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New molecular tools for meningitis diagnostics in Ethiopia - a necessary step towards improving antimicrobial prescription.

ABSTRACT: BACKGROUND:Meningitis remains a top cause of premature death and loss of disability-adjusted life years in low-income countries. In resource-limited settings, proper laboratory diagnostics are often scarce and knowledge about national and local epidemiology is limited. Misdiagnosis, incorrect treatment and overuse of antibiotics are potential consequences, especially for viral meningitis. METHODS:A prospective study was conducted over three months in a teaching hospital in Ethiopia with limited laboratory resources. Cerebrospinal fluid (CSF) samples from patients with suspected meningitis were analysed using a multiplex PCR-based system (FilmArray, BioFire), in addition to basic routine testing with microscopy and culture. Clinical data, as well as information on treatment and outcome were collected. RESULTS:Two hundred and eighteen patients were included; 117 (54%) neonates (0-29?days), 63 (29%) paediatrics (1?month-15?years) and 38 (17%) adults (?16?years). Of 218 CSF samples, 21 (10%) were PCR positive; 4% in neonates, 14% in paediatrics and 18% in adults. Virus was detected in 57% of the PCR positive samples, bacteria in 33% and fungi in 10%. All CSF samples that were PCR positive for a bacterial agent had a white cell count ?75 cells/mm3 and/or turbid appearance. The majority (90%) of patients received more than one antibiotic for treatment of the meningitis episode. There was no difference in the mean number of different antibiotics received or in the cumulative number of days with antibiotic treatment between patients with a microorganism detected in CSF and those without. CONCLUSIONS:A rapid molecular diagnostic system was successfully implemented in an Ethiopian setting without previous experience of molecular diagnostics. Viral meningitis was diagnosed for the first time in routine clinical practice in Ethiopia, and viral agents were the most commonly detected microorganisms in CSF. This study illustrates the potential of rapid diagnostic tests for reducing antibiotic usage in suspected meningitis cases. However, the cost of consumables for the molecular diagnostic system used in this study limits its use in low-income countries.

SUBMITTER: Barnes GK

PROVIDER: S-EPMC6302510 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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New molecular tools for meningitis diagnostics in Ethiopia - a necessary step towards improving antimicrobial prescription.

Bårnes Guro K GK Gudina Esayas Kebede EK Berhane Melkamu M Abdissa Alemseged A Tesfaw Getnet G Abebe Gemeda G Feruglio Siri Laura SL Caugant Dominique A DA Jørgensen Hannah Joan HJ

BMC infectious diseases 20181220 1

<h4>Background</h4>Meningitis remains a top cause of premature death and loss of disability-adjusted life years in low-income countries. In resource-limited settings, proper laboratory diagnostics are often scarce and knowledge about national and local epidemiology is limited. Misdiagnosis, incorrect treatment and overuse of antibiotics are potential consequences, especially for viral meningitis.<h4>Methods</h4>A prospective study was conducted over three months in a teaching hospital in Ethiopi ...[more]

PMID: 30572843

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Project description:Patients value effective pain relief. Complications of inadequate pain control include increased risk of infection, decreased patient comfort and progression to chronic pain, all of which have significant socioeconomic consequence. Accessibility to analgesia is vital to effective administration. This improvement project aimed to improve the consistency and adequacy of analgesia prescribing for trauma inpatients over a 12-month period. Four PDSA ('plan, do, study, act') cycles resulted in sustained and significant improvements in analgesia prescription. The interventions included senior encouragement, teaching sessions, targeted inductions and implementation of a novel e-prescribing protocol. Prospective data and real-time discussion from stakeholder medical and management teams enabled iterative change to practice. Drug charts were reviewed for all trauma inpatients (n=276) over a 10-month period, recording all analgesia prescribed within 24?hours of admission. Each prescription was scored (maximum of 10 points) according to parameters agreed by the acute pain specialty leaders. An improving trend was observed in the analgesia score over the study period. Each intervention was associated with improved practice. Based on observed improvements, a novel electronic prescribing protocol was developed in conjunction with the information technology department, resulting in maximum scores for prescribing which were sustained over the final 3 months of the study. This was subsequently adopted as standard practice within the department. One year following completion of the project, a further 3?weeks of data were collected to assess long-term sustainability-scores remained 10 out of 10. Addressing the prescribing habits of junior doctors improved accessibility to analgesia for trauma patients. The electronic prescribing tool made prescribing straightforward and faster, and was the most successful intervention. Doctor satisfaction using this time-saving tool was high. Identifying a stakeholder within the information technology department proved pivotal to transferring the project aims into clinical practice.

Project description:BackgroundGlobally, antimicrobial resistance (AMR) is a complex public problem, which is mainly fuelled by inappropriate use of antimicrobials. Rational use of antimicrobials is the main strategy for the prevention of AMR, which can be achieved by changing the prescribers' behavior and knowledge. Hence, this study aimed to assess knowledge and attitude of paramedical students regarding antimicrobial resistance, which helps to rationalize the use of antimicrobials.MethodsAn institutional based cross-sectional study was performed on 323 graduates paramedical students at the University of Gondar, Ethiopia. Participants were invited to complete a self-reported structured questionnaire on hard copy. The data were summarized using summary statistics such as the median. Furthermore, Kruskal Wallis test, at the level of significance of 0.05, was conducted to compare group difference.ResultsAmong 360 eligible paramedical students, 323 (90%) of them participated and most of them were males 202 (62.5%). Nearly 96% of the participants perceived that antimicrobial resistance is a catastrophic and preventable public problem but about half of the participants (55%) had a poor level of knowledge. It was also found that there was a statistically significant knowledge and attitude difference across the department (p-value<?0.0001) and (p =?0.002), respectively. Furthermore, those participants who had a good level of knowledge had greater attitude rank as compared to those who had a moderate and poor level of knowledge (p-value<?0.0001).ConclusionMajority of the participants viewed antimicrobial resistance as a preventable public problem if appropriate strategies are formulated. Nonetheless, most of them had a poor knowledge regarding antimicrobial resistance, and their knowledge and attitude significantly vary across their field of study. This result implicates that improving the students' level of knowledge about antimicrobial resistance might be an approach to flourish their attitude and to rationalize their antimicrobial use.

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New molecular tools for meningitis diagnostics in Ethiopia - a necessary step towards improving antimicrobial prescription.

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New molecular tools for meningitis diagnostics in Ethiopia - a necessary step towards improving antimicrobial prescription.

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