Escherichia coli extraintestinal, resistencia antimicrobiana y producción de betalactamasas en aislados cubanos / Extraintestinal Escherichia coli, antimicrobial resistance and betalactamase production in Cuban isolates

Introducción: Escherichia coli extraintestinal constituye uno de los principales patógenos causantes de infecciones asociadas a la asistencia sanitaria con un alto impacto en la salud por su morbilidad y mortalidad. Objetivo: Describir el comportamiento clínico de E. coli extraintestinal en hospitales cubanos, así como determinar la resistencia antimicrobiana y la producción de betalactamasas. Métodos: Se realizó un estudio descriptivo de corte transversal, durante el período de mayo 2017 a junio 2018, en el Laboratorio Nacional de Referencia de Microbiología del Instituto de Medicina Tropical Pedro Kourí que incluyó 119 aislados de Escherichia coli causantes de infecciones extraintestinales en 30 hospitales de diferentes áreas geográficas del país. Se llevó a cabo la identificación mediante el sistema API 20E y la determinación de la susceptibilidad in vitro a 16 antimicrobianos por el sistema automatizado VITEK-2 y el método de difusión por disco, excepto para la colistina que se empleó el método de elución de disco. Se realizó, además, la detección fenotípica de betalactamasa de espectro extendido, de tipo AmpC y metalobetalactamasa. Resultados: E. coli extraintestinal causó con mayor frecuencia infección de herida quirúrgica (23,5 por ciento), infección del torrente sanguíneo (20,7 por ciento), infecciones respiratorias (17,6 por ciento), infecciones de piel (16,8 por ciento) e infección del tracto urinario (12,6 por ciento). Predominó la resistencia a betalactámicos que osciló entre 61,3 por ciento y 89,1 por ciento, mientras que 79,8 por ciento y 80,5 por ciento de los aislados fueron resistentes a trimetoprim/sulfametoxazol y tetraciclina, respectivamente. La amikacina, la fosfomicina, la colistina y los carbapenémicos mostraron mayor actividad in vitro. El 43,7 por ciento produjo betalactamasas de espectro extendido, 7,6 por ciento AmpC plasmídica y 0,8 por ciento metalobetalactamasa. Conclusiones: La escasa sensibilidad en los aislados de E. coli extraintestinal a los antimicrobianos de primera línea, así como la detección de un aislado productor de metalobetalactamasa evidencia la necesidad de mantener un monitoreo continuo de este patógeno para el cual las alternativas de tratamiento son cada vez más restringidas(AU)

Introduction: Extraintestinal Escherichia coli is one of the main pathogens causing infections associated to health care, with a high impact on health, due to its morbidity and mortality. Objective: Describe the clinical behavior of extraintestinal E. coli in Cuban hospitals, and determine antimicrobial resistance and betalactamase production. Methods: A descriptive cross-sectional study was conducted at the Microbiology National Reference Laboratory of Pedro Kourí Tropical Medicine Institute from May 2017 to June 2018. The study included 119 Escherichia coli isolates causing extraintestinal infections in 30 hospitals from various geographic areas in the country. Identification was based on the API 20E system, and determination of in vitro susceptibility to 16 antimicrobials on the automated system VITEK-2 and the disk diffusion method, except for colistin, for which the disk elution method was used. Phenotypical detection was also performed of AmpC extended-spectrum betalactamase and metallobetalactamase. Results: The most common disorders caused by extraintestinal E. coli were surgical wound infection (23.5 percent), bloodstream infection (20.7 percent), respiratory infections (17.6 percent), skin infections (16.8 percent) and urinary tract infection (12.6 percent). A predominance was found of resistance to betalactams, which ranged between 61.3 percent y 89.1 percent, whereas 79.8 percent and 80.5 percent of the isolates were resistant to trimethoprim / sulfamethoxazole and tetracycline, respectively. Amikacin, fosfomycin, colistin and carbapenemics displayed greater in vitro activity. 43.7 percent produced extended spectrum betalactamases, 7.6 percent plasmid AmpC and 0.8 percent metallobetalactamase. Conclusions: The low sensitivity of extraintestinal E. coli isolates to first-line antimicrobials and the detection of a metallobetalactamase producing isolate are evidence of the need to maintain continuous surveillance of this pathogen, for which the treatment options are ever more restricted.

Antenatal Care (Anc) Services Utilization In Maternal And Child Health (Mch) Clinics Of Kinabatangan (Rural) And Sandakan (Urban) Of Sabah, Malaysia

This paper investigates the antenatal care (ANC) services utilization in currently pregnant women during their visits to maternal and child health (MCH) clinics of rural (Kinabatangan) and urban (Sandakan), Sabah. A community clinic based, cross-sectional descriptive study was performed. In total, 800 currently pregnant women attending two MCH clinics, from April to September 2012, were participated using tested set questionnaires. Descriptive analysis was used for background characteristics and chi-square analysis was applied to identify the rural-urban differences among the variables.In both study areas, previous births delivered by skilled birth personnel were same. In pregnant women from rural, less income, more grand-multiparity, earlier antenatal care booking, more frequent post-natal care, more use of contraception compared to those in urban. In comparison, urban pregnant women had more anti-tetanus toxoid injection in their previous pregnancies, past history of antenatal care for at least four times, increase in household members. As this study found the differences in ANC services utilization at Rural and Urban, further study is needed to explore concrete reasons for above findings. By delivering services according to the needs of all clients, irrespective of their place of residence, it will improve ANC services utilization in both areas of Sabah and hence will improve more on existing health status of the Nation.

Underweight prevalence among young adults from rural areas, Salin Towinship, Magwe Region.

Maintaining a normal body mass index (BMI) throughout the life-span of a person may reduce occurrence as well as the burden of non-communicable diseases (NCDs), in terms of years lived with disability and premature death. Lifestyle and socioeconomic factors like physical activity and availability of healthy or unhealthy food may contribute to both extremes of BMI, namely underweight and overweight/obesity. The aim of the present cross-sectional study was to estimate the prevalence of underweight and overweight/obesity and selected lifestyle factors in a cluster randomized sample of 335 young adults aged 18-35 years from rural communities residing at SalinTownship, Magwe Region. In addition, it also aims to investigate the association between selected socioeconomic and lifestyle factors with underweight. Data were collected by carrying out face to face interviews with the individuals selected in the sample in 2011 using semi-structured questionnaires and measuring of their weight and height. SPSS version 16 and STATA version 11 were used for data entry and analysis respectively. Based on WHO criteria, participants were classified according to their BMI into underweight (BMI < 18.5); normal weight (BMI 18.5 - 24.99); and overweight/obese (BMI > 25). Individuals with normal BMI was found in 72% (95% confi dence interval (CI): 67.1 - 77.0) and the prevalence of underweight was found in 28% (23.0 - 32.9). The majorities of respondents were illiterates, of monastic and primary schooling, and working as farmers and manual workers. Nearly 84% of the respondents were able to have 3 meals per day, and the same proportion consumed vegetables daily. The prevalence of current smokers was 11% and all were found to be males. Seventy-two percent were physically active on a daily basis. Out of these respondents, three-fourths of them were physically active at least two hours per day. A total of 64% reported to sleep during the day and 71% reported less than 8 hours of sleeping during the night. Logistical regression analysis showed that underweight was significantly associated with lower age as compared to higher age (OR = 0.54: CI 0.32 - 0.92). There was no significant association between sex, education, occupation and lifestyle factors.

Catastrophic expenditure for health care in Myanmar.

Protecting households from the catastrophic health care expenditure is important for every health system because it can prevent some people from seeking care and result in impoverishment. Therefore, this cross-sectional study was done in 2014 to determine the magnitude of the catastrophic health care expenditure and its relationship with income, expenditure, residence, and receiving an in-patient care. Altogether 437 households from both urban and rural areas of 1 State and 5 Regions including Nay-Pyi-Taw territory were included in the study. Two thresholds that cover the 10% of total expenditure and 40% of non-food expenditure were used to estimate the catastrophic health care expenditure for one year period in randomly selected households. The estimates of catastrophic health care expenditure were 37.1% and 32.9% for thresholds of 10% of total annual expenditure and 40% of annual non-food expenditure, respectively. The catastrophic health care expenditure was significantly related to both annual household income (p = 0.012) and expenditure (p = 0.009). The estimate of catastrophic expenditure for health care was highest in households of lowest income (quintile) group (42.3%) whereas this estimate was lowest in households with highest income (21.2%), (p = 0.008). The similar trend was detected in the expenditure quintile groups (p = 0.013). The catastrophic expenditure for health care was significantly higher among households residing in the rural area compared to those of urban area (p = 0.001). Similarly, households experiencing hospitalization of any of its members was more likely to have the catastrophic expenditure than those who did not (p = 0.001). This study highlighted the urgent need to promote health, strengthen the strategic approach to universal health care coverage and also to seek ways to improve household income, especially for the rural poor. The establishment of nationwide health insurance system should also be considered.

Influencing Factors For Cholera And Diarrhoea: Water Sanitation And Hygiene In Impoverished Rural Villages Of Beluran District, Sabah Malaysia

The lower percentage of water, sanitation and hygiene are the root causes of diarrhoea and cholera. Cholera is a sudden onset of acute watery diarrhoea which can progress to severe dehydration and death if untreated. The current pandemic, Vibrio Cholera O1 started in 1961. This study explores water, sanitation, hygiene and cholera and diarrhoea in three affected villages of Beluran District, Sabah Malaysia to support effective and timely public health intervention. This cross sectional study uses purposive sampling. All (114) households were interviewed and household water samples collected. The study reported lower coverage improved sanitation facilities (35.3% to 52.3%), no latrine at home (37% to 63%), improved water supply (52% to 60%), and prevalence of hand washing after toilet (57% - 74%). For water quality, Ecoli was present in household water (32% to 37%) but Vibrio cholerae was not isolated in any of the water samples tested. Statistically significant associations were found for; 1) occupation−non-agriculture and unimproved sanitation facility and 2) house ownership and correct knowledge of ORS preparation. Predictors for household water quality were: latrine at home, and improved household toilet. Aggressive strategies to improve water supply, sanitation and hygiene−hand washing after toilet−were recommended for future prevention of cholera and diarrhoea in the affected area.

Infection control measures among interns / house surgeons in teaching hospitals under University of Medicine (1), Yangon.

Health care workers are responsible for prevention and control of communicable diseases in the hospital environment. This study aimed to focus on infection control measures among house officers. A cross-sectional descriptive study was conducted in 2010 at three teaching hospitals in Yangon City by introducing anonymous self-administered questionnaires to randomly selected 150 respondents. SPSS version 16.0 was used for analysis. Over half of the respondents had high knowledge and perception but the practice was poor. Infection control messages acquired through health talks, seminars and media were infl uencing factors on knowledge while training programs signifi cantly infl uenced both knowledge and perception. Senior house offi cers had significantly higher mean perception scores than their juniors (p=0.005). Their hand washing practice was signifi cantly infl uenced by newspapers and magazines (p=0.003) and poster and pamphlet(p=0.056). Compliance on utilization of surgical mask as a precautionary measure for airborne transmission was associated with knowledge (0.020), adequate supply in wards (p=0.001) and donation from medical product company (p=0.042). They bought gloves for handling infectious materials (p=0.000), and needle recapping practice before discarding was related to knowledge (p=0.05). Knowledge, perception and practice of house offi cers were interrelated to each other. Further education and training of house surgeons, resource allocation and continuous monitoringwere necessary for proper infection control and safe hospital environment.

Evaluation of dengue blot test

Dengue blot test is a dot enzyme immuno-assay which detects the antibodies to dengue virus of all tyes (1 to 4). The result of the test can be obtained after three hours.In the management od dengue haemorrhagic fever confirmation of diagnosis should be made at early stage.This requires a test which is highly specific, highly sensitive and quick.To determine the usefulness of dengue blot test in diagnosing dengue haemorrhagic fever, this study was carried out in 319 patients who were clinically diagnosed as dengue haemorrhagic fever at Yangon Children Hospital.They were tested for both blot test and standard test of haemagglutination inhibition (HI).Blot test was positive in 304 patients out of which only one is negative for HI test (True positive 303 false positive 1).Out of 15 patients who were negative for blot test 10 were positive for HI test (True negative 5, false negative 10).This test was found to be highly sensitive (sensitivity 96

), and specific (specificity 83

).Positive predictive valve was 99.6

but negative predictive value was only 33.3

.

Dose intensity of chemotherapy in chemotherapy sensitive Malignancies in Myanmar

In order to find out the appropriate dose intensities of various chemotherapeutic regimes for chemotherapy-sensitive malignancies in Myanmar patients, all cancer patients treated by the medical oncologist of the Radiotherapy Department over the period of two years (September 1996 to August 1998) were closely monitored. In this paper the chemotherapeutic dose intensities for Non-Hodgkin's Lymphoma and Breast Cancer patients were analysed and the tolerability of the patients, side effects (according to the Common Toxicity Criteria, WHO) and clinical responses (according to the WHO Criteria) were reported. It was found that Myanmar patients could tolerate the internationally standard dosages of chemotherapeutic regimes provided that their body surface areas, performance status, blood counts, liver functions, renal functions and cardiac functions were properly monitored and taken into consideration in calculating the dosages. The clinical implications of giving optimal dosages of chemotherapy in terms of their impact on short-term response rates and longterm survival rates were discussed.

Efficacy of polymerase chain reaction (PCR) Technique in detection of malaria parasite species

Since 1985, Polymerase Chain Reaction (PCR) technique has been developed and applided as a diagnostic tool for edtection of many parasitic infections. Because of its ability to amplify DNA fragments and using specific nucleotide primers, the test is highly sensitive as well as specific. Efficacy of PCR test in detection of malaria species was compared with that of conventional microscopic examination of Giemsa stained blood film in the study. A study done on (111) patients attending the Central Malaria Clinic revealed that,(20) patients were found to be positive by PCR test, while only (12) patients were positive by microscopic examination could detect only Plasmodium falciparum and Plasmodium vivax, while PCR test was able to detect all human malaria parasite species includinPlasmodium ovale in (10) samples. Thus PCR test was founcd to be highly effective for detection of malaria parasites, especially in cases of mixed infections.

Efficacy of polymerase chain reaction (PCR) technique in detection of malaria parasite species

Since 1985, Polymerase Chain Reaction (PCR) technique has been developed and applied as a diagnostic tool for detection of many parasitic infections. Because of its ability to amplify DN fragments and using specific nucleotide primer, the test is highly sensitive as ell a specific. Efficacy of PCR test in detection of malaria pecies wwas compared with that of conventional microscopic examination of Giemsa stained blood film in the study. a study done on (111) patients attending the Central Malaria Clinic reveald that, (20) patients were found to be positive by PCR test, while only (12) patients were positive by microscopic examination could detect only Plasmodium falciparum and Plasmodium vivax, hile PCR test was able to detect all human malaria parasite species including Plasmodium ovale in (10) samples. Thus PCR test was found to be highly effective for detection of malaria parasites, especially in cases of mixed infections.

Maturation of foetal thyroid hormone synthesis and regulation

A total of 343 pairs of maternal serum and foetal cord serum samples were assayed for thyroxine (T4), triiodothyronine (T3) and thyrotropin (TSH) levels. Foetal serum total T4 levels showed a positive correlation not only with gestational age(r=0.14) but also with maternal serum T4 levels (r=0.42). Although these correlations were not very strong, they were statistically significant. Foetuses were found to be T3 deficient for all gestational age groups in the study. Despite these deficient levels, there was still a significant positive correlation between foetal serum T3 levels and the maternal serum T3 levels (r=0.24). Foetal serum TSH levels were about three times higher than the corresponding maternal levels for all gestational age groups. High TSH levels in the face of deficient T3 levels for all gestational age groups in the study indicated that the function of the foetal hypothalamic-pituitary feedback control system of the thyroid gland has been well established even before the foetal maturity.

Cost analysis of hospitalized malaria patients in Taikkyi Township

A hospital-based study was conducted in Taikkyi Township to elicit the various types of cost incurred and factors influencing these costs. data were obtained from malaria cases of different severity admitted to two hospitals from July to October, 1995. All study subjects were interviewed by using a pretested standardized questionnaire. the total costs of illness per patient for one episode of malaria were estimated as kyats 2582 for uncomplicated malaria case, kyats 4568 for other severe and complicated malaria case and kyats 4758 for malaria with other disease case. In the cost before and during hospitalization, direct cost was more than indirect cost. Cost for income lost and drug cost were the highest. Multivariate analysis revealed that days of illness and days of absence from work before hospitalization, malaria parasite density status, income lost of patient and total attendant's cost before hospitalization, family income, distance between home and hospital and days of actual illness were important determinants for various types of cost incurred for hospitalized malaria patients. This study will focus on the need for large-scale similar studies in the country in future.

Intervention study to improve the misuse of artemisinin and its derivatives at a township in Myanmar

Intervention study to remove the misuse of Artemisinin and its derivatives was conducted in Myeik township. Workshops to use Artemisinin compound together with Mefloquine was conducted for doctors, basic health workers and drug dealers separately. Mefloquine tablets that are to be used together with Artemisinin compounds were made available with low price at hospital cost sharing shop, meditrade government clinic and rural health centres. Assessment was done on doctors, basic health workers and drug dealers on how they improve their knowledge on the use of Artemisinin compounds before and 6 months after intervention. Assessment was also done on 100 consecutive patients who had been treated in hospital and another 100 who had been treated outside the hospital before and after intervention. After intervention all doctors and basic health workers, had improved the knowledge of Artemisinin and 90 percent and 36.5 percent of them can give proper dosage of these drugs. All the doctors change their attitude and use combined therapy on all of their patients. Among the general practitioners all 100 percent did use combined therapy, but the patients did not come regularly for 3 day treatment as the cost of first visit is high and patients get better after 24 hours. These are the main reasons for the failure. Ninety-four percent of the drug dealers cannot keep simple records for the sale of these compounds. Only 3.6 percent of the Artemisinin compound bought from the drug dealers continue to buy Mefloquine. This include 46 percent of the patients who bought from the drug store and received referral tickets with necessary instruction to use combined drug therapy. This findings is also supported from the study on ex-patients. We conclude that special strip tablets are required so that all Artemisinin compounds are sold with Mefloquine all in one packet. It is also necessary to enforce the existing Food and Drug Act so that we can give more rigid training to drug dealers.

Comparison of the effect of combinations of parentral artemisinin derivatives (I/M artemether, I/V artesunate) plus oral mefloquine with intravenous quinine plus oral tetracycline on patients with cerebral malaria: A multicentre trial (Preliminary Report)

In order to find out the best drug combination for treatment of cerebral malaria at less equipped hospitals, 105 cases of cerebral malaria belonging to Mawlamyine, Pyin Oo Lwin and North Okkalapa hospitals were studied in a controlled trial of three regimens. (1) Intramuscular artemether total dose 480 mg plus mefloquine 750 mg in a single dose given through nasogastric tube at day 0. (2) Intravenous artesunate total dose 240 mg plus mefloquine 750 mg as in regimen 1. (3) Intravenous quinine dighdrochloride 600 mg in 180 ml infusion of dextrose saline given over 4 hours. The dose is repeated every 8 hours until the patient can swallow the tablets. Then oral quinine sulphate tablets were given 600 mg 8 hourly. Total period of quinine therapy is 7 days. Tetracycline 250 mg capsules were given 6 hourly for 7 days (started via nasogastric tube while the patient is unconscious). There was no significant difference in overall mortality rate, mean parasite clearance time, mean fever clearance time and mean time to regain consiousness between the three groups. Thus quinine-tetracycline (if necessary to supplement with artemether-mefloquine at 48 hours if the patient failed to respond to initial treatment) is suggested, as the drug of first choice for the management of cerebral malaria in Myanmar.

Evaluation of copper sulfate method for screening anaemia

The haemoglobin values of 102 blood samples were determined by 3 different observers; the first two observers using the copper sulfate method, and the third observer using the cyanmethaemoglobin method. The sensitivity and specificity of copper sulfate method was callculated at haemoglobin levels of 80 g/l and 100 g/l with comparison to the cyanmethaemoglobin method. At 80 g/l level, it was found to be 100 percent sensitive with a specificity of 70 percent. At 110 g/l level, the sensitivity was reduced to 82 percent while the specificity increased to 100 percent. The numbers of cases that were either correctly or incorrectly diagnosed by each observer were not significantly different and a good agreement (Kappa statistic = 0.82, 95 percent Confidence Intervals 0.77 to 0.87) was found between the two observers. The copper sulfate method was found to be reasonably accurate for screening anaemia.

Situation analysis of drug resistant malaria in Myanmar

Since early 70's drug resistant falciparum malaria has been discovered and gradually emerged as a major hindrance to effective management of malaria. Drug sensitivity tests conducted all over the country revealed that, chloroquine resistant was highest near the Thailand border, with RII/III more than 60 percent and lower near India border with RII/III 25 percent. Sulphadoxine-Pyrimethamine (S-P) resistance was also highest near the Thailand border with RII/III 45 percent and lowest in the delta area with RII/III 15 percent. Although Mefloquine resistance has been discovered near the Thailand border with RII/III 5-20 percent Plasmodium falciparum is almost sensitive to the drug in other parts of Myanmar. The studies conclude that, chloroquine and S-P drugs are still effective for treatment of uncomplicated malaria among the semiimmune persons residing in the endemic areas, while mefloquine is a drug of choice for non-immune persons and high risk groups.

Assessing the accuracy of respiratory rates at different counting periods and methods

The respiratory rates of 198 children (aged 2-59 months) suffering from acute respiratory infections (ARI) were monitored by observation, palpation and auscultation (Gold standard). Two 30-second and one 60-second counts were obtained. The difference among respiratory rate counts determined simultaneously by observation, palpation and auscultation in relation to their mean count was analyzed for 60-second counting period, 30 plus 30-second period and 30-second doubled. The variability among the different counting methods and counting periods was not significantly different whether the children were feeding, sleeping, resting and awake or awake but not resting. The data from the study suggest that respiratory rate counting either by observation or palpation are similar in accuracy and one minute's counting either at a stretch or 30-second doubled or two blocks of 30-second intervals are also similarly accurate.