Rajeev Peeyush Nagassar

Background: Antibiotic prophylaxis is a critical intervention in reducing postoperative infections, yet inappropriate prescribing remains a global contributor to antimicrobial resistance (AMR). Trinidad and Tobago lacks localized data on perioperative antibiotic practices, hindering effective antimicrobial stewardship. The aim of this paper was to assess the prescribing patterns, appropriateness, and outcomes of prophylactic antibiotic use across various surgical departments at the Sangre Grande Hospital, a secondary care hospital in eastern Trinidad. Methods: A retrospective observational study was conducted on 235 randomly selected patient records from January 2024 to April 2025. Data included demographics, surgical category, type and route of antibiotics administered, duration of hospital stay, and use of microbiological testing. Antibiotics were classified using the WHO AWaRe framework. Results: Among the 235 patients, n=124 52.8% were female and n=111, 47.2% were male. General surgery accounted for the majority of procedures n=175 (74.5%). Antibiotic prophylaxis was administered in n= 225, 85.1% of cases. The majority n=140, 62.2% were from the WHO “Access” category and n=85, 37.8% from the “Watch” category. Augmentin n=100 (44.4%), Ceftriaxone n=57 (25.3%), and Metronidazole n=39 (17.3%) were the most frequently used antibiotics. Most antibiotics were delivered intravenously 155 (66%). Only four patients (1.7%) had microbiological cultures sent, despite the availability of susceptibility testing. The surgical site infection (SSI) rate was low (0.44%), and n=102, 45.5% of patients were discharged within one day post-surgery. Conclusion: This study reveals widespread empirical antibiotic use with low reliance on culture-based prescribing. Despite a low SSI rate, the underutilization of microbiological testing and the reliance on “Watch” category antibiotics present stewardship concerns. This article bridges antibiotic stewardship with infection prevention and control and emphasizes the utility of combining the two disciplines.

Background: Antimicrobial resistance (AMR) is a critical global health challenge, linked to 4·71 million deaths in 2021 and affecting human health, animals, food, plants, and the environment. This scoping review aims to map out published interventions addressing AMR in the Latin America and Caribbean (LAC) region. Methods: We searched PubMed, Web of Science, LILACS, and grey literature for articles reporting the implementation of AMR programs, interventions, or policies aimed at tackling AMR published between January 2018 and December 2024. Results: A total of 82 studies were included, comprising 64 peer-reviewed articles and 18 from grey literature. The majority ( n = 75) focused on human health, while a smaller subset ( n = 7) addressed animal health. Geographically, most studies were conducted in Brazil ( n = 32) and Colombia ( n = 22) with only one study in the Caribbean. Antimicrobial stewardship interventions were the primary focus in 50 studies. Only 53 out of 74 studies included an evaluation of the intervention. Conclusion: Significant gaps remain in AMR research in LAC, particularly in animal and environmental health. Rigorous intervention evaluations are needed to generate high-quality evidence for policy and practice. Increased funding for intervention and implementation research across all sectors is crucial to tackling AMR regionally and globally.

Postoperative infections with multidrug-resistant (MDR) Acinetobacter baumannii present significant challenges in orthopedic surgery. This case report highlights the management and successful treatment of an MDR Acinetobacter infection following open reduction and internal fixation (ORIF) of a right acetabulum fracture. A 51-year-old male presented with a comminuted right acetabular fracture following a motor vehicle accident. Initial ORIF was complicated by intraoperative blood loss, necessitating early termination of the procedure. The patient subsequently developed a deep surgical site infection caused by MDR A. baumannii, resistant to multiple antibiotic classes. This case underscores the importance of culture-guided antibiotic selection, a role for the use of local antibiotic therapy. It also highlights therapeutic challenges in managing MDR infections in orthopedic surgery and the need for collaboration with the microbiology team.

Antimicrobial resistance (AMR) represents a major threat to health with significant global economic and safety implications. One of the major drives of this resistance is the misuse and overuse of antimicrobials. Background/Objectives: In this sense, WHO proposed to it members to estimate the antimicrobial consumption (AMC) at each country level, in order to help local authorities in their decision making related to AMR control. Although this program is already installed worldwide, in the American continent, the rate of countries’ inclusion has been delayed. This paper describes the efforts of Latin American & Caribbean countries in terms of AMC local assessment. Methods: AMC data collection was done as per the GLASS tool proposed by WHO. Analysis was performed using Daily Defined Dose each one thousand inhabitants day (DID) for global, therapeutical group or each antibiotic. Access, Watch and target Reserve (AWaRe) WHO classification was applied after data collection. Results: 13 countries were included during the period 2019–2022. The global DID ranged from 2.55 DID to 36.26 DID. The trend of this consumption did downward along the years. One of the factors than impacted the AMC was the COVID-19 pandemic. The most problematic antimicrobial misuse was seen in certain beta lactams and macrolides, like ceftriaxone and azithromycin. Regarding the AWaRe classification, 5 out of 13 countries accomplished the target until 2023 of 60% consumption for “Access antimicrobial’s group by 2023). This data helped local health managers to propose changes for better control of the AMR problem (ceftriaxone usage limitations in Peru, antimicrobial law in Argentina, etc.). Conclusions: The first steps towards AMC country’s assessment has been initiated. The present work provided essential inputs to local health authorities for decision making related to AMR control. It will be necessary to keep applying this results in regulate antibiotic usage at country level, as well as enrolling more countries in the AMC project.

Chronic bacterial prostatitis is generally difficult to treat. It may involve multiple courses of antibiotics and may be difficult to eradicate with high rates of recurrence. We present the case of a 33-year-old male patient with a previous history of renal tract calculi, stent insertions, and perinephric abscess with percutaneous drainage, which then led to a right nephrectomy. He eventually developed recurrent urinary tract infections with the prostate as the source. This patient had at least two prior, prolonged courses of intravenous antibiotics, one consisted of two weeks and the other of six weeks of intravenous meropenem at different times. His last episode of prostatitis was managed with intraprostatic injections of lidocaine and a mixture of amikacin and meropenem, given at once-a-week intervals for four weeks along with simultaneous thrice-daily meropenem during this period.

Over the past decade, there has been an increasing number of case reports of bronchopulmonary infection due to Lophomonas spp. The Caribbean has not been included in any reports. We describe two cases of bronchopulmonary infection due to Lophomonas spp. We also describe successful treatment with metronidazole and an alternative, albendazole. We also briefly review the controversy of Lophomonas spp. as a true pathogen and the population groups affected.

The inappropriate consumption, use, and dispensing of antibiotics are problems faced globally, with a pattern of inappropriate consumption differing in higher-income countries due to the ease of accessibility of antibiotics. The main drivers of consumption and inappropriate use are the over-the-counter sales of antibiotics by pharmacies. Trinidad and Tobago (T&T), a twin island state in the Caribbean, has two Acts of Parliament that regulate antibiotics: the Antibiotics Act and the Food and Drug Act, yet the Over-the-Counter (OTC) sale of antibiotics still exists. This study sought to determine the knowledge, attitudes, and practices regarding the OTC dispensing of antibiotics in T&T. A cross-sectional study gathered data from pharmacists in both the private and public sectors of Trinidad over 7 months. The results showed that antibiotic resistance and antibiotic abuse were seen as significant problems. The level of experience, gender (female), and age (younger) were significantly associated with having good overall knowledge of good dispensing habits and antibiotic laws (p = 0.036, p = 0.047, and p = 0.001, respectively). Pharmacists generally agreed that antibiotics under the Food and Drug Act may have contributed to OTC dispensing in the private sector (p = 0.013) and that all antibiotics should be under the Antibiotic Act (p = 0.002). Additionally, it was found that the dispensing of antibiotics OTC in the private sector (p = 0.006) occurred: without doctors’ advice and without requesting prescriptions; because it was perceived as lawful (especially by older pharmacists); and because of the perceived motivation of profit. Regulation enforcement was perceived as deficient. OTC dispensing for reasons, such as misunderstanding of laws, occurs in T&T.

An antimicrobial consumption (AMC) study was performed in Trinidad and Tobago at the Eastern Regional Health Authority (ERHA). A retrospective, cross-sectional survey was conducted from 1 November 2021 to 30 March 2022. Dosage and package types of amoxicillin, azithromycin, co-amoxiclav, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, nitrofurantoin and co-trimoxazole were investigated. Consumption was measured using the World Health Organization’s Antimicrobial Resistance and Consumption Surveillance System methodology version 1.0, as defined daily doses (DDD) per 1000 population per day (DID). They were also analyzed using the ‘Access’, ‘Watch’ and ‘Reserve’ classifications. In the ERHA, AMC ranged from 6.9 DID to 4.6 DID. With regards to intravenous formulations, the ‘Watch’ group displayed increased consumption, from 0.160 DID in 2017 to 0.238 DID in 2019, followed by a subsequent drop in consumption with the onset of the COVID-19 pandemic. Oral co-amoxiclav, oral cefuroxime, oral azithromycin and oral co-trimoxazole were the most highly consumed antibiotics. The hospital started off as the higher consumer of antibiotics, but this changed to the community. The consumption of ‘Watch’ group antibiotics increased from 2017 to 2021, with a drop in consumption of ‘Access’ antibiotics and at the onset of COVID-19. Consumption of oral azithromycin was higher in 2021 than 2020.