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ABSTRACT Objective. To compare the epidemiology of antimicrobial resistance in bacteria isolated from inpatient and outpatient samples in Ecuador. Methods. A secondary analysis was done of data on bacteria isolated from inpatient and outpatient samples. Data were taken from the 2018 national antimicrobial resistance surveillance database of the National Reference Center for Antimicrobial Resistance. The variables included were: age, sex, inpatient versus outpatient setting, type of specimen, bacterial species identified, pattern of resistance to antibiotics, and geographic area. Results. Data from 57 305 bacterial isolates were included in the study: 48.8% were from hospitalized patients, 55.7% were from women, and 60.1% were from patients older than 45 years. Urine (42.9%) and blood (12.4%) were the most common clinical samples. Overall, 77.1% of bacterial isolates were gram-negative (83% and 71% in outpatients and inpatients, respectively). The most common gram-positive and gram-negative species were Staphylococcus aureus and Escherichia coli, respectively. Antimicrobial resistance levels were high (up to 80% for some antimicrobial drugs), and were higher in hospitalized patients compared with outpatients. A variety of carbapenemases were found to confer resistance to carbapenems (antibiotics of last resort) in gram-negative bacteria. Conclusions. The study findings provide an important baseline on antimicrobial resistance in Ecuador. This will allow the strengthening of guidelines of the surveillance system, the creation of public policies for standardization of laboratory methodologies, the proper handling of information, and the development of empirical therapy guidelines based on local epidemiology.
RESUMEN Objetivo. Comparar las características epidemiológicas de la resistencia a los antimicrobianos en cepas bacterianas aisladas de muestras de pacientes de servicios hospitalarios y ambulatorios en Ecuador. Métodos. Se realizó un análisis secundario de los datos sobre cepas bacterianas aisladas en muestras de pacientes de servicios hospitalarios y ambulatorios. Se recogieron los datos de la base de datos nacional del 2018 para la vigilancia de la resistencia a los antimicrobianos del Centro de Referencia Nacional para la Resistencia a los Antimicrobianos. Las variables incluidas fueron: edad, sexo, entorno hospitalario frente a entorno ambulatorio, tipo de muestra, especies bacterianas detectadas, patrón de resistencia a los antibióticos y zona geográfica. Resultados. En el estudio se incluyeron datos de 57 305 cepas aislamientos bacterianos: 48,8% fueron de pacientes hospitalizados, 55,7% fueron de mujeres y 60,1% fueron de pacientes mayores de 45 años. La orina (42,9%) y la sangre (12,4%) fueron las muestras clínicas más comunes. En general, 77,1% de las cepas bacterianas aisladas fueron gramnegativas (83% y 71% en pacientes de servicios ambulatorios y hospitalarios, respectivamente). Las especies grampositivas y gramnegativas más comunes fueron Staphylococcus aureus y Escherichia coli, respectivamente. Los niveles de resistencia a los antimicrobianos fueron elevados (hasta 80% en el caso de algunos fármacos antimicrobianos) y fueron más elevados en los pacientes de servicios hospitalarios en comparación con los pacientes de servicios ambulatorios. Se encontró que una variedad de carbapenemasas confiere resistencia a los carbapenémicos (antibióticos de último recurso) en bacterias gramnegativas. Conclusiones. Los resultados del estudio proporcionan una línea de base importante sobre la resistencia a los antimicrobianos en Ecuador, que permitirá el fortalecimiento de las directrices del sistema de vigilancia, la creación de políticas públicas para la estandarización de los métodos de laboratorio, una adecuada gestión de la información y la elaboración de orientaciones de tratamiento empírico basadas en las características epidemiológicas locales.
RESUMO Objetivo. Comparar a epidemiologia da resistência aos antimicrobianos em bactérias isoladas de amostras hospitalares e ambulatoriais no Equador. Métodos. Foi feita uma análise secundária de dados sobre bactérias isoladas de amostras hospitalares e ambulatoriais. Os dados foram obtidos do banco de dados nacional de vigilância da resistência aos antimicrobianos de 2018 do Centro Nacional de Referência para a Resistência aos Antimicrobianos. As variáveis incluídas foram: idade, sexo, ambiente hospitalar versus ambiente ambulatorial, tipo de espécime, espécies bacterianas identificadas, padrão de resistência a antibióticos e área geográfica. Resultados. Foram incluídos no estudo os dados de 57 305 isolados bacterianos: 48,8% eram de pacientes hospitalizados, 55,7% eram de mulheres e 60,1% eram de pacientes com mais de 45 anos. As amostras clínicas mais comuns foram urina (42,9%) e sangue (12,4%). No total, 77,1% dos isolados bacterianos eram gram-negativos (83% e 71% em pacientes ambulatoriais e pacientes internados, respectivamente). As espécies gram-positivas e gram-negativas mais comuns foram Staphylococcus aureus e Escherichia coli, respectivamente. Os níveis de resistência aos antimicrobianos foram elevados (até 80% para alguns antimicrobianos) e foram mais elevados em pacientes hospitalizados em comparação com pacientes ambulatoriais. Foram encontradas várias carbapenemases que conferem resistência aos carbapenêmicos (antibióticos de último recurso) em bactérias gram-negativas. Conclusões. Os resultados do estudo fornecem uma importante linha de base sobre a resistência aos antimicrobianos no Equador. Isto permitirá o fortalecimento das diretrizes do sistema de vigilância, a criação de políticas públicas para padronização de metodologias laboratoriais, o manejo adequado de informações e o desenvolvimento de diretrizes para a antibioticoterapia empírica com base na epidemiologia local.
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Background: Vaccination being one of the cheapest and safest methods of primary prevention, indicators of maternal and child healthcare are crucial. Multi-indicator cluster survey was planned to check these objectives as set up in reproductive child health (RCH)-II and National Rural Health Mission (NRHM) plan. This study was initiated to determine the vaccination coverage among the children in tribal district in Gujarat and to determine factors associated with partial immunization and non-immunization.Methods: A community based cross-sectional study was done in tribal district Narmada in Gujarat for a period of four months from May 2011 to August 2011. The study population consisted of all children aged between 12-23 months. After using cluster sampling method, assessment of vaccination programme was obtained from 346 out of total 352 children scattered across 30 clusters. A pre-tested semi-structured questionnaire was administered by interview technique.Results: Highest coverage was seen in the first dose of diphtheria, pertussis, and tetanus (DPT) 95.7% (CI 92.3-99) followed by Bacillus Calmette-Guérin (BCG) 95.4% (CI 92-98.7) and first dose of oral poliovirus vaccines (OPV) 95.4% (CI 92-98.7). The proportion of fully immunized children was 77.7% (CI 69.4-86.1), whereas 2.9% (CI 0.0-6.1) children were not vaccinated at all. The drop-out rate was 8.76% from DPT1 to DPT3 and 16% for DPT1 to measles.Conclusions: Vaccination coverage was highest for DPT first dose followed by BCG. The drop- out rate was 8.76% from DPT1 to DPT3 and 16% for DPT1 to measles. Non-awareness regarding subsequent doses of vaccines was most common reason for partial or non-vaccination.
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Background: India shoulders the largest global burden of blindness. Despite all the advances of science, there is no artificial substitute invented so far to replace human cornea. This study was conducted to assess the knowledge, attitude and practice about eye donation among the eye donors’ and recipient’s family.Methods: A community based cross sectional study was conducted from January 2011 to December 2011 in Ahmedabad city, Gujarat. Eighty-one eye donors and 127 eye recipients using pre-designed and pre-tested proforma was finalized to collect the information from the participants either by home visit (in city) or by telephonic or e-mail interview. Data was entered and analyzed in MS Excel 2007 and Epi info7 software. Knowledge, attitude and practice were expressed as proportions.Results: A total of 81 eye donors and 127 eye recipient’s relatives were interviewed. Doctor or hospital was the most common source of knowledge regarding eye donation for both eye donors (68, 83.95%) and eye recipients (113, 88.97%). In this study 11 (13.58%) eye donors and 4 (3.15%) eye recipients were regular blood donors showing their positive attitude. Only nine (11.11%) donations were done by either donor’s personal will or by already pledging. Among our participants 68 (83.95%) family members had closed the eye lids of the donor after death, 39 (48.15%) had switched off fan of the room after death.Conclusions:Relatives of eye donors and eye recipients are willing to pledge for eye donation after death. Media and medical person was the mainstay in imparting knowledge to the participants. The relative of the donors are well versed with various aspect of preserving eyes after the death of donor compared to those recipients.
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Background: Men having sex with men (MSM) are at higher risk of getting STIs, including HIV. Their role as bridge population is also very important in the spread of HIV. This study was done with the objective to study the demographic and behavioural factors of MSM and to measure the prevalence of STI among MSM using laboratory facilities of regional RTI/STI centre.Methods: This was a cross sectional study conducted at a targeted intervention (TI) site of Vadodara city. Sixty-eight MSM were enrolled, counselled regarding HIV and other STI testing followed by an interview using a pretested semi-structured study instrument for the information regarding socio-demographic status, sexual behaviour, present and past history of STI and health seeking behaviour. Following that, clinical examination for presence of any signs of STI and sample collection [oro-pharyngeal, urethral and anorectal swab] was done in an examination room and blood samples were collected. The samples were tested for various STIs at Regional RTI/STI centre.Results: Thirty-seven percent of MSM were bisexual. 37% MSM were not using condom consistently with ‘unavailability at all the time’ being the main reason. Six out of 68 MSM found positive of STI. Prevalence was maximum for Chlamydia infection followed by HSV2, HBsAg.Conclusions: Prevalence of STI was 8.82% among MSM of Vadodara city