Colonial War Memorial Hospital

Introduction:Understanding antimicrobial susceptibility patterns is essential for guiding clinical management and informing surveillance strategies. This study aimed to analyse antimicrobial susceptibility trends of WHO-designated critical Gram-negative pathogens in Fijian hospitals. Methods:We conducted a retrospective study of antimicrobial susceptibility among Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae isolated from three hospitals in Fiji from 1 January 2016 to 31 December 2021. Data were stratified by hospital, hospital setting, and specimen type. Only the first isolate per patient was included. Chi-square tests and linear regression were used to assess group differences and temporal trends. Results:A total of 44 524 isolates were analysed: K. pneumoniae 17 016 (38.2%), E. coli 14 935 (33.5%), P. aeruginosa 6632 (14.9%), and A. baumannii 5941 (13.3%). Specimens included blood 4612 (10.4%), urine 13 369 (30.0%), and other types 26 543 (59.6%). Meropenem susceptibility declined significantly in A. baumannii (60.4% to 40.8%, P = 0.0004) and P. aeruginosa (100% to 40.8%, P = 0.005). Ceftriaxone susceptibility was low in E. coli (49.8%) and K. pneumoniae (32.7%). Meropenem susceptibility remained high in K. pneumoniae (96.6% in 2021) and E. coli (>80%). ESBL production was identified in 18.2% of E. coli and 37.6% of K. pneumoniae. Conclusions:These findings highlight substantial AMR challenges in Fijian hospitals, including declining carbapenem susceptibility and high ceftriaxone resistance, underscoring the need for strengthened antimicrobial stewardship, infection control, and surveillance systems.

The World Health Organization identified Stenotrophomonas maltophilia as an underestimated, multi-drug-resistant and opportunistic nosocomial pathogen. It poses a threat to patients who are immunocompromised, suffering chronic disease, requiring indwelling catheters and undergoing mechanical ventilation, as well as victims of trauma and burns. Here, whole-genome sequences of 266 Stenotrophomonas spp. from diverse environmental sources in Fiji and Australia were generated and used to improve understanding of the phylogeny of the genus. Isolates were sourced from freshwater, soil, waste biosolids, wastewater and animal agriculture using selective differential growth media. Phylogenomic analysis identified eight species, plus a singular novel Australian isolate most closely related to Stenotrophomonas indicatrix and Stenotrophomonas lactitubi. The Fijian isolates were primarily S. maltophilia (Sm), with isolates belonging to 13 of the previously recognized 19 Sm subgroups, while most Australian isolates were notably non-maltophilia. A genotypic characterization of the collections was performed, with a focus on well-characterized antimicrobial resistance and virulence genes identified in S. maltophilia, highlighting the presence of these key genes within other Stenotrophomonas species, particularly S. indicatrix, S. lactitubi and Stenotrophomonas rhizophila. Allelic analysis of chromosomal β-lactamase bla L2 revealed its presence across the entire Stenotrophomonas genus, while carbapenemase gene bla L1 was restricted to S. maltophilia and its closest relatives. These data represent a significant contribution of non-maltophilia genome sequences to the public domain, and the first dataset representing Stenotrophomonas from Fiji.

Introduction Our Bulabula MaPei trial of azithromycin administered during labour in Fiji found no evidence of a reduction in the primary endpoint of infant skin and soft tissue infections (SSTIs) at 3 months of age. Here, we determine the efficacy of this intervention on several secondary outcomes.Methods This randomised controlled trial included healthy pregnant adults presenting to hospital in labour. Prior to delivery, participants were randomly assigned a single dose of 2 g of oral azithromycin or placebo that were identical in appearance to mask treatment allocation, in a 1:1 ratio stratified by ethnicity. Cumulative incidence of infections and antibiotic prescription was compared using an intention-to-treat analysis of complete cases. Adverse events described as proportions by group at specified time points.Results From June 2019 to January 2022, we enrolled 2110 pregnant people and their infants (n=2122; azithromycin n=1059; placebo n=1063). At 3 months, the cumulative incidence of infant infections was 13.6% in the azithromycin group compared with 17.3% in the placebo group (risk ratio (RR) 0.79; 95% CI 0.63 to 0.99; p=0.038). Infections among birthing parents, including SSTIs, were reduced with the greatest effect 1 week postdelivery (infections: RR 0.31; 95% CI 0.13 to 0.71; p=0.006, SSTIs: RR 0.25; 95% CI 0.08 to 0.75; p=0.013) but with a diminishing effect up to 6 months postdelivery. There was no effect on the prescription of antibiotics at any time point.Conclusions Intrapartum azithromycin prevents a variety of infections for birthing parents and infants up to 12 months post partum in Fiji. However, further research is required to identify target populations and better characterise potential impacts on antimicrobial resistance and the infant microbiome and resistome.Trial registration number NCT03925480.

AIM:To characterise the epidemiology and outcomes of Lupus Nephritis (LN) in Fiji. METHODS:All adult LN cases diagnosed from 2016 to 2020 at the national referral hospital were included. Treatment response, kidney failure, dialysis dependence and death were reported. RESULTS:From 33 cases, a crude annual incidence of 2.44 (95% CI 1.73-3.43) per 100,000 population and an age-standardised incidence of 2.37 (95% CI 0.65-4.09) per 100,000 population was derived. The median age was 25.7 years (IQR 19.5-32) with a predominance of indigenous iTaukei ethnicity (67%). Kidney biopsy with adequate tissue was performed in 24 patients (73%), revealing LN class III in 10 patients (42%) and class IV in 14 patients (58%). Twenty-eight patients (85%) underwent induction immunosuppression, with complete and partial response in 12 patients (43%) and 2 patients (7%) at 12 months, respectively. No factor was found to be significantly associated with complete response at 12 months. At 2 years, 13 patients (39%) had developed kidney failure, 6 of whom commenced dialysis, and 13 patients (39%) had died. The risk of dialysis dependence or death was associated with suboptimal adherence to therapy (OR 12.0, 95% CI 1.23-117, p = 0.028) and 12-month complete response (OR 0.08, 95% CI 0.01-0.54, p = 0.005). CONCLUSION:Fiji has a high incidence of LN and nearly half of our cohort had either died or were dialysis dependent within 2 years of diagnosis. These results will inform targeted healthcare strategies that can be implemented in Fiji and neighbouring Pacific Island countries.

Multiple Lower extremity amputation (MLEA) is an unfortunate outcome following a lower extremity amputation (LEA) in individuals with diabetes. The challenges faced by individual with MLEA are significantly higher than those who have undergone a single amputation. Therefore, developing a reliable and accurate method for determining risk factors associated with MLEA is essential for reducing the incidence of this outcome among diabetic patients. This study aimed to explore the demographic and clinical characteristics of diabetic inpatients with foot ulcers. The goal was to develop a statistical model to determine the risk factors of MLEA among patients type 2 diabetic mellitus (T2DM). Data for statistical model development were collected from patients’ folders involving 1,972 patients with T2DM who were hospitalized for acute diabetic foot ulcers (DFU) at three tertiary care hospitals in Fiji from 2016 to 2019. This cross-sectional study was conducted in accordance with the STROBE guidelines focusing on patients who experienced MLEA at the hospitals. Patients were categorized into three ordinal outcomes: no-amputation, primary amputation, and multiple amputations. A partial proportional odds model was developed to fit the ordinal outcome and determine the risk factors associated with MLEA. The proposed model was validated by comparing it to a proportional odds model and a multinomial logistics regression model. The proposed partial proportional odds model (PPOM) identified several risk factors for MLEA, including age, gender, ethnicity, hypertension, anemia, leukocytosis, and thrombocytosis. The analytical findings reveal that the PPOM is appropriate for determining the risk factors associated with MLEA in T2DM patients in Fiji.