Antimicrobial activity of cefepime-tazobactam combination against extended spectrum beta-lactamase and/or AmpC beta-lactamase- producing gram-negative bacilli.

BACKGROUND: The problem of resistance to beta-lactam antibiotics, which is caused by ESBL and AmpC ß-lactamases, is getting worse globally. Infections caused by bacterial isolates harboring these enzymes are difficult to treat with carbapenems being the sole effective treatment option for such infections. The objective of this study was to determine the frequency of ESBLs and AmpC-producing Gram-negative bacilli isolated from clinical specimens and to evaluate the sensitivity of cefepime-tazobactam combination against them. METHODS: This is an observational cross-sectional study carried out on 100 Gram-negative bacilli at Theodor Bilharz Research Institute Hospital during the period from February 2015 to January 2016. ESBL production was screened by using the disc diffusion test followed by confirmation by the combined disc confirmatory test, the screening for AmpC production was conducted using the cefoxitin disc test, which was subsequently confirmed by the AmpC disc test. Isolates confirmed positive for ESBL and/ or AmpC production were investigated for their susceptibility to antibiotics. RESULTS: Among 100 Gram-negative bacilli, 44 isolates were confirmed as ESBL producers by the combined disc confirmatory test out of 56 isolates that tested positive for ESBL production through the disc diffusion test. The presence of AmpC production was assessed using the cefoxitin disc test, 32 isolates were screened to be AmpC producers, and the AmpC disc test confirmed AmpC production in 9 isolates of them. Using the Mast® D68C set, 32 isolates were ESBL producers, 3 were AmpC producers, and 4 isolates were ESBL/AmpC co-producers. The highest sensitivity was to cefepime-tazobactam (91.48%) followed by the carbapenems. CONCLUSION: Cefepime-tazobactam showed remarkable activity against ESBL and/or AmpC-producing Gram-negative bacilli and may be considered as a therapeutic alternative to carbapenems.

Assessing the policy utility of routine mortality statistics: a global classification of countries.

Objective: To evaluate the utility and quality of death registration data across countries. Methods: We compiled routine death and cause of death statistics data from 2015-2019 from national authorities. We estimated completeness of death registration using the Adair-Lopez empirical method. The quality of cause of death data was assessed by evaluating the assignment of usable causes of death among people younger than 80 years. We grouped data into nine policy utility categories based on data availability, registration completeness and diagnostic precision. Findings: Of an estimated 55 million global deaths in 2019, 70% of deaths were registered across 156 countries, but only 52% had medically certified causes and 42% of deaths were assigned a usable cause. In 54 countries, which are mostly high-income, there is complete and high-quality mortality data. In a further 29 countries, located across different regions, death registration is complete, but cause of death data quality remains suboptimal. Additionally, 37 countries possess functional death registration systems with cause of death data of poor to moderate quality. In 30 countries, death registration ranges from limited to nascent completeness, accompanied by poor or unavailable cause of death data. Furthermore, 38 countries lack accessible data altogether. Conclusion: By implementing more proactive death notification processes, expanding the use of digitized data collection platforms, streamlining data compilation procedures and improving data quality assessment, governments could enhance the policy utility of mortality data. Encouraging the routine application of automated verbal autopsy methods is crucial for accurately determining the causes of deaths occurring at home.

Comparative performance of national civil registration and vital statistics systems: a global assessment.

Objective: To assess the current state of the world's civil registration and vital statistics systems based on publicly available data and to propose strategic development pathways, including priority interventions, for countries at different levels of civil registration and vital statistics performance. Methods: We applied a performance assessment framework to publicly available data, using a composite indicator highly correlated with civil registration and vital statistics performance which we then adjusted for data incomparability and missing values. Findings: Globally, civil registration and vital statistics systems score on average 0.70 (0-1 scale), with substantial variations across countries and regions. Scores ranged from less than 0.50 in emerging systems to nearly 1.00 in the most developed systems. Approximately one fifth of the world's population live in the 43 countries with low system performance (< 0.477). Irrespective of system development, health sector indicators consistently scored lower than other determinants of civil registration and vital statistics performance. Conclusion: From our assessment, we provide three main recommendations for how the health sector can contribute to improving civil registration and vital statistics systems: (i) enhanced health sector engagement in birth and death notification; (ii) a more systematic approach to training cause of death diagnostics; and (iii) leadership in the implementation of verbal autopsy methods. Four different civil registration and vital statistics improvement pathways for countries at different levels of system development are proposed, that can constitute a blueprint for regional civil registration and vital statistics strengthening activities that countries can adapt and refine to suit their capabilities, resources, and particular challenges.

Global analysis of birth statistics from civil registration and vital statistics systems.

Objective: To assess civil registration and vital statistics completeness for births in World Health Organization's Member States and identify data completeness gaps. Methods: For the 194 Member States, we sourced birth registration data from the United Nations Children's Fund database of national surveys, and, where available, vital registration reports. We acquired publicly available vital statistics compiled by national authorities. We determined civil registration completeness as the percentage of living children younger than five years whose births have been reported as registered. We evaluated vital statistics completeness against the United Nations World Population Prospects' live birth estimates, and grouped countries into seven categories based on their civil registration and vital statistics completeness. Findings: Globally, civil registration completeness for births was 77%, exceeding vital statistics completeness for births at 63%. Twenty countries had limited civil registration (25% to 74% completeness) and had nascent or no vital statistics data (completeness < 25%) for births. Five countries had nascent or no civil registration and vital statistics for births. Twenty countries had functional civil registration (75% to 94% completeness) but nascent or no available vital statistics. Approximately half (96) of the countries had complete civil registration and vital statistics for births, but contributed to only 22% of global births. Conclusion: The gap in completeness between civil registration data and vital statistics for births is most pronounced in countries with lower civil registration completeness. Enhancing data transfer processes for birth registration, along with targeted investments to elevate registration rates, is crucial for yielding comprehensive fertility statistics for governmental planning.

Milk production and milk fatty acid profile as a response to feeding dairy cows with flax products during the persistence period.

The response of enhanced dietary dairy cows with linolenic-rich sources during the persistence period was studied to determine its effectiveness on some blood constituents, milk yield and milk fatty acid profile. A complete randomized design experiment was conducted in the spring and involved 20 Friesian cows (60 days in milk) that were divided into four groups of five animals by milk production according to different types of flax source in isonitrogenous and isoenergetic rations: a traditional diet with no flax source (CO), a diet contains flaxseed meal (FLM), a diet contains whole flaxseed (FLS) and a diet contains flax oil (FLO). DM intake and DMI% of weight were increased for cows fed FLM. However, Omega-3 intake was reduced for cows fed on CO ration. Although, blood serum metabolites did not differ among treatments (p < 0.05) except serum cholesterol which was increased with FLO cows, and serum total lipid which was reduced with FLM cows. Cows fed on flax product and control peaked in milk production at the same time (8-week post-partum), and cows fed on FLM continued in peak production for a longer period. Using flax products enhanced milk production, cows fed FLM had higher milk yield than those fed CO (20.76 vs.16.32 kg/d), and there was no difference between cows fed FLO (17.87 kg/d) and those fed FLS (18.01 kg/d). Also, energy-corrected milk yield and 3.5 fat-corrected milk yield were increased with cows fed on FLM as compared with cows fed CO ration. Flax products had no significant effect on milk fat and protein %, whereas cows fed FLM had the greatest fat% value (3.35%) and FLS had the greatest protein% value (2.66%). Moreover, fat and protein yield increased significantly in treatment groups compared to the CO group, whereas they were the greatest in FLM g (0.700 and 0.540 kg/d), respectively. Concentrations of omega-3-fatty acids in milk fat were increased by using FLO in the ration; using flaxseed meal enhanced conjugated linoleic acids in milk fat and resulted in the highest omega-6-to-omega-3-fatty-acids ratio. The data suggest that flax seed meals can be used as a fat source in the diet of dairy cows during the persistence period with a good response to milk production and its health properties. Moreover, flax oil should be protected before use in rations to prevent its components from saturation or being changed in the rumen.

Estimating causes of death where there is no medical certification: evolution and state of the art of verbal autopsy.

Over the past 70 years, significant advances have been made in determining the causes of death in populations not served by official medical certification of cause at the time of death using a technique known as Verbal Autopsy (VA). VA involves an interview of the family or caregivers of the deceased after a suitable bereavement interval about the circumstances, signs and symptoms of the deceased in the period leading to death. The VA interview data are then interpreted by physicians or, more recently, computer algorithms, to assign a probable cause of death. VA was originally developed and applied in field research settings. This paper traces the evolution of VA methods with special emphasis on the World Health Organization's (WHO)'s efforts to standardize VA instruments and methods for expanded use in routine health information and vital statistics systems in low- and middle-income countries (LMICs). These advances in VA methods are culminating this year with the release of the 2022 WHO Standard Verbal Autopsy (VA) Toolkit. This paper highlights the many contributions the late Professor Peter Byass made to the current VA standards and methods, most notably, the development of InterVA, the most commonly used automated computer algorithm for interpreting data collected in the WHO standard instruments, and the capacity building in low- and middle-income countries (LMICs) that he promoted. This paper also provides an overview of the methods used to improve the current WHO VA standards, a catalogue of the changes and improvements in the instruments, and a mapping of current applications of the WHO VA standard approach in LMICs. It also provides access to tools and guidance needed for VA implementation in Civil Registration and Vital Statistics Systems at scale.