Diagnosis and management of bacterial meningitis in adult Sudanese patients: a six years hospital based, retrospective, cross-sectional study.

PURPOSE: To evaluate the diagnosis and management of bacterial meningitis in adult Sudanese patients in accordance with the Infectious Diseases Society of America (IDSA) guidelines for bacterial meningitis management. PATIENTS AND METHODS: A cross-sectional, retrospective study design was used to recruit all patients aged > 18 years who were diagnosed with or suspected of having bacterial meningitis and admitted to Wad Medani Teaching Hospital, Gezira State, Sudan, between January 2017 and October 2022. RESULTS: In total, 201 patients were included in the analysis. The mean age of the participants was 44.1 ± 21.4 years, and 107 (53.2%) were male. Community-acquired bacterial meningitis accounted for 193 (96%) of the studied patients, and only 8 (4%) of the patients had healthcare-associated meningitis. Neuroimaging was utilized appropriately in 148 (73.6%) patients, blood cultures were not performed entirely, and lumbar puncture was seldom performed in 1 (0.5%) patient. Corticosteroids were appropriately administered to 65 (32.3%) patients, and antibiotics were administered appropriately to only 5 (2.5%) patients. Ceftriaxone 185 (76.1%) was the most frequently utilized antibiotic, followed by vancomycin 23 (9.5%). In terms of overall adherence, this study demonstrated that the IDSA guidelines were not followed at all in the treatment of patients with suspected bacterial meningitis. CONCLUSION: The results of this study contradict the IDSA guidelines for the standard of care for bacterial meningitis. Antibiotic regimens are often incorrect, corticosteroids are administered appropriately in approximately one-third of patients, and neuroimaging is reasonably utilized. This study raises attention to several important issues regarding the diagnosis of bacterial meningitis, including the lack of confirming microbiological tests and the reliance of the diagnosis primarily on CT and clinical examination.

A Four-Year Trend of Ceftriaxone Resistance and Associated Risk Factors Among Different Clinical Samples in Wad Medani, Sudan: A Cross-Sectional Retrospective Study.

Introduction In sub-Saharan Africa, including Sudan, there is commonly no local data on the bacterial profile or antibiotic resistance pattern. Therefore, to bridge these gaps, this study aimed to evaluate ceftriaxone resistance patterns and associated risk factors among different clinical samples. Methods This study was a laboratory-based, retrospective, cross-sectional study. All clinical specimens were obtained from patients at Wad Medani and examined at the Pathology Center for Diagnosis and Research, Faculty of Medicine, University of Gezira, Sudan, from January 2020 to October 2023. Results Overall, 1784 specimens exhibited bacterial growth over four years. Of these, 1260 (70.6%) were females. Approximately one-third of the 588 (33%) studied patients were aged 30 to 44 years. Of the studied samples, 1108 (62.1%) were urine, and 465 (26.1%) were wound swabs. Staphylococcus aureus (697, 39.1%) and Escherichia coli (656, 36.8%) were the most frequently encountered bacteria. Generally, ceftriaxone resistance has been evaluated in 150 positive culture samples. The overall ceftriaxone resistance rate was 106 (70.7%). The greatest proportion of ceftriaxone resistance was observed in 4/4 (100%) of Klebsiella spp. and 66/82 (80.5%) of E. coli strains. The type of isolate (95% Cl, p-value; 0.006) and type of bacterial stain (95% Cl, p-value 0.013) have been significantly associated with ceftriaxone resistance, in which Gram-negative bacteria had a greater resistance rate of 98/132 (74.2%) than Gram-positive bacteria 8/18 (44.4%). Conclusions This study revealed a high rate of ceftriaxone resistance. The most resistant bacteria were Klebsiella spp. and E. coli. The type of isolate and bacterial stain were significantly associated with ceftriaxone resistance. Therefore, hospitals should immediately and significantly modify their antibiotic prescription policy to give doctors a consistent strategy for the rational, safe, and effective administration of antibiotics.

Prevalence and Antimicrobial Sensitivity Patterns of Uropathogens in Wad Medani, Sudan: A Three Years, Cross-Sectional Study.

Purpose: Urinary tract infections exert a significant negative impact on an individual's quality of life and cause significant economic and public health burdens. Therefore, this study was conducted to identify the common bacterial uropathogens associated with urinary tract infections in Wad Medani patients and their susceptibility to antibiotics. Patients and Methods: This was a cross-sectional study. All urine samples were collected from patients at Wad Medani and investigated at the Pathology Center for Diagnosis and Research, Faculty of Medicine, University of Gezira, Sudan, from the 1st of January 2021 to the 15th of October 2023. Results: A total of 2698 urine samples were analyzed during the three years study period, with a mean age of 45.29 ± 18.9 years. Among these patients, 1108 (41.8%) were positive for bacterial growth, and 888 (80.14%) were female. A total of 522 (47.1%) were gram positive bacteria (GPB), and 586 (52.9%) were gram negative bacteria (GNB). The most frequently isolated bacteria were S. aureus 42% (465/1108) and E. coli 38.5% (427/1108), while P. aeruginosa was less detected 3.4% (38/1108). Amikacin 91.5% was the most sensitive drug to isolated GPB, while cotrimoxazole 20.9% was the least sensitive drug. In particular, amikacin 94.1% (144/153) was the most sensitive drug to S. aureus, while cotrimoxazole 20.7% (80/386) was the least sensitive drug. Moreover, amikacin 91.5% was the most sensitive drug to the isolated GNB, while ampicillin 5.7% was the least sensitive drug. Notably, amikacin was the most sensitive drug to all the isolated GNB, and ampicillin was the least sensitive drug to all the isolated GNB. Conclusion: This study reported a moderate uropathogen isolation rate of 41.8%. S. aureus and E. coli were the most frequently isolated bacteria, most of which were from female patients. Remarkably, amikacin was the most sensitive drug to isolated GNB and GPB.

Impact of Clinical Pharmacist Intervention in the Intensive Care Unit, Wad Medani, Sudan: A Cross-Sectional, Prospective Study.

Purpose: Critical care pharmacists are uniquely qualified to provide a key role within the critical care multi-disciplinary team in managing the aspect of therapy, given their contributions to improved patient outcomes, medication safety, and reduced cost of the drug. Therefore, the purpose of this study was to assess the frequency, type, and impact of clinical pharmacist interventions in the Intensive Care Unit and their physicians' acceptance. Methods: This was a cross-sectional, prospective study. Data were gathered over six months (15th June 2023 to 15th December 2023) on a daily basis, with a minimum sample size of 384 interventions. All patients admitted to the ICU at Wad Medani Teaching Hospital, Gezira State, Sudan during the study period were included. Results: In general, a total of 510 interventions were made for 123 patients throughout the six months course of study. Among them, 493 (96.7%) clinical pharmacist interventions were agreed by physicians. Among categories of interventions, most of the recommendations were concerned about safety 34.11% (174/510), in which drug discontinuation due to long duration was the highest one 48.27% (48/174) followed by the renal dose adjustment 30.46% (53/174). Another clinical intervention involving indication accounted for 23.33% (119/510) in second place. Regarding the cost-saving interventions the study showed that, of the total number of interventions, 124 had a costrelated component, accounting for (24.31%) of the total interventions. Among all the interventions, the addition of drug, with a frequency of 103 (20.2%) was the most recurring intervention, followed by dosing at 100 (19.6%), and renal dose adjustment at 53 (10.4%). Conclusion: This study demonstrated how clinical pharmacists might enhance critical care patients' quality management while reducing the costs associated with medication and care. In addition, it contributes valuable insights into the integration of clinical pharmacists in ICU settings, especially in resource-limited environments.

Evaluation of errors in preparation and administration of intravenous medications in critically ill patients.

BACKGROUND: Intravenous medications have greater complexity and require multiple steps in their preparation and administration, which is considered a high risk for patients. OBJECTIVE: To determine the incidence of intravenous medications preparation and administration errors in critically ill patients. METHODS: This was an observational, cross-sectional, prospective study design. The study was performed in Wad Medani Emergency Hospital, Sudan . RESULTS: All nurses working at the study setting were observed over nine days. During the study period, a total number of 236 drugs were observed and evaluated. The total error rate was 940 (33.4%), of which 136 (57.6%) errors with no harm, 93 (39.4%) errors with harm and 7 (3%) of errors associated with mortality. 17 different drug categories were involved, in which antibiotic was the highest error rate 104 (44.1%) and 39 different drugs were involved, in which metronidazole was the most drug involved 34 (14.4%). The total error rate was associated with nurse experience, OR (95% CI); 3.235 (1.834-5.706), and nurse education level, OR (95% CI); 0.125 (0.052-0.299). CONCLUSION: The study reported high frequency of IV medications preparation and administration errors. Nurse education level, and experiences were influenced the total errors.