Browsing by Subject "Antimicrobial resistance"

Background: Acute febrile respiratory illnesses, including influenza, account for a large proportion of ambulatory care visits worldwide. In the developed world, these encounters commonly result in unwarranted antibiotic prescriptions; data from more resource-limited settings are lacking. The purpose of this study was to describe the epidemiology of influenza among outpatients in southern Sri Lanka and to determine if access to rapid influenza test results was associated with decreased antibiotic prescriptions.

Methods: In this pretest- posttest study, consecutive patients presenting from March 2013- April 2014 to the Outpatient Department of the largest tertiary care hospital in southern Sri Lanka were surveyed for influenza-like illness (ILI). Patients meeting World Health Organization criteria for ILI-- acute onset of fever ≥38.0°C and cough in the prior 7 days--were enrolled. Consenting patients were administered a structured questionnaire, physical examination, and nasal/nasopharyngeal sampling. Rapid influenza A/B testing (Veritor System, Becton Dickinson) was performed on all patients, but test results were only released to patients and clinicians during the second phase of the study (December 2013- April 2014).

Results: We enrolled 397 patients with ILI, with 217 (54.7%) adults ≥12 years and 188 (47.4%) females. A total of 179 (45.8%) tested positive for influenza by rapid testing, with April- July 2013 and September- November 2013 being the periods with the highest proportion of ILI due to influenza. A total of 310 (78.1%) patients with ILI received a prescription for an antibiotic from their outpatient provider. The proportion of patients prescribed antibiotics decreased from 81.4% in the first phase to 66.3% in the second phase (p=.005); among rapid influenza-positive patients, antibiotic prescriptions decreased from 83.7% in the first phase to 56.3% in the second phase (p=.001). On multivariable analysis, having a positive rapid influenza test available to clinicians was associated with decreased antibiotic use (OR 0.20, 95% CI 0.05- 0.82).

Conclusions: Influenza virus accounted for almost 50% of acute febrile respiratory illness in this study, but most patients were prescribed antibiotics. Providing rapid influenza test results to clinicians was associated with fewer antibiotic prescriptions, but overall prescription of antibiotics remained high. In this developing country setting, a multi-faceted approach that includes improved access to rapid diagnostic tests may help decrease antibiotic use and combat antimicrobial resistance.

Background: Post-cesarean section peritonitis is the leading cause of maternal morbidity and mortality at the main referral hospital in Rwanda. Published data on the management of post-cesarean section peritonitis is limited. This study examined predictors of maternal morbidity and mortality for post-cesarean peritonitis.

Methods: We performed a prospective observational cohort study at the University Teaching Hospital Kigali (CHUK) from January 1 until December 31 2015, followed by a retrospective chart review of all subjects with post-cesarean section peritonitis admitted to CHUK from January 1 until December 31, 2014. All patients admitted with the diagnosis of post-cesarean section peritonitis undergoing exploratory laparotomy at CHUK were enrolled. Patients were followed to either discharge or death. Study variables included baseline demographic/clinical characteristics, admission physical exam, intraoperative findings, and management. Data were analyzed using STATA version 14.

Results: Of the 167 patients enrolled, 81 survived without requiring hysterectomy (49%), 49 survived requiring hysterectomy (29%), and 36 died (22%). In the multivariate analysis, severe sepsis was the most significant predictor of mortality (RR=4.0 [2.2-7.7]) and uterine necrosis was the most significant predictor of hysterectomy (RR=6.3 [1.6-25.2]). There were high rates of antimicrobial resistance (AMR) among the bacterial isolates cultured from intra-abdominal pus, with 52% of bacteria resistant to third-generation cephalosporins.

Conclusions: Post-cesarean section peritonitis carries a high mortality rate in Rwanda. It is also associated with a high rate of hysterectomy. Understanding the disease process and identifying factors associated with outcomes can help guide management during admission.

Background: Antimicrobial overprescription has been associated with antimicrobial resistance, and is common for lower respiratory tract infections (LRTI) as viral and bacterial infections generally present with similar clinical features. The aim of this study was to identify the prevalence and predictors of antibiotic prescription among children and adults hospitalized with viral LRTI. Methods: A prospective cohort study was conducted among patients hospitalized with viral LRTI in a tertiary care hospital in Southern Province, Sri Lanka from April 2018 to October 2021. Consecutive patients ≥1 year old who met a case definition for LRTI were enrolled. Patients’ demographic, clinical, and laboratory data were recorded. A nasopharyngeal sample and blood sample were collected from all patients for multiplex polymerase chain reaction (PCR) testing for respiratory pathogens and procalcitonin (PCT) detection, respectively. Among patients with viral RTI, demographic and clinical features associated with antibiotic prescription were identified using Chi Square and t-tests, as appropriate. Significant variables (p<0.05) on bivariable analyses were included in a multivariable logistic regression model to identify features associated with antibiotic prescription. The potential impact of procalcitonin testing on antibiotic prescription was simulated using standard PCT cut-offs. Analyses were conducted separately for children (<18 years) and adults using R Statistical Software (R Core Team 2022). Results: A total of 1217 patients were enrolled during the study period; of these, 438 (36.0%) had one or more respiratory viruses detected. Of 438 patients, 48.4% were male and 30.8% were children; the median age was 4 years (IQR 2-7) for children and 61 years (IQR 48-70) for adults. The most commonly detected viruses were influenza A (39.3%), human rhinovirus/ enterovirus (HRV/HEV; 28.3%), and respiratory syncytial virus A (RSV A; 10.3%). Overall, 114 (84.4%) children and 266 (87.8%) adults with respiratory viruses were treated with antibiotics during hospitalization. On multivariable modeling for children, neutrophil percentage (median 63.8% vs 47.3%, p=0.03) was positively associated with antibiotic prescription. Among adults, headache (60.6% vs 35.1%, p=0.003), presence of crepitations/crackles on exam (55.3% vs 21.6%, p<0.001), rhonchi/wheezing on exam (42.9% vs 18.9%, p=0.005), and presence of opacities on chest x-ray (27.4% vs 8.1%, p=0.01) were associated with antibiotic prescription. Access to PCT test results could have potentially decreased inappropriate antibiotic prescription in this study by 83.3%. Conclusions: A high percentage of viral detection and high prevalence of antibiotic prescription were observed among a large inpatient cohort with LRTI. Our results suggest that improved access to point-of-care biomarker testing may improve antimicrobial stewardship for LRTI in this low-resource setting.