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- Volume 30, Issue 1, 2015
Southern African Journal of Infectious Diseases - Volume 30, Issue 1, 2015
Volume 30, Issue 1, 2015
Author Melinda SuchardSource: Southern African Journal of Infectious Diseases 30, pp 3 –4 (2015)More Less
The fear inspired by the Ebola virus disease epidemic has gripped the world and held its gaze for almost a year. The ugly spectre of Ebola highlights the power of "contagion" to unite diverse peoples in pursuit of a common goal. The international collaborative effort to assist Ebola-infected countries has been forceful and inspiring, despite criticism of the time lag to gain traction. Global attention has been drawn to the race to develop an Ebola vaccine. It is imagined that demand for such a vaccine, once successfully developed, would be overwhelming in the affected countries, as presumably would demand for a future vaccine against the human immunodeficiency virus in southern Africa. The iconic picture of queues around the block for a newly developed oral polio vaccine in 1960s USA reminds us of the intensity of the fear of polio disease at the time, a disease which seems very distant and remote today to most of the globe. The USA had just experienced mass epidemics of polio that paralysed tens of thousands of children annually. Successes driven by the Global Polio Eradication Initiative have largely driven such fear of polio to the archives of the past. Why can we not maintain such a public passion for vaccines against measles, a very real, present and aggressive enemy, against which there has been a preventative vaccine since the 1970s?
Molecular epidemiology of a suspected methicillin-resistant Staphylococcus aureus outbreak in a renal unit of a central academic hospital in KwaZulu-Natal, South Africa : original researchSource: Southern African Journal of Infectious Diseases 30, pp 6 –10 (2015)More Less
Methicillin-resistant Staphylococcus aureus (MRSA) colonisation and infections have a significant impact on individual patients and institutions. Therefore, continuous epidemiological surveillance of MRSA, including genotypic analysis, is important to obtain a better understanding of the dynamics of these microorganisms. We were able to identify an increase in MRSA prevalence in the adjoining renal and dermatology units in our central academic hospital in KwaZulu-Natal as a result of a local continuous MRSA epidemiological surveillance programme. Here, we on report the findings of this infection control investigation, and how an MRSA risk assessment profile, the utilisation of surveillance swabs and genotypic pulsed-field gel electrophoresis analysis assisted in excluding what appeared to be an outbreak of MRSA in the renal and dermatology units.
Molecular characterisation and associated drug susceptibility patterns of Mycobacterium tuberculosis isolates from South African children : original researchSource: Southern African Journal of Infectious Diseases 30, pp 11 –16 (2015)More Less
According to the World Health Organization, South Africa is ranked the third highest country (0.4-0.6 million), after India and China, with a tuberculosis burden, coupled with drug resistance that is threatening tuberculosis control efforts. Understanding the genetic diversity and drug resistance patterns of Mycobacterium tuberculosis is crucial. The purpose of this study was to describe the molecular characterisation and associated drug susceptibility patterns of M. tuberculosis isolates from South African children. M. tuberculosis strains from children from four South African provinces were characterised and the drug resistance patterns determined. One hundred and four isolates that were culture positive in the Bactec Mycobacterium Growth Indicator Tube 960® and positively identified by AccuProbe® assay as M. tuberculosis were used. To ensure purity, the samples were subcultured on LÃ¶wenstein-Jensen medium agar slants. Spoligotyping was performed according to the manufacturerâ??s instructions. The international spoligotyping database 4 (SpolDB4) was used to analyse the genotypic data. First-line drugs, excluding pyrazinamide, were tested using the Middlebrook 7H11 Agar® proportion method. Twenty-one genotype families were identified in 93 isolates: Beijing (39%), T1 (14%), T2 (3%), T3 (1%), T4-CEU1 (1%), LAM3 (8%), LAM3 and S/convergent (1%), LAM4 (2%), LAM9 (1%), LAM11-ZWE (5%), H1 (2%), H2 (1%), H3 (1%), CAS (1%), CAS-KILI (1%), MANU2 (1%), EAI1-SOM (1%), EAI7-BGD2 (1%), S (3%), X3 (2%) and Bovis1-BCG (2%). Eleven (11%) isolates could not be assigned within the SpolDB4. The Beijing family was the most dominant in Gauteng (27%), followed by Mpumalanga (5%), North West (5%) and Limpopo (2%). The Beijing family was observed in 19 (18%) of isolates from children aged 0-5 years, and in 22 (21%) of isolates from children aged 6-12 years. Ninety-five (91%) isolates were susceptible to all drugs. Overall, of the 104 isolates, 3 (3%) were multidrug-resistant tuberculosis, one each from the Beijing family, T2 and LAM3. The Beijing family was the most dominant genotype, with most cases being from Gauteng, followed by T1. The Beijing genotype was distributed equally between children aged 0-5 years and those aged 6-12 years. The high prevalence of the Beijing genotype poses a serious threat to tuberculosis control owing to its high virulence and association with multi-drug resistance. Continuous surveillance programmes are needed to control tuberculosis, especially in areas with high tuberculosis and human immunodeficiency virus rates, such as those where the study was conducted.
An evaluation of antibiotic prescribing patterns in adult intensive care units in a private hospital in KwaZulu-Natal : original researchSource: Southern African Journal of Infectious Diseases 30, pp 17 –22 (2015)More Less
The emergence of resistant microorganisms and its association with antimicrobial use is widely recognised as a global concern. Therefore, rational and regulated antimicrobial use is essential in both the public and private healthcare sectors in South Africa. A retrospective chart review was conducted of patients who were prescribed antibiotics over a two-month period. Prescriptions were assessed for adherence to the guidelines, either local or international, and/or to drug registration information, as a measure of rational prescribing practice. Accuracy of dose, and the frequency and duration of administration were evaluated, as were microbiologically informed treatment and de-escalation. 28.8% of patients (n = 226) received antibiotics during their intensive care unit (ICU) admission. A clear indication for antibiotic therapy was noted in 58.5% (n = 131) of the patients, of whom 70.2% were prescribed treatment consistent with the guidelines or drug registration information. Doses were deemed to be correct for 91.1% of the sample, microbiological investigations were evident for 61.2% of patients and de-escalation was noted in only 13.1% of the 70.8% of cases where de-escalation was indicated. Antibiotic prescription rates were relatively lower than those described in the international literature on antibiotic use in the ICU. Antibiotic prescription in the absence of indication in 41.1% of patients, the lack of microbiological verification in 38.8% of patients, inaccurate drug choice in 29.8% of the subset for whom antibiotics were indicated and incorrect dosing in 8.9% of the subset necessitates microbiologically informed therapy and compliance with the treatment guidelines.
Tuberculosis and blood-borne infectious diseases : workplace conditions and practices of healthcare workers at three public hospitals in the Free State : original researchSource: Southern African Journal of Infectious Diseases 30, pp 23 –28 (2015)More Less
Healthcare workers (HCWs) have increased risks due to continued exposure to patients with infectious diseases, particularly tuberculosis and hepatitis B. This study assessed workplace conditions and practices regarding air- and blood-borne infections in public hospitals in the Free State. Workplace audits were conducted in intensive care, medical wards and casualty departments at three Free State public hospitals. A questionnaire survey was also administered to a targeted 20% stratified quota sample at these facilities. Of the 513 HCWs surveyed, 21.2% reported needle-stick injuries and other body fluid exposure and 19.1% were not adequately protected against hepatitis B. Additionally, 68.3% were never screened for tuberculosis, 54.8% did not wear N95® respirators when needed, only 28.5% washed their gloves and 19.8% did not always wash their hands between caring for different patients. Physicians were at highest risk of needle-stick injuries, were less compliant with hand hygiene, and associated with lower rates of tuberculosis screening, reporting spills and wearing N95® respirators. A significant association was also found between training and screening for tuberculosis, and the use of N95® respirators. The workplace audits highlighted infection control hazards, including the improper use of N95® respirators, a lack of available soap and inadequate availability of sharps containers. There is an urgent need to protect HCWs from workplace hazards. Considerable attention is needed to improve infection control practices by HCWs, and especially physicians. Guidelines and legal frameworks exist. It is time to implement the needed measures.
"My experience in getting tuberculosis was horrible, and I know other doctors who have had it much worse (full-blown multidrug-resistant tuberculosis).The system has to do much more to protect us if there are going to be people to provide health care in this country." - Young doctor with rifampicin-resistant tuberculosis, Free State (February 2013)
Haemodialysis catheter-related bloodstream infections at Universitas Academic Hospital, Bloemfontein : should we change our empiric antibiotics? : original researchSource: Southern African Journal of Infectious Diseases 30, pp 29 –33 (2015)More Less
Nosocomial bloodstream infections are only second to cardiovascular disease in causing mortality in patients with end-stage renal disease. The majority of these infections relate to haemodialysis catheters. Empiric antimicrobial treatment is instituted on the clinical suspicion of a catheter-related bloodstream infection (CRBSI) while awaiting the blood culture results. There is a paucity of local data on microbial resistance patterns to guide empiric antibiotic use. This prompted our study. A retrospective survey was performed of cultured organisms and their antibiograms from patients with haemodialysis catheters in the Nephrology Unit at Universitas Academic Hospital, Bloemfontein, between January and December 2012. A list of all blood cultures performed during 2012 at the nephrology unit was compiled from the National Health Laboratory Service's electronic record system. All positive blood cultures associated with CRBSI were included in this study. Duplicate cultures, as well as negative cultures, were excluded. Demographic details were collected from the patient records. There were 79 episodes of suspected CRBSI in the 311 patients dialysed in 2012. Thirty-one distinct episodes of culture-positive, catheter-related infections were identified from 296 blood cultures. These were equally divided between tunnelled and non-tunnelled catheters. There were 15 Staphylococcus spp., eight of which were methicillin resistant, five Enterococcus spp., and three extended-spectrum beta-lactamase (ESBL)-producing Enterobacter spp. There was one episode each of various other organisms. Vancomycin and amikacin remain the empiric treatment for CRBSI in our unit. The emergence of ESBL-related infections should be monitored.
First report of an IMI-2 carbapenemase-producing Enterobacter asburiae clinical isolate in South Africa : case studySource: Southern African Journal of Infectious Diseases 30, pp 34 –35 (2015)More Less
Imipenem-hydrolysing β-lactamase (IMI) enzymes form an uncommon group within the Ambler class A carbapenemases. This report documents the first case in South Africa of an IMI-2 carbapenemase-producing Enterobacter asburiae. The circumstances under which this isolate was acquired are unclear.
Measles outbreak and response immunisation in a south-western district of Nigeria : January to June 2013 : original researchSource: Southern African Journal of Infectious Diseases 30, pp 36 –40 (2015)More Less
An outbreak of measles occurred in Olorunda district, Nigeria, between January and June 2013. Outbreak response immunisation (ORI) was conducted as a control measure. We will describe the epidemiology of the outbreak and assess the impact of ORI. We visited all of the health facilities (73) in July 2013 to ascertain the cases through a review of the patient registers and case notes, using the World Health Organization case definition of measles. Data on children vaccinated during ORI were retrieved. To assess the impact of ORI, cumulative measles incidence for the targeted age group (6-59 months) and non-target age group (< 6 months and ≥ 5 years) was calculated before and after ORI. A total of 94 cases were identified, of which 89% were confirmed by laboratory and epidemiological linkage. More than three quarters (80%) of the confirmed cases were children < 5 years, with a 2% case fatality rate. The outbreak spanned 26 weeks, reaching its peak in week 12. Cases were clustered in the Sabo and Ota Efun wards, with over 88% of the confirmed cases having a zero-dose measles vaccination history. A total of 2 861 children were vaccinated during ORI, with administrative coverage of 10%. The cumulative incidence in the target age prior to ORI was 153.8 per 100 000, which decreased to 27.9 per 100 000 after ORI. The incidence in the non-target age group also decreased from 11.1 per 100 000 before ORI to 2.2 per 100 000 after ORI. Our investigation shows that ORI was effective in the control of the measles outbreak in Olorunda district. Hence, there is need to strengthen the conduct of ORI exercises during a measles outbreak to achieve higher coverage.