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Malan L, Labuschagne Q, Brechtelsbauer E, Goff DA, Schellack N. Sustainable Access to Antimicrobials; A Missing Component to Antimicrobial Stewardship-A Tale of Two Countries. Front Public Health 2018; 6:324. [PMID: 30488031 PMCID: PMC6246712 DOI: 10.3389/fpubh.2018.00324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/25/2018] [Indexed: 12/31/2022] Open
Abstract
Antimicrobial stewardship encompasses a wide range of processes and interventions designed to ensure that antimicrobials are used in the most effective manner. An important, but often neglected process to include is medicine procurement within hospitals, as the untimely administration of antimicrobials has a direct impact on patient care and antimicrobial resistance. A tender system (an open Request for Proposal, RFP) in South Africa is used in the procurement process to supply medicines and pharmaceutical supplies, whereas in the United States, each hospital is responsible for their own procurement processes. Possible key challenges facing countries to ensure a sustainable medical procurement are poor procurement practices, outdated information systems, and unavailability of human resources to support the current system. This article describes the need for adequate pharmacist–led inventory management systems, for sustainable antimicrobial delivery and the successful implementation of antimicrobial stewardship programs. Strategies to improve inventory control and medication delivery for public sector hospitals in South Africa include the development of national pharmaceutical data management standards. Pharmacist involvement in inventory management principles will ensure that antimicrobials are consistently in adequate supply for patient use, hence promoting safe and effective use while decreasing antimicrobial resistance.
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Affiliation(s)
- Lucille Malan
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Quinten Labuschagne
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | | | - Debra A Goff
- Department of Pharmacy, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Natalie Schellack
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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Mitgang EA, Hartley DM, Malchione MD, Koch M, Goodman JL. Review and mapping of carbapenem-resistant Enterobacteriaceae in Africa: Using diverse data to inform surveillance gaps. Int J Antimicrob Agents 2018; 52:372-384. [DOI: 10.1016/j.ijantimicag.2018.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 01/05/2023]
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Newton-Foot M, Snyman Y, Maloba MRB, Whitelaw AC. Plasmid-mediated mcr-1 colistin resistance in Escherichia coli and Klebsiella spp. clinical isolates from the Western Cape region of South Africa. Antimicrob Resist Infect Control 2017; 6:78. [PMID: 28785405 PMCID: PMC5543748 DOI: 10.1186/s13756-017-0234-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/25/2017] [Indexed: 12/02/2022] Open
Abstract
Background Colistin is a last resort antibiotic for the treatment of carbapenem-resistant Gram negative infections. Until recently, mechanisms of colistin resistance were limited to chromosomal mutations which confer a high fitness cost and cannot be transferred between organisms. However, a novel plasmid-mediated colistin resistance mechanism, encoded by the mcr-1 gene, has been identified, and has since been detected worldwide. The mcr-1 colistin resistance mechanism is a major threat due to its lack of fitness cost and ability to be transferred between strains and species. Surveillance of colistin resistance mechanisms is critical to monitor the development and spread of resistance.This study aimed to determine the prevalence of the plasmid-mediated colistin resistance gene, mcr-1, in colistin-resistant E. coli and Klebsiella spp. isolates in the Western Cape of South Africa; and whether colistin resistance is spread through clonal expansion or by acquisition of resistance by diverse strains. Methods Colistin resistant E. coli and Klebsiella spp. isolates were collected from the NHLS microbiology laboratory at Tygerberg Hospital. Species identification and antibiotic susceptibility testing was done using the API® 20 E system and the Vitek® 2 Advanced Expert System™. PCR was used to detect the plasmid-mediated mcr-1 colistin resistance gene and REP-PCR was used for strain typing of the isolates. Results Nineteen colistin resistant isolates, including 12 E. coli, six K. pneumoniae and one K. oxytoca isolate, were detected over 7 months from eight different hospitals in the Western Cape region. The mcr-1 gene was detected in 83% of isolates which were shown to be predominantly unrelated strains. Conclusions The plasmid-mediated mcr-1 colistin resistance gene is responsible for the majority of colistin resistance in clinical isolates of E. coli and Klebsiella spp. from the Western Cape of South Africa. Colistin resistance is not clonally disseminated; the mcr-1 gene has been acquired by several unrelated strains of E. coli and K. pneumoniae. Acquisition of mcr-1 by cephalosporin- and carbapenem-resistant Gram negative bacteria may result in untreatable infections and increased mortality. Measures need to be implemented to control the use of colistin in health care facilities and in agriculture to retain its antimicrobial efficacy.
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Affiliation(s)
- Mae Newton-Foot
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Yolandi Snyman
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Cape Town, South Africa
| | - Motlatji Reratilwe Bonnie Maloba
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Andrew Christopher Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Molecular Characteristics and Antibiotic Resistance Profiles of Klebsiella Isolates in Mthatha, Eastern Cape Province, South Africa. Int J Microbiol 2017; 2017:8486742. [PMID: 28250772 PMCID: PMC5303861 DOI: 10.1155/2017/8486742] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/27/2016] [Indexed: 11/26/2022] Open
Abstract
The increase in the incidence of extended-spectrum β-lactamase- (ESBL-) producing Klebsiella species has become a serious problem worldwide, because of their incrimination in antibiotic resistance. The objective of this study is to investigate the resistance genes responsible for ESBL-producing Klebsiella species and carbapenemase-producing Klebsiella (CRE) isolated in Mthatha and to study their epidemiology. A prospective, descriptive study of 202 nonrepetitive samples from patients was obtained from Nelson Mandela Academic Hospital. The cultured Klebsiella isolates were subjected to antimicrobial susceptibility tests and the polymerase chain reaction of blaCTX-M, blaTEM, blaSHV, blaKPC, and blaNDM genes. Overall K. pneumoniae were the majority with 169 (83.7%) species isolates, followed by K. oxytoca with 29 (14.4%), while K. ozaenae and Raoultella ornithinolytica were 2 (0.9%) each. The prevalence of ESBL production in all Klebsiella species was 117 (57.9%). ESBL-genotypic resistance is driven in Mthatha by blaSHV 121 (77.1%) followed by blaTEM 105 (66.9%) and blaCTX-M at 89 (56.7%). The most common ESBL genotype combination among the Klebsiella was blaTEM + blaSHV + blaCTX-M at 79 (50.3%). There is a steady increase in the rate of ESBL genes in the last five years.
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Pretorius T, Brennan B, Thomas J. Staphylococcus aureus bacteraemia in children: a formidable foe. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2015.1122151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kock M, Bellomo A, Storm N, Ehlers M. Prevalence of carbapenem resistance genes inAcinetobacter baumanniiisolated from clinical specimens obtained from an academic hospital in South Africa. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/10158782.2013.11441516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M.M. Kock
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria; National Health Laboratory Service
| | - A.N. Bellomo
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria
| | - N. Storm
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria
| | - M.M. Ehlers
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria; National Health Laboratory Service
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Boyles TH, Whitelaw A, Bamford C, Moodley M, Bonorchis K, Morris V, Rawoot N, Naicker V, Lusakiewicz I, Black J, Stead D, Lesosky M, Raubenheimer P, Dlamini S, Mendelson M. Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates. PLoS One 2013; 8:e79747. [PMID: 24348995 PMCID: PMC3857167 DOI: 10.1371/journal.pone.0079747] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/27/2013] [Indexed: 11/26/2022] Open
Abstract
Background Antibiotic consumption is a major driver of bacterial resistance. To address the increasing burden of multi-drug resistant bacterial infections, antibiotic stewardship programmes are promoted worldwide to rationalize antibiotic prescribing and conserve remaining antibiotics. Few studies have been reported from developing countries and none from Africa that report on an intervention based approach with outcomes that include morbidity and mortality. Methods An antibiotic prescription chart and weekly antibiotic stewardship ward round was introduced into two medical wards of an academic teaching hospital in South Africa between January-December 2012. Electronic pharmacy records were used to collect the volume and cost of antibiotics used, the patient database was analysed to determine inpatient mortality and 30-day re-admission rates, and laboratory records to determine use of infection-related tests. Outcomes were compared to a control period, January-December 2011. Results During the intervention period, 475.8 defined daily doses were prescribed per 1000 inpatient days compared to 592.0 defined daily doses/1000 inpatient days during the control period. This represents a 19.6% decrease in volume with a cost reduction of 35% of the pharmacy’s antibiotic budget. There was a concomitant increase in laboratory tests driven by requests for procalcitonin. There was no difference in inpatient mortality or 30-day readmission rate during the control and intervention periods. Conclusions Introduction of antibiotic stewardship ward rounds and a dedicated prescription chart in a developing country setting can achieve reduction in antibiotic consumption without harm to patients. Increased laboratory costs should be anticipated when introducing an antibiotic stewardship program.
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Affiliation(s)
- Tom H. Boyles
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrew Whitelaw
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
- Division of Medical Microbiology, University of Stellenbosch, Cape Town, South Africa
| | - Colleen Bamford
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Mischka Moodley
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Kim Bonorchis
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Vida Morris
- Quality Assurance, Groote Schuur Hospital, Cape Town, South Africa
| | | | | | | | - John Black
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - David Stead
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Department of General Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter Raubenheimer
- Division of General Internal Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sipho Dlamini
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- * E-mail:
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