making in Disasters and Crises.

Crises such as Hurricane Maria and the coronavirus disease 2019 (COVID-19) pandemic have revealed that untimely reporting of the death toll results in inadequate interventions, impacts communication, and fuels distrust on response agencies. Delays in establishing mortality are due to the contested definition of deaths attributable to a disaster and lack of rapid collection of vital statistics data from inadequate health system infrastructure. Readily available death counts, combined with geographic, demographic, and socioeconomic data, can serve as a baseline to build a continuous mortality surveillance system. In an emergency setting, real-time Total, All-cause, Excess Mortality (TEM) can be a critical tool, granting authorities timely information ensuring a targeted response and reduce disaster impact. TEM measurement can identify spikes in mortality, including geographic disparities and disproportionate deaths in vulnerable populations. This study recommends that measuring total, all-cause, excess mortality as a first line of response should become the global standard for measuring disaster impact.

Low Urinary Potassium Excretion Is Associated with Higher Risk of All-Cause Mortality in Patients with Type 2 Diabetes: Results of the Dutch Diabetes and Lifestyle Cohort Twente (DIALECT)

Low 24-h urinary potassium excretion, reflecting low potassium intake, is associated with premature mortality in the general population. To determine whether urinary potassium excretion is associated with all-cause mortality in patients with type 2 diabetes. We performed a prospective cohort study in 654 patients with type 2 diabetes in the Diabetes and Lifestyle Cohort Twente (DIALECT). Sex-specific tertiles of 24-h urinary potassium excretion were analyzed in a multivariable Cox regression model with all-cause mortality. The outpatient program of the hospital uses a continuous surveillance system by the municipal registry of death to ensure up-to-date information on the patient's status (alive or deceased). FFQs were used to study associations between urinary potassium excretion and food products. Urinary potassium excretion at baseline was 84 ± 25 mmol/d in males and 65 ± 22 mmol/d in females, corresponding to estimated potassium intakes of 4250 ± 1270 mg/d and 3300 ± 875 mg/d. During a median follow-up of 5.2 (IQR: 2.7-7.9] y, 96 participants died. In a fully adjusted model, patients in the lowest sex-specific tertile had a higher risk of all-cause mortality, compared with patients in the highest sex-specific tertile (HR: 2.09; 95% CI: 1.06, 4.10; P = 0.03). Patients in the lowest sex-specific tertile consumed fewer fruits and vegetables, dairy, coffee, and potato products compared with patients in the highest sex-specific tertile (all P < 0.05). Low potassium intake is associated with a higher risk of all-cause mortality in Dutch patients with type 2 diabetes. Intervention studies are needed to determine whether potassium supplementation improves longevity in patients with type 2 diabetes. This trial was registered in the Dutch Trial Register as NTR trial code 5855.

Norovirus Genetic Diversity in Children under Five Years Old with Acute Diarrhea in Mozambique (2014-2015).

Norovirus (NoV) is the second most important cause of viral diarrheal disease in children worldwide after rotavirus and is estimated to be responsible for 17% of acute diarrhea in low-income countries. This study aimed to identify and report NoV genotypes in Mozambican children under the age of five years with acute diarrhea. Between May 2014 and December 2015, stool specimens were collected within the Mozambique Diarrhea National Surveillance (ViNaDia) and tested for NoV genogroups I (GI) and II (GII) using conventional reverse transcriptase-polymerase chain reaction (RT-PCR). Partial capsid and RNA-dependent RNA polymerase (RdRp) nucleotide sequences were aligned using the Muscle tool, and phylogenetic analyses were performed using MEGA X. A total of 204 stool specimens were tested for NoV. The detection rate of NoV was 14.2% (29/204). The presence of NoV was confirmed, by real-time RT-PCR (RT-qPCR), in 24/29 (82.8%) specimens, and NoV GII predominated (70.8%; 17/24). NoV GII.4 Sydney 2012[P31] was the predominant genotype/P-type combination detected (30.4%; 7/23). This is the first study which highlights the high genetic diversity of NoV in Mozambican children and the need to establish a continuous NoV surveillance system.

Association of Nonpharmaceutical Interventions During the COVID-19 Pandemic With Invasive Pneumococcal Disease, Pneumococcal Carriage, and Respiratory Viral Infections Among Children in France

An association between pneumococcal nasopharyngeal carriage and invasive pneumococcal disease (IPD) has been previously established. However, it is unclear whether the decrease in IPD incidence observed after implementation of nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic was associated with concomitant changes in pneumococcal carriage and respiratory viral infections. To assess changes in IPD incidence after the implementation of NPIs during the COVID-19 pandemic and examine their temporal association with changes in pneumococcal carriage rate and respiratory viral infections (specifically respiratory syncytial virus [RSV] and influenza cases) among children in France. This cohort study used interrupted time series analysis of data from ambulatory and hospital-based national continuous surveillance systems of pneumococcal carriage, RSV and influenza-related diseases, and IPD between January 1, 2007, and March 31, 2021. Participants included 11 944 children younger than 15 years in France. Implementation of NPIs during the COVID-19 pandemic. The estimated fraction of IPD change after implementation of NPIs and the association of this change with concomitant changes in pneumococcal carriage rate and RSV and influenza cases among children younger than 15 years. The estimated fraction of change was analyzed using a quasi-Poisson regression model. During the study period, 5113 children (median [IQR] age, 1.0 [0.6-4.0] years; 2959 boys [57.9%]) had IPD, and 6831 healthy children (median [IQR] age, 1.5 [0.9-3.9] years; 3534 boys [51.7%]) received a swab test. Data on race and ethnicity were not collected. After NPI implementation, IPD incidence decreased by 63% (95% CI, -82% to -43%; P < .001) and was similar for non-13-valent pneumococcal conjugate vaccine serotypes with both high disease potential (-63%; 95% CI, -77% to -48%; P < .001) and low disease potential (-53%; 95% CI, -70% to -35%; P < .001). The overall pneumococcal carriage rate did not significantly change after NPI implementation (-12%; 95% CI, -37% to 12%; P = .32), nor did the carriage rate for non-PCV13 serotypes with high disease potential (-26%; 95% CI, -100% to 52%; P = .50) or low disease potential (-7%; 95% CI, -34% to 20%; P = .61). After NPI implementation, the estimated number of influenza cases decreased by 91% (95% CI, -74% to -97%; P < .001), and the estimated number of RSV cases decreased by 74% (95% CI, -55% to -85%; P < .001). Overall, the decrease in influenza and RSV cases accounted for 53% (95% CI, -28% to -78%; P < .001) and 40% (95% CI, -15% to -65%; P = .002) of the decrease in IPD incidence during the NPI period, respectively. The decrease in IPD incidence was not associated with pneumococcal carriage, with carriage accounting for only 4% (95% CI, -7% to 15%; P = .49) of the decrease. In this cohort study of data from multiple national continuous surveillance systems, a decrease in pediatric IPD incidence occurred after the implementation of NPIs in France; this decrease was associated with a decrease in viral infection cases rather than pneumococcal carriage rate. The association between pneumococcal carriage and IPD was potentially modified by changes in the number of RSV and influenza cases, suggesting that interventions targeting respiratory viruses, such as immunoprophylaxis or vaccines for RSV and influenza, may be able to prevent a large proportion of pediatric IPD cases.

Leptospiral infection: a serosurvey in urban and rural communities in Olavarría county, Argentina.

Leptospirosis is a neglected zoonotic disease, affecting mainly poor and vulnerable populations. A cross sectional-study was carried out in 557 subjects from Olavarría county (Argentina) to estimate the seroprevalence of leptospirosis and the factors associated with seropositivity. A survey was carried out to obtain clinical and epidemiological data. Serum was tested for anti-leptospiral antibodies by Microscopic Agglutination Test (MAT). Chi-square or Fisher Exact tests were used to assess association between the MAT results and the exploratory variables. For the variables statistically associated, odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated. Individuals from Olavarría city were georeferenced to describe the spatial distribution and to detect clusters of seropositivity for leptospiral antibodies. The overall prevalence of leptospirosis infection was 7.00%, higher in rural (19.66%) than in urban populations (3.64%) (p < 0.001). Sejroe was the most predominant serogroup in rural communities while Icterohaemorrhagiae was the most prevalent in urban populations. The factors associated with Leptospira infection were the presence of rodents inside households (OR = 3.9) in rural populations, while contact with cats (OR = 4.97) and male gender (OR = 7.75) represented higher risk of infection for the urban ones. Cases with positive serology have been found near Tapalqué stream or in the peripheral areas of Olavarría city. The results from data obtained during the study period were similar to other reports and demonstrate the importance of continuous epidemiological surveillance system and specific community educational campaigns to prevent the leptospirosis infection in Olavarría county and other communities with similar characteristics especially in rural areas.

Distribution of Carbapenemase Genes among Carbapenem-Non-Susceptible Acinetobacter baumanii Blood Isolates in Indonesia: A Multicenter Study.

Carbapenem non-susceptible Acinetobacter baumannii (CNSAB) is an important pathogen that causes nosocomial bacteremia among critically ill patients worldwide. The magnitude of antibiotic resistance of A. baumanii in Indonesia is expected to be significant; however, the data available are limited. The aim of this study was to analyze the genetic profiles of CNSAB isolates from patients with bacteremia in Indonesia. CNSAB isolates from blood cultures of bacteremia patients in 12 hospitals in Indonesia were included. The blood cultures were conducted using the BacT/Alert or BACTEC automated system. The CNSAB were identified with either Vitek 2 system or Phoenix platform followed by a confirmation test using a multiplex polymerase chain reaction (PCR) assay, targeting the specific gyrB gene. The carbapenemase genes were detected by multiplex PCR. In total, 110 CNSAB isolates were collected and were mostly resistant to nearly all antibiotic classes. The majority of CNSAB isolates were susceptible to tigecycline and trimethoprim-sulfamethoxazole (TMP-SMX), 45.5% and 38.2%, respectively. The blaOXA-51-like gene was identified in all CNSAB isolates. Out of the total, 83.6% of CNSAB isolates had blaOXA-23-like gene, 37.3% blaOXA-24-like gene, 4.5% blaNDM-1 gene, 0.9% blaIMP-1 gene, and 0.9% blaVIM gene. No blaOXA-48-like gene was identified. The blaOXA-23-like gene was the predominant gene in all except two hospitals. The presence of the blaOXA-24-like gene was associated with resistance to tigecycline, amikacin, TMP-SMX and cefoperazone-sulbactam, while blaOXA-23-like gene was associated with resistance to TMP-SMX and cefoperazone-sulbactam. In conclusion, the blaOXA-23-like gene was the predominant gene among CNSAB isolates throughout Indonesia. A continuous national surveillance system needs to be established to further monitor the genetic profiles of CNSAB in Indonesia.

Athletes sleep duration during COVID-19 pandemic and its relationship with health condition

During the coronavirus desease 2019 (COVID-19) pandemic, athletes must be able to adapt to new habits, such as: social restriction, change of competition schedule, and sending back home. This situation has led to an 18.2% increase in sleep disturbances. This study aimed to look at the sleep duration of adolescent athletes during the COVID-19 pandemic and its impact on athlete’s health conditions. A total of 126 adolescent athletes from 15 sports were recruited in this cross-sectional study. Adequate sleep duration was assessed according to the American Academy of Sleep Medicine criteria. Data on health conditions, medical history, injury history, were taken using a questionnaire. Behavioral assessment was assessed through the strengths and difficulties questionnaire. About 80.2% of adolescent athletes had insufficient sleep, and there was a significant relationship between sleep duration and disease incidence with a relative risk (RR) of 3.31 (1.32-8.28) 95% convidence interval (CI). There was no significant relationship between adequate sleep duration and health conditions (p&amp;gt;0.05). Things that may be the cause of sleep disturbances; use of electronic devices (37.6%), environmental conditions (53.4%), and worry (9%). In the end, this indicates adolescent athletes face difficulties in achieving adequate sleep duration during this pandemic and a continuous surveillance system is needed to monitor athletes outside the dormitory.

Adverse effects associated with use of specific dietary supplements: The US Military Dietary Supplement Use Study

Dietary supplements (DSs) are used by 50% of Americans and 70% of United States military service members (SMs); some have adverse effects (AEs). This cross-sectional investigation examined AEs associated with specific DSs. A stratified random sample of SMs from the Air Force, Army, Marine Corps, and Navy was obtained. Volunteers completed a questionnaire reporting AEs for 96 generic and 62 specific DSs. The highest prevalence (≥1 AE) in specific DS categories was 35% prohormones, 33% weight loss supplements, 26% pre/post workout supplements, 14% herbal products, 12% multivitamin/multiminerals, 11% protein/amino acids, 9% muscle building supplements, 7% other DSs, 6% joint health products, and 5% individual vitamins/minerals. Specific DSs of concern (with proportion reporting AEs) included: Libido Max® (35%), Hydroxycut Hardcore® (33%), OxyElite® (33%), Roxylean® (31%), Growth Factor 9® (30%), Super HD® (29%), Hydroxycut Advanced® (29%), Lipo 6® (28%), The Ripper® (27%), Test Booster® (27%), Xenadrine Xtreme Thermogenic® (27%), C4 Extreme® (26%), and C4 Original® (25%). Products marketed for weight loss, use before/after workout, and prohormones had the highest AE prevalence. DSs can contain substances with independent/additive AEs and/or interact with other ingredients or prescribed medications. Methods described here could provide a continuous surveillance system detecting dangerous DSs entering the market.

Surveillance for Antibiogram Pattern of Nosocomial Bacteria from two Selected Hospitals in Kano State, Nigeria

In a bid to determine the level of antimicrobial resistance among bacterial pathogens feared to be nosocomially transmitted in some hospitals, Firstly, patients of HCAI was identified and followed-up accordingly with standardized questionnaire in the hospitals. Sample were collected for bacteriological assay using Culture and biochemical methods for the investigation of bacteria associated with nosocomial, Antibiogram pattern was assessed by Disk diffusion as to mark the resistant ones and presence of gene encoding for mecA and blaZ with the aid of PCR. At AKTH, A total of 63% of isolates were Gram-positive while 37% were Gram-negative bacteria. S. aureus were the most common isolates with frequency of 37%. Most of all the Gram-positive isolates were resistant to cefuroxime (30μg) and Amoxicillin (10μg) while they shown high sensitivity to other antibiotics tested against them. Only 18% of S. aureus are suspected MRSA. Most of Gram-negative isolates were found to be resistant to amoxicillin (10μg) 100%, gentamicin (10μg) 71% and chloramphenicol (30μg) 57%. At MMSH, 86% of the isolates were Gram-positive while 14% were Gram-negative bacteria. S. aureus, 42% were the most common isolates. All the isolates were resistance to cefuroxime and Amoxicillin (10μg) while they showed sensitivity to other tested antibiotics. while most shows sensitivity to other tested antibiotics. Only 24% of S. aureus were MRSA. 63% of the tested MRSA were mecA positive while 100% were blaZ positive. The high rates of resistome of isolates represent a substantial threat to the public where well-structured and continuous surveillance system for antimicrobial resistance is needed to encourage the monitoring of antimicrobial therapy.

Smart border patrol using drones and wireless charging system under budget limitation

Harsh environmental factors surrounding the national borders as well as their extensive length make the use of manned systems for monitoring every location on the border a risky, expensive, and hardly possible task. Smart border patrol using small-size drones may provide significant help in patrolling areas inaccessible to patrol agents, reduce agent response time, and increase the safety of patrol agents working in dangerous regions. However, the short flight duration associated with small-size drones due to battery limitation can be a serious drawback for such a system for seamless surveillance. Therefore, this paper proposes a drone-based continuous surveillance system for border patrol with a dynamic wireless battery charging system that is built onto an electrification line (E-line). To control the maximum time interval between two consecutive flights to a particular section of the border, a permitted revisiting gap is assigned to each location on the border based on its criticality. A multi-objective mixed-integer non-linear programming (MINLP) model is developed to minimize both the total length of the E-line system for the wireless charging system and the number of drones to satisfy the revisiting gap constraint for a secure border patrol. A solution algorithm is proposed to achieve the Pareto-optimal set. This method provides the decision-maker with a set of candidate solutions to choose from based on their priorities and budgetary constraints. We illustrate our method using a case study on a segment of the US-Mexico borderline.

Potnet: Online Potable Water Quality Monitoring Network for Overhead Water Tanks in Rural Water Supply Schemes in India

Background: Monitoring the quality of potable water is a challenging endeavor due to the significant sources of contaminants, the majority of which are human-induced. Limited access to drinking water owing to acceleration in industrialization, urbanization in consort with growing inhabitants, unprocessed sewage discharge, and toxic industrial effluents causes different life-threatening diseases. Manual water quality monitoring techniques vividly aggravate quality deterioration. Considering the significance of the automatic water quality monitoring system, we need an in-situ, real-time, continuous surveillance system to ascertain the quality of potable water. Wireless Sensor Network (WSN) motivated us for a practical water quality monitoring system due to their continuous, real-time, and adaptive infrastructure to provide an early alert in hazardous conditions. Objective: To design and implement an online potable water quality monitoring network for rural water supply schemes in Nagapattinam district, Tamilnadu, India, to sense physiochemical parameters of potable water such as pH, turbidity, conductivity and temperature. Methods: Online POTable water quality monitoring NETwork (POTNET) integrates the reimbursements of WSN and different information and communication technologies for data acquisition, data processing, and data visualization. The core hardware of POTNET contains off-the-shelf sensors (i.e., electrodes), a microcontroller, a data transmission system, a customized buoyage, and a sink node. It senses physiochemical parameters of potable water such as pH, turbidity, conductivity, and temperature in a pre-programmed time interval. Furthermore, it enables cloud storage for gathered information and generates an alert to the preregistered user via mobile phones when there is a deviation of quality measures from threshold values. Results: The system was implemented in three overhead tanks for seven days in order to validate the stability of the buoy and efficiency of energy source, storage, and data transmission. It senses physiochemical parameters of potable water such as pH, turbidity, conductivity, and temperature in its predefined interval of 30 minutes. To check the system accuracy, the measured data values from developed sensors were compared with the observed data values using a commercial multi-parameter water checker, the Horiba® probe. Measured data were sent through the transceivers to the base station for data logging in a suitable format for ease of data visualization and utilization. Conclusion: Extensive experimental results reveal that our POTNET can be employed for potable water quality surveillance to help consumers or concern authorities to make a sound decision by providing appropriate and real-time data.

Mutation Prone Point Within Spike Protein Molecule of SARS-CoV2: A Nanoinformatics Study

Coronavirus disease 2019 (COVID-19) is a new emerging infection caused by a novel coronavirus, SARS CoV2. The pandemic of COVID-19 causes several problems worldwide. The interesting data from epidemiological surveillance show that the mutated virus already occurs and might result in a more serious outbreak. In this study, a standard combined bioinformatics analysis for SARS CoV2 nanostructure analysis was performed. The present study aims to determine the risk for mutation within the amino acid sequence of SARS CoV2. The standard tool, namely GlobPlot, was used for sequence analysis. According to the present study, the prediction of the positions resistant to a mutation within the spike protein of SARS CoV2 is made. There are many identified prone positions. This finding can imply that there will be a further new mutated type of SARS CoV2 pathogen. Therefore, the system for continuous molecular epidemiology surveillance is required.

Trends of Antifungal Use Based on Sales Data in Japan from 2006 to 2015.

The detailed epidemiology of invasive mycoses and superficial mycoses has not been clarified in Japan. In addition, treatment options have increased because of novel antifungals and/or guidelines for fungal infection. In the present study, we aimed to clarify the trends of antifungal use in Japan from 2006 to 2015 based on sales data to serve as an alternative indicator of fungal infection trends. We found that the total antifungal use decreased over time (r = -0.057, Pfor trend < 0.0001). Oral and parenteral use significantly decreased by 44.1% (r = -0.056, Pfor trend < 0.0001) and 27.1% (r = -0.0012, Pfor trend = 0.00061), respectively. The trend of antifungal use for superficial mycoses significantly decreased by 49.8% (r = -0.061, Pfor trend < 0.0001). However, the trend of antifungal use for invasive mycoses was significantly increased by 19.9% (r = 0.0032, Pfor trend = 0.00045). In Japan, the increase in the number of immunocompromised patients might be associated with the increase in the frequency of antifungal use for invasive mycoses. This is the first study to clarify the trends of antifungal use in Japan. Further research is needed to establish a continuous surveillance system to compare fungal infections between Japan and the world.

MOLECULAR EPIDEMIOLOGY AND HOSPITAL SPREAD OF CEFTRIAXONE NON‐SUSCEPTIBLE ENTEROBACTERALES IN THE SUNSHINE COAST REGION, AUSTRALIA

Background: Extended spectrum beta‐lactamase (ESBL) and AmpC‐producing Enterobacterales are prevalent worldwide. Poor clinical outcomes, including death, are more common in patients both colonised and infected with these organisms1. Australia is thought to have a comparatively low prevalence of such organisms, however no clear continuous surveillance system exists2. Specific ESBL type has shown significant geographic variation, having different therapeutic and infection control implications for different regions3. Little is known about the prevalence, molecular type and spread of ESBL and AmpC‐producing Enterobacterales among hospitalised patients in the Sunshine Coast region. Aims: To (i) Determine the prevalence and molecular epidemiology of ESBL and AmpC‐producing Enterobacterales, (ii) Develop an in‐house multiplex polymerase chain reaction (PCR) assay to detect common ESBL genes, (iii) Compare our PCR assay to the double disc diffusion method for detection of ESBLs, and to (iv) Establish, with whole genome sequencing (WGS), whether transmission was occurring in our intensive care unit (ICU). Methods: Clinical specimens from adult and paediatric patients culturing Enterobacterales resistant to a third‐generation cephalosporin were collected prospectively from July 2017 to August 2018 at the Sunshine Coast University Hospital laboratory. Antibiotic susceptibility testing was determined using VITEK‐2®. A validated in‐house pentaplex PCR assay was developed and used to detect common beta‐lactamase genes (CTX‐1, CTX‐9, SHV, TEM, CMY). All isolates collected from patients admitted to the ICU were identified and underwent WGS analysis using the Illumina® platform. Results: 295 clinical specimens were identified. Escherichia coli (78.8%), Klebsiella pneumoniae (16.8%) with 1‐2% consisting of Enterobacter spp., Serratia marcescens and Citrobacter freundii. Specimens included urine (53.8%), rectal swab (39.4%), pus (3.0%) and blood (2.4%). Carbapenem resistance was observed in 3.3%. ICU patient specimens made up 18.2%. The majority (87.8%) of isolates had at least one gene identified on PCR testing of which 48.5% produced CTX‐1, 31.2% produced CTX‐9, 15.9% produced SHV, 12.5% produced CMY and 40.6% produced TEM. Approximately forty percent of isolates produced more than one ESBL with the most common being CTX‐1 and TEM coproduction. A small amount (<5%) of isolates were negative on PCR testing. Fourteen (4.7%) isolates that were negative on double disc diffusion had ESBL genes detected by our PCR assay. WGS of non‐identical ICU patient E. coli (n = 44) and K. pneumoniae (n = 10) isolates revealed no strong evidence for transmission of these organisms between patients during this time period, with the smallest single nucleotide polymorphism (SNP) difference being 300 SNPs. Conclusion: Multidrug resistant Gram‐negative organisms are present on the Sunshine Coast and cause significant morbidity. Our real‐time pentaplex PCR assay was able to successfully identify common beta‐lactamase genes, revealing a frequency distribution among our organisms similar to that noted in previous Australian studies (CTX‐1 group most commonly identified). We were not able to identify evidence of ICU transmission, which recognises the success of current infection control practices at our institution.

Reducing Missed Medication Doses in Intensive Care Units: A Pharmacist-Led Intervention.

Objective:The objectives of this study were to investigate the frequency and reasons for missing doses and impact of a pharmacist-led intervention to reduce the missed doses in intensive care units.Methods:This study was completed in two phases. In the first phase, a retrospective quality assurance audit was conducted to quantify the problem of missed doses from the pharmacist/nurse communication slip record. The frequency and potential reasons for missing dose occurrences were identified and listed, and respective solutions were finalized by a joint health-care team. In the second phase of the study, post-intervention analysis was done for a period of 1 month to check the impact of intervention. The data were recorded from pharmacy/nursing communication forms for medication, dosage form, route of administration (ROA), frequency of missed doses, and underlying reasons for missing doses.Findings:There was a substantial reduction in the number of incidences of missed doses in post-intervention phase. The number of events decreased from 190 (pre-intervention; 2 months) to 11 (post-intervention; 1 month), 389 to 87, and 133 to 12 for automatic stop order, unknown reason, and late mix medication, respectively. No missed dose event was recorded secondary to order overseen and inactive patient status in post-intervention phase. Moreover, identified reasons, ROA, frequency, and the system status were the significant predictors of missing doses.Conclusion:The findings of this study emphasized the need to introduce better documentation procedures and continuous surveillance system to decrease the number of missing doses and further improve already established drug distribution service.

Analysis of Injury Patterns of Motorcycle Riders Admitted to Teaching Hospital, Karapitiya, Sri Lanka

Introduction: The number of fatality and the disability due to motorcycle collisions is being increasing globally and most of them are preventable tragedies. Motorcycle riders are a major vulnerable group of road users and the severity of crashes could be dependent on several factors. The aim of this study is to study the characteristics of crashes and the injury pattern of motorcycle riders. Methods: A cross-sectional descriptive prospective study was conducted on patients admitted to Teaching Hospital Karapitiya with a history of motorcycle crashes. Data on socio-demographic profile and different characteristics relevant to driver, vehicle, environment and road factors were collected and analysis of injuries was performed. Results: The injury pattern and the characteristics of the motorcycle riders, including 461 riders and 197 pillion riders were analyzed. There is a male predominance in both groups. Accidents among riders are more prevalent in 20-34 age groups. There is bi-fold prevalence of the time of incident representing usual traffic peaks in the area. The 10% of drivers in our study did not possess a license and 24% of riders were drunk at the time of the accidents. Injuries, commonly the abrasions and lacerations were prevalent in both extremities and head area in both types of riders. Drivers are often encountered with severe injuries compared to the pillion riders with a significant difference. Conclusions: Higher prevalence in age group of 20-34 years, and the male sex were identified. Injuries to limbs and head were common in both types of riders. Drivers are at the risk of sustaining more serious injuries than pillion riders in the study population. Continuous injury surveillance system and the enforcement of legal limit is recommended to minimize preventable incidents.

Traumatic injuries in rural Honduras: A two month pilot study

ObjectivesTrauma is a leading cause of morbidity and mortality worldwide, with a disproportionate burden of illness in low- and middle- income countries. This study sought to provide a proof-of-concept pilot study to evaluate the feasibility of a trauma registry in the Western Honduras Hospital. MethodsA cross-sectional, observation study was performed that included all admitted, transferred, or deceased trauma patients presenting to the Western Honduras Hospital from February 4, 2019 until April 4, 2019. Descriptive statistics were utilized to describe patient demographics and injury characteristics. Results268 patients were enrolled. The average age was 27.5 years (SD ±21.3). 10% of injuries were due to interpersonal violence. The most common mechanisms of injury were falls (33.6%) and motor vehicle collisions (MVCs) (22.4%). The mean Modified Kampala Trauma Score (M-KTS) was 12 (SD ±1.4). The mortality rate was 1.1% (N = 3). 94.5% of data points were complete. ConclusionsA continuous injury surveillance system in the Western Honduras Hospital is feasible and provides valuable information. The data completeness was suboptimal, but the current data collection system may be improved via modifying and utilizing the registry form as both a clinical and data collection instrument.