Prevalence of Antibiotic-Resistant Pathogenic Bacteria and Level of Antibiotic Residues in Hospital Effluents in Selangor, Malaysia: Protocol for a Cross-sectional Study.

BACKGROUND: Antimicrobial resistance (AMR) has emerged as a major global public health challenge due to the overuse and misuse of antibiotics for humans and animals. Hospitals are among the major users of antibiotics, thereby having a large contribution to AMR. OBJECTIVE: The aim of this study is to determine the prevalence of antibiotic-resistant pathogenic bacteria and the level of antibiotic residues in the hospital effluents in Selangor, Malaysia. METHODS: A cross-sectional study will be performed in the state of Selangor, Malaysia. Tertiary hospitals will be identified based on the inclusion and exclusion criteria. The methods are divided into three phases: sample collection, microbiological analysis, and chemical analysis. Microbiological analyses will include the isolation of bacteria from hospital effluents by culturing on selective media. Antibiotic sensitivity testing will be performed on the isolated bacteria against ceftriaxone, ciprofloxacin, meropenem, vancomycin, colistin, and piperacillin/tazobactam. The identification of bacteria will be confirmed using 16S RNA polymerase chain reaction (PCR) and multiplex PCR will be performed to detect resistance genes (ermB, mecA, blaNDM-L, blaCTX-M, blaOXA-48, blaSHV, VanA, VanB, VanC1, mcr-1, mcr-2, mcr-3, Intl1, Intl2, and qnrA). Finally, the level of antibiotic residues will be measured using ultrahigh-performance liquid chromatography. RESULTS: The expected outcomes will be the prevalence of antibiotic-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter (ESKAPE) bacterial species from the hospital effluents, the occurrence of antibiotic resistance genes (ARGs) from the isolated ESKAPE bacteria, and the level of antibiotic residues that may be detected from the effluent. Sampling has been conducted in three hospitals. Data analysis from one hospital showed that as of July 2022, 80% (8/10) of E. faecium isolates were resistant to vancomycin and 10% (1/10) were resistant to ciprofloxacin. Further analysis will be conducted to determine if the isolates harbor any ARGs and effluent samples are being analyzed to detect antibiotic residues. Sampling activities will be resumed after being suspended due to the COVID-19 pandemic and are scheduled to end by December 2022. CONCLUSIONS: This study will provide the first baseline information to elucidate the current status of AMR of highly pathogenic bacteria present in hospital effluents in Malaysia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39022.

METER (Mental health emergency response) program: Findings of psychological impact status and factors associated with depression, anxiety and stress among healthcare workers in public hospital in Malaysia during the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic has become the greatest challenge of the new millennium. Most healthcare workers (HCWs) experienced unprecedented levels of workload since the pandemic. This study aims to identify the prevalence and factors of depression, anxiety and stress among HCWs in Malaysian healthcare facilities in the midst of the pandemic due to the SARs-CoV-2. METHODS: An emergency response programme on mental health was conducted from June to September 2020. A standardized data collection form was distributed among the HCWs in the government hospital in Klang Valley. The form contained basic demographic information and the self-reported Malay version of the Depression, Anxiety and Stress scale (BM DASS-21). RESULTS: Of the1,300 staff who attended the Mental Health and Psychosocial Support in Covid-19 (MHPSS COVID-19) programme, 996 staff (21.6% male, 78.4% female) completed the online survey (response rate: 76.6%). Result showed that staff aged above 40 years old were almost two times more likely to have anxiety (AOR = 1.632; 95% CI = 1.141-2.334, p:0.007) and depression (AOR = 1.637; 95% CI = 1.1.06-2.423, p:0.014) as compared to staff who were less than 40 years old. Those who had direct involvement with COVID-19 patients were likely to suffer stress (AOR = 0.596; 95% CI = 0.418-0.849, p:0.004), anxiety (AOR = 0.706; 95% Ci = 0.503-0.990, p:0.044) and depression (AOR = 0.630; 95% Ci = 0.427-0.928, p:0.019). HCWs with stress (AOR = 0.638; 95% CI of 0.476-0.856, p = 0.003), anxiety (AOR = 0.720; 95% CI 0.542-0.958, p = 0.024) and depression (AOR = 0.657; 95% CI 0.480-0.901, p = 0.009) showed less confidence to treat critically ill patients and need psychological help during outbreak. CONCLUSION: This study showed the importance of psychosocial support to reduce psychological distress among HCWs when working or coping during the COVID-19 pandemic or outbreak.

Effects of temperature, humidity, air quality and anthropic activities on the transmission of SARS-CoV-2: a systematic review protocol.

INTRODUCTION: The current global pandemic of the virus that emerged from Hubei province in China has caused coronavirus disease in 2019 (COVID-19), which has affected a total number of 900 036 people globally, involving 206 countries and resulted in a cumulative of 45 693 deaths worldwide as of 3 April 2020. The mode of transmission is identified through airdrops from patients' body fluids such as during sneezing, coughing and talking. However, the relative importance of environmental effects in the transmission of the virus has not been vastly studied. In addition, the role of temperature and humidity in air-borne transmission of infection is presently still unclear. This study aims to identify the effect of temperature, humidity and air quality in the transmission of SARS-CoV-2. METHODS AND ANALYSIS: We will systematically conduct a comprehensive literature search using various databases including PubMed, EMBASE, Scopus, CENTRAL and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to latest available studies in 2020. We will include all the observational studies such as cohort case-control and cross-sectional studies that explains or measures the effects of temperature and/or humidity and/or air quality and/or anthropic activities that is associated with SARS-CoV-2. Study selection and reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Meta-Analysis of Observational Studies in Epidemiology guideline. All data will be extracted using a standardised data extraction form and quality of the studies will be assessed using the Newcastle-Ottawa Scale guideline. Descriptive and meta-analysis will be performed using a random effect model in Review Manager File. ETHICS AND DISSEMINATION: No primary data will be collected, and thus no formal ethical approval is required. The results will be disseminated through a peer-reviewed publication and conference presentation. PROSPERO REGISTRATION NUMBER: CRD42020176756.