Associations between echocardiographic manifestations and bacterial species in patients with infective endocarditis: a cohort study.

BACKGROUND: The diagnosis of infective endocarditis (IE) is based on microbiological analyses and diagnostic imaging of cardiac manifestations. Echocardiography (ECHO) is preferred for visualization of IE-induced cardiac manifestations. We investigated associations between bacterial infections and IE manifestations diagnosed by ECHO. METHODS: In this cohort study, data from patients aged 18 years or above, with definite IE admitted at the Karolinska University Hospital between 2008 and 2017 were obtained from Swedish National Registry of Endocarditis. Bacteria registered as pathogen were primarily selected from positive blood culture and for patients with negative blood culture, bacteria found in culture or PCR from postoperative material was registered as pathogen. Patients with negative results from culture or PCR, and patients who did not undergo ECHO during hospital stay, were excluded. IE manifestations diagnosed by ECHO were obtained from the registry. Chi-squared test and two-sided Fisher's exact test was used for comparisons between categorical variables, and student's t test was used for continuous numerical variables. Multivariable analyses were performed using logistic regression. Secular trend analyses were performed using linear regression. Associations and the strength between the variables were estimated using odds ratios (ORs) with 95% confidence intervals (CIs). P < 0.05 was considered significant. RESULTS: The most common bacteria were Staphylococcus aureus (n = 239, 49%) and viridans group streptococci (n = 102, 21%). The most common manifestations were vegetation in the mitral (n = 195, 40%), aortic (n = 190, 39%), and tricuspid valves (n = 108, 22%). Associations were seen between aortic valve vegetations and Enterococcus faecalis among patients with native aortic valves, between mitral valve vegetations and streptococci of group B or viridans group, between tricuspid valve vegetations and S. aureus among patients with intravenous drug abuse, and between perivalvular abscesses as well as cardiovascular implantable electronic device (CIED)-associated IE and coagulase negative staphylococci (all P < 0.05). CONCLUSIONS: Associations were found between certain bacterial species and specific ECHO manifestations. Our study contributes to a better understanding of IE manifestations and their underlying bacterial etiology, which pathogens can cause severe infections and might require close follow-up and surgical treatment.

'Struggling to be a defender of health' -a qualitative study on the pharmacists' perceptions of their role in antibiotic consumption and antibiotic resistance in Romania.

BACKGROUND: Antibiotic resistance is a serious global public health problem directly correlated to high antibiotic consumption. Romania is one of the European countries with the highest rates of antibiotic consumption, non-prescription antibiotics use and resistance of several pathogens to antibiotics. Pharmacists are an important stakeholder in respect to antibiotic management and context specific research on this topic is needed. The aim of the research is to increase the understanding of how community pharmacists in Romania perceive their roles in respect to antibiotic consumption and antibiotic resistance. Semi-structured interviews with 18 pharmacists were conducted to explore the perceptions and attitudes of pharmacists towards their roles on antibiotics consumption and antibiotic resistance. Manifest and latent qualitative content analysis was used to analyse interview transcripts. RESULTS: Three sub-themes emerged from the analysis. 'Maintaining equilibrium between ethics, law and economy' expresses how pharmacists often feel when trying to fulfil their duties considering all the dimensions of the pharmacist profession.' Antibiotic resistance problem rooted in a low social capital environment' reflects the pharmacists' perceptions of the deep causes of antibiotic resistance and the underlying problems that perpetuate the status quo and impact their role in relation to this problem. Wanting to fulfil their educational role illustrates how the pharmacists feel they could best contribute to improving the present situation. The overarching theme 'Undervalued medicines' professionals struggling with agency related and structural barriers to meet their deontological duties'- meaning the ethical responsibilities that come with the pharmacy practice, reflects that the pharmacists see their roles as being challenged by several barriers. CONCLUSIONS: A health system and societal context perspective is helpful in order to understand the pharmacists' roles in respect to antibiotic consumption and antibiotic resistance. Health promotion interventions and policy revisions should take into account concepts of structure and agency. These could highlight barriers that pharmacists encounter in their activities related to antibiotics management.

Antibiotic use and resistance in animal farming: a quantitative and qualitative study on knowledge and practices among farmers in Khartoum, Sudan.

Antibiotic resistance is a major emerging global public health threat. Farmers in the Khartoum state are believed to misuse antibiotics in animal farming leading to daily exposure to resistant bacteria and antibiotic residues. Hence, farmers are at potential risk exposure to bacteria, zoonotic infection and toxicity. We hypothesized that farmers' misuse of antibiotics could be due to their ignorance of the importance of optimal use of antibiotics, the potential health hazards and the economical waste associated with antibiotic misuse practices. In the present study, we investigated knowledge and practices among farmers regarding antibiotic use and resistance. For this purpose, a cross-sectional study was conducted in Khartoum state where data were collected from 81 farmers using structured interviews. Data were analysed both quantitatively and qualitatively. Fifty-two per cent of farmers were uneducated or had studied for < 6 years. The majority reported antibiotic use for treatment and prevention while only 5% stated use for growth promotion. Antibiotic group treatment for both sick and healthy animals was commonly practiced among most farmers. The most commonly used group of antibiotics was the quinolones, which was reported by one-third. Only 30% of the farmers had heard of antibiotic resistance and provided their definition. Almost half were not aware of the commonly transferred zoonotic infections between humans and animals. The farmers consume 1-2 meals/day from their own farm products. A significant association between low education, poor knowledge of farmers on antibiotic use, antibiotic resistance and zoonotic infections was found. This association may play a vital role in the present practiced misuse of antibiotics. Our findings on farmers' practices could be used as baseline information in defining the gaps related to antibiotic use and resistance in animal farming in Sudan. It can thus serve as a foundation for future interventions.

Qualitative study on perceptions of hand hygiene among hospital staff in a rural teaching hospital in India.

BACKGROUND: Hand hygiene is a simple but underutilized measure to control healthcare-associated infections. AIM: To explore staff perceptions of hand hygiene using focus group discussions (FGDs) in a teaching hospital in India. METHODS: Qualitative study. The FGD guide included questions on transmission of infections, hand hygiene practices and problems with implementation, and ways to improve adherence to hand hygiene recommendations. The FGDs were recorded, transcribed verbatim, translated into English (when conducted in Hindi) and analysed using content analysis. FINDINGS: Two themes emerged: 'inter-relationship of knowledge, beliefs, motivation, practices and needs' and 'roles and responsibilities for sustainable and efficient implementation of context-relevant approaches and interventions'. Staff were generally aware of the importance of hand hygiene for the prevention of healthcare-associated infections, but perceived practical problems with implementation. CONCLUSIONS: The staff suggested various interventions and appeared to be prepared to follow hand hygiene guidelines if the hospital provided the necessary facilities.

Population-based assessment of Mycoplasma genitalium in Vietnam--low prevalence among married women of reproductive age in a rural area.

OBJECTIVE: To analyse the prevalence of Mycoplasma genitalium infection in a population-based study among married women from a demographic surveillance site in a rural geographical area of Vietnam. MATERIALS AND METHODS: Women, aged 18-49 years, were randomly selected to participate. DNA was isolated from endocervical swabs sampled from 990 participating women. The M. genitalium MgPa adhesion gene was detected using a real-time polymerase chain reaction with TaqMan probe. RESULTS: Eight (0.8%; 95% confidence interval, 0.25-1.35%) of the included women were infected with M. genitalium. Two of these positive women reported clinical symptoms. One additional M. genitalium-positive but symptom-free woman, however, showed clinical signs of vaginitis. None of the M. genitalium-positive women was concomitantly infected with Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis or human immunodeficiency virus (HIV). Furthermore, there was no obvious association between M. genitalium infection and vaginal douching, use of intrauterine device, or occurrence of bacterial vaginosis, candidiasis, or Trichomonas vaginalis. CONCLUSIONS: The prevalence of M. genitalium among married women in Vietnam was relatively low. However, more large, well-designed and appropriately performed studies in other population groups including unmarried women and men, and in other geographical areas, rural as well as urban, are crucial in order to extract any evidence-based conclusions regarding the overall prevalence of sexually transmitted infections (STIs), including M. genitalium infections, in the Vietnamese society. The present study compiled with such future studies may form the basis for a national sexual health strategy for prevention, diagnosis, and surveillance of STIs, including M. genitalium infections, in Vietnam.

Health professionals' and consumers' views on the role of the pharmacy personnel and the pharmacy service in Hanoi, Vietnam--a qualitative study.

OBJECTIVES: To explore the views of health professionals and consumers concerning (i) the role of the pharmacy personnel and (ii) the pharmacy service in Hanoi, Vietnam. METHOD: A qualitative approach influenced by both content analysis and phenomenography was used. The different groups of participants were selected by purposive sampling, whereas the representatives from each group were selected based on availability. Data were collected by means of face-to-face interviews. Pre-tested, semi-structured interview guides were used. The interviews were tape-recorded and transcribed. The analysis followed commonly applied procedures in qualitative research. The views of the respondents were categorized and described concerning the main issues. RESULTS: A total of 21 interviews were conducted with six pharmacists, five medical doctors, five pharmacy students and five pharmacy customers. An interpreter was used in 16 cases. The role of the pharmacy personnel was viewed in three different ways, as: counsellor, doctor's assistant or businessman. It was also believed that sometimes the pharmacy personnel might play a double role--both as doctor and pharmacist. They were considered to have a passive or active role in the provision of information to the customers. Some of the subjects put emphasis on the quality of the information given, and some others considered the information given at the pharmacies as merely a reiteration of the doctor's instruction. Concerning the pharmaceutical field in general, three different categories could be discerned, which describe the interviewee's perspective on the main actors influencing pharmacy practice: a mutual, a central and an individual perspective. CONCLUSION: This study describes different ways of viewing the role of the pharmacy personnel and the pharmacy service in Hanoi. The estimation of the impact of the different views on the pharmacy profession in Hanoi requires another kind of study.

Asthma management in five European countries: doctors' knowledge, attitudes and prescribing behaviour. Drug Education Project (DEP) group.

The aim of the study was to examine the relationship between guideline recommendations on asthma management, and the performance of doctors in five different European health care contexts. Knowledge, attitudes and prescribing behaviour of doctors recruited to an educational project was investigated. A total of 698 general practitioners from Germany, The Netherlands, Norway and Sweden, and 94 specialists from the Slovak Republic participated. A questionnaire was used to assess their knowledge and attitudes. Antiasthmatic drugs dispensed to their patients reflected their prescribing behaviour. In response to questions on how to treat chronic asthma, most doctors were in agreement with guideline recommendations. In practice, however, the proportion of asthma patients receiving inhaled steroids varied almost twofold, ranging 31% in Germany to 58% in The Netherlands. On questions related to exacerbation of asthma, German and Slovakian doctors often preferred treatment with antibiotics to steroids. They also more often associated yellow-green sputum with bacterial infection. In conclusion, although many doctors in different health care contexts have accepted the recommendations given in guidelines, the proportion of their patients treated accordingly differed. German and Slovakian doctors seem to attach less importance to the inflammatory features of asthma than the doctors from the other three European countries.