Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon, Central Africa

Background: Physicians depend on reliable information on the local epidemiology of infection and antibiotic resistance rates to guide empiric treatment in critically ill patients. As these data are scarce for Central Africa, we performed a retrospective analysis of microbiological findings from a secondary care hospital in Gabon. Methods: Microbiological reports from 2009 to 2012 were used to assess the non-susceptibility rates of the three most common isolates from six major types of infections (bloodstream, ear-eye-nose-throat, surgical site, skin and soft tissue, urinary tract and wound infection). Results: A high diversity of pathogens was found, but Staphylococcus aureus was predominant in the majority of infections. Overall, the three most prevalent pathogens in children were S. aureus (33.7%), Streptococcus pyogenes (8.1%) and Escherichia coli (4.5%) and in adults S. aureus (23.5%), E. coli (15.1%) and Klebsiella pneumoniae (7.4%). In total, 5.8% (n = 19) of all S. aureus isolates were methicillin resistant. The proportion of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae was 15.4% (n = 78), 49.4% of all K. pneumoniae were ESBL-producer (n = 42). Conclusion: The high diversity of potential pathogens and high resistance rates in Gram-negative bacteria challenge a rational empiric use of antibiotics. Countrywide continuous sentinel surveillance is therefore urgently needed.<br

Aspects Thérapeutiques du Décollement de la Rétine chez les Évacués Sanitaires de Horns, Bénin, de 2015 à 2020

L’objectif de cette étude est de décrire les aspects thérapeutiques du décollement de la rétine chez les évacués sanitaires hors Bénin de 2015 à 2020. Nous avons réalisé une étude observationnelle transversale descriptive à visée analytique avec collecte rétrospective des données. Elle s’est déroulée à la Direction Générale de la Médecine Hospitalière et des Explorations Diagnostiques et dans des centres d’Ophtalmologie publics et privés. La durée moyenne entre le diagnostic et la chirurgie était de 81,67 ±23,05 jours avec des extrêmes de 2 et 400 jours.&nbsp; Une chirurgie de DR par voie endoculaire était réalisée sur 28 yeux (60,87%). Notons que des 28 yeux ayant subi une chirurgie endoculaire, 19 ont eu un tamponnement par huile de silicone et les 9 restants, un tamponnement par gaz. Sur les 46 yeux, 25 (54,35%) présentaient des complications postopératoires dont 15 cataractes et 9 récidives du DR. En préopératoire, 28 yeux sur 46 (60,87%) avaient une AV&lt;1/20 et 5 yeux (10,87%) avaient une AV&gt;3/10. En postopératoire, 34 yeux (73,91%) avaient une AV≥1/20 dont 32 (69,57%) une AV &gt;1/20 et 17 (36,96%) une AV&gt;3/10. L’AV était réduite pour 7 yeux (15,22%), stationnaire pour 10 yeux (21,74%) et 29 yeux (63,04%) ont eu un gain d’AV. En préopératoire, 6 yeux (13,04%) avaient une AV&lt;1/20 et 2 yeux (4,35%) avaient une AV&gt;3/10. En postopératoire, 4 yeux (8,70%) avaient une AV&lt;1/20 et 4 yeux (8,70%) avaient une AV&gt;3/10. Chez les 2 sujets opérés dans un délai ≤ 7 jrs (4,35%), l'AV était améliorée et le gain supérieur à 6 lignes. Le décollement de la rétine est une pathologie oculaire grave pouvant causer la cécité. Toutefois, de bonnes pratiques thérapeutiques donnent généralement un bon gain visuel. &nbsp; The objective of this study is to describe the therapeutic aspects of retinal detachment in medical evacuees outside Benin from 2015 to 2020. We conducted an observational cross-sectional descriptive study with an analytical purpose and retrospective data collection. The study took place at the General Directorate of Hospital Medicine and Diagnostic Explorations and in public and private Ophthalmology centers. The average duration between diagnosis and surgery was 81.67 ± 23.05 days, ranging from 2 to 400 days. Endocular surgery for retinal detachment was performed on 28 eyes (60.87%). Of these 28 eyes undergoing endocular surgery, 19 had tamponade with silicone oil, and the remaining 9 had tamponade with gas. Among the 46 eyes, 25 (54.35%) had postoperative complications, including 15 cataracts and 9 retinal detachment recurrences. Preoperatively, 28 eyes out of 46 (60.87%) had visual acuity (VA) &lt;1/20, and 5 eyes (10.87%) had VA &gt;3/10. Postoperatively, 34 eyes (73.91%) had VA ≥1/20, with 32 (69.57%) having VA &gt;1/20 and 17 (36.96%) having VA &gt;3/10. VA was reduced for 7 eyes (15.22%), remained stationary for 10 eyes (21.74%), and 29 eyes (63.04%) showed a gain in VA. Preoperatively, 6 eyes (13.04%) had VA &lt;1/20, and 2 eyes (4.35%) had VA &gt;3/10. Postoperatively, 4 eyes (8.70%) had VA &lt;1/20, and 4 eyes (8.70%) had VA &gt;3/10. Among the 2 subjects operated within ≤ 7 days (4.35%), VA improved, and the gain was greater than 6 lines. Retinal detachment is a serious ocular condition that can lead to blindness. However, proper therapeutic practices generally result in significant visual improvement

Aspects Thérapeutiques du Décollement de la Rétine chez les Évacués Sanitaires de Horns, Bénin, de 2015 à 2020

L’objectif de cette étude est de décrire les aspects thérapeutiques du décollement de la rétine chez les évacués sanitaires hors Bénin de 2015 à 2020. Nous avons réalisé une étude observationnelle transversale descriptive à visée analytique avec collecte rétrospective des données. Elle s’est déroulée à la Direction Générale de la Médecine Hospitalière et des Explorations Diagnostiques et dans des centres d’Ophtalmologie publics et privés. La durée moyenne entre le diagnostic et la chirurgie était de 81,67 ±23,05 jours avec des extrêmes de 2 et 400 jours.&nbsp; Une chirurgie de DR par voie endoculaire était réalisée sur 28 yeux (60,87%). Notons que des 28 yeux ayant subi une chirurgie endoculaire, 19 ont eu un tamponnement par huile de silicone et les 9 restants, un tamponnement par gaz. Sur les 46 yeux, 25 (54,35%) présentaient des complications postopératoires dont 15 cataractes et 9 récidives du DR. En préopératoire, 28 yeux sur 46 (60,87%) avaient une AV&lt;1/20 et 5 yeux (10,87%) avaient une AV&gt;3/10. En postopératoire, 34 yeux (73,91%) avaient une AV≥1/20 dont 32 (69,57%) une AV &gt;1/20 et 17 (36,96%) une AV&gt;3/10. L’AV était réduite pour 7 yeux (15,22%), stationnaire pour 10 yeux (21,74%) et 29 yeux (63,04%) ont eu un gain d’AV. En préopératoire, 6 yeux (13,04%) avaient une AV&lt;1/20 et 2 yeux (4,35%) avaient une AV&gt;3/10. En postopératoire, 4 yeux (8,70%) avaient une AV&lt;1/20 et 4 yeux (8,70%) avaient une AV&gt;3/10. Chez les 2 sujets opérés dans un délai ≤ 7 jrs (4,35%), l'AV était améliorée et le gain supérieur à 6 lignes. Le décollement de la rétine est une pathologie oculaire grave pouvant causer la cécité. Toutefois, de bonnes pratiques thérapeutiques donnent généralement un bon gain visuel. &nbsp; The objective of this study is to describe the therapeutic aspects of retinal detachment in medical evacuees outside Benin from 2015 to 2020. We conducted an observational cross-sectional descriptive study with an analytical purpose and retrospective data collection. The study took place at the General Directorate of Hospital Medicine and Diagnostic Explorations and in public and private Ophthalmology centers. The average duration between diagnosis and surgery was 81.67 ± 23.05 days, ranging from 2 to 400 days. Endocular surgery for retinal detachment was performed on 28 eyes (60.87%). Of these 28 eyes undergoing endocular surgery, 19 had tamponade with silicone oil, and the remaining 9 had tamponade with gas. Among the 46 eyes, 25 (54.35%) had postoperative complications, including 15 cataracts and 9 retinal detachment recurrences. Preoperatively, 28 eyes out of 46 (60.87%) had visual acuity (VA) &lt;1/20, and 5 eyes (10.87%) had VA &gt;3/10. Postoperatively, 34 eyes (73.91%) had VA ≥1/20, with 32 (69.57%) having VA &gt;1/20 and 17 (36.96%) having VA &gt;3/10. VA was reduced for 7 eyes (15.22%), remained stationary for 10 eyes (21.74%), and 29 eyes (63.04%) showed a gain in VA. Preoperatively, 6 eyes (13.04%) had VA &lt;1/20, and 2 eyes (4.35%) had VA &gt;3/10. Postoperatively, 4 eyes (8.70%) had VA &lt;1/20, and 4 eyes (8.70%) had VA &gt;3/10. Among the 2 subjects operated within ≤ 7 days (4.35%), VA improved, and the gain was greater than 6 lines. Retinal detachment is a serious ocular condition that can lead to blindness. However, proper therapeutic practices generally result in significant visual improvement

Aspects Therapeutiques du Decolement de Retine chez les Evacues Sanitares Hors Benin de 2015 a 2020

L’objectif de cette étude est de décrire les aspects thérapeutiques du décollement de la rétine (DR) chez les évacués sanitaires hors Bénin de 2015 à 2020. Nous avons réalisé une étude observationnelle transversale descriptive à visée analytique avec collecte rétrospective des données. Elle s’est déroulée à la Direction Générale de la Médecine Hospitalière et des Explorations Diagnostiques et dans des centres d’Ophtalmologie publics et privés. La durée moyenne entre le diagnostic et la chirurgie était de 81,67 ±23,05 jours avec des extrêmes de 2 et 400 jours.&nbsp; 46 yeux de 42 patients ont été inclus dans l’étude. Une chirurgie de DR était réalisée par voie endoculaire sur 28 yeux (60,87%), par voie externe sur 4 yeux (8,70%) et technique chirurgicale non précisée sur 14 yeux (30,43%).&nbsp; Notons que des 28 yeux ayant subi une chirurgie endoculaire, 19 ont eu un tamponnement par huile de silicone et les 9 restants, un t amponnement par gaz. Sur les 46 yeux, 25 (54,35%) présentaient des complications postopératoires dont 15 cataractes et 9 récidives du DR. En préopératoire, 28 yeux sur 46 (60,87%) avaient une AV&lt;1/20 et 5 yeux (10,87%) avaient une AV&gt;3/10. En postopératoire, 34 yeux (73,91%) avaient une AV≥1/20 et 17 (36,96%) une AV&gt;3/10. L’AV était réduite pour 7 yeux (15,22%), stationnaire pour 10 yeux (21,74%) et 29 yeux (63,04%) ont eu un gain moyen d’AV de 3 lignes. Chez les 2 sujets opérés dans un délai ≤ 7 jours (4,35%), l'AV était améliorée et le gain supérieur à 6 lignes. Le décollement de la rétine est une pathologie oculaire grave pouvant causer la cécité. Toutefois, de bonnes pratiques thérapeutiques donnent généralement un bon gain visuel. The objective of this study is to describe the therapeutic aspects of retinal detachment in medical evacuees outside Benin from 2015 to 2020. We conducted an observational cross-sectional descriptive study with an analytical purpose and retrospective data collection. The study took place at the General Directorate of Hospital Medicine and Diagnostic Explorations and in public and private Ophthalmology centers. The average duration between diagnosis and surgery was 81.67 ± 23.05 days, ranging from 2 to 400 days. Endocular surgery for retinal detachment was performed on 28 eyes (60.87%), externally in 4 eyes (8,70%) and unspecified surgical technique in 14 eyes (30,43%). Of these 28 eyes undergoing endocular surgery, 19 had tamponade with silicone oil, and the remaining 9 had tamponade with gas. Among the 46 eyes, 25 (54.35%) had postoperative complications, including 15 cataracts and 9 retinal detachment recurrences. Preoperatively, 28 eyes out of 46 (60.87%) had visual acuity (VA) &lt;1/20, and 5 eyes (10.87%) had VA &gt;3/10. Postoperatively, 34 eyes (73.91%) had VA ≥1/20, with 17 (36.96%) having VA &gt;3/10. VA was reduced for 7 eyes (15.22%), remained stationary for 10 eyes (21.74%), and 29 eyes (63.04%) showed a gain in VA. Among the 2 subjects operated within ≤ 7 days (4.35%), VA improved, and the gain was greater than 6 lines. Retinal detachment is a serious ocular condition that can lead to blindness. However, proper therapeutic practices generally result in significant visual improvement

Evaluation of the Safety and Immunogenicity of the RTS,S/AS01E Malaria Candidate Vaccine When Integrated in the Expanded Program of Immunization

Background. The RTS,S/AS01E malaria candidate vaccine is being developed for immunization of African infants through the Expanded Program of Immunization (EPI). Methods. This phase 2, randomized, open, controlled trial conducted in Ghana, Tanzania, and Gabon evaluated the safety and immunogenicity of RTS,S/AS01E when coadministered with EPI vaccines. Five hundred eleven infants were randomized to receive RTS,S/AS01E at 0, 1, and 2 months (in 3 doses with diphtheria, tetanus, and wholecell pertussis conjugate [DTPw]; hepatitis B [HepB]; Haemophilus influenzae type b [Hib]; and oral polio vaccine [OPV]), RTS,S/AS01E at 0, 1, and 7 months (2 doses with DTPwHepB/Hib+OPV and 1 dose with measles and yellow fever), or EPI vaccines only. Results. The occurrences of serious adverse events were balanced across groups; none were vaccine-related. One child from the control group died. Mild to moderate fever and diaper dermatitis occurred more frequently in the RTS,S/AS01E coadministration groups. RTS,S/AS01E generated high anti-circumsporozoite protein and anti- hepatitis B surface antigen antibody levels. Regarding EPI vaccine responses upon coadministration when considering both immunization schedules, despite a tendency toward lower geometric mean titers to some EPI antigens, predefined noninferiority criteria were met for all EPI antigens except for polio 3 when EPI vaccines were given with RTS,S/AS01E at 0, 1, and 2 months. However, when antibody levels at screening were taken into account, the rates of response to polio 3 antigens were comparable between groups. Conclusion. RTS,S/AS01E integrated in the EPI showed a favorable safety and immunogenicity evaluation. Trial registration. ClinicalTrials.gov identifier: NCT00436007. GlaxoSmithKline study ID number: 106369 (Malaria-050

Severe malaria in children leads to a significant impairment of transitory otoacoustic emissions--a prospective multicenter cohort study.

BACKGROUND: Severe malaria may influence inner ear function, although this possibility has not been examined prospectively. In a retrospective analysis, hearing impairment was found in 9 of 23 patients with cerebral malaria. An objective method to quickly evaluate the function of the inner ear are the otoacoustic emissions. Negative transient otoacoustic emissions are associated with a threshold shift of 20 dB and above. METHODS: This prospective multicenter study analyses otoacoustic emissions in patients with severe malaria up to the age of 10 years. In three study sites (Ghana, Gabon, Kenya) 144 patients with severe malaria and 108 control children were included. All malaria patients were treated with parental artesunate. RESULTS: In the control group, 92.6 % (n = 108, 95 % confidence interval 86.19-6.2 %) passed otoacoustic emission screening. In malaria patients, 58.5 % (n = 94, malaria vs controls p < 0.001, 95 % confidence interval 48.4-67.9 %) passed otoacoustic emission screening at the baseline measurement. The value increased to 65.2 % (n = 66, p < 0.001, 95 % confidence interval 53.1-75.5 %) at follow up 14-28 days after diagnosis of malaria. The study population was divided into severe non-cerebral malaria and severe malaria with neurological symptoms (cerebral malaria). Whereas otoacoustic emissions in severe malaria improved to a passing percentage of 72.9 % (n = 48, 95 % confidence interval 59-83.4 %) at follow-up, the patients with cerebral malaria showed a drop in the passing percentage to 33 % (n = 18) 3-7 days after diagnosis. This shows a significant impairment in the cerebral malaria group (p = 0.012 at days 3-7, 95 % confidence interval 16.3-56.3 %; p = 0.031 at day 14-28, 95 % confidence interval 24.5-66.3 %). CONCLUSION: The presented data show that 40 % of children have involvement of the inner ear early in severe malaria. In children, audiological screening after severe malaria infection is not currently recommended, but is worth investigating in larger studies

Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis.

The criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis. Electronic databases (Medline, Embase, Cochrane Database of Systematic Reviews, Thomson Reuters Web of Knowledge) were searched to identify publications including African children with severe malaria. PRISMA guidelines were followed. Selection was based on design (epidemiological, clinical and treatment studies), setting (Africa), participants (children &lt; 15 years old with severe malaria), outcome (survival/death rate), and prognostic indicators (clinical and laboratory features). Quality assessment was performed following the criteria of the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Odds ratios (ORs) were calculated for each study and prognostic indicator, and, when a test was assessed in at least two studies, pooled estimates of ORs were computed using fixed- or random-effects meta-analysis. A total of 601 articles were identified and screened and 30 publications were retained. Features with the highest pooled ORs were renal failure (5.96, 95% CI 2.93-12.11), coma score (4.83, 95% CI 3.11-7.5), hypoglycemia (4.59, 95% CI 2.68-7.89), shock (4.31, 95% CI 2.15-8.64), and deep breathing (3.8, 95% CI 3.29-4.39). Only half of the criteria had an OR &gt; 2. Features with the lowest pooled ORs were impaired consciousness (0.58, 95% CI 0.25-1.37), severe anemia (0.76, 95% CI 0.5- 1.13), and prostration (1.12, 95% CI 0.45-2.82). The findings of this meta-analysis show that the strength of association between the criteria defining severe malaria and death is quite variable for each clinical and/or laboratory feature (OR ranging from 0.58 to 5.96). This ranking allowed the identification of features weakly associated with death, such as impaired consciousness and prostration, which could assist to improve case definition, and thus optimize antimalarial treatment

High prevalence of dhfr triple mutant and correlation with high rates of sulphadoxine-pyrimethamine treatment failures in vivo in Gabonese children

Background: Drug resistance contributes to the global malaria burden. Plasmodium falciparum dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) polymorphisms confer resistance to sulphadoxine-pyrimethamine (SP). Methods: The study assessed the frequency of SP resistance-conferring polymorphisms in Plasmodium falciparum-positive samples from two clinical studies in Lambarene. Their role on treatment responses and transmission potential was studied in an efficacy open-label clinical trial with a 28-day follow-up in 29 children under five with uncomplicated malaria. Results: SP was well tolerated by all subjects in vivo. Three subjects were excluded from per-protocol analysis. PCR-corrected, 12/26 (46%) achieved an adequate clinical and parasitological response, 13/26 (50%) were late parasitological failures, while 1/26 (4%) had an early treatment failure, resulting in early trial discontinuation. Of 106 isolates, 98 (92%) carried the triple mutant dhfr haplotype. Three point mutations were found in dhps in a variety of haplotypic configurations. The 437G + 540E double mutant allele was found for the first time in Gabon. Conclusions: There is a high prevalence of dhfr triple mutant with some dhps point mutations in Gabon, in line with treatment failures observed, and molecular markers of SP resistance should be closely monitore