Prevalence of multi-drug resistant Pseudomonas aeruginosa isolated from selected residential sewages in Dutsin-Ma, Katsina State, Nigeria

The global surge in Multidrug resistant (MDR) bacteria is an issue of great concern. Pseudomonas aeruginosa has been implicated in several nosocomial infections, where it has caused grave complications in immunocompromised patients. This is the first study to report the prevalence of MDR P. aeruginosa isolated from residential sewage in Dutsin-Ma, Katsina State, Nigeria. Pseudomonads count, isolation, biochemical characterization and antibiogram were carried out using standard microbiological procedures. This study examined sixty (60) samples from selected residential sewage in the study site collected at different intervals between July and September 2021. A total of 40 (66.7%) P. aeruginosa were isolated from the analyzed sewage samples. The highest (2.84x104) pseudomonad count was recorded from sewage samples collected from Kadangaru. Pseudomonas aeruginosa isolates from this sample site showed the highest (100%) resistance to cephalosporins (cefuroxime) and nitrofurantoin. Similarly, isolates from Miami area also demonstrated the highest (95%) resistance to a cephalosporin (ceftazidime). All (100%) isolates used in this study showed MDR resistance to tested antibiotics. The occurrence of MDR P. aeruginosa from a residential sewage site that may contaminate drinking water sources in the study area is of public health threat to the inhabitants. Surveillance and molecular epidemiology of antibiotics resistant bacteria are urgently needed in the study area.

Patient satisfaction with directly observed treatment and multidrug-resistant tuberculosis injection administration by lay health workers in rural Eswatini

Background: The human resources for health crisis in rural Eswatini led to a novel community-based multidrug-resistant tuberculosis (MDR-TB) treatment strategy based on task-shifting, that is delegation of directly observed treatment (DOT) and administration of MDR-TB injections, traditionally restricted to professional nurses, to lay community treatment supporters (CTSs). Aim: This study assessed the level of patient satisfaction with receiving community-based MDR-TB care from a CTS. Setting: The study was conducted at three MDR-TB-treating facilities in the mostly rural Shiselweni region. Methods: A cross-sectional survey of a purposive sample of 78 patients receiving DOT and intramuscular MDR-TB injections from CTSs was carried out in 2017. Descriptive statistics and regressions were calculated. Results: A high overall general patient satisfaction score for receiving community-based MDR-TB care from a CTS was observed. Adherence counselling, confidentiality, provider selection and treatment costs significantly (p < 0.05) influenced satisfaction. A large majority (n = 62; 79.5%) of patients indicated that they would likely recommend their significant others to receive MDR-TB care from a CTS. Respondents identified the need to provide CTSs with adequate training, regular supervision and sufficient incentives and also to broaden the scope of their services. Conclusion: This study observed that task-shifting of DOT and MDR-TB injection administration to CTSs was supported from a patient perspective. However, adherence counselling, confidentiality, provider selection and treatment costs should be taken into account in community-based MDR-TB care programming. Further to the patients, community-based tuberculosis care could be enhanced by improving CTSs' training, supervision and incentives, and broadening the scope of their services

Silver nanoparticles: A potential antibacterial and antibiofilm agent against biofilm forming multidrug resistant bacteria

Background: Multi-drug resistant (MDR) bacteria are seriously endangering the antibiotics. Different alternative strategies are needed to reinforce antibiotics, of, these; nanostructured materials may play a fruitful role. This study aimed to investigate the antibacterial and antibiofilm activity of silver nanoparticles (AgNPs) against MDR bacteria. Methods: In a cross-sectional study, a total of 33 methicillin resistant Staphylococcus aureus (MRSA) and 52 MDR Pseudomonas aeruginosa (P. aeruginosa) isolates were recovered from intensive care units' (ICUs) admitted patients over a period of 9 months, from December 2017 to August 2018. The antibacterial activity of AgNPs on the clinical isolates of MRSA and MDR P. aeruginosa was assessed by minimum inhibitory concentrations (MICs) using broth microdilution method. The minimum bactericidal concentrations (MBCs) were determined as the lowest concentrations required to kill 99.9% of the initial inoculum. Tissue culture plate method was used to evaluate the antibiofilm activity. Results: The MIC and MBC values ranged from 1 to 16 µg/ml and 2 to 64 µg/ml, respectively. Silver nanoparticles exerted a significant antibiofilm activity against MRSA and MDR P.aeruginosa at all tested concentrations, recording a maximum inhibition value of (82%) and (91%), respectively. Conclusions: AgNPs exhibited a considerable antibacterial and antibiofilm, effect; it could represent a promising weapon in the fight against biofilm forming MDR organisms

Predictors of time to sputum culture conversion in multi-drug-resistant tuberculosis and extensively drug-resistant tuberculosis in patients at Tshepong-Klerksdorp Hospital

Setting: Klerksdorp-Tshepong Hospital Complex MDR-TB Unit, North-West Province, South Africa.Background: To determine the time to sputum culture conversion (TTSCC) and factors predictive of TTSCC in patients with multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in the North-West Province.Methods: A retrospective cohort study, abstracting patient demographic and clinical data, laboratory results, dates of sputum testing and sputum culture conversion results, from medical records of 526 MDR-TB and 47 XDR-TB patients started on TB treatment between 01 January 2012 and 31 December 2014. Predictors of TTSCC were determined by Cox proportional hazards regression.Results: The median age was 38 years (interquartile range 31­47) with 64% being male. Overall, 79% (449) were Human Immunodeficiency Virus (HIV)-infected. The median TTSCC was 56.5 days and 162.5 days for MDR-TB and XDR-TB patients, respectively. In the multivariate analysis, age [hazard ratio (HR): 0.89, 95% confidence interval (CI): 0.96­0.99], being underweight (HR: 0.631.61, 95% CI: 0.451.03­0.882.51), Acid Fast Bacilli (AFB) positivity (HR: 0.72, 95% CI: 0.51­1.01) and having XDR-TB (HR: 0.36. 95% CI: 0.19­0.69) were predictive of longer TTSCC.Conclusion: Predictors of TTSC allow for MDR-TB- and XDR-TB-diagnosed patients to be identified early for effective management. Those with risk factors for delayed sputum culture conversion which are being underweight and having XDR-TB should be monitored carefully during treatment so that they can achieve sputum culture conversion early

Toxicité hématologique sévère du linezolide au cours du traitement de la tuberculose pharmacorésistante : A propos de deux(2) cas au service de Pneumo-Phtisiologie du CHU de Conakry

Introduction : Le linezolide est un médicament potentiellement efficace pour le traitement des patients atteints de tuberculose pharmaco-résistante. En dépit de son efficacité et sa bonne biodisponibilité, il présente des toxicités, dont celle hématologique demeure l'une des plus graves. Nous rapportons deux cas de toxicité hématologique du linézolide au cours du traitement de la tuberculose pharmacorésistante. Le premier cas concernait un patient de 65 ans traité pour une tuberculose multi-résistante avec un schéma thérapeutique contenant du linézolide. L'évolution fut marquée par la survenue d'une pancytopénie avec anémie sévère à 5,4 g et un tableau d'insuffisance rénale. L'issue fut favorable après arrêt du médicament et transfusion sanguine. Le second cas concernait un patient de 33 ans, pré XDR qui lutte contre la tuberculose depuis 10 ans avec cinq cures de chimiothérapie antituberculeuse qui se sont soldées par des échecs et résistances. Au cours de son suivi, il a présenté une bonne évolution clinique et bactériologique initiale mais rapidement était survenue une anémie sévère à 5g/dl, à cette anémie était associées des neuropathies périphériques. Le Linezolide avait été retiré du schéma thérapeutique, suivi de transfusions sanguines. La suite avait été favorable sous traitement antituberculeux et le patient fut guéri de sa tuberculose. Conclusion Le linézolide est efficace dans le traitement de la tuberculose pharmacorésistante mais présente une toxicité hématologique

Tuberculose multirésistante. Evaluation situationnelle à l'Hôpital Central des Armées de Brazzaville au Congo

Introduction : L'objectif de notre étude était d'évaluer la situation des formes résistantes de tuberculose à Brazzaville à partir d'une analyse descriptive transversale de patients au service de médecine interne de l'Hôpital Central des Armées de mars 2014 à Juin 2015.Matériels et méthode : Pour 32 patients ayant répondu aux critères cliniques de recrutement, seuls 25 ont été inclus après confirmation microbiologique de la résistance à la rifampicine. Résultats : Le sex-ratio était de 2,6 en faveur des hommes. L'âge moyen était de 32 ± 7 ans. Les extrêmes d'âge étaient de 19 et 46 ans. Environ 66% des patients étaient dans l'informel. La résistance était présente dans 78% des cas et le diagnostic était long dans 60% des cas. Conclusion : La TB-MDR est une réalité qui pose un problème diagnostique et thérapeutique par manque d'une prise en charge codifiée et d'antituberculeux de deuxième ligne

Knowledge and practices about multidrug-resistant tuberculosis amongst healthcare workers in Maseru

Background: To date; no study has been found that described the knowledge and practices of healthcare workers surrounding multidrug-resistant tuberculosis (MDR-TB) in Lesotho.Aim and setting: This study was conducted to fill this gap by investigating the knowledge level and practices surrounding MDR-TB amongst healthcare workers at Botsabelo Hospital in Maseru; Lesotho.Method: This was a cross-sectional survey conducted by means of a questionnaire designed specifically for this study. Data collected included sociodemographic and professional details; and responses to questions about knowledge and practices regarding MDR-TB. The questions ranged from the definition of MDR-TB to its treatment. Respondents' practices such as the use of masks; guidelines and patient education were also assessed. Results: A response rate of 84.6%(110 out of 130) was achieved. The majority of participants were women (60%); married (71.8%) and nursing staff (74.5%). Overall; less than half (47.3%) of the participants had a good level of knowledge about MDR-TB. With regard to practice; about 83%of participants stated that they used protective masks whilst attending to MDR-TB patients. About two-thirds (66.4%) reported being personally involved in educating patients about MDR-TB; whilst about 55%stated that they referred to these guidelines.Conclusion: The level of knowledge about MDR-TB amongst healthcare workers at the study site was not at an acceptable level. Unsafe practices; such as not wearing protective masks and not referring to the MDR-TB treatment guidelines; were found to be associated with an insufficient level of knowledge about MDR-TB. An educational intervention is recommended for all healthcare providers at this facility

Multidrug-resistant tuberculosis at the National Hospital, Abuja, Nigeria

Five hundred (500) cases of pulmonary tuberculosis (TB) were seen at the Chest Clinic of the National Hospital; Abuja; Nigeria over a 2-year period (2004-2005). The diagnosis and management of multidrug-resistant (MDR) TB were studied as part of DOTS-Plus: Directly Observed Treatment Short-course (DOTS) programmes that add components for MDR-TB diagnosis; management; and treatment. The cases of pulmonary TB that showed mycobacterium resistance to rifampicin and isoniazid (MDR-TB) using the Lowenstein Jensen (solid medium) slope at the National Hospital and later using BACTEC 460 available at Zankli Medical Center at Abuja; were treated with the standard WHO recommended regimen for MDR-TB and the outcomes were studied. Twenty cases (4) of MDRTB were recorded; all 20 were also HIV-positive. One (8) died and 19 (95) were apparently cured at the end of therapy. This is the first report of MDR-TB and DOTS-Plus in Nigeria. There is an urgent need to study the MDR-TB pattern in Nigeria as extensive resistant TB (XDR-TB) has now been reported which is even worse prognostically than MDR-TB