Acinetobacter baumannii is an opportunistic pathogen which has been implicated in a variety of nosocomial infections among immunocompromised patients worldwide. Recently, Multi-drug resistant (MDR) isolates of A. baumannii have been isolated from military personnel returning from service in Iraq and Afghanistan. Antibiotic resistance of A. baumannii has limited the number of active antibacterial, making very difficult to treat these types of infections. This work investigated the role of Resistance-Nodulation-cell Division (RND) efflux pumps in the antibiotic resistance mechanism of A. baumannii. Expression of six different RND pumps was analyzed in clinical isolates of A. baumannii. A novel RND family pump, AdeMNO, was found to be present in a majority of isolates. The adeMNO operon was cloned, sequenced, and characterized using the single copy gene expression system in an efflux sensitized surrogate Pseudomonas aeruginosa strain. Antibiotics, trimethoprim, chloramphenicol, and clindamicin were identified as the substrates of this pump. In order to understand the mechanisms of regulation of adeMNO operon, a putative regulator belonging to the lysR-family was identified, cloned, and sequenced from the upstream region of the operon. Promoter regions of the adeMNO operon were also sequenced from various clinical isolates and sequence polymorphisms identified that could be implicated in the regulation of adeMNO expression. / UOIT

published_or_final_version / Microbiology / Doctoral / Doctor of Philosophy

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

Thesis (M.Sc. (Clinical Tropical Medicine))--Mahidol University, 1999.

Thesis (M.Sc. (Clinical Tropical Medicine))--Mahidol University, 1999.

Patients diagnosed with Multidrug-resistant(MDR) and Extreme drug-resistant (XDR) tuberculosis (TB) have to be hospitalised for a period of six to twelve months, according to the MDR/XDR Policy Guidelines on the treatment of drug-resistant TB – until the patient recovers, and is no longer infectious. There are factors associated with both the patients’ and their partners’ (spouses) resistance to long-term hospitalisation. This has resulted in several acts of violence against the hospital property and members of the health-care team. However, there are a small number of partners who assist the health-care team – by ensuring compliance from the patients and providing their continued support to the patient – despite their own risk of being infected with MDR and XDR TB. This qualitative study was aimed at exploring and describing the resilience factors that have been observed amongst a small number of partners of patients with MDR and XDR TB at an in-patient treatment centre in Port Elizabeth. The research design was exploratory, descriptive and contextual in nature; and the researcher interviewed eight spouses or live-in partners of patientsfor this study, until data saturation was achieved. The data were collected through semi-structured interviews; and the data analysis was conducted, according to the eight steps proposed by Tesch model of data analysis (in Creswell, 1998).Guba’smodel of trustworthiness was used to assess the data collected during the interviews. The findings from this study will inform the health-care team on methods of how the support of the patients’ partners could be mobilised in the holistic treatment plan of MDR and XDR TB patients in an in-patient treatment centre.

Magister Curationis - MCur / Multidrug resistant TB (MDR-TB) is a form of TB caused by bacteria (germs) that are resistant to the usual drugs that are used to treat "normal" TB. The duration of treatment for MDR-TB is a maximum of 22 months. People with MDR-TB are treated in specialized tertiary hospitals and in out-patient clinics in the PHC facilities. The treatment includes a six months injectable phase with a wide range of TB drugs. The adverse effects of MDR-TB drugs are among the worst side effects ever reported by patients. The aim of the current study was to explore the experiences of adverse effects of MDR-TB treatment amongst patients in a primary health care facility in the Western Cape. An explorative qualitative study design was used to explore the experiences of patient with the adverse effects of MDR-TB treatment in a primary health care facility in the Western Cape. In depth interviews were conducted with 12 MDR-TB patients. Data analysis was done by using the Tesch's method of content analysis. The study revealed that participating MDR-TB patients experienced various emotional, financial, physical and social challenges. Participants explained that the experience of being on MDR-TB treatment is emotionally draining; the pain and discomfort of the adverse effect of treatment makes a person to feel anxious and depressed. Financially they depended on social grants because they had to stop working after starting treatment. They could not function well physically because of the toxic nature of the adverse effects of treatment; which resulted in fatigue, dizziness and burning sensation on the feet and hands. They were faced with a lot of stigma from the community and even family members because of their illness. The study also revealed that in spite of the challenges and obstacles the participants were all motivated to complete their treatment and get cured. It is recommended that more support structures be made available for patients who are being treated for MDRT-TB such as; psychotherapy, social support and counselling on health education. Provision needs to be made for patients who are receiving daily injection; for it to be given in their homes. Health care providers treating MDR-TB patients need to do home visits together with MDR-TB adherence counsellors, to monitor the physical wellbeing of patients at home. This will also provide patients with the platform to discuss their health concerns in a more accommodative and relaxed environment. New drug regimen with fewer tablets and less treatment duration is needed for MDR-TB.

Submitted in fulfilment of the requirements for the Master of Health Sciences in Nursing, Durban University of Technology, 2017. / Tuberculosis (TB) is South Africa’s greatest community health problem. Nurses have a critical role in supporting patients in the TB treatment process. An estimated 480 000 new cases of Multidrug-Resistant Tuberculosis (MDR-TB) and 190 000 people died in 2014. An estimated 43 million lives were saved between 2000 and 2014 with effective diagnosis and treatment of TB. Despite these measures TB remains one of the world’s biggest threats. In an attempt to improve the practice of nurses in the prevention of MDR-TB, the knowledge of nurses with regards to the prevention of MDR-TB is essential. Aim of the Study The aim of the study was to describe the practice of the nurses in the prevention of MDR-TB and to determine whether the practice was effective in the prevention of MDR-TB. Methodology Quantitative, descriptive survey was used to conduct the study. Purposive sampling method was employed to select six primary health care clinics at uThungulu District. The target population consisted of professional nurses and enrolled nurses working in these clinics. The sample size was 122. The questionnaire was used to collect data. Descriptive statistics was used to describe the data graphically. In order to test for significant trends in the data, inferential statistics were applied. Results The findings of the study revealed that nurses were implementing measures of preventing MDR-TB like tracing of patients who interrupted TB treatment although there were inconsistencies with implementation of other measures. There were gaps related to attendance of TB courses by TB staff. Nurses were working in an overcrowded environment where it was difficult to implement measures for preventing MDR-TB. There was an increase in the workload due to the high number of patients having TB. Conclusion In this study, the majority of nurses working in primary health care clinics scored well in infection control measures with regard to practicing cough hygiene, placing patients in a well-ventilated area, collection of sputum from patients suspected of having TB and giving of health education to patients with TB and relatives but there areas that need improvement. The findings indicate knowledge gap with regard to TB. There is a need for attendance of short courses in TB, increase of staff attending to TB patients so as to cope with the workload and efficient allocation of resources. / M

The purpose of the study was to investigate the problem of defaulting of tuberculosis (TB) treatment in the Khomas region of Namibia. A quantitative, descriptive research approach was used to investigate the reasons for defaulting of TB treatment under the DOTS strategy in Khomas Region of Namibia. Data was collected by using a structured interview schedule with 54 participants who were on DOTS strategy and defaulted. Data were analysed by using the Epi info computer program. The major findings from the data obtained, revealed that the respondents did not have an in-depth knowledge of TB and the health education was not successful. This contributed to the defaulting of their treatment. Based on the study findings nurses should improve health education to TB patients on DOTS and also educate members of the community to address the stigmatisation of TB. Recommendations for further improvement in the compliance of TB treatment were made. / Public Health / M.A. (Public Health)