Burden of Serious Bacterial Infections and Multidrug-Resistant Organisms in an Adult Population of Nepal: A Comparative Analysis of Minimally Invasive Tissue Sampling Informed Mortality Surveillance of Community and Hospital Deaths

Bacterial etiology and antimicrobial resistance in bloodstream infections at the University of Gondar Comprehensive Specialized Hospital: a cross-sectional study

Background

Bacterial bloodstream infections are a major global health concern, particularly in resource-limited settings including Ethiopia. There is a lack of updated and comprehensive data that integrates microbiological data and clinical findings. Therefore, this study aimed to characterize bacterial profiles, antimicrobial susceptibility, and associated factors in patients suspected of bloodstream infections at the University of Gondar Comprehensive Specialized Hospital.

Methods

A cross-sectional study analyzed electronic records from January 2019 to December 2021. Sociodemographic, clinical, and blood culture data were analyzed. Descriptive statistics and binary logistic regression were employed to identify factors associated with bloodstream infections. Descriptive statistics such as frequency and percentage were computed. Furthermore, a binary and multivariable logistic regression model was fitted to determine the relationship between BSI and associated factors. Variables with p-values of <0.05 from the multivariable logistic regression were used to show the presence of statistically significant associations.

Results

A total of 4,727 patients' records were included in the study. Among these, 14.8% (701/4,727) were bacterial bloodstream infections, with Gram-negative bacteria accounting for 63.5% (445/701) of cases. The most common bacteria were Klebsiella pneumoniae (29.0%), Staphylococcus aureus (23.5%), and Escherichia coli (8.4%). The study revealed a high resistance level to several antibiotics, with approximately 60.9% of the isolates demonstrating multidrug resistance. Klebsiella oxytoca, Klebsiella pneumoniae, and Escherichia coli exhibited high levels of multidrug resistance. The study identified emergency OPD [AOR = 3.2; (95% CI: 1.50-6.74)], oncology ward [AOR = 3.0; (95% CI: 1.21-7.17)], and surgical ward [AOR = 3.3; (95% CI: 1.27-8.43)] as factors associated with increased susceptibility to bloodstream infections.

Conclusion

The overall prevalence of bacterial isolates was high with concerning levels of multi-drug resistance. The study identified significant associations between bloodstream infections with age groups and presentation in specific clinical settings, such as the emergency OPD, oncology ward, and surgical ward. Strict regulation of antibiotic stewardship and the implementation of effective infection control programs should be enforced.

A Six Years' Trend Analysis of Antimicrobial Resistance Among Bacterial Isolates at Public Health Institute in Amhara Region, Ethiopia

Background: Antimicrobial resistance (AMR) is one of the top global threats to public health. This study determined trends in AMR from 2016 to 2021 in a regional research laboratory in Northwest Ethiopia. Methods: Data from 2016 to 2021 was extracted from a database. Bacterial identification and resistance tests were made using the standard microbiologic procedures. The results were described, trends in AMR were determined using polynomial regressions, and binary logistic regression at p value < 0.05 was used. Results: From 2016 to 2021, 25,143 specimens were sent for culture and susceptibility testing, among which 16,825 (66.9%) bacteria were isolated. About 12,528 (74.5%) isolates were gram-negative, and 4297 (25.5%) were gram-positive. Klebsiella pneumoniae (3783, 30.2%) and Escherichia coli (3199, 25.5%) were the most common gram-negative bacteria, whereas coagulase-negative Staphylococcus spp. (CoNS) (1765, 40.1%) and Staphylococcus aureus (1293, 30.1%) were the most common gram-positive bacteria. The overall prevalence of AMR was 2738 (59.9%), of which about 1807 (66.0%) accounted for gram-negative and 931 (34.0%) for gram-positive bacteria. K. pneumoniae (743, 80.2%), Enterobacter cloacae (196, 74.8%), and Acinetobacter baumannii (213, 66.6%) were the most common resistant isolates among gram-negative bacteria, while CoNS (406, 58%), Streptococcus species (34, 50%), and S. aureus (196, 37%) were from gram-positive bacteria. About 571 (20.9%) of bacteria were resistant to 2-10 drugs. The overall trend of AMR has been rising from year to year, reaching a peak in 2019 which was approximately 66% and then after has been predicted to decline. Conclusion: AMR in the regional laboratory is prevalent and has been increasing although the quadratic equation has revealed downward-opening parabola over time. A growing number of multidrug-resistant bacteria are an alarm to awaken policymakers and those concerned to intervene before it is too late. This calls for a periodic, integrated, and continuing system to monitor AMR for commonly used antibiotics.

A Decade-Long Analysis of Trends in Antimicrobial Resistance in a Neurosurgical Hospital in Kathmandu, Nepal

Multidrug-resistant (MDR) bacteria cause infections with higher risks of morbidity, mortality, and financial burden. Understanding the antimicrobial resistance patterns of these pathogens is crucial for effective treatment and managing resistance. Therefore, this retrospective study examined the prevalence, causes, and trends in antimicrobial resistance in bacterial infections at a neurosurgical hospital in Nepal. We analyzed the demographics, bacteriological profiles, and antimicrobial susceptibility results in patients who visited Dirghayu Guru Hospital and Research Center, Kathmandu, Nepal, between January 2014 and January 2024, using SPSS, version 17.00. Among 4758 patients, 465 (9.77%) had infections caused by 571 bacteria. Of them, 435 (93.55%) patients had urinary tract infections, 89 (19.14%) had bloodstream infections, and 31 (6.67%) had respiratory tract infections. Klebsiella pneumoniae (n = 172, 30.12%) was the predominant bacteria. Proportions of drug-resistant Enterobacterales and gram-positive cocci among drug-resistant bacteria against tetracyclines were 83.33% and 45.83%, cephalosporins were 78.02% and 40.45%, quinolones were 72.25% and 50.00%, aminoglycosides were 65.14% and 43.53%, carbapenems were 62.96% and 30.00%, penicillins were 54.55% and 57.89%, and penicillin with beta-lactamase inhibitors (PwBLIs) were 40.54% and 42.31%, respectively. Proportions of drug-resistant nonfermenters among drug-resistant bacteria showed 100.00% resistance to these antimicrobials. MDR isolates (n = 118, 20.67%) were 100.00% susceptible to piperacillin-tazobactam and 83.33% to polymyxin B. Over the years, resistance increased for cephalosporins (48.15%-60.53%) but decreased for carbapenems (50.00%-33.33%), penicillins (64.29%-42.31%), PwBLIs (50.00%-12.50%), aminoglycosides (60.00%-49.12%), tetracyclines (100.00%-16.67%), and polymyxins (76.22%-16.67%). One-tenth of hospital-visiting patients had bacterial infections, with three-fourths involving Enterobacterales and one-fifth involving MDR bacteria. In recent years, resistance to cephalosporins has increased, whereas resistance to other beta-lactams, aminoglycosides, and polymyxins has decreased.

Phage probe on RAFT polymer surface for rapid enumeration of E. coli K12

This study presents a simple, fast, and sensitive label-free sensing assay for the precise enumeration of modeled pathogenic Escherichia coli K12 (E. coli K12) bacteria for the first time. The method employs the covalent binding bacteriophage technique on the surface of a reversible addition-fragmentation chain transfer (RAFT) polymer film. The Nyquist plots obtained from electrochemical impedance spectroscopy (EIS) identified the charge transfer resistance Rct was calculated from a suitable electrochemical circuit model through an evaluation of the relevant parameter after the immobilization of the bacteriophage and the binding of specific E. coli K12. The impedimetric biosensor reveals specific and reproducible detection with sensitivity in the linear working range of 104.2-107.0 CFU/mL, a limit of detection (LOD) of 101.3 CFU/mL, and a short response time of 15 min. The SERS response validates the surface roughness and interaction of the SERS-tag with E. coli K12-modified electrodes. Furthermore, the covalently immobilized active phage selectivity was proved against various non-targeting bacterial strains in the presence of targeted E.coli K12 with a result of 94 % specificity and 98 % sensitivity. Therefore, the developed phage-based electrode surface can be used as a disposable, label-free impedimetric biosensor for rapid and real-time monitoring of serum samples.

Epidemiology and Antimicrobial Resistance Profiles of Bacterial Isolates from Clinical Specimens at Felege Hiwot Comprehensive Specialized Hospital in Ethiopia: Retrospective Study

Background: Bacterial infections constitute a large portion of infectious disorders. The location of culture-positive specimens and profiles of antibiotic resistance for common pathogens have been the focal points of subsequent investigations. Methodology: The diagnosis of microbiology was carried out using traditional culture techniques. In accordance with Clinical and Laboratory Standards Institute guidelines, the Kirby–Bauer disk diffusion method was employed for antimicrobial susceptibility analysis. The data were extracted from WHONET 2022 software version 22.5.5 and analyzed using SPSS software. Results: In total, 2489 pathogens were isolated from 2073 patients in three consecutive years. About 768 (34.9%) of the isolates were from the neonatal intensive care unit and the pediatric wards, and 63.2% isolates were from blood specimens. The ESKAPE pathogens were predominant (67%). About 100 Enterobacteriaceae family member bacteria were resistant to carbapenem drugs, and 320 isolates of this family were expected to be beta lactamase producers. A total of 120 methicillin-resistant S. aureus isolates were also identified. Conclusions: Among the isolates, ESKAPE pathogens accounted for the greatest proportion. Most isolates were from the neonatal intensive care unit. A significant number of multidrug-resistant, extreme drug-resistant, and pandrug-resistant isolates were identified in the present study.

Impedimetric Gram-Positive Bacteria Biosensor Using Vancomycin-Coated Silica Nanoparticles with a Gold Nanocluster-Deposited Electrode

We introduce a swift, label-free electrochemical biosensor designed for the precise on-site detection of Gram-positive bacteria via electrochemical impedance spectroscopy. The biosensor was prepared by electroplating the electrode surface with gold nanoclusters (AuNCs) on the gold-interdigitated wave-shaped electrode with a printed circuit board (Au-PCB) electrode, which plays a role in cost-effective and promising lab-on-a-chip microsystems and integrated biosensing systems. This was followed by the application of silica nanoparticle-modified vancomycin (SiNPs-VAN) that binds to Gram-positive bacteria and facilitates their detection on the AuNC-coated surface. The biosensor demonstrated remarkable sensitivity and specificity. It could detect as few as 102 colony-forming units (CFU)/mL of Staphylococcus aureus, 101 CFU/mL of Bacillus cereus, and 102 CFU/mL of Micrococcus luteus within 20 min. Additionally, SiNPs-VAN is also known for its high stability, low cost, and ease of preparation. It is effective in identifying Gram-positive bacteria in water samples across a concentration range of 102-105 CFU/mL and shows selective identification of Gram-positive bacteria with minimal interference from Gram-negative bacteria like Escherichia coli. The ability of the biosensor to quantify Gram-positive bacteria aligns well with the results obtained from the quantitative real-time polymerase chain reaction (qRT-PCR). These findings highlight the potential of electrochemical biosensors for the detection of pathogens and other biological entities, marking a significant advancement in this field.

From green chemistry to biomedicine: the sustainable symphony of cobalt oxide nanoparticles

Deciphering the importance of nanostructures in advanced technologies for a broad application spectrum has far-reaching implications for humans and the environment. Cost-effective, abundant cobalt oxide nanoparticles (NPs) are among the most attractive and extensively utilized materials in biomedical sciences due to their high chemical stability, and biocompatibility. However, the methods used to develop the NPs are hazardous for human health and the environment. This article precisely examines diverse green synthesis methods employing plant extracts and microbial sources, shedding light on their mechanism, and eco-friendly attributes with more emphasis on biocompatible properties accompanied by their challenges and avenues for further research. An in-depth analysis of the synthesized cobalt oxide NPs by various characterization techniques reveals their multifaceted functionalities including cytotoxicity, larvicidal, antileishmanial, hemolytic, anticoagulating, thrombolytic, anticancer and drug sensing abilities. This revelatory and visionary article helps researchers to contribute to advancing sustainable practices in nanomaterial synthesis and illustrates the potential of biogenically derived cobalt oxide NPs in fostering green and efficient technologies for biomedical applications.

Tityus stigmurus-Venom-Loaded Cross-Linked Chitosan Nanoparticles Improve Antimicrobial Activity

The rapid resistance developed by pathogenic microorganisms against the current antimicrobial pool represents a serious global public health problem, leading to the search for new antibiotic agents. The scorpion Tityus stigmurus, an abundant species in Northeastern Brazil, presents a rich arsenal of bioactive molecules in its venom, with high potential for biotechnological applications. However, venom cytotoxicity constitutes a barrier to the therapeutic application of its different components. The objective of this study was to produce T. stigmurus-venom-loaded cross-linked chitosan nanoparticles (Tsv/CN) at concentrations of 0.5% and 1.0% to improve their biological antimicrobial activity. Polymeric nanoparticles were formed with a homogeneous particle size and spherical shape. Experimental formulation parameters were verified in relation to mean size (<180 nm), zeta potential, polydispersity index and encapsulation efficiency (>78%). Tsv/CN 1.0% demonstrated an ability to increase the antimicrobial venom effect against Staphylococcus aureus bacteria, exhibiting an MIC value of 44.6 μg/mL. It also inhibited different yeast species of the Candida genus, and Tsv/CN 0.5% and 1.0% led to a greater inhibitory effect of C. tropicalis and C. parapsilosis strains, presenting MIC values between 22.2 and 5.5 µg/mL, respectively. These data demonstrate the biotechnological potential of these nanosystems to obtain a new therapeutic agent with potential antimicrobial activity.

Potential of Portuguese Viticulture By-Products as Natural Resources of Bioactive Compounds—Antioxidant and Antimicrobial Activities

Vitis vinifera is the grape variety used in the production of wine and other products. In the wine production process, many of the vine’s by-products are wasted, namely seeds and stems. Given the proportion of wine production worldwide, the quantity of by-products is beginning to be an environmental problem, making it urgent to take measures for their use to obtain bioactive compounds with health benefits. The aim of this work was to study the antioxidant and antimicrobial activities of extracts from the seeds and stems of four Portuguese grape varieties: Touriga Franca, Touriga Nacional, Viosinho, and Tinta Roriz. Total phenolic (TPC) and total flavonoids (TFC) contents present in the different extracts were evaluated, as well as the antioxidant activity, by DPPH and FRAP methods. TPC and TFC values of the stem’s extracts are much higher than those of the seeds of the same grape variety in the same solvent. The antioxidant activity of aqueous and ethanolic stem extracts is higher than that obtained for the seeds, showing that antioxidant activity is related to the content of polyphenols. The antimicrobial activity of different stem and seed extracts was determined against yeasts and Gram-positive and Gram-negative bacteria, and the effect was determined based on the minimal inhibitory concentrations calculated (MIC). In general, the ethanol:water (1:1) extract of the seeds from the different varieties tested inhibited C. albicans ATCC10231 and C. krusei ATCC6258 growth even at 200 μg/mL, and the effect was fungicidal at 200 μg/mL. The same type of extract showed selective antimicrobial activity, inhibiting S. aureus ATCC29213 growth but having no effect against E. coli ATCC25922 even at 200 μg/mL. The effect against S. aureus was bactericidal (at 200 μg/mL) for Touriga Franca, Touriga Nacional, and Viosinho. Taking all these results into account, it can be concluded that the by-products of the grape varieties tested are important sources of bioactive products, particularly as antioxidants and antimicrobials.

Assessment of challenges and opportunities in antibiotic stewardship program implementation in Northwest Ethiopia

Background

Indiscriminate use of antibiotics leads to antibiotic resistance (AMR) and results in mortality, morbidity, and financial burden. Antibiotic stewardship programs (ASPs) with education can resolve a number of barriers recognized in the implementation of successful ASPs. The aim of this study was to assess health professionals' perceptions and status of ASPs in hospitals in 2022.

Methods

A cross-sectional study was conducted from September 1, 2022 to October 30, 2022. A total of 181 health professionals were included, and a self-administered questionnaire was used to collect data. The status of hospitals was assessed using a checklist. The data were analyzed using SPSS version 23, and descriptive statistics and Chi-square tests (X2) at a P-value of <0.05 were used.

Results

Of the 181 respondents, 163 (90.1 %), and 161 (89.0 %) believed that AMR is a significant problem in Ethiopia and globally, respectively. Easy access to antibiotics 155 (85.6 %), and inappropriate use 137 (75.7 %) were perceived as key contributors to AMR. Antibiotics were believed to be prescribed/dispensed without laboratory results 86 (47.5 %), and antibiotic susceptibility patterns were not considered to guide empiric therapy 81 (44.8 %). ASP was believed to reduce the duration of hospital stays and associated costs 137 (75.7 %), and improve the quality of patient care 133 (73.5 %), whereas 151 (83.4 %), 143 (79 %), and 142 (78.5 %) suggested education, institutional guidelines, and prospective audits with feedback interventions to combat AMR in their hospitals, respectively. There were significant differences in perception among professionals based on professional category and attempts by hospitals to implement ASPs. Although ASPs were not functioning according to standard, there have been attempts to implement it in three hospitals. The issue of ASP had never been heard in general hospitals. Currently, it is feasible to implement ASPs in four hospitals.

Conclusion

The status of ASP in hospitals was very poor. Despite a lack of prior knowledge on ASPs, most respondents do have a positive perception of AMR and the implementation of ASPs. Pharmacist-led prospective audits and feedback with education and institutional guidelines for empiric antibiotic use can be better implemented in hospitals. Involvement of representatives from infection prevention and control, and collaboration among hospitals in ASP implementation will help establish a strong ASP in the area.

Multiplex detection of bacterial pathogens by PCR/SERS assay

Bacterial infections are a leading cause of death globally. The detection of DNA sequences correlated to the causative pathogen has become a vital tool in medical diagnostics. In practice, PCR-based assays for the simultaneous detection of multiple pathogens currently rely on probe-based quantitative strategies that require expensive equipment but have limited sensitivity or multiplexing capabilities. Hence, novel approaches to address the limitations of the current gold standard methods are still in high demand. In this study, we propose a simple multiplex PCR/SERS assay for the simultaneous detection of four bacterial pathogens, namely P. aeruginosa, S. aureus, S. epidermidis, and M. smegmatis. Wherein, specific primers for amplifying each target gDNA were applied, followed by applying SERS nanotags functionalized with complementary DNA probes and Raman reporters for specific identification of the target bacterial pathogens. The PCR/SERS assay showed high specificity and sensitivity for genotyping bacterial pathogen gDNA, whereby as few as 100 copies of the target gDNA could be detected. With high sensitivity and the convenience of standard PCR amplification, the proposed assay shows great potential for the sensitive detection of multiple pathogen infections to aid clinical decision-making.

Carvacrol and Thymol Hybrids: Potential Anticancer and Antibacterial Therapeutics

Cancer is ranked among lethal diseases globally, and the increasing number of cancer cases and deaths results from limited access to effective therapeutics. The use of plant-based medicine has been gaining interest from several researchers. Carvacrol and its isomeric compound, thymol, are plant-based extracts that possess several biological activities, such as antimalarial, anticancer, antifungal, and antibacterial. However, their efficacy is compromised by their poor bioavailability. Thus, medicinal scientists have explored the synthesis of hybrid compounds containing their pharmacophores to enhance their therapeutic efficacy and improve their bioavailability. Hence, this review is a comprehensive report on hybrid compounds containing carvacrol and its isomer, thymol, with potent anticancer and antibacterial agents reported between 2020 and 2024. Furthermore, their structural activity relationship (SAR) and recommended future strategies to further enhance their therapeutic effects will be discussed.

MAIT cells in bacterial infectious diseases: heroes, villains, or both?

Due to the aggravation of bacterial drug resistance and the lag in the development of new antibiotics, it is crucial to develop novel therapeutic regimens for bacterial infectious diseases. Currently, immunotherapy is a promising regimen for the treatment of infectious diseases. Mucosal-associated invariant T (MAIT) cells, a subpopulation of innate-like T cells, are abundant in humans and can mount a rapid immune response to pathogens, thus becoming a potential target of immunotherapy for infectious diseases. At the site of infection, activated MAIT cells perform complex biological functions by secreting a variety of cytokines and cytotoxic substances. Many studies have shown that MAIT cells have immunoprotective effects because they can bridge innate and adaptive immune responses, leading to bacterial clearance, tissue repair, and homeostasis maintenance. MAIT cells also participate in cytokine storm generation, tissue fibrosis, and cancer progression, indicating that they play a role in immunopathology. In this article, we review recent studies of MAIT cells, discuss their dual roles in bacterial infectious diseases and provide some promising MAIT cell-targeting strategies for the treatment of bacterial infectious diseases.

Bioprospecting of unexplored halophilic actinobacteria against human infectious pathogens

Human pathogenic diseases received much attention recently due to their uncontrolled spread of antimicrobial resistance (AMR) which causes several threads every year. Effective alternate antimicrobials are urgently required to combat those disease causing infectious microbes. Halophilic actinobacteria revealed huge potentials and unexplored cultivable/non-cultivable actinobacterial species producing enormous antimicrobials have been proved in several genomics approaches. Potential gene clusters, PKS and NRPKS from Nocardia, Salinospora, Rhodococcus, and Streptomyces have wide range coding genes of secondary metabolites. Biosynthetic pathways identification via various approaches like genome mining, In silico, OSMAC (one strain many compound) analysis provides better identification of knowing the active metabolites using several databases like AMP, APD and CRAMPR, etc. Genome constellations of actinobacteria particularly the prediction of BGCs (Biosynthetic Gene Clusters) to mine the bioactive molecules such as pigments, biosurfactants and few enzymes have been reported for antimicrobial activity. Saltpan, saltlake, lagoon and haloalkali environment exploring potential actinobacterial strains Micromonospora, Kocuria, Pseudonocardia, and Nocardiopsis revealed several acids and ester derivatives with antimicrobial potential. Marine sediments and marine macro organisms have been found as significant population holders of potential actinobacterial strains. Deadly infectious diseases (IDs) including tuberculosis, ventilator-associated pneumonia and Candidiasis, have been targeted by halo-actinobacterial metabolites with promising results. Methicillin resistant Staphylococus aureus and virus like Encephalitic alphaviruses were potentially targeted by halophilic actinobacterial metabolites by the compound Homoseongomycin from sponge associated antinobacterium. In this review, we discuss the potential antimicrobial properties of various biomolecules extracted from the unexplored halophilic actinobacterial strains specifically against human infectious pathogens along with prospective genomic constellations.

Unveiling the volatile compounds and antibacterial mechanisms of action of Cupressus sempervirens L., against Bacillus subtilis and Pseudomonas aeruginosa

Cupressus sempervirens is a known traditional plant used to manage various ailments, including cancer, inflammatory and infectious diseases. In this investigation, we aimed to explore the chemical profile of Cupressus sempervirens essential oil (CSEO) as well as their antibacterial mode of action. The volatile components were characterized using gas chromatography coupled to a mass spectrometer (GC-MS). The results revealed remarkable antibacterial properties of EO derived from C. sempervirens. GC-MS analysis indicated that C. sempervirens EO characterized by δ-3-carene (47.72%), D-limonene (5.44%), β-pinene (4.36%), β-myrcene (4.02%). The oil exhibited significant inhibitory effects against a range of bacteria, including Staphylococcus aureus ATCC 29213, Bacillus subtilis ATCC 13048, Bacillus cereus (Clinical isolate), Pseudomonas aeruginosa ATCC 27853, and Escherichia coli ATCC 25922. These inhibitory effects surpassed those of conventional antibiotics. Furthermore, the EO demonstrated low minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs), indicating its bactericidal nature (MBC/MIC < 4.0). Time-kill kinetics analysis showed that CSEO was particularly effective at 2 × MIC doses, rapidly reduced viable count of B. subtilis and P. aeruginosa within 8 h. This suggests that the oil acts quickly and efficiently. The cell membrane permeability test further demonstrated the impact of CSEO on the relative conductivity of B. subtilis and P. aeruginosa, both at 2 × MIC concentrations. These observations suggest that EO disrupts the bacterial membrane, thereby influencing their growth and viability. Additionally, the cell membrane integrity test indicated that the addition of CSEO to bacterial cultures resulted in the significant release of proteins from the bacterial cells. This suggests that EO affects the structural integrity of the bacterial cells. Furthermore, the anti-biofilm assay confirmed the efficacy of CSEO as a potent anti-biofilm agent. It demonstrated the oil's ability to inhibit quorum sensing, a crucial mechanism for biofilm formation, and its competitive performance compared to the tested antibiotics.

Effect of antibiotic medicines availability on adherence to standard treatment guidelines among hospitalized adult patients in southern Malawi

BACKGROUND

Antibiotic resistance is a global public health problem. High and inappropriate use of antibiotic therapy exacerbate the risk of antibiotic resistance. We assessed the effect of availability of antibiotic medicines on adherence to standard treatment guidelines among hospitalized adult patients in Southern Malawi.

METHODS

A cross-sectional study was done to assess the availability of 16 antibiotics among the first-line recommended treatments for common bacterial infections in Malawi. Data for up to six-month duration was extracted from stock card records in Machinga and Nsanje District Hospitals and Zomba Central Hospital. This was complemented by a retrospective review of 322 patient management files from medical wards to assess adherence to the Malawi Standard Treatment Guidelines (MSTG). Investigators abstracted data such as patient demographics, diagnoses, and prescribed therapy using a data collection form that resulted in analyzing 304 patient files. Data was entered into Microsoft excel and analyzed using STATA 14.1. Point availability, stock-out duration and adherence to treatment guidelines were presented in terms of frequencies and percentages. Chi-square test or Fisher's exact test was applied to assess the association between variables and adherence to treatment guidelines.

RESULTS

Point availability of antibiotics was 81.5%, 87.7%, and 42.8% for Zomba Central, Machinga and Nsanje District Hospitals respectively. Over a period of six months, 12.5% of antibiotic medicines were stocked out for at least one day at Zomba (Median stock out days = 0, (IQR 0-0 days), while 64.3% were stocked out at Machinga (Median stock out days = 21, IQR 0-31 days) and 85.7% were stocked out at Nsanje District Hospital (Median stock out days = 66.5, IQR 18-113 days). Overall, adherence to MSTG was 79.6%, (95% CI, 73.3-84.9%). By facilities, adherence to guidelines at Zomba Central Hospital was 95.9% (95% CI, 89.7-98.9%) while at Nsanje and Machinga District Hospitals was 73.2% (95% CI, 59.7-84.2%) and 54.2% (95% CI, 39.2-68.6%) respectively. Adherence to treatment guidelines was associated with health facility, presence of laboratory test results, antibiotic spectrum, and WHO-AWaRe category of the medicine, p<0.005. Adherence was lower for antibiotics that were stocked out than antibiotics that were not stocked out during the study period (63.8%, 95% CI 48.5-77.3% vs 84.4%, 95% CI 77.7-89.8%), p< 0.002.

CONCLUSION

We found unstable availability of antibiotic medicines in hospitals which might contribute to the sub-optimal adherence to standard treatment guidelines. This is a setback to efforts aimed at curbing antibiotic resistance in Malawi.

Determination of causes of adult deaths using minimally invasive tissue sampling in Gandaki province of Nepal: a multicenter hospital-based study

BACKGROUND

Minimally Invasive Tissue Sampling (MITS) has been successfully used to establish the cause of death in low- and middle-income countries, mostly in stillbirths and neonates. The objective of this study was to determine the causes of death among adults using MITS in the Gandaki province of Nepal and to find out the contribution of MITS to identify the causes of death.

METHODS

A multicentric hospital-based pilot study was conducted to enroll 100 cases of adult deaths. The specimens of cerebrospinal fluid, blood, brain, lungs, and liver tissue were collected utilizing MITS. These specimens underwent standard histopathological, serological, and microbiological analyses. The findings from MITS, and if available, clinical records and forensic autopsy findings were compiled and the cause of death panel identified the causes of death. The final cause of death allocated to each case was based on the WHO International Medical Certificate of Death.

RESULTS

Among a total of 100 cases enrolled during the study period, infectious cause attributed to the immediate cause of death in 77 (77%), cardiovascular in 10 (10%), neurological in 8 (8%), malignancy in two (2%), and gastrointestinal and hepatobiliary cause in one (1%) case. The mean age of the cases was 50.8 ± 15.9 years and 76 (76%) were males. MITS established the cause of death in the causal chain of events in 81(81%) cases and identified the cause of death significantly more with infectious than non-infectious causes (p < 0.001).

CONCLUSIONS

MITS was useful in establishing the cause of death in the majority of adult deaths and the most common cause was infectious disease. Our findings suggest that MITS can be a valuable and alternative tool for mortality surveillance in low-resource settings, where complete diagnostic autopsies are less accepted or less prioritized.

Isoniazid Mono-Resistant Tuberculosis Presenting as Empyema Thoracis With Citrobacter koseri and Morganella morganii Infections: The World's First Reported Case of Its Type

Drug resistance is very common in developing countries. Isolated cases of concomitant infection with Mycobacterium tuberculosis, Citrobacter koseri, and Morganella morganii are rare. Furthermore, there is no report available in the literature of concurrent infection of Citrobacter koseri and Morganella morganii in an isoniazid mono-resistant tuberculosis patient. In this case, we present a concomitant infection with drug-resistant strains of Mycobacterium tuberculosis, Citrobacter koseri, and Morganella morganii in a 40-year-old Indian male who presented with fever, dry cough, and chest pain. He was initiated on an isoniazid mono regimen and a broad-spectrum antibiotic, following the national guidelines.

Bridge-DNA synthesis triggered by an allosteric aptamer for the colorimetric detection of pathogenic bacteria

Rapid and sensitive quantification of pathogenic bacteria is highly desired for environmental health supervision and food safety control. Yet, the amplification and detection of bacteria with a concentration lower than 10² cfu mL^-1 remains a great challenge. Here, we combined an allosteric aptamer (AAP) with a gold nanoparticle (AuNP) for assembling a bridge-DNA synthesis system (named as AuNP-BDS) to amplify the bacterial signals. The AAP and its paired primer (PP) were covalently linked to two different AuNPs, respectively: one named as AAP-AuNP and the other PP-AuNP. Upon recognition of the antigen from the pathogenic bacteria, AAP alters its conformation to initiate DNA synthesis on the AuNP surface. The DNA products from AAP-AuNP and PP-AuNP form bridges to each other through base pairing, resulting in the aggregation and colorimetric response of the AuNPs. By using E. coli O157:H7 as an example, the AuNP-BDS could quantify pathogenic bacteria in water with a concentration as low as 10 cfu mL^-1 within 60 min and without any enrichment. The colorimetric response values of AuNP-BDS were found to be linearly related to the bacterial concentrations in the range of 10 to 10³ cfu mL^-1. Good practicability of the AuNP-BDS in quantifying E. coli O157:H7 from tap water, juices, and milks was demonstrated. The AuNP-BDS could be exploited to facilitate the rapid and sensitive quantification of pathogenic bacteria for food safety control.

Prevalence of Antibiotic Use and Disposal at Household Level in Informal Settlements of Kisumu, Kenya

The use and abuse of antibiotics are directly related to the development of drug resistance, a global public health problem. Whereas the majority of research focus is on the use and misuse of antibiotics in drug resistance development, little is known about improper disposal, as a source of contamination in the environment that includes groundwater, especially in informal settlements. This study sought to determine antibiotic use and disposal in informal settlements in Kisumu, Kenya. A random cross-sectional sample of 447 households in selected informal settlements of Kisumu, Kenya was studied. A structured questionnaire was issued to persons heading households. The prevalence of antibiotic use was 43% (n = 193). Among these people, 74% (n = 144) had consulted a health worker in a healthcare facility for a prescription. Respondents did not always complete doses but kept the remainder for the next time they would become ill (54%). About 32% disposed of the remainder of the antibiotics in pit latrines and compost pits (10%) while 4% disposed through burning. Antibiotic use was fairly high despite a low level of awareness of the health effects of consuming water contaminated with antibiotics (35%) (n = 156); p = 0.03. Misuse and inappropriate disposal of antibiotics as identified may lead to a higher risk of antibiotic resistance, increasing the disease burden in the informal settlements.

Social determinants of health and the double burden of disease in Nepal: a secondary analysis

Background

As the global burden of disease evolves, lower-resource countries like Nepal face a double burden of non-communicable and infectious disease. Rapid adaptation is required for Nepal’s health system to provide life-long, person-centred care while simultaneously improving quality of infectious disease services. Social determinants of health be key in addressing health disparities and could direct policy decisions to promote health and manage the disease burden. Thus, we explore the association of social determinants with the double burden of disease in Nepal.

Methods

This is a retrospective, ecological, cross-sectional analysis of infectious and non-communicable disease outcome data (2017 to 2019) and data on social determinants of health (2011 to 2013) for 753 municipalities in Nepal. Multinomial logistic regression was conducted to evaluate the associations between social determinants and disease burden.

Results

The ‘high-burden’ combined double burden (non-communicable and infectious disease) outcome was associated with more accessible municipalities, (adjOR3.94[95%CI2.94–5.28]), municipalities with higher proportions of vaccine coverage (adjOR12.49[95%CI3.05–51.09]) and malnutrition (adjOR9.19E103[95%CI19.68E42-8.72E164]), lower average number of people per household (adjOR0.32[95%CI0.22–0.47]) and lower indigenous population (adjOR0.20[95%CI0.06–0.65]) compared to the ‘low-burden’ category on multivariable analysis. ‘High-burden’ of non-communicable disease was associated with more accessible municipalities (adjOR1.93[95%CI1.45–2.57]), higher female proportion within the municipality (adjOR1.69E8[95%CI3227.74–8.82E12]), nutritional deficiency (adjOR1.39E17[95%CI11799.83–1.64E30]) and malnutrition (adjOR2.17E131[95%CI4.41E79-1.07E183]) and lower proportions of population under five years (adjOR1.05E-10[95%CI9.95E-18–0.001]), indigenous population (adjOR0.32[95%CI0.11–0.91]), average people per household (adjOR0.44[95%CI0.26–0.73]) and households with no piped water (adjOR0.21[95%CI0.09–0.49]), compared to the ‘low-burden’ category on adjusted analysis. ‘High burden’ of infectious disease was also associated with more accessible municipalities (adjOR4.29[95%CI3.05–6.05]), higher proportions of population under five years (adjOR3.78E9[95%CI9418.25–1.51E15]), vaccine coverage (adjOR25.42[95%CI7.85–82.29]) and malnutrition (adjOR4.29E41[95%CI12408.29–1.48E79]) and lower proportions of households using firewood as fuel (adjOR0.39[95%CI0.20–0.79]) (‘moderate-burden’ category only) compared to ‘low-burden’.

Conclusions

While this study produced imprecise estimates and cannot be interpreted for individual risk, more accessible municipalities were consistently associated with higher disease burden than remote areas. Female sex, lower average number per household, non-indigenous population and poor nutrition were also associated with higher burden of disease and offer targets to direct interventions to reduce the burden of infectious and non-communicable disease and manage the double burden of disease in Nepal.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13905-3.