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woensdag 7 maart 2018

The Lancet: [Comment] Cold steel might cure, but it takes a village to prevent surgical infections

[Comment] Cold steel might cure, but it takes a village to prevent surgical infections
Surgical infections are the most common cause of hospital-acquired infections in resource-poor settings;1 a prospective study in sub-Saharan Africa, published in 2018, reported an infection rate of one in ten surgical patients.2 Infections can double the length of hospital stay, and lead to financially devastating costs for patients, facilities, and health systems.3,4 Patients who develop infections also have a much higher risk of death than those who do not.
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[Articles] A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before–after, cohort study
Implementation of our intervention is feasible in African hospitals. Improvement was observed across all perioperative prevention practices. A significant effect on the overall SSI risk was observed, but with some heterogeneity between sites. Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes.
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[Personal View] Clinical bacteriology in low-resource settings: today's solutions
Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure.
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[Comment] Dual antimicrobial therapy for gonorrhoea: what is the role of azithromycin?
Antimicrobial resistance in Neisseria gonorrhoeae compromises the treatment of gonorrhoea globally.1,2 After the reports of the first gonococcal strains with high-level resistance to ceftriaxone, the last remaining option for empirical gonorrhoea monotherapy, dual antimicrobial therapy (mainly ceftriaxone plus azithromycin) was implemented as the first-line treatment for uncomplicated gonorrhoea in many countries.2–7 Azithromycin resistance is described in many countries, which might threaten this dual therapy in the longer term.
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[Articles] Clinical and laboratory predictors of Lassa fever outcome in a dedicated treatment facility in Nigeria: a retrospective, observational cohort study
Our study presents detailed clinical and laboratory data for Nigerian patients with Lassa fever and provides strong evidence for intrinsic renal dysfunction in acute Lassa fever. Early recognition and treatment of acute kidney injury might significantly reduce mortality.
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