Point Prevalence Survey of Antimicrobial Prescription and Consumption in a Nigerian Tertiary Hospital: A Gateway to the Antimicrobial Stewardship Program.

BACKGROUND: Antimicrobial stewardship is an important action plan for curbing the rising trend of antimicrobial resistance (AMR). Surveillance of antimicrobial use and consumption is needed as baseline data and for monitoring the impact of antimicrobial stewardship interventions. The survey was done to understand the burden of AMR, in view of establishing an antimicrobial stewardship program in our hospital. METHODS: A point prevalence survey (PPS) of antimicrobial use and consumption was conducted on all inpatients admitted before 8.00 am on the days of the survey using a standardized questionnaire. The collected data were entered online into the Global PPS web-based application (www.global-pps.com), for analysis. RESULT: Of the 178 patients admitted during the survey period, 50.6% were on one or more antimicrobial agents. All the patients in adult intensive care units were on antibiotics (100%), followed by neonatal intensive care units (83.3%), with the least being adult medical wards (39.4%). Beta-lactam antibiotics were the most frequently prescribed antimicrobial for various infections, especially skin and soft tissue infections, 41.3%, which were the most common diagnoses treated with antibiotics. The infection was mostly community-acquired (81.6%), of which 94.9% were treated empirically. There was no written guideline in existence. CONCLUSION: The present study revealed a poor prescribing habit because of a high rate of empirical treatment. The need for antimicrobial stewardship cannot be overemphasized as it will help streamline and improve the prescribing pattern.

Multi-Pathogen Innovative (5 in 1) Vaccine for Viral Haemorrhagic Fevers will Save More Lives.

Mankind has developed strategies to mitigate calamitous pandemics, by using vaccines. Eradication of some diseases was successful through usage of vaccines. Lassa, Yellow, Crimean-Congo, Marburg and Ebola viruses need special attention. Lassa fever, that now has a candidate vaccine, was discovered in 1969 when two missionary nurses died in Nigeria, while Yellow fever has a vaccine from its 17D attenuated strain. Crimean-Congo haemorrhagic fever is a widespread tick-borne viral disease, and the nucleoprotein and glycoproteins are identified for inclusion in a vaccine. Marburg virus is highly pathogenic with mortality rate of 90%. Ebola virus outbreak in West Africa in 2013-2016 necessitated an early introduction of a vaccine. The classical vaccine platforms are commonly used for human vaccines, and next-generation platforms, are being developed. Development of a novel multivalent vaccine against viral haemorrhagic fevers will eliminate the difficulties of single vaccines and may lead to the eradication of these diseases.

L'Humanité a développé des strategies pour atténuer les pandémiescalamiteuses, en utilisant des vaccins. L'éradication de certaines maladies a été réussie grâce à l'utilisation de vaccins. Les virus de Lassa, de la fièvre jaune, de la fièvre de Crimée-Congo, de Marburg et d'Ebola méritent une attention particulière. La fièvre de Lassa, qui dispose aujourd'hui d'un candidat vaccin, a été découverte en 1969 lors du décès de deux infirmières missionnaires au Nigeria, tandis que la fièvre jaune dispose d'un vaccin à partir de sa souche atténuée 17D. La fièvre hémorragique de Crimée-Congo est une maladie virale répandue, transmise par les tiques, et la nucléoprotéine et les glycoprotéines sont identifiées pour être incluses dans un vaccin. Le virus de Marburg est hautement pathogène avec un taux de mortalité de 90 %. L'épidémie de virus Ebola en Afrique de l'Ouest en 2013- 2016 a nécessité l'introduction rapide d'un vaccin. Les plateformes vaccinales classiques sont couramment utilisées pour les vaccins humains, et des plateformes de nouvelle sont en cours de développement. Le développement d'un nouveau vaccin multivalent contre les fièvres hémorragiques virales éliminera les difficultés des vaccins uniques et pourrait conduire à l'éradication de ces maladies. Mots clés: Innovant ; Multi-pathogène ; Développement de vaccins; Fièvres hémorragiques virales.

Etiologic dilemma and challenges of management of nodular vasculitis in tertiary health-care facility: A case report.

Nodular vasculitis is a rare inflammatory disease of the skin and subcutaneous fat tissue, characterized by crops of small, tender, erythematous nodules on the legs, mostly on the calves and shins. We present a 17-year-old adolescent female who presented with a six-month history of cough; recurrent fever and bilateral lower limb multiple ulcerated nodules of 1-month duration. Clinical examination revealed generalized lymphadenopathy with bilateral pitting leg edema which had multiple nodules and discoid ulcers extending from the groin to the ankles and discharging purulent fluid. Tests for human immunodeficiency virus and tuberculosis were negative. Histology of nodule biopsy revealed extensive caseous and coagulative fat necrosis, granulomatous inflammation with epitheloid macrophages and multinucleated giant cells surrounding the necrosis, and lymphoid infiltration of vessel walls with fibrous thickening of the intima, typical of Whitfield-type erythema induratum. There was initial but very transient response to antibiotic treatment, with further deterioration and eventual death from overwhelming sepsis.