Health Science Reports

Introduction Glomerular filtration rate (GFR) is invasive to measure. Therefore, in clinical care, estimated GFR is derived from serum levels of endogenous filtration markers such as creatinine and cystatin C. Multiple studies from high income countries showed differences between estimated glomerular filtration rate based on cystatin C (eGFRcys) and creatinine (eGFRcr). This study aimed to assess the agreement between eGFRcys and eGFRcr in Ethiopian children and identify factors influencing higher eGFRcys and eGFRcr. Method We studied 350 Ethiopian children who were part of the iABC birth cohort study. At the recent follow-up (average age 10 years), serum cystatin C and creatinine were measured. Formulas by Berg (2015) and Hoste (2014) were used to estimate eGFRcys and eGFRcr, respectively, and Bland-Altman plots assessed their agreement. The difference in eGFR (eGFRdiff) was calculated and categorized as less than -15 mL/min/1.73 m2 (higher eGFRcr), between -15 and <15 mL/min/1.73 m2 (concordant), and greater than or equal to 15 mL/min/1.73 m2 (higher eGFRcys). Multinomial logistic regression was used to identify factors associated with higher eGFRcr and higher eGFRcys. Result Estimated glomerular filtration rate (eGFR) showed significant variation based on the estimation formula used. When using formulas by Berg (2015) and Hoste (2014), the median (IQR) eGFRcys and eGFRcr were 99.4 (90.0; 114.1), and 123.2 (110.3; 143.8) mL/min/1.73 m2, respectively. Overall, we observed a poor agreement between eGFRcys and eGFRcr, with only 94 (27.6%) children having concordant results compared to 220 (64.7%) with higher eGFRcr and 26 (7.6%) with higher eGFRcys. If the eGFRcys results are considered reliable, 27.5% of the children had eGFR below 90 mL/min/1.73 m2. Conclusion There was very marked variation in the distributions of estimated eGFRs depending on which formulas for children were used. Agreement between eGFR estimated using cystatin C and creatinine was poor among Ethiopian children. Relative to eGFRcys, kidney function may be overestimated by creatinine-based equation as up to 30ml/min in Ethiopia. Ideally, a validation study with GFR measured by gold standard methods (Inlulin clearance) among children is required. However, because of its invasive nature and financial concerns, Iohexol clearance studies are recommended.

BackgroundCatheter-related bloodstream infection (CRBSI) is a major cause of morbidity and mortality among patients undergoing hemodialysis (HD), particularly in low- and middle-income settings where non-tunneled hemodialysis catheters (NTHC) are widely used. Local epidemiological data are essential to guide preventive and therapeutic strategies. ObjectivesTo determine the prevalence, microbiological profile, antimicrobial resistance patterns, and clinical outcomes of CRBSI in patients undergoing HD via internal jugular NTHC at a tertiary care center in South India. MethodsThis retrospective observational study included adults initiated on HD using internal jugular NTHC between January 2017 and December 2023. Patients with pre-existing infections or catheters inserted elsewhere were excluded. CRBSI was defined using KDOQI criteria. Demographic, clinical, laboratory, microbiological, and outcome data were analyzed. Logistic regression identified risk factors, and receiver operating characteristic (ROC) analysis evaluated predictors of adverse outcomes. ResultsAmong 396 patients (mean age 56.3 {+/-} 14 years; 70.4% male), 65 (16.4%) developed CRBSI, with an incidence of 4.7 per 1000 catheter days. Emergency HD initiation (OR 14.86, p < 0.001) and access failure (OR 2.71, p = 0.004) significantly increased CRBSI risk, while planned initiation for uremic symptoms was protective. Patients with CRBSI had lower serum albumin and higher leukocyte counts. Gram-negative organisms predominated (53.8%), with Klebsiella pneumoniae being the most common isolate. High resistance was observed to {beta}-lactam/{beta}-lactamase inhibitor combinations and carbapenems. Gram-negative CRBSI was associated with significantly higher odds of hospitalization, ICU admission, inotropic support, and mortality. ROC analysis showed good predictive ability for adverse outcomes (AUC 0.73-0.77). ConclusionsCRBSI remains a significant complication of NTHC-based HD. Predominant Gram-negative infections with high antimicrobial resistance are associated with worse clinical outcomes, underscoring the need for early permanent access creation, strict catheter care, and robust antibiotic stewardship.

IntroductionChronic kidney disease imposes a high clinical and economic burden on the Brazilian Unified Health System, and kidney transplantation offers the best prognosis. ObjectiveTo describe trends in living kidney (LD) donation in Brazil (2010-2023), analyzing the donor-recipient relationship and the operational stock-to-annual production ratio on the waiting list, and to compare hospital indicators and estimated patient and graft survival between LD and deceased-donor (DD) kidney transplants. MethodsDescriptive ecological time-series study using aggregated, publicly available data. ResultsThe waiting list increased by 15% (from 33,253 to 38,258), and the total number of transplants rose by 29% (from 4,656 to 6,047). Data showed an increase in deceased-donor transplants (from 3,001 to 5,189) and a decrease in LD transplants (from 1,655 to 858), with the LD share declining from 35.55% to 14.19% and the per-million-population rate falling from 8.8 to 4.2. Among LD, there was a relative decrease in related donors (from 82.80% to 71.21%), a relative increase in unrelated spouse donors (from 10.57% to 18.65%), and in other unrelated donors (from 6.63% to 10.14%). Comparatively, LD showed better descriptive performance on survival indicators and lower in-hospital mortality, length of stay, and mean Hospital Admission Authorization value. ConclusionThe findings indicate a need for strategies to sustain DD procurement and LD donation.

BackgroundSnakebite is a neglected tropical disease with a high burden in South Asia, particularly India. Acute kidney injury (AKI) is one of the most serious complications of snake envenomation, which has significant morbidity, mortality and risk of chronic kidney disease (CKD). The present study aimed to evaluate the incidence, predictors, and outcomes of snakebite-associated AKI (SBE-AKI) in a tertiary care centre. MethodsWe retrospectively analysed 325 patients with snakebite envenomation, admitted to our institution. Demographic, clinical, laboratory, and treatment variables were compared between patients with and without AKI. AKI was staged according to KDIGO criteria. Renal biopsy was performed in selected patients. Outcomes assessed included recovery, Progression to CKD, and mortality. ResultsOf the 325 patients, 79 (32.1%) developed AKI. Patients with AKI were significantly younger (mean age 34 vs. 45 years, p = 0.001). Delay in anti-snake venom (ASV) administration (18 vs. 6 hrs, p = 0.001), need for inotropes (41.8% vs. 14.2%, p = 0.001), and mechanical ventilation (36.7% vs. 6.9%, p = 0.001) were strong predictors. Proteinuria was more frequent in AKI (80% vs. 32.5%). Among AKI patients, 57% had stage 3 AKI; 39.2% required dialysis. Biopsy (n=8) showed acute tubular necrosis in 37.5% and cortical necrosis in 25%. Outcomes included 77.2% recovery, 6.3% progression to CKD, and 16.5% mortality. ConclusionSBE-AKI is a common and serious complication of snakebite. Delay in ASV administration, hemodynamic instability, proteinuria, advanced AKI stage and cortical necrosis predict poor outcomes. Early ASV, timely dialysis, and long-term nephrology follow-up are essential to improve survival and reduce CKD progression.

BackgroundThe never-ending emergence of superbugs casts a shadow over the victorious age of antibiotics. In fact, the triumph of antibiotics was previously viewed in retrospection as our final victory over bacteria. Bacteria like Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli are now raising an alarming number of infections across hospitals and communities around the globe. The objective was to evaluate the implications for antimicrobial stewardship based on identifying the antibiotic resistance profiles, genotype mechanisms, and trends in common pathogenic bacteria found in various hospitals across Iraq. MethodsWe used a two-fold approach that was comprehensive in scope and involved both efficient multicenter surveillance as well as cutting edge genetic analysis to unravel the complex topography of antibiotic resistance. We provided a geographically heterogeneous but diverse set of clinically obtained isolates to participate in hospitals for a period of 24 months and concentrated our efforts on prioritized pathogens K. pneumoniae, A. baumannii, E. coli, P. aeruginosa, and S. aureus that are well known to pose serious threats. Beginning with clinically obtained isolates sourced across the entire globe, we used standardized techniques such as broth microdilution to first undertake phenotyping in a central reference lab to establish microbial identity based on resistance phenotypes to a set of prioritized antibiotics that include carbapenems, third generation cephalosporins, or fluoroquinolones. Finally, we derived data concerning the emergence patterns and geographic distribution of resistant microbes such as MRSA or CRE. We used genome-wide sequencing to unlock information concerning the genetic blueprints for a set of specifically chosen isolates based on their representational diversity across geographic locales, resistance phenotypes, and specific times. ResultsThe sample was made up of Escherichia coli (n = 225), Klebsiella pneumoniae (n = 185), Staphylococcus aureus (n = 135), Pseudomonas aeruginosa (n= 90), and Acinetobacter baumannii (n = 125). Ceftriaxone resistance was found in 80.4% of E. Coli, ciprofloxacin resistance in 45.6%, and meropenem resistance in 15.1%. K. pneumoniae exhibited 38.9% resistance to aminoglycosides and 70.2% resistance to carbapenems. The percentage of MRSA in S. aureus was 55.5%. P. aeruginosa showed 22.2% resistance to colistin, 37.8% resistance to piperacillin tazobactam, and 50.0% resistance to ceftazidime. Imipenem resistance was found in 85.6% of A. baumannii isolates, whereas colistin resistance was found in 28.8% of isolates. In all, 3.4% of isolates are pan-drug-resistant (PDR), 14.6% are extensively drug-resistant (XDR), and 52.1% are multidrug-resistant (MDR). WGS identified common genes such bla_NDM-1, bla_OXA-48, mcr-1, aac (6)-Ib, and plasmid replicons IncF, IncL/M, and IncI2. Carbapenem resistance in Gram-negative bacteria rose by around 18% over the course of five years. ConclusionsThis study shows that the rapid spread of complex genetic information in bacteria causes antibiotic resistance problems. High-level resistance represents an expected consequence of the spread of resistance genes and successful bacteria within healthcare systems. We demonstrate in our results that our expertise in overcoming resistance at a molecular level will play a crucial role in combating infectious diseases in the coming years.

IntroductionThe coverage of access to basic drinking water and sanitation facilities in India was estimated to be 93% and 60%, respectively, in 2017. The monitoring of the burden of diarrhoeal illnesses, especially in children, remains important to assess the impact of the expansion of water and sanitation (WaSH) in the Indian setting. This study aimed to estimate the burden of diarrhoea in an established longitudinal pediatric cohort in an urban settlement of Vellore in South India. MethodsThe Surveillance for Enteric Fever in India (SEFI) cohort established in an urban settlement of Vellore, south India, enrolled 6760 children aged between 6 months and 15 years. The cohort was followed up for typhoid and paratyphoid fever between 2017 and 2019. Field research assistants contacted caregivers of these children weekly to elicit any diarrhoeal illness in the child in the preceding week. As a part of SEFI environmental surveillance, drinking water samples from the study households were tested for coliforms. Sociodemographic characteristics, including source of drinking water, sanitation and hygiene practices, were collected. Incidence of diarrhoea was estimated and expressed as the number of diarrhoeal episodes over child-years of observation (CYO). Poisson regression analysis was performed to identify predictors of diarrhoeal episodes. ResultsThe estimated incidence of diarrhoea in the 6501 children followed up between November 1, 2017, and October 31, 2019, was 31.1 episodes per 100 CYO, with children in the age group of 6 months and <5 years having a higher incidence of diarrhoea than those aged between 5 and 15 years (58.6 versus 22 episodes per 100 CYO). Of the 6467 children with information on WaSH available, 5812 (89.9%) used the public distribution system for drinking water. Of the 1804 drinking water samples tested, 1346 (74.6%) had coliform counts >10,000/100 mL. Only about one-third of the cohort (n=2293, 35.5%) lived in households with access to improved sanitation. Multivariable analysis showed that children aged <2 years, residing in crowded settlements, using the public distribution system for drinking water and from households with poor hygiene practices related to excreta disposal of under-five children had a higher risk for diarrhoea. ConclusionApproximately 8 in 10 children in urban Vellore lack access to safely managed drinking water, and thereby, are at a high risk for diarrheal illnesses, especially in the under-5 children. With rapidly expanding urbanisation in the Indian setting, it is pertinent that emphasis be laid on robust planning and provision of safely managed water and sanitation.

BackgroundAntimicrobial resistance particularly from extended-spectrum {beta}-lactamase-producing Enterobacteriaceae (ESBL-PE) is a critical global public health threat, contributing significantly to infection-related mortality. The human intestinal tract is a key reservoir for ESBL-PE, and exposure to antibiotics can disrupt the gut microbiota, thereby making it easier for these pathogens to colonize the intestine. Colonized individuals are at risk of developing subsequent infections and can silently transmit these resistant bacteria to others. This transmission risk is particularly significant in food handlers, who can inadvertently spread pathogens to consumers, posing a substantial food safety hazard. In Africa, the rapid spread of ESBL-PE is exacerbated by a lack of regular surveillance and antibiotic stewardship programs. While primary studies on ESBL-PE exist, a comprehensive synthesis of data specific to the food handler population is lacking. Therefore, this systematic review and meta-analysis aimed to determine the pooled fecal colonization rate of ESBL-PE among food handlers in Africa to inform public health interventions. Materials and MethodsThis review was conducted according to a protocol registered in PROSPERO (ID: CRD420251075141). A systematic search was performed from September 5 to 15, 2025 in PubMed, Google Scholar, and Hinari/Research4Life to identify relevant studies. The methodological quality of the included studies was appraised using the Joanna Briggs Institute (JBI) critical appraisal tool. Data were extracted into Microsoft Excel 2019 and analyzed with Stata software version 17. Given significant heterogeneity among the studies (I{superscript 2} = 98.3%, p < 0.001), a random-effects meta-analysis model (DerSimonian and Laird) was used to calculate the pooled prevalence. To investigate the substantial heterogeneity, we performed subgroup analysis. Furthermore, sensitivity analysis was conducted to assess the influence of individual studies on the overall results. The potential for publication bias was assessed visually with a funnel plot and statistically using Eggers test. Finally, results were presented via text, figures, and tables. ResultsThe meta-analysis incorporated nine studies with publication year ranged between 2012 and 2023, involving 4,061 participants. The pooled fecal colonization rate of ESBL-PE among food handlers in Africa was 23.64% (95% CI: 15.3, 31.94%). A high degree of heterogeneity was observed (I{superscript 2} = 98.3%, p < 0.001). The most prevalent ESBL-PE species identified was E. coli, with a pooled prevalence of 85.83% (95% CI: 79.97, 91.69%, I2 = 95.56%, p <0.001), followed by Klebsiella species at 23.92% (95% CI: 18.48, 29.35%, I2 = 0.00%, p = 0.65) Conclusion and recommendationsThis meta-analysis establishes that approximately one in four food handlers in Africa are colonized with ESBL-PE, indicating a substantial reservoir for community transmission. This colonization risk facilitates the spread of antimicrobial resistance and can lead to severe, hard-to-treat infections. We therefore recommend implementing targeted public health measures, including routine screening, antimicrobial stewardship, and strict infection control protocols for food handlers to mitigate this threat.

BackgroundCampylobacter is a major cause of childhood diarrhoea across Africa and asymptomatic carriage is frequently reported, however risk factors for Campylobacter presence remain poorly defined. This meta-analysis aimed to calculate the pooled prevalence of Campylobacter in diarrhoeic and non-diarrhoeic stool, assess its association with diarrhoea, identify risk factors for Campylobacter presence and antimicrobial resistance (AMR) patterns. MethodEnglish language studies on Campylobacter in children (<18 years) in Africa were searched. Prevalence of Campylobacter and AMR, Odds Ratios (OR) for Campylobacter presence in diarrhoeic stool and risk factors for Campylobacter were estimated. Heterogeneity was assessed using I2 and bias assessed via funnel plots and Eggers test. ResultsA total of 168 studies were included in the meta-analysis. The pooled prevalence of Campylobacter in diarrhoeic stool was 11.25% (9.41-13.23%), in non-diarrhoeic stool 12.56% (7.79-18.27%), and mixed stool types 33.47% (20.53-47.81%). The OR for Campylobacter presence in diarrhoeic stool versus non-diarrhoeic stool was 1.95 (95% CI: 1.62-2.33). Age affected the OR with children 0-6 months old having an OR 2.57 (1.74-3.81), 7-12 months old an OR 1.60 (1.07-2.40), 13-24 months old an OR 1.02 (0.68-1.52) and 25-60 months old an OR 1.76 (0.77-4.05). Risk factors for Campylobacter presence in stool were children living in rural areas (pooled Adjusted Odds Ratio (pAOR) = 2.59 95% CI 1.43-4.69) and having contact with animals (pAOR 4.28 95% CI: 2.40-7.61). AMR prevalence ranged from 54.85% for ampicillin to 9.85% for chloramphenicol. Heterogeneity was high across all analyses. ConclusionCampylobacter prevalence is high in symptomatic and asymptomatic children across Africa. Contact with animals and living in an urban environment are risk factors for Campylobacter presence. Risk factor identification in the African context would be strengthened with standardized risk factors. Further research is needed to clarify the public health significance of asymptomatic carriage. What is already known on this topic - Campylobacter is a significant cause of diarrhoea in children and asymptomatic carriage is common. However, the burden of asymptomatic carriage and risk factors are not well understood in Africa. What this study adds - This meta-analysis highlights the high burden of asymptomatic Campylobacter carriage, its relation to age, and identified risk factors for Campylobacter in children in Africa. How this study might affect research, practice or policy - Standardising risk factor assessments can guide future control strategies. Further research into the impact of asymptomatic carriage is warranted.

Rationale & ObjectiveCompetency-based medical education emphasizes observable skills rather than time-based training. Entrustable Professional Activities (EPA) transform competencies into distinct, assessable clinical tasks but have not yet been systematically developed for U.S nephrology fellowships. We aimed to create and achieve consensus on a set of nephrology-specific EPAs and align them with Accreditation Council for Graduate Medical Education (ACGME) competency standards. Study DesignA consensus framework was developed using an online 3-round modified Delphi method. Settings & ParticipantsStudy was conducted within the University of New Mexico nephrology fellowship program. Participants included eight faculty nephrologists and one nephrology fellow. Analytical ApproachAn initial EPA list was generated by the study team using program objectives, literature review, and clinician insight. Participants rated each EPA using a 5-point Likert scale with consensus requiring strict criteria. Final EPAs were independently mapped to ACGME nephrology program requirements to ensure alignment with national competency. ResultsNine study participants (100% response rate) completed all survey rounds. Through iterative consensus, utilizing strict criteria, a final list of 22 distinct EPAs were achieved covering core domains of practice including dialysis management, acute kidney injury, chronic kidney disease, electrolyte abnormalities, hypertension, kidney stones, glomerular disease, pregnancy, transplant care, and education. Mapping demonstrated that the EPAs sufficiently corresponded to the breadth of ACGME-required sub competencies, offering a practical framework for translating broad milestones into observable clinical tasks. LimitationsThe study was conducted at a single fellowship program with a small number of participants which may limit generalizability. Implementation feasibility, resource implications, and potential unintended consequences such as checklist mentality and documentation burden were evaluated during a subsequent phase of the study. ConclusionsWe developed the first consensus-consensus based set of EPAs geared for U.S based nephrology fellowship programs while being systematically aligned with ACGME program requirements. This framework provides a foundation for standardized assessment and curriculum development in nephrology and may inform broader efforts to implement EPA-based evaluation across fellowship programs nationally.

BackgroundChildren who are HIV-exposed uninfected (HEU) show greater morbidity and mortality than HIV-unexposed children (HUU). In this study we investigate sex differences in growth, infection rates and antibody response among HEU and HUU infants. MethodsThe study enrolled 107 pregnant women with HIV and 103 pregnant women without HIV with follow-up of their infants from birth to 12 months of age. Study measures assessed included growth parameters, the prevalence of children with overt disease symptoms as reported by the mother, PCR-based assessment of infections (cytomegalovirus (CMV), respiratory syncytial virus (RSV), rhinovirus, influenza A & B, rotavirus and malaria) as well as antibody profile to CMV, RSV and enterovirus infections. ResultsCompared to male HUU, male HEU infants had lower Height-for-age-z-scores ({beta} -0.75; P=0.047) in mixed-effect model accounting for age. Additionally, they showed transiently lower Weight-for-age-z-scores at 3 months (1.07 vs 0.05, P=0.04), with higher risk of rhinorrhea (RR=2.29, P=0.02) and lower enterovirus titers at birth (P=0.0066). Female HEU showed transiently higher stunting at 6 months (0% vs 21%; P=0.01) and lower CMV viremia at 6 months, with elevated CMV antibody titers at 3 months (P=0.04) compared to female HUU. With prevalence ranging from 25%-61%, CMV and Rhinovirus infections were dominant in all groups. HEU and HUU exhibited similar antibody decay and acquisition patterns for CMV, RSV, and Enterovirus across both sexes. ConclusionHEU infants show transient sex-based differences in growth, infection and immune profiles raising the relevance for considering sex as a key parameter to assess infant health.

IntroductionAs the seventh greatest cause of premature mortality, chronic kidney disease (CKD) affects over 850 million people worldwide and poses a public health concern. Despite extensive research on CKD, it is still unclear which studies have had the greatest impact on treatment practices. Bibliometric analysis provides an evidence-based approach to identify key research trends, priorities, and global disparities. This study aimed to determine the 50 most referenced publications on CKD treatment, examining citation patterns, thematic clusters, evidence quality, and global research distribution. MethodsA comprehensive search of the Web of Science Core Collection was performed using the terms "Chronic Kidney Disease" AND "Treatment." English-language publications involving human CKD treatment were included. After screening in Rayyan, data were extracted on study type, evidence level, treatment modality, and authorship. Analysis proceeded through four steps: (1) data cleaning and standardization; (2) descriptive bibliometrics of publication trends, core journals, and productivity indicators; (3) citation analysis using h-index-type metrics excluding self-citations; and (4) science mapping via VOSviewer and Bibliometrix to visualize keyword co-occurrence networks. Descriptive statistics summarized study characteristics. ResultsRandomized controlled trials accounted for only 16% of the top 50 papers (2000-2022), while narrative reviews comprised 42% and review articles 16%. Key subjects included SGLT2 inhibitors, metabolic therapies, and renin-angiotensin-aldosterone system blockade. Research output was concentrated in high-income regions, with limited contribution from low- and middle-income countries. Only 24% of publications achieved Level 1 evidence. ConclusionThe literature on CKD treatment is geographically imbalanced, centralized, and dominated by narrative evidence. Region-specific bibliometric evaluations and more rigorous multicenter trials are required. For Saudi Arabia, aligning locally generated data with international knowledge is essential to develop equitable, context-driven, and evidence-based CKD management strategies.

BackgroundHIV exposed infants (HEIs) are at a higher risk of infant mortality compared to their counterparts who are not HIV exposed. Early Infant Diagnosis (EID) is the critical first step in reducing HIV-related infant mortality through prompt identification of HIV-infected infants and subsequent initiation of antiretroviral therapy. However, there is limited information on Uptake of EID and factors associated with its timely completion among HIV exposed infants. Therefore, this study aimed at determining the uptake of EID and factors associated with its timely completion among HIV exposed infants at Lira Regional Referral Hospital (LRRH). MethodsThe study was a retrospective cohort of 252 HEIs born in the period of 1st January 2021 to 31st December 2021 chosen through consecutive sampling. Data abstraction tools were used to collect data on uptake of 1st, 2nd, 3rd DNA-PCR and final rapid test from mother-baby pair files and EID register. The main outcome was Uptake of EID and classified as timely and untimely according to the PMTCT guideline. Data was analyzed using descriptive statistics and generalized estimating equations (GEE) with poisson family, log link and unstructured correlation structure. ResultsThe timely uptake of EID among HIV exposed infants at 4-6 weeks, 9 months, 6 weeks after cessation of breastfeeding and 18 months were 80.1% (95% CI:74.5-84.7), 84.2% (95% CI:79.0-88.3), 3.7% (95% CI:2.0-7.0) and 78.8% (95% CI:73.2-83.6) respectively. Having cotrimoxazole given was associated with timely completion of EID [aRR=2.974, 95% CI (1.45-6.10)] ConclusionUptake of EID among HEIs was sub-optimal, below the Ministry of Healths 90% target. Timely cotrimoxazole administration was associated with EID completion,

BackgroundHealthcare-associated carbapenemase-producing Enterobacterales (CPE) outbreaks are a major healthcare challenge. Epidemiological studies have identified patient-level risk factors for CPE transmission, and genomic studies have highlighted high-risk lineages or mobile genetic elements (MGEs); however, a unified dissemination risk-prediction framework is lacking. ObjectivesTo synthesise available data on epidemiological, microbiological and genomic risk factors to quantify healthcare-associated CPE outbreak potential. MethodsO_ST_ABSDataC_ST_ABSSix bibliographic databases and other sources were searched ( carbapenemase AND outbreak AND MGE; [&le;]31/01/24). Data were extracted on primary (patients infected/colonised) and secondary (outbreak duration/resolution, mortality) outcomes, and risk/protective factors including epidemiological, microbiological/genomic and infection control measures. Study eligibilityStudies reporting healthcare-associated CPE outbreaks involving MGE-associated IMP/KPC/NDM/OXA-48-like/VIM carbapenemases confirmed by whole-genome sequencing. Study qualityReporting quality was assessed against the ORION checklist (random subset). Data synthesisAfter descriptive summaries, multivariable linear mixed effect modelling was used to estimate associations between risk/protective factors and outbreak size. Results179 records (272 outbreaks) were included from 3,188 screened (41 countries, 2004-2023), affecting median 10 patients (IQR=5-27, range=2-223), and lasting 12 months (IQR=5-30, range=1 day-16 years). Data on outbreak size (primary outcome) was 99.6% complete (271/272) but more limited for secondary outcomes (29-97% complete) and risk/protective factors (70/91 factors had [&ge;]10% missingness). 39% (107/272) of outbreaks involved MGE-mediated transmission, which is a potential underestimate as 66% (104/157) of reports used clonal outbreak definitions. The involvement of more institutions (adjusted relative outbreak size: 1.10 per institution [95% CI: 1.04-1.16];p=0.001), and more Enterobacterales sequence types (1.04 per sequence type [1.01-1.08];p=0.011), were associated with larger outbreaks. Reporting quality assessment (n=98 studies) revealed adequate reporting on median 11/19 relevant ORION items (IQR=8-13; range=1-18). ConclusionsHeterogenous/incomplete reporting of CPE outbreaks precludes integrated risk evaluation based on epidemiological, microbiological, and genomic factors. Systematic sampling, sequencing and epidemiological metadata reporting may strengthen data quality for quantifying healthcare-associated CPE dissemination risk.

Background and objectivesCeftazidime-Avibactam (CAZ-AVI) is one of the last options to treat Enterobacteriales and Pseudomonas aeruginosa carbapenem-resistant. We aim to describe the susceptibility profile of bloodstream isolates of Enterobacterales and Pseudomonas aerunosa to ceftazidime-avibactam (CAZ-AVI) among strains resistant to third- and fourth-generation cephalosporins and/or carbapenems. MethodsWe conducted a retrospective descriptive study in two pediatric hospitals of Rio de Janeiro city, Brazil, between January 2023 and February 2025. All blood samples with resistance to third/fourth cephalosporins and/or carbapenem resistance were tested to CAZ-AVI, according to the BRCast methodology. Sensibility of CAZ-AVI and clinical profile of patients and outcomes were described. ResultsWe analyzed 116 blood samples. Of these, 107/116 (92.2%) were resistant to third/fourth-generation cephalosporins with susceptibility to carbapenems, and 9/116 (7.8%) were resistant to both third/fourth-generation cephalosporins and carbapenems. Overall susceptibility to CAZ-AVI was 107/116 (92.2%). The 116 blood samples represented 73 bloodstream infections (BSI) in 66 patients, including 66 single episodes and 7 persistent BSIs. Of the 73 infections, 69(94.5%) were caused by Enterobacterales and 4 (5.5%) by Pseudomonas aeruginosa. Twenty-two (30.1%) infections were detected at hospital admission, and 51 (69.9%) were healthcare-associated infections. Death occurred in 5/73 (6.8%) patients. Length of hospital stay (p=0.01596) were statistically significantly higher in non-survivors compared to survivors. The CAZ-AVI was prescribed for four patients with Enterobacteriales or Pseudomonas aeruginosa infections with clearance from the blood. ConclusionSusceptibility of CAZ-AVI to BSI in children was higher and this antibiotic could be an option to treat carbapenem-resistant infection due to Enterobacteriales and Pseudomonas aeruginosa.

BackgroundAntimicrobial resistance (AMR) represents one of the most serious threats to global public health, with a disproportionate burden borne by low- and middle-income countries. Rural healthcare settings in India remain under-represented in molecular AMR surveillance despite high antimicrobial use and limited diagnostic capacity. ObjectivesTo describe longitudinal phenotypic and molecular AMR patterns in clinical bacterial isolates from a rural district hospital in Gujarat, India, and to assess the feasibility of clinician-led molecular surveillance in a resource-limited setting. MethodsA retrospective observational study was conducted on 242 non-duplicate discarded clinical bacterial isolates collected between January 2021 and August 2025 at Banas Civil Hospital, Palanpur, Gujarat. Antimicrobial susceptibility testing was performed according to Clinical and Laboratory Standards Institute guidelines (CLSI M100, 31st edition) using Kirby-Bauer disk diffusion and broth microdilution methods. Molecular detection of blaCTX-M, blaNDM, blaOXA-48, mecA, and vanA resistance genes was carried out using polymerase chain reaction, with confirmation by Sanger sequencing. Data were analysed using R software (version 4.3.2). ResultsThe most common pathogens were Escherichia coli (38%), Klebsiella pneumoniae (26%), and Pseudomonas aeruginosa (17%). Resistance to third-generation cephalosporins was high in E. coli (64%) and K. pneumoniae (59%). Carbapenem resistance peaked at 17% in 2024. Molecular analysis identified blaCTX-M in 42% of Gram-negative isolates, while blaNDM and blaOXA-48 were detected in 11% and 7%, respectively. Genotype-phenotype concordance exceeded 80%. Ethical ApprovalEthical approval for the study was obtained from the Institutional Ethics Committee of Banas Medical College and Research Institute, Palanpur, Gujarat, India. No patient identifiers were accessed, and no patient interviews, direct contact, or additional specimen collection were performed for research purposes. ConclusionThis study demonstrates a substantial burden of ESBL- and carbapenemase-mediated antimicrobial resistance in rural Gujarat. Clinician-led molecular surveillance using discarded clinical samples is feasible and essential for guiding empirical therapy and strengthening antimicrobial stewardship in resource-limited settings

BackgroundThe Intensive care unit (ICU) service is highly limited in sub Saharan Africa countries due to varying of quantities and qualities infrastructures. However, the burden of critical ill patient in low resource countries is higher and possibly increasing with urbanization, developing epidemics and access to hospitals service. The main objective of this study was to assess the outcomes of ICU admission and identify the areas of improvement in critical care. Methodsan institutional based retrospective cross sectional study design was conducted on eligible patients who were recorded at intensive care unit registration log book from January 1, 2019 to June 30, 2020. The data was entered, edited and analyzed in stata software (version14). We performed the adjusted survival analysis between ICU mortality and independent variables by using logistic regression. We also showed patients mortality in ICU by Kaplan-Meier (KM) survival analysis. ResultsFrom January 1, 2019 to June 30, 2020 data were taken from 454 cases at Tibebe Ghion Specialized Teaching Hospital ICU registered log book through prepared questionnaire. The overall ICU mortality was 31.3%. The common leading causes of admission to ICU were head injury (19.6%) followed by non-tuberculosis respiratory problems (11.89%), post abdominal surgeries (8.37%) and myocardial infarction (6.82%). In this study, 36.3% of ICU admitted patients were served by mechanical ventilation. The logistic regression analysis ICU mortality showed that patient stayed in ICU with odds ratio (OR = 1.37 [95% CI, 1.16 - 1.62]; P = 0.000),needs for mechanical ventilation(OR = 0.18 [95% CI, 0.12 - 0.28]; P = 0.000), days on mechanical ventilation (OR = 0.73 [95% CI, 0.61 - 0.87]; P = 0.001) and non-infection (OR = 0.45 [95% CI, 0.24 - 0. 69]; P = 0.000) were associated with risk of ICU mortality. ConclusionThe mortality rate of our adult ICU was 31.3% with the most common causes of admission and deaths being on head injury. The highly statistical significant predictors of ICU mortality were infection, needs for mechanical ventilation, ICU stay and days on mechanical ventilation.

IntroductionAtmospheric conditions under climate change increase pressure on healthcare systems. Especially, the intensive care units (ICU) are vulnerable due to low buffer capacity and high utilization rates. MethodsDaily ICU cases from 2009 to 2023 were derived from the German statutory health insurance data of eleven regional AOK insurances. Cases were stratified by age and sex. Generalized additive models were used to investigate the associations between daily ICU cases and lagged atmospheric variables. Thirteen intensive care relevant diseases were analyzed using disease-specific predictor sets. Analyses were conducted for regions derived from a human-biometeorological characterization of Germany. Model performance was assessed using (weighted) explained deviance. ResultsOver the 15-year study period, 9,970,548 ICU patients were recorded (44% women), 74.3% aged [&ge;]60 years. Trauma was the most common ICU-related disease, followed by non-ST elevation myocardial infarction (NSTEMI), pneumonia and ischemic stroke. ICU demand was most sensitive (p [&le;] 0.05) to pressure-related factors, thermo-physiological parameters and ozone concentration. In terms of sex-age differences, atmospheric factors affected men more frequently, while women were more impacted by cold weather and particulate matter (PM10). Heat was more relevant for patients aged [&ge;]60 years. The NSTEMI model in Central Eastern Germany performed best (weighted explained deviance of 49.3%). In males [&ge;]60 years, heatwaves were associated with a reduced risk of ICU cases (Relative Risk = 0.94, 95%-Confidence Interval 0.89 to 0.99). ConclusionThe study identified key atmospheric factors for ICU, enabling the German healthcare system to prepare better for short-term impacts of meteorological and air quality factors. KEY MESSAGESWhat is already known on this topic: O_LIThe atmospheric changes have a direct impact on public health and the inpatient care, particularly in intensive care units. C_LIO_LIConsequently, there is a necessity to investigate the influence of atmospheric factors on intensive care in order to prepare the healthcare system for the new circumstances. C_LI What this study adds: O_LIThe study provides evidence that atmospheric factors influence the intensive care in Germany and describes age and sex-specific aspects. C_LIO_LIThe results offer valuable insights into how different atmospheric factors affect the demand for intensive care in hospitals. C_LI How this study might affect research, practice or policy: O_LIThe study enables the German healthcare system to better prepare for short-term effects of atmospheric factors, and structural or resource-related adjustments could be made in hospitals to anticipate for short-term fluctuations in intensive care demand. C_LI

BackgroundConsanguineous unions are defined as the matrimony between individuals who are blood relatives. Researchers in all over the world worked on this issue and they checked the ratio of prevalence and effects of consanguinity in different regions of world. This research was conducted in the District Faisalabad, upper Punjab. ObjectiveTo find rate of consanguinity, coefficient of inbreeding (F) and its impacts. MethodsThe data was collected from six tehsils of District Faisalabad by interviewing the subjects. The data collected within the time span of six months. Total of 2366 subjects were interviewed after their consent approval. ResultsThe rate of consanguinity was noted 41.83% with 0.03053 coefficient of inbreeding. High rate of consanguinity (23.36%) was noted among first cousins. The distantly related and not related unions were 35.64% and 22.56% respectively. The rate of consanguineous unions in six tehsils ranged from 33.99% in Jaranwala to 53.85% in Tandlianwala. Consanguineous marriages were noted high in Punjabi speaking subjects, in housewives, in reciprocal marital types, in grand-parents and one couple family types and Rajpoot castes. There was found no significant differences of consanguinity in rural and urban areas. The rate of still births was noted high (82.25%) in consanguineous unions while neonatal, post neonatal and child mortality was low such less as 6.45%, 8.06% and 3.22% respectively. The prenatal mortality was noted slightly high 44.94% in consanguineous unions as compared to non-consanguineous unions. The congenital malformation rate was 6.29% in all marital unions but this rate was high (59.06%) in consanguineous unions as compared to non-consanguineous unions (40.93%). This is a pilot study to analyze the potential of inbreeding coefficient (F) in the District Faisalabad.

BackgroundMeasles is a highly contagious infectious disease and a leading cause of childhood morbidity and mortality worldwide. In developing country like Ethiopia, effective immunization is a proven strategy for reducing measles related illness and deaths. However, measles second dose vaccination drop out has become a major public health concern. In a densely populated city such as Addis Ababa drop rate tends to be higher than the minimum acceptable threshold, leading to increased number of cases and recurrent outbreaks. Despite of this limited evidence exists on the determinants of second dose drop out and the problem is not well investigated, as a result this study will try to identify determinants of measles second dose vaccination dropout among children 24 - 35 months of age. ObjectivesTo identify determinants of measles second dose vaccination dropout among children 24 - 35 months of age Addis Ababa, Ethiopia in 2025. MethodCommunity based unmatched case control study was conducted in Addis Ababa from September 1/2024 to October /2025 with a total of 636 participants, consisting of 212 cases and 424 controls. Data were collected using structured Quesionariie and entered into EpiData 3.1 then StataSE 18 was used for detailed analysis including Descriptive statistics. Model fitness was checked using Hosmer-Lemeshow and multicollinearity were assessed using variance inflation factor. Furthermore, Bivariable and multivariable logistic regression analyses was employed and Adjusted odds ratio with 95% confidence intervals was used to identify significant variables. ResultsA total of 620 mothers/caregivers participants respond to the study, comprising 206 (97%) cases and 414(97.6%) controls, yielding a total response rate of 97.4%. In this study, waiting time longer than 30 minutes (AOR= 3.34, 95%CI: 1.86-5.9), Lack of counseling (AOR = 2.63, 95% CI: 1.60-4.30), Lack of reminders (AOR = 2.86, 95% CI: 1.89-4.30), Previous adverse event following immunization (AOR = 2.00, 95% CI: 1.39-3.00), postnatal care visit (AOR = 0.58, 95% CI: 0.40-0.85) and family size of greater than 3 (AOR = 1.96, 95% CI: 1.29-2.98) were significantly associated with measles second dose dropout. Conclusion and recommendationIn study shows measles second dose dropout is found to be associated with long waiting time, lack of counseling, lack of reminder, history of adverse event following immunization and postnatal visit. Which suggests Strengthening Immunization Counseling, reducing waiting time, establishing effective reminding system, integrating Immunization with postnatal services and promptly addressing concerns about adverse event following immunization can help reduce measles second dose dropout.

BackgroundRising kidney discard rates and uncertainty around accepting higher risk donor kidneys highlight the need for decision support tools that integrate donor and recipient factors and communicate risk in ways that are understandable and usable at the time of offer. Conventional indices (e.g., KDPI/KDRI) provide population level signals but do not deliver individualized, cognitively accessible information aligned with real time clinical workflows. ObjectiveTo describe how key transplant stakeholders (patients, coordinators, and providers) interpret and evaluate a prototype Kidney Risk Calculator app that generates donor-recipient specific survival projections and to identify the content, format and features, and functionality needed for clinically meaningful, patient-centered decision support. DesignQualitative study using focus groups and individual interviews. SettingUniversity of New Mexico Hospital (UNMH) Kidney Transplant Center. ParticipantsFive patients (four transplant candidates and one patient advocate), three transplant coordinators, and five transplant providers (3 attending physicians and 2 advanced practice practitioners). MethodsSemi-structured sessions (45 to 60 minutes) with 13 stakeholders (patients, coordinators, and providers) included a live app demonstration and explored usability, interpretability, contextual information needs, perceived clinical utility, and anticipated barriers/facilitators. Data were collected via one coordinator focus group, one patient focus group, and five provider interviews; sessions were recorded, transcribed, de-identified, and analyzed using inductive reflexive thematic analysis. ResultsStakeholders affirmed the value of personalized projections as an adjunct to clinical judgment, particularly for higher risk offers. Participants prioritized: 1) Content: clear education on hepatitis C virus (HCV) positive donors and Public Health Service (PHS) risk criteria; plain explanations of Calculated Panel Reactive Antibody (CPRA); and framing that makes time on dialysis and tradeoffs salient; 2) Format & Features: plain language narratives, percentages rather than decimals, simple visuals, minimized acronyms, U.S. customary units, and a stepwise (TurboTax-like) input flow preferred by patients; and 3) Functionality: attention to cognitive load and workflow alignment, given phone based time pressure and digital access constraints. Stakeholders emphasized that the value of the tool hinges on clarity, context, and workflow fit, not predictive accuracy alone. LimitationsSingle center, formative prototype study with a modest sample; findings are illustrative and may have limited transferability. Participants reacted to a demonstration rather than using the app during real time offer calls; convenience/email recruitment and Zoom only English sessions may introduce selection bias; team involvement in app development may contribute residual confirmation bias despite mitigation. ConclusionsEarly stakeholder input suggests that a kidney offer decision support tool should integrate individualized predictions with plain language explanations, contextual information that addresses common misconceptions, workflow aligned functionality, and accessible outputs. Tools designed and implemented with these features may support acceptance of medically complex kidneys and may help reduce offer bypass and organ discard. These inferences reflect stakeholder perceptions in a formative qualitative study and warrant prospective evaluation.