Importance:Escherichia coli and Klebsiella pneumoniae are major causes of urinary tract infections. While antibiotic resistance in these critical pathogens is a global concern, data from Africa remain sparse, cover short time frames, and aggregate multiple specimen types. Objective:To model antimicrobial resistance trends in urinary E coli and K pneumoniae isolates from 6 African countries between 2010 and 2022 and to project future resistance patterns. Design, Setting, and Participants:Data for this retrospective cross-sectional study were obtained from Pasteur Network clinical laboratories located in the capital cities of 5 African countries (Cameroon, Central African Republic [CAR], Madagascar, Morocco, and Senegal) and from 1 university hospital in Benin. Urine samples yielding E coli or K pneumoniae collected during routine clinical care were included. Data collection spanned 2008 to 2023, with a shared observation period from October 2014 to December 2021. Data were analyzed from March through December 2025. Main Outcomes and Measures:The primary outcome was resistance in E coli and K pneumoniae urinary isolates, measured as nonsusceptibility to aminopenicillins (for E coli), fluoroquinolones, third- and fourth-generation cephalosporins, β-lactam and β-lactamase inhibitor combinations, aminoglycosides, and carbapenems. Resistance trends were analyzed using logistic regression with generalized estimating equations. Results:A total of 44 367 urinary isolates (mean [SD] age of patients, 35.8 [30.2] years; 26 935 isolates from women among 42 839 samples with sex data [62.9%]) were included. Mean (SD) age ranged from 29.1 (30.5) years among patients with K pneumoniae-positive samples in Cameroon to 54.3 (23.4) years among patients with E coli-positive samples in Morocco. E coli-positive samples were more common in women, with the highest proportions in Madagascar (11 948 women among 16 137 patients [74.0%]) and CAR (1329 women among 1893 patients [70.2%]), whereas K pneumoniae positive samples showed no clear sex pattern. At study end, amoxicillin resistance in E coli exceeded 85% across sites (eg, 96.0% [95% CI, 93.5%-97.6%] in Morocco), and amoxicillin-clavulanate resistance surpassed 50% for E coli (eg, 84.9% [95% CI, 77.7%-90.1%] in Morocco) and K pneumoniae (eg, 96.1% [95% CI, 89.4%-98.7%] in Morocco) in most countries. E coli resistance to third-generation cephalosporins (3GCs) and fluoroquinolones surpassed 35% at study end, with increasing trends in most countries (eg, 34.5% [95% CI, 27.3%-42.6%] to 59.8% [95% CI, 55.7%-63.8%] for cefotaxime in Benin and 32.4% [95% CI, 25.1%-40.7%] to 75.9% [95% CI, 72.4%-79.1%] for norfloxacin in Senegal). For K pneumoniae, resistance to 3GCs increased in Cameroon, Madagascar, CAR, and Senegal, exceeding 50% in most settings (eg, 50.7% [95% CI, 45.6%-55.9%] to 76.6% [95% CI, 71.7%-80.9%] for cefotaxime in Madagascar). Rates remained stable in Benin and Morocco. Fluoroquinolone resistance increased in Cameroon, Senegal, and CAR (eg, 38.5% [95% CI, 25.7%-53.0%] to 65.8% [95% CI, 58.8%-72.2%] for ciprofloxacin in Senegal); remained high in Benin and Morocco; and decreased in Madagascar but remained elevated (eg, 63.7% [95% CI, 58.7%-68.3%] to 59.9% [95% CI, 54.1%-65.4%] for norfloxacin). For both bacteria, carbapenem resistance remained less than 18% (eg, 17.2% [95% CI, 11.8%-24.3%] for K pneumoniae resistance to ertapenem in Senegal), but resistance to ertapenem reached 28.0% (95% CI, 25.7%-30.5%) for E coli and 27.8% (95% CI, 22.0%-34.5%] for K pneumoniae in Madagascar. Projections suggest that 3GC and carbapenem resistance could exceed 90% by 2050 in most countries (eg, 2037 [95% CI, 2032-2053] for E coli resistance to imipenem in Benin). Conclusions and Relevance:In this study, elevated and increasing resistance levels were observed, underlining the urgent need for improved measures against antimicrobial resistance in Africa.
INTRODUCTION:Since 2013, global HIV treatment guidelines have included recommendations for medication adherence support and monitoring for people on antiretroviral therapy (ART). We examined the implementation of recommended strategies for adherence support and monitoring for adults with HIV through serial cross-sectional structured surveys conducted by the International epidemiology Databases to Evaluate AIDS (IeDEA). METHODS:We used data from surveys completed by HIV clinics across 43 countries in 2017 (n = 206), 2020 (n = 200) and 2023 (n = 214); 131 clinics completed all three surveys. We used descriptive statistics to examine clinic resources and routine adherence support and monitoring at each time point, stratified by country income level (i.e. low/middle-income vs. high-income countries [LMICs/HICs]), and trends among clinics completing all three surveys. We created composite measures of the level or intensity of routine provision of adherence aids/reminders, adherence support and adherence monitoring, ranging from "none" to "enhanced" levels. Among clinics participating in the 2023 survey, we also examined adherence aids and support routinely provided to clients eligible for intensified support versus all clients. RESULTS:At each time point, surveyed clinics were predominantly in LMICs (68.4%-74.3%) and urban settings (65.0%-65.5%), situated within health centres (60.2%-64.0%) or regional/provincial or university hospitals (28.0%-33.5%). Among 131 clinics participating in all surveys, there was a decrease in the provision of multiple adherence readiness counselling sessions from 52.2% of clinics reporting ≥2 sessions before treatment initiation in 2017 to 26.0% in 2023, along with increased provision of 6-month ART refills (from 11.5% to 40.5%). The provision of "enhanced" levels of adherence support to all clients decreased from 2017 to 2023 in both LMICs (64.6% to 28.1%) and HICs (34.3% to 8.6%); in 2023, substantial proportions of clinics reported that such support was routinely provided only to clients eligible for intensive adherence support. At each time point, higher proportions of clinics in LMICs reported "enhanced" adherence monitoring than in HICs (63.5%-70.8% vs. 31.4%-54.3%). CONCLUSIONS:While streamlined provision of ART adherence support may reflect the implementation of guidelines recommending the targeting of support towards clients with known or suspected adherence challenges, further research should examine how evolving clinic adherence support practices are associated with care retention and virologic suppression outcomes.
Objectif Évaluer les résultats anatomiques et fonctionnels du traitement chirurgical des fractures des plateaux tibiaux. Patients et méthode Soixante-dix patients avec un âge moyen de 43,9 ans ont été opérés pour une fracture des plateaux tibiaux entre le 1er janvier 2014 et le 31 décembre 2019. Selon la classification Schatkzer, les fractures étaient de type I (n=2), type II (n=11), type III (n=13), type IV (n=5), type V (n=14), type VI (n=25). Il a été réalisé une ostéosynthèse à ciel ouvert par plaque en L pour les fractures de type I, II et III avec relèvement et greffe osseuse pour les types II et III. Les type IV ont été opérés par ostéosynthèse par plaque en T tandis que les types V et VI ont été opérés par double ostéosynthèse par plaque en L latéral et en T médial ou vissage médial. Les résultats anatomiques et fonctionnels ont été évalués au recul moyen de 31 mois chez 67 patients. Résultats La réduction était jugée excellente (n=5), bonne (n=24), moyenne (n=35), et mauvaise (n=6). La consolidation osseuse a été obtenue chez 64 patients dans un délai moyen de cinq (05) mois. Les résultats fonctionnels étaient excellents et bons chez 58 patients. Conclusion L’ostéosynthèse à ciel ouvert par des plaques en T ou en L des fractures des plateaux tibiaux a permis d’obtenir d’excellents résultats. Mots clés : Fracture des plateaux tibiaux, Ostéosynthèse à ciel ouvert, Plaque vissée. Niveau de preuve : IV
Background Antiseptics, disinfectants, and hand hygiene products can be contaminated with bacteria and cause healthcare-associated infections, which are underreported from low- and middle-income countries. To better understand the user-related risk factors, we conducted a knowledge, awareness, and practice survey among hospital staff in sub-Saharan Africa. Methods Self-administered questionnaire distributed among healthcare workers in three tertiary care hospitals (Burkina Faso, Benin, Democratic Republic of the Congo). Results 617 healthcare workers (85.3% (para)medical and 14.7% auxiliary staff) participated. Less than half (45.5%) had been trained in Infection Prevention & Control (IPC), and only 15.7% were trained < 1 year ago. Near two-thirds (64.2%) preferred liquid soap for hand hygiene, versus 33.1% for alcohol-based hand rub (ABHR). Most (58.3%) expressed confidence in the locally available products. Knowledge of product categories, storage conditions and shelf-life was inadequate: eosin was considered as an antiseptic (47.5% of (para)medical staff), the shelf life and storage conditions (non-transparent container) of freshly prepared chlorine 0.5% were known by only 42.6% and 34.8% of participants, respectively. Approximately one-third of participants approved using tap water for preparation of chlorine 0.5% and liquid soap. Most participants (> 80%) disapproved recycling soft-drink bottles as liquid soap containers. Nearly two-thirds (65.0%) declared that bacteria may be resistant to and survive in ABHR, versus 51.0% and 37.4% for povidone iodine and chlorine 0.5%, respectively. Depicted risk practices (n = 4) were ignored by 30 to 40% of participants: they included touching the rim or content of stock containers with compresses or small containers, storing of cotton balls soaked in an antiseptic, and hand-touching the spout of pump dispenser. Filling containers by topping-up was considered good practice by 18.3% of participants. Half (52.1%) of participants acknowledged indefinite reuse of containers. Besides small differences, the findings were similar across the study sites and professional groups. Among IPC-trained staff, proportions recognizing all 4 risk practices were higher compared to non-trained staff (35.9% versus 23.8%, p < 0.0001). Conclusions The present findings can guide tailored training and IPC implementation at the healthcare facility and national levels, and sensitize stakeholders' and funders' interest.
Background: Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models. Methods: This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July-November 2014) and GlobalSurg-2 (January-July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores externally validated using GlobalSurg-1 data. The primary outcome was 30-day surgical-site infections, with two predictive techniques explored: penalized regression (least absolute shrinkage and selection operator ('LASSO')) and machine learning (extreme gradient boosting ('XGBoost')). Final model selection was based on prognostic accuracy and clinical utility. Results: There were 14 019 patients (surgical-site infections = 12.3%) for derivation and 8464 patients (surgical-site infections = 11.4%) for external validation. The LASSO model was selected due to similar discrimination to extreme gradient boosting (AUC 0.738 (95% c.i. 0.725 to 0.750) versus 0.737 (95% c.i. 0.709 to 0.765)), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC 0.730 (95% c.i. 0.715 to 0.744); calibration intercept -0.098 and slope 1.008) and demonstrated superior performance to the external validation of all previous models. Conclusion: The 'Global Surgical-Site Infection' score allows accurate prediction of the risk of surgical-site infections with six simple variables that are routinely available at the time of surgery across global settings. This can inform the use of intraoperative and postoperative interventions to modify the risk of surgical-site infections and minimize associated harm.e the score is so simple, this is easy to use all around the world.
