Antimicrobial Resistance Patterns in Patients with Vaginal Discharge: A 2019-2022 Analysis at the National Health Laboratory in Eritrea.

Background: Antimicrobial resistance poses a significant global threat to the treatment of bacterial infections, particularly in low- and middle-income regions such as Africa. This study is aimed at analyzing antimicrobial resistance patterns in vaginal swab samples from patients at the National Health Laboratory from 2019 to 2022. Methods: This retrospective study examined patient records from vaginal swab analyses performed at the National Health Laboratory between January 1, 2019, and December 31, 2022. Ethical approval was obtained from the Ministry of Health Research Ethical Approval and Clearance Committee on 15/02/2023. Results: Of the 622 samples, 83% underwent microbial isolation and identification. Citrobacter spp. exhibited high resistance (>43%) to antibiotics such as cephalexin, ceftazidime, nalidixic acid, ampicillin, gentamicin, and tetracycline. E. coli showed resistance rates of more than 50% to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline. Klebsiella spp. and Proteus spp. exhibited resistance rates that exceeded 47% to specific antibiotics. Gram-positive bacteria have resistance rates of more than 49% with ampicillin, trimethoprim-sulfamethoxazole, tetracycline, oxacillin, vancomycin, and penicillin G. In particular, S. aureus demonstrated no resistance to rifampicin or clindamycin, while Streptococcus spp. showed 100% resistance to rifampicin and vancomycin. Several species, including Proteus species, Streptococcus spp., S. aureus, and Klebsiella spp. exhibited multidrug resistance. Conclusion: Most gram-negative bacteria displayed higher resistance of >45% to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline. Among gram-positive bacteria, a higher resistance rate with ampicillin, trimethoprim-sulfamethoxazole, tetracycline, oxacillin, vancomycin, and penicillin G was recorded. S. aureus showed no resistance to rifampicin and clindamycin, and Strep. spp. indicated 100% resistance to rifampicin and vancomycin. This study highlights critical gaps and areas for further exploration. Expanding the spectrum of antibiotics tested and investigating underlying multidrug resistance mechanisms would provide a more comprehensive understanding of resistance patterns.

Toxic Epidermal Necrolysis Associated with Misoprostol: A Case Report.

Misoprostol, a synthetic prostaglandin E1 analog, is currently used for medical termination of pregnancy. In the summary of the product characteristics of different market authorization holders of misoprostol tablets, approved by major regulators, serious mucocutaneous reactions, including toxic epidermal necrolysis are not documented as adverse effects. We are now reporting an unusual case of toxic epidermal necrolysis following the use of misoprostol 200 mcg tablets prescribed for termination of a pregnancy. A 25-year-old grand multipara woman from the Gash-Barka region of Eritrea visited Tesseney hospital with a history of amenorrhea that lasted for four months. She was admitted as a case of missed abortion for medical termination of pregnancy. Following three doses of misoprostol 200 mcg tablet the patient developed toxic epidermal necrolysis. Except misoprostol, no other possible alternatives that could explain the condition were identified. Accordingly, the adverse effect was judged to be possibly related to misoprostol. The patient recovered after four weeks of treatment without sequelae. Toxic epidermal necrolysis could, therefore, be a possible adverse effect of misoprostol that needs to be further investigated with better epidemiological studies.