Search

Background: The use of phage therapy as an alternative method of treating infections caused by multidrug-resistant bacteria has been a controversial issue. The present study sought to determine safety and therapeutic efficacy of environmentally obtained Staphylococcus aureus lytic phage against multidrug-resistant S.aureus (MDRSA) in mice. Methods & Materials: Phages and MDRSA were isolated from sewage and waste water collected from within Nairobi County. The isolated S.aureus bacterium was screened for resistance towards; Ceftazidime, Oxacillin, Vancomycin, Netilmicin, Gentamicin and Erythromycin, Trimethroprim-Sulfamethoxazole and Cefuroxime. Thirty BALB/c mice were randomly assigned into three groups; the MDRSA infection group (n = 20), the phage-infection group (n = 5) and non-infection group (n = 5). After 24 or 72 hours postinfection (p.i.) with MDRSA, the infected mice were either treated with a single dose of clindamycin (8 mg/kg/bwt) or 108 PFU/ml of S.aureus phage or a combination (clindamycin and S.aureus phage). Safety was determined by monitoring animal physical health postinfection as well as gross pathology and histopathology. Bacteremia was determined daily for 10 days and used to establish therapeutic efficacy of the phage. Results: Treatment with phage was efficacious (100%) compared to clindamycin (62.25%) at 24 hrs p.i and 87.5% at 72 hrs p.i.) while combination therapy (75% at 24 hrs p.i. and 100% at 72 hrs p.i.). Efficacy of the treatment regimens was dependent on the time of treatment post infection. The mice infected with MDRSA and treated with phage had no bacteremia at day 7 post-treatment compared to those treated with clindamycin and combination therapy (P < 0.001). There were no tissue abscesses, inflammation in the brain, lungs and liver tissues of phage treated mice compared to those treated with clindamycin and combination therapy. Conclusion: The S.aureus phage obtained from sewage and waste water from within Nairobi County was safe and possessed therapeutic efficacy against MDRSA bacterium. [ABSTRACT FROM AUTHOR]

Background: Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya., Methods: Cadavers aged 15 years and older at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29 to March 3, 2015. Cause of death was abstracted from medical files and death notification forms. Cardiac blood was drawn and tested for HIV infection using the national HIV testing algorithm followed by viral load testing of HIV-positive samples., Results: Of 807 eligible cadavers, 610 (75.6%) had an HIV test result available. Cadavers from KNH had significantly higher HIV positivity at 23.2% (95% CI: 19.3 to 27.7) compared with City Mortuary at 12.6% (95% CI: 8.8 to 17.8), P < 0.001. HIV prevalence was significantly higher among women than men at both City (33.3% vs. 9.2%, P = 0.008) and KNH Mortuary (28.8% vs. 19.0%, P = 0.025). Half (53.3%) of HIV-infected cadavers had no diagnosis before death, and an additional 22.2% were only diagnosed during hospitalization leading to death. Although not statistically significant, 61.9% of males had no previous diagnosis compared with 45.8% of females (P = 0.144). Half (52.3%) of 44 cadavers at KNH with HIV diagnosis before death were on treatment, and 1 in 5 (22.7%) with a previous diagnosis had achieved viral suppression., Conclusions: HIV prevalence was high among deaths in Nairobi, especially among women, and previous diagnosis among cadavers was low. Establishing routine mortuary surveillance can contribute to monitoring HIV-associated deaths among cadavers sent to mortuaries.

Background: Declines in HIV prevalence and increases in antiretroviral treatment coverage have been documented in Kenya, but population-level mortality associated with HIV has not been directly measured. In urban areas where a majority of deaths pass through mortuaries, mortuary-based studies have the potential to contribute to our understanding of excess mortality among HIV-infected persons. We used results from a cross-sectional mortuary-based HIV surveillance study to estimate the association between HIV and mortality for Nairobi, the capital city of Kenya., Methods and Findings: HIV seropositivity in cadavers measured at the two largest mortuaries in Nairobi was used to estimate HIV prevalence in adult deaths. Model-based estimates of the HIV-infected and uninfected population for Nairobi were used to calculate a standardized mortality ratio and population-attributable fraction for mortality among the infected versus uninfected population. Monte Carlo simulation was used to assess sensitivity to epidemiological assumptions. When standardized to the age and sex distribution of expected deaths, the estimated HIV positivity among adult deaths aged 15 years and above in Nairobi was 20.9% (95% CI 17.7-24.6%). The standardized mortality ratio of deaths among HIV-infected versus uninfected adults was 4.35 (95% CI 3.67-5.15), while the risk difference was 0.016 (95% CI 0.013-0.019). The HIV population attributable mortality fraction was 0.161 (95% CI 0.131-0.190). Sensitivity analyses demonstrated robustness of results., Conclusions: Although 73.6% of adult PLHIV receive antiretrovirals in Nairobi, their risk of death is four-fold greater than in the uninfected, while 16.1% of all adult deaths in the city can be attributed to HIV infection. In order to further reduce HIV-associated mortality, high-burden countries may need to reach very high levels of diagnosis, treatment coverage, retention in care, and viral suppression.

Background: Immediate trauma fatality is not amenable to trauma care and primary prevention is the key. The published profiles of deaths due to trauma differ in different regions. Injury mortality rates are higher in developing countries where injury data capture systems are unreliable for prevention purposes., Objective: To describe the pattern of pre-hospital injury (immediate) deaths at the Nairobi city mortuary and compare these with hospital (late) trauma deaths., Methods: Consecutive trauma autopsies performed over one year (November 2009 to December 2010) at the main mortuary of the Nairobi city council were analyzed for demographic (age, sex, occupation) characteristics, circumstances of the trauma and injury patterns. The patterns of injuries were compared to those of victims who survived and later died at the Kenyatta National Hospital over the same period., Results: Two hundred and thirty seven trauma autopsies were analyzed. The average age of the victims was 29.8 years (range 1-67 years). Christians (93.7%) and males (89.5%) predominated. The place of injury was the road in 32.9% and home/neighborhood in 57.5% of cases. The main mechanisms of fatal injury were traffic (35.4%), gunshot wounds (25.7%) and assault (19.8%). Burns and suicides accounted for 5.9% and 6.3% of fatalities. Most fatalities were intentional (59.4%) Of vehicular injuries, pedestrians predominated (65.5%). For assault, blunt and penetrating injuries accounted for 68.7% and 31.11% of fatalities. Law enforcement officers were responsible for majority of gunshot deaths. Fatal injuries were sustained in single, two and multiple regions in 56.2%, 25.7% and 14.2% of cases. The body region most involved was the head/neck (40.5%). Twelve children under 15 years died. Compared to in-hospital deaths, pre-hospital deaths were associated with intentional injuries, night-time occurrence and preponderance of gun involvement., Conclusion: Injury was a significant cause of mortality among adults of working age in this urban African setting. Intentional injuries predominate in causation of immediate but not late deaths. Local prevention programs should incorporate mortuary data to unravel further aspects of trauma and address violence as a key determinant of prehospital mortality., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)