Introduction: Pseudomonas aeruginosa bacteremia (PAB) is a major cause of morbidity and mortality, increasingly complicated by multidrug-resistant (MDR) strains which becomes a challenge to the treating physician. This study aimed to evaluate risk factors associated with PAB and its outcomes. Methodology: A retrospective cohort study was conducted at the American University of Beirut Medical Center (AUBMC), including 85 patients who were > 18 years of age with confirmed PAB during their hospital stay between 2017 and 2022. Results: Regarding resistance patterns, 8 (9.4%) patients had MDR strains and 19 (22.4%) were difficult to treat (DTR). Prior antibiotic use within 1 month was associated with the DTR infections (OR 4.97; p = 0.026). The in-hospital mortality rate was 51.8%. Male gender was associated with decreased mortality (OR 0.13; p = 0.036). Recent central line placement and Pitt bacteremia score were linked to increased mortality (OR 2.63; p = 0.028 and OR 51.71; p < 0.001, respectively). High-risk primary sources of infection such as central line, gastrointestinal, and respiratory systems had increased mortality compared with low-risk sources such as skin, abscess, and urinary tract (OR 25.96; p = 0.001). Conclusions: Prompt empirical therapy and identifying the infection source are critical in assessing severity of the infection in PAB. Pitt bacteremia score is a valuable predictor of outcomes. Rising DTR rates was linked to prior antibiotic use which highlights the importance of antimicrobial stewardship.
Introduction: Non-tuberculous Mycobacteria (NTM) are opportunistic pathogens causing community and hospital infections, often misdiagnosed as M. tuberculosis; accurate, timely differentiation is essential due to differing treatment strategies. Objectives: To genotype NTM from TB-suspected patients at a tertiary care hospital and correlate findings with clinical and epidemiological features. Methodology: A prospective observational study (Aug 2018–Dec 2019) analysed 2,050 pulmonary and extrapulmonary specimens from TB-suspected patients. Specimens were processed conventionally, MTBC and NTM were differentiated via MPT64 antigen test, and 42 randomly selected NTM isolates were genotyped using line probe assay targeting the 23S rRNA gene. Results: Of 2,050 specimens, 8.8% (180/2050) yielded mycobacterial growth. Non-tuberculous Mycobacteria were detected in 104 (5.1%) of the samples. Among these, 42.3% of patients were aged > 45 years, with a male predominance (62.5%). Nearly half of the cases (47.1%) presented clinically with pulmonary disease. Genotypic characterisation by line probe assay identified M. abscessus as the most frequent species, accounting for 35.6% of the isolates. Conclusions: NTM is prevalent among TB-suspected patients, with pulmonary disease and rapid-growing M. abscessus predominating, emphasizing the need for accurate species identification to guide management and public health measures.
Introduction: Syphilis remains an important public health concern worldwide. This study aimed to evaluate ten-year trends in syphilis serology test requests and seropositivity rates at Muğla Training and Research Hospital, with particular emphasis on the impact of the COVID-19 pandemic. Methodology: This retrospective study included all patients tested for syphilis between 2014 and 2023. Extracted data comprised age, requesting department, anti-Treponema pallidum antibody results, and Venereal Disease Research Laboratory (VDRL) or Rapid Plasma Reagin (RPR) findings. Analyses were performed at the patient level, and repeated test requests from the same individual were excluded. A case was considered positive when both treponemal and non-treponemal assays were reactive. Results: Annual test requests varied over the decade, ranging from 1,334 in 2018 to 3,331 in 2023. Testing declined sharply during the COVID-19 pandemic, then increased substantially. Most test requests originated from obstetrics/gynecology and infectious diseases; however, positivity rates were highest in infectious diseases and dermatology. Overall seropositivity ranged from 0.2–1.4 percent before the pandemic and increased to 3–4.3 percent in the post-pandemic period. Conclusions: Positivity remained low among obstetric patients despite high test volumes, whereas infectious diseases and dermatology services demonstrated a clear rise in syphilis positivity after the pandemic. These findings highlight a resurgence of syphilis and underscore the need for continued surveillance, targeted screening strategies, and strengthened sexual health services.
Introduction: Lower respiratory tract infections (LRTIs) remain a leading cause of morbidity and mortality among children under five years of age, particularly in low- and middle- income countries (LMICs), where limitations in diagnostic capacity contribute to delayed and suboptimal clinical management. Conventional diagnostic methods are limited by slow turnaround time and reduced sensitivity, especially in mixed infections. This review synthesizes current evidence on the role of multiplex polymerase chain reaction (MxPCR) in the diagnosis and management of pediatric LRTIs, with emphasis on diagnostic accuracy, clinical impact, and implementation considerations in LMIC settings. Methodology: A narrative review of published literature was undertaken, focusing on studies evaluating MxPCR diagnostic performance, clinical outcomes, epidemiological insights, and cost-effectiveness in pediatric respiratory infections, with cross-reference to LMIC specific health system constraints. Observations: MxPCR consistently demonstrates high sensitivity and specificity for the detection of viral, bacterial, and mixed respiratory pathogens, enabling rapid and comprehensive pathogen identification. Evidence indicates improved antibiotic stewardship, reduced unnecessary investigations, and strengthened epidemiological surveillance. However, widespread adoption in LMICs remains limited by high per-test costs, infrastructure requirements, supply chain challenges, and limited local economic evaluation. Conclusions: MxPCR represents a valuable diagnostic advancement for pediatric LRTIs. Sustainable integration in LMICs will require context-specific cost-effectiveness studies, appropriate panel selection based on local epidemiology, and feasible funding. Until these conditions are met, selective use in tertiary or high-dependency pediatric settings, or case-by-case application based on severity, remains the most practical approach.
Introduction: Wound infections represent a major therapeutic challenge, particularly in low- and middle-income countries where antimicrobial resistance is rapidly increasing. Gram-negative bacilli are of special concern due to their ability to produce extended-spectrum β-lactamases (ESBLs), which compromise β-lactam therapy. However, molecular data from northern Benin remain scarce. This study aimed to determine the antimicrobial resistance profiles and detect major ESBL genes (blaTEM, blaSHV, blaCTX-M) among Gram-negative bacteria isolated from suppurative wound infections at CHUD-BA, Benin. Methodology: A prospective study was conducted from June 2021 to February 2022. Gram-negative bacteria were isolated from infected wound samples. Identification was performed using standard biochemical tests, the API 20E system, and oxidase testing where appropriate. Antimicrobial susceptibility testing followed EUCAST 2021 guidelines. Biofilm production was assessed using the quantitative microtiter plate assay. ESBL genes (blaTEM, blaSHV, blaCTX-M) were detected by PCR using appropriate controls. Results: Out of 107 pus samples, 51/107 (47.7%) yielded Gram-negative bacilli. Escherichia coli accounted for 24/51 (47.1%) isolates, followed by Klebsiella pneumoniae (11.76%), Klebsiella ornithinolytica (9.80%), and Klebsiella oxytoca (7.84%). The isolates exhibited multidrug resistance, and 39.6% of the gram-negative bacilli were biofilm producers. ESBL genes were detected as follows: blaCTX-M (17/50; 34%), blaTEM (14/50; 28%), and blaSHV (4/50; 8%). Conclusions: The high prevalence of multidrug resistance, ESBL genes, and biofilm-forming capacity among Gram-negative wound isolates underscores the urgent need for antimicrobial stewardship and infection control strategies in Northern Benin.
