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Background Nigeria instituted the National Health Insurance Scheme (NHIS) for universal health coverage. This study compared the NHIS and out-of-pocket (OOP) antibiotic prescribing with the World Health Organization (WHO) optimal values. Methods A total of 2190 prescription forms from the NHIS and OOP were included in this study conducted at Obafemi Awolowo University Teaching Hospitals Complex, Nigeria from January 2021 to December 2022 and analysed using WHO drug prescribing guidelines. Results The average number of drugs per encounter was higher in the NHIS prescribing (χ2=58.956, p=0.00) than in OOP prescribing. The percentage of encounters with an antibiotic prescribed is higher in NHIS prescribing (χ2=46.034, p=0.000) than in OOP prescribing. The percentage of parenteral antibiotic prescribing is higher in OOP prescribing (χ2=25.413, p=0.000) than in NHIS prescribing. The percentage of antibiotic prescribed from the National Essential Medicine List is higher in NHIS prescribing (χ2=8.227, p=0.000) as well as the antibiotics prescribed from the Access category of the WHO Access, Watch and Reserve (AWaRe) Classification of antibiotics (χ2=23.946, p=0.000) when compared with OOP prescribing. Conclusions Prescribing indicators show better performances with NHIS antibiotic prescribing and are closer to the WHO-recommended optimal values than in OPP prescribing. Hence NHIS prescribing can be an easy target for hospital antibiotic stewardship intervention for optimal antibiotic prescribing. [ABSTRACT FROM AUTHOR]

Introduction Antibiotic-resistant bacteria complicate treatment options in neonatal sepsis, especially in developing countries. This study determined the epidemiology and bacteriological characteristics of neonatal sepsis at a tertiary hospital, in southwest Nigeria. Methods This was a cross-sectional study from December 2017 to April 2019 among admitted babies with clinical neonatal sepsis. Blood culture was performed by semi-automated system, sepsis biomarker assay (serum procalcitonin) by a semi-quantitative kit while proforma was used to capture clinicodemographic data. Bacterial identification, antibiotic susceptibility patterns, determination of genetic elements mediating resistance, were performed by standard methods and polymerase chain reaction protocols, respectively. Quantitative data were expressed as frequencies, mean; bivariate and multivariate analyses were performed by Chi-square or Fishers’ exact test and logistic regression. Results Of the 192 cases of neonatal sepsis enrolled, 42.7% (82/192) were blood culture positive. Factors associated with blood culture positivity included respiratory rate ≥60 bpm (60/82; p<0.03), lethargy/unconsciousness (59/82; FE=7.76; p<0.001), grunting respiration (54/82; p=0.04), meconium passage before birth (17/82; p=0.03) and prolonged rupture of membranes ≥24 hours (50/82; FE=6.90; p=0.01). On the other hand, mortality in the neonates was associated with elevated serum procalcitonin assay (>0.5 ng/mL) χ² =13.58; p=0.03] and Gram-negative bacteremia (χ² =24.64; p<0.001). The most common bacterial isolates were Staphylococcus aureus (42/82), coagulase-negative Staphylococcus spp. (17/82), Enterobacter spp. (8/82), and Acinetobacter spp. (6/82). Methicillin resistance was present in 85.7% (36/42) of Staphylococcus aureus and 52.9% (9/17) of coagulase-negative Staphylococcus, while extended-spectrum beta-lactamase (ESBL) and AmpC enzymes were present in (21.1%; 4/19) of the Gram-negative bacilli. Conclusions Almost half of the cases of clinically diagnosed neonatal sepsis have bacterial etiologic confirmation of sepsis. Gram-negative bacteremia and high serum procalcitonin predict mortality in neonatal sepsis. There was high resistance to common antibiotics for the treatment of neonatal sepsis in our settings. [ABSTRACT FROM AUTHOR]

This study was undertaken to determine the prevalence of intestinal parasites and enteropathogenic bacteria in fecal effluents from abattoir. A total of 162 samples were examined out of which 70 faecal samples were collected from cow, 35 from pig, 35 from goat and 22 from sheep. These samples were processed using standard parasitological techniques (macroscopy, microscopy; the Formol-ether concentration technique and zinc sulphate floatation technique) and bacteriological (culture, Gram reaction and biochemical characterization). Data was analyzed using Chi-square test. One hundred and eleven (111) samples were found positive with one or more parasites giving an overall prevalence of 68.5%. Pigs recorded the highest prevalence of 77.1% for intestinal parasites, followed by goat and cow with prevalence of 68.6% and 65.7% respectively and the least prevalence was observed in sheep, 63.6%. The prevalence of different parasites encountered include Fasciolopsis buski (8.6%), Hookworm (8.0%), Ascaris suum (7.4%), Balantidium coli (7.4%), Fasciola hepatica (7.4%), Entamoeba histolytica (7.4%), Taenia species (6.2%), Fasciola gigantica (4.3%) and Toxocara species (1.2%). Mixed infections of Balantidium coli+Entamoeba histolytica has the highest frequency of 4(2.5%) followed by Entamoeba histolytica+Hookworm and Toxocara species+Balantidium coli with the frequency of 3(1.9%) each, Ascaris suum+Taenia species, Ascaris suum+Taenia species+Hookworm and Balantidium coli+Fasciola hepatica with a frequency of 2(1.2%) each and Toxocara species+Balantidium coli recorded the lowest frequency of 1(0.6%). Also the prevalence of potentially pathogenic bacteria and yeast cells encountered include Bacillus species (29.6%), Escherichia coli (23.5%), Campylobacter species (17.3%), Pseudomonas aeruginosa (11.1%), Staphylococcus aureus (10.5%), Yeast cells (4.9%) and Staphylococcus species (3.1%). This study shows high degrees of fecal contamination of intestinal parasites and bacterial agents. As a result of this sanitary measures and Government policy should be strictly employed as this will go a long way to help check environmental contamination and reduce potential risks posed by these pathogens. [ABSTRACT FROM AUTHOR]

Background Klebsiella pneumoniae is a World Health Organization high-priority antibiotic-resistant pathogen. However, little is known about Klebsiella lineages circulating in Nigeria. Methods We performed whole-genome sequencing (WGS) of 141 Klebsiella isolated between 2016 and 2018 from clinical specimens at 3 antimicrobial-resistance (AMR) sentinel surveillance tertiary hospitals in southwestern Nigeria. We conducted in silico multilocus sequence typing; AMR gene, virulence gene, plasmid, and K and O loci profiling; as well as phylogenetic analyses, using publicly available tools and Nextflow pipelines. Results Phylogenetic analysis revealed that the majority of the 134 K. pneumoniae and 5 K. quasipneumoniae isolates from Nigeria characterized are closely related to globally disseminated multidrug-resistant clones. Of the 39 K. pneumoniae sequence types (STs) identified, the most common were ST307 (15%), ST5241 (12%), ST15 (~9%), and ST25 (~6%). ST5241, 1 of 10 novel STs detected, is a single locus variant of ST636 carrying dfrA14 , tetD , qnrS , and oqxAB resistance genes. The extended-spectrum β-lactamase (ESBL) gene bla CTX_M-15 was seen in 72% of K. pneumoniae genomes, while 8% encoded a carbapenemase. No isolate carried a combination of carbapenemase-producing genes. Four likely outbreak clusters from 1 facility, within STs 17, 25, 307, and 5241, were ESBL but not carbapenemase-bearing clones. Conclusions This study uncovered known and novel K. pneumoniae lineages circulating in 3 hospitals in Southwest Nigeria that include multidrug-resistant ESBL producers. Carbapenemase-producing isolates remain uncommon. WGS retrospectively identified outbreak clusters, pointing to the value of genomic approaches in AMR surveillance for improving infection prevention and control in Nigerian hospitals. [ABSTRACT FROM AUTHOR]