Conference Material > Video (talk)
Malaeb R, Nagwan Y
Epicentre Scientific Day Paris 2022. 2022 June 21
Conference Material > Abstract
Malaeb R, Nagwan Y
Epicentre Scientific Day Paris 2022. 2022 June 1
BACKGROUND
Antimicrobial resistance (AMR) is a global health problem and growing at an alarming rate, resulting in a rapid deterioration of the effectiveness of antibiotics. The middle and low-income countries are currently carrying the highest burden resulting in an increased risk of death, prolonged treatment duration and unaffordable costs of antibiotic therapy. In countries like Yemen, this problem appears to be more complex due to the current war, high number of trauma patients and limited access to healthcare. In this study we aimed to describe the clinical characteristics and antimicrobial resistance patterns among patients treated at the MSF Aden Acute Trauma hospital.
METHODS
We conducted a retrospective descriptive analyses using routinely collected programme data for all patients who were admitted between 2018 and June 2021 and received antibiotic therapy for a diagnosed infection based on MSF guidelines.
RESULTS
The study cohort consisted of 481 trauma patients treated with antibiotics for more than 500 infections. The most common infections were soft and skin tissue infection (25%), intra-abdominal infection (20%), and osteomyelitis (20%). Secondary blood stream infections were also present in 20% of all the diagnosed infections. 65 % of these patients were infected with at least one multi-drug resistant (MDR) organism. A wide variety of 993 isolated organisms were detected mainly consisting of Escherichia coli (20%), Enterococcus faecalis (14%), Staphylococcus aureus (9.7%), Pseudomonas aeruginosa (8.6%), and Klebsiella pneumoniae (8.2%). The antibiotic resistance patterns for the most common antibiotics showed a high level of resistance.
CONCLUSION
The findings of this study showed a very high number of MDR infections among trauma patients in Aden with worrisome drug resistance rate to the most antibiotics. This would assist MSF in reviewing its current empiric treatment and in strengthening its antibiotic stewardship programme.
KEY MESSAGE
A high level of antibiotic resistance patterns were observed at the MSF Aden trauma centre highlighting the need to strengthen the antibiotic stewardship programme and evaluate the current empiric treatment provided.
This abstract is not to be quoted for publication
Antimicrobial resistance (AMR) is a global health problem and growing at an alarming rate, resulting in a rapid deterioration of the effectiveness of antibiotics. The middle and low-income countries are currently carrying the highest burden resulting in an increased risk of death, prolonged treatment duration and unaffordable costs of antibiotic therapy. In countries like Yemen, this problem appears to be more complex due to the current war, high number of trauma patients and limited access to healthcare. In this study we aimed to describe the clinical characteristics and antimicrobial resistance patterns among patients treated at the MSF Aden Acute Trauma hospital.
METHODS
We conducted a retrospective descriptive analyses using routinely collected programme data for all patients who were admitted between 2018 and June 2021 and received antibiotic therapy for a diagnosed infection based on MSF guidelines.
RESULTS
The study cohort consisted of 481 trauma patients treated with antibiotics for more than 500 infections. The most common infections were soft and skin tissue infection (25%), intra-abdominal infection (20%), and osteomyelitis (20%). Secondary blood stream infections were also present in 20% of all the diagnosed infections. 65 % of these patients were infected with at least one multi-drug resistant (MDR) organism. A wide variety of 993 isolated organisms were detected mainly consisting of Escherichia coli (20%), Enterococcus faecalis (14%), Staphylococcus aureus (9.7%), Pseudomonas aeruginosa (8.6%), and Klebsiella pneumoniae (8.2%). The antibiotic resistance patterns for the most common antibiotics showed a high level of resistance.
CONCLUSION
The findings of this study showed a very high number of MDR infections among trauma patients in Aden with worrisome drug resistance rate to the most antibiotics. This would assist MSF in reviewing its current empiric treatment and in strengthening its antibiotic stewardship programme.
KEY MESSAGE
A high level of antibiotic resistance patterns were observed at the MSF Aden trauma centre highlighting the need to strengthen the antibiotic stewardship programme and evaluate the current empiric treatment provided.
This abstract is not to be quoted for publication
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.
Journal Article > ResearchFull Text
PLOS Glob Public Health. 2022 November 9; Volume 2 (Issue 11); e0000767.; DOI:10.1371/journal.pgph.0000767
Malaeb R, Yousef N, Al-Nagdah O, Ali QH, Saeed MAS, et al.
PLOS Glob Public Health. 2022 November 9; Volume 2 (Issue 11); e0000767.; DOI:10.1371/journal.pgph.0000767
The true burden of COVID-19 in Yemen is underestimated. The healthcare system is dysfunctional and there is a high shortage of health care workers in the country. Testing for SARS-CoV-2 remains limited and official surveillance data is restricted to those who are severe or highly suspected. In this study, Médecins Sans Frontières (MSF) aimed to conduct serological screening using rapid tests for asymptomatic staff at the MSF Aden Trauma Center to determine the SARS-CoV-2 antibody seropositivity. Four months after the peak of the first wave, we offered all the staff at the MSF Aden Trauma Center PCR if symptomatic, and a baseline SARS-CoV-2 serology screening followed by follow-up screenings. A final round was scheduled four months after the baseline. A rapid serology lateral flow test, NG-Test IgM-IgG was used in all rounds and in the final round, an electrochemiluminescence immunoassay (ECLIA) (Elecsys Anti-SARS-CoV-2 assay). Univariate and multivariate analyses were used to identify risk factors for seropositivity. The level of agreement between the different serology assays used was investigated. Overall 69 out of 356 participants (19.4%, 95% CI 17.9–20.8) tested positive by NG-Test between September and November 2020. A sub-sample of 161 staff members were retested in January 2021. Of these, the NG-Test detected only 13 positive cases, whereas the ECLIA detected 109 positive cases. The adjusted seroprevalence by ECLIA was 59% (95%CI 52.2–65.9). The non-medical staff had significantly lower odds of seropositivity compared to the medical staff (AOR 0.43, 95% CI 0.15–0.7, p<0.001). The positive percent agreement between the two tests was very low (11%). Our results suggest a very high SARS-CoV-2 seroprevalence in healthcare workers in Yemen, highlighting the need for regular testing and rapid vaccination of all healthcare workers in the country.
Protocol > Research Study
Malaeb R, Lenglet AD, Langlois C, White K, Hussein S, et al.
2018 July 1
Aims and objectives
2.1. Primary objective
To estimate the prevalence of current illnesses (self-reported), vaccination coverage, and mental health distress related symptoms in the IDP population in order to obtain a baseline that can guide MSF response activities in Raqqa as well as in Tal Abyad and Manbij districts.
2.2. Secondary objectives
1) To estimate the vaccination coverage for key vaccine preventable diseases in children aged 6-59 months among the new IDP population;
2) To describe the demographic characteristics of the IDP population;
3) To describe the displacement routes and experiences of the IDP population;
4) To estimate the prevalence of self-reported morbidities in the previous two weeks;
5) To estimate the global acute malnutrition (GAM) rate of in children aged 6-59 months and pregnant women;
6) To estimate the prevalence of self-reported major chronic diseases;
7) To estimate the prevalence of symptoms commonly associated with mental health distress;
8) To estimate the prevalence of conflict-related violence/trauma experienced during the recall period (365 days);
9) To estimate the retrospective mortality since the beginning of Ar-Raqqa offensive in northern Syria (12 June 2016);
10) To gain more understanding related to the concerns, challenges and priority needs of the IDPs in the community.
2.1. Primary objective
To estimate the prevalence of current illnesses (self-reported), vaccination coverage, and mental health distress related symptoms in the IDP population in order to obtain a baseline that can guide MSF response activities in Raqqa as well as in Tal Abyad and Manbij districts.
2.2. Secondary objectives
1) To estimate the vaccination coverage for key vaccine preventable diseases in children aged 6-59 months among the new IDP population;
2) To describe the demographic characteristics of the IDP population;
3) To describe the displacement routes and experiences of the IDP population;
4) To estimate the prevalence of self-reported morbidities in the previous two weeks;
5) To estimate the global acute malnutrition (GAM) rate of in children aged 6-59 months and pregnant women;
6) To estimate the prevalence of self-reported major chronic diseases;
7) To estimate the prevalence of symptoms commonly associated with mental health distress;
8) To estimate the prevalence of conflict-related violence/trauma experienced during the recall period (365 days);
9) To estimate the retrospective mortality since the beginning of Ar-Raqqa offensive in northern Syria (12 June 2016);
10) To gain more understanding related to the concerns, challenges and priority needs of the IDPs in the community.
Journal Article > ResearchFull Text
Front Public Health. 2023 August 31; Volume 11; DOI:10.3389/fpubh.2023.1185330
Malaeb R, Haider A, Abdulateef MM, Hameed M, Daniel U, et al.
Front Public Health. 2023 August 31; Volume 11; DOI:10.3389/fpubh.2023.1185330
BACKGROUND
The Coronavirus Disease 2019 (COVID-19) pandemic has highlighted the challenges of the healthcare system in Iraq, which has limited intensive care unit beds, medical personnel, and equipment, contributing to high infection rates and mortality. The main purpose of the study was to describe the clinical characteristics, the length of Intensive Care Unit (ICU) stay, and the mortality outcomes of COVID-19 patients admitted to the ICU during the first wave and two subsequent surges, spanning from September 2020 to October 2021, in addition to identify potential risk factors for ICU mortality.
METHODS
This retrospective cohort study analyzed data from COVID-19 patients admitted to the COVID-19 ICU at Al-Kindi Ministry of Health hospital in Baghdad, Iraq, between September 2020 and October 2021.
RESULTS
The study included 936 COVID-19 patients admitted to the ICU at Al-Kindi Hospital. Results showed a high mortality rate throughout all waves, with 60% of deaths due to respiratory failure. Older age, male gender, pre-existing medical conditions, ICU procedures, and complications were associated with increased odds of ICU mortality. The study also found a decrease in the number of complications and ICU procedures between the first and subsequent waves. There was no significant difference in the length of hospital stay between patients admitted during different waves.
CONCLUSION
Despite improvements in critical care practices, the mortality rate did not significantly decrease during the second and third waves of the pandemic. The study highlights the challenges of high mortality rates among critical COVID-19 patients in low-resource settings and the importance of effective data collection to monitor clinical presentations and identify opportunities for improvement in ICU care.
The Coronavirus Disease 2019 (COVID-19) pandemic has highlighted the challenges of the healthcare system in Iraq, which has limited intensive care unit beds, medical personnel, and equipment, contributing to high infection rates and mortality. The main purpose of the study was to describe the clinical characteristics, the length of Intensive Care Unit (ICU) stay, and the mortality outcomes of COVID-19 patients admitted to the ICU during the first wave and two subsequent surges, spanning from September 2020 to October 2021, in addition to identify potential risk factors for ICU mortality.
METHODS
This retrospective cohort study analyzed data from COVID-19 patients admitted to the COVID-19 ICU at Al-Kindi Ministry of Health hospital in Baghdad, Iraq, between September 2020 and October 2021.
RESULTS
The study included 936 COVID-19 patients admitted to the ICU at Al-Kindi Hospital. Results showed a high mortality rate throughout all waves, with 60% of deaths due to respiratory failure. Older age, male gender, pre-existing medical conditions, ICU procedures, and complications were associated with increased odds of ICU mortality. The study also found a decrease in the number of complications and ICU procedures between the first and subsequent waves. There was no significant difference in the length of hospital stay between patients admitted during different waves.
CONCLUSION
Despite improvements in critical care practices, the mortality rate did not significantly decrease during the second and third waves of the pandemic. The study highlights the challenges of high mortality rates among critical COVID-19 patients in low-resource settings and the importance of effective data collection to monitor clinical presentations and identify opportunities for improvement in ICU care.