BackgroundInfections are common complications in critically ill patients with associated significant morbidity and mortality.AimThis study determined the prevalence, risk factors, clinical outcome and microbiological profile of hospital-acquired infections in the intensive care unit of a Nigerian tertiary hospital.Materials and MethodsThis was a prospective cohort study, patients were recruited and followed up between September 2011 and July 2012 until they were either discharged from the ICU or died. Antimicrobial susceptibility testing of isolates was done using CLSI guidelines.ResultsSeventy-one patients were recruited with a 45% healthcare associated infection rate representing an incidence rate of 79/1000 patient-days in the intensive care unit. Bloodstream infections (BSI) 49.0% (22/71) and urinary tract infections (UTI) 35.6% (16/71) were the most common infections with incidence rates of 162.9/1000 patient-days and 161.6/1000 patient-days respectively. Staphylococcus aureus was the most common cause of BSIs, responsible for 18.2% of cases, while Candida spp. was the commonest cause of urinary tract infections, contributing 25.0% of cases. Eighty percent (8/10) of the Staphylococcus isolates were methicillin-resistant. Gram-negative multidrug bacteria accounted for 57.1% of organisms isolated though they were not ESBL-producing. Use of antibiotics (OR = 2.98; p = 0.03) and surgery (OR = 3.15, p< 0.05) in the month preceding ICU admission as well as urethral catheterization (OR = 5.38; p<0.05) and endotracheal intubation (OR = 5.78; p< 0.05) were risk factors for infection.ConclusionOur findings demonstrate that healthcare associated infections is a significant risk factor for ICU-mortality and morbidity even after adjusting for APACHE II score.

BackgroundMalaria remains a major cause of febrile illness in Nigeria and interventions to reduce malaria burden in Nigeria focus on the use of insecticide-treated nets. This study determined the prevalence of malaria parasitaemia and the use of insecticide-treated nets (ITNs) for the control of malaria amongst under-five year old children in Calabar, Nigeria.MethodsA total of 270 under-5 year old children were recruited and structured questionnaires were used to obtain information on the background characteristics of the respondents from their caregivers. Capillary blood samples were collected from each of the patients through finger-pricking and tested for malaria parasites by Rapid Diagnostic Test and microscopy.ResultsAn overall parasitaemia prevalence of 32.2 % (by Rapid diagnostic test kit [RDT]) and 40.1 % (by microscopy) were obtained in this study. Forty-six (45.5 %) of the febrile patients had malaria parasitaemia (by RDT) or 41 (59.4 %) by microscopy. One hundred and fifty (55.6 %) of the caregivers acknowledged the use of nets on doors and windows for malaria prevention and control. One hundred and thirty-nine (51.5 %) mentioned sleeping under mosquito net while 138 (51.1 %) acknowledged the use of insecticide sprays. Although 191 (71.5 %) of the households possessed at least one mosquito net, only 25.4 % of the under-5 children slept under any net the night before the survey. No statistically significant reduction in malaria parasitaemia was observed with the use of mosquito nets among the under-5 children. Almost all the respondents (97.8 %) identified mosquito bite as the cause of malaria. Fever was identified by the majority of the respondents (92.2 %) as the most common symptom of malaria.ConclusionsThe findings of the study showed high prevalence of parasitaemia and that fever was significantly associated with malaria parasitaemia. Mosquito net utilization among the under-fives was low despite high net ownership rate by households. Therefore, for effective control of malaria, public health education should focus on enlightening the caregivers on signs/symptoms of both uncomplicated and complicated malaria as well as encourage the use of ITNs especially among the under-fives.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1459-5) contains supplementary material, which is available to authorized users.

Pawpaw root (Carica papaya), Guava leaf (Psidium guajava) and Bush Mango leaf (Irvingia gabonensis) are commonly used locally to treat diarrhoea. The present study evaluated the anti-diarrhoeal effects of these plant extracts on E. coli -induced diarrhoea in albino rats. Fresh tender roots and leaves of these plants were collected, air dried, powdered and percolated in n-hexane, Methanol and aqueous solvents. Qualitative phytochemical analysis was done using different standard methods. Diarrhoea was induced with Ecoli in albino rats using standard procedures. Qualitative phytochemical analysis confirmed the presence of various phytochemicals like saponins, alkaloids, flavonoids, cardiac glycosides, tannins, phytates, oxalates and phenols. The extracts, in a dose dependent manner, significantly protected the rats against diarrhoea induced experimentally by E. coli in terms of the nature of stool passage; there was no significant difference when compared with the control drug (loperamide) (P> 0.05). Generally, methanol extract of Irvingia gabonensis was more effective at low (100 ml/kg) and high (200 ml/kg) doses. The study justifies the ethno pharmacological uses of these medicinal plants for treatments of diarrhoeal disease.

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Background: The daily use of Trimethoprim-Sulfamethoxazole (TMP-SMX) prophylaxis reduces morbidity and mortality among patients infected with Human Immunodeficiency Virus (HIV) but its impact on increasing antimicrobial resistance rates has been of public concern globally. This study investigated the effect of daily TMP-SMX prophylaxis on faecal carriage rates of resistant isolates of Escherichia coli in HIV-infected adult patients in Lagos. Methods: A total of 550 HIV-infected patients with CD4-cell count of less than 350 cell/mm 3 and were eligible for TMP-SMX prophylaxis attending Lagos University Teaching Hospital, Lagos, Nigeria, were recruited. Stool/rectal swab samples were aseptically collected from the patients and processed using standard methods for culture and sensitivity. Results: There was a baseline Trimethoprim-Sulfamethoxazole resistance rate of 54% which increased to 77.9% in first 3 months, rising to 96.1% by 6 months and all isolates were resistant by the 9th month. There was also evidence of crossresistance to other antibiotics with significant association with TMP-SMX resistance (p<0.0001). The Escherichia coli isolates showed a progressive increase in resistance to the tested antibiotics over the 12-month period. The resistance was in the following order: Ampicillin (74% to 82.6% in the first 3 months; 98.3% by the 6th month and 99.4% by the 9th month; all isolates were resistant by the 12th month). Augmentin (32.5% to 47.7% in first 3 months; 76.1% by the 6th month; 86.3% by the 9th month; all isolates were resistant by 12 months). Ceftriaxone (2.0% to 10.8% in first 3 months; 20.6% by the 6th month; 24.2% by the 9th month; 54.3% by the 12 months). Conclusion:The carriage rate of faecal E. coli resistant to TMP-SMX is common before TMP-SMX prophylaxis. Initiation of TMP-SMX leads to further increase in resistance to TMP-SMX and cross-resistance to other antimicrobials.