No abstract

Carbapenem resistance among Enterobacteriaceae, especially Klebsiella pneumoniae and Escherichia coli, has remained a challenge in infectious disease management. Although several resistance mechanisms have been documented that neutralize the efficacy of carbapenems, the expression of carbapenemases is the most prominent. Carbapenemase producing Klebsiella pneumoniae has been identified as a major public health threat because of the potential for rapid plasmid mediated spread of the resistance genes among bacterial species and resulting limited therapeutic options available. These pathogens could express resistance to almost all available antibiotics and are associated with high morbidity and mortality. This crosssectional study was carried out in the University of Port Harcourt Teaching Hospital, Nigeria. A total of 225 clinical isolates of Klebsiella pneumoniae from wounds, urine, blood, sputum and cerebrospinal fluid were recruited. All isolates were screened for Carbapenem resistance using Ertapenem (10µg; Oxoid, England) according to CLSI guidelines. All non-susceptible isolates were then tested for phenotypic carbapenemase production using the Modified Hodge test (MHT). The MHT positive isolates were thereafter, subjected to Polymerase Chain Reaction to detect the presence of blaKPC resistance gene. The study showed that 8.4% (19/225) of Klebsiella pneumoniae isolates were not susceptible to Ertapenem. Out of these, 6.2% (14/225) expressed carbapenemase production by the modified Hodge test. However, on molecular analysis, only six (6) of these isolates possessed the blaKPC gene giving a 2.7% genotypic prevalence of Klebsiella pneumoniae carbapenemase among the isolates. Critically ill patients are more likely to develop infections by blaKPC-producing Klebsiella pneumoniae. It is therefore pertinent that the approach to prevention and control of infections by multi-drug resistant Klebsiella pneumoniae isolates must be multi-pronged to effectively counteract the various mechanisms that may be responsible. From control of prescribing and dispensing patterns, rational use of antimicrobials, institution of antimicrobial stewardship programs, optimization of infection prevention and control measures to effective surveillance; a well-coordinated approach is necessary to reduce the prevalence and spread of this pathogens since the blaKPC resistance gene is plasmid mediated and associated with high rates of both inter and intra-species transfer among bacteria.

Trichomoniasis is the most prevalent non-viral sexually transmitted infection worldwide. Apart from being a key biologic indicator of sexual activity, it's been associated with the transmission of Human Immunodeficiency virus. The use of vaginal speculum is traditionally required for specimen collection. The limited application of this step in various primary health care facilities in resource-poor settings due to difficulties with sterilization of speculae among others, has grossly reduced the offer of testing for Trichomoniasis. Self-collected vaginal swab could be an acceptable alternative specimen for diagnosis of trichomoniasis in these settings. We compared the yield of Trichomonas vaginalis from speculum and nonspeculum based specimens. Five hundred women between 18-45 years presenting with abnormal vaginal discharge in two health care facilities in Rivers State, Nigeria, were enrolled. Three specimens were collected from each woman; two nonspeculum based /non-invasive and the third, speculum based. Microscopists were trained and the procedure standardized. Wet mount microscopy was performed on all specimens within thirty minutes of collection. Three Microscopists examined each specimen independently. All infected patients were managed according to existing guidelines. Ethical approval was obtained and data analyzed using SPSS version 21. Median age of participants was 31 years. Of the 500 women, 53 were infected giving an overall prevalence of 10.6%. Using the speculum-based specimens, 90.5% (48) of infected women were detected while 83.0% (44) and 30.1% (16) were detected using the self-collected swab and first void urine respectively. Interestingly, first void urine was able to detect five (5) more cases that were not detected by the speculum-based method. In low income settings, use of self-collected swabs in combination with first void urine is likely to increase detection rate of Trichomonas vaginalis when compared with the use of speculum-based specimen only.