MyMedR

Risk factors of emerging multidrug resistant Acinetobacter baumannii in burn patients at burn Unit of Dr. Soetomo Hospital

Primasari M, Budi AS, Hariani L, Kurniati ND, Saputro ID

Med J Malaysia, 2024 Mar;79(2):115-118.

PMID: 38553912

INTRODUCTION: Burn injury patients are at high risk of infection as a result of the nature of the burn injury itself, including prolonged hospital stays, antibiotics use, treatment procedures, etc. In this era, nosocomial infections caused by Acinetobacter baumannii (A.ba) have increased significantly. This study was conducted to investigate the micro-organism pattern and the risk factors for burn patients with multi-drug resistant (MDR) Acinetobacter baumannii (A.ba) in the Burn Unit at Dr. Soetomo Hospital.

MATERIALS AND METHODS: We conducted a retrospective, observational study among burn patients with A.ba admitted to the Burn Unit at Dr. Soetomo Hospital from January 2020 to December 2021. Potential risk factors for MDR-A.ba were analysed by univariate and multivariate analysis. The patients diagnosed with MDR-A.ba wound infection were included in the case group. The patients diagnosed with non MDR, these are: (1) the patients isolated micro-organisms other than A.ba, (2) sterile isolates, and (3) the patients isolated as A.ba but not MDR, were included in the control group.

RESULTS: A total of 120 burn patients were included in this study. During this study, 24% burn patients were found to have Acinetobacter baumannii and 79% (from 24% of Acinetobacter baumannii) had MDR-A.ba. According to univariate analysis, risk factors that significant were: Abbreviated Burn Severity Index (ABSI) (p = 0,002; OR: 6.10; CI: 1,68 - 21,57); hospital Length Of Stay (LOS) (p < 0,000; OR: 6.95; CI: 2,56 - 18,91) and comorbid (p = 0,006; OR: 3,72; CI: 1,44 - 9,58). But, after analysed by multivariate analysis, only ABSI was the significant factor (p = 0,010; OR: 1,70; CI: 1,23 - 2,36).

CONCLUSION: Based on univariate analysis, the significant risk factors for MDR-A.ba were: ABSI, hospital length of stay and comorbid. But after adjusted by multivariate analysis, only ABSI was the significant factor.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Bacterial co-infections, secondary infections and antimicrobial use among hospitalized COVID-19 patients in the sixth wave in Pakistan: findings and implications

Ul Mustafa Z, Batool A, Ibrar H, Salman M, Khan YH, Mallhi TH, et al.

Expert Rev Anti Infect Ther, 2024 Apr;22(4):229-240.

PMID: 38146949 DOI: 10.1080/14787210.2023.2299387

INTRODUCTION: Previous studies in Pakistan have shown considerable over prescribing of antibiotics in patients hospitalized with COVID-19 despite very low prevalence of bacterial infections. Irrational use of antibiotics will worsen antimicrobial resistance (AMR).

METHODS: Retrospective analysis of medical records of patients in the COVID-19 wards of three tertiary care hospitals to assess antibiotic use during the sixth COVID-19 wave.

RESULTS: A total of 284 patients were included, most were male (66.9%), aged 30-50 years (50.7%) with diabetes mellitus the most common comorbidity. The most common symptoms at presentation were cough (47.9%) and arthralgia-myalgia (41.5%). Around 3% were asymptomatic, 34.9% had mild, 30.3% moderate, and 23.6% had severe disease, with 8.1% critical. Chest X-ray abnormalities were seen in 43.3% of patients and 37% had elevated white cell counts, with 35.2% having elevated C-reactive protein levels. Around 91% COVID-19 patients were prescribed antibiotics during their hospital stay, with only a few with proven bacterial co-infections or secondary bacterial infections. Most antibiotics were from the 'Watch' category (90.8%) followed by the 'Reserve' category (4.8%), similar to previous COVID-19 waves.

CONCLUSION: There continued to be excessive antibiotics use among hospitalized COVID-19 patients in Pakistan. Urgent measures are needed to address inappropriate prescribing including greater prescribing of Access antibiotics where pertinent.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Urinary Tract Infection Prevention and Treatment

Bavanandan S, Keita N

Semin Nephrol, 2023 Sep;43(5):151468.

PMID: 38403525 DOI: 10.1016/j.semnephrol.2023.151468

Urinary tract infections are the most common bacterial infections encountered by health care professionals. In women, the lifetime incidence of urinary tract infections may be up to 40% to 50%, of whom a further 40% may have recurrent infections. Urinary tract infections are associated with significant morbidity and potential mortality-they may be complicated by frequent recurrences, kidney damage, sepsis, and preterm birth, as well as collateral damage of antimicrobial use, which includes Clostridium difficile colitis and selection of drug-resistant organisms. There are personal costs such as reduced quality of life in patients affected by recurrent urinary tract infections, and societal impacts resulting from absenteeism and health care costs. In this review, we discuss the definitions and classifications, pathogenesis, and current principles of management and prevention of urinary tract infections. Semin Nephrol 43:x-xx © 2023 Elsevier Inc. All rights reserved.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Antibiotic resistance before, during, and after the COVID-19 pandemic: a retrospective study

Al Sulayyim H, Ismail R, Al Hamid A, Mohammed B, Abdul Ghafar N

J Infect Dev Ctries, 2024 Mar 31;18(3):371-382.

PMID: 38635620 DOI: 10.3855/jidc.19071

INTRODUCTION: Prevalence of antibiotic resistance (AR) during the coronavirus 2019 (COVID-19) pandemic was higher than pre-pandemic times. This study determined the prevalence and patterns of AR among Gram-positive and negative bacteria before, during and after COVID-19 in Saudi Arabia and identified the associated factors.

METHODOLOGY: A retrospective cross-sectional study was employed to identify patients with positive AR bacteria between March 2019 and March 2022. The bacterial isolates and patients' data were identified from laboratory and medical records departments retrospectively. Binary logistic regression analysis was performed to identify the factors associated with AR and deaths. Multinominal logistic regression was applied to confirm the factors associated with AR classification.

RESULTS: AR Gram-negative bacteria decreased during and after the pandemic. However, S. aureus showed a negligible increase in resistance rate after pandemic, while E. faecium, recorded a higher-than-average resistance rate during the pandemic. The prevalence of pan drug resistance (PDR) during the pandemic (85.7%) was higher than before (0%) and after (14.3%), p = 0.001. The length of stay and time were significant predictors for AR classification. The odds of multi drug resistance (MDR) development to PDR during the pandemic were 6 times higher than before and after (OR = 6.133, CI =, p = 0.020). Age, nationality, COVID-19 infection, smoking, liver disease, and type and number of bacteria were associated with death of patients with positive AR.

CONCLUSIONS: Further studies are recommended to explore the prevalence of PDR and to justify the increased rates of E. faecium AR during the COVID-19 pandemic.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Antibiotic prescribing for upper respiratory tract infections in Sarawak district hospitals

Kho BP, Ong CMY, Tan FTY, Wee CY

Med J Malaysia, 2013 Apr;68(2):136-40.

PMID: 23629559 MyJurnal

Upper respiratory tract infection (URTI) is mostly viral in aetiology, but patients presenting with such complaints are frequently prescribed antibiotics. This may result in increased development of antimicrobial resistance. The objectives of this study are to determine the choice and proportion of oral antibiotics prescribed in patients with URTI, in a Sarawak district hospital setting. All outpatient prescriptions received in July 2011 in 10 hospitals with relevant diagnoses were analysed. A total of 6747 URTI prescriptions met the inclusion criteria, and 64.8% (95% CI 63.7%, 65.9%) had antibiotic prescribed. Medical Assistants (MAs) were significantly more likely to prescribe antibiotics compared to Medical Officers (MOs) (p < 0.001). Prescribers were significantly influenced by the patient's age and specific diagnosis when prescribing antibiotics for URTI (p < 0.001). Antibiotic choices differed between MOs and MAs, where some of the antibiotic choices were inappropriate. There is a need for multi-faceted interventions to improve antibiotic prescribing rate and choice.
Study site: 10 district hospitals, Sarawak, Malaysia

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Lemierre syndrome

Lim AL, Pua KC

Med J Malaysia, 2012 Jun;67(3):340-1.

PMID: 23082433 MyJurnal

Lemierre syndrome is an uncommon disease which commonly arise from acute bacterial oropharyngeal infection. This disease was first described in 1900 by Courmont and Cade Lemierre. It is commonly caused by Fusobacterium necrophorum. Lemierre syndrome has been reported to be serious and potentially fatal in the preantibiotic era. It is characterized by an oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein with embolization to the lungs and other organs. The incidence has become relatively rare at present and is usually only diagnosed when unsuspected culture results are available. We report a case of Lemierre syndrome which was recently diagnosed in our centre.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Fulltext Increasing rate of detection of fusidic acid resistance in methicillin-resistant Staphylococcus aureus isolated from clinical samples in Malaysia

Alreshidi MA, Mariana NS

Med J Malaysia, 2011 Aug;66(3):276.

PMID: 22111461

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Fulltext Excellent outcome of primary Neisseria meningitidis keratoconjunctivitis

Daud J, Ishak SR, Deris ZZ, Hitam WH

Asian Pac J Trop Biomed, 2011 Oct;1(5):419-20.

PMID: 23569805 DOI: 10.1016/S2221-1691(11)60092-0

Infectious conjunctivitis is a very common presentation to medical professional and ophthalmologist all over the world. Although its typically self-limiting and treatable in almost all of the cases, but we need to be aware of the rare and potentially life threatening if the cause is not promptly identified and treated accordingly. In our case report, we highlighted the rare case of Neisseria meningitidis as a primary cause of keratoconjunctivitis. Neisseria meningitidis is a rare etiology of keratoconjunctivitis and its ocular presentations are quite similar with other bacterial or viral infection. The infection may potentially fatal if systemic invasion occurred, however with immediate and proper treatment the outcome is satisfactory. Early diagnosis and proper antibiotic treatment are critical to prevent systemic spread of the infection. Public health intervention is needed to prevent outbreak of the disease.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext A ten year retrospective review of orbital complications secondary to acute sinusitis in children

Suhaili DN, Goh BS, Gendeh BS

Med J Malaysia, 2010 Mar;65(1):49-52.

PMID: 21265249 MyJurnal

Acute sinusitis is most often a mild self-limiting disease. However, it may progress into severe and life threatening complications. One of the commonest being orbital complication of which visual loss is a direct consequence. In this 10 year retrospective study, the nature of orbital complication, clinical presentation and treatment modalities and outcome seen in children with acute sinusitis in a tertiary referral institute were reviewed. Of six patients, there was a case of preseptal cellulitis, 4 cases of subperiosteal abscess and one case of orbital abscess. Periorbital swelling was a common presenting feature. In 5 cases this was associated with proptosis with one case of impending optic nerve compression. The value of computed tomography and opthalmological examination as a component in the management plan is highlighted. All patients were treated with intravenous antibiotics but evidence of abscess collection warranted urgent surgical drainage in 5 patients, 3 being endoscopic drainage while external approach was done for the remaining 2 patients. Thus a child exhibiting orbital complication of acute sinusitis, prompt diagnosis and treatment is essential in obtaining the best outcome for the child.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Exacerbation of chronic obstructive pulmonary disease

Ismail TS

Med J Malaysia, 2009 Sep;64(3):250-5; quiz 256.

PMID: 20527283 MyJurnal

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in COPD patients and place a large burden on healthcare resources. COPD patients with frequent exacerbations have accelerated decline in lung function, poorer health status and are at higher risk of mortality. The mainstay of treatment includes increasing short acting bronchodilator therapy and systemic glucocorticosteroids with or without antibiotics. Non invasive ventilation is indicated in those with respiratory failure with acidosis or hypercapnia. Preventive strategies to reduce exacerbations include smoking cessation, immunisation against influenza and S. pneumonia, chronic maintenance inhaled pharmacotherapy, pulmonary rehabilitation and self management education.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Cytotoxic and antibacterial activities of endophytic fungi isolated from plants at the National Park, Pahang, Malaysia

Hazalin NA, Ramasamy K, Lim SM, Wahab IA, Cole AL, Abdul Majeed AB

BMC Complement Altern Med, 2009;9:46.

PMID: 19930582 DOI: 10.1186/1472-6882-9-46

Endophytes, microorganisms which reside in plant tissues, have potential in producing novel metabolites for exploitation in medicine. Cytotoxic and antibacterial activities of a total of 300 endophytic fungi were investigated.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Fulltext Vancomycin treatment failure in a vancomycin susceptible methicillin-resistant Staphylococcus aureus (MRSA) infected patient

Norazah A, Salbiah N, Nurizzat M, Santhana R

Med J Malaysia, 2009 Jun;64(2):166-7.

PMID: 20058580 MyJurnal

A 64-year old patient, who had bacteraemia, did not respond to vancomycin despite the MRSA isolate being sensitive to the antibiotic at MIC 2 microg/mL. Electron microscopy of the MRSA isolate showed thickening of the cell wall, which was not observed in MRSA with lower vancomycin MIC.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Fulltext Outcome of bacteraemia in patients admitted to the adult medical wards of the UKM hospital

Petrick P, Kong NC, Nordiah AJ, Cheong IK, Tamil MA

Med J Malaysia, 2007 Oct;62(4):329-34.

PMID: 18551939 MyJurnal

The clinical outcome of bacteraemic patients is influenced by many factors. It is vital to know one's own local hospital epidemiological data so as to provide optimal care to the affected patients. This was a prospective, observational study carried out in the said patient population over a period of four months in the year 2005. One hundred and ninety one patients presented with bacteraemia over the study period. Fifty-two (27%) of the patients died. Mechanical ventilation, inappropriate empirical antibiotic usage, Chinese ethnicity and low serum albumin levels independently affected prognosis. These factors should alert physicians to those patients who require more intensive monitoring and care.
KEY WORDS:
Bacteraemia, Blood Culture Positive, Outcome, Risk factors, Kuala Lumpur, Malaysia

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Antibiotics for mastitis in breastfeeding women

Jahanfar S, Ng CJ, Teng CL

Cochrane Database Syst Rev, 2009 Jan 21.

PMID: 19160255 DOI: 10.1002/14651858.CD005458.pub2

BACKGROUND: Mastitis can be caused by ineffective positioning of the baby at the breast or restricted feeding. Infective mastitis is commonly caused by Staphylococcus Aureus. Incidence of mastitis in breastfeeding women may reach 33%. Effective milk removal, pain medication and antibiotic therapy have been the mainstays of treatment.

OBJECTIVES: This review aims to examine the effectiveness of antibiotic therapies in relieving symptoms for breastfeeding women with mastitis with or without laboratory investigation.

SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2007), the Cochrane Central Register of Clinical Trials (The Cochrane Library 2007, Issue 4), MEDLINE (1996 to 2007) and EMBASE (January 1985 to 2007). We contacted investigators and other content experts known to us for unpublished trials and scanned the reference lists of retrieved articles

SELECTION CRITERIA: Randomized and quasi-randomized clinical trials comparing the effectiveness of various types of antibiotic therapies or antibiotic therapy versus alternative therapies for the treatment of mastitis were selected.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. When in dispute, we consulted a third author.

MAIN RESULTS: Two trials met the inclusion criteria. One small trial (n = 25) compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation. Another, older study compared breast emptying alone as "supportive therapy" versus antibiotic therapy plus supportive therapy, and no therapy. The findings of the latter study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic.

AUTHORS' CONCLUSIONS: There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis. There is an urgent need to conduct high-quality, double-blinded randomized clinical trials to determine whether antibiotics should be used in this common postpartum condition.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Fulltext Salmonella: the pelvic masquerader

Valayatham V

Int J Infect Dis, 2009 Mar;13(2):e53-5.

PMID: 18829361 DOI: 10.1016/j.ijid.2008.06.015

Salmonella sp is a significant cause of morbidity and mortality. Although commonly infecting the gastrointestinal system, other presentations are not unheard of. Salmonella is an unlikely and an unusual cause of genital tract infection. We describe a woman with suspected pelvic inflammatory disease eventually confirmed as Salmonella O C2 infection.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Over-prescription of antibiotics: both doctors and patients need education

Norsa'adah B

Med J Malaysia, 2007 Jun;62(2):181.

PMID: 18705463

Principally, there are two problems in prescribing . They are prescribing decision and prescribing writing process, which contribute to 39% and 61% of prescription problems respectively. The first type of problem has more serious consequences and may even cause mortality. In that study, the issue is the appropriateness of prescribing antibiotics for upper respiratory tract infections (URTI). Over-prescribing of antibiotics in primary health care, especially for respiratory tract diseases is a problem worldwide . There are concerns about the rising prevalence of antibiotic resistant bacteria, cost and the potentially harmful consequences of unnecessary prescription such as drug interaction and allergy.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Fulltext A case of auricular myiasis in Malaysia

Rohela M, Jamaiah I, Amir L, Nissapatorn V

Southeast Asian J. Trop. Med. Public Health, 2006;37 Suppl 3:91-4.

PMID: 17547059

Many cases of myiasis have been reported in Malaysia. This is the second reported case of auricular myiasis caused by Chrysomya bezziana. The patient was a 41-year-old, mentally retarded, Orang Asli man. He was brought to the clinic by his mother with a complaint of pain and bleeding in his right ear for 3 days. On examination, blood and multiple maggots were seen packed in the external auditory canal of the right ear. A total of 39 live maggots were removed and maintained until they developed into 3rd instar larvae, which were later processed and identified as Chrysomya bezziana. The patient was discharged with amoxicillin 500 mg three times a day for 1 week.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Ciprofloxacin-resistant Salmonella enterica serotype typhi in a patient with osteomyelitis of the rib

Wilson G, Prabhu N, Easow JM, Mukhopadhyay C

Med J Malaysia, 2005 Dec;60(5):667-9.

PMID: 16515126

Salmonella osteomyelitis of the rib is a rare clinical entity. In our case, a muhidrug resistant Salmonella enterica serotype Typhi was isolated from an immuno-competent patient with osteomyclitis of the ribs, who was treated earlier with ciprotloxacin for typhoid fever. The patient was successfully treated for osteomyclitis with intravenous ceftriaxone.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Endobronchial actinomycosis: is a repeat bronchoscopy after treatment necessary?

How SH, Ramachandram K, Aziz AA

Br J Hosp Med (Lond), 2006 Jan;67(1):42-3.

PMID: 16447411 DOI: 10.12968/hmed.2006.67.1.20327

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Mycoplasma pneumoniae infection complicated by empyema: a rare presentation

Othman N, Yip CW, Samat NA

Med J Malaysia, 2005 Aug;60(3):389-91.

PMID: 16379202

Mycoplasma pneumoniae is a common causative agent for childhood pneumonia. However, empyema is a rare presentation. We report a case of a previously well child who presented with a right-sided empyema. M. pneumoniae was confirmed serologically with evidence of a four-fold rise in Mycoplasma IgM titre. The empyema required drainage procedures for more than two weeks. The infection resolved with a course of six weeks of treatment with erythromycin.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

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