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Background The long history of conflicts in the Middle East has resulted in a high burden of complications from conflict-related wounds like post-trauma osteomyelitis (PTO). This is particularly challenging to manage in settings like Mosul, Iraq and Gaza, Palestine, where healthcare systems are weakened. In non-conflict settings, PTO caused by Pseudomonas aeruginosa (PAPTO) can lead to >20% of treatment failures. This is twice the relapse rate as with other causes of PTO. We aim to describe the clinical characteristics, outcomes, and management, including appropriateness of antibiotic treatment, in PAPTO patients admitted to Médecins Sans Frontières (MSF) facilities in Mosul (Iraq) and Gaza (Palestine) between 01-April-2018 and 31-January-2022. Methods We conducted a retrospective cohort study on patients with PAPTO diagnosed with culture of intraoperative bone biopsy. We reviewed routinely collected patient data to describe the characteristics of PAPTO patients and episodes, antibiotic resistance patterns, polymicrobial infections, and the appropriateness of antibiotic treatment in comparison to the clinical guidelines followed. Differences between Mosul and Gaza were analysed using Pearson chi-square or Fisher exact tests for categorical variables, and unpaired t-tests or Wilcoxon Mann-Whitney tests for continuous variables, as appropriate. Results Among 66 PAPTO episodes from 61 enrolled patients who were hospitalized for a median of 42 days [interquartile range (IQR): 24-53], 37.9% had a multidrug resistant Pseudomonas aeruginosa, with higher antibiotic resistance in Gaza. Polymicrobial infections were prevalent (74.2%), mainly involving Staphylococcus aureus (74.1%), of which predominantly methicillin-resistant (MRSA) (95.0%). Overall, 81.7% received appropriate antibiotic treatment, with monotherapy used in 60.6% of episodes and a median treatment duration of 45.5 days. Recurrence was observed in 24.6% of episodes within a median of 195 days (IQR: 64-440). Within the overall cohort, no significant differences were found in recurrence rates based on the type of antibiotic treatment (mono- or dual therapy) or the type of episode (mono- or polymicrobial). Conclusions Management of PAPTO in the conflict-affected, low-resource settings of Mosul and Gaza, achieved a recurrence rate aligned with global reports through appropriate and targeted antibiotic use, primarily in monotherapy, provided over a mean treatment duration of 45.5 days.
Background The long history of conflicts in the Middle East has resulted in a high burden of complications from conflict-related wounds like post-trauma osteomyelitis (PTO). This is particularly challenging to manage in settings like Mosul, Iraq and Gaza, Palestine, where healthcare systems are weakened. In non-conflict settings, PTO caused by Pseudomonas aeruginosa (PAPTO) can lead to >20% of treatment failures. This is twice the relapse rate as with other causes of PTO. We aim to describe the clinical characteristics, outcomes, and management, including appropriateness of antibiotic treatment, in PAPTO patients admitted to Médecins Sans Frontières (MSF) facilities in Mosul (Iraq) and Gaza (Palestine) between 01-April-2018 and 31-January-2022. Methods We conducted a retrospective cohort study on patients with PAPTO diagnosed with culture of intraoperative bone biopsy. We reviewed routinely collected patient data to describe the characteristics of PAPTO patients and episodes, antibiotic resistance patterns, polymicrobial infections, and the appropriateness of antibiotic treatment in comparison to the clinical guidelines followed. Differences between Mosul and Gaza were analysed using Pearson chi-square or Fisher exact tests for categorical variables, and unpaired t-tests or Wilcoxon Mann-Whitney tests for continuous variables, as appropriate. Results Among 66 PAPTO episodes from 61 enrolled patients who were hospitalized for a median of 42 days [interquartile range (IQR): 24-53], 37.9% had a multidrug resistant Pseudomonas aeruginosa, with higher antibiotic resistance in Gaza. Polymicrobial infections were prevalent (74.2%), mainly involving Staphylococcus aureus (74.1%), of which predominantly methicillin-resistant (MRSA) (95.0%). Overall, 81.7% received appropriate antibiotic treatment, with monotherapy used in 60.6% of episodes and a median treatment duration of 45.5 days. Recurrence was observed in 24.6% of episodes within a median of 195 days (IQR: 64-440). Within the overall cohort, no significant differences were found in recurrence rates based on the type of antibiotic treatment (mono- or dual therapy) or the type of episode (mono- or polymicrobial). Conclusions Management of PAPTO in the conflict-affected, low-resource settings of Mosul and Gaza, achieved a recurrence rate aligned with global reports through appropriate and targeted antibiotic use, primarily in monotherapy, provided over a mean treatment duration of 45.5 days.
Background/Objectives: Antimicrobial resistance is considered one of the foremost global public health challenges, and its prevalence is increasing. In Jordan, particularly in Al-Karak Governorate, there is a lack of sufficient data on antimicrobial resistance to make accurate assessments. The main aim of the current study was to evaluate antibiotic resistance trends in clinical specimens from 2022 and assess antibiotic resistance patterns. The emphasis on the WHO antibiotic classification as Access, Watch, and Reserved (AWaRe) was adopted in the current study. Results: Among Gram-positive bacteria, Enterococcus faecalis exhibited 100% susceptibility to nitrofurantoin and 96% to vancomycin, Streptococcus viridans exhibited 100% susceptibility to teicoplanin, while CoNS (coagulase-negative Staphylococci) showed moderate resistance to Trimethoprim + Sulfamethoxazole (63%) and clindamycin (47%). Among Gram-negative bacteria, Escherichia coli and Klebsiella pneumoniae displayed high susceptibility to fosfomycin (E. coli: 95%, K. pneumoniae: 80%) and amikacin (E. coli: 93%, K. pneumoniae: 81%). Resistance was notable for trimethoprim + sulfamethoxazole (E. coli: 47%, K. pneumoniae: 53%) and nitrofurantoin (K. pneumoniae: 30%). Pseudomonas aeruginosa exhibited the highest proportion of XDR strains (15%), followed by K. pneumoniae (11%) and E. coli (4%), while PDR strains were found in P. aeruginosa (6%), K. pneumoniae (3%), and E. coli (0.6%). XDR was observed in 4% of CoNS and 3% of S. viridans (α), with Staphylococcus aureus exhibiting both XDR and PDR at 1%. Methods: A cross-sectional retrospective study of bacterial species and their antimicrobial susceptibility was carried out at a hospital in Al Karak, Jordan, from January to December of 2022, the study included 1187 isolates from all locations in Al-Karak Governmental Hospital. Conclusions: The significant prevalence of XDR and PDR strains in key pathogens, particularly P. aeruginosa and K. pneumoniae, underscores the need for a robust Antimicrobial Stewardship Program (ASP) and infection control measures at Al-Karak Governmental Hospital. High susceptibility in several Access group antibiotics (e.g., amikacin and nitrofurantoin) supports their prioritization in empirical therapy, while the emergence of resistance in Watch and Reserved antibiotics highlights the necessity for rational use. These findings are very important for adjusting the local strategies to lower the spread of resistant strains and improve clinical outcomes.
Objective: Staphylococcus aureus (SA), including methicillin-resistant strains (MRSAs), is a major cause of skin and soft tissue infections (SSTIs) in military populations. This study investigated SSTI incidence and SA carriage in a military training site over 16 weeks using a prospective observational cohort design. Methods: Two training cohorts provided pre- and post-training self-collected swabs for bacterial carriage, and environmental swabs from accommodations, personal items, and training facilities. Hygiene awareness and practices were assessed through questionnaires. Bacteria were identified using culture, mass spectrometry (MALDI-TOF), and genomic sequencing. Results: Nasal carriage of SA increased from 19% to 49% by the end of training. SSTIs requiring treatment occurred in 16% of participants. Steam cleaning reduced but did not eliminate SA on personal bed linen. Additionally, 40% of participants had poor knowledge of antibacterial cleaning practices and wound management. Conclusions: Increased SA carriage was linked to human-to-human transmission in close-quarter military training environments. Implications for Public Health: Improved personal hygiene training, wound management education, and monitored cleaning protocols are essential to mitigate SSTI risks in communal military training environments.
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