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Despite the often uphill human rights battle that lies before individuals with mental illness, pioneering individuals and groups have been inspired to act, organizing grassroots movements of affected individuals in a wide variety of contexts. The mental health movement in Ghana has grown dramatically from its inception at the grassroots level. The Mental Health Society of Ghana (MEHSOG) is made up of representatives from the district associations and some community groups. The main aim of Pan African Network of People with Psychosocial Disabilities (PANUSP) was to work with groups across Africa to establish more organized branches in different countries. Grassroots movements are most powerful when led by the vulnerable groups directly affected by the injustices these movements seek to change. Grassroots movements in mental health are fueled by the tireless efforts of passionate individuals who often have overcome great personal injustices to advocate for change for themselves and others.
To examine the effect of restricting ciprofloxacin on the resistance of nosocomial gram-negative bacilli, including Pseudomonas aeruginosa, to antipseudomonal carbapenems.
Interrupted time-series analysis.
Tertiary care teaching hospital with 11 intensive care and intermediate care units with a total of 295 beds.
All nosocomial isolates of P. aeruginosa.
Restriction of ciprofloxacin.
There was a significant decreasing trend observed in the percentage (P = .0351) and the rate (P = .0006) of isolates of P. aeruginosa that were resistant to antipseudomonal carbapenems following the restriction of ciprofloxacin. There was also a significant decreasing trend observed in the percentage (P = .0017) and the rate (P = .0001) of isolates of ciprofloxacin-resistant P. aeruginosa. The rate of cefepime-resistant P. aeruginosa isolates declined (P = .004 ) but the percentage of cefepime-resistant P. aeruginosa isolates did not change. There were no significant changes observed in the rate or the percentage of piperacillin-tazobactam-resistant P. aeruginosa isolates. There were no significant changes observed in the susceptibilities of nosocomial Enterobacteriaciae or Acinetobacter baumannii isolates that were resistant to carbapenems. Over the study period there was a significant increase in the use of carbapenems (P = .0134); the use of ciprofloxacin decreased significantly (P = .0027). There were no significant changes in the use of piperacillin-tazobactam or cefepime.
Restriction of ciprofloxacin was associated with a decreased resistance of P. aeruginosa isolates to antipseudomonal carbapenems and ciprofloxacin in our hospital's intermediate care and intensive care units. There were no changes observed in the susceptibilities of nosocomial Enterobacteriaciae or A. baumannii to carbapenems, despite increased carbapenem use. Reducing ciprofloxacin use may be a means of controlling multidrug-resistant P. aeruginosa.
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