The impact of respite care from the perspectives and experiences of people with amyotrophic lateral sclerosis and their care partners: a qualitative study.

BACKGROUND: Respite care provides caregiving support to people with amyotrophic lateral sclerosis (ALS) and their care partners by providing the care partner with temporary relief from their caregiving duties. The aim of this study was to explore the impact of respite care through the perspectives and lived experiences of people with ALS and their care partners. METHODS: Thirty-one dyads (62 participants) of people with ALS and their care partners were assigned to either the control group or the respite care intervention. Respite care was provided in the form of home-based services. Semi-structured interviews were conducted with participants at baseline and after a six-month period to gather perspectives on ALS caregiving, perceptions of respite care, and the respite care experience. Interviews were transcribed and subjected to thematic analysis. RESULTS: Caregiving challenges specific to the care partner and the patient-care partnership relationship were identified. Overall, people with ALS and care partners responded positively to in-home respite care and reported improved relationship quality, more time for the care partner to pursue personal commitments or take a break, and improved emotional well-being for both the person with ALS and the care partner. Barriers and concerns were raised surrounding privacy and staff consistency. CONCLUSION: This study highlights respite care as a critical tool to alleviate caregiving challenges and support the needs of people with ALS and their care partners. Engagement with the ALS community and formal evaluations of respite care services should be prioritized in order to minimize barriers and best meet the needs of people with ALS and their care partners.

Pneumococcal carriage among children under five in Accra, Ghana, five years after the introduction of pneumococcal conjugate vaccine.

BACKGROUND: The study objective was to determine the carriage and serotype distribution of Streptococcus pneumoniae among children in Accra, Ghana, five years after the introduction of the pneumococcal conjugate vaccine (PCV-13) in 2012. METHODS: Nasopharyngeal swab samples were collected from 410 children below 5 years of age in Accra, Ghana, from September to December, 2016. Pneumococcal isolates were identified by optochin sensitivity and bile solubility. Serotyping was performed using the latex agglutination kit and Quellung reaction. The isolates were furthermore tested for antimicrobial susceptibility for different antimicrobials, including penicillin (PEN). Twelve isolates including seven non-typeable (NT) isolates were characterized using whole-genome sequencing analysis (WGS). RESULTS: The overall carriage prevalence was found to be 54% (95% CI, 49-59%), and 20% (95% CI, 49-59%) of the children were carrying PCV-13 included serotypes, while 37% (95% CI, 33-42%) of the children were carrying non-PCV-13 serotypes. Based on the serotype distribution, 33% of all observed serotypes were included in PCV-13 while 66% were non-PCV-13 serotypes. The dominating non-PCV-13 serotypes were 23B, 16F, and 11A followed by PCV-13 serotypes 23F and 19F. The PCV-13 covers the majority of resistant isolates in Accra. A proportion of 22.3% of the isolates showed intermediate resistance to penicillin G, while only one isolate showed full resistance. Forty-five isolates (20.5%) were defined as multidrug-resistant (MDR) as they were intermediate/resistant to three or more classes of antimicrobials. Of the seven NT isolates characterized by WGS, four showed highest match to genotype 38, while the remaining three showed highest match to genotype 14. Four MDR serotype 19A isolates were found to be MLST 320. CONCLUSION: PCV-13 introduced in Ghana did not eliminate PCV-13 covered serotypes, and the carriage rate of 54% in this study is similar to carriage studies from pre PCV-13 period. However, the penicillin non-susceptible isolates have been reduced from 45% of carriage isolates before PCV-13 introduction to 22.3% of the isolates in this study. Continuous monitoring of serotype distribution is important, and in addition, an evaluation of an alternative vaccination schedule from 3 + 0 to 2 + 1 will be important to consider.

Evaluating decontamination protocols for the isolation of Mycobacterium ulcerans from swabs.

BACKGROUND: Mycobacterium ulcerans (M. ulcerans) is the causative agent of Buruli Ulcer (BU) disease. In order to inhibit the growth of the microbial contaminants during culture of M. ulcerans, it is necessary to decontaminate BU samples with effective chemical agents. This study aimed at investigating some selected chemicals as potential decontamination agents for the isolation of M. ulcerans from swabs. RESULTS: Povidone iodine at 0.5 and 1% exhibited the lowest contamination and recovery rate for microbial contaminants and M. ulcerans. The most effective decontamination method was the protocol using 2% cetylpyridinium chloride/4% sodium chloride (recovery rate = 53%, contamination rate = 14%). The observed difference between the recovery rate of 2% CPC/4% NaC and the other protocols was however not statistically significant (p = 0.76). CONCLUSIONS: Two percent (2%) cetylpyridinium chloride/4% sodium chloride can be conveniently used as an alternative decontamination method for the isolation of M. ulcerans from swabs.

Susceptibility Profiles of Mycobacterium ulcerans Isolates to Streptomycin and Rifampicin in Two Districts of the Eastern Region of Ghana.

Background. Drug resistance is a major challenge in antibiotic chemotherapy. Assessing resistance profiles of pathogens constitutes an essential surveillance tool in the epidemiology and control of infectious diseases, including Buruli ulcer (BU) disease. With the successful definitive management of BU using rifampicin and streptomycin, little attention had been paid to monitoring emergence of resistant Mycobacterium ulcerans (M. ulcerans) isolates in endemic communities. This study investigated the susceptibility profiles of M. ulcerans isolates from two BU endemic areas in Ghana to streptomycin and rifampicin. Methods. The antibiotic susceptibility of seventy (70) M. ulcerans isolates to rifampicin and streptomycin was determined simultaneously at critical concentrations of 40 µg/mL and 4 µg/mL, respectively, by the Canetti proportion method. Results. Resistance to rifampicin was observed for 12 (17.1%) M. ulcerans isolates tested, whilst 2 (2.9%) showed resistance to streptomycin. None of the isolates tested showed dual resistance to both rifampicin and streptomycin. Conclusion. Outcomes from this study may not be reflective of all BU endemic communities; it, however, provides information on the resistance status of the isolates, which is useful for monitoring of M. ulcerans, as well as BU disease surveillance and control.

Invasive disease and paediatric carriage of Streptococcus pneumoniae in Ghana.

This study was carried out primarily to evaluate the public health burden related to Streptococcus pneumoniae in Ghana and to provide related preliminary molecular epidemiological data on the organism. Invasive and nasopharyngeal specimens were screened for S. pneumoniae, and isolates were subjected to serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. Overall, the prevalence of S. pneumoniae in cerebrospinal fluid (CSF) was 1.7%, in blood was 0.2%, and in nasopharyngeal specimens was 15.3%. The prevalence of multiple drug resistance among the isolates was 48.6%, while the percentage resistance to various drugs was in the range of 11.1-84.0%. Serotyping of the S. pneumoniae isolates showed 7 different serotypes (3, 6B, 9, 10, 14, 16 and 23F). The extent of coverage of serotypes by the 7-valent pneumococcal conjugate vaccine was 57.1%, for the 10-valent vaccine was 57.1%, and for the 13-valent vaccine was 71.4%. MLST of 7 housekeeping genes of the organism showed a high level of genetic diversity among the isolates. S. pneumoniae appears to be an important organism in invasive infections in Ghana, being the most prevalent organism in CSF in this study. The high multiple drug resistance of the organism observed heightens the public health burden, which may be controlled by pneumococcal conjugate vaccines to a large extent.

Antimicrobial resistance and serotype distribution of Streptococcus pneumoniae strains causing childhood infection in Burkina Faso.

In Burkina Faso, a Western African country, reports on pneumococci carriage, resistance patterns and serotypes are inconsistent. The present study was conducted in order to evaluate these parameters. Thus 860 nasopharyngeal swabs were collected from children attending vaccination centers for pneumococci isolation, identification and serotype determination. The susceptibility to 16 antibiotics was assayed as recommended by the National Committee for Clinical Laboratory Standard (NCCLS). The results revealed that the majority of children were of 2 to 24 months age and 73.4% of children were well vaccinated. A carriage rate of 50.6% was recoded among the children. The main serotypes were: 6 (22.22%); 23 (16.67%); 7 and 9 (3.70%); 4, 11, 14, 15, 20 and 24 (1.85%). Serotypesl9, 23, 6, 7 and 18 were linked to penicillin resistance. Globally, high resistance rates to: amikacin, tetracyclin, pefloxacin, cotrimoxazol and penicillins (resistance rates greater than 25%) were recorded; however the following antibiotics remained active on the strains: rifampicin, ceftriaxone, erythromycin, spectinomycin, chloramphenicol, vancomycin, lincomycin and ciprofloxacin.

Characterization of human invasive isolates of Listeria monocytogenes in Sweden 1986-2007.

Since 1986, 68% of the Listeria monocytogenes isolates from human cases of invasive listeriosis in Sweden are available for retrospective studies. The aim of the present study was to characterize 601 human invasive isolates of L. monocytogenes in Sweden from 1986 to 2007 by using serotyping and pulsed-field gel electrophoresis. Since 1996, serovar 4b was permanently reduced to the second or third most common serovar in human cases in Sweden. During the latter period, 2000-2007, only 13% belonged to serovar 4b and 71% to 1/2a. The dendrogram, based on pulsovars, reveals two clusters with different serovars. Cluster 1 exhibits serovars 4b and 1/2b, whereas cluster 2 consists of serovar 1/2a. Serovar 1/2a seems to be more heterogeneous than serovar 4b.