Prevalence, organ distribution and antimicrobial susceptibility profile of Salmonella isolated from chickens purchased from markets in selected districts of West Shoa, Ethiopia

Salmonella is one of the major causes of heavy losses in chicken and foodborne diseases worldwide. The current study was conducted from  November 2015 to May 2016 to estimate the prevalence of Salmonella and determine the antimicrobial susceptibility of isolates in chickens. Chickens (n=205) were purchased from local markets of five selected districts of West Shoa Zone, Central Ethiopia. Following clinical examination, chicken were euthanized and 2-3 ml of blood sample was collected immediately. Then after postmortem examination, samples were collected from the liver, kidney, ovary, and spleen. The slide agglutination test was used to assess the seroprevalence of Salmonella antibodies. Isolation of Salmonella was performed according to the ISO-6579 procedure. The isolates were subjected to antimicrobial susceptibility testing (using 13 antimicrobial drugs) following the Kirby-Bauer disc diffusion method. The seroprevalence of Salmonella antibodies was 63.5% (95% CI: 55.9-70.5). The isolation rate of Salmonella was 19.0% (95% CI: 13.9-20.1) at the chicken level and 7.3% (95% CI: 5.5-9.4) at the organ level. The detection rate was 11.2%, 7.0%, 6.1%, and 4.4% for spleen, liver, ovary, and kidney, respectively. The majority of the Salmonella isolates were susceptible to norfloxacin (97.4%) and chloramphenicol (92.3%). All the 39 isolates were resistant to amoxicillin, tetracycline, and nitrofurantoin. Three multidrug resistance patterns to six antimicrobial classes were observed. Four isolates were resistant to five antimicrobial classes. Therefore, regular  surveillance of Salmonella and its antimicrobial resistance is needed for a better understanding of the epidemiological dynamics. Awareness creation for chicken farmers about improving farming practices and the risks of antimicrobial resistance warrants special attention. Keywords: Antimicrobial susceptibility; Chicken; Prevalence; Salmonella; Ethiopi

Hemodialysis-Related Infections: A 4-Year Surveillance

Objective: To analyze the results from the surveillance of hemodialysis-related infections. Material and Methods: Data was prospectively gathered from outpatients attending a hemodialysis unit from April 2019 until March 2023. The National Healthcare Safety Network (NHSN) Dialysis Event Surveillance was used to identify three types of infection-related dialysis events. Event rates were calculated and stratified by vascular access type, standardized infection ratios for bloodstream infections (BSI), intravenous antimicrobial starts, and described pathogens identified among BSI. Results: A total of 2,288 patient-month follow-ups were included. There were 79 infection-related dialysis events (24 BSI; 46 intravenous antimicrobial starts, nine pus, redness, or increased swelling at the vascular access site). The incidence of BSI per 100 patient-months was 1.05 (0.59 arteriovenous fistula, 0.83 arteriovenous graft, and 2.22 central venous catheter). Seventeen BSI were vascular access-related. Access-related BSI per 100 patient-months was 0.74 (0.39 arteriovenous fistula, 0.41 arteriovenous graft, and 1.85 central venous catheter). Intravenous antimicrobial starts per 100 patient-months was 2.01 (0.98 arteriovenous fistula, 2.62 arteriovenous graft, and 3.14 central venous catheter). Most events occurred in patients with a central venous catheter. When benchmarked with the 2014 NHSN, the standardized infection ratio of BSI, access-related BSI, and intravenous antimicrobial starts were 1.40, 1.26, and 0.55, respectively. The most serious outcome was BSI; resulting in 83.3% hospitalizations, 25% loss of vascular access, and 15.8% deaths.  Conclusion: Surveillance of infection-related dialysis events is important for prevention. These events were highest among patients with a central venous catheter compared with other vascular access types

Urgent-start peritoneal dialysis for end-stage renal disease patients: literature review and worldwide evidence-based practice

AbstractThe prevalence of end-stage renal disease (ESRD) is on the rise worldwide. Meanwhile, the number of older people requiring dialysis therapy is increasing as a result of this population. We found that starting dialysis in an unplanned manner is a common occurrence, even for patients with nephrology follow-up. Most centers choose hemodialysis with a high rate of central venous catheter use at the time of initiation of dialysis. Current data has found that central venous catheter use is independently associated with increased mortality and high bacteremia rates. Peritoneal dialysis is one option to avoid bacteremia. The International Society for Peritoneal Dialysis guidelines suggests a break-in period of at least two weeks prior to an elective start of peritoneal dialysis, without mentioning urgent-start peritoneal dialysis. For unplanned ESRD patients, it is unrealistic to wait for two weeks before initiating peritoneal dialysis therapy. Urgent-start peritoneal dialysis has been suggested to be a practical approach of prompt initiation of peritoneal dialysis after catheter insertion, which may avoid an increased risk of central venous catheter-related complications, including bacteremia, central venous stenosis, and thrombosis associated with the temporary use of hemodialysis. Peritoneal dialysis is the alternative option, and many studies have presented an interest in urgent-start peritoneal dialysis. Some reports have compared urgent-start hemodialysis to peritoneal dialysis and found that urgent-start peritoneal dialysis is a safe and effective alternative to hemodialysis for an unplanned dialysis patient. This review aims to compare each literature report regarding techniques, prescriptions, outcomes, complications, and costs of urgent-start peritoneal dialysis.</jats:p

Successful treatment with intense immunosuppressive therapy in an initially 100% crescentic lesion of anti-GBM nephritis

Anti-glomerular basement membrane (anti-GBM) nephritis is uncommon glomerular disease caused by autoantibodies targeting the capillary beds of the kidney. The clinical presentation of the disease is a variable nephritic syndrome, rapidly progressing to glomerulonephritis. Treatment outcomes are dependent on predictors at first diagnosis. We presented a case of 58-year-old man who did not have underlying disease presented with marked abdominal distension and acute kidney injury. He had no evidence of chronic renal disease before admission however, laboratory test showed microscopic haematuria (RBC 30-50 per high-powered field), proteinuria (2.9 g/d), and renal failure (serum creatinine 610 µmol/L) compatible with rapidly progressive glomerulonephritis; hence, a renal biopsy was conducted. The pathology showed 100% crescentic glomerulonephritis with IgG deposits in a linear pattern at the GBM. The initial serum anti-GBM titre was 105.59 RU/mL. This patient had poor renal prognosis factors for treatment response. After a discussion regarding treatment option with the patient, we decided to give intensive immunosuppressive therapy and plasmapheresis due to his good baseline functional status. The patient achieved partial remission and is not dialysis dependent. In conclusion, despite a poor renal prognosis with 100% crescents and serum creatinine ≥ 600 µmol/L, the treated patient had a good survival status and did not become dialysis-dependent. However, immunosuppressive treatment should be performed along with careful monitoring for infection to avoid infection-related morbidity and mortality. </jats:p

Prevalence, organ distribution and antimicrobial susceptibility profile of Salmonella isolated from chickens purchased from markets in selected districts of West Shoa, Ethiopia

Salmonella is one of the major causes of heavy losses in chicken and foodborne diseases worldwide. The current study was conducted from  November 2015 to May 2016 to estimate the prevalence of Salmonella and determine the antimicrobial susceptibility of isolates in chickens. Chickens (n=205) were purchased from local markets of five selected districts of West Shoa Zone, Central Ethiopia. Following clinical examination, chicken were euthanized and 2-3 ml of blood sample was collected immediately. Then after postmortem examination, samples were collected from the liver, kidney, ovary, and spleen. The slide agglutination test was used to assess the seroprevalence of Salmonella antibodies. Isolation of Salmonella was performed according to the ISO-6579 procedure. The isolates were subjected to antimicrobial susceptibility testing (using 13 antimicrobial drugs) following the Kirby-Bauer disc diffusion method. The seroprevalence of Salmonella antibodies was 63.5% (95% CI: 55.9-70.5). The isolation rate of Salmonella was 19.0% (95% CI: 13.9-20.1) at the chicken level and 7.3% (95% CI: 5.5-9.4) at the organ level. The detection rate was 11.2%, 7.0%, 6.1%, and 4.4% for spleen, liver, ovary, and kidney, respectively. The majority of the Salmonella isolates were susceptible to norfloxacin (97.4%) and chloramphenicol (92.3%). All the 39 isolates were resistant to amoxicillin, tetracycline, and nitrofurantoin. Three multidrug resistance patterns to six antimicrobial classes were observed. Four isolates were resistant to five antimicrobial classes. Therefore, regular  surveillance of Salmonella and its antimicrobial resistance is needed for a better understanding of the epidemiological dynamics. Awareness creation for chicken farmers about improving farming practices and the risks of antimicrobial resistance warrants special attention.&#x0D; Keywords: Antimicrobial susceptibility; Chicken; Prevalence; Salmonella; Ethiopia </jats:p

Identification and antimicrobial susceptibility profile of Escherichia coli isolated from backyard chicken in and around ambo, Central Ethiopia

Abstract Background Escherichia coli is bacteria that exist as commensal in the intestine of animals and humans, but pathogenic strains cause disease in chickens. The development of antimicrobial resistance in E. coli is one of major concern worldwide. A cross-sectional study was conducted from November, 2015 to April, 2016 in and around Ambo town on backyard chicken with the objectives of isolating E. coli from selected visceral organs, assessment of potential risk factor and determination of antimicrobial resistance pattern of the isolates. Results The overall isolation rate of E. coli was 11.5% (80/694) [95% CI: 9.64–14.61] and 32.5% (62/191) [95% CI: 25.39–39.09] at organ and chicken level, respectively. E. coli isolation rate was 15.2% (29/191), 13.6% (27/191), 6.3% (12/191) and 10.7% (13/121) from spleen, liver, kidney and ovary samples, respectively. The multivariable logistic regression analysis revealed higher probability of E. coli isolation from adult (adjusted Odds ratio [aOR] =2.5, P = 0.013) than younger chickens, from clinically sick chickens (aOR = 3.0, P = 0.003) than apparently healthy. E. coli isolates were 100% susceptible to ciprofloxacin, norfloxacin and sulfamethoxazole-trimethoprim followed by 89–63.4% susceptibility to gentamicin, streptomycin, ceftazidime, nalidxic acid, nitrofurantoin, kanamycin, amikacin and chloramphenicol. Whereas, 100% resistance was observed against cloxacilin, cefotaxime and amoxicillin, whereas 92.7 and 46.3% were resistant to cefuroxime, and tetracycline, respectively. Multidrug resistant (MDR) was observed in 78.1% (64/82) of the isolates which exhibited 5 different MDR patterns to 7 antimicrobial classes. Conclusions Higher isolation rate of E. coli was observed from visceral organs of chickens. Age and health status were predictors of E. coli isolation. Remarkable numbers of the isolates are resistant to different antimicrobials and multidrug resistant E coli isolates are widespread in the area

Comparative Effectiveness of Local Application of Chlorhexidine Gluconate, Mupirocin Ointment, and Normal Saline for the Prevention of Peritoneal Dialysis-related Infections (COSMO-PD Trial): a multicenter randomized, double-blind, controlled protocol

Abstract Background Current international guidelines recommend the use of a daily topical exit-site antimicrobial to prevent peritoneal dialysis (PD)-related infections. Although nonantibiotic-based therapies are appealing because they may limit antimicrobial resistance, no controlled trials have been conducted to compare topical antimicrobial agents with usual exit-site care for the prevention of PD-related infections among the Thai PD population. We propose a controlled three-arm trial to examine the efficacy and safety of a daily chlorhexidine gluconate-impregnated patch versus mupirocin ointment versus usual exit-site care with normal saline for the prevention of PD-related infections. Methods/Designs This study is a randomized, double-blind, multicenter, active-controlled, clinical trial. Adult patients aged 18 years or older who have end-stage kidney disease and are undergoing PD will be enrolled at three PD Centers in Thailand. A total of 354 PD patients will be randomly assigned to either the 2% chlorhexidine gluconate-impregnated patch, mupirocin ointment, or usual exit-site care with normal saline dressing according to a computer-generated random allocation sequence. Participants will be followed until discontinuation of PD or completion of 24 months. The primary study outcomes are time to first PD-related infection (exit-site/tunnel infection or peritonitis) event and the overall difference in PD-related infection rates between study arms. Secondary study outcomes will include (i) the rate of infection-related catheter removal and PD technique failure, (ii) rate of nasal and exit-site Staphylococcus aureus colonization, (iii) healthcare costs, and (iv) skin reactions and adverse events. We plan to conduct a cost-utility analysis alongside the trial from the perspectives of patients and society. A Markov simulation model will be used to estimate the total cost and health outcome in terms of quality-adjusted life years (QALYs) over a 20-year time horizon. An incremental cost-effectiveness ratio in Thai Baht and U.S. dollars per QALYs gained will be illustrated. A series of probabilistic sensitivity analyses will be conducted to assess the robustness of the cost-utility analysis findings. Discussion The results from this study will provide new clinical and cost-effectiveness evidence to support the best strategy for the prevention of PD-related infections among the Thai PD population. Trial registration ClinicalTrials.gov, NCT02547103. Registered on September 11, 2015. </jats:sec