Phage therapy is one of the alternatives to treat infections caused by both antibiotic-sensitive and antibiotic-resistant bacteria, with no or low toxicity to patients. It was started a century ago, although rapidly growing bacterial antimicrobial resistance, resulting in high levels of morbidity, mortality, and financial cost, has initiated the revival of phage therapy. It involves the use of live lytic, bioengineered, phage-encoded biological products, in combination with chemical antibiotics to treat bacterial infections. Importantly, phages will be removed from the body within seven days of clearing an infection. They target specific bacterial strains and cause minimal disruption to the microbial balance in humans. Phages for medication must be screened for the absence of resistant genes, virulent genes, cytotoxicity, and their interaction with the host tissue and organs. Since they are immunogenic, applying a high phage titer for therapy exposes them and activates the host immune system. To date, no serious side effects have been reported with human phage therapy. In this review, we describe phage–phagocyte interaction, bacterial resistance to phages, how phages conquer bacterial resistance, the role of genetic engineering and other technologies in phage therapy, and the therapeutic application of modified phages and phage-encoded products. We also highlight the comparison of antibiotics and lytic phage therapy, the pros and cons of phage therapy, determinants of human phage therapy trials, phage quality and safety requirements, phage storage and handling, and current challenges in phage therapy.
Background: Although based on a single system, each laboratory should have their own quality management system, in Ethiopia, quality management systems in medical laboratories were introduced in 2009 with the aim of improving the quality of services. Objective: This review was designed to evaluate the status of quality management practice and challenges among medical laboratories in Ethiopia. Methods: A systematic qualitative review of the literature was made by searching the international electronic bibliographic database of PubMed (NML), web of science (TS), google scholar, African journals online (AJOL) and Cochrane Library. Results: Thirty-six full-text articles, which were published between 2010 and 2022, were included in this review. In this review, 33 of 36 (91.7%) studies showed that status of quality management practice in Ethiopian medical laboratories was limited. As a result, the quality of medical laboratories was inadequate. The main challenges were problems associated with laboratory professionals (35/ 36=97.2%), inadequate support from management bodies (21/36=58.3%), limited on-job training access (8 /36=22.2%) and high workload (5/36=13.8%). Conclusion:The status of quality management practice among medical laboratories in Ethiopia is limited. The main quality compromising factors were problems associated with laboratory professionals, inadequate support from management bodies, high workload, and limited on-job training access. Therefore, all responsible stakeholders should focus on ensuring Quality Management Systems and the system should be applied in all Medical laboratories. Only this will ensure the improvement of quality within medical laboratories across Ethiopia.
Objective: Bacterial meningitis (BM) is a public health threat with considerable mortality and morbidity worldwide; particularly in the meningitis belt of Africa where Ethiopia is located. The study aims to assess the prevalence, antibiogram, and associated factors of bacteria isolated from presumptive meningitis patients at Debre Markos Comprehensive Specialized Hospital (DMCSH), Northwest Ethiopia.Methods: We conducted a cross-sectional study between March 1, 2021, and May 30, 2021. Sociodemographic and clinical data were collected using structured questionnaires. Cerebrospinal fluid (CSF) was collected aseptically, and gram stain, culture, and biochemical tests were performed to identify bacterial isolates. An antimicrobial susceptibility test was conducted using the disc diffusion method on Mueller-Hinton agar (MHA). Data were entered into EpiData version 3.1 (Epidata Association, Denmark) and exported to SPSS version 23 software (IBM Corp., Armonk, NY) for analysis. P values ≤ 0.05 at 95% CI were considered statistically significant.Results: CSF samples from 152 study participants were analyzed and half (50%, 76/152) of them were males. Bacteria were isolated from 17 individuals with an overall prevalence rate of 11.2% (95% CI= 5.9-16.4). The predominant bacterial isolates were Staphylococcus aureus (S. aureus) and Klebsiella pneumonia (K. pneumoniae) each accounting for 29.4% (5/17). About 41% (7/17) of the isolated bacteria were found to be multi-drug resistant (MDR) with the predominance of gram-negative bacteria (6/7). Bacteria prevalence was significantly higher in individuals with stiff neck [adjusted odds ratio (AOR), 95% CI, 47.529 (3.2-10.92), P=0.023] and tonsillectomy [AOR, 95% CI, 137.015 (6.25-12.34), P=0.02]. Conclusion: S. aureus and K. pneumoniae were the leading isolates among presumptive meningitis patients. The alarming presence of a high rate of MDR isolates mandates the need to implement the antibiotic stewardship program in the study setting.
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