Ajith Nagahawatte - Academia.edu (original) (raw)

Papers by Ajith Nagahawatte

BMC Health Services Research

Background The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and... more Background The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we conducted a cost analysis to assess the direct and indirect costs associated with hospitalized patients with dengue to households and to the public healthcare system. Methods From June 2017–December 2018, we prospectively enrolled children and adults with acute dengue hospitalized at the largest, public tertiary-care (1800 bed) hospital in the Southern Province, Sri Lanka. We administered a structured questionnaire to obtain information regarding direct costs spent by households on medical visits, medications, laboratory testing, and travel for seeking care for the illness. Indirect costs lost by households were estimated by identifying the days of work lost by patients and caregivers and school days lost by children. Direct hospital costs were estimated using gross costing approach ...

Dengue virus (DENV), a globally emerging cause of undifferentiated fever, has been documented in ... more Dengue virus (DENV), a globally emerging cause of undifferentiated fever, has been documented in the heavily urbanized western coast of Sri Lanka since the 1960s. New areas of Sri Lanka are now being affected, and the reported number and severity of cases have increased. To study emerging DENV in southern Sri Lanka, we obtained epidemiologic and clinical data and acute- and convalescent-phase serum samples from patients>2 years old with febrile illness. We tested paired serum samples for DENV IgG and IgM and serotyped virus by using isolation and reverse transcription PCR. We identifi ed acute DENV infection (serotypes 2, 3, and 4) in 54 (6.3%) of 859 patients. Only 14 % of patients had clinically suspected dengue; however, 54 % had serologically confi rmed acute or past DENV infection. DENV is a major and largely unrecognized cause of fever in southern Sri Lanka, especially in young adults. Dengue virus (DENV), with 4 antigenically distinct serotypes (DEN1–4), is the most common...

Methicillin Resistant Staphylococcus aureus (MRSA) is resistant to all β lactam antibiotics and i... more Methicillin Resistant Staphylococcus aureus (MRSA) is resistant to all β lactam antibiotics and it can cause small abscess to life threatening sepsis or endocarditis. The risks of death in MRSA patients were three times greater than other nosocomial infections. Student nurses are tomorrow’s staff nurses and without proper knowledge about MRSA, they may be vulnerable to MRSA infection and dissemination. The objective of this paper is to evaluate knowledge, attitudes and practices related to MRSA among BSc nursing students. A descriptive cross-sectional study was conducted among 134 BSc nursing students. Overall knowledge related to MRSA of the most students (65.7%) were not satisfactory, (the mean was 9.5 ±5:277 out of 20). The majority of students had a satisfactory level of knowledge (P=0. 000) with increased exposure to clinical training. Most of the students (90.3%) have good caring attitude towards MRSA positive patients (mean, 24.68 ± 2.90; n=30). Further, significantly good at...

Ceylon Journal of Medical Science, 2001

Ceylon Medical Journal, 2018

This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

B57. CLINICAL STUDIES IN LUNG INFECTIONS: RISK FACTORS AND BIOMARKERS, 2019

BACKGROUND: The origin and prevalence of near-death experiences are unknown. A recent study sugge... more BACKGROUND: The origin and prevalence of near-death experiences are unknown. A recent study suggested a link with REM sleep intrusion but was criticized for its selection of control participants. We therefore assessed the association of REM intrusion and near-death experiences with different methods. METHODS: Using a crowd-sourcing platform, we recruited 1034 lay people from 35 countries to investigate the prevalence of near-death experiences and self-reported REM sleep intrusion. Reports were validated using the Greyson Near-Death Experiences Scale (GNDES) with ≥7 points as cutoff for near-death experiences. RESULTS: Near-death experiences were reported by 106 of 1034 participants (10%; CI 95% 8.5-12%). Evidence of REM intrusion was more common in people with near-death experiences (n= 50/106; 47%) than in people with experiences with 6 points or less on the GNDES (n= 47/183; 26%) or in those without such experiences (n= 107/744; 14%; p=<0.0001). Following multivariate regression analysis to adjust for age, gender, place of residence, employment and perceived danger, this association remained highly significant; people with REM intrusion were more likely to exhibit near-death experiences than those without (OR 2.85; CI 95% 1.68-4.88; p=0.0001). DISCUSSION: Using a crowd-sourcing approach, we found a prevalence of near-death experiences of 10%. While age, gender, place of residence, employment status and perceived threat do not seem to influence the prevalence of near-death experiences, we confirmed a possible association with REM sleep intrusion.

Ceylon Medical Journal, 2018

Background The ability to predict candidaemia gives a significant advantage to the clinician by e... more Background The ability to predict candidaemia gives a significant advantage to the clinician by enabling preemptive treatment to reduce mortality. Objectives To identify the prevalence, risk factors, and to validate candida colonization index (CI), candida score (CS) to reliably predict the development of candidaemia in the identified study sample. Methods Cross sectional analytical study of consecutive admissions fulfilling inclusion criteria to intensive care units (ICUs) of Teaching Hospital Karapitiya from 1 st December 2015 to 30 th March 2016. Candida colonization of non-blood body sites was measured by culture on admission and repeated every 3 rd day until discharge from ICU, death or development of candidaemia. CI, corrected CI (CCI), and CS were calculated for the study patients. Results Candida colonization was found in 100 (65.7%) patients out of 152 patients screened. The presence of sepsis, gastro-intestinal infection or surgery, central venous line colonization, higher density of rectal, oral and urine colonization was significantly different among the infected and non-infected groups. Change of species of colonizing candida was also a significant new risk factor found in the study. All the indices and scores had excellent sensitivity and negative predictive values. However none of the scores had good specificity except for CCI, which was 94%. Conclusions A combination of CI, CCI and CS formulated for the study sample could reliably predict candidaemia. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Indian Journal of Endocrinology and Metabolism, 2014

Study design A descriptive cross sectional study conducted over a period of one year. Selection a... more Study design A descriptive cross sectional study conducted over a period of one year. Selection and distribution of participants Three hundred and eighty fi ve type 2 diabetic patients,

Open Forum Infectious Diseases, 2014

The American Journal of Tropical Medicine and Hygiene

Antibiotic resistance is an emerging global public health threat. One of the main drivers of this... more Antibiotic resistance is an emerging global public health threat. One of the main drivers of this threat is the inappropriate use of antibiotics. In Sri Lanka, antibiotic consumption is increasing, but little is known locally about how patients perceive antibiotics. We conducted a qualitative study to gain a better understanding of the knowledge, perceptions, and attitudes of patients regarding antibiotics and antibiotic resistance. Semi-structured interviews involving 18 patients with lower respiratory tract infection (LRTI) admitted to a large, public tertiary care hospital in southern Sri Lanka were conducted. Interviews were analyzed to identify themes regarding the patients’ knowledge of LRTI etiology and treatment, perceptions and attitudes toward LRTI treatment, including antibiotics, and patient–physician communication. Most patients mentioned multiple care visits and the use of multiple pharmaceuticals prior to admission. Patients sought a quick resolution to their ailments...

Antimicrobial Resistance & Infection Control

Background Antimicrobial resistance has been named as one of the top ten threats to public health... more Background Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine perceived barriers to the development and implementation of ASPs in tertiary care centers in three low- and middle-income countries (LMICs). Methods Interviews were conducted with 45 physicians at tertiary care hospitals in Sri Lanka (n = 22), Kenya (12), and Tanzania (11). Interviews assessed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics that inform antimicrobial use, receptiveness to ASPs, and perceived barriers to implementing ASPs. Two independent reviewers coded the interviews using principles of applied thematic analysis, and comparisons of themes were made across the three sites. Results Barriers to improving antimicrobial prescribing included prohibitively e...

BMC Infectious Diseases

Background Inappropriate antibiotic use is linked to the spread of antimicrobial resistance world... more Background Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. The purpose of this study was to evaluate the prevalence and patterns of antibiotic prescription in an ambulatory care setting in Sri Lanka. Methods This cross-sectional survey was conducted at the Outpatient Department of a public tertiary medical center in Southern Province, Sri Lanka from February to April 2019. Among consecutive outpatients presenting for care, questionnaires were verbally administered to a systematic random sample to capture information about patient demographics, illness characteristics, and visit outcomes. Prescription data were obtained from the outpatient pharmacy’s electronic prescribing system. Results Of 409 surveyed patients, 146 (35.7%) were prescribed an antibiotic. The most frequently prescribed agents were amoxicillin (41 patients, 28.1% of antibiotic...

Open Forum Infectious Diseases

Background Antimicrobial stewardship programs (ASPs) are being developed internationally to mitig... more Background Antimicrobial stewardship programs (ASPs) are being developed internationally to mitigate the misuse of antimicrobials. An understanding of current practices and prescribing patterns is necessary to determine targets to develop context-specific ASPs in low- and middle-income country (LMIC) hospitals. Methods We conducted a prospective study of patients admitted to the adult medical wards at three LMIC tertiary care centers in 2018- 2019: a 1,800-bed public hospital in Galle, Sri Lanka; a 991-bed public hospital in Eldoret, Kenya; and a 630-bed private hospital in Moshi, Tanzania. Information regarding antimicrobial therapy received during hospitalization, indications for antimicrobial therapy, and duration of antimicrobial use were extracted from the medical record. Results In total, 3150 patients were enrolled: 1297 in Sri Lanka, 750 in Kenya, and 1103 in Tanzania. Antimicrobial use prevalence varied between the three sites, with 56.0% of patients receiving antimicrobial...

Open Forum Infectious Diseases

Background Antimicrobial resistance has been named as one of the top ten threats to health in the... more Background Antimicrobial resistance has been named as one of the top ten threats to health in the world. The World Health Organization has endorsed the implementation of hosptial-based antimicrobial stewardship programs (ASPs) to reduce antimicrobial resistance. We conducted a qualitative study to determine perceived barriers to the development and implementation of ASPs in low- and middle-income countries (LMICs). Methods We conducted 46 interviews with medical doctors at tertiary care hospitals in Sri Lanka (22 doctors), Kenya (12), and Tanzania (12). Interviews assessed knowledge and receptiveness to ASPs and barriers to implementing ASP protocols. Interviews were conducted in English, audio recorded, and transcribed. The interviews discussed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics, receptiveness to ASPs, and perceived barriers to implementing ASPs. Data analysis followed procedures of applied thematic ana...

Open Forum Infectious Diseases

Background Pathogen-based diagnostics for acute respiratory infection (ARI) have limited ability ... more Background Pathogen-based diagnostics for acute respiratory infection (ARI) have limited ability to detect etiology of illness. We previously showed that peripheral blood-based host gene expression classifiers accurately identify bacterial and viral ARI in cohorts of European and African descent. We determined classifier performance in a South Asian cohort. Methods Patients ≥15 years with fever and respiratory symptoms were enrolled in Sri Lanka. Comprehensive pathogen-based testing was performed. Peripheral blood ribonucleic acid was sequenced and previously developed signatures were applied: a pan-viral classifier (viral vs nonviral) and an ARI classifier (bacterial vs viral vs noninfectious). Results Ribonucleic acid sequencing was performed in 79 subjects: 58 viral infections (36 influenza, 22 dengue) and 21 bacterial infections (10 leptospirosis, 11 scrub typhus). The pan-viral classifier had an overall classification accuracy of 95%. The ARI classifier had an overall classific...

BMJ Open

ObjectivesTo determine aetiology of illness among children and adults presenting during outbreak ... more ObjectivesTo determine aetiology of illness among children and adults presenting during outbreak of severe respiratory illness in Southern Province, Sri Lanka, in 2018.DesignProspective, cross-sectional study.Setting1600-bed, public, tertiary care hospital in Southern Province, Sri Lanka.Participants410 consecutive patients, including 371 children and 39 adults, who were admitted with suspected viral pneumonia (passive surveillance) or who met case definition for acute respiratory illness (active surveillance) in May to June 2018.ResultsWe found that cocirculation of influenza A (22.6% of cases), respiratory syncytial virus (27.8%) and adenovirus (AdV) (30.7%; type B3) was responsible for the outbreak. Mortality was noted in 4.5% of paediatric cases identified during active surveillance. Virus type and viral coinfection were not significantly associated with mortality.ConclusionsThis is the first report of intense cocirculation of multiple respiratory viruses as a cause of an outbre...

Molecules

Traditional folk medicine in Sri Lanka is mostly based on plants and plant-derived products, howe... more Traditional folk medicine in Sri Lanka is mostly based on plants and plant-derived products, however, many of these medicinal plant species are scientifically unexplored. Here, we evaluated the anti-inflammatory and antimicrobial potency of 28 different extracts prepared from seven popular medicinal plant species employed in Sri Lanka. The extracts were subjected to cell-based and cell-free assays of 5-lipoxygenase (5-LO), microsomal prostaglandin E2 synthase (mPGES)-1, and nitric oxide (NO) scavenging activity. Moreover, antibacterial and disinfectant activities were assessed. Characterization of secondary metabolites was achieved by gas chromatography coupled to mass spectrometric (GC-MS) analysis. n-Hexane- and dichloromethane-based extracts of Garcinia cambogia efficiently suppressed 5-LO activity in human neutrophils (IC50 = 0.92 and 1.39 µg/mL), and potently inhibited isolated human 5-LO (IC50 = 0.15 and 0.16 µg/mL) and mPGES-1 (IC50 = 0.29 and 0.49 µg/mL). Lipophilic extracts...

Open Forum Infectious Diseases

Background Skin and soft-tissue infections (SSTI) are a common reason for antimicrobial use in th... more Background Skin and soft-tissue infections (SSTI) are a common reason for antimicrobial use in the outpatient and inpatient settings. Inappropriate antimicrobial use for SSTI is common. We determined the prevalence of SSTI and associated inappropriate antimicrobial use among inpatients in Sri Lanka. Methods A point-prevalence study of antimicrobial use was conducted using one-day cross-sectional surveys at five public hospitals in Southern Province, Sri Lanka from Jun-August 2017. Inpatients’ medical records were reviewed for clinical data including antimicrobials prescribed. Inappropriate antimicrobial use was identified as (1) antimicrobial use discordant with guidelines by the Sri Lanka College of Microbiologists (SLCM), and (2) redundant combinations of antimicrobials. Results Of 1,709 surveyed patients, 935 (54.7%) received antimicrobials, of whom 779 (83.3%) had a specified or inferred indication for antimicrobial use. Among patients with an indication for antimicrobial use, S...

BMC Health Services Research

Background The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and... more Background The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we conducted a cost analysis to assess the direct and indirect costs associated with hospitalized patients with dengue to households and to the public healthcare system. Methods From June 2017–December 2018, we prospectively enrolled children and adults with acute dengue hospitalized at the largest, public tertiary-care (1800 bed) hospital in the Southern Province, Sri Lanka. We administered a structured questionnaire to obtain information regarding direct costs spent by households on medical visits, medications, laboratory testing, and travel for seeking care for the illness. Indirect costs lost by households were estimated by identifying the days of work lost by patients and caregivers and school days lost by children. Direct hospital costs were estimated using gross costing approach ...

Dengue virus (DENV), a globally emerging cause of undifferentiated fever, has been documented in ... more Dengue virus (DENV), a globally emerging cause of undifferentiated fever, has been documented in the heavily urbanized western coast of Sri Lanka since the 1960s. New areas of Sri Lanka are now being affected, and the reported number and severity of cases have increased. To study emerging DENV in southern Sri Lanka, we obtained epidemiologic and clinical data and acute- and convalescent-phase serum samples from patients>2 years old with febrile illness. We tested paired serum samples for DENV IgG and IgM and serotyped virus by using isolation and reverse transcription PCR. We identifi ed acute DENV infection (serotypes 2, 3, and 4) in 54 (6.3%) of 859 patients. Only 14 % of patients had clinically suspected dengue; however, 54 % had serologically confi rmed acute or past DENV infection. DENV is a major and largely unrecognized cause of fever in southern Sri Lanka, especially in young adults. Dengue virus (DENV), with 4 antigenically distinct serotypes (DEN1–4), is the most common...

Methicillin Resistant Staphylococcus aureus (MRSA) is resistant to all β lactam antibiotics and i... more Methicillin Resistant Staphylococcus aureus (MRSA) is resistant to all β lactam antibiotics and it can cause small abscess to life threatening sepsis or endocarditis. The risks of death in MRSA patients were three times greater than other nosocomial infections. Student nurses are tomorrow’s staff nurses and without proper knowledge about MRSA, they may be vulnerable to MRSA infection and dissemination. The objective of this paper is to evaluate knowledge, attitudes and practices related to MRSA among BSc nursing students. A descriptive cross-sectional study was conducted among 134 BSc nursing students. Overall knowledge related to MRSA of the most students (65.7%) were not satisfactory, (the mean was 9.5 ±5:277 out of 20). The majority of students had a satisfactory level of knowledge (P=0. 000) with increased exposure to clinical training. Most of the students (90.3%) have good caring attitude towards MRSA positive patients (mean, 24.68 ± 2.90; n=30). Further, significantly good at...

Ceylon Journal of Medical Science, 2001

Ceylon Medical Journal, 2018

This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

B57. CLINICAL STUDIES IN LUNG INFECTIONS: RISK FACTORS AND BIOMARKERS, 2019

BACKGROUND: The origin and prevalence of near-death experiences are unknown. A recent study sugge... more BACKGROUND: The origin and prevalence of near-death experiences are unknown. A recent study suggested a link with REM sleep intrusion but was criticized for its selection of control participants. We therefore assessed the association of REM intrusion and near-death experiences with different methods. METHODS: Using a crowd-sourcing platform, we recruited 1034 lay people from 35 countries to investigate the prevalence of near-death experiences and self-reported REM sleep intrusion. Reports were validated using the Greyson Near-Death Experiences Scale (GNDES) with ≥7 points as cutoff for near-death experiences. RESULTS: Near-death experiences were reported by 106 of 1034 participants (10%; CI 95% 8.5-12%). Evidence of REM intrusion was more common in people with near-death experiences (n= 50/106; 47%) than in people with experiences with 6 points or less on the GNDES (n= 47/183; 26%) or in those without such experiences (n= 107/744; 14%; p=<0.0001). Following multivariate regression analysis to adjust for age, gender, place of residence, employment and perceived danger, this association remained highly significant; people with REM intrusion were more likely to exhibit near-death experiences than those without (OR 2.85; CI 95% 1.68-4.88; p=0.0001). DISCUSSION: Using a crowd-sourcing approach, we found a prevalence of near-death experiences of 10%. While age, gender, place of residence, employment status and perceived threat do not seem to influence the prevalence of near-death experiences, we confirmed a possible association with REM sleep intrusion.

Ceylon Medical Journal, 2018

Background The ability to predict candidaemia gives a significant advantage to the clinician by e... more Background The ability to predict candidaemia gives a significant advantage to the clinician by enabling preemptive treatment to reduce mortality. Objectives To identify the prevalence, risk factors, and to validate candida colonization index (CI), candida score (CS) to reliably predict the development of candidaemia in the identified study sample. Methods Cross sectional analytical study of consecutive admissions fulfilling inclusion criteria to intensive care units (ICUs) of Teaching Hospital Karapitiya from 1 st December 2015 to 30 th March 2016. Candida colonization of non-blood body sites was measured by culture on admission and repeated every 3 rd day until discharge from ICU, death or development of candidaemia. CI, corrected CI (CCI), and CS were calculated for the study patients. Results Candida colonization was found in 100 (65.7%) patients out of 152 patients screened. The presence of sepsis, gastro-intestinal infection or surgery, central venous line colonization, higher density of rectal, oral and urine colonization was significantly different among the infected and non-infected groups. Change of species of colonizing candida was also a significant new risk factor found in the study. All the indices and scores had excellent sensitivity and negative predictive values. However none of the scores had good specificity except for CCI, which was 94%. Conclusions A combination of CI, CCI and CS formulated for the study sample could reliably predict candidaemia. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Indian Journal of Endocrinology and Metabolism, 2014

Study design A descriptive cross sectional study conducted over a period of one year. Selection a... more Study design A descriptive cross sectional study conducted over a period of one year. Selection and distribution of participants Three hundred and eighty fi ve type 2 diabetic patients,

Open Forum Infectious Diseases, 2014

The American Journal of Tropical Medicine and Hygiene

Antibiotic resistance is an emerging global public health threat. One of the main drivers of this... more Antibiotic resistance is an emerging global public health threat. One of the main drivers of this threat is the inappropriate use of antibiotics. In Sri Lanka, antibiotic consumption is increasing, but little is known locally about how patients perceive antibiotics. We conducted a qualitative study to gain a better understanding of the knowledge, perceptions, and attitudes of patients regarding antibiotics and antibiotic resistance. Semi-structured interviews involving 18 patients with lower respiratory tract infection (LRTI) admitted to a large, public tertiary care hospital in southern Sri Lanka were conducted. Interviews were analyzed to identify themes regarding the patients’ knowledge of LRTI etiology and treatment, perceptions and attitudes toward LRTI treatment, including antibiotics, and patient–physician communication. Most patients mentioned multiple care visits and the use of multiple pharmaceuticals prior to admission. Patients sought a quick resolution to their ailments...

Antimicrobial Resistance & Infection Control

Background Antimicrobial resistance has been named as one of the top ten threats to public health... more Background Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine perceived barriers to the development and implementation of ASPs in tertiary care centers in three low- and middle-income countries (LMICs). Methods Interviews were conducted with 45 physicians at tertiary care hospitals in Sri Lanka (n = 22), Kenya (12), and Tanzania (11). Interviews assessed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics that inform antimicrobial use, receptiveness to ASPs, and perceived barriers to implementing ASPs. Two independent reviewers coded the interviews using principles of applied thematic analysis, and comparisons of themes were made across the three sites. Results Barriers to improving antimicrobial prescribing included prohibitively e...

BMC Infectious Diseases

Background Inappropriate antibiotic use is linked to the spread of antimicrobial resistance world... more Background Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. The purpose of this study was to evaluate the prevalence and patterns of antibiotic prescription in an ambulatory care setting in Sri Lanka. Methods This cross-sectional survey was conducted at the Outpatient Department of a public tertiary medical center in Southern Province, Sri Lanka from February to April 2019. Among consecutive outpatients presenting for care, questionnaires were verbally administered to a systematic random sample to capture information about patient demographics, illness characteristics, and visit outcomes. Prescription data were obtained from the outpatient pharmacy’s electronic prescribing system. Results Of 409 surveyed patients, 146 (35.7%) were prescribed an antibiotic. The most frequently prescribed agents were amoxicillin (41 patients, 28.1% of antibiotic...

Open Forum Infectious Diseases

Background Antimicrobial stewardship programs (ASPs) are being developed internationally to mitig... more Background Antimicrobial stewardship programs (ASPs) are being developed internationally to mitigate the misuse of antimicrobials. An understanding of current practices and prescribing patterns is necessary to determine targets to develop context-specific ASPs in low- and middle-income country (LMIC) hospitals. Methods We conducted a prospective study of patients admitted to the adult medical wards at three LMIC tertiary care centers in 2018- 2019: a 1,800-bed public hospital in Galle, Sri Lanka; a 991-bed public hospital in Eldoret, Kenya; and a 630-bed private hospital in Moshi, Tanzania. Information regarding antimicrobial therapy received during hospitalization, indications for antimicrobial therapy, and duration of antimicrobial use were extracted from the medical record. Results In total, 3150 patients were enrolled: 1297 in Sri Lanka, 750 in Kenya, and 1103 in Tanzania. Antimicrobial use prevalence varied between the three sites, with 56.0% of patients receiving antimicrobial...

Open Forum Infectious Diseases

Background Antimicrobial resistance has been named as one of the top ten threats to health in the... more Background Antimicrobial resistance has been named as one of the top ten threats to health in the world. The World Health Organization has endorsed the implementation of hosptial-based antimicrobial stewardship programs (ASPs) to reduce antimicrobial resistance. We conducted a qualitative study to determine perceived barriers to the development and implementation of ASPs in low- and middle-income countries (LMICs). Methods We conducted 46 interviews with medical doctors at tertiary care hospitals in Sri Lanka (22 doctors), Kenya (12), and Tanzania (12). Interviews assessed knowledge and receptiveness to ASPs and barriers to implementing ASP protocols. Interviews were conducted in English, audio recorded, and transcribed. The interviews discussed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics, receptiveness to ASPs, and perceived barriers to implementing ASPs. Data analysis followed procedures of applied thematic ana...

Open Forum Infectious Diseases

Background Pathogen-based diagnostics for acute respiratory infection (ARI) have limited ability ... more Background Pathogen-based diagnostics for acute respiratory infection (ARI) have limited ability to detect etiology of illness. We previously showed that peripheral blood-based host gene expression classifiers accurately identify bacterial and viral ARI in cohorts of European and African descent. We determined classifier performance in a South Asian cohort. Methods Patients ≥15 years with fever and respiratory symptoms were enrolled in Sri Lanka. Comprehensive pathogen-based testing was performed. Peripheral blood ribonucleic acid was sequenced and previously developed signatures were applied: a pan-viral classifier (viral vs nonviral) and an ARI classifier (bacterial vs viral vs noninfectious). Results Ribonucleic acid sequencing was performed in 79 subjects: 58 viral infections (36 influenza, 22 dengue) and 21 bacterial infections (10 leptospirosis, 11 scrub typhus). The pan-viral classifier had an overall classification accuracy of 95%. The ARI classifier had an overall classific...

BMJ Open

ObjectivesTo determine aetiology of illness among children and adults presenting during outbreak ... more ObjectivesTo determine aetiology of illness among children and adults presenting during outbreak of severe respiratory illness in Southern Province, Sri Lanka, in 2018.DesignProspective, cross-sectional study.Setting1600-bed, public, tertiary care hospital in Southern Province, Sri Lanka.Participants410 consecutive patients, including 371 children and 39 adults, who were admitted with suspected viral pneumonia (passive surveillance) or who met case definition for acute respiratory illness (active surveillance) in May to June 2018.ResultsWe found that cocirculation of influenza A (22.6% of cases), respiratory syncytial virus (27.8%) and adenovirus (AdV) (30.7%; type B3) was responsible for the outbreak. Mortality was noted in 4.5% of paediatric cases identified during active surveillance. Virus type and viral coinfection were not significantly associated with mortality.ConclusionsThis is the first report of intense cocirculation of multiple respiratory viruses as a cause of an outbre...

Molecules

Traditional folk medicine in Sri Lanka is mostly based on plants and plant-derived products, howe... more Traditional folk medicine in Sri Lanka is mostly based on plants and plant-derived products, however, many of these medicinal plant species are scientifically unexplored. Here, we evaluated the anti-inflammatory and antimicrobial potency of 28 different extracts prepared from seven popular medicinal plant species employed in Sri Lanka. The extracts were subjected to cell-based and cell-free assays of 5-lipoxygenase (5-LO), microsomal prostaglandin E2 synthase (mPGES)-1, and nitric oxide (NO) scavenging activity. Moreover, antibacterial and disinfectant activities were assessed. Characterization of secondary metabolites was achieved by gas chromatography coupled to mass spectrometric (GC-MS) analysis. n-Hexane- and dichloromethane-based extracts of Garcinia cambogia efficiently suppressed 5-LO activity in human neutrophils (IC50 = 0.92 and 1.39 µg/mL), and potently inhibited isolated human 5-LO (IC50 = 0.15 and 0.16 µg/mL) and mPGES-1 (IC50 = 0.29 and 0.49 µg/mL). Lipophilic extracts...

Open Forum Infectious Diseases

Background Skin and soft-tissue infections (SSTI) are a common reason for antimicrobial use in th... more Background Skin and soft-tissue infections (SSTI) are a common reason for antimicrobial use in the outpatient and inpatient settings. Inappropriate antimicrobial use for SSTI is common. We determined the prevalence of SSTI and associated inappropriate antimicrobial use among inpatients in Sri Lanka. Methods A point-prevalence study of antimicrobial use was conducted using one-day cross-sectional surveys at five public hospitals in Southern Province, Sri Lanka from Jun-August 2017. Inpatients’ medical records were reviewed for clinical data including antimicrobials prescribed. Inappropriate antimicrobial use was identified as (1) antimicrobial use discordant with guidelines by the Sri Lanka College of Microbiologists (SLCM), and (2) redundant combinations of antimicrobials. Results Of 1,709 surveyed patients, 935 (54.7%) received antimicrobials, of whom 779 (83.3%) had a specified or inferred indication for antimicrobial use. Among patients with an indication for antimicrobial use, S...