Antimicrobial resistance (AMR) is a global security threat that accounts for about 700 000 deaths annually. Studies have shown that antimicrobial resistance could result in a 2% to 3.5% reduction in global Gross Domestic Product by 2050 and a loss of between 60 and 100 trillion US dollars, worth of economic output resulting in significant and widespread human suffering. Low- and middle-income countries (LMICs) will be worse hit by an unchecked rise of AMR. For example, it is predicted that AMR could kill about 4.1 million people in Africa by 2050 if it is not curbed. Similarly rising rates of AMR will lead to increased treatment costs and an inability to attain universal health coverage, in LMICs with fragile health systems. Sadly, AMR is driven by the inappropriate use of antimicrobials, especially antibiotics. Inappropriate antibiotic use is a pertinent problem in LMICs where regulatory frame works are weak. Inappropriate antibiotic use in LMICs is a multifaceted problem that cuts across clinical and veterinary medicine and agriculture. Therefore, efforts geared at curbing inappropriate antibiotic use in LMICs must identify the factors that drive this problem (i.e. inappropriate antibiotic use) in these countries. A clear knowledge of these factors will guide effective policy and decision making to curb inappropriate antibiotic use and ultimately AMR. The focus of this review is to discuss the factors that drive inappropriate antibiotic use in LMICs.

In contrast to industrialized countries, until recently Group B Streptococcus (GBS) was infrequently reported in the developing world. This study was aimed at investigating the prevalence of GBS maternal colonization and to analyze the serotype distribution among the isolates. Vagino-rectal swabs collected from pregnant women were cultured for GBS using conventional media. Swabs were also taken from the mouths, ears and umbilical stumps of the neonates born to colonized mothers. Multiplex PCR and a conventional PCR to discern the gbs2018-ST-17 gene (specific for sequence type(ST)-17 clone) was performed to characterize the Group B streptococcus isolates. A total of 300 pregnant women and 53 neonates were studied by culture but only 175 mothers by PCR. GBS was identified in four (6.8%) of 59 (19.7%) neonates of colonized mothers. Out of 175 mothers investigated by PCR, 112 (64%) were colonized. Serotype Ia (23.9%) was the most common among vagino-rectal isolates. Serotype II (71.4%) predominates among colonizing strain in newborns. A significant association between frequency of intercourse of > 2 per week and GBS carriage was found (t-test= 2.2; P value < 0.05). GBS carriage is high with low transmission. Strains that have been associated with GBS neonatal disease were reported, though in very low rates. Though none of the babies studied had invasive GBS disease, a more expansive study in the future will be required to establish if invasive GBS neonatal disease is uncommon in Nigeria.

Hepatitis B virus (HBV) has long been recognized as an occupational risk for healthcare workers (HCWs) as a result of regular and routine exposure to blood and other body fluids in the course of their duties. The risk of occupational exposure to such infection has been the concerns of HCWs for years. However, there were scarcities of information on frequency of Hepatitis B virus infection in the study area. This study aimed to determine the seroprevalence of Hepatitis B surface antigenaemia among Health Care Workers in Babcock University Teaching Hospital, Ilisan, Nigeria. A descriptive, cross-sectional study conducted among HCWs from across various occupation categories in the study area between May and June 2015. A structured questionnaire was used to collect demographics and clinical data. Sample analytical process was carried out using the HBsAg commercially available kits (Genedia, Green Cross, Korea). Of the 100 HCWs enrolled in the study, HBsAg was detected in 7%. The positivity of HBsAg, in this study, was more among males and all were from staff younger than 50 years old. The occupational risk of HBV infection among the HCWs in this study was highest among the cleaning staff followed by nurses and doctors. None was documented among the Medical laboratory Scientists/technicians. The occupation risk of HBV infection among the HCWs in this study was high. Regular Infection prevention and control training is required and HBV vaccine should be more readily available for HCWs by coordinated institutional vaccination programs.

Commercial Aspergillus IgG antibody assays have become pivotal in the current diagnosis of chronic pulmonary aspergillosis (CPA). However, diagnostic cutoffs have been found to vary from manufactures’ recommendations in different settings. This study aimed to establish the Aspergillus IgG reference range among Nigerians and determine a diagnostic cutoff for CPA. Sera from 519 prospectively recruited healthy blood donors and 39 previously confirmed cases of CPA were analysed for Aspergillus IgG levels using the Bordier test kit (Bordier Affinity Products SA, Crissier, Switzerland). Accuracy versus cutoff profile and receiver operating characteristics (ROC) curve were analysed for both CPA cases and controls using the R-Studio (2020), (Window desktop, version 4.0.2 software with R packages “nnet” and “ROCR”). Among healthy blood donors, 141 (27.2%) were aged 16–25 years with median (interquartile range, IQR) of 22 (20–24) years; 304 (58.6%) were aged 26–40 years with median (IQR) of 32 (29–36) years; while 74 (14.2%) were aged 41–60 years with median (IQR) of 46 (44–49.75). Median IgG level in respective age groups were 0.069 (0.009–0.181), 0.044 (0.014–0.202) and 0.056 (0.01–0.265) with no significant difference found in the three age categories (p = 0.69). The overall diagnostic cutoff for the diagnosis of CPA was 0.821 with an accuracy of 97.1% and area under the curve (AUC) = 0.986. The optimal diagnostic cutoff for diagnosing CPA in Nigerians using the Bordier kit was 0.821 which is lower than the manufacturer’s recommended cutoff of 1.0. The determination of this cutoff among Nigerians will significantly enhance accurate identification of CPA and assessment of its true burden in Nigeria.

Background: Urinary tract infections (UTI’s) are among the commonest bacterial infectious disease in clinical practice with a wide range of etiologic agents. It frequently occurs in both the hospital and the community. Aims/Objectives: To determine the etiology of UTI at BUTH and obtain data on their susceptibility and resistance patterns. Methods: This was a prospective analysis of data on patients with UTI obtained from in and outpatients over a six month period. Samples had been obtained by clean catch mid-stream urine or suprapubic aspiration. The organisms had been identified by biochemical methods with susceptibility and resistance testing performed. Data analysis was with EPI-INFO version 3.5.1 Results: There were a total of 200 urine samples that had positive growth. Prevalent organisms were Escherichia coli (48%) and Klebsiella spp (24%), followed by Staphylococcus aureus (10%) and Coagulase Negative Staphylococci (6.5%). The risk factors for UTI were female gender (p = 0.00), Diabetes mellitus (p = 0.03) and genitourinary surgery (p = 0.04). Effective antibiotics in-vitro to Escherichia coli were Nitrofurantoin and Cefepime at 84.8% and 92.3% respectively; while Cotrimoxazole performed poorly (32.5% susceptibility). Conclusion: Urinary tract infections are an important cause of morbidity in our environment and inaccuracies in diagnosis will prolong morbidity and may lead to costly and unsafe treatments.The prevalent pathogens in our environment are the Gram negative bacilli, Escherichia coli and Klebsiella pneumoneae. Nitrofurantoin retains efficacy to both urinary pathogens. Keywords: Urinary Tract Infection, Catheterization, Escherichia coli, Risk factors, Nitrofurantoin

Enterobacter spp. are an important cause of healthcare-associated bloodstream infections that are uncommonly reported in Africa. This study utilized whole-genome sequencing to characterize Enterobacter spp. from hospitals in Nigeria’s antimicrobial resistance surveillance system. Bloodstream Enterobacter spp. isolates from six sentinel tertiary-care hospitals recovered between 2014 and 2020 were re-identified and antimicrobial susceptibility-tested using VITEK 2 system. Illumina technology provided whole-genome sequences for genome nomenclature, antimicrobial resistance gene prediction, SNP phylogeny and multi-locus sequence typing via publicly available bioinformatics pipelines. Initial biochemical delineation often misclassifies Enterobacter, necessitating whole-genome sequencing for accurate classification. Among 98 Enterobacter received, Enterobacter hormaechei subspecies xiangfangensis predominated (43), followed by other E. hormaechei subspecies (18) and Enterobacter spp. such as Enterobacter cloacae (26), Enterobacter roggenkampii (4), Enterobacter bugandensis (3), Enterobacter kobei (2), Enterobacter asburiae (1) and Enterobacter cancerogenus (1). Resistance to extended-spectrum cephalosporins, aminoglycosides, phenicols, macrolides and carbapenems in E. hormaechei was attributed to known resistance genes. E. hormaechei isolates belonged to clusters III, IV and VIII based on hsp60 typing and clades A, B, C and D according to Sutton and Co’s nomenclature. This and other recent reports from Nigeria reveal the extensive diversity of E. hormaechei, as well as clusters representing potential outbreaks. E. hormaechei, often misidentified and rarely reported from Nigeria, is the most common Enterobacter spp. isolated from blood culture in this study. Uncovering underappreciated species as important bloodstream pathogens and retrospective detection of likely outbreaks emphasize the value of genomic surveillance in resource-limited settings.