Raising concerns about the Sepsis-3 definitions.

The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.

The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey.

BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.

Cross-sectional community-based study of the socio-demographic factors associated with the prevalence of dengue in the eastern part of Sudan in 2011.

BACKGROUND: Dengue is caused by an arthropod-borne flavivirus. Infection can be either primary or secondary based on serology, with each stage of the disease characterized by specific serological conversion and antibody formation. Further study is needed to fully identify the factors associated with and predisposing to dengue infection. The objective of this study was to identify socio-demographic factors associated with the prevalence of dengue serotypes in Kassala State in the eastern part of Sudan in 2011. METHODS: This was a cross-sectional community-based study with 530 participants who were randomly selected through multi-stage cluster sampling. Dengue serotype prevalence was determined using capture Enzyme-linked immunosorbent assay (ELISA). ELISA IgG. A multivariate logistic regression model was designed to measure the strength of associations between socio-demographic factors and dengue serotype prevalence. All participants who tested negative for dengue were used as the statistical reference group. RESULTS: From this study, the prevalence of dengue in Kassala was estimated to be 9.4% (95% CI: 7.1-12.3). Lack of knowledge about dengue fever disease (OR 2.8, 95% CI: 1.24-6.53) and a household density of more than 3 people per room (OR 2.1, 95% CI: 1.06-4.09) were the most important factors associated with dengue infection among the study population. CONCLUSIONS: Community-oriented interventions are needed to modify existing social behaviors to reduce the risk of dengue in the eastern part of Sudan. Additional studies are also required in this field.

Factors associated with dengue fever IgG sero-prevalence in South Kordofan State, Sudan, in 2012: Reporting prevalence ratios.

BACKGROUND: Dengue fever (DF) is a vector-borne virus transmitted to humans by infected Aedes mosquitoes. In this study, we identified the most important factors associated with the prevalence of IgG antibodies in a border state between Sudan and the new republic of South Sudan. OBJECTIVES: To quantify the association of specific factors with the prevalence of DF IgG antibodies in Lagawa among subjects aged 16-60 years in 2012. METHODOLOGY: Analytical cross-sectional community-based study conducted in Lagawa in 2012. RESULTS: Indoor mosquito breeding was the most significant predictor affecting DF IgG serology. Household water storage was also strongly associated with the presence of IgG antibodies. Residence in urban areas, younger age and a history of travel to the Red Sea State were significant predictors of DF IgG seroprevalence in South Kordofan state. CONCLUSION: Indoor (household) behaviors associated with DF infection should be modified to mitigate the infection risk in the study area. Awareness should be raised regarding DF in Lagawa to ensure community participation in all control measures, and the surveillance system at the border between Sudan and the republic of South Sudan should be strengthened.

Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report.

INTRODUCTION: Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF), which is considered to be a very serious illness. Yellow Fever (YF) outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. OBJECTIVE: To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. METHODOLOGY: >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. RESULTS: The field investigation confirmed the outbreak and identified its cause to be YF. CONCLUSION: National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs) are usually very high among the index cases.