GERMS

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Open AccessCorrection

Erratum

by Jayaweera Arachchige Asela Sampath Jayaweera and Wikum Widuranga Kumbukgolla

GERMS 2020, 10(4), 395; https://doi.org/10.18683/germs.2020.1234 - 28 Dec 2020

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Jayaweera JAAS, Kumbukgolla WW. Antibiotic resistance patterns of methicillin-resistant Staphylococcus aureus(MRSA) isolated from livestock and associated farmers in Anuradhapura, Sri Lanka [...] Full article

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Open AccessCommunication

Verifying the Real Estimates of COVID-19 Deaths in Africa

by Olayinka Stephen Ilesanmi and Aanuoluwapo Adeyimika Afolabi

GERMS 2020, 10(4), 392-395; https://doi.org/10.18683/germs.2020.1233 - 28 Dec 2020

Cited by 3 | Viewed by 31

Abstract

Verifying the estimates of COVID-19 deaths in Africa is quintessential due to the known vulnerability of the African continent to diseases in previous times [...] Full article

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Open AccessCase Report

Fulminant Cryptococcal Meningoencephalitis After Successful Treatment of Primary Cutaneous Cryptococcosis

by Iordanis Romiopoulos, Zoi Dorothea Pana, Athina Pyrpasopoulou, Ioanna Linardou, Eugenia Avdelidi, Maria Sidiropoulou, Eleni Chatzidrosou, Dimitrios Ioannides, Asterios Karagiannis and Emmanuel Roilides

GERMS 2020, 10(4), 388-391; https://doi.org/10.18683/germs.2020.1232 - 28 Dec 2020

Cited by 5 | Viewed by 32

Abstract

Introduction: Cryptococcal meningoencephalitis is a life-threatening disease affecting mainly immunocompromised hosts. Case report: We present a case of a 64-year-old immunocompetent patient, who initially developed a traumatic scalp skin infection due to Cryptococcus neoformans. The patient received oral fluconazole and subsequently liposomal [...] Read more.

Introduction: Cryptococcal meningoencephalitis is a life-threatening disease affecting mainly immunocompromised hosts. Case report: We present a case of a 64-year-old immunocompetent patient, who initially developed a traumatic scalp skin infection due to Cryptococcus neoformans. The patient received oral fluconazole and subsequently liposomal amphotericin B due to the development of resistance with resolution of the infection. Two years later, during chemotherapy for newly diagnosed gastric and lung cancer, he developed fulminant cryptococcal meningoencephalitis, which did not respond to liposomal amphotericin B and flucytosine. Conclusions: To our knowledge, this is the first case of fulminant cryptococcal meningoencephalitis following long latency after adequately treated primary cutaneous infection. Full article

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Open AccessOpinion

When Antibiotics Experts Say No to Antibiotics

by Abrar K. Thabit, Shouq A. Turkistani, Shahad A. Alsubaie, Enas A. Takroni, Lamis F. Basaeed and Daleen W. Saadawi

GERMS 2020, 10(4), 380-384; https://doi.org/10.18683/germs.2020.1230 - 28 Dec 2020

Cited by 4 | Viewed by 34

Abstract

Overuse or misuse of antibiotics is one reason for the emergence of antibiotic resistance. Here, we present four cases where antibiotics were started (or proposed) although they were not needed. The first case was asymptomatic bacteriuria where antibiotic therapy was initiated but then [...] Read more.

Overuse or misuse of antibiotics is one reason for the emergence of antibiotic resistance. Here, we present four cases where antibiotics were started (or proposed) although they were not needed. The first case was asymptomatic bacteriuria where antibiotic therapy was initiated but then stopped after the case was referred to the infectious diseases (ID) service. The second case was a cholangiocarcinoma patient in whom four antibiotics were continued after completing the treatment for a remote infection. Hence, the ID team discontinued the unneeded therapy after considering that the inflammatory process was due to malignancy. The third case was a patient who was diagnosed with pneumonia in whom both antibiotics and an antiviral were initiated. However, antibiotic therapy was continued despite the lack of bacterial growth in the respiratory culture. Thus, it wasn’t until the ID team evaluated the case and decided that the pneumonia was viral in nature that antibiotic therapy was discontinued. The last case was for a patient who presented with dry cough presumed to be a pneumonia and was about to be started on antibiotics. The ID team noticed the patient had a history of decompensated congestive heart failure causing the cough. Antibiotics were not initiated when lack of clinical findings suggestive of pneumonia was also confirmed. These cases represent an example of daily occurrences of antibiotics overuse. Healthcare providers are encouraged to augment their knowledge regarding the safe and judicious use of antibiotics, as well as consulting an ID expert if doubts concerning the necessity of antibiotics arise. Full article

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Open AccessReview

Molecular Mechanisms of Colistin Resistance in Africa: A Systematic Review of Literature

by Ahmed Olowo-Okere and Abdourahamane Yacouba

GERMS 2020, 10(4), 367-379; https://doi.org/10.18683/germs.2020.1229 - 28 Dec 2020

Cited by 14 | Viewed by 32

Abstract

Introduction: Updated and comprehensive data on the mechanism underlying colistin resistance is lacking in Africa. Literature search: Herein, we aimed to review available literature on the molecular mechanisms of colistin resistance in Africa. PubMed, Google Scholar, and African Journal online databases were searched [...] Read more.

Introduction: Updated and comprehensive data on the mechanism underlying colistin resistance is lacking in Africa. Literature search: Herein, we aimed to review available literature on the molecular mechanisms of colistin resistance in Africa. PubMed, Google Scholar, and African Journal online databases were searched on the 15th of January 2020 for original research articles that reported mechanisms of colistin resistance in any of the 54 African countries. Review: Of the 1473 studies identified through initial database search, 36 met the inclusion criteria. Colistin resistance was mostly observed in Escherichia coli isolated from human clinical samples. Plasmid-mediated colistin resistance mechanism (26; 72.2%) was the most frequently reported resistance mechanism. About three-quarters (27; 75.0%) of the 36 studies were done in North Africa. In this zone, the mobilized colistin resistance (mcr) genes were mostly detected in E. coli harboring three plasmid types, IncHI2, IncI2, and IncX4, from animal samples (n = 9; 42.8%). Of the six studies performed in Southern Africa, four reported mcr-1 mostly detected from human samples (n = 2; 50.0%) in E. coli isolates carrying IncHI2, IncI2, and IncX4 with diverse range of STs. One hitherto unknown mutation, the mutation in the I527N gene was detected in colistin resistant isolates in this region, which was absent in colistin susceptible isolates. In West and Central Africa, two and one studies, respectively, reported mcr-1 gene exclusively in Escherichia coli isolates. Conclusions: Transferable plasmid mediated colistin resistance is rapidly emerging in Africa with mcr-1 as the predominant genetic variant in human, animals, and environmental samples. Full article

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Open AccessArticle

The Experiences of Healthcare Workers During the COVID-19 Crisis in Lagos, Nigeria: A Qualitative Study

by James Olatunde Okediran, Olayinka Stephen Ilesanmi, Adedoyin Anuoluwapo Fetuga, Ikenna Onoh, Aanuoluwapo Adeyimika Afolabi, Oladipo Ogunbode, Lois Olajide, Ayi Vandi Kwaghe and Muhammad Shakir Balogun

GERMS 2020, 10(4), 356-366; https://doi.org/10.18683/germs.2020.1228 - 28 Dec 2020

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Abstract

Introduction: The novel coronavirus (COVID-19) pandemic has overwhelmed health systems globally. Healthcare workers (HCWs) are faced with numerous challenges during the COVID-19 response. In this study, we aimed to describe the experiences of HCWs during the COVID-19 outbreak in Lagos, Nigeria. Methods: We [...] Read more.

Introduction: The novel coronavirus (COVID-19) pandemic has overwhelmed health systems globally. Healthcare workers (HCWs) are faced with numerous challenges during the COVID-19 response. In this study, we aimed to describe the experiences of HCWs during the COVID-19 outbreak in Lagos, Nigeria. Methods: We conducted a qualitative study on the experiences of frontline HCWs at the COVID-19 isolation centers in Lagos, Nigeria using purposive and snowballing sampling techniques. An in-depth interview which lasted for 25–40 minutes for each respondent was conducted among ten medical officers and four nurses between 15th June and 13th July 2020. We analyzed data using Colaizzi's phenomenological method. Results: Respondents’ age ranged between 29 and 51 years with a median age of 36.5 years. Four themes were identified from data analysis. In the first theme, "COVID-19 care: A call to responsibility”, HCWs expressed optimism regarding COVID-19 care, and described the work conditions at COVID-19 isolation centers. In the second theme, "Challenges encountered while caring for COVID-19 patients – coping strategies”, HCWs experienced difficulties working in a new environment and with limited resources. They however coped through the available support systems. Regarding the "Experiences in COVID-19 care”, the feelings of HCWs varied from pleasure on patients’ recovery to distress following patients’ demise. On the "Necessities in COVID-19 care”, HCWs identified the need for increased psychosocial support, and adequate provision of material and financial support. Conclusions: HCWs at COVID-19 isolation centers need to be assured of a safe working environment while providing them with a strengthened support system. Full article

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Open AccessArticle

Diabetic Foot Infection and Osteomyelitis. Are Deep-Tissue Cultures Necessary?

by Angeliki M. Andrianaki, Christos Koutserimpas, Alexandros Kafetzakis, Emmanouil Tavlas, Sofia Maraki, John A. Papadakis, Petros Ioannou, George Samonis and Diamantis P. Kofteridis

GERMS 2020, 10(4), 346-355; https://doi.org/10.18683/germs.2020.1227 - 28 Dec 2020

Cited by 6 | Viewed by 34

Abstract

Introduction: Diabetic foot infections (DFIs) are common and difficult to treat. The objective of this study was to compare swab and tissue cultures as indicators of appropriate treatment of DFIs. Methods: This is a prospective study conducted during a 4-year period. All patients [...] Read more.

Introduction: Diabetic foot infections (DFIs) are common and difficult to treat. The objective of this study was to compare swab and tissue cultures as indicators of appropriate treatment of DFIs. Methods: This is a prospective study conducted during a 4-year period. All patients with DFIs and/or diabetic foot osteomyelitis (DFO) admitted to the University Hospital of Heraklion, Greece, were included. Clinical data were collected, while cultures taken with swabs and/or tissue biopsies were used as indicators of the microbiological cause and the appropriate treatment. Results: In total, 83 individuals (62.7% males) with mean age of 72 years, were enrolled. Coexisting osteomyelitis was present in 18.1%. From tissue and pus cultures, 131 and 176 pathogens, respectively, were isolated. Gram-positive aerobes were the most common microorganisms, followed by Gram-negatives. Infection was polymicrobial in 40 (70.2%) out of 57 patients with tissue culture and in 54 (75.0%) out of 72 with pus culture. Microbiological results from tissue cultures were compatible with those from pus at a rate of 80%, while in cases of osteomyelitis concordance reached 100%. Multidrug-resistant organisms (MDROs) were isolated from 32 (24.4%) tissue and 44 (25%) pus cultures (p = 0.910). Initial empirical antimicrobial treatment was considered inappropriate in 44.6% of cases. Conclusions: A high concordance between easily taken swab cultures and those taken by biopsy was noted, especially in DFO. This was helpful for early change to appropriate treatment in cases where MDROs were isolated and empirical treatment was inappropriate. Further research is needed to confirm this observation in clinical practice. Full article

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Open AccessArticle

Severe Dehydration Among Cholera Patients in Yemen: A Cohort Profile

by Mohammed M. Alassar, Oyelola A. Adegboye, Theophilus I. Emeto, Kazi M. Rahman, Lawal Olumuyiwa Mashood and Faiz Am. Elfaki

GERMS 2020, 10(4), 338-345; https://doi.org/10.18683/germs.2020.1226 - 28 Dec 2020

Cited by 3 | Viewed by 41

Abstract

Introduction: Cholera, an acute diarrheal illness caused by ingestion of food or water contaminated with Vibrio cholerae, is one of the major causes of morbidity and mortality globally. The occurrence of outbreaks of cholera are difficult to prevent in low and middle-income [...] Read more.

Introduction: Cholera, an acute diarrheal illness caused by ingestion of food or water contaminated with Vibrio cholerae, is one of the major causes of morbidity and mortality globally. The occurrence of outbreaks of cholera are difficult to prevent in low and middle-income countries, especially those under armed conflicts. Methods: This study aimed to describe the characteristics of a cohort of inpatients with cholera in two main hospitals in Taiz and Sana’a, Yemen, between 3rd February 2017 and 8th December 2017. Patient data were entered into an excel database and analyzed using STATA 16.1. Descriptive summaries of patient’s data were presented as frequencies and percentages. Patients’ demographic and clinical characteristics were compared using the Chi-square test. Results: Preliminary findings from 172 hospitalizations for cholera during the study period include 163 that were severely dehydrated (94.8%). Age, education, hand hygiene, sanitation, water source, stool content and malnutrition were significantly associated with severe dehydration. Conclusions: This data contributes to a greater understanding of the associated risk factors for the occurrence of the infectious disease in the study region. Future study will analyze the risks for severe dehydration and diarrhea, and the associated healthcare costs. Full article

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Open AccessArticle

Improving the Diagnosis of Pulmonary Tuberculosis Using Line Probe Assay and Determining the Factors Associated With the Disease in Children in Jos, Nigeria

by Augustine O. Ebonyi, Stephen Oguche, Ibrahim I. Abok, Yetunde O. Isa, Charles C. Ani, Helen O. Akhiwu, Marcia M. Ihekaike, Esther S. Yiltok, Martha O. Ochoga and Atiene S. Sagay

GERMS 2020, 10(4), 328-337; https://doi.org/10.18683/germs.2020.1225 - 28 Dec 2020

Cited by 4 | Viewed by 30

Abstract

Introduction: Diagnosing tuberculosis (TB), including pulmonary tuberculosis (PTB), in children remains a challenge, partly due to its paucibacillary nature in young children. Data on the use of line probe assay (LPA), on gastric and sputum samples, for diagnosing PTB in children are scarce. [...] Read more.

Introduction: Diagnosing tuberculosis (TB), including pulmonary tuberculosis (PTB), in children remains a challenge, partly due to its paucibacillary nature in young children. Data on the use of line probe assay (LPA), on gastric and sputum samples, for diagnosing PTB in children are scarce. We determined the proportion of samples positive for Mycobacterium tuberculosis (MTB) by smear microscopy (SM) and LPA in presumptive PTB cases as well as the factors associated with PTB confirmed by LPA, in children in Jos, Nigeria. Methods: An observational study in children aged 6 months-16 years. Gastric and sputum samples were examined by SM and by LPA for MTB using GenoType MTBDRplus Ver 2.0 (Hain Lifescience). Multivariate logistic regression was performed to determine the factors associated with PTB. Results: Out of 103 children with presumptive PTB, 47 had confirmed PTB, 26 unconfirmed PTB and 30 unlikely PTB by LPA. In 67 gastric samples, MTB was identified by SM in 2 (3.0%) compared to 28 (41.8%) by LPA while in 31 sputum samples, MTB was identified by SM in 5 (16.1%) compared to 18 (58.1%) by LPA. The factors associated with pulmonary tuberculosis were an abnormal chest X-ray (adjusted odds ratio (AOR)) = 12.39 [3.75-40.90], p < 0.001), sleeping in the same room with more than three persons (AOR = 3.30 [1.23-8.85], p = 0.018) and sleeping in a room with none or one window (AOR = 2.86 [1.03-7.95], p = 0.044). Conclusions: Line probe assay improves the diagnosis of pulmonary TB in children, especially with gastric samples, while an abnormal chest X-ray is a useful adjunct in PTB diagnosis. Avoiding overcrowding and having windows in sleeping rooms are a necessary part of TB prevention. Full article

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Open AccessArticle

An Overview of Cervical Cancer Epidemiology and Prevention in Bulgaria

by Milena Karcheva, Angel Yordanov and Sergey Kostadinov

GERMS 2020, 10(4), 322-327; https://doi.org/10.18683/germs.2020.1224 - 28 Dec 2020

Cited by 4 | Viewed by 40

Abstract

Introduction: Cervical cancer ranks as the fourth leading cause of female cancer in Bulgaria. The objective of the study was to describe the current burden of cervical cancer in Bulgaria for a one-year period and prevention options. Methods: In this retrospective epidemiological study, [...] Read more.

Introduction: Cervical cancer ranks as the fourth leading cause of female cancer in Bulgaria. The objective of the study was to describe the current burden of cervical cancer in Bulgaria for a one-year period and prevention options. Methods: In this retrospective epidemiological study, online database from National Statistical Institute-Sofia, National Center of Public Health and Analyses-Sofia, National Center of Infectious and Parasitic Diseases-Sofia for one year were analyzed. Annual data were presented in numbers and per 100,000 of population. Results: A total of 15,759 women in Bulgaria were diagnosed with cervical cancer in 2018. Morbidity is 23.5 of 100,000 population. Mortality of malignancy of the cervix in 2018 per 100,000 populations was 8.4 among women. Differences of mortality have been recorded as per statistical regions. A low immunization range has been recorded of vaccine against human papilloma virus (HPV)—7.2% (girls 13 years of age) and 12.8% (girls 12 years of age) for first dose and 11.9% (girls 12 year of age) for second dose in 2019. Conclusions: High morbidity and mortality from cervical cancer were registered in Bulgaria. The immunization coverage was low. The strategy for disease prevention through mandatory screening and mandatory immunizations needs to be rethought. Full article

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Open AccessArticle

High Prevalence of Multidrug-Resistant Gram-Negative Bacterial Infections in Northwest Nigeria

by Ahmed Olowo-Okere, Yakubu Kokori Enevene Ibrahim, Larbi Zakaria Nabti and Busayo Olalekan Olayinka

GERMS 2020, 10(4), 310-321; https://doi.org/10.18683/germs.2020.1223 - 28 Dec 2020

Cited by 14 | Viewed by 27

Abstract

Introduction: There is limited data on the prevalence and antibiotic susceptibility profile of Gram-negative bacteria in northwest Nigeria. This study thus aimed to investigate the prevalence of multidrug resistant Gram-negative bacterial infections among patients in two healthcare facilities in Sokoto, northwest Nigeria. Methods: [...] Read more.

Introduction: There is limited data on the prevalence and antibiotic susceptibility profile of Gram-negative bacteria in northwest Nigeria. This study thus aimed to investigate the prevalence of multidrug resistant Gram-negative bacterial infections among patients in two healthcare facilities in Sokoto, northwest Nigeria. Methods: A total of 735 non-duplicate clinical bacterial isolates were collected between January and July 2019, from among specimens processed by the diagnostic microbiological laboratory of the two hospitals. The isolates were identified using MALDI-TOF mass spectrometry and tested against a panel of sixteen (16) antibiotics using the current EUCAST guidelines. Results: Of the 735 randomly selected bacterial isolates, 397 (54.0%) yielded Gram-negative bacteria. In the two hospitals, E. coli 104 (26.2%) and Klebsiella spp. 58 (14.6%) were the most common Gram-negative pathogens implicated in all infections. Overall, the isolates exhibited moderate to high resistance to all tested antibiotics, the lowest was observed against amikacin (7.1%). The phenotypic test for ESBL and carbapenemase enzymes showed that 48 (24.6%) and 15 (32.6%) of the isolates were positive, with 88.9% of the isolates being multidrug resistant. Conclusions: The study documents prevalent high multidrug resistant Gram-negative bacterial infections, predominantly caused by E. coli and K. pneumoniae in Sokoto, northwest Nigeria. The isolates were mostly MDR and exhibited ESBL and carbapenemase activities. The findings of this study call for urgent implementation of infection control measures and antibiotic stewardship in our hospitals so as to limit the spread of antibiotic-resistant bacteria in our healthcare facilities. Full article

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Open AccessArticle

Reliability of Phenotypic Methods for Detection of Colistin Resistance Among Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates from Egypt

by Nevine S. Fam, Sara H. Mohamed, Doaa Gamal, Reham M. Wasfy, May S. Soliman and Amani A. El-Kholy

GERMS 2020, 10(4), 303-309; https://doi.org/10.18683/germs.2020.1222 - 28 Dec 2020

Cited by 2 | Viewed by 25

Abstract

Introduction: Acinetobacter baumannii is a challenging pathogen responsible for serious nosocomial infections. Colistin resistance in carbapenem-resistant A. baumannii strains is a critical health problem as it limits the available therapeutic options. The current work aimed to study the reliability of several phenotypic methods [...] Read more.

Introduction: Acinetobacter baumannii is a challenging pathogen responsible for serious nosocomial infections. Colistin resistance in carbapenem-resistant A. baumannii strains is a critical health problem as it limits the available therapeutic options. The current work aimed to study the reliability of several phenotypic methods for the detection of colistin resistance among carbapenem-resistant A. baumannii isolates in Egypt. Methods: A total of 22 carbapenem-resistant A. baumannii isolates were recovered. Colistin minimum inhibitory concentrations (MICs) were determined using broth microdilution (BMD) and compared to agar dilution (AD), automated system (VITEK-2) and gradient test (E-test) and were analyzed by statistical methods. Results: Phenotypic testing showed that nine of 22 isolates (40.9%) were colistin-resistant by BMD and seven of them were also resistant by AD, with the categorical agreement (CA) of 72.7% and essential agreement (EA) of 90.9%. Colistin MIC results ranged from 1-8 µg/mL and 1-32 µg/mL by both AD and BMD respectively. Detection of colistin resistance by gradient test and automated system showed high very major error (VME) rates (40.9%) compared to BMD with a lack of CA between them. AD gave moderate agreement with BMD by 90.9% EA, 72.7% CA and only 9.1% VME. Conclusions: In delineating colistin breakpoints BMD followed by AD method are defined as the only reliable phenotypic methods for colistin resistance evaluation. More rapid and reliable tests, other than BMD and AD, are required for the convenient detection of colistin resistance in the routine clinical microbiology laboratory daily workflow. Full article

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Open AccessArticle

Molecular Characterization of Staphylococcus aureus Isolated from Hospital Acquired Sepsis in Pediatrics, Relation to Antibiotics, Resistance and Virulence Genes

by Maysaa Zaki, Sara Galeb, Abdel-Rahman Eid, Doaa Ahmed, Amna Mabrouk and Radwa Abdel Latif

GERMS 2020, 10(4), 295-302; https://doi.org/10.18683/germs.2020.1221 - 28 Dec 2020

Cited by 4 | Viewed by 30

Abstract

Introduction: The objective of this study was to determine the prevalence of antibiotic resistance genes mecA, vanA, B, C and virulence genes Panton-Valentine Leucocidin (PVL) and fibronectin-binding protein (fnBPA) among S. aureus isolates from hospital-acquired sepsis from pediatric [...] Read more.

Introduction: The objective of this study was to determine the prevalence of antibiotic resistance genes mecA, vanA, B, C and virulence genes Panton-Valentine Leucocidin (PVL) and fibronectin-binding protein (fnBPA) among S. aureus isolates from hospital-acquired sepsis from pediatric intensive care units. Methods: The study was a retrospective cross-sectional study, including 250 unique isolates of S. aureus obtained from pediatric patients with hospital-acquired sepsis. The isolates were subjected to study of antibiotic susceptibility by disc diffusion method and molecular analysis of antibiotic resistance genes and certain virulence genes (PVL and fnBPA genes). Results: Methicillin resistant S. aureus represented 178 (71%) of the isolated S. aureus and reduced susceptibility to vancomycin was detected by minimum inhibitory concentration in 39 (22%) isolates. It was found that there was a strong association between the MRSA strains and resistance to some antibiotics, devices association (p < 0.001) and patient outcomes (p = 0.003). There was a significant association between reduced vancomycin susceptibility (p = 0.010), the presence of a central line catheter (p = 0.000) and fnBPA gene (p < 0.001) and mortality rate. Conclusions: The present study highlights that major S. aureus strains isolated from sepsis in pediatric patients were methicillin resistant with a substantial proportion of reduced susceptibility to vancomycin. Although none of the isolates had van genes responsible for vancomycin resistance, this finding warrants a considerable attention for study as it was a risk factor for mortality in those patients. The virulence genes fibronectin-binding protein and Panton-Valentine Leucocidin were not uncommon in S. aureus. Full article

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Open AccessEditorial

COVID-19 in the Pediatric Population and Parental Perceptions

by Victor Daniel Miron

GERMS 2020, 10(4), 294; https://doi.org/10.18683/germs.2020.1220 - 28 Dec 2020

Cited by 11 | Viewed by 31

Abstract

In Romania, from the beginning of the pandemic, the percentage of children infected with the novel coronavirus has remained relatively constant, around 2.5-3% of confirmed cases, with a zero fatality rate among children under the age of 10 [...] Full article

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GERMS, Volume 10, Issue 4 (12 2020) – 14 articles

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