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      Increasing Antimicrobial Resistance in Surgical Wards at Mulago National Referral Hospital, Uganda, from 2014 to 2018—Cause for Concern?

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          Abstract

          Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAIs) are major global public health challenges in our time. This study provides a broader and updated overview of AMR trends in surgical wards of Mulago National Referral Hospital (MNRH) between 2014 and 2018. Laboratory data on the antimicrobial susceptibility profiles of bacterial isolates from 428 patient samples were available. The most common samples were as follows: tracheal aspirates (36.5%), pus swabs (28.0%), and blood (20.6%). Klebsiella (21.7%), Acinetobacter (17.5%), and Staphylococcus species (12.4%) were the most common isolates. The resistance patterns for different antimicrobials were: penicillins (40–100%), cephalosporins (30–100%), β-lactamase inhibitor combinations (70–100%), carbapenems (10–100%), polymyxin E (0–7%), aminoglycosides (50–100%), sulphonamides (80–100%), fluoroquinolones (40–70%), macrolides (40–100%), lincosamides (10–45%), phenicols (40–70%), nitrofurans (0–25%), and glycopeptide (0–20%). This study demonstrated a sustained increase in resistance among the most commonly used antibiotics in Uganda over the five-year study period. It implies ongoing hospital-based monitoring and surveillance of AMR patterns are needed to inform antibiotic prescribing, and to contribute to national and global AMR profiles. It also suggests continued emphasis on infection prevention and control practices (IPC), including antibiotic stewardship. Ultimately, laboratory capacity for timely bacteriological culture and sensitivity testing will provide a rational choice of antibiotics for HAI.

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          Carbapenems: past, present, and future.

          In this review, we summarize the current "state of the art" of carbapenem antibiotics and their role in our antimicrobial armamentarium. Among the β-lactams currently available, carbapenems are unique because they are relatively resistant to hydrolysis by most β-lactamases, in some cases act as "slow substrates" or inhibitors of β-lactamases, and still target penicillin binding proteins. This "value-added feature" of inhibiting β-lactamases serves as a major rationale for expansion of this class of β-lactams. We describe the initial discovery and development of the carbapenem family of β-lactams. Of the early carbapenems evaluated, thienamycin demonstrated the greatest antimicrobial activity and became the parent compound for all subsequent carbapenems. To date, more than 80 compounds with mostly improved antimicrobial properties, compared to those of thienamycin, are described in the literature. We also highlight important features of the carbapenems that are presently in clinical use: imipenem-cilastatin, meropenem, ertapenem, doripenem, panipenem-betamipron, and biapenem. In closing, we emphasize some major challenges and urge the medicinal chemist to continue development of these versatile and potent compounds, as they have served us well for more than 3 decades.
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            Surgical site infection - a European perspective of incidence and economic burden.

            This retrospective review of reported surgical site infection (SSI) rates in Europe was undertaken to obtain an estimated scale of the problem and the associated economic burden. Preliminary literature searches revealed incomplete datasets when applying the National Nosocomial Infection Surveillance System criteria. Following an expanded literature search, studies were selected according to the number of parameters reported, from those identified as critical for accurate determination of SSI rates. Forty-eight studies were analysed. None of the reviewed studies recorded all the data necessary to enable a comparative assessment of the SSI rate to be undertaken. The estimated range from selected studies analysed varied widely from 1.5-20% - a consequence of inconsistencies in data collection methods, surveillance criteria and wide variations in the surgical procedures investigated - often unspecified. SSIs contribute greatly to the economic costs of surgical procedures - estimated range: 1.47-19.1 billion Euro dollars. The analysis suggests that the true rate of SSIs, currently unknown, is likely to have been previously under-reported. Consequently, the associated economic burden is also likely to be underestimated. A significant improvement in study design, data collection, analysis and reporting will be necessary to ensure that SSI baseline rates are more accurately assessed to enable the evaluation of future cost-effective measures.
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              Strengthening the Reporting of Molecular Epidemiology for Infectious Diseases (STROME-ID): an extension of the STROBE statement

              Molecular data are now widely used in epidemiological studies to investigate the transmission, distribution, biology, and diversity of pathogens. Our objective was to establish recommendations to support good scientific reporting of molecular epidemiological studies to encourage authors to consider specific threats to valid inference. The statement Strengthening the Reporting of Molecular Epidemiology for Infectious Diseases (STROME-ID) builds upon the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative. The STROME-ID statement was developed by a working group of epidemiologists, statisticians, bioinformaticians, virologists, and microbiologists with expertise in control of infection and communicable diseases. The statement focuses on issues relating to the reporting of epidemiological studies of infectious diseases using molecular data that were not addressed by STROBE. STROME-ID addresses terminology, measures of genetic diversity within pathogen populations, laboratory methods, sample collection, use of molecular markers, molecular clocks, timeframe, multiple-strain infections, non-independence of infectious-disease data, missing data, ascertainment bias, consistency between molecular and epidemiological data, and ethical considerations with respect to infectious-disease research. In total, 20 items were added to the 22 item STROBE checklist. When used, the STROME-ID recommendations should advance the quality and transparency of scientific reporting, with clear benefits for evidence reviews and health-policy decision making.
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Trop Med Infect Dis
                Trop Med Infect Dis
                tropicalmed
                Tropical Medicine and Infectious Disease
                MDPI
                2414-6366
                19 May 2021
                June 2021
                : 6
                : 2
                : 82
                Affiliations
                [1 ]The African Center of Excellence in Bioinformatics and Data-Intensive Sciences, The Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
                [2 ]Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; dickson.aruhomukama@ 123456chs.mak.ac.ug (D.A.); ivangunz23@ 123456gmail.com (I.S.)
                [3 ]Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; jkis8751@ 123456gmail.com (J.K.); maggienalum@ 123456gmail.com (M.L.); henrykajumbula427@ 123456gmail.com (H.K.)
                [4 ]Strengthening Pharmaceutical Systems (SPS) Unit, Pharmacy Department, School of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; kitutufred@ 123456gmail.com
                [5 ]Tuberculosis Research and Prevention Center NGO, Yerevan 0014, Armenia; haykdav@ 123456gmail.com
                [6 ]Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 9505, Eldoret 30100, Kenya; philip.owiti@ 123456gmail.com
                [7 ]Research Capacity Strengthening, Special Programme for Research and Training in Tropical Diseases, 1201 Geneva, Switzerland; kamaued@ 123456who.int
                [8 ]Department of Dermatovenerology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar P.O. Box 1996, Ethiopia; wendaab@ 123456gmail.com
                [9 ]Amsterdam UMC, Academic Medical Centre, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&I), University of Amsterdam, 1012 Amsterdam, The Netherlands
                [10 ]Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit, 1617 Luxembourg, Luxembourg; Tony.Reid@ 123456brussels.msf.org
                [11 ]Department of Environmental Health Sciences, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; bulafudouglas@ 123456gmail.com
                Author notes
                [* ]Correspondence: gmboowa@ 123456gmail.com ; Tel.: +256-775-766-249
                Author information
                https://orcid.org/0000-0001-8445-9414
                https://orcid.org/0000-0003-4643-3162
                https://orcid.org/0000-0001-7785-7297
                https://orcid.org/0000-0003-2277-9572
                https://orcid.org/0000-0002-9836-4261
                https://orcid.org/0000-0002-1376-4910
                https://orcid.org/0000-0001-5362-7577
                https://orcid.org/0000-0003-4706-6157
                Article
                tropicalmed-06-00082
                10.3390/tropicalmed6020082
                8163195
                34069345
                b00c3551-2a1a-474b-b07d-06e543877aed
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 22 March 2021
                : 28 April 2021
                Categories
                Article

                antimicrobial resistance (amr),trends,structured operational research and training initiative (sort it),surgical wards,mulago national referral hospital (mnrh),uganda

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