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Introduction Inappropriate antibiotic use is one of the main drivers of anti-microbial resistance. (1) The standard of care for pregnant women is to give antibiotics to prevent complications, particularly in [...], Objective To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use. Methods We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Medecins Sans Frontieres sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm. Findings The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48 euros per woman. Conclusion A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible. Objectif Determiner si l'ajout d'une uroculture pour diagnostiquer une infection urinaire chez les femmes enceintes dans les camps de refugies au Liban permet d'eviter de recourir inutilement aux antibiotiques. Methodes Nous avons mene une etude transversale prospective entre avril et juin 2022 sur des femmes enceintes frequentant une clinique de sante sexuelle et reproductive geree par Medecins Sans Frontieres dans le sud de Beyrouth. Les femmes presentant deux tests positifs par bandelette urinaire (c'est-a-dire souffrant potentiellement d'une infection urinaire) ont fourni des echantillons d'urine pour culture. Les tests d'identification bacterienne et de sensibilite aux antimicrobiens ont ete effectues conformement aux lignes directrices du Comite europeen des antibiogrammes. Nous avons compare les caracteristiques des femmes ayant obtenu des resultats d'uroculture positifs et negatifs puis nous avons calcule la proportion d'antibiotiques surprescrits ou utilises de fagon inappropriee. Enfin, nous avons estime combien couterait l'ajout d'une uroculture a l'algorithme de diagnostic. Resultats Letude a porte sur 449 femmes enceintes susceptibles de souffrir d'infections urinaires: 18,0% (81/449) ont obtenu des resultats positifs lors de l'uroculture. Si des antibiotiques avaient ete administres uniquement sur la base des resultats aux tests par bandelette urinaire, 368 femmes en auraient regu sans en avoir besoin, ce qui equivaut a un taux de surprescription de 82% (368/449). S'ils avaient ete administres sur la base des resultats de l'uroculture ainsi que des symptomes d'infection urinaire, 144 des 368 femmes ayant obtenu des resultats negatifs auraient regu des antibiotiques sans en avoir besoin, ce qui represente un taux de surprescription de 39,1% (144/368). La mise en place de l'uroculture a engendre un cout supplemental de 0,48 euro par femme. Conclusion Dans les camps de refugies, une proportion elevee de femmes enceintes potentiellement atteintes d'infections urinaires se sont vu prescrire des antibiotiques sans que ce ne soit necessaire. Inclure dans le diagnostic une uroculture, proposee a prix abordable au Liban, permettrait de reduire considerablement leur surprescription. Des approches similaires pourraient en outre etre adoptees dans d'autres regions ou des laboratoires de microbiologie sont accessibles. Objetivo Determinar si la adicion del urocultivo al diagnostico de infeccion urinaria en mujeres embarazadas de campos de refugiados en Libano redujo el uso innecesario de antibioticos. Metodos Entre abril y junio de 2022, se realizo un estudio prospectivo transversal en el que participaron mujeres embarazadas que acudian a una clinica de salud reproductiva sexual de Medicos Sin Fronteras en el sur de Beirut. Las mujeres con dos pruebas de tira reactiva en orina positivas (es decir, sospecha de infeccion urinaria) proporcionaron muestras de orina para cultivo. La identificacion bacteriana y las pruebas de sensibilidad antimicrobiana se realizaron siguiendo las directrices del Comite Europeo sobre Pruebas de Susceptibilidad Antimicrobiana. Se compararon las caracteristicas de las mujeres con urocultivos positivos y negativos, y se calculo el porcentaje de antibioticos prescritos en exceso o utilizados de forma inadecuada. Tambien se calculo el coste de anadir el urocultivo al algoritmo diagnostico. Resultados En el estudio participaron 449 mujeres embarazadas con sospecha de infeccion urinaria: el 18,0% (81/449) tuvieron resultados positivos en el urocultivo. Si la administracion de antibioticos se basaba unicamente en los resultados de la tira reactiva de orina, 368 mujeres habrian recibido antibioticos sin necesidad: una tasa de prescripcion excesiva del 82% (368/449). Si la administracion se basaba en los resultados del urocultivo mas los sintomas de infeccion urinaria, 144 de las 368 mujeres con resultados negativos del urocultivo habrian recibido antibioticos sin necesidad: una tasa de sobreprescripcion del 39,1% (144/368). El coste adicional del urocultivo fue de 0,48 [euro] por mujer. Conclusion Un alto porcentaje de embarazadas con sospecha de infeccion urinaria procedentes de campos de refugiados recibieron antibioticos innecesariamente. La inclusion del urocultivo en el diagnostico, asequible en Libano, reduciria en gran medida la prescripcion excesiva de antibioticos. Se podrian adoptar enfoques similares en otras regiones donde se pueda acceder a los laboratorios de microbiologia. [phrase omitted]

Background The history of conflicts in the Middle East has resulted in a high burden of complications from conflict-related wounds like posttraumatic osteomyelitis (PTO). This is particularly challenging to manage in settings like Mosul, Iraq and Gaza, Palestine, where healthcare systems are weakened. In nonconflict settings, PTO caused by Pseudomonas aeruginosa (PAPTO) can lead to >20% of treatment failures. We aim to describe the clinical characteristics, outcomes, and management, in PAPTO patients admitted to Médecins Sans Frontières (MSF) facilities in Mosul and Gaza between 1 April 2018 and 31 January 2022. Methods We conducted a retrospective cohort study on patients with PAPTO diagnosed with culture of intraoperative bone biopsy, using routinely collected data. Results Among 66 PAPTO episodes from 61 enrolled patients, 37.9% had a multidrug-resistant Pseudomonas aeruginosa , with higher antibiotic resistance in Gaza. Polymicrobial infections were prevalent (74.2%), mainly involving Staphylococcus aureus (74.1%), being predominantly methicillin-resistant (95.0%). Overall, 81.7% received appropriate antibiotic treatment, with monotherapy used in 60.6% of episodes and a median treatment duration of 45.5 days. Recurrence was observed in 24.6% of episodes within a median of 195 days (interquartile range, 64–440 days). No significant differences were found in recurrence rates based on the type of antibiotic treatment (mono- or dual therapy) or episode (mono- or polymicrobial). Conclusions Management of PAPTO in the conflict-affected, low-resource settings of Mosul and Gaza achieved a recurrence rate aligned with global reports through appropriate and targeted antibiotic use, primarily in monotherapy, provided over a mean treatment duration of 45.5 days. [ABSTRACT FROM AUTHOR]

The Médecins Sans Frontières Tertiary Orthopaedic Care center in Mosul, Iraq, provides reconstructive surgery, microbiological analysis, integrated infection prevention and control, and antibiotic stewardship services. Between May 2018 and February 2020, we recorded soft tissue and/or bone infections caused by gram-negative extensively drug-resistant (XDR) bacteria in 4.9% (13/266) of the admitted patients. The XDR bacteria identified among 12 patients in this case series were extended-spectrum β-lactamase–producing Klebsiella pneumoniae (n = 5, 41.7%) with intermediate sensitivity or resistance to imipenem and/or meropenem, Acinetobacter spp (n = 3, 25.0%; 2 Acinetobacter baumannii strains) resistant to imipenem and/or meropenem, Pseudomonas aeruginosa (n = 2, 16.7%) resistant to imipenem and meropenem, and extended-spectrum β-lactamase–producing Proteus mirabilis (n = 2, 16.7%) resistant to meropenem. Most XDR isolates were sensitive only to colistin or polymyxin B, neither of which is available in Iraq. Therefore, the only treatment option was multiple rounds of surgical debridement and wound care. The infection was deemed cured before discharge in 7 patients (58.3%). Meanwhile, 4 patients (33.3%) were discharged with unhealed wounds, and outpatient follow-up was planned. One patient died in the intensive care unit of a referral hospital after developing septicemia postsurgery. XDR bacteria pose substantial health risks in Iraq. Thus, improving antimicrobial stewardship and accessibility to essential antibiotics is critical to address this issue. [ABSTRACT FROM AUTHOR]

Introduction Lead poisoning is a major and likely under-reported global health problem. There are many widely prevalent sources of lead exposure: lead-acid battery maanufacturing and recycling [1]; mining, smelting, and [...], Background: In 2010, Medecins Sans Frontieres (MSF) discovered extensive lead poisoning impacting several thousand children in rural northern Nigeria. An estimated 400 fatalities had occurred over 3 mo. The US Centers for Disease Control and Prevention (CDC) confirmed widespread contamination from lead-rich ore being processed for gold, and environmental management was begun. MSF commenced a medical management programme that included treatment with the oral chelating agent 2,3-dimercaptosuccinic acid (DMSA, succimer). Here we describe and evaluate the changes in venous blood lead level (VBLL) associated with DMSA treatment in the largest cohort of children ≤ 5 y of age with severe paediatric lead intoxication reported to date to our knowledge. Methods and Findings: In a retrospective analysis of programme data, we describe change in VBLL after DMSA treatment courses in a cohort of 1,156 children ≤ 5 y of age who underwent between one and 15 courses of chelation treatment. Courses of DMSA of 19 or 28 d duration administered to children with VBLL ≥45 µg/dl were included. Impact of DMSA was calculated as end-course VBLL as a percentage of pre-course VBLL (ECP). Mixed model regression with nested random effects was used to evaluate the relative associations of covariates with ECP. Of 3,180 treatment courses administered, 36% and 6% of courses commenced with VBLL ≥80 µg/dl and [greater than or equal to] 120 µg/dl, respectively. Overall mean ECP was 74.5% (95% CI 69.7%-79.7%);among 159 inpatient courses, ECP was 47.7% (95% CI 39.7%-57.3%). ECP after 19-d courses (n = 2,262) was lower in older children, first-ever courses, courses with a longer interval since a previous course, courses with more directly observed doses, and courses with higher pre-course VBLLs. Low haemoglobin was associated with higher ECP. Twenty children aged ≤ 5 y who commenced chelation died during the period studied, with lead poisoning a primary factor in six deaths. Monitoring of alanine transaminase (ALT), creatinine, and full blood count revealed moderate ALT elevation in Conclusions: Oral DMSA was a pharmacodynamically effective chelating agent for the treatment of severe childhood lead poisoning in a resource-limited setting. Re-exposure to lead, despite efforts to remediate the environment, and nonadherence may have influenced the impact of outpatient treatment. Please see later in the article for the Editors' Summary.

Context • Despite the fact that herbal products (HP) are used frequently during gestation worldwide, studies indicate that they may not be free of danger for fetuses. Evidence about the safety of HP use during pregnancy and their impact on pregnancy outcomes is currently lacking. Objective • To quantify the association between HP use during the last 2 trimesters of pregnancy (⩾15 weeks of gestation [WG])—and more specifically, between use of chamomile (Anthemis nobilis), flax (Linum usitatissimum), peppermint (M. balsamea), or green tea (Caniellia sinensis) (alone or in combination with other HPs) and the risk of low birth weight (LBW). Design • We evaluated data from the Quebec Pregnancy Registry, which was created by the linkage of 3 administrative databases in Quebec, and a self-administered questionnaire mailed to subjects. Participants • 8505 women were randomly selected from the registry. Overall, 38.5% of women (n = 3273) returned their questionnaires, and 3183 were included in the study (8 were excluded because of missing values on birth weight or giving birth to twins or triplets). Outcome measures • We performed a case-control analysis. Cases were defined as women who delivered a newborn <2500g and controls as women who delivered a newborn ⩾2500g. Multivariate logistic regression models were used to analyze data. Results •Amongst the selected 3183 participants, 424(13.32%) were cases. After adjusting for potential confounders, no statistically significant associations were found between the use of any HP during the last 2 trimesters of pregnancy and the risk of LBW, or between the use of flax, chamomile, peppermint, or green tea (alone or in combination with other HPs) during the last 2 trimesters of pregnancy and the risk of LBW. Conclusion • HP use during the last 2 trimesters of pregnancy-and more specifically, use of flax, chamomile, peppermint, or green tea alone or in combination with other HPs did not significantly increase the risk of LBW. [ABSTRACT FROM AUTHOR]