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38 result(s)
Journal Article > ReviewFull Text

Conflict-associated wounds and burns infected with GLASS pathogens in the Eastern Mediterranean Region: A systematic review

BMC Infect Dis. 7 February 2025; Volume 25 (Issue 1); 187.; DOI:10.1186/s12879-025-10569-3
Wild A, Shortall C, Dewachi O, Naim C, Green A,  et al.
BMC Infect Dis. 7 February 2025; Volume 25 (Issue 1); 187.; DOI:10.1186/s12879-025-10569-3

BACKGROUND

While the relationship between conflict-associated injuries and antimicrobial resistance is increasingly being elucidated, data concerning civilian casualties is sparse. This systematic review assesses literature focused on Global Antimicrobial Resistance Surveillance System (GLASS) Priority Pathogens causing infections in civilian wounds and burns in conflict-affected countries within the World Health Organisation's Eastern Mediterranean Region Office (EMRO)


METHODS

 A systematic literature review was conducted following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Five databases and grey literature were searched, identifying studies published from January 2010 to June 2024. Search terms included "wounds", "burns," "antimicrobial resistance", and the twelve countries of interest. Included studies reported resistance of GLASS pathogens. Two reviewers used Covidence to assess papers for inclusion. Data were extracted into a spreadsheet for analysis. Where quantitative data were available, medians, interquartile ranges and percentages were calculated by pathogen and country.


RESULTS

621 records were identified; 19 studies met inclusion criteria. Nine of the papers were from Iraq, three from Libya, three from Lebanon, one each from Yemen and Gaza; two reported on conflict affected refugees in Jordan. A total of 1,942 distinct microbiological isolates were reported, representing all four critical and high priority GLASS pathogen categories. Among the isolates, Staphylococcus aureus was the most prevalent (36.3%). Median resistances identified: Methicillin resistant Staphylococcus aureus (n = 680): 55.6% (IQR:49.65-90.3%); carbapenem resistant Pseudomonas aeruginosa (n = 372): 22.14% (7.43-52.22%); carbapenem resistant Acinetobacter baumannii (n = 366): 60.3% (32.1-85%); carbapenem resistant Klebsiella pneumoniae (n = 75): 12.65% (9.73-34.25%); ceftriaxone resistant Escherichia coli (n = 63): 76% (69-84.65%); ceftriaxone resistant Klebsiella pneumoniae (n = 40): 81.45% (76.73-86.18%). Only three studies had a low risk of bias.


DISCUSSION

Findings imply high rates of GLASS priority pathogens among wounded civilians in conflict-affected EMRO countries. However, evidence was heterogeneous, low quality and sparse in certain countries, highlighting the necessity of effective surveillance including standardised data collection. Improving primary data will facilitate the production of large, high-quality studies throughout the EMRO, including under-represented countries.

Conclusion: Laboratory diagnostic capacity building and improved surveillance in conflict-affected settings in the Eastern Mediterranean Region are required to assess the burden of GLASS priority pathogens in vulnerable non-combatant populations.

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Journal Article > ResearchFull Text

Overuse of antibiotics for urinary tract infections in pregnant refugees, Lebanon

Bull World Health Organ. 1 June 2024; Volume 102 (Issue 06); 389-399.; DOI:10.2471/BLT.23.291235
Al Kady C, Moussally K, Chreif W, Farra A, Caluwaerts S,  et al.
Bull World Health Organ. 1 June 2024; Volume 102 (Issue 06); 389-399.; DOI:10.2471/BLT.23.291235
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OBJECTIVE
To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use.

METHODS
We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Médecins Sans Frontières sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm.

FINDINGS
The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48 euros per woman.

CONCLUSION
A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible.
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Conference Material > Slide Presentation

Antibiogo as an innovative solution to detect antimicrobial resistance: from an operational need to a CE-marked diagnostic test available for low-income and middle-income countries

Rapoud D, Cramer E, Al Asmar M, Sagara F, Ndiaye B,  et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/2acXDPpuix
Conference Material > Video

Antibiogo as an innovative solution to detect antimicrobial resistance: from an operational need to a CE-marked diagnostic test available for low-income and middle-income countries

Malou N
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/FYVqmt4gsw
Conference Material > Poster

A nurse-led home-care programme for people with restricted mobility and their caregivers living in refugee camps: a descriptive study

Tarantini F, Soukarieh D, Sunallah M, Moussally K, El-Hawari N,  et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/kBd2zY4Z
Conference Material > Video

Are antibiotics being over-prescribed for the treatment of urinary tract infections? A prospective study among pregnant refugees in Beirut, Lebanon

Al Kady C
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/6cdv-9f90
Conference Material > Abstract

Are antibiotics being over-prescribed for the treatment of urinary tract infections? A prospective study among pregnant refugees in Beirut, Lebanon

Al Kady C, Moussally K, Caluwaerts S, Chreif W, Dibiasi J,  et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/73jr-dg45
INTRODUCTION
Inappropriate use of antibiotics is widespread, and one of the main drivers for antimicrobial resistance (AMR). In pregnant women with suspected urinary tract infection (UTI), studies have suggested antibiotic over-use in up to 96%; use may be particularly high in settings with limited diagnostic resources and where reliant on symptomatic approaches. In south Beirut, specifically within camps where refugees settle and living conditions are poor, MSF has been operational since 2014 as the main provider of free primary healthcare services as well as sexual and reproductive health (SRH) care. Current MSF protocols operational in this setting recommend the use of urine dipsticks for UTI screening in pregnant women, followed by empirical antibiotic treatment for those with a positive result (positive for nitrites and/or leucocytes).

METHODS
In 2021, around 6,300 (24%) of the total 26,300 antenatal care (ANC) consultations conducted had a suspected UTI, based on urine dipstick results, and all those suspected with UTI were prescribed antibiotics. A prospective study was conducted between April and July 2022, to determine if adding urine
culture, following positive urine dipstick, to the protocol would reduce the use of unnecessary antibiotics. We used descriptive statistics to describe the population and compare positive and negative urine cultures. We calculated the proportion of patients receiving appropriate or inappropriate antibiotics.

ETHICS
This study was approved by the MSF Ethics Review Board, and by the ethics committee of the Lebanese American University.

RESULTS
A total of 449 pregnant women with suspected UTI were included in this study; all received urine culture. 81 (18%) were culture-positive. Under usual practice, 368 women (82%) would have been overprescribed antibiotics, based solely on urine dipstick results. 197 (44%) of the cohort were symptomatic, and were given empirical antibiotic treatment, with cefixime administered to 42 (21%) women and fosfomycin to 155 (79%). Escherichia coli (79%) was the most common bacterial species isolated, followed by Proteus (11%). In addition, among the 81 positive cultures, 4 (5%) were found resistant to fosfomycin and 39 (48%) to cefixim

CONCLUSION
These study findings reinforce concern around potential over prescription of unnecessary antibiotics in such populations, which could contribute to a potential rise in AMR. In addition, resistance to cefixime, one of the recommended antibiotics to treat UTI’s, is relatively high in this community. In contexts where urine culture is feasible, not costly, accessible, and results rapidly available, particularly with large cohorts of patients, urine culture should be the main method used to diagnose UTI; treatment should be based on microbiology/antibiotic sensitivity results.

CONFLICTS OF INTEREST
None declared.
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Conference Material > Slide Presentation

Are antibiotics being over-prescribed for the treatment of urinary tract infections? A prospective study among pregnant refugees in Beirut, Lebanon

Al Kady C, Moussally K, Caluwaerts S, Chreif W, Dibiasi J,  et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/hymf-1a27
Conference Material > Poster

How is MSF developing its position on antimicrobial resistance in relation to global policies and local practices? An anthropological study in Lebanon

Trentesaux M, Pellecchia U, Naim C, Baxerres C
MSF Scientific Day International 2023. 7 June 2023
Conference Material > Poster

Evaluating task-sharing for non-communicable disease management in humanitarian settings: lessons learned from MSF’s model of care in Lebanon

Doumit M, Masri S, Beltran I, Incerti A, Ciglenecki I,  et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/wad8-6g32