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Chibabhai V, Marais GJ, Alex V. Microbe Mail: A microbiology and infectious diseases podcast for clinicians and students. S Afr J Infect Dis 2023; 38:570. [PMID: 38223436 PMCID: PMC10784259 DOI: 10.4102/sajid.v38i1.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
Microbe Mail medical podcast is an audio-only informal educational platform, which addresses widespread topics in medical microbiology and infectious diseases (ID), with a particular focus on low- and middle-income settings. Podcasting has become a common form of informal learning in healthcare education and for continual professional development (CPD). Contribution In this article, we discuss the development of the Microbe Mail podcast, its informal microbiology and ID education impact in the 2 years since commencement and future directions to improve uptake in Africa and low- and middle-income countries.
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Affiliation(s)
- Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - Gert J.K. Marais
- Department of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medical Microbiology Laboratory, Groote Schuur Hospital, National Health Laboratory Service, Cape Town, South Africa
| | - Vinitha Alex
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, Ekurhuleni Region, National Health Laboratory Service, Johannesburg, South Africa
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Chibabhai V, Bekker A, Black M, Demopoulos D, Dramowski A, du Plessis NM, Lorente VPF, Nana T, Rabie H, Reubenson G, Thomas R. Appropriate use of colistin in neonates, infants and children: Interim guidance. S Afr J Infect Dis 2023; 38:555. [PMID: 38223435 PMCID: PMC10784269 DOI: 10.4102/sajid.v38i1.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/24/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Vindana Chibabhai
- Division of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, National Health Laboratory Service, Johannesburg, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marianne Black
- Division of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, Lancet Laboratories, Johannesburg, South Africa
| | - Despina Demopoulos
- Department of Paediatrics, Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nicolette M. du Plessis
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Veshni Pillay-Fuentes Lorente
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Trusha Nana
- Division of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, Lancet Laboratories, Johannesburg, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gary Reubenson
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reenu Thomas
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Christ Hani Baragwanath Academic Hospital, Johannesburg, South Africa
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Reddy K, Ramsamy Y, Swe Swe-Han K, Nana T, Black M, Kolojane M, Chibabhai V. Antimicrobial resistance and antimicrobial stewardship in South Africa: a survey of healthcare workers in academic and nonacademic hospitals. Antimicrob Steward Healthc Epidemiol 2023; 3:e202. [PMID: 38028921 PMCID: PMC10654946 DOI: 10.1017/ash.2023.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023]
Abstract
Objective Antimicrobial stewardship programmes (ASPs) facilitate appropriate antimicrobial use and require contextualization for optimal functioning. We aimed to investigate perceptions of and antimicrobial resistance (AMR) and ASPs among healthcare workers in academic and nonacademic hospitals. Design Cross-sectional survey. Setting Three academic (Charlotte Maxeke Johannesburg Academic, Inkosi Albert Luthuli, Tygerberg) and three nonacademic hospitals (Leratong, Prince Mshiyeni Memorial, and Paarl) in South Africa from January to June 2022. Participants Doctors, nurses, and pharmacists. Methods Voluntary questionnaire using Google Forms, encompassing AMR, ASPs, and selected discipline-specific components. Results Participants comprised 79 doctors (50 academic), 178 nurses (169 academic), and 21 pharmacists (18 academic) and were female predominant. AMR was a problem in academic hospitals (74.7% vs 51.2%, p 0.004); 73.5% overall reported inappropriate antimicrobial use as a major contributor. Adequate education on antimicrobials occurred in only 36.4% overall. Microbiological testing guided therapy more often in nonacademic settings (80.0% vs 50.2%, p <0.001). In both settings, antimicrobial availability drove selection in 48.2%. Overall, ASPs improved patient care (89.8%) and reduced antimicrobial use (86.9%), although felt to override prescriber autonomy in academic settings (29.4% vs 7.5%, p 0.007), mainly among nurses. Only 50.2% reported successful local ASPs. A minority of pharmacists (20.0%) reported sufficient hospital support for ASPs. Education, involvement of infection control staff, and inclusion of nurses in ASPs were most impactful on AMR. Conclusion Selected healthcare worker perspectives differ by category and setting and can be targeted to improve ASPs. Further studies should target a higher number of clinical staff in both settings.
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Affiliation(s)
- Kessendri Reddy
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- National Health Laboratory Service Tygerberg, Cape Town, Western Cape, South Africa
| | - Yogandree Ramsamy
- Department of Medical Microbiology, School of Laboratory Medicine & Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Khine Swe Swe-Han
- Department of Medical Microbiology, School of Laboratory Medicine & Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- National Health Laboratory Service Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal, South Africa
| | - Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Marianne Black
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Molebogeng Kolojane
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
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Cook A, Ferreras-Antolin L, Adhisivam B, Ballot D, Berkley JA, Bernaschi P, Carvalheiro CG, Chaikittisuk N, Chen Y, Chibabhai V, Chitkara S, Chiurchiu S, Chorafa E, Dien TM, Dramowski A, de Matos SF, Feng J, Jarovsky D, Kaur R, Khamjakkaew W, Laoyookhong P, Machanja E, Mussi-Pinhata MM, Namiiro F, Natraj G, Naziat H, Ngoc HTB, Ondongo-Ezhet C, Preedisripipat K, Rahman H, Riddell A, Roilides E, Russell N, Sastry AS, Tasimwa HB, Tongzhen J, Wadula J, Wang Y, Whitelaw A, Wu D, Yadav V, Yang G, Stohr W, Bielicki JA, Ellis S, Warris A, Heath PT, Sharland M. Neonatal invasive candidiasis in low- and middle-income countries: Data from the NeoOBS study. Med Mycol 2023; 61:myad010. [PMID: 36881725 PMCID: PMC10026246 DOI: 10.1093/mmy/myad010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/11/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Neonatal invasive candidiasis (NIC) has significant morbidity and mortality. Reports have shown a different profile of those neonates affected with NIC and of fluconazole-resistant Candida spp. isolates in low- and middle-income countries (LMICs) compared to high-income countries (HICs). We describe the epidemiology, Candida spp. distribution, treatment, and outcomes of neonates with NIC from LMICs enrolled in a global, prospective, longitudinal, observational cohort study (NeoOBS) of hospitalized infants <60 days postnatal age with sepsis (August 2018-February 2021). A total of 127 neonates from 14 hospitals in 8 countries with Candida spp. isolated from blood culture were included. Median gestational age of affected neonates was 30 weeks (IQR: 28-34), and median birth weight was 1270 gr (interquartile range [IQR]: 990-1692). Only a minority had high-risk criteria, such as being born <28 weeks, 19% (24/127), or birth weight <1000 gr, 27% (34/127). The most common Candida species were C. albicans (n = 45, 35%), C. parapsilosis (n = 38, 30%), and Candida auris (n = 18, 14%). The majority of C. albicans isolates were fluconazole susceptible, whereas 59% of C. parapsilosis isolates were fluconazole-resistant. Amphotericin B was the most common antifungal used [74% (78/105)], followed by fluconazole [22% (23/105)]. Death by day 28 post-enrollment was 22% (28/127). To our knowledge, this is the largest multi-country cohort of NIC in LMICs. Most of the neonates would not have been considered at high risk for NIC in HICs. A substantial proportion of isolates was resistant to first choice fluconazole. Understanding the burden of NIC in LMIC is essential to guide future research and treatment guidelines.
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Affiliation(s)
- Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George's University of London, London, UK
| | - Laura Ferreras-Antolin
- Centre for Neonatal and Paediatric Infection, St. George's University of London, London, UK
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Bethou Adhisivam
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Daynia Ballot
- School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - James A Berkley
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Paola Bernaschi
- Microbiology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Cristina G Carvalheiro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Yunsheng Chen
- Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, China
| | - Vindana Chibabhai
- Department of Clinical Microbiology & Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- NHLS Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Shweta Chitkara
- Lady Hardinge Medical College & Associated SSK & KSC Hospitals, New Delhi, India
| | - Sara Chiurchiu
- Academic Hospital Paediatric Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elisavet Chorafa
- Infectious Diseases Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Tran Minh Dien
- Vice Director Vietnam National Children's Hospital, Hanoi, Vietnam
- Department of Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Jinxing Feng
- Department of Neonatology, Shenzhen Children's Hospital, Shenzhen, China
| | | | - Ravinder Kaur
- Lady Hardinge Medical College & Associated SSK & KSC Hospitals, New Delhi, India
| | | | | | - Edwin Machanja
- Department of Microbiology, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Flavia Namiiro
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | - Gita Natraj
- Seth G. S. Medical College & KEM Hospital, Mumbai, India
| | - Hakka Naziat
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Hoang Thi Bich Ngoc
- Department of Microbiology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Claude Ondongo-Ezhet
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Amy Riddell
- Centre for Neonatal and Paediatric Infection, St. George's University of London, London, UK
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Neal Russell
- Centre for Neonatal and Paediatric Infection, St. George's University of London, London, UK
| | - Apurba S Sastry
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | | | - Ji Tongzhen
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University,Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jeannette Wadula
- National Health Laboratory Services, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yajuan Wang
- Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, 2# Yabao Road, Chaoyang District, Beijing, China
- Department of Neonatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Andrew Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Dan Wu
- Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, 2# Yabao Road, Chaoyang District, Beijing, China
| | - Varsha Yadav
- Seth G. S. Medical College & KEM Hospital, Mumbai, India
| | - Gao Yang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University,Beijing, China
- National Health Laboratory Services, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wolfgang Stohr
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Julia Anna Bielicki
- Centre for Neonatal and Paediatric Infection, St. George's University of London, London, UK
| | - Sally Ellis
- Global Antibiotic Research & Development Partnership (GARDP), Geneva, Switzerland
| | - Adilia Warris
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Paul T Heath
- Centre for Neonatal and Paediatric Infection, St. George's University of London, London, UK
| | - Michael Sharland
- Centre for Neonatal and Paediatric Infection, St. George's University of London, London, UK
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Ramdin TD, Chibabhai V, Saggers RT, Bandini RM, Ballot DE. Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019). Clinical Epidemiology and Global Health 2023. [DOI: 10.1016/j.cegh.2023.101247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Lowe M, Singh-Moodley A, Ismail H, Thomas T, Chibabhai V, Nana T, Lowman W, Ismail A, Chan WY, Perovic O. Molecular characterisation of Acinetobacter baumannii isolates from bloodstream infections in a tertiary-level hospital in South Africa. Front Microbiol 2022; 13:863129. [PMID: 35992699 PMCID: PMC9391000 DOI: 10.3389/fmicb.2022.863129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/14/2022] [Indexed: 12/26/2022] Open
Abstract
Acinetobacter baumannii is an opportunistic pathogen and causes various infections in patients. This study aimed to describe the clinical, epidemiological and molecular characteristics of A. baumannii isolated from BCs in patients at a tertiary-level hospital in South Africa. Ninety-six isolates from bloodstream infections were collected. Clinical characteristics of patients were recorded from patient files. Organism identification and AST was performed using automated systems. PCR screening for the mcr-1 to mcr-5 genes was done. To infer genetic relatedness, a dendrogram was constructed using MALDI-TOF MS. All colistin-resistant isolates (n = 9) were selected for WGS. The patients were divided into three groups, infants (<1 year; n = 54), paediatrics (1–18 years; n = 6) and adults (≥19 years; n = 36) with a median age of 13 days, 1 and 41 years respectively. Of the 96 A. baumannii bacteraemia cases, 96.9% (93/96) were healthcare-associated. The crude mortality rate at 30 days was 52.2% (48/92). The majority of the isolates were multidrug-resistant (MDR). All isolates were PCR-negative for the mcr-1 to mcr-5 genes. The majority of the isolates belonged to cluster 1 (62/96) according to the MALDI-TOF MS dendrogram. Colistin resistance was confirmed in nine A. baumannii isolates (9.4%). The colistin-resistant isolates belonged to sequence type (ST) 1 (5/6) and ST2 (1/6). The majority of ST1 isolates showed low SNP diversity (≤4 SNPs). All the colistin-resistant isolates were resistant to carbapenems, exhibited an XDR phenotype and harboured the blaOXA–23 gene. The blaNDM gene was only detected in ST1 colistin-resistant isolates (n = 5). The lpsB gene was detected in all colistin-resistant isolates as well as various efflux pump genes belonging to the RND, the MFS and the SMR families. The lipooligosaccharide OCL1 was detected in all colistin-resistant ST1 and ST2 isolates and the capsular polysaccharide KL3 and KL17 were detected in ST2 and ST1 respectively. This study demonstrated a 9.4% prevalence of colistin-resistant ST1 and ST2 A. baumannii in BC isolates. The detection of the lpsB gene indicates a potential threat and requires close prospective monitoring.
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Affiliation(s)
- Michelle Lowe
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg, South Africa
- *Correspondence: Michelle Lowe,
| | - Ashika Singh-Moodley
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Husna Ismail
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Teena Thomas
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
- Infection Control Services Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
- Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
- Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - Warren Lowman
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
- Pathcare/Vermaak Pathologists, Johannesburg, South Africa
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Arshad Ismail
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Wai Yin Chan
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute, University of Pretoria, Pretoria, South Africa
| | - Olga Perovic
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
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Nana T, Perovic O, Chibabhai V. Comparison of carbapenem minimum inhibitory concentrations of OXA-48-like Klebsiella pneumoniae by Sensititre, Vitek 2, MicroScan and Etest. Clin Microbiol Infect 2022; 28:1650.e1-1650.e5. [PMID: 35811020 DOI: 10.1016/j.cmi.2022.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this laboratory-based study was to compare carbapenem minimum inhibitory concentrations (MICs) yielded by Sensititre, Vitek 2, MicroScan WalkAway plus and Etest for OXA-48-like Klebsiella pneumoniae isolates. METHODS Analysis was performed for categorical agreement for ertapenem, meropenem and imipenem, and the proportion of isolates with MICs ≤8μg/mL and the MIC50/MIC90 for meropenem and imipenem, from a convenience sample of 82 deduplicated blood culture OXA-48-like K. pneumoniae isolates. RESULTS The proportion of isolates testing susceptible to ertapenem by Etest (19/82, 23.1%) differed from Sensititre/Vitek (0/82) and MicroScan (2/82, 2.4%) (p<0.001 for all). For meropenem the proportion of isolates susceptible by Etest (31/82, 37.8%) differed from Sensititre/Vitek (16/82, 19.5%) (p=0.015). There was variation in the proportion of isolates that tested imipenem susceptible when comparing Sensititre (9/82, 11%) and Vitek (8/82, 9.8%) to MicroScan (27/82, 32.9%), p=0.001 and p<0.001, respectively, Sensititre and Vitek to Etest (45/82, 54.9%), p<0.001 for both, and MicroScan to Etest, p=0.007. The proportion of isolates with meropenem MICs ≤8μg/mL with Sensititre and Vitek differed significantly from Etest, 58.5% and 85.4%, respectively, p<0.001. A 2-fold difference between the Sensititre and Vitek meropenem and imipenem MIC at which ≥50% of isolates were inhibited compared to the MicroScan, and a 4-fold difference compared to Etest, was present. CONCLUSIONS Substantial variability in carbapenem MICs for OXA-48-like CPE isolates by the four methods was demonstrated. Performance characteristics verification of MIC methods in use for the predominant CPE type is required by laboratories to optimise accuracy of carbapenem reporting.
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Affiliation(s)
- Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa; Charlotte Maxeke Johannesburg academic Hospital Microbiology Laboratory, National Health Laboratory Services, South Africa.
| | - Olga Perovic
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa; Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, South Africa
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, South Africa; Charlotte Maxeke Johannesburg academic Hospital Microbiology Laboratory, National Health Laboratory Services, South Africa
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Chibabhai V. Incidence of candidemia and prevalence of azole-resistant candidemia at a tertiary South African hospital – A retrospective laboratory analysis 2016–2020. S Afr J Infect Dis 2022; 37:326. [PMID: 35284564 PMCID: PMC8905471 DOI: 10.4102/sajid.v37i1.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Candidemia is associated with high morbidity and mortality. The epidemiology of candidemia has changed globally over the past 20 years. South African surveillance demonstrated a shift in epidemiology from Candida albicans to non-albicans species including Candida parapsilosis and Candida auris. Hospital-level candidemia incidence from South Africa has not been reported previously. Methods We performed a retrospective laboratory-based analysis of blood cultures with confirmed causative agents of candidemia. Ward type, department, gender and admission to critical care units were captured. Data were analysed in Microsoft Excel, Statistical Package for the Social Sciences (SPSS) and Epitools. Results The incidence of candidemia during the study period was 2.87 per 1000 admissions. The total proportion of non-albicans species causing candidemia was 425/618 (69.7%). Overall, 65.4% of candidemia cases occurred in non-critical care units. There was a significant increase in the proportion of C. auris isolates between 2016 and 2020 (p < 0.001). Isolation of C. auris was associated with admission to critical care units (p < 0.001, odds ration [OR] 3.856, 95% confidence interval [CI]: 2.360–6.300). The proportion of azole-resistant candidemia cases increased from 21/53 (39.6%) in 2016 to 41/59 (69.5%) in 2020 (p = 0.002). Conclusion The incidence of candidemia remained stable over the five-year study period. However, the proportion of C. auris isolates increased significantly during the study period as did the overall proportion of azole-resistant candidemia. Antifungal stewardship and continued hospital-level surveillance are imperative.
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Affiliation(s)
- Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Clinical Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
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Parak A, Stacey SL, Chibabhai V. Clinical and laboratory features of patients with Candida auris cultures, compared to other Candida, at a South African Hospital. J Infect Dev Ctries 2022; 16:213-221. [PMID: 35192540 DOI: 10.3855/jidc.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/09/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Multidrug resistant Candida auris is an emerging threat worldwide. It has been identified in Africa, however, there is minimal data available comparing C. auris to other Candida species in Africa. METHODOLOGY Retrospective, case control study at a tertiary South African Hospital. Clinical and laboratory features of patients with positive C. auris clinical cultures from 1 January 2015 to 31 August 2018 were compared to patients who cultured C. albicans and C. glabrata. RESULTS Forty-five clinical cases with C. auris cultures were identified. The median age was 32 years (IQR = 26-46). The median duration of hospital stay was 64 days (IQR = 39-88) and median time from admission to diagnosis 35 days (IQR = 21-53). Indwelling devices and previous antibiotic exposure were found to be significant risk factors. All C. auris isolates were susceptible to amphotericin B and micafungin. Patients treated with amphotericin B alone, had a higher mortality (73.33%, n = 11/15) than patients treated with an echinocandin (54.55%, n = 6/11), however this was not statistically significant. All C. auris isolates were healthcare associated with 80% (n = 36/45) acquired in ICU. The 30-day all-cause in-patient mortality was 42% (n = 19/45) for C. auris, 36% (n = 16/45) for C. albicans and 53% (n = 24/45) for C. glabrata. CONCLUSIONS C. auris is an emerging multi drug resistant threat in South Africa. Improved access to echinocandins and improvement of infection prevention and control strategies are imperative to prevent further morbidity and mortality due to this pathogen.
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Affiliation(s)
- Amirah Parak
- Department of Internal Medicine, University of the Witwatersrand Johannesburg, South Africa.
| | - Sarah Lynn Stacey
- Division of Infectious Diseases, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa
| | - Vindana Chibabhai
- Microbiology Laboratory, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa
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Iskandar K, Murugaiyan J, Hammoudi Halat D, Hage SE, Chibabhai V, Adukkadukkam S, Roques C, Molinier L, Salameh P, Van Dongen M. Antibiotic Discovery and Resistance: The Chase and the Race. Antibiotics (Basel) 2022; 11:antibiotics11020182. [PMID: 35203785 PMCID: PMC8868473 DOI: 10.3390/antibiotics11020182] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
The history of antimicrobial resistance (AMR) evolution and the diversity of the environmental resistome indicate that AMR is an ancient natural phenomenon. Acquired resistance is a public health concern influenced by the anthropogenic use of antibiotics, leading to the selection of resistant genes. Data show that AMR is spreading globally at different rates, outpacing all efforts to mitigate this crisis. The search for new antibiotic classes is one of the key strategies in the fight against AMR. Since the 1980s, newly marketed antibiotics were either modifications or improvements of known molecules. The World Health Organization (WHO) describes the current pipeline as bleak, and warns about the scarcity of new leads. A quantitative and qualitative analysis of the pre-clinical and clinical pipeline indicates that few antibiotics may reach the market in a few years, predominantly not those that fit the innovative requirements to tackle the challenging spread of AMR. Diversity and innovation are the mainstays to cope with the rapid evolution of AMR. The discovery and development of antibiotics must address resistance to old and novel antibiotics. Here, we review the history and challenges of antibiotics discovery and describe different innovative new leads mechanisms expected to replenish the pipeline, while maintaining a promising possibility to shift the chase and the race between the spread of AMR, preserving antibiotic effectiveness, and meeting innovative leads requirements.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1295, 31000 Toulouse, France
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573, Lebanon;
- Faculty of Pharmacy, Lebanese University, Beirut 6573, Lebanon
- Correspondence: (K.I.); (D.H.H.)
| | - Jayaseelan Murugaiyan
- Department of Biological Sciences, SRM University–AP, Amaravati 522502, India; (J.M.); (S.A.)
| | - Dalal Hammoudi Halat
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Bekaa Campus, Beirut 1103, Lebanon
- Correspondence: (K.I.); (D.H.H.)
| | - Said El Hage
- Faculty of Medicine, Lebanese University, Beirut 6573, Lebanon;
| | - Vindana Chibabhai
- Division of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg 2193, South Africa;
- Microbiology Laboratory, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| | - Saranya Adukkadukkam
- Department of Biological Sciences, SRM University–AP, Amaravati 522502, India; (J.M.); (S.A.)
| | - Christine Roques
- Laboratoire de Génie Chimique, Department of Bioprocédés et Systèmes Microbiens, Université Paul Sabtier, Toulouse III, UMR 5503, 31330 Toulouse, France;
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR 1295, Université Paul Sabatier Toulouse III, 31000 Toulouse, France;
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573, Lebanon;
- Faculty of Medicine, Lebanese University, Beirut 6573, Lebanon;
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia 2408, Cyprus
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11
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Nana T, Bhoora S, Chibabhai V. Trends in the epidemiology of urinary tract infections in pregnancy at a tertiary hospital in Johannesburg: Are contemporary treatment recommendations appropriate? S Afr J Infect Dis 2021; 36:328. [PMID: 34957292 PMCID: PMC8678934 DOI: 10.4102/sajid.v36i1.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are common during pregnancy and are associated with maternal and foetal complications. Empiric antibiotic choices in pregnancy require consideration of efficacy and safety, resulting in limited oral options. With rapidly evolving antibiotic resistance, surveillance to guide empiric treatment recommendations is essential. METHODS A retrospective analysis of urine culture isolates from the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Obstetrics Department for 1 January 2015 to 31 December 2020 was performed. RESULTS The top 3 pathogens were Escherichia coli, Enterococcus faecalis and Klebsiella pneumoniae. For E. coli susceptibility to cefuroxime declined (95% to 81%, p < 0.0001). Similarly, the E. coli extended spectrum beta-lactamase rate increased from 5% to 10% (p = 0.04). E. coli susceptibility to nitrofurantoin (93%) and fosfomycin (96%) remained high. In 2019, carbapenem-resistant K. pneumoniae emerged. Ampicillin susceptibility was high amongst the E. faecalis isolates. Amoxicillin-clavulanate demonstrated high levels of activity against the top 3 uropathogens. CONCLUSION The Essential Drug List recommended antibiotics for lower UTIs, nitrofurantoin and fosfomycin, are appropriate empiric options for E. coli, the most common uropathogen in the CMJAH obstetric population. The high rate of E. faecalis susceptibility to nitrofurantoin reported from other Gauteng tertiary obstetric patients, suggests that nitrofurantoin will provide adequate empiric cover for a large proportion of UTIs. However, the determination of the E. faecalis nitrofurantoin and fosfomycin susceptibility rates in the CMJAH obstetric population will provide useful data. Periodic surveillance at the various levels of antenatal care in different regions of South Africa and the determination of risk factors for infections with resistant uropathogens is needed.
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Affiliation(s)
- Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
- Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Services, Johannesburg, South Africa
| | - Shastra Bhoora
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital, South Africa
- Gauteng Department of Health, Johannesburg, South Africa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Baylor College, Houston, United States of America
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
- Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Services, Johannesburg, South Africa
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12
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Shuping L, Mpembe R, Mhlanga M, Naicker SD, Maphanga TG, Tsotetsi E, Wadula J, Velaphi S, Nakwa F, Chibabhai V, Mahabeer P, Moncho M, Prentice E, Bamford C, Reddy K, Maluleka C, Mawela D, Modise M, Govender NP. Epidemiology of Culture-confirmed Candidemia Among Hospitalized Children in South Africa, 2012-2017. Pediatr Infect Dis J 2021; 40:730-737. [PMID: 33872278 DOI: 10.1097/inf.0000000000003151] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND We aimed to describe the epidemiology of candidemia among children in South Africa. METHODS We conducted laboratory-based surveillance among neonates (≤28 days), infants (29 days to <1 year), children (1-11 years) and adolescents (12-17 years) with Candida species cultured from blood during 2012-2017. Identification and antifungal susceptibility of viable isolates were performed at a reference laboratory. We used multivariable logistic regression to determine the association between Candida parapsilosis candidemia and 30-day mortality among neonates. RESULTS Of 2996 cases, neonates accounted for 49% (n = 1478), infants for 27% (n = 806), children for 20% (n = 589) and adolescents for 4% (n = 123). The incidence risk at tertiary public sector hospitals was 5.3 cases per 1000 pediatric admissions (range 0.39-119.1). Among 2943 cases with single-species infections, C. parapsilosis (42%) and Candida albicans (36%) were most common. Candida auris was among the 5 common species with an overall prevalence of 3% (n = 47). Fluconazole resistance was more common among C. parapsilosis (55% [724/1324]) versus other species (19% [334/1737]) (P < 0.001). Of those with known treatment (n = 1666), 35% received amphotericin B deoxycholate alone, 32% fluconazole alone and 30% amphotericin B deoxycholate with fluconazole. The overall 30-day in-hospital mortality was 38% (n = 586) and was highest among neonates (43% [323/752]) and adolescents (43% [28/65]). Compared with infection with other species, C. parapsilosis infection was associated with a reduced mortality among neonates (adjusted odds ratio 0.41, 95% confidence interval: 0.22-0.75, P = 0.004). CONCLUSIONS Candidemia in this setting mainly affected neonates and infants and was characterized by fluconazole-resistant C. parapsilosis with no increased risk of death.
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Affiliation(s)
- Liliwe Shuping
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Ruth Mpembe
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mabatho Mhlanga
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Serisha D Naicker
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Tsidiso G Maphanga
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ernest Tsotetsi
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Jeannette Wadula
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, National Health Laboratory Service, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Firdose Nakwa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Prasha Mahabeer
- Department of Microbiology, National Health Laboratory Service, King Edward VIII Hospital, KZN Academic Complex, Durban, South Africa
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Masego Moncho
- Department of Medical Microbiology, Faculty of Health Sciences, Universitas Hospital, National Health Laboratory Service, University of Free State, Bloemfontein, South Africa
| | - Elizabeth Prentice
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Groote Schuur Microbiology Laboratory, National Health Laboratory Service, Cape Town, South Africa
| | - Colleen Bamford
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University/National Health Laboratory Services, Tygerberg, Cape Town, South Africa
| | - Kessendri Reddy
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University/National Health Laboratory Services, Tygerberg, Cape Town, South Africa
| | - Caroline Maluleka
- Department of Microbiology, National health Laboratory Service, Dr George Mukhari Hospital, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Dini Mawela
- Department of Microbiology, National health Laboratory Service, Dr George Mukhari Hospital, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Motshabi Modise
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a Division of National Health Laboratory Service, Johannesburg, South Africa
| | - Nelesh P Govender
- From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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13
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Ansari S, Hays JP, Kemp A, Okechukwu R, Murugaiyan J, Ekwanzala MD, Ruiz Alvarez MJ, Paul-Satyaseela M, Iwu CD, Balleste-Delpierre C, Septimus E, Mugisha L, Fadare J, Chaudhuri S, Chibabhai V, Wadanamby JMRWW, Daoud Z, Xiao Y, Parkunan T, Khalaf Y, M'Ikanatha NM, van Dongen MBM. The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance: an AMR Insights global perspective. JAC Antimicrob Resist 2021; 3:dlab038. [PMID: 34192258 PMCID: PMC8083476 DOI: 10.1093/jacamr/dlab038] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic presents a serious public health challenge in all countries. However, repercussions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on future global health are still being investigated, including the pandemic’s potential effect on the emergence and spread of global antimicrobial resistance (AMR). Critically ill COVID-19 patients may develop severe complications, which may predispose patients to infection with nosocomial bacterial and/or fungal pathogens, requiring the extensive use of antibiotics. However, antibiotics may also be inappropriately used in milder cases of COVID-19 infection. Further, concerns such as increased biocide use, antimicrobial stewardship/infection control, AMR awareness, the need for diagnostics (including rapid and point-of-care diagnostics) and the usefulness of vaccination could all be components shaping the influence of the COVID-19 pandemic. In this publication, the authors present a brief overview of the COVID-19 pandemic and associated issues that could influence the pandemic’s effect on global AMR.
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Affiliation(s)
- Shamshul Ansari
- Department of Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur, 44200 Chitwan, Nepal
| | - John P Hays
- Department of Medical Microbiology & Infectious Diseases, Erasmus University Medical Centre Rotterdam (Erasmus MC), Rotterdam, The Netherlands
| | - Andrew Kemp
- Scientific Advisory Board of the British Institute of Cleaning Sciences, Northampton, UK
| | - Raymond Okechukwu
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Agulu Campus, Nigeria
| | | | - Mutshiene Deogratias Ekwanzala
- Department of Environmental, Water and Earth Sciences, Tshwane University of Technology, Pretoria, South Africa.,Environmental Engineering, Department of Civil Engineering, Kyung Hee University, Yongin-si, Gyeonggi-do, Republic of Korea
| | | | | | - Chidozie Declan Iwu
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Ed Septimus
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, 02215, Texas A&M College of Medicine, Houston, TX 77030, USA
| | - Lawrence Mugisha
- College of Veterinary Medicine, Animal Resources & Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | - Susmita Chaudhuri
- Translational Health Science and Technology Institute, Faridabad 121001, India
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, and Clinical Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - J M Rohini W W Wadanamby
- Department of Microbiology, Lanka Hospital Diagnostics, Lanka Hospital 578, Elvitigala Mw, Colombo 05, Sri Lanka
| | - Ziad Daoud
- Department of Clinical Microbiology & Infection Prevention, Michigan Health Clinics-Saginaw, MI, USA and Department of Foundational Sciences, CMED-CMU, Mount Pleasant, MI, USA
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis & Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 300013, China
| | - Thulasiraman Parkunan
- Department of Veterinary Physiology and Biochemistry, Faculty of Veterinary and Animal Sciences, Institute of Agricultural Sciences, Rajiv Gandhi South Campus, Banaras Hindu University, Mirzapur, Uttar Pradesh, India
| | - Yara Khalaf
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Nkuchia M M'Ikanatha
- Division of Infectious Disease Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
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Perovic O, Ismail H, Quan V, Bamford C, Nana T, Chibabhai V, Bhola P, Ramjathan P, Swe Swe-Han K, Wadula J, Whitelaw A, Smith M, Mbelle N, Singh-Moodley A. Carbapenem-resistant Enterobacteriaceae in patients with bacteraemia at tertiary hospitals in South Africa, 2015 to 2018. Eur J Clin Microbiol Infect Dis 2020; 39:1287-1294. [PMID: 32124106 DOI: 10.1007/s10096-020-03845-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/09/2020] [Indexed: 11/26/2022]
Abstract
Enhanced surveillance for CREs was established at national sentinel sites in South Africa. We aimed to apply an epidemiological and microbiological approach to characterise CREs and to assess trends in antimicrobial resistance from patients admitted to tertiary academic hospitals. A retrospective analysis was conducted on patients of all ages with CRE bacteraemia admitted at any one of 12 tertiary academic hospitals in four provinces (Gauteng, KwaZulu-Natal, Western Cape and Free State) in South Africa. The study period was from July 2015 to December 2018. A case of CRE bacteraemia was defined as a patient admitted to one of the selected tertiary hospitals where any of the Enterobacteriaceae was isolated from a blood culture, and was resistant to the carbapenems (ertapenem, meropenem, imipenem and/or doripenem) or had a positive result for the Modified Hodge Test (MHT) according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. A positive blood culture result obtained after 21 days of the last blood culture result was regarded as a new case. To distinguish hospital-acquired (HA) from the community-acquired (CA) bacteraemia, the following definitions were applied: the HA CRE bacteraemia was defined as a patient with CRE isolated from blood culture ≥ 72 h of hospital admission or with any prior healthcare contact, within 1 year prior to the current episode or referral from a healthcare facility where the patient was admitted before the current hospital. A case of the CA CRE bacteraemia was defined as a patient with CRE isolated from blood culture < 72 h of hospital admission and with no prior healthcare contact. The majority of carbapenem-resistant Enterobacteriaceae (CRE) (70%) were hospital-acquired (HA) with Klebsiella pneumoniae being the predominant species (78%). In-hospital mortality rate was 38%. The commonest carbapenemase genes were bla-OXA-48 (52%) and bla-NDM (34%). The high mortality rate related to bacteraemia with CRE and the fact that most were hospital-acquired infections highlights the need to control the spread of these drug-resistant bacteria. Replacement with OXA-48 is the striking finding from this surveillance analysis. Infection control and antibiotic stewardship play important roles in decreasing the spread of resistance.
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Affiliation(s)
- O Perovic
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - H Ismail
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - V Quan
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - C Bamford
- Department of Pathology, Groote Schuur Hospital Microbiology Laboratory, National Health Laboratory Service and Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - T Nana
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
- National Health Laboratory Service, Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - V Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
- National Health Laboratory Service, Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - P Bhola
- National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital Academic Complex, Durban, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - P Ramjathan
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- National Health Laboratory Service, King Edward VIII Hospital, Durban, KwaZulu-Natal, South Africa
| | - K Swe Swe-Han
- National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital Academic Complex, Durban, KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - J Wadula
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
- National Health Laboratory Service, Microbiology Laboratory, Chris Hani Baragwanath Academic Hospital Laboratory, Johannesburg, South Africa
| | - A Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - M Smith
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Nontombi Mbelle
- Department of Medical Microbiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - A Singh-Moodley
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
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15
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van Schalkwyk E, Mpembe RS, Thomas J, Shuping L, Ismail H, Lowman W, Karstaedt AS, Chibabhai V, Wadula J, Avenant T, Messina A, Govind CN, Moodley K, Dawood H, Ramjathan P, Govender NP. Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016-2017 1. Emerg Infect Dis 2020; 25:1698-1707. [PMID: 31441749 PMCID: PMC6711229 DOI: 10.3201/eid2509.190040] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Candida auris is an invasive healthcare-associated fungal pathogen. Cases of candidemia, defined as illness in patients with Candida cultured from blood, were detected through national laboratory-based surveillance in South Africa during 2016–2017. We identified viable isolates by using mass spectrometry and sequencing. Among 6,669 cases (5,876 with species identification) from 269 hospitals, 794 (14%) were caused by C. auris. The incidence risk for all candidemia at 133 hospitals was 83.8 (95% CI 81.2–86.4) cases/100,000 admissions. Prior systemic antifungal drug therapy was associated with a 40% increased adjusted odds of C. auris fungemia compared with bloodstream infection caused by other Candida species (adjusted odds ratio 1.4 [95% CI 0.8–2.3]). The crude in-hospital case-fatality ratio did not differ between Candida species and was 45% for C. auris candidemia, compared with 43% for non–C. auris candidemia. C. auris has caused a major epidemiologic shift in candidemia in South Africa.
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Govender NP, Avenant T, Brink A, Chibabhai V, Cleghorn J, du Toit B, Govind C, Lewis E, Lowman W, Mahlangu H, Maslo C, Messina A, Mer M, Pieton K, Seetharam S, Sriruttan C, Swart K, van Schalkwyk E. Federation of Infectious Diseases Societies of Southern Africa guideline: Recommendations for the detection, management and prevention of healthcare-associated Candida auris colonisation and disease in South Africa. S Afr J Infect Dis 2019; 34:163. [PMID: 34485460 PMCID: PMC8377779 DOI: 10.4102/sajid.v34i1.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 11/03/2022] Open
Abstract
Candida auris has been detected at almost 100 South African hospitals, causing large outbreaks in some facilities, and this pathogen now accounts for approximately 1 in 10 cases of candidaemia. The objective of this guideline is to provide updated, evidence-informed recommendations outlining a best-practice approach to prevent, diagnose and manage C. auris disease in public- and private-sector healthcare settings in South Africa. The 18 practical recommendations cover five focus areas: laboratory identification and antifungal susceptibility testing, surveillance and outbreak response, infection prevention and control, clinical management and antifungal stewardship.
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Affiliation(s)
- Nelesh P Govender
- National Institute for Communicable Diseases, Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, Division of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Theunis Avenant
- Kalafong Provincial Tertiary Hospital and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Adrian Brink
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Ampath Laboratories, Cape Town, South Africa
| | - Vindana Chibabhai
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,National Health Laboratory Service, Johannesburg, South Africa.,Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Joy Cleghorn
- Life Healthcare Group, Johannesburg, South Africa
| | | | | | - Elsie Lewis
- Steve Biko Pretoria Academic Hospital, Pretoria, South Africa
| | - Warren Lowman
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,WITS Donald Gordon Medical Centre and Vermaak and Partners Pathologists, Johannesburg, South Africa
| | | | | | - Angeliki Messina
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Netcare Hospitals Limited, Johannesburg, South Africa
| | - Mervyn Mer
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Kim Pieton
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | - Charlotte Sriruttan
- National Institute for Communicable Diseases [Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses], a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karin Swart
- Netcare Hospitals Limited, Johannesburg, South Africa
| | - Erika van Schalkwyk
- National Institute for Communicable Diseases [Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses], a Division of the National Health Laboratory Service, Johannesburg, South Africa
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Chibabhai V, Fadana V, Bosman N, Nana T. Comparative sensitivity of 1,3 beta-D-glucan for common causes of candidaemia in South Africa. Mycoses 2019; 62:1023-1028. [PMID: 31393662 DOI: 10.1111/myc.12982] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
Culture-based diagnosis of candidaemia suffers poor sensitivity and prolonged turnaround time. The 1,3-beta-D-glucan (BDG) assay is a non-culture-based broad fungal antigen with rapid turnaround time. To assess overall, species-specific and population-specific sensitivity of the BDG assay for candidaemia, to determine if the BDG assay is able to detect candidaemia prior to blood culture collection, and to evaluate the performance of the assay for the detection of Candida auris candidaemia. A retrospective review of all blood cultures (BC) with C albicans, C parapsilosis, C glabrata, C krusei and C auris was performed. A corresponding BDG result (Fungitell® ) within 10 days of the BC was sought on the laboratory information system. Overall sensitivity of the assay was 79% (95% CI 73-85; 173/218). Per species sensitivity was 81% (95% CI 72-90; 66/81) for C albicans, 72% (61-83; 60/83) for C parapsilosis, 90% (95% CI 79-100; 27/30) for C glabrata, 71% (95% CI 43-99; 10/14) C auris and 100% (10/10) for C krusei. No statistically significant difference in sensitivity between species was noted (P = .093). The assay demonstrated 92% (59/64) sensitivity in neonatal ICU (P = .047) compared to 94% (15/16) in surgery, 81% (59/73) in adult ICUs and 71% (15/21) in Oncology. BDG results were positive up to 10 days prior to blood culture collection with no significant difference in detection rate (P = .563). BDG results were positive up to 10 days prior to blood culture collection. BDG when collected a mean of 2.5 days (range 1-10 days) prior to blood culture collection were positive.
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Affiliation(s)
- Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa.,Clinical Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - Vuyolwethu Fadana
- Clinical Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa.,Department of Chemical Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Norma Bosman
- Pathcare/Vermaak and Partners Pathologists, Pretoria, South Africa
| | - Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa.,Clinical Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
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18
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van Schalkwyk E, Mpembe RS, Thomas J, Shuping L, Ismail H, Lowman W, Karstaedt AS, Chibabhai V, Wadula J, Avenant T, Messina A, Govind CN, Moodley K, Dawood H, Ramjathan P, Govender NP. Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–20171. Emerg Infect Dis 2019. [DOI: 10.3201/eid2509190040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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19
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MacDonald JW, Chibabhai V. Evaluation of the RESIST-4 O.K.N.V immunochromatographic lateral flow assay for the rapid detection of OXA-48, KPC, NDM and VIM carbapenemases from cultured isolates. Access Microbiol 2019; 1:e000031. [PMID: 32974526 PMCID: PMC7470286 DOI: 10.1099/acmi.0.000031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/17/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to evaluate the performance of the RESIST-4 O.K.N.V immunochromatographic lateral flow assay for the detection of OXA-48, KPC, NDM and VIM carbapenemases in 100 clinical Enterobacteriaceae isolates using solid culture media. Methodology In total, 100 clinical Enterobacteriaceae isolates with characterized β-lactamase enzymes (OXA-48 n=46, KPC n =4, NDM n =43 and VIM n =10) were evaluated using the RESIST-4 O.K.N.V assay. The assay was also evaluated using carbapenem-sensitive control strains and confirmed non-carbapenemase-producing Enterobacteriaceae clinical isolates resistant to carbapenems. Inter-rater agreement of the test was evaluated by four different users who tested 11 randomly selected isolates daily over 3 days. Results Overall accuracy of the assay was 99.5 %. For the detection of KPC, OXA-48 and its variants and VIM the assay correctly identified 100 % of the isolates when compared to PCR. Initial performance for NDM detection was sensitivity=95.3 %, specificity=100 %. Two PCR positive Providencia rettgeri isolates rendered false negative results on the assay. Retesting from a carbapenem zone of inhibition rendered a positive result for both isolates increasing the sensitivity to 100 %. No false positive results or cross reactions were detected. Conclusion The RESIST-4 O.K.N.V is reliable, sensitive and specific for the detection of OXA-48, KPC, NDM and VIM carbapenemases. Further evaluation on improving NDM detection in organisms from the Proteeae tribe is warranted to determine optimal test conditions.
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Affiliation(s)
- James Wesley MacDonald
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa.,Clinical Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, South Africa
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa.,Clinical Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, South Africa
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20
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Von Knorring N, Nana T, Chibabhai V. Cumulative antimicrobial susceptibility data for a tertiary-level paediatric oncology unit in Johannesburg, South Africa. S Afr j oncol 2019. [DOI: 10.4102/sajo.v3i0.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: There is global concern regarding the spread of antimicrobial resistance in bacteria and fungi. Oncology patients are at particular risk of infections with multidrug resistant organisms. These patients require urgent initiation of empiric antimicrobial therapy when presenting with neutropenic fever. Currently, piperacillin-tazobactam and amikacin with or without vancomycin is the treatment of choice in the unit.Aim: The purpose of this study was to develop a cumulative antibiogram for the paediatric oncology unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) to guide empiric treatment recommendations for patients presenting with suspected bacterial or fungal infection.Setting: Tertiary-level paediatric oncology unit.Methods: A retrospective observational analysis was performed of bacterial and fungal antimicrobial susceptibility data extracted from the microbiology laboratory information system for clinical specimens submitted from the paediatric oncology unit at CMJAH. Data was analysed for the period January 2015 to May 2018. In addition, analysis and comparison of two 17-month time periods was performed in order to elicit any changes over time.Results: Klebsiella pneumoniae and Escherichia coli were the most common gram-negative organisms isolated. Twenty-one percent of Enterobacteriaceae showed resistance to third generation cephalosporins and 9% to carbapenems. Rates of carbapenem-resistant isolates decreased significantly over time. Adding amikacin to piperacillin-tazobactam significantly increased bacterial coverage. Coagulase-negative staphylococci and Candida parapsilosis were the most common gram-positive and fungal isolates recovered during the study.Conclusion: The results support the continued use of piperacillin-tazobactam and amikacin for paediatric oncology patients presenting with neutropenic fever in this unit. Antibiograms are an important component of antimicrobial stewardship in conjunction with efficient infection prevention and control measures.
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21
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Perovic O, Singh-Moodley A, Govender NP, Kularatne R, Whitelaw A, Chibabhai V, Naicker P, Mbelle N, Lekalakala R, Quan V, Samuel C, Van Schalkwyk E. A small proportion of community-associated methicillin-resistant Staphylococcus aureus bacteraemia, compared to healthcare-associated cases, in two South African provinces. Eur J Clin Microbiol Infect Dis 2017; 36:2519-2532. [PMID: 28849285 DOI: 10.1007/s10096-017-3096-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
We compared the proportion of cases of community-associated and healthcare-associated methicillin-resistant Staphylococcus aureus (CA-MRSA and HA-MRSA, respectively) bacteraemia among patients at five hospitals in the Gauteng and Western Cape provinces in South Africa and described the molecular characteristics and antimicrobial susceptibility trends. This was a cross-sectional study using data collected by enhanced surveillance for S. aureus bacteraemia. A total of 2511 cases of S. aureus bacteraemia were identified from January 2013 to January 2016. Among 1914 cases of S. aureus, 557 (29.1%) cases were identified as MRSA infection. Forty-four cases (44/1914 [2.3%] of all S. aureus cases) were considered CA-MRSA infection and 513/1914 (26.8% of all cases) had HA-MRSA infection; the majority were neonates. CA-MRSA constituted 7.9% (44/557) of all cases of MRSA infection. Staphylococcus aureus isolates demonstrated significantly reduced susceptibility to the following classes of antimicrobial agents: macrolides, tetracyclines, aminoglycosides and cotrimoxazole, in 2015 compared to 2013 (p < 0.05). Of the 557 MRSA isolates, 484 (87%) were typed for SCCmec elements and spa types: the most common SCCmec type was type III (n = 236, 48.76%), followed by type IV (n = 144, 29.76%). The most common spa types were t037 (n = 229, 47.31%) and t1257 (n = 90, 18.60%). Of 28 isolates selected for multilocus sequence typing (MLST), the most common sequence types (STs) were ST239 and ST612 of clonal complex 8 (CC8) (n = 8 each) and a novel ST (ST4121) was obtained for one isolate. This study demonstrates that S. aureus bacteraemia is common in South African academic centres and characterised by HA-MRSA SCCmec types III and IV. A small proportion of CA-MRSA cases were caused by a few different sequence types.
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Affiliation(s)
- O Perovic
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa. .,Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the University at the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa.
| | - A Singh-Moodley
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.,Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the University at the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - N P Govender
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.,Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the University at the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa.,Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - R Kularatne
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the University at the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa.,Centre for Human Immunodeficiency Virus and Sexually Transmitted Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - A Whitelaw
- National Health Laboratory Service, Stellenbosch, Stellenbosch University, Stellenbosch, South Africa
| | - V Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the University at the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - P Naicker
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - N Mbelle
- Department of Medical Microbiology, University of Pretoria and National Health Laboratory Service, Pretoria, South Africa
| | - R Lekalakala
- Department of Medical Microbiology, University of Limpopo and National Health Laboratory Service, Polokwane, South Africa
| | - V Quan
- Division of Public Health Surveillance and Response, National Institute for Communicable Disease, Johannesburg, South Africa
| | - C Samuel
- National Health Laboratory Service, Stellenbosch, Stellenbosch University, Stellenbosch, South Africa
| | - E Van Schalkwyk
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
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Chibabhai V, Lowman W. Epidemiology of cystic fibrosis respiratory pathogens isolated at a South African Hospital, 2006–2010. S Afr J Infect Dis 2016. [DOI: 10.4102/sajid.v31i4.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The epidemiology of cystic fibrosis (CF) associated pathogens other than Pseudomonas aeruginosa in the South African cystic fibrosis population has not been previously described.Methods: A retrospective review of respiratory cultures taken from cystic fibrosis clinic patients at the Charlotte Maxeke Johannesburg Academic Hospital from 2006 to 2010 was performed.Results: During the study period, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia cepacia complex and Candida albicans prevalence remained stable, Aspergillus fumigatus increased from 8% to 20% (p = 0.0132); Staphylococcus aureus decreased from 66% to 50% (p = 0.0243) and Haemophilus influenzae decreased from 13% to 3% (p = 0.0136). There were significant antimicrobial susceptibility changes to meropenem (p 0.0001) amongst P. aeruginosa isolates and cloxacillin (p 0.0001) amongst S. aureus isolates. Prevalence of most bacterial pathogens appeared to increase with increasing age.Conclusion: The findings of this study illustrate the epidemiology of CF associated respiratory pathogens and the trends in prevalence and susceptibility patterns over a 5-year period.
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Chibabhai V, Lowman W. Epidemiology of cystic fibrosis respiratory pathogens isolated at a South African Hospital, 2006–2010. S Afr J Infect Dis 2015. [DOI: 10.1080/23120053.2016.1156864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Chibabhai V, Perovic O. Epidemiology of carbapenem resistant Enterobacteriaceae at Charlotte Maxeke Johannesburg Academic Hospital. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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