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1.
BMC Infect Dis ; 21(1): 22, 2021 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413172

RESUMEN

BACKGROUND: Antimicrobial resistance (AMR) is a global problem compromising the effective treatment of infectious diseases. The World Health Organization (WHO) is encouraging and promoting awareness creation among health workers as one of its strategies to reduce the rate of emergence and transmission of AMR. Available data on the prescribing behavior of healthcare workers (HCWs) in Nigeria remains incomplete. This study was designed to provide an up-to-date estimate of the knowledge, attitude and antibiotic prescribing behavior of HCWs in Nigeria. METHODS: This is a cross-sectional study. Self-administered questionnaires were distributed to healthcare workers selected from six states, one each from the 6 geopolitical zones in Nigeria. A multi-stage sampling technique was used to reflect the three tiers of healthcare: primary, secondary and tertiary levels. Quantitative data was summarized using descriptive statistics. All data analysis was done using the Statistical package for social sciences version 26.0. RESULTS: Of the 420 questionnaires distributed, 358 (85.2%) responded. The mean year of practice of the respondents was 9.32 ± 7.8 years. About a half (50.3%) agreed that their prescribing behavior could promote antimicrobial resistance. 49.2% had a good knowledge of AMR and physicians had significantly better knowledge than other HCWs (X2 = 69.59, P < 0.001). Several participants prescribed antibiotics for common viral infections such as sore throats (75.7%), measles (37.7%), common cold and flu (21.2%). Over 60.3% admitted prescribing antibiotics just to be on the safe side. In general, 70.9% of the respondents frequently or moderately use practice guidelines while 25.7% often apply the delayed antibiotic prescription (DAP) strategy to reduce antimicrobial prescription. CONCLUSION: This study reveals an overall moderate level of knowledge of AMR and attitude towards minimizing the emergence of antimicrobial resistance though this did not translate significantly to practice. Further efforts must be made in order to improve rational prescription of antimicrobials among HCWs in Nigeria.

2.
Eur J Obstet Gynecol Reprod Biol ; 255: 1-12, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33059307

RESUMEN

Routine screening for Chlamydia and gonococcal infection in pregnancy is not widespread, especially in low- and middle-income countries (LMICs), despite their potential adverse consequences on pregnancy outcome. We conducted a systematic literature search of three major databases to review current literature surrounding Chlamydia trachomatis and Neisseria gonorrhoeae infections in pregnancy. We discuss the epidemiology and burden of both infections, detection methods, potential adverse feto-maternal and infant outcomes and provide an overview of treatment options. A total of 67 articles met the inclusion criteria. The prevalence of C. trachomatis and N. gonorrhoeae across all trimesters ranged between 1.0%-36.8% and 0-14.2% worldwide, respectively. The most common diagnostic method is the Nucleic acid amplification test (NAAT). In pregnancy, chlamydia is associated with preterm birth, spontaneous miscarriage, stillbirth and neonatal conjunctivitis, while gonorrhoea is mainly associated with preterm birth and stillbirth. Amoxicillin, erythromycin and azithromycin showed similar efficacy in the treatment of chlamydia in pregnancy, while ceftriaxone and cefixime were effective in treating gonorrhoea in pregnancy. Being largely asymptomatic infections in women, we opine that detection strategies with locally appropriate tools should be combined with the syndromic approach in LMICs, where there is a high burden of disease.

3.
Antimicrob Resist Infect Control ; 9(1): 81, 2020 06 09.
Artículo en Inglés | MEDLINE | ID: mdl-32517810

RESUMEN

BACKGROUND: Healthcare-associated infections (HAI) especially outbreaks of multi-drug-resistant organisms within hospitals are recognized as a major contributor to morbidity and mortality of hospitalized patients. The healthcare environment can act as an amplifier of HAI during outbreaks. The risk of acquiring HAI are 20 times higher in Low-and-middle-income countries. The purpose of this article is to review the challenges associated with controlling environmental contamination in low and lower-middle income countries (LMIC), highlighting possible solutions. METHOD: This is a narrative review. A literature search was carried out in Google scholar, PubMed, Science Direct, EBSCOHOST, CENGAGE, Scopus, ProQuest, Clinical Key and African journals online using the key words - Health care Associated Infections (HCAIs) in LMICs, Challenges of HAIs in LMIC, Challenges of Prevention and Control of HAIs in LMICs, Environment of care and infection transmission, Contaminated environment and HAIs. RESULTS: From the accessed databases, 1872 articles related to environmental sources of contamination in healthcare settings were found. Of these, only 530 articles focused on LMICs. However, only 186 articles met the inclusion criteria studies published in English, conducted between 2000 and 2019 and exploring environmental sources of contamination in LMIC healthcare settings). The sources of environmental contamination in healthcare are numerous and commonly associated with poor governance, Inadequate infrastructure, human capacity and inadequate funding. Low awareness exists at all levels as to the role of the environment in healthcare outcomes and may explain in part the low priority given for funding. CONCLUSION: Leadership and trained personnel, both Infection prevention and control practitioners and cleaners are crucial to drive and sustain the process to reduce environmental contamination in healthcare environments.

4.
medRxiv ; 2020 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-32577686

RESUMEN

Background: Nigeria became the first sub Saharan African country to record a case of COVID-19 after an imported case from Italy was confirmed on February 27, 2020. Moving averages and the Epidemic Evaluation Indices (EEI) are two important but complementary methods useful in monitoring epidemic trends, they can also serve as a useful guide for policy makers and inform the timing of decisions on preventive measures. The objectives of this paper are to graphically depict the trends of new COVID-19 cases nationally and in two key States (Lagos and Kano) and the Federal Capital Territory (FCT) using the moving averages and the EEI. In addition, we examined the effects of government's public health interventions on the spread of COVID-19 and appraise the progress made so far in addressing the challenges of COVID-19 in Nigeria. Methods: We used data on new cases of COVID-19 from public sources released by the Nigeria Center for Disease Control (NCDC) from the 27th February 2020, when the first case was recorded, to 11th May, 2020, one week after the lockdowns in Lagos and the FCT were lifted. We computed moving averages of various orders, the log transformations of the moving averages and then the EEIs of new COVID-19 cases for Nigeria as a whole, and then for two of the most affected states i.e. Lagos and Kano, as well as the Federal Capital Territory (FCT). Then, we plotted graphs to depict these indices and show the epidemic trends for COVID-19 in each scenario. Results: Nationally, the number of new cases of COVID-19 showed an initial gradual rise from the first reported case on the 27th February 2020. However, by the second week in April, these numbers began to show a relatively sharper increase and this trend has continued till date. Similar trends were observed in Lagos state and the FCT. The rate of growth of the logarithm-transformed moving average in the period leading to, and including the lockdowns reduced by a factor of 0.65. This suggests that the policies put in place by the government including the lockdown measures in Lagos and the FCT may have had a positive effect on the development of new cases of COVID-19 in Nigeria. Nationally and in Lagos, the EEIs of the COVID-19 cases started off on very high notes, however, the effects of the lockdown gradually became evident by the end of April and early May 2020, as the EEIs headed closer to 1.0. In all case scenarios, the EEIs are still above 1.0. Conclusions and recommendations: The number of new cases of COVID-19 has been on a steady rise since the first reported case. In Nigeria especially across the two states and the FCT, public health interventions including the lockdown measures appear to have played a role in reducing the rate of increase of new infections. The EEIs are still above 1.0, suggesting that despite the progress that appears to have been made, the epidemic is still evolving and Nigeria has not yet reached her peak for COVID-19 cases. We recommend that aggressive public health interventions and restrictions against mass gatherings should be sustained.

5.
Antimicrob Resist Infect Control ; 9(1): 72, 2020 05 20.
Artículo en Inglés | MEDLINE | ID: mdl-32434552

RESUMEN

BACKGROUND: One of the objectives of the Global Action Plan by the World Health Organization (WHO) to contain antimicrobial resistance (AMR), is to improve global awareness through effective communication and education. Comprehensive information on the level of awareness of AMR among Nigerian public is deficient. This study was therefore designed to assess the current level of awareness and knowledge of the Nigerian public of AMR. METHODS: Pre-tested and validated questionnaire was used to obtain information from the general public across the six geopolitical zones (North Central, North East, North West, South East, South South and South West) in Nigeria. Multi-stage sampling was used to select one state from each zone and respondents were selected through a multi-stage sampling technique. Responses to eight questions were used to grade the level of knowledge categorized as poor, fair and good. Collation and analysis of data were performed at the Microbiology Department of the Nigerian Institute of Medical Research (NIMR), Lagos, Nigeria, using SPSS version 24.0. RESULTS: Questionnaires from 482 respondents comprising 242 (50.2%) females and 240 (49.8%) males from six states (Lagos, Ebonyi, Delta, Plateau, Borno and Jigawa) were analyzed. Of the 482 respondents, 322 (66.8%) had taken antibiotics in the last six months out of which 31.3% were without prescription. 26.1% of respondents believe they don't need to complete the dosage as long as they feel better. Although 272(56.5%) of the respondents were familiar with the term "antibiotic resistance", only 40(8.3%) had good knowledge of AMR. A majority (76.6%) believed that they were powerless to stop the spread of AMR. There was no association between the gender of respondents and knowledge of AMR (p = 0.13). However, respondents from Ebonyi and Delta states in southern Nigeria were more likely to have good knowledge of AMR (X2 = 53.22, P < 0.0001). The respondents in the urban area had a higher score for knowledge level compared to the rural dwellers, though this was not statistically significant within and across states. CONCLUSION: This survey provides an insight into the level of AMR awareness and antibiotic use in the wider Nigeria public. Our findings show that about a third of the general public consume antibiotics obtained without prescription. There is an overall poor understanding of antimicrobial resistance and/or proper use of antibiotics among respondents. It is critical that more holistic public enlightenment programs are carried out to increase awareness of AMR and promote responsible use of antibiotics.

6.
Niger Postgrad Med J ; 27(2): 136-142, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32295946

RESUMEN

Context: Bowel carriage has been identified as the main reservoir of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and hospital-acquired infections. There are gaps in the knowledge of trends of these rates, which need to be filled for the development and implementation of hospital surveillance systems and antibiotic stewardship programmes in Nigeria. Aim: This study investigated the carriage rates of ESBL-PE among 273 children admitted to the paediatric wards of a university teaching hospital, Nigeria, using a prospective cohort study design over a 6-month period. Settings and Design: The study explored the role of new and transferred patients in introducing resistant strains of ESBLs into paediatric wards and how quickly paediatric patients that were previously free of resistant strains acquired these within the hospital environment. Materials and Methods: E-swabs (Copan Diagnostics, Italy) were used to obtain rectal samples from participants. Positive colonies were Gram stained and subcultured onto purity plates for further identification, and antibiotic susceptibility pattern of identified ESBL-PE was obtained using a range of antibiotics. Statistical Analysis Used: Data were analysed using SPSS statistics 20 (IBM SPSS Statistics, version 20). Statistical significance was determined using the Chi-square test and Fisher's exact test. A logistic regression analysis was also conducted to identify independent risk factors for colonisation. Results: The findings showed that transferred patients contributed to the introduction of ESBLs into the hospital. Independent multivariate risk factors for colonisation of ESBL-PE were age >10-14 years, instrumentation (odds ratio [OR]: 0.2 [P < 0.05]) and sharing of thermometers (OR: 0.11 [P < 0.05]). Conclusions: The carriage rate of ESBL-PE is high (25.3%) among children, and none-carriers may become colonised within 14 days of hospitalisation.


Asunto(s)
Antibacterianos/uso terapéutico , Portador Sano/epidemiología , Infección Hospitalaria/microbiología , Infecciones por Enterobacteriaceae/diagnóstico , Enterobacteriaceae/aislamiento & purificación , Hospitalización/estadística & datos numéricos , beta-Lactamasas/biosíntesis , Adolescente , Antibacterianos/farmacología , Portador Sano/microbiología , Niño , Infección Hospitalaria/epidemiología , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/microbiología , Hospitales de Enseñanza , Humanos , Nigeria/epidemiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo
7.
PLoS One ; 13(5): e0196224, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29742119

RESUMEN

OBJECTIVES: Disseminated histoplasmosis is an AIDS-defining illness. Histoplasmosis is commonly misdiagnosed as tuberculosis. Nigeria has the second highest number of people living with HIV/AIDS in Africa. The present study was carried out to investigate the prevalence of skin sensitivity amongst Nigerians to histoplasmin. DESIGN: A cross-sectional study was conducted in six centres across five geopolitical zones of Nigeria. METHODS: We recruited both healthy non-HIV and HIV-positive adults with CD4 count ≥ 350 cells/mm3 regardless of their ART status from March to May 2017. Skin tests were performed intradermally; induration ≥5 mm were considered to be histoplasmin positive. RESULTS: 750 participants were recruited from Lagos (n = 52), Yola (n = 156), Ilorin (n = 125), Calabar (n = 120), Ibadan (n = 202) and Benin (n = 95). 467 (62.3%) were HIV negative, 247 (32.9%) were HIV positive and 36 (4.8%) did not know their HIV status. A total of 32/735 (4.4%) participants had a positive skin test. Study centre (p<0.001), education (p = 0.002) and age (p = 0.005) appeared to be significantly associated with positive skin reactivity at the 0.5% significance level, while sex (p = 0.031) and occupation (p = 0.031) would have been significant at the 5% significance level. Males had a higher rate of reactivity than females (p = 0.031, 7% vs 3%). The highest positive rates were recorded from Benin City (13/86 (15%)) and Calabar (7/120 (6%)) and no positives were recorded in Lagos (p<0.001). HIV status was not statistically significant (p = 0.70). CONCLUSION: Histoplasmosis diagnostics should be included in the Nigerian HIV guidelines. Epidemiological vigilance of progressive disseminated histoplasmosis should be considered by local health authorities.


Asunto(s)
Histoplasmina/análisis , Histoplasmosis/diagnóstico , Histoplasmosis/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Pruebas Cutáneas , Adulto Joven
8.
Microb Pathog ; 111: 232-237, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28867621

RESUMEN

BACKGROUND: Clostridium perfringens is an anaerobic Gram-positive bacterium which is commonly present in the gastrointestinal tract of man and animals and causes enteritic diseases in animals and food poisoning in humans. Previous studies have looked at the epidemiological relationship between C. perfringens isolates from outbreak source. In this study, the genetic diversity of C. perfringens strains from non-outbreak food and faecal specimens was investigated for epidemiological purposes. METHODS: We analyzed thirty-eight (38) Clostridium perfringens strains isolated from food and faecal specimens in Lagos State. Bacterial identification was done using colonial morphology, Gram stain reaction, conventional biochemical tests and PCR. Genetic analysis was performed using arbitrary primed polymerase chain reaction (AP-PCR) technique with oligonucleotide primer of random sequences (OPA-3) to determine the genetic diversity of C. perfringens. The distance between the different bands produced were analyzed using numerical taxonomy and multivariate system software (NTSYS). RESULTS: Seventeen (44.7%) C. perfringens strains showed at least one polymorphic DNA patterns when genotyped. However, this method identified polymorphisms among the C. perfringens species from which four genetic groups (1, 2, 3 and 4) were established. CONCLUSIONS: Our findings suggest that there may be faecal contamination of food products and similar clones of Clostridium perfringens may be incriminated.


Asunto(s)
Clostridium perfringens/genética , Clostridium perfringens/aislamiento & purificación , Heces/microbiología , Microbiología de Alimentos , Variación Genética , Amoxicilina/farmacología , Técnicas de Tipificación Bacteriana , Clostridium perfringens/clasificación , Clostridium perfringens/efectos de los fármacos , ADN Bacteriano/genética , Enterotoxinas/genética , Enfermedades Transmitidas por los Alimentos/microbiología , Humanos , Metronidazol/farmacología , Pruebas de Sensibilidad Microbiana , Nigeria , Reacción en Cadena de la Polimerasa/métodos , Polimorfismo Genético
9.
Anaerobe ; 42: 176-181, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27789246

RESUMEN

Food-borne diseases contribute to the huge burden of sickness and death globally and in the last decade, have become more frequently reported in Africa. In line with this, food safety is becoming a significant and growing public health problem in Nigeria. Diarrhoea is a common problem in Nigeria and has been reported but there has been little data on the possibility of clostridia as aetiological agents. Clostridium species are ubiquitous in the environment and in the gastrointestinal tract of man and animals and can serve as a marker for faecal contamination. We set out to determine the potential of these foods to transmit Clostridium species. A total of 220 food commodities from six local governments in Lagos State were sampled. Isolates obtained were identified based on cultural, morphological and biochemical characteristics. Toxinotyping was done using multiplex-PCR with primers specific for alpha, beta, epsilon and iota-toxin genes, enterotoxigenic cpe gene and neurotoxigenic BoNt gene. Fifty (22.7%) clostridial species were isolated of which 29 (58%) were identified as C. perfringens. Toxinotyping of the 29 strains showed that 28 (96.6%) were toxin producing C. perfringens type A while one (3.4%) was C. perfringens type D. Two (4%) C. botulinum species were isolated and identified by 16S rRNA sequencing, both harbouring BoNt/A gene. The contamination rates of food with Clostridium species show that food hygiene is a problem and Clostridium species may be a source of food borne disease in Lagos State, Nigeria.


Asunto(s)
Toxinas Botulínicas/genética , Clostridium botulinum/aislamiento & purificación , Clostridium perfringens/aislamiento & purificación , Productos Lácteos/microbiología , Productos de la Carne/microbiología , Verduras/microbiología , Animales , Técnicas de Tipificación Bacteriana , Toxinas Botulínicas/aislamiento & purificación , Clostridium botulinum/clasificación , Clostridium botulinum/genética , Clostridium perfringens/clasificación , Clostridium perfringens/genética , Productos Lácteos/análisis , Humanos , Productos de la Carne/análisis , Reacción en Cadena de la Polimerasa Multiplex , Nigeria , ARN Ribosómico 16S/genética , Análisis de Secuencia de ARN
10.
PLoS One ; 11(10): e0165242, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27776162

RESUMEN

BACKGROUND: Infections are common complications in critically ill patients with associated significant morbidity and mortality. AIM: This study determined the prevalence, risk factors, clinical outcome and microbiological profile of hospital-acquired infections in the intensive care unit of a Nigerian tertiary hospital. MATERIALS AND METHODS: This was a prospective cohort study, patients were recruited and followed up between September 2011 and July 2012 until they were either discharged from the ICU or died. Antimicrobial susceptibility testing of isolates was done using CLSI guidelines. RESULTS: Seventy-one patients were recruited with a 45% healthcare associated infection rate representing an incidence rate of 79/1000 patient-days in the intensive care unit. Bloodstream infections (BSI) 49.0% (22/71) and urinary tract infections (UTI) 35.6% (16/71) were the most common infections with incidence rates of 162.9/1000 patient-days and 161.6/1000 patient-days respectively. Staphylococcus aureus was the most common cause of BSIs, responsible for 18.2% of cases, while Candida spp. was the commonest cause of urinary tract infections, contributing 25.0% of cases. Eighty percent (8/10) of the Staphylococcus isolates were methicillin-resistant. Gram-negative multidrug bacteria accounted for 57.1% of organisms isolated though they were not ESBL-producing. Use of antibiotics (OR = 2.98; p = 0.03) and surgery (OR = 3.15, p< 0.05) in the month preceding ICU admission as well as urethral catheterization (OR = 5.38; p<0.05) and endotracheal intubation (OR = 5.78; p< 0.05) were risk factors for infection. CONCLUSION: Our findings demonstrate that healthcare associated infections is a significant risk factor for ICU-mortality and morbidity even after adjusting for APACHE II score.


Asunto(s)
Infección Hospitalaria/epidemiología , Hospitales Universitarios/organización & administración , Unidades de Cuidados Intensivos , Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Infección Hospitalaria/patología , Farmacorresistencia Microbiana , Humanos , Incidencia , Pruebas de Sensibilidad Microbiana , Nigeria , Estudios Prospectivos , Factores de Riesgo
11.
Open Forum Infect Dis ; 3(2): ofw055, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27186581

RESUMEN

Background. Cryptococcal meningitis has a high mortality in human immunodeficiency virus (HIV)-infected persons in Africa. This is preventable with early screening and preemptive therapy. We evaluated the prevalence of cryptococcal disease by antigen testing, possible associated factors, and outcomes in HIV-infected patients being managed in a tertiary hospital in Lagos, Nigeria. Methods. Sera were collected from 214 consenting HIV-infected participants with CD4(+) counts <250 cells/mm(3), irrespective of their antiretroviral therapy (ART) status, between November 2014 and May 2015. A cryptococcal antigen (CrAg) lateral flow assay was used for testing. Pertinent clinical data were obtained from patients and their case notes. Results. Of the 214 participants, females (124; 57.9%) outnumbered males. Mean age was 41.3 ± 9.4 (standard deviation) years. The majority (204; 95.3%) were ART experienced. The median CD4(+) cell count was 160 cells/mm(3) (interquartile range, 90-210). The overall seroprevalence of cryptococcal antigenemia was 8.9% (19 of 214); 6 of 61 (9.8%) in those with CD4(+) cell counts <100 cells/mm(3), 4 of 80 (5.0%) in the 100-200 group, and 9 of 73 (12.3%) in 200-250 cells/mm(3) group. Among ART-naive patients, 1 of 10 (10%) was CrAg positive. Twenty-seven of 214 (12.6%) had associated oral thrush. Potential baseline meningitis symptoms (3 of 214 [1.4%] experienced neck pain or stiffness and 21 of 214 [9.8%] experienced headache) were common in the study group, but the result was not statistically significant in relation to CrAg positivity. Two of 19 (10.5%) CrAg-positive patients died, 10 of 19 (52.6%) were lost to follow up, and 7 of 19 (36.8%) were alive. Empirical fluconazole was routinely given to those with low CD4 counts <100 cells/mm(3), which was unrelated to CrAg positivity (P = .018). Conclusions. We report a prevalence of 8.9% cryptococcal antigenemia in a setting where first-line antifungals are not readily available. We recommend CrAg screening for HIV-infected patients, even for patients on ART.

12.
J Craniomaxillofac Surg ; 42(8): 1783-8, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25028067

RESUMEN

The aim of the study was to investigate the effect of preoperative 0.2% chlorhexidine mouthwash on the risk of bacteraemia following routine intra-alveolar tooth extraction. The study was a randomized controlled clinical study of 101 subjects who underwent intra-alveolar dental extractions under local anaesthesia. Subjects were randomly assigned to either chlorhexidine or a control group. The chlorhexidine group had 0.2% chlorhexidine mouthwash administered for 1 min before any dental manipulation, and the control group had a mouthrinse of sterile water. Blood samples were collected at baseline, 1 min and 15 min after the dental extractions. Subculture and further identification of the isolated bacteria were performed by conventional microbiological techniques. There was a statistically significant difference in the incidence of bacteraemia between the control group (52.4%) and chlorhexidine group (27.1%) (P = 0.012). Bacteraemia was most frequently detected at 1 min after extraction (33.3%). Of the 30 subjects who had positive blood culture at 1 min, bacteraemia persisted in 8 (26.7%) of the subjects after 15 min. Bacteria isolated included Staphylococcus aureus, Actinomycetes naesulendi, Prevotella species, Streptococcus spp., and Acinetobacter iwoffii. Routine use of 0.20% chlorhexidine mouthwash before dental extraction is recommended to reduce the risk of bacteraemia following tooth extraction.


Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Bacteriemia/prevención & control , Clorhexidina/administración & dosificación , Antisépticos Bucales/administración & dosificación , Extracción Dental/métodos , Acinetobacter/aislamiento & purificación , Actinobacteria/aislamiento & purificación , Adolescente , Adulto , Anciano , Bacteriemia/microbiología , Femenino , Estudios de Seguimiento , Humanos , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Diente Molar/cirugía , Bloqueo Nervioso/métodos , Cuidados Preoperatorios , Prevotella/aislamiento & purificación , Factores de Riesgo , Staphylococcus aureus/aislamiento & purificación , Streptococcus/aislamiento & purificación , Adulto Joven
13.
J Craniofac Surg ; 24(4): 1126-31, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23851754

RESUMEN

The aim of the study was to determine the prevalence and bacteriology of bacteremia associated with cleft lip and palate (CLP) surgery. Three venous blood samples were obtained from 90 eligible subjects who presented for CLP surgery: before surgical incision, 1 minute after placement of the last suture, and 15 minutes thereafter. The samples were injected into an Oxoid Signal blood culture and transported to the laboratory for gram-positive/negative and aerobic/anaerobic bacteria analysis. Prevalence of bacteremia associated with cleft surgery was 38.1%. Prevalence rates of bacteremia in cleft lip surgery, cleft palate surgery, and alveoloplasty were 40.9%, 33.3%, and 50%, respectively. There was no significant difference in prevalence rate of positive blood culture in cleft lip surgery, cleft palate surgery, and alveoloplasty (P = 0.69). Positive blood culture was detected most frequently (47%) 1 minute after placement of the last suture. Of the 23 subjects who had positive blood culture at 1 minute, bacteremia persisted in 8 (35%) of them after 15 minutes. The most common bacteria isolated were coagulase-negative staphylococcus, Acinetobacter lwoffii, and coagulase-positive Staphylococcus aureus. Sex and age of the subjects, duration of surgery, blood loss, and type of cleft surgery were not significantly associated with positive blood culture. Bacteremia associated with CLP surgery is polymicrobial and persisted for at least 15 minutes after surgery in 35% of cases. This may reinforce the need for prophylactic antibiotics to protect at-risk patients from developing focal infection of the heart by oral flora.


Asunto(s)
Bacteriemia/epidemiología , Bacteriemia/microbiología , Labio Leporino/microbiología , Fisura del Paladar/microbiología , Adolescente , Adulto , Niño , Preescolar , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Lactante , Masculino , Nigeria/epidemiología , Prevalencia , Adulto Joven
14.
Int J Mol Epidemiol Genet ; 3(1): 84-90, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22493755

RESUMEN

Fluconazole resistance is an important type of resistance in Candida because in most countries, fluconazole is the drug of choice for vulvovaginal candidiasis. Candida species resist fluconazole by various mechanisms but there is paucity of data on these in our environment. Such mechanisms include among others, over-expression of the ERG11 gene, which codes for synthesis of the target enzymes in the fungus. The aim of this study was to screen Candida spp. resistant to fluconazole for the expression of ERG11 gene. Fluconazole susceptibility test was performed on 28 clinical strains of Candida species previously obtained from students of a School of Nursing in Lagos, Nigeria. They were identified by API Candida, CHROMagar candida and germ tube test. Using 25 mcg discs, fluconazole susceptibility was determined by the disc diffusion method and results were interpreted in accordance with the Clinical Laboratory Standard Institute (CLSI) criteria; sensitive (S), resistant (R) and susceptible dose dependent (SDD). The R and SDD isolates were subsequently evaluated for the presence of ERG11 gene. Of the 28 clinical isolates, 14 were identified as C. albicans and six as C. tropicalis. The remaining isolates were identified as C. glabrata (2), C. famata (2) C. kefyr (2) one each of C. parapsilosis and C. guilliermondii respectively. In this study, 18 were susceptible (S) to fluconazole, eight were SDD and two were resistant to the antifungal agent. Out of the 14 C. albicans isolates, 12 were susceptible, one showed high level resistance and similar number showed susceptible dose dependence. ERG11 was detected in three susceptible dose dependent Candida species. This analysis demonstrates that susceptible dose dependence should not be overlooked as it may be associated with the presence of ERG11 gene and resistance to fluconazole. There is a need to consider routine antifungal susceptibility testing for Candida species causing vulvovaginitis.

15.
Cochrane Database Syst Rev ; (3): CD006055, 2009 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-19588379

RESUMEN

BACKGROUND: Bacterial vaginosis (BV) is a very common cause of vaginitis that has been associated with a high incidence of obstetric and gynaecologic complications and increased risk of HIV-1 transmission. This has led to renewed research interest in its treatment. OBJECTIVES: To assess the effects of antimicrobial agents on BV in non-pregnant women. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, LILACS, and African Healthline (December 2007); and proceedings of relevant international conferences (from 1981 to date). SELECTION CRITERIA: Randomised controlled trials comparing any two or more antimicrobial agents, or antimicrobial agents with placebo or no treatment, in women with clinical or Gram-stain criteria of BV. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data from the original publications while the third author cross checked the data. MAIN RESULTS: Twenty-four trials involving 4422 participants were reviewed. Most examined symptomatic women only. Only seven trials analysed results by intention to treat; we re-analysed the remainder.Compared with placebo, clindamycin showed a lower rate of treatment failure (relative risk (RR) 0.25, 95% confidence interval (CI) 0.16 to 0.37). Clindamycin and metronidazole showed identical rates of treatment failure, irrespective of regimen type, at two and four-week follow up (RR 1.01, 95% CI 0.69 to 1.46; RR 0.91, 95% CI 0.70 to 1.18, respectively). Clindamycin tended to cause a lower rate of adverse events (RR 0.75, 95% CI 0.56 to 1.02); metallic taste, and nausea and vomiting were more common in the metronidazole group (RR 0.08, 95% CI 0.1 to 0.59; RR 0.23, 95% CI 0.10 to 0.51, respectively). Given intravaginally as gelatin tablets, lactobacillus was more effective than oral metronidazole (RR 0.20, 95% CI 0.05 to 0.08). Similarly, oral lactobacillus combined with metronidazole was more effective than metronidazole alone (RR 0.33, 95% CI 0.14 to 0.77). Clindamycin showed a lower rate of clinical failure than triple sulfonamide cream (RR 0.46, 95% CI 0.29 to 0.72). Hydrogen peroxide douche showed a higher rate of clinical failure (RR 1.75, 95% CI 1.02 to 3.00) and adverse events (RR 2.33, 95% CI 1.21 to 4.52) than a single 2 g dose of metronidazole. AUTHORS' CONCLUSIONS: Clindamycin preparations, oral metronidazole, and oral and intravaginal tablets of lactobacillus were effective for bacterial vaginosis. Hydrogen peroxide douche and triple sulphonamide cream were ineffective. Metronidazole caused metallic taste, nausea and vomiting. We need better-designed trials with larger sample sizes to test the effectiveness of promising drugs.


Asunto(s)
Vaginosis Bacteriana/terapia , Antiinfecciosos/efectos adversos , Antiinfecciosos/uso terapéutico , Clindamicina/efectos adversos , Clindamicina/uso terapéutico , Femenino , Humanos , Lactobacillus , Metronidazol/efectos adversos , Metronidazol/uso terapéutico , Probióticos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Ducha Vaginal/efectos adversos
17.
Braz J Infect Dis ; 11(1): 63-9, 2007 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-17625730

RESUMEN

Staphylococcus aureus infections are growing problems worldwide with important implications in hospitals. The organism is normally present in the nasal vestibule of about 35% of apparently healthy individuals and its carriage varies between different ethnic and age groups. Staphylococcal nasal carriage among health workers is particularly important to establish new clones and track origin of infections during outbreak situations. To determine the carriage rate and compare the pulsed field gel patterns of the strains, nasal swabs were collected from 185 medical students in a teaching hospital in Lagos, Nigeria. Isolates of S. aureus were tested for heamolysin production, methicillin sensitivity and Pulsed Field Gel Electrophoresis (PFGE) was performed. The results showed S.aureus nasal carrier rate of 14% with significant rate among males compared to females. All the isolates produced heamolysin. Antibiotic susceptibility pattern revealed that majority of the isolates was susceptible. Five strains (19%) harboured resistant determinants to penicillin and tetracycline. None of the strains was resistant to methicillin. 44% of the isolates typed by PFGE had type B, the most predominant pulsotype. PFGE A clone exhibited a single resistance phenotype suggesting a strong clonal relationship that could punctual an outbreak in the hospital. The results speculate that nasal carriage among medical personnel could be a function of various risk factors. Personal hygiene and behaviour may however be the means to reducing colonization and spread of S.aureus in our hospitals.


Asunto(s)
Antibacterianos/farmacología , Portador Sano/microbiología , Resistencia a la Meticilina , Cavidad Nasal/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Adulto , Electroforesis en Gel de Campo Pulsado , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Nigeria , Factores de Riesgo , Staphylococcus aureus/efectos de los fármacos , Estudiantes de Medicina
18.
Braz. j. infect. dis ; 11(1): 63-69, Feb. 2007. tab, graf
Artículo en Inglés | LILACS | ID: lil-454684

RESUMEN

Staphylococcus aureus infections are growing problems worldwide with important implications in hospitals. The organism is normally present in the nasal vestibule of about 35 percent of apparently healthy individuals and its carriage varies between different ethnic and age groups. Staphylococcal nasal carriage among health workers is particularly important to establish new clones and track origin of infections during outbreak situations. To determine the carriage rate and compare the pulsed field gel patterns of the strains, nasal swabs were collected from 185 medical students in a teaching hospital in Lagos, Nigeria. Isolates of S. aureus were tested for heamolysin production, methicillin sensitivity and Pulsed Field Gel Electrophoresis (PFGE) was performed. The results showed S.aureus nasal carrier rate of 14 percent with significant rate among males compared to females. All the isolates produced heamolysin. Antibiotic susceptibility pattern revealed that majority of the isolates was susceptible. Five strains (19 percent) harboured resistant determinants to penicillin and tetracycline. None of the strains was resistant to methicillin. 44 percent of the isolates typed by PFGE had type B, the most predominant pulsotype. PFGE A clone exhibited a single resistance phenotype suggesting a strong clonal relationship that could punctual an outbreak in the hospital. The results speculate that nasal carriage among medical personnel could be a function of various risk factors. Personal hygiene and behaviour may however be the means to reducing colonization and spread of S.aureus in our hospitals.


Asunto(s)
Adulto , Femenino , Humanos , Masculino , Antibacterianos/farmacología , Portador Sano/microbiología , Resistencia a la Meticilina , Cavidad Nasal/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Electroforesis en Gel de Campo Pulsado , Pruebas de Sensibilidad Microbiana , Nigeria , Factores de Riesgo , Estudiantes de Medicina , Staphylococcus aureus/efectos de los fármacos
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