Journal Article > ResearchFull Text
Journal of the American Medical Association (JAMA). 2019 August 2; Volume 2 (Issue 8); DOI:10.1001/jamanetworkopen.2019.9118
Lenglet AD, van Deursen B, Viana R, Abubakar N, Hoare S, et al.
Journal of the American Medical Association (JAMA). 2019 August 2; Volume 2 (Issue 8); DOI:10.1001/jamanetworkopen.2019.9118
IMPORTANCE
Hand hygiene adherence monitoring and feedback can reduce health care-acquired infections in hospitals. Few low-cost hand hygiene adherence monitoring tools exist in low-resource settings.
OBJECTIVE
To pilot an open-source application for mobile devices and an interactive analytical dashboard for the collection and visualization of health care workers' hand hygiene adherence data.
DESIGN, SETTING, AND PARTICIPANTS
This prospective multicenter quality improvement study evaluated preintervention and postintervention adherence with the 5 Moments for Hand Hygiene, as suggested by the World Health Organization, among health care workers from April 23 to May 25, 2018. A novel data collection form, the Hand Hygiene Observation Tool, was developed in open-source software and used to measure adherence with hand hygiene guidelines among health care workers in the inpatient therapeutic feeding center and pediatric ward of Anka General Hospital, Anka, Nigeria, and the postoperative ward of Noma Children's Hospital, Sokoto, Nigeria. Qualitative data were analyzed throughout data collection and used for immediate feedback to staff. A more formal analysis of the data was conducted during October 2018.
EXPOSURES
Multimodal hand hygiene improvement strategy with increased availability and accessibility of alcohol-based hand sanitizer, staff training and education, and evaluation and feedback in near real-time.
MAIN OUTCOMES AND MEASURES
Hand hygiene adherence before and after the intervention in 3 hospital wards, stratified by health care worker role, ward, and moment of hand hygiene.
RESULTS
A total of 686 preintervention adherence observations and 673 postintervention adherence observations were conducted. After the intervention, overall hand hygiene adherence increased from 32.4% to 57.4%. Adherence increased in both wards in Anka General Hospital (inpatient therapeutic feeding center, 24.3% [54 of 222 moments] to 63.7% [163 of 256 moments]; P < .001; pediatric ward, 50.9% [132 of 259 moments] to 68.8% [135 of 196 moments]; P < .001). Adherence among nurses in Anka General Hospital also increased in both wards (inpatient therapeutic feeding center, 17.7% [28 of 158 moments] to 71.2% [79 of 111 moments]; P < .001; pediatric ward, 45.9% [68 of 148 moments] to 68.4% [78 of 114 moments]; P < .001). In Noma Children's Hospital, the overall adherence increased from 17.6% (36 of 205 moments) to 39.8% (88 of 221 moments) (P < .001). Adherence among nurses in Noma Children's Hospital increased from 11.5% (14 of 122 moments) to 61.4% (78 of 126 moments) (P < .001). Adherence among Noma Children's Hospital physicians decreased from 34.2% (13 of 38 moments) to 8.6% (7 of 81 moments). Lowest overall adherence after the intervention occurred before patient contact (53.1% [85 of 160 moments]), before aseptic procedure (58.3% [21 of 36 moments]), and after touching a patient's surroundings (47.1% [124 of 263 moments]).
CONCLUSIONS AND RELEVANCE
This study suggests that tools for the collection and rapid visualization of hand hygiene adherence data are feasible in low-resource settings. The novel tool used in this study may contribute to comprehensive infection prevention and control strategies and strengthening of hand hygiene behavior among all health care workers in health care facilities in humanitarian and low-resource settings.
Hand hygiene adherence monitoring and feedback can reduce health care-acquired infections in hospitals. Few low-cost hand hygiene adherence monitoring tools exist in low-resource settings.
OBJECTIVE
To pilot an open-source application for mobile devices and an interactive analytical dashboard for the collection and visualization of health care workers' hand hygiene adherence data.
DESIGN, SETTING, AND PARTICIPANTS
This prospective multicenter quality improvement study evaluated preintervention and postintervention adherence with the 5 Moments for Hand Hygiene, as suggested by the World Health Organization, among health care workers from April 23 to May 25, 2018. A novel data collection form, the Hand Hygiene Observation Tool, was developed in open-source software and used to measure adherence with hand hygiene guidelines among health care workers in the inpatient therapeutic feeding center and pediatric ward of Anka General Hospital, Anka, Nigeria, and the postoperative ward of Noma Children's Hospital, Sokoto, Nigeria. Qualitative data were analyzed throughout data collection and used for immediate feedback to staff. A more formal analysis of the data was conducted during October 2018.
EXPOSURES
Multimodal hand hygiene improvement strategy with increased availability and accessibility of alcohol-based hand sanitizer, staff training and education, and evaluation and feedback in near real-time.
MAIN OUTCOMES AND MEASURES
Hand hygiene adherence before and after the intervention in 3 hospital wards, stratified by health care worker role, ward, and moment of hand hygiene.
RESULTS
A total of 686 preintervention adherence observations and 673 postintervention adherence observations were conducted. After the intervention, overall hand hygiene adherence increased from 32.4% to 57.4%. Adherence increased in both wards in Anka General Hospital (inpatient therapeutic feeding center, 24.3% [54 of 222 moments] to 63.7% [163 of 256 moments]; P < .001; pediatric ward, 50.9% [132 of 259 moments] to 68.8% [135 of 196 moments]; P < .001). Adherence among nurses in Anka General Hospital also increased in both wards (inpatient therapeutic feeding center, 17.7% [28 of 158 moments] to 71.2% [79 of 111 moments]; P < .001; pediatric ward, 45.9% [68 of 148 moments] to 68.4% [78 of 114 moments]; P < .001). In Noma Children's Hospital, the overall adherence increased from 17.6% (36 of 205 moments) to 39.8% (88 of 221 moments) (P < .001). Adherence among nurses in Noma Children's Hospital increased from 11.5% (14 of 122 moments) to 61.4% (78 of 126 moments) (P < .001). Adherence among Noma Children's Hospital physicians decreased from 34.2% (13 of 38 moments) to 8.6% (7 of 81 moments). Lowest overall adherence after the intervention occurred before patient contact (53.1% [85 of 160 moments]), before aseptic procedure (58.3% [21 of 36 moments]), and after touching a patient's surroundings (47.1% [124 of 263 moments]).
CONCLUSIONS AND RELEVANCE
This study suggests that tools for the collection and rapid visualization of hand hygiene adherence data are feasible in low-resource settings. The novel tool used in this study may contribute to comprehensive infection prevention and control strategies and strengthening of hand hygiene behavior among all health care workers in health care facilities in humanitarian and low-resource settings.
Conference Material > Slide Presentation
Malou N, Al Asmar M, Fakhri RM, Badaro N, Kanapathipillai R, et al.
MSF Scientific Days International 2021: Innovation. 2021 May 20
Journal Article > ResearchFull Text
Open Forum Infect Dis. 2024 September 27; Volume 11 (Issue 10); DOI:10.1093/ofid/ofae579
Taher AQM, Aqel R, Alnajjar M, Walker C, Repetto E, et al.
Open Forum Infect Dis. 2024 September 27; Volume 11 (Issue 10); DOI:10.1093/ofid/ofae579
BACKGROUND
The history of conflicts in the Middle East has resulted in a high burden of complications from conflict-related wounds like posttraumatic osteomyelitis (PTO). This is particularly challenging to manage in settings like Mosul, Iraq and Gaza, Palestine, where healthcare systems are weakened. In nonconflict settings, PTO caused by Pseudomonas aeruginosa (PAPTO) can lead to >20% of treatment failures. We aim to describe the clinical characteristics, outcomes, and management, in PAPTO patients admitted to Médecins Sans Frontières (MSF) facilities in Mosul and Gaza between 1 April 2018 and 31 January 2022.
METHODS
We conducted a retrospective cohort study on patients with PAPTO diagnosed with culture of intraoperative bone biopsy, using routinely collected data.
RESULTS
Among 66 PAPTO episodes from 61 enrolled patients, 37.9% had a multidrug-resistant Pseudomonas aeruginosa, with higher antibiotic resistance in Gaza. Polymicrobial infections were prevalent (74.2%), mainly involving Staphylococcus aureus (74.1%), being predominantly methicillin-resistant (95.0%). Overall, 81.7% received appropriate antibiotic treatment, with monotherapy used in 60.6% of episodes and a median treatment duration of 45.5 days. Recurrence was observed in 24.6% of episodes within a median of 195 days (interquartile range, 64-440 days). No significant differences were found in recurrence rates based on the type of antibiotic treatment (mono- or dual therapy) or episode (mono- or polymicrobial).
CONCLUSIONS
Management of PAPTO in the conflict-affected, low-resource settings of Mosul and Gaza achieved a recurrence rate aligned with global reports through appropriate and targeted antibiotic use, primarily in monotherapy, provided over a mean treatment duration of 45.5 days.
Journal Article > LetterFull Text
BMJ. 2018 October 15; Volume 363; k4273 .; DOI:10.1136/bmj.k4273
Kanapathipillai R, Malou N, Baldwin K, Marty P, Rodaix C, et al.
BMJ. 2018 October 15; Volume 363; k4273 .; DOI:10.1136/bmj.k4273
Journal Article > ReviewFull Text
Clin Microbiol Infect. 2021 October 1; Volume 27 (Issue 10); 1414-1421.; DOI:10.1016/j.cmi.2021.04.015
Ronat JB, Natale A, Kesteman T, Andremont A, Elamin W, et al.
Clin Microbiol Infect. 2021 October 1; Volume 27 (Issue 10); 1414-1421.; DOI:10.1016/j.cmi.2021.04.015
BACKGROUND
In low- and middle-income countries (LMICs), data related to antimicrobial resistance (AMR) are often inconsistently collected. Humanitarian, private and non-governmental medical organizations (NGOs), working with or in parallel to public medical systems, are sometimes present in these contexts. Yet, what is the role of NGOs in the fight against AMR, and how can they contribute to AMR data collection in contexts where reporting is scarce? How can context-adapted, high-quality clinical bacteriology be implemented in remote, challenging and underserved areas of the world?
OBJECTIVES
The aim was to provide an overview of AMR data collection challenges in LMICs and describe one initiative, the Mini-Lab project developed by Médecins Sans Frontières (MSF), that attempts to partially address them.
SOURCES
We conducted a literature review using PubMed and Google scholar databases to identify peer-reviewed research and grey literature from publicly available reports and websites.
CONTENT
We address the necessity of and difficulties related to obtaining AMR data in LMICs, as well as the role that actors outside of public medical systems can play in the collection of this information. We then describe how the Mini-Lab can provide simplified bacteriological diagnosis and AMR surveillance in challenging settings.
IMPLICATIONS
NGOs are responsible for a large amount of healthcare provision in some very low-resourced contexts. As a result, they also have a role in AMR control, including bacteriological diagnosis and the collection of AMR-related data. Actors outside the public medical system can actively contribute to implementing and adapting clinical bacteriology in LMICs and can help improve AMR surveillance and data collection.
In low- and middle-income countries (LMICs), data related to antimicrobial resistance (AMR) are often inconsistently collected. Humanitarian, private and non-governmental medical organizations (NGOs), working with or in parallel to public medical systems, are sometimes present in these contexts. Yet, what is the role of NGOs in the fight against AMR, and how can they contribute to AMR data collection in contexts where reporting is scarce? How can context-adapted, high-quality clinical bacteriology be implemented in remote, challenging and underserved areas of the world?
OBJECTIVES
The aim was to provide an overview of AMR data collection challenges in LMICs and describe one initiative, the Mini-Lab project developed by Médecins Sans Frontières (MSF), that attempts to partially address them.
SOURCES
We conducted a literature review using PubMed and Google scholar databases to identify peer-reviewed research and grey literature from publicly available reports and websites.
CONTENT
We address the necessity of and difficulties related to obtaining AMR data in LMICs, as well as the role that actors outside of public medical systems can play in the collection of this information. We then describe how the Mini-Lab can provide simplified bacteriological diagnosis and AMR surveillance in challenging settings.
IMPLICATIONS
NGOs are responsible for a large amount of healthcare provision in some very low-resourced contexts. As a result, they also have a role in AMR control, including bacteriological diagnosis and the collection of AMR-related data. Actors outside the public medical system can actively contribute to implementing and adapting clinical bacteriology in LMICs and can help improve AMR surveillance and data collection.
Journal Article > CommentaryFull Text
J Antimicrob Chemother. 2019 April 10; Volume 1 (Issue 1); dlz002.; DOI:10.1093/jacamr/dlz002
Kanapathipillai R, Malou N, Hopman J, Bowman C, Yousef N, et al.
J Antimicrob Chemother. 2019 April 10; Volume 1 (Issue 1); dlz002.; DOI:10.1093/jacamr/dlz002
Médecins Sans Frontières (MSF) has designed context-adapted antibiotic resistance (ABR) responses in countries across the Middle East. There, some health systems have been severely damaged by conflict resulting in delayed access to care, crowded facilities and supply shortages. Microbiological surveillance data are rarely available, but when MSF laboratories are installed we often find MDR bacteria at alarming levels. In MSF’s regional hospital in Jordan, where surgical patients have often had multiple surgeries in field hospitals before reaching definitive care (often four or more), MSF microbiological data analysis reveals that, among Enterobacteriaceae isolates, third-generation cephalosporin and carbapenem resistance is 86.2% and 4.3%, respectively; MRSA prevalence among Staphylococcus aureus is 60.5%; and resistance types and rates are similar in patients originating from Yemen, Syria and Iraq. These trends compel MSF to aggressively prevent and diagnose ABR in Jordan, providing ABR lessons that inform the antibiotic choices, microbiological diagnostics and anti-ABR strategies in other Middle Eastern MSF trauma projects (such as Yemen and Gaza).
As a result, MSF has created a multifaceted, context-adapted, field experience-based, approach to ABR in hospitals in Middle Eastern conflict settings. We focus on three pillars: (1) infection prevention and control (IPC); (2) microbiology and surveillance; and (3) antibiotic stewardship.
As a result, MSF has created a multifaceted, context-adapted, field experience-based, approach to ABR in hospitals in Middle Eastern conflict settings. We focus on three pillars: (1) infection prevention and control (IPC); (2) microbiology and surveillance; and (3) antibiotic stewardship.
Conference Material > Abstract
Malou N, Al Asmar M, Fakhri RM, Badaro N, Kanapathipillai R, et al.
MSF Scientific Days International 2021: Innovation. 2021 May 20
INTRODUCTION
Timely and accurate identification of microorganisms and assessment of antimicrobial susceptibility in clinical specimens help clinicians in selecting the most appropriate treatment for their patients. In low-to-middle income countries (LMIC), bacteriological testing is generally not performed routinely due to technological challenges. This contributes to treatment delays and consequent clinical complications, extended hospital stays, and the global spread of multidrug resistance (MDR). The MSF Foundation has developed Antibiogo, an offline smartphone-based application that allows non-microbiologists to carry out antimicrobial susceptibility testing (AST) and interpret the results. We are presenting the preliminary results of the Antibiogo performance evaluation.
METHODS
Antibiogo comprises several components: the Image Analysis Program (IAP) that detects and measures inhibition zone diameters (IZDs); the Expert System (ES) that adjusts AST results based on the application of expert rules and identifies resistance mechanisms; and the Selective Reporting Program. For the evaluation of the IAP, we used collection isolates (n=8) and compared the automatic measurement of IZDs using Antibiogo with the readings made by eight laboratory technicians who inspected the plates manually. For evaluation of the ES, we used Antibiogo to assess 60 pathogens isolated from bone and tissues from patients admitted to MSF’s Reconstructive Surgical Project in Amman, Jordan, between February and September 2020. In parallel, pictures of AST were shared with an external clinical microbiologist who performed an independent and blinded interpretation. Results of the two parallel interpretations were compared and the discordances categorised (minor, major, very major).
RESULTS
Evaluation of the IAP showed good concordance of measurements between technicians and Antibiogo (Krippendorff’s alpha value of 0.957, 95% confidence interval [CI] 0.94-0.97; p<0.001). These results indicate excellent inter-rater agreement between human raters and the Antibiogo platform for these pathogen-antibiotic pairs. For evaluation of the ES, 509 paired samples were read in parallel, and agreement of the measured diameters was excellent (R2=0.95). The ES correctly classified 474 (95.2%) of 498 interpretable samples (95% CI 92.9- 97.4), corresponding to a Krippendorff’s alpha value of 90.6% (95% CI 87%-94%). This indicates excellent to near-perfect agreement. Further investigation of the samples showing non-agreement is underway.
CONCLUSIONS
Preliminary results suggest that Antibiogo is a very promising tool that can be used for the interpretation of antibiograms. This could improve access to microbiology diagnostic tests and the rational use of antibiotics in LMIC. The application currently undergoing further evaluation using a diverse set of pathogens isolated from multiple sites.
ETHICS
This study was approved by the MSF Ethics Review Board and the Hospital Director of Al Mowasah Hospital, Amman, Jordan.
Timely and accurate identification of microorganisms and assessment of antimicrobial susceptibility in clinical specimens help clinicians in selecting the most appropriate treatment for their patients. In low-to-middle income countries (LMIC), bacteriological testing is generally not performed routinely due to technological challenges. This contributes to treatment delays and consequent clinical complications, extended hospital stays, and the global spread of multidrug resistance (MDR). The MSF Foundation has developed Antibiogo, an offline smartphone-based application that allows non-microbiologists to carry out antimicrobial susceptibility testing (AST) and interpret the results. We are presenting the preliminary results of the Antibiogo performance evaluation.
METHODS
Antibiogo comprises several components: the Image Analysis Program (IAP) that detects and measures inhibition zone diameters (IZDs); the Expert System (ES) that adjusts AST results based on the application of expert rules and identifies resistance mechanisms; and the Selective Reporting Program. For the evaluation of the IAP, we used collection isolates (n=8) and compared the automatic measurement of IZDs using Antibiogo with the readings made by eight laboratory technicians who inspected the plates manually. For evaluation of the ES, we used Antibiogo to assess 60 pathogens isolated from bone and tissues from patients admitted to MSF’s Reconstructive Surgical Project in Amman, Jordan, between February and September 2020. In parallel, pictures of AST were shared with an external clinical microbiologist who performed an independent and blinded interpretation. Results of the two parallel interpretations were compared and the discordances categorised (minor, major, very major).
RESULTS
Evaluation of the IAP showed good concordance of measurements between technicians and Antibiogo (Krippendorff’s alpha value of 0.957, 95% confidence interval [CI] 0.94-0.97; p<0.001). These results indicate excellent inter-rater agreement between human raters and the Antibiogo platform for these pathogen-antibiotic pairs. For evaluation of the ES, 509 paired samples were read in parallel, and agreement of the measured diameters was excellent (R2=0.95). The ES correctly classified 474 (95.2%) of 498 interpretable samples (95% CI 92.9- 97.4), corresponding to a Krippendorff’s alpha value of 90.6% (95% CI 87%-94%). This indicates excellent to near-perfect agreement. Further investigation of the samples showing non-agreement is underway.
CONCLUSIONS
Preliminary results suggest that Antibiogo is a very promising tool that can be used for the interpretation of antibiograms. This could improve access to microbiology diagnostic tests and the rational use of antibiotics in LMIC. The application currently undergoing further evaluation using a diverse set of pathogens isolated from multiple sites.
ETHICS
This study was approved by the MSF Ethics Review Board and the Hospital Director of Al Mowasah Hospital, Amman, Jordan.
Journal Article > ReviewFull Text
JAC Antimicrob Resist. 2023 May 17; Volume 5 (Issue 3); dlad057.; DOI:10.1093/jacamr/dlad057
Lamrous A, Repetto EC, Depp T, Jimenez C, Chua AC, et al.
JAC Antimicrob Resist. 2023 May 17; Volume 5 (Issue 3); dlad057.; DOI:10.1093/jacamr/dlad057
OBJECTIVES
C-reactive protein (CRP) and procalcitonin (PCT) are widely used biomarkers in high-income countries. However, evidence for their use in low- and middle-income countries (LMICs) is scant. Because many factors, including rates of endemic disease, comorbidities and genetics, may influence biomarkers’ behaviour, we aimed to review available evidence generated in LMICs.
METHODS
We searched the PubMed database for relevant studies within the last 20 years that originated in regions of interest (Africa, Latin America, Middle East, South Asia or South East Asia), and full-text articles involving diagnosis, prognostication and evaluation of therapeutic response with CRP and/or PCT in adults (n = 88) were reviewed and categorized in 12 predefined focus areas.
RESULTS
Overall, results were highly heterogeneous, at times conflicting, and often lacking clinically useful cut-off values. However, most studies demonstrated higher levels of CRP/PCT in patients with bacterial versus other infections. HIV and TB patients had consistently higher levels of CRP/PCT versus controls. In addition, higher CRP/PCT levels at baseline and follow-up in HIV, TB, sepsis and respiratory tract infections were associated with poorer prognosis.
CONCLUSIONS
Evidence generated from LMIC cohorts suggests that CRP and PCT may have potential to become effective clinical guiding tools particularly in respiratory tract infections, sepsis and HIV/TB. However, more studies are needed to define potential scenarios for use and cost-effectiveness. Consensus across stakeholders regarding target conditions, laboratory standards and cut-off values would support the quality and applicability of future evidence.
C-reactive protein (CRP) and procalcitonin (PCT) are widely used biomarkers in high-income countries. However, evidence for their use in low- and middle-income countries (LMICs) is scant. Because many factors, including rates of endemic disease, comorbidities and genetics, may influence biomarkers’ behaviour, we aimed to review available evidence generated in LMICs.
METHODS
We searched the PubMed database for relevant studies within the last 20 years that originated in regions of interest (Africa, Latin America, Middle East, South Asia or South East Asia), and full-text articles involving diagnosis, prognostication and evaluation of therapeutic response with CRP and/or PCT in adults (n = 88) were reviewed and categorized in 12 predefined focus areas.
RESULTS
Overall, results were highly heterogeneous, at times conflicting, and often lacking clinically useful cut-off values. However, most studies demonstrated higher levels of CRP/PCT in patients with bacterial versus other infections. HIV and TB patients had consistently higher levels of CRP/PCT versus controls. In addition, higher CRP/PCT levels at baseline and follow-up in HIV, TB, sepsis and respiratory tract infections were associated with poorer prognosis.
CONCLUSIONS
Evidence generated from LMIC cohorts suggests that CRP and PCT may have potential to become effective clinical guiding tools particularly in respiratory tract infections, sepsis and HIV/TB. However, more studies are needed to define potential scenarios for use and cost-effectiveness. Consensus across stakeholders regarding target conditions, laboratory standards and cut-off values would support the quality and applicability of future evidence.
Journal Article > ResearchFull Text
JAC Antimicrob Resist. 2024 March 5; Volume 6 (Issue 2); dlae024.; DOI:10.1093/jacamr/dlae024
Almehdar H, Yousef N, van den Boogaard W, Haider A, Kanapathipillai R, et al.
JAC Antimicrob Resist. 2024 March 5; Volume 6 (Issue 2); dlae024.; DOI:10.1093/jacamr/dlae024
BACKGROUND
Antimicrobial resistance (AMR) is an urgent global health concern, especially in countries facing instability or conflicts, with compromised healthcare systems. Médecins Sans Frontières (MSF) established an acute trauma hospital in Aden, Yemen, treating mainly war-wounded civilians, and implemented an antimicrobial stewardship (AMS) programme. This study aimed to describe clinical characteristics and identify antibiotic susceptibility patterns representative of patients treated with antibiotics.
METHODS
Retrospective cross-sectional study using routinely collected data from all patients treated with antibiotics in the MSF-Aden Acute Trauma hospital between January 2018 and June 2021. Routine clinical data from patients’ files was entered into an AMS electronic database and microbiological data were entered into WHONET. Both databases were imported and merged in REDCap and analysed using RStudio.
RESULTS
Three hundred and sixty-three of 481 (75%) included patients were injured by violence-related trauma. Most were men aged 19–45 years (n = 331; 68.8%). In total, 598 infections were diagnosed and treated. MDR organisms were identified in 362 (60.5%) infections in 311 (65%) patients. Skin and soft-tissue infections (SSTIs) (n = 143; 24%) were the most common, followed by osteomyelitis (n = 125; 21%) and intra-abdominal-infections (IAIs) (n = 116; 19%), and 111 (19%) secondary bloodstream infections were identified. Escherichia coli was the most frequently identified pathogen, causing IAI (n = 87; 28%) and SSTI (n = 43; 16%), while Staphylococcus aureus caused mainly osteomyelitis (n = 84; 19%). Most Gram-negatives were ESBL producers, including E. coli (n = 193; 81.4%), Klebsiella pneumoniae (n = 72; 77.4%) and Enterobacter cloacae (n = 39; 50%) while most S. aureus were methicillin resistant (n = 93; 72.6%).
CONCLUSIONS
High rates of MDR were found. This information will facilitate a comprehensive review of the empirical antibiotic treatment guidelines.
Antimicrobial resistance (AMR) is an urgent global health concern, especially in countries facing instability or conflicts, with compromised healthcare systems. Médecins Sans Frontières (MSF) established an acute trauma hospital in Aden, Yemen, treating mainly war-wounded civilians, and implemented an antimicrobial stewardship (AMS) programme. This study aimed to describe clinical characteristics and identify antibiotic susceptibility patterns representative of patients treated with antibiotics.
METHODS
Retrospective cross-sectional study using routinely collected data from all patients treated with antibiotics in the MSF-Aden Acute Trauma hospital between January 2018 and June 2021. Routine clinical data from patients’ files was entered into an AMS electronic database and microbiological data were entered into WHONET. Both databases were imported and merged in REDCap and analysed using RStudio.
RESULTS
Three hundred and sixty-three of 481 (75%) included patients were injured by violence-related trauma. Most were men aged 19–45 years (n = 331; 68.8%). In total, 598 infections were diagnosed and treated. MDR organisms were identified in 362 (60.5%) infections in 311 (65%) patients. Skin and soft-tissue infections (SSTIs) (n = 143; 24%) were the most common, followed by osteomyelitis (n = 125; 21%) and intra-abdominal-infections (IAIs) (n = 116; 19%), and 111 (19%) secondary bloodstream infections were identified. Escherichia coli was the most frequently identified pathogen, causing IAI (n = 87; 28%) and SSTI (n = 43; 16%), while Staphylococcus aureus caused mainly osteomyelitis (n = 84; 19%). Most Gram-negatives were ESBL producers, including E. coli (n = 193; 81.4%), Klebsiella pneumoniae (n = 72; 77.4%) and Enterobacter cloacae (n = 39; 50%) while most S. aureus were methicillin resistant (n = 93; 72.6%).
CONCLUSIONS
High rates of MDR were found. This information will facilitate a comprehensive review of the empirical antibiotic treatment guidelines.
Conference Material > Poster
Langendorf C, Michel J, Barks P, Mollo B, Kanapathipillai R
Epicentre Scientific Day 2024. 2024 May 23