RESUMEN
BACKGROUND: Antibiotic overuse and misuse for upper respiratory tract infections in children is widespread and fuelled by public attitudes and expectations. This study assessed knowledge, beliefs, and practices regarding antibiotic use for these paediatric infections among children's caregivers' in Trinidad and Tobago in the English speaking Caribbean. METHODS: In a cross-sectional observational study, by random survey children's adult caregivers gave a telephone interview from November 1998 to January 1999. On a pilot-tested evaluation instrument, respondents provided information about their knowledge and beliefs of antibiotics, and their use of these agents to treat recent episodes (< previous 30 days) of upper respiratory tract infections in children under their care. Caregivers were scored on an antibiotic knowledge test and divided based on their score. Differences between those with high and low scores were compared using the chi-square test. RESULTS: Of the 417 caregivers, 70% were female and between 18-40 years, 77% were educated to high school and beyond and 43% lived in urban areas. Two hundred and forty nine (60%) respondents scored high (>or12) on antibiotic knowledge and 149 (34%) had used antibiotics in the preceding year. More caregivers with a high knowledge score had private health insurance (33%), (p < 0.02), high school education (57%) (p < 0.002), and had used antibiotics in the preceding year (p < 0.008) and within the last 30 days (p < 0.05). Caregivers with high scores were less likely to demand antibiotics (p < 0.05) or keep them at home (p < 0.001), but more likely to self-treat with antibiotics (p < 0.001). Caregivers administered antibiotics in 241/288 (84%) self-assessed severe episodes of infection (p < 0.001) and in 59/126 (43%) cough and cold episodes without visiting a health clinic or private physician (p < 0.05). CONCLUSIONS: In Trinidad and Tobago, caregivers scoring low on antibiotic knowledge have erroneous beliefs and use antibiotics inappropriately. Children in their care receive antibiotics for upper respiratory tract infections without visiting a health clinic or a physician. Educational interventions in the community on the consequences of inappropriate antibiotic use in children are recommended. Our findings emphasise the need to address information, training, legislation and education at all levels of the drug delivery system towards discouraging self-medication with antibiotics in children.
Asunto(s)
Antibacterianos/uso terapéutico , Cuidadores/psicología , Cuidado del Niño/métodos , Conocimientos, Actitudes y Práctica en Salud , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Adulto , Antibacterianos/farmacología , Cuidadores/estadística & datos numéricos , Niño , Estudios Transversales , Resistencia a Medicamentos , Escolaridad , Episodio de Atención , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pediatría , Proyectos Piloto , Infecciones del Sistema Respiratorio/microbiología , Población Rural , Encuestas y Cuestionarios , Trinidad y Tobago , Población UrbanaRESUMEN
BACKGROUND: Tertiary care hospitals are a potential source for development and spread of bacterial resistance being in the loop to receive outpatients and referrals from community nursing homes and hospitals. The liberal use of third-generation cephalosporins (3GCs) in these hospitals has been associated with the emergence of extended-spectrum beta- lactamases (ESBLs) presenting concerns for bacterial resistance in therapeutics. We studied the 3GC utilization in a tertiary care teaching hospital, in warded patients (medical, surgical, gynaecology, orthopedic) prescribed these drugs. METHODS: Clinical data of patients (>or= 13 years) admitted to the General Hospital, Port of Spain (POSGH) from January to June 2000, and who had received 3GCs based on the Pharmacy records were studied. The Sanford Antibiotic Guide 2000, was used to determine appropriateness of therapy. The agency which procures drugs for the Ministry of Health supplied the cost of drugs. RESULTS: The prevalence rate of use of 3GCs was 9.5 per 1000 admissions and was higher in surgical and gynecological admissions (21/1000) compared with medical and orthopedic (8 /1000) services (p < 0.05). Ceftriaxone was the most frequently used 3GC. Sixty-nine (36%) patients without clinical evidence of infection received 3Gcs and prescribing was based on therapeutic recommendations in 4% of patients. At least 62% of all prescriptions were inappropriate with significant associations for patients from gynaecology (p < 0.003), empirical prescribing (p < 0.48), patients with undetermined infection sites (p < 0.007), and for single drug use compared with multiple antibiotics (p < 0.001). Treatment was twice as costly when prescribing was inappropriate CONCLUSIONS: There is extensive inappropriate 3GC utilization in tertiary care in Trinidad. We recommend hospital laboratories undertake continuous surveillance of antibiotic resistance patterns so that appropriate changes in prescribing guidelines can be developed and implemented. Though guidelines for rational antibiotic use were developed they have not been re-visited or encouraged, suggesting urgent antibiotic review of the hospital formulary and instituting an infection control team. Monitoring antibiotic use with microbiology laboratory support can promote rational drug utilization, cut costs, halt inappropriate 3GC prescribing, and delay the emergence of resistant organisms. An ongoing antibiotic peer audit is suggested.
Asunto(s)
Antibacterianos/farmacología , Cefalosporinas/farmacología , Prescripciones de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/legislación & jurisprudencia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Farmacorresistencia Bacteriana , Femenino , Hospitales , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Política Pública , España , Trinidad y TobagoRESUMEN
BACKGROUND: Tertiary care hospitals are a potential source for development and spread of bacterial resistance being in the loop to receive outpatients and referrals from community nursing homes and hospitals. The liberal use of third-generation cephalosporins (3GCs) in these hospitals has been associated with the emergence of extended-spectrum beta- lactamases (ESBLs) presenting concerns for bacterial resistance in therapeutics. We studied the 3GC utilization in a tertiary care teaching hospital, in warded patients (medical, surgical, gynaecology, orthopedic) prescribed these drugs. METHODS: Clinical data of patients (>or= 13 years) admitted to the General Hospital, Port of Spain (POSGH) from January to June 2000, and who had received 3GCs based on the Pharmacy records were studied. The Sanford Antibiotic Guide 2000, was used to determine appropriateness of therapy. The agency which procures drugs for the Ministry of Health supplied the cost of drugs. RESULTS: The prevalence rate of use of 3GCs was 9.5 per 1000 admissions and was higher in surgical and gynecological admissions (21/1000) compared with medical and orthopedic (8 /1000) services (p < 0.05). Ceftriaxone was the most frequently used 3GC. Sixty-nine (36%) patients without clinical evidence of infection received 3Gcs and prescribing was based on therapeutic recommendations in 4% of patients. At least 62% of all prescriptions were inappropriate with significant associations for patients from gynaecology (p < 0.003), empirical prescribing (p < 0.48), patients with undetermined infection sites (p < 0.007), and for single drug use compared with multiple antibiotics (p < 0.001). Treatment was twice as costly when prescribing was inappropriate. CONCLUSIONS: There is extensive inappropriate 3GC utilization in tertiary care in Trinidad. We recommend hospital laboratories undertake continuous surveillance of antibiotic resistance patterns so that appropriate changes in prescribing guidelines can be developed and implemented. Though guidelines for rational antibiotic use were developed they have not been re-visited or encouraged, suggesting urgent antibiotic review of the hospital formulary and instituting an infection control team. Monitoring antibiotic use with microbiology laboratory support can promote rational drug utilization, cut costs, halt inappropriate 3GC prescribing, and delay the emergence of resistant organisms. An ongoing antibiotic peer audit is suggested.
Asunto(s)
Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Femenino , Antibacterianos/farmacología , Cefalosporinas/farmacología , Farmacorresistencia Bacteriana , Utilización de Medicamentos/legislación & jurisprudencia , Hospitales , Pruebas de Sensibilidad Microbiana , Política Pública , Trinidad y TobagoRESUMEN
BACKGROUND: Antibiotic overuse and misuse for upper respiratory tract infections in children is widespread and fuelled by public attitudes and expectations. This study assessed knowledge, beliefs, and practices regarding antibiotic use for these paediatric infections among children's caregivers' in Trinidad and Tobago in the English speaking Caribbean. METHODS: In a cross-sectional observational study, by random survey children's adult caregivers gave a telephone interview from November 1998 to January 1999. On a pilot-tested evaluation instrument, respondents provided information about their knowledge and beliefs of antibiotics, and their use of these agents to treat recent episodes (< previous 30 days) of upper respiratory tract infections in children under their care. Caregivers were scored on an antibiotic knowledge test and divided based on their score. Differences between those with high and low scores were compared using the chi-square test. RESULTS: Of the 417 caregivers, 70% were female and between 18-40 years, 77% were educated to high school and beyond and 43% lived in urban areas. Two hundred and forty nine (60%) respondents scored high (>or12) on antibiotic knowledge and 149 (34%) had used antibiotics in the preceding year. More caregivers with a high knowledge score had private health insurance (33%), (p < 0.02), high school education (57%) (p < 0.002), and had used antibiotics in the preceding year (p < 0.008) and within the last 30 days (p < 0.05). Caregivers with high scores were less likely to demand antibiotics (p < 0.05) or keep them at home (p < 0.001), but more likely to self-treat with antibiotics (p < 0.001). Caregivers administered antibiotics in 241/288 (84%) self-assessed severe episodes of infection (p < 0.001) and in 59/126 (43%) cough and cold episodes without visiting a health clinic or private physician (p < 0.05). CONCLUSIONS: In Trinidad and Tobago, caregivers scoring low on antibiotic knowledge have erroneous beliefs and use antibiotics inappropriately. Children in their care receive antibiotics for upper respiratory tract infections without visiting a health clinic or a physician. Educational interventions in the community on the consequences of inappropriate antibiotic use in children are recommended. Our findings emphasise the need to address information, training, legislation and education at all levels of the drug delivery system towards discouraging self-medication with antibiotics in children.
Asunto(s)
Preescolar , Niño , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Estudio Comparativo , Research Support, Non-U.S. Gov't , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Cuidado del Niño/métodos , Estudios Transversales , Resistencia a Medicamentos , Escolaridad , Episodio de Atención , Conocimientos, Actitudes y Práctica en Salud , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Pediatría , Proyectos Piloto , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología , Población Rural , Población Urbana , Trinidad y TobagoRESUMEN
Extended-spectrum beta-lactamase (ESBL) mediated resistance to third generation cephalosporins, amongst the family Enterobacteriaceae, is emerging worldwide. This is the Caribbean's first survey on ESBL production, and was conducted during two six-month periods in 1998 and 2001, in a tertiary health institution in Trinidad and Tobago. Consecutive ampicillin resistant isolates of the family Enterobacteriaceae from in-patients were screened for resistance to third generation cephalosporins, and for ESBL production. The proportion of isolates found to be ESBL producers was similar in both samples (40 of 560 and 23 of 361). Overall, ESBL production was more frequent in enterobacter, citrobacter and proteus (and related organisms) than in Klebsiella and Escherichia (11.2% and 4.6%, respectively, p < 0.001). In the 1998 sample, this proportion (9.8% versus 5.8%) was significant (p < 0.05), but the difference was more marked in the 2001 sample (13.6% versus 2.9%, p < 0.001). Continued distribution of these resistant bacterial strains is of concern. In the Caribbean region, more laboratory surveillance and increased infection control vigilance are recommended, with focus on specific genera in the family.
Asunto(s)
Resistencia betalactámica/fisiología , beta-Lactamasas/metabolismo , Enterobacteriaceae/enzimología , Enterobacteriaceae/aislamiento & purificación , Humanos , Trinidad y Tobago/epidemiologíaRESUMEN
Extended-spectrum beta-lactamase (ESBL) mediated resistance to third generation cephalosporins, amongst the family Enterobacteriaceae, is emerging worldwide. This is the Caribbean's first survey on ESBL production, and was conducted during two six-month periods in 1998 and 2001, in a tertiary health institution in Trinidad and Tobago. Consecutive ampicillin resistant isolates of the family Enterobacteriaceae from in-patients were screened for resistance to third generation cephalosporins, and for ESBL production. The proportion of isolates found to be ESBL producers was similar in both samples (40 of 560 and 23 of 361). Overall, ESBL production was more frequent in enterobacter, citrobacter and proteus (and related organisms) than in Klebsiella and Escherichia (11.2 and 4.6, respectively, p < 0.001). In the 1998 sample, this proportion (9.8 versus 5.8) was significant (p < 0.05), but the difference was more marked in the 2001 sample (13.6 versus 2.9, p < 0.001). Continued distribution of these resistant bacterial strains is of concern. In the Caribbean region, more laboratory surveillance and increased infection control vigilance are recommended, with focus on specific genera in the family
Asunto(s)
Humanos , Resistencia betalactámica/fisiología , beta-Lactamasas/metabolismo , Enterobacteriaceae/enzimología , Enterobacteriaceae/aislamiento & purificación , Trinidad y Tobago/epidemiologíaRESUMEN
We determined the prevalence of Neisseria gonorrhoeae and describe sociodemographic factors, knowledge and sexually transmitted disease (STD) history associated with gonococcal infection among 991 STD clinic attenders in Trinidad, West Indies (WI). The prevalence of gonorrhoea was 25%. Predictors for gonorrhoea were: male gender (odds ratios [OR] 3.5), age 15-19 (OR 2.5) and 20-29 years (OR 2.1), unawareness of the term STD (OR 1.5), self-perceived risk for STDs (OR 1.7) and no history of syphilis (OR 2.0). When the data were analysed by gender, significant associations were identified between gonococcal infection and age <30 years, single status, and self-perceived risk for STDs for males. Among females, significant associations existed between gonorrhoea and age <30 years, and unawareness of the term STD. This study is novel in describing sociodemographic characteristics of STD clinic attenders, and risk markers associated with gonococcal infection in Trinidad.
Asunto(s)
Gonorrea/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Neisseria gonorrhoeae , Adolescente , Adulto , Factores de Edad , Femenino , Gonorrea/transmisión , Humanos , Masculino , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Asunción de Riesgos , Factores Sexuales , Trinidad y Tobago/epidemiologíaRESUMEN
Sexual behavioural factors associated with gonococcal infection among 991 STD clinic attenders in Trinidad, West Indies (WI) were determined by univariate and stepwise multiple logistic regression analysis. Casual sex (odds ratios [OR] 1.6) was the only predictor of gonorrhoea. Among males, significant associations were identified by univariate analysis between concurrent partnerships, > or =one sexual partner(s) in the past 6 months, and drug use prior to engaging in casual and/or oral sex. No significant associations were identified between gonorrhoea and sexual behaviour factors among females. This study is the first to describe sexual behaviours associated with gonococcal infection in Trinidad and to evaluate risk behaviours by gender.
Asunto(s)
Gonorrea/epidemiología , Neisseria gonorrhoeae , Conducta Sexual , Factores de Edad , Femenino , Gonorrea/transmisión , Humanos , Masculino , Análisis Multivariante , Oportunidad Relativa , Factores de Riesgo , Factores Sexuales , Trinidad y Tobago/epidemiologíaRESUMEN
The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7-10 days for follow-up. Of the 735 patients who were enrolled in the study, 319 (43.4) had N gonorrhoeae and 100 (13.6) had C trachomatis. Only 151 (36) of the 419 patients with a pathogenic isolate returned for clinical and microbiological assessment. The remaining 268 (64) of the 419 patients were lost to follow-up. One hundred and forty-three patients (94.7) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100) patients who had single infection with N gonorrhoeae and in 23 patients (96) with C trachomatis infection. Of 12 patients with combined infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Gonorrea , Chlamydia trachomatis , Azitromicina , Antibacterianos , Cooperación del Paciente , Enfermedades Bacterianas de Transmisión Sexual/tratamiento farmacológico , Infecciones por Chlamydia/tratamiento farmacológico , Trinidad y Tobago , Anciano de 80 o más Años , Chlamydia trachomatis , Neisseria gonorrhoeae , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Relación Dosis-Respuesta a DrogaRESUMEN
BACKGROUND: The percentage of Neisseria gonorrhoeae isolates resistant to antimicrobial agents commonly used for treatment is unknown in many Caribbean countries. GOAL: To determine the antimicrobial susceptibility of N gonorrhoeae isolates from Trinidad (144 isolates), Guyana (70 isolates), and St. Vincent (68 isolates) so baseline data can be established for further studies, and to assist in establishing effective treatment guidelines. STUDY DESIGN: Consecutive urethral and endocervical specimens from several clinics were collected and identified as N gonorrhoeae. Isolates of N gonorrhoeae were tested for their susceptibility to penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin. The presumptive identification of penicillinase-producing N gonorrhoeae and/or tetracycline-resistant N gonorrhoeae isolates based on MIC was confirmed by plasmid and tetM content analysis. RESULTS: High percentages of penicillin and/or tetracycline resistance were observed in N gonorrhoeae isolates from Guyana (92.9%), St. Vincent (44.1%), and Trinidad (42.4%). Isolates from all three countries were susceptible to ceftriaxone, ciprofloxacin, and spectinomycin. One penicillinase-producing N gonorrhoeae/tetracycline-resistant N gonorrhoeae from Guyana had an MIC of 0.5 microg/l to ciprofloxacin. This and nine other isolates from Guyana also were resistant to azithromycin (defined as MIC > or = 2.0 microg/ml) as well as penicillin and tetracycline. A reduced susceptibility to azithromycin was displayed by 16% of the isolates from St. Vincent and 72% of the isolates from Guyana (MIC, 0.25-1.0 microg/ml). Most penicillinase-producing N gonorrhoeae isolates carried Africa-type plasmids (61/90), with 28 of 90 having Toronto-type plasmids and a single isolate carrying an Asia-type plasmid. The tetM determinant in tetracycline-resistant N gonorrhoeae isolates was predominantly of the Dutch type (68/91). CONCLUSIONS: The high prevalence of N gonorrhoeae isolates from 3 of 21 English- and Dutch-speaking Caricom countries in the Caribbean with either plasmid-mediated or chromosomal resistance to penicillin and tetracycline supports international observations that these drugs should not be used to treat gonococcal infections. The detection of isolates with reduced susceptibility to drugs such as azithromycin, which currently are recommended for treatment in the region, attest to the importance of the continued monitoring of gonococcal antimicrobial susceptibility for the maintenance of effective treatment guidelines.
Asunto(s)
Farmacorresistencia Microbiana , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae/efectos de los fármacos , Antibacterianos/farmacología , Antiinfecciosos/farmacología , Azitromicina/farmacología , Ceftriaxona/farmacología , Cefalosporinas/farmacología , Ciprofloxacina/farmacología , Guyana/epidemiología , Humanos , Técnicas In Vitro , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae/aislamiento & purificación , Resistencia a las Penicilinas , Prevalencia , San Vicente y las Grenadinas/epidemiología , Espectinomicina/farmacología , Resistencia a la Tetraciclina , Trinidad y Tobago/epidemiologíaRESUMEN
A prospective case-control study involving 46 case patients and 92 age- and neighborhood-matched control subjects was conducted in Trinidad and Tobago (T&T) between March 1998 and May 1999 to determine the etiology, sources, and risk factors for Salmonella enteritidis (SE) infection. SE infection in T&T was found to be associated with the consumption of shell eggs, and in particular raw or undercooked eggs. SE isolates from 30 (88%) of 34 patients and from 9 implicated egg or egg-containing food samples were phage type 4. Homemade eggnog and ice cream, cake batter, and egg-containing beverages were the main raw egg-containing foods, reflecting the cultural practices of the people of T&T. Public health education on the risks of eating raw or undercooked eggs, thorough cooking of all egg dishes, and refrigeration of shell eggs and egg dishes; studies tracing infected eggs to their sources; and testing of flocks of layer chickens for SE are needed to reduce the incidence of this infection.
Asunto(s)
Intoxicación Alimentaria por Salmonella/epidemiología , Salmonella enteritidis/aislamiento & purificación , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Huevos , Femenino , Alimentos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Factores de Riesgo , Intoxicación Alimentaria por Salmonella/etiología , Intoxicación Alimentaria por Salmonella/microbiología , Salmonella enteritidis/clasificación , Trinidad y Tobago/epidemiologíaRESUMEN
We tested the susceptibility patterns of 128 N. gonorrhoeae isolates to six antimicrobials; penicillin, tetracycline, spectinomycin, ceftriaxone, ciprofloxacin and azithromycin, and examined whether certain demographic or behavioral factors related to antibiotic use increased the likelihood of infection by a resistant strain. There was a low rate of resistance to penicillin; penicillinase-producing and chromosomal-mediated penicillin resistant gonorrhea were estimated to be 0.8%. A much higher proportion of isolates were resistant to tetracycline (up to 15%). All isolates were sensitive to spectinomycin, ciprofloxacin and ceftriaxone. However, less than 2% of isolates displayed intermediate resistance to both ciprofloxacin and ceftriaxone, and 9% exhibited intermediate resistance to spectinomycin. Patients who had obtained medication before attending the clinic and had taken all of the medication were more likely (p = 0.03) to be infected with a resistant strain of gonococcus. Also, patients who were asked by a clinic doctor to return for a test of cure during an earlier clinic visit, but who did not return were more likely to be infected with a resistant organism (p = 0.006) compared to those who returned at the doctor's request. These findings have important implications for antibiotic use and educational programs in Trinidad and Tobago.
Asunto(s)
Antibacterianos/farmacología , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae/efectos de los fármacos , Adolescente , Adulto , Antibacterianos/uso terapéutico , Azitromicina/farmacología , Ceftriaxona/farmacología , Cefalosporinas/farmacología , Ciprofloxacina/farmacología , Farmacorresistencia Bacteriana Múltiple , Gonorrea/epidemiología , Gonorrea/microbiología , Conductas Relacionadas con la Salud , Humanos , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae/enzimología , Neisseria gonorrhoeae/aislamiento & purificación , Resistencia a las Penicilinas , Penicilinasa/biosíntesis , Penicilinas/farmacología , Prevalencia , Espectinomicina/farmacología , Tetraciclina/farmacología , Resistencia a la Tetraciclina , Trinidad y Tobago/epidemiologíaRESUMEN
The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7-10 days for follow-up. Of the 735 patients who were enrolled in the study, 319 (43.4%) had N gonorrhoeae and 100 (13.6%) had C trachomatis. Only 151 (36%) of the 419 patients with a pathogenic isolate returned for clinical and microbiological assessment. The remaining 268 (64%) of the 419 patients were lost to follow-up. One hundred and forty-three patients (94.7%) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65%), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100%) patients who had single infection with N gonorrhoeae and in 23 patients (96%) with C trachomatis infection. Of 12 patients with combined infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad.
Asunto(s)
Antibacterianos/administración & dosificación , Azitromicina/administración & dosificación , Infecciones por Chlamydia/tratamiento farmacológico , Chlamydia trachomatis , Gonorrea/tratamiento farmacológico , Cooperación del Paciente , Enfermedades Bacterianas de Transmisión Sexual/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Chlamydia trachomatis/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neisseria gonorrhoeae/efectos de los fármacos , Evaluación de Resultado en la Atención de Salud , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Trinidad y Tobago/epidemiologíaAsunto(s)
Humanos , Inmunización/normas , Personal de Salud , Vacunas contra Hepatitis B , Guías como Asunto , Vacuna contra la Varicela , Vacuna contra la Fiebre Amarilla , Hepatitis B , Mycobacterium bovis , Región del Caribe , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificaciónAsunto(s)
Personal de Salud , Inmunización/normas , Región del Caribe , Vacuna contra la Varicela/administración & dosificación , Guías como Asunto , Hepatitis B/prevención & control , Vacunas contra Hepatitis B/administración & dosificación , Humanos , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Mycobacterium bovis , Vacuna contra la Fiebre Amarilla/administración & dosificaciónRESUMEN
The aim of this study was to determine whether the contents of farm eggs in Trinidad are contaminated with Salmonella and if transovarian transmission occurs. 750 fresh eggs from 10 farms supplying 75% of the country's eggs were cultured for Salmonella. Salmonella was found on the egg shells' surfaces from all farms, and in the egg contents from three farms. Isolates were obtained from the cultures of the contents and shells of nine (1.2%) and 35 (4.66%) eggs, respectively (p < 0.005). Serotypes found in the contents were S. enteritidis (0.8%; deduced to be contaminated by transovarian transmission) and S. typhimurium (0.4%); those isolated from the shells (contaminated by faecal transmission) were S. typhimurium (3.06%), S. enteritidis (0.67%), S. ohio (0.27%), S. cerro (0.27%), S. infantis (0.27%) and S. heidelberg (0.13%). This study provides the first evidence for Salmonella and, more importantly, S. enteritidis, in eggs in Trinidad. This is of major public health significance because S. enteritidis infected eggs appear normal and the organism is difficult to detect and control. The consumption of these eggs may increase the risk of Salmonella infection. Food safety practices, particularly the thorough cooking (> or = 70 degrees C) of all egg dishes and the refrigeration (< 10 degrees C) of shell eggs and egg dishes, are recommended.
Asunto(s)
Huevos/microbiología , Microbiología de Alimentos , Intoxicación Alimentaria por Salmonella/transmisión , Animales , Pollos , Humanos , Salmonella/aislamiento & purificación , Trinidad y TobagoRESUMEN
The aim of this study was to determine whether the contents of farm eggs in Trinidad are contaminated with Salmonella and if transovarian transmission occurs. 750 fresh eggs from 10 farms supplying 75of the country's eggs were cultured for Salmonella. Salmonella was found on the egg shells' surfaces from all farms, and in the egg contents from three farms. Isolates were obtained from the cultures of the contents and shells of nine (1.2) and 35 (4.66) eggs, respectively (p or = 70 degrees C) of all egg dishes and the refrigeration (< 10 degrees C) of shell eggs and egg dishes, are recommended.
Asunto(s)
Humanos , Animales , Intoxicación Alimentaria por Salmonella/transmisión , Microbiología de Alimentos , Huevos/microbiología , Pollos , Salmonella/aislamiento & purificación , Trinidad y TobagoRESUMEN
Treatment failures with standard doses of penicillin have been observed in the Sexually Transmitted Diseases (STD) clinics in Trinidad and Tobago. In the absence of an ongoing surveillance system, the antimicrobial susceptibility of 518 Neisseria gonorrhoeae strains was determined in order to guide treatment. 39 (7.6) strains were resistant to penicillin, including 27 (5.2) positive for beta-lactamase; that is penicillinase-producing Neisseria gonorrhoeae (PPNG). 51 (10) strains were resistant to tetracycline, with 26 (5.0) of these exhibiting high levels of resistance compatible with tetracycline resistant Neisseria gonorrhoeae (TRNG). Six strains showed evidence of having both PPNG and TRNG plasmids, and five strains showed chromosomally-mediated resistance to both penicillin and tetracycline. The overall resistance rate to penicillin and tetracycline was 17.7. There was no resistance to spectinomycin, cefuroxime, ceftriaxone and norfloxacin. The resistance rates demonstrated in this study are sufficiently significant to preclude the use of penicillin and tetracycline in the STD clinics and to justify the use of newer antimicrobials. It is essential that resistance patterns be monitored by continued surveillance.