International Medical Publisher Journals (iMedPub)
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Antibiotherapy management in respiratory infections in ambulatory in Tunisia
Get PDFAcute respiratory tract infections are the commonest acute conditions managed in general practice and the main causes of antibiotic use. In Tunisia, the rates of antibiotic prescriptions remain high in general practice. In order to assess antibiotics prescribing practices of 23 general practitioners when facing an ENT or a respiratory tract infection, we conducted an observational study from February 1st, 2014 to November 25th, 2014.
The study involved 374 patients, 45.6 mean age of years, among them 193 men (51.6%) and 174 (51.9%) with comorbidities. Tonsillitis, acute maxillary sinusitis and acute bronchitis are the main diagnosis, accounting for over 90% of ENT and respiratory tract infection. The diagnosis of these infections was based on clinical criteria, additional tests were prescribed for only 75 patients (20%).
An antibiotic was prescribed for 360 patients (96.2%). β-lactams were the main prescribed class of antibiotics (58.3%). The antibiotic treatment was considered as inappropriate in 42.5% of prescriptions. The main causes were the prescription of amoxicillin-clavulanic acid during tonsillitis, non-antipneumococcal fluoroquinolones, when streptococci or streptococcus pneumoniae are presumed to be responsible for infection (tonsillitis, acute maxillary sinusitis, pneumonia), and unnecessary combination of antibiotics.
A concomitant treatment was prescribed for 365 patients (97.6%). The most prescribed drugs were antipyretics (71.4%), corticosteroids (44.7%) and mucolytic (30.2%).
The outcome was favorable in 333 cases (89%) and unfavorable in 26 cases (7.1%). The total average cost of an infectious episode was 79.776 ± 36.988 TND (45 ± 20 USD)., with a minimum and maximum values respectively 19.5 and 315.5 TND (35 to 558 USD).
This study highlights the frequency of antibiotics prescription (96.2%) during supposed viral infections such as acute bronchitis, tonsillitis or when antibiotic prescription has to be debatable such as in acute otitis media, sinusitis maxillary or exacerbations of COPD.
The over-use of antibiotics is an important concern in many countries of the region leading to emergence of bacterial resistance. National guidelines should be developed in order to promote rational use of antibiotics
Detection and Antibiotic Resistance Pattern of Staphylococcus aureus and MRSA Isolated from Healthcare Workers Nares at Gaza Hospitals, Palestine
Get PDFBackground: Staphylococcus aureus is a significant cause of nosocomial morbidity and mortality and has been identified as an emerging problem in the community. Here we detect the carriage rate and antibiotic resistance pattern of S. aureus and MRSA isolated from 140 healthcare workers (HCWs) nares at Gaza hospitals.Methods: A cross sectional study was conducted on a total of 140 HCWs. S. aureus were recovered and identified from nasal swabs by conventional and molecular laboratory techniques. Susceptibility to 13 commonly used antibiotics against S. aureus infections was determined by disk diffusion test according to the CLSI guidelines. Testing by PCR for the presence of nuc, mecA, cap5 and cap8 genes was performed on all isolates.Results: The nasal carriage rate of S. aureus was 42.1% (59/140), of MRSA was 22.6% (32/140) and of MSSA was 19.3% (27/140), with the highest carriage rate of MRSA among HCWs from surgery wards. There was no significant difference between the gender or hospitals with regard to S. aureus and MRSA carriage rate. However, a statistically significant difference was found for ward type and work experience. All 59 strains of S. aureus were sensitive to vancomycin and doxycycline, while nearly all were resistant to penicillin and ampicillin. The antibiotic resistance among MRSA was much higher than that among MSSA with a statistically significant difference for most antibiotics tested. Nearly 61% of isolates were noted to be multidrug resistant with higher percentage in MRSA (24/32; 75%) in comparison to MSSA (12/27; 44,44%). All isolates were successfully genotyped for capsular polymorphism type 5 (55.9%) and type 8 (44.1%).Conclusion: This is the first study in Gaza Strip investigating the nasal carriage of S. aureus among HCWs. High number of MRSA isolates were shown to be MDR. These results highlight the critical need for screening and tracking MRSA among HCWs and to monitor and manage the usage of antibiotics in the hospitals and community.Â
Prevalence of carbapenem resistance encoding genes and corresponding MIC 90 in enterobacteriaceae at a tertiary care center in Lebanon
No full textBackground: The aim of this study was to correlate genes involved in carbapenem resistance to MIC levels among clinical ESBL and non-ESBL producing carbapenem resistant Enterobacteriaceae (CRE) isolates of Escherichia coli and Klebsiella pneumoniae. Materials and Methods: E. coli (n= 76) and K. pneumoniae (n=54), collected between July 2008 and July 2014, were analyzed. The MICs were determined against ertapenem (ERT), imipenem (IMP) and meropenem (MER). PCR was performed on all 130 isolates to amplify the resistance and outer membrane proteins (OMPs) encoding genes: bla OXA-48, blaNDM-1,blaTEM-1,blaCTX-M-15, ompCand ompF.Sequencing was performed on selected isolates.  Results: The prevalence of bla OXA-48, blaNDM-1, blaTEM-1 and/or blaCTX-M-15 among E. coli isolates were 36%, 12%, 20% and 80%, respectively, while among K. pneumoniae they were 37%, 28%, 28% and 72%, respectively. K. pneumoniae isolates positive for any of these genes had an MIC90> 32µg/ml against ERT, IMP and MER, while in E. coli isolates there was a variation in the MIC90 values. Porin impermeabilitieswere due to mutations in ompCand ompF genes in E. coli, and loss of ompCand ompF genes in K. pneumoniae,andincreased MIC90 values. The presence of more than one carbapenem resistance encoding gene and/ or ESBL encoding genedid not have an effect on the MIC90 value in K. pneumoniae isolates, while in E. coliit showed higher MIC90 values. Conclusion: Levels of MIC in CRE may largely depend on the type of resistance encoding genes, and porin impermeabilities. These resultsmay provide information for antibiotic regimen selection and epidemiological monitoring of resistance
SÃndrome de DRESS inducido por sulfasalazina
Get PDFEl sÃndrome de DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), es una reacción severa inducida por fármacos que puede llegar a ser potencialmente mortal. Se han descrito mas de 50 fármacos asociados, incluyendo las sulfamidas, aunque es más frecuente su aparición por anticonvulsivantes. Presentamos el caso de un varón de 34 años de raza negra que recibió tratamiento con sulfasalazina durante 21 dÃas por una clÃnica de poliartritis. Requirió ingreso hospitalario por presentar fiebre, malestar general, rash cutáneo y alteraciones hematológicas y orgánicas. Tras 48 horas de terapia con corticoides se evidenció una respuesta con recuperación del estado general, parámetros analÃticos y resolución de lesiones cutáneas.El sÃndrome DRESS sigue teniendo una alta tasa de mortalidad por lo que una alta sospecha del mismo debe ser tenida en cuenta en aquellos pacientes que reciben estos fármacos
Sarcoidosis pulmonar inducida por Infliximab en un paciente con Artritis Psoriásica. Ausencia de recidiva con Golimumab.
No full textLa sarcoidosis es un efecto secundario de distintas terapias anti-TNFα, que puede obligar a la retirada del fármaco y a cambio de diana terapéutica, en base a un supuesto “efecto de claseâ€. Comunicamos un caso en un paciente con Artritis Psoriasica (APs) con una Sarcoidosis pulmonar paradójica inducida por Infliximab (IFX) sin recidiva de la misma tras inicio y mantenimiento de Golimumab durante más de tres años. 
Tasa de recidivismo en urgencias por dorsalgia y lumbalgia en función del tratamiento administrado tras una primera valoración
Get PDFEl recidivismo en urgencias es la demanda asistencial generada por pacientes que ya han sido valorados previamente por el mismo motivo o por un motivo derivado por el tratamiento indicado. El propósito del presente estudio es determinar en qué medida influye el tipo de tratamiento analgésico pautado en los procesos dolorosos axiales dorsales y lumbalgia en el recidivismo. Se realizó un estudio retrospectivo sobre 24490 registros de pacientes que consultaron por estos motivos en urgencias entre 2010 y 2015. Se identificaron la existencia de consultas posteriores hasta cumplidos 30 dÃas y el tipo de tratamiento analgésico pautado. En general el 18.02% de los pacientes consultaron nuevamente antes del primer mes. A los 30 dÃas la proporción de pacientes que no habÃan reconsultado fue 67.4%, 78.6% y 91.7%, según fueron tratados con medicamentos del primer, segundo o tercer escalón analgésico. En todos los periodos de observación, el mal control analgésico fue el principal motivo de reconsulta. La identificación de eventos adversos como causa de consulta repetida se presentó mayoritariamente en pacientes que recibieron fármacos del segundo escalón analgésico.Aunque se requiere estudios prospectivos y controlados para validar el valor protector de ciertas prescripciones contra el recidivismo en urgencias, nuestros resultados sugieren intensamente que el uso de fármacos del tercer escalón puede tener un impacto positivo en este indicador. Urgency recidivism is defined as further need of medical assessment after a initial consultation due to the same chief complain or to an adverse effect caused by the original prescription. Aim of this study is to determine in what extent, the kind of analgesic treatment influences recidivism in patients who consulted by axial pain. A retrospective study based on 24490 records from 2010 to 2015 was performed. A survival curve was performed for each group of treatments. Globally, 18.02% of patients consulted before the first month. At the thirtieth day the proportion of patients who did not consulted again was 67.4%, 78.6% and 91.7%, according to have been treated with medications of the first, second or third analgesic step, respectively. In all periods of follow up, pain control failure was the most frequent chief complain, however, adverse effects of prescription were identified as major cause of consultation among patients who were treated with medications of the second analgesic step. Further prospective controlled studied should be performed to validate the protector value of certain prescriptions against urgency recidivism, however, our results strongly suggest that the use of medications of the third analgesic step could have a positive effect in this measure.Â
Antibiotic Susceptibility of Salmonella spp., Shigella spp. and enteropathogenic Escherichia coli strains isolated from diarrheic children in Tripoli, North Lebanon
Get PDFBackground. – Enteric infections are a leading cause of diarrheal disease and death in infants and young children, particularly in the developing regions. The aim of this study is to determine the antibiotic susceptibility of three Enterobacteriaceae enteropathogens (Salmonella spp., Shigella spp. and enteropathogenic Escherichia coli (EPEC)) isolated from hospitalized diarrheic children in North Lebanon during the period of 7 years.Methods and Findings. – 172 Enterobacteriaceae enteropathogens strains were isolated from fecal or blood specimens of 158 hospitalized diarrheic children collected at Nini hospital in Tripoli, North Lebanon. Culture, identification and antibiotic susceptibility of strains were carried out through conventional tools according to standard protocols proposed by the REMIC group and the recommendations of the European Committee on Antimicrobial Susceptibility Testing. Out of 172, 158 (91.9%) Enterobacteriaceae enteropathogens strains were isolated from stool samples and only 14 (8.1%) were isolated from blood cultures. EPEC were predominant (78/172; 45.3%), followed by Salmonella spp. (64/172; 37.2%) and Shigella spp. (30/172; 17.5%). According to API identification and immunological serotyping reports of Salmonella isolates, Salmonella Typhi was the predominant serotype (32/64; 50%). During the study period, antibiotics susceptibility testing showed that around 50% and 25% of the isolates were resistant to ampicillin and extended-spectrum cephalosporins, respectively. Overall, Salmonella Typhi strains were the most susceptible to antibiotics.Conclusion. – Our study revealed a relatively high antibiotic resistance rate of EPEC, Shigella spp. and non-Typhi Salmonella strains among studied population. The findings of this study provide useful information to survey, prevent and control diarrheal disease and antimicrobial resistance in Lebanon
Occurrence and antimicrobial susceptibility pattern of ESBL among Gram-negative bacteria isolated from burn unit of Al Shifa hospital in Gaza, Palestine
No full textAbstractBackground: Infection is an important cause of death in burns. The emergence of antimicrobial resistant pathogens like ESBL producers is leading to inappropriate/or treatment failure and increased morbidity and mortality.Objective: the purpose of this study was to determine the antimicrobial susceptibility pattern with the identification of Extended spectrum Beta-lactamase (ESBL) producers among pathogens isolated from burn patients at Al-Shifa burn unit in Gaza, Palestine.Methods: A total of 40 gram-negative bacterial isolates were obtained from burn wound patients at Al-Shifa Hospital burn unit from August 2012 to December 2012. Antibiotic susceptibility profiles were determined by the standard disc diffusion method according to CLSI guidelines. The ESBL detection was screened by using double disc diffusion method.Results: Pseudomonas aeruginosa was the predominant isolate 15 (37.5%) followed by Klebsiella pneumoniae 10 (25%), Escherichia coli 9 (22.5%), Enterobacter cloacae 4 (10%) and Acinetobacter baumannii 2 (5%). ESBL was detected in 37.5% of isolates. Most of ESBL-producing isolates were susceptible to meropenem and imipenem (80% and 73% respectively). However, ESBL producing isolates showed 100% resistance against cefotaxime, followed by ampicillin with 93.3% resistance. The resistance rate towards sulfamethoxazole/trimethoprim, tetracycline, cefepime, tobramycin and aztreonam was 80%, 73.3%, 66.7%, 60% and 60% respectively. A. baumannii isolates were resistance to all tested antibiotics.Conclusion: P. aeruginosa is the most common bacteria isolated from burn wound patients. The frequency of ESBL among gram-negative bacteria is high. Carbapenems including imipenem and meropenem remain the most effective treatment options against gram-negative producing ESBL isolated from Al-Shifa burn unit
Spontaneous Bacterial Peritonitis in the Medical Intensive Care Unit of a University Hospital in Egypt: Frequency, Bacteriological Profile, Risk Factors and Outcomes
Get PDFObjectives: This work was carried out to assess the frequency of spontaneous bacterial peritonitis (SBP) and its variants in the medical intensive care unit (ICU) of the Internal Medicine department, zagazig Faculty of Medicine, Egypt and to identify the causative organisms and their susceptibility to commonly used antimicrobials. Other objectives were to determine risk factors and clinical outcomes. Subjects and methods: One-hundred and eighty- nine patients having ascites due to liver cirrhosis were studied. Each patient was subjected to: history collection, physical examination, diagnostic paracentesis, radiological and laboratory investigations and assessment of disease severity. Organisms isolated were identified and their antibiotic susceptibility profiles were tested. MELD score was used for diseases assessment. Risk factors and clinical outcomes were concluded using statistical methods. Results: Frequency of SBP was 56.1%. Classic SBP accounted for 47.2% of cases, while the remaining 52.8% were culture negative neutrocytic ascites (CNNA). E-coli were the most frequently isolated bacteria. Piperacillin- tazobactam was the most effective antibiotic. SBP cases were significantly associated with hepatocellular carcinoma and with use of beta blockers. Patients with SBP were more likely to present with fever and abdominal pain, whereas those with non- SBP were more likely to present with hypotension. Non- significant relationship was found between SBP and non-SBP cases regarding ICU stay. Meanwhile mortality was higher among SBP cases; age and MELD score were the independent risk factor
Patterns of antibiotic prescriptions and appropriateness in the emergency room in a major secondary care hospital in Bahrain
Get PDFObjective: To describe the pattern and appropriateness of antibiotics prescribed in the emergency room in a major secondary care hospital in Bahrain.Methods: Patients aged more than or equal to 14 years old that attended emergency room and was prescribed antibiotics from 1 to 31 July 2014 were included. Data were obtained from patients’ emergency records. Antibiotic treatment was classified to appropriate, inappropriate or unjustified use according to the local or international guidelines. Chi Square was performed to evaluate the variables associated to appropriateness antibiotic treatment.Results: A total of 1313 patients were included (52.6% males), mostly in the age group 14-30 years old (45.3%). The most frequent diseases attended were upper respiratory and urinary tract infections (27.3% and 22.1%,respectively). Cefuroxime was the most prescribed antibiotic (37.5%) followed by ciprofloxacin (20.8%). Percentage of inappropriate antibiotics prescription was 81.9% mostly due to unjustified use. Inappropriate antibiotic treatment was significantly more common in males (87.1%; P-value <0.001), in patients without mentioned diagnosis, then upper respiratory tract infection (100%, 96.9%. P-value <0.001) and prescriptions written by emergency physicians (85.5%; P- value <0.001).Conclusion: The study concludes that high rate of inappropriate antibiotics use mostly among patients treated by emergency doctors