10 research outputs found
Clostridioides difficile infection and testing rates in South Africa A multicentre study 20172020
No full textMicrobiological analysis and predictors of gallbladder infection with antimicrobial susceptibility patterns in an HIV setting
No full textBackground
South Africa has a high prevalence of people living with human immunodeficiency virus (HIV; PLWH) who have shown to affect the prevalence and severity of infection and sepsis particularly gallbladder disease. Empirical Antimicrobial (EA) therapy for acute cholecystitis (AC) is based largely on bacteria colonisation of bile (bacteriobilia) and antimicrobial susceptibility patterns (antibiograms) obtained from the developed world where the prevalence of PLWH is very low. In an ever-emerging era of increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored.
Objective
Due to the paucity of data available locally to guide treatment we found it pertinent to examine gallbladder bile for bacteriobilia and antibiograms in a setting with a high prevalence of PLWH to determine if this may demand a review of our local antimicrobial policies for gallbladder infections for both EA and pre-operative antimicrobial prophylaxis (PAP) for laparoscopic cholecystectomies (LC).
Methodology
A retrospective observational descriptive study was undertaken at King Edward VIII Hospital, Durban, KwaZulu-Natal, South Africa. Hospital records were reviewed for all patients undergoing cholecystectomy over a 3-year period. Gallbladder bacteriobilia and antibiograms were assessed and compared between PLWH and HIV uninfected (HIV-U). Pre-operative age, ERCP, PCT, CRP and NLR were used as predictors for bacteriobilia. Statistical analyses were performed using R Project and p values of less than 0.05 were considered as statistically significant.
Results
There were no differences in bacteriobilia or antibiograms between PLWH and HIV-U. There was >30% resistance to amoxicillin/clavulanate and cephalosporins. Aminoglycoside-based therapy, had good susceptibility patterns whilst carbapenem-based therapy demonstrated the lowest resistance levels. ERCP and age were predictors of bacteriobilia (p<0.001 and 0.002 respectively). PCT, CRP and NLR were not.
Conclusion
PLWH should follow the same PAP and EA recommendations as HIV-U. For EA, we recommend, a combination of amoxicillin/clavulanate with aminoglycoside-based therapy (amikacin or gentamycin) or piperacillin/tazobactam as monotherapy. Carbapenem-based therapy should be reserved for drug resistant species. For PAP, we recommend the routine use in older patients and patients with history of ERCP undergoing LC
Emerg Infect Dis
No full textCandida 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
Meeting the psychosocial needs of refugees and asylum-seekers in South Africa: prespective of NGO service providers
No full textSince 1994, South Africa has become one of the major destinations for asylum-seekers and refugees from unsettled countries throughout the African continent. While the international literature has recognised that refugees and asylum-seekers across many different countries have complex psychosocial needs, there is a dearth of literature regarding the psychosocial needs of refugees and asylum-seekers in South Africa. A number of non-governmental organisations (NGOs) provide services to refugees and asylum-seekers in South Africa. However, literature documenting the psychosocial needs that refugees and asylum-seekers present with and the range of services provided by these NGOs is severely limited. In the context of this gap, this study aimed to explore the psychosocial needs that refugees and asylum-seekers in Cape Town present with when they approach an organisation for help, as well as the service provision responses to these needs. In order to do this, a qualitative study focusing on service providers' perceptions about the psychosocial needs of refugees and asylum-seekers in Cape Town, and of service responses to these needs, was conducted. A qualitative approach was used in order to elicit in-depth data from multiple perspectives. Semi-structured interviews were conducted with 14 service providers recruited from four NGOs in Cape Town. Thematic analysis was used to analyse the data generated from the semi-structured interviews. The results of this study emphasise the need to address social and material conditions resulting from conflict and displacement. These needs were perceived as most pressing and immediate. Furthermore, the service provision responses to these needs align with the ecological model, adding to literature that suggests that a multi-modal response is more appropriate for refugees and asylum-seekers than a bio-medically focused response. The findings of this study may contribute to the development of a systematic framework for understanding and responding to the needs of refugees and asylum-seekers in South Africa, and potentially other low and middle-income countries
Laboratory based antimicrobial resistance surveillance for Pseudomonas aeruginosa blood isolates from South Africa
No full textArticle published in the Journal of Infection in Developing Countries; vol 12(8):616-624. doi:10.3855/jidc.9539Introduction: Antimicrobial resistant bacterial infections are widespread globally and increases in antimicrobial resistance presents a major threat to public health. Pseudomonas aeruginosa is an opportunistic healthcare-associated pathogen with high rates of morbidity and mortality and an extensive range of resistance mechanisms. This study describes the antibiotic susceptibility profiles of P. aeruginosa isolates from patients with bacteraemia submitted by sentinel laboratories in South Africa from 2014 to 2015. Methodology: Organism identification and antimicrobial susceptibility testing were done using automated systems. Molecular methods were used to detect common resistance genes and mechanisms. Results: Overall the susceptibility was high for all antibiotics tested with a decrease over the two-year period. There was no change in the MIC50 and MIC90 breakpoints for all antibiotics from 2014 to 2015. The MIC50 was within the susceptible breakpoint range for most antibiotics and the MIC90 was within the susceptible breakpoint range for colistin only. Phenotypically carbapenem non-susceptible isolates harboured the following plasmid-mediated genes: blaVIM (n = 81, 12%) and blaGES (n = 6, 0.9%); blaNDM (n = 4, 0.6%) and blaOXA-48 and variants (n = 3, 0.45%). Porin deletions were observed in one meropenem non-susceptible isolate only, and multi-drug resistance efflux pumps were expressed in the majority of the non-susceptible isolates investigated. BlaVEB-1, blaIMP and blaKPC were not detected. Conclusion: The prevalence of resistance to commonly used antibacterial agents was low for P. aeruginosa isolates and similarly, tested resistance mechanisms were detected in a relatively small proportion of isolates. Findings in this study represent baseline information for understanding antimicrobial susceptibility patterns in P. aeruginosa isolates from blood. Our surveillance report may assist in contributing to hospital treatment guidelines
Laboratory based antimicrobial resistance surveillance for Pseudomonas aeruginosa blood isolates from South Africa
No full textArticle published in the Journal of Infection in Developing Countries 2018; 12(8):616-624. doi:10.3855/jidc.9539Introduction: Antimicrobial resistant bacterial infections are widespread globally and increases in antimicrobial resistance presents a major threat to public health. Pseudomonas aeruginosa is an opportunistic healthcare-associated pathogen with high rates of morbidity and mortality and an extensive range of resistance mechanisms. This study describes the antibiotic susceptibility profiles of P. aeruginosa isolates from patients with bacteraemia submitted by sentinel laboratories in South Africa from 2014 to 2015. Methodology: Organism identification and antimicrobial susceptibility testing were done using automated systems. Molecular methods were used to detect common resistance genes and mechanisms. Results: Overall the susceptibility was high for all antibiotics tested with a decrease over the two-year period. There was no change in the MIC50 and MIC90 breakpoints for all antibiotics from 2014 to 2015. The MIC50 was within the susceptible breakpoint range for most antibiotics and the MIC90 was within the susceptible breakpoint range for colistin only. Phenotypically carbapenem non-susceptible isolates harboured the following plasmid-mediated genes: blaVIM (n = 81, 12%) and blaGES (n = 6, 0.9%); blaNDM (n = 4, 0.6%) and blaOXA-48 and variants (n = 3, 0.45%). Porin deletions were observed in one meropenem non-susceptible isolate only, and multi-drug resistance efflux pumps were expressed in the majority of the non-susceptible isolates investigated. BlaVEB-1, blaIMP and blaKPC were not detected. Conclusion: The prevalence of resistance to commonly used antibacterial agents was low for P. aeruginosa isolates and similarly, tested resistance mechanisms were detected in a relatively small proportion of isolates. Findings in this study represent baseline information for understanding antimicrobial susceptibility patterns in P. aeruginosa isolates from blood. Our surveillance report may assist in contributing to hospital treatment guidelines
Laboratory based antimicrobial resistance surveillance for Pseudomonas aeruginosa blood isolates from South Africa
No full textCITATION: Singh-Moodley, A., et al. 2018. Laboratory based antimicrobial resistance surveillance for Pseudomonas aeruginosa blood isolates from South Africa. Journal of Infection in Developing Countries, 12(8):616-624, doi:10.3855/jidc.9539.The original publication is available at https://jidc.orgIntroduction: Antimicrobial resistant bacterial infections are widespread globally and increases in antimicrobial resistance presents a major threat to public health. Pseudomonas aeruginosa is an opportunistic healthcare-associated pathogen with high rates of morbidity and mortality and an extensive range of resistance mechanisms. This study describes the antibiotic susceptibility profiles of P. aeruginosa isolates from patients with bacteraemia submitted by sentinel laboratories in South Africa from 2014 to 2015.
Methodology: Organism identification and antimicrobial susceptibility testing were done using automated systems. Molecular methods were used to detect common resistance genes and mechanisms.
Results: Overall the susceptibility was high for all antibiotics tested with a decrease over the two-year period. There was no change in the MIC50 and MIC90 breakpoints for all antibiotics from 2014 to 2015. The MIC50 was within the susceptible breakpoint range for most antibiotics and the MIC90 was within the susceptible breakpoint range for colistin only. Phenotypically carbapenem non-susceptible isolates harboured the following plasmid-mediated genes: blaVIM (n = 81, 12%) and blaGES (n = 6, 0.9%); blaNDM (n = 4, 0.6%) and blaOXA-48 and variants (n = 3, 0.45%). Porin deletions were observed in one meropenem non-susceptible isolate only, and multi-drug resistance efflux pumps were expressed in the majority of the non-susceptible isolates investigated. BlaVEB-1, blaIMP and blaKPC were not detected.
Conclusion: The prevalence of resistance to commonly used antibacterial agents was low for P. aeruginosa isolates and similarly, tested resistance mechanisms were detected in a relatively small proportion of isolates. Findings in this study represent baseline information for understanding antimicrobial susceptibility patterns in P. aeruginosa isolates from blood. Our surveillance report may assist in contributing to hospital treatment guidelines.https://jidc.org/index.php/journal/article/view/9539Publisher's versio
Epidemiologic shift in Candidemia driven by Candida auris, South Africa, 2016–2017
No full textCandida 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.http://wwwnc.cdc.gov/eidam2020School of Health Systems and Public Health (SHSPH
Securitisation from Below: The Relationship between immigration and foreign policy in South Africa's Approach to the Zimbabwe Crisis
No full textThe political and economic debacle in
Zimbabwe has led to a large-scale influx of
Zimbabweans into neighbouring South
Africa. This article argues that there is a
complex and significant link between the
domestic response to this immigration influx
and South Africa’s foreign policy towards
Zimbabwe. South Africa’s foreign and
security policy elite preferred to use an
immigration approach of benign neglect as a
tool to promote its ‘quiet diplomacy’
approach towards the Zimbabwean regime,
treating the influx as a ‘non-problem’. But
increased xenophobic violence, vigilantism
and protests in townships and informal
settlements against Zimbabwean and other
African immigrants, culminating in
widespread riots across the country in
2008, contributed to a change not only in
immigration policy but also in the mediation
efforts towards the Zimbabwean parties. I
argue that this foreign policy change
was pushed by a process of ‘securitisation
from below’, where the understanding of
Zimbabwean immigrants as a security
threat were promoted not by traditional
security elites but by South Africa’s
marginalised urban poor
Exploring atitudes towards immigrants in Cape Town, South Africa
No full textEarlier studies conducted in South Africa suggest that negative attitudes towards immigrants are widespread and driven by resource strain, issues around national identity, and the process of ‘othering’. This study uses data from the fifth wave of the Cape Area Panel Study, with a representative sample of young adults (n=2915), in order to explore attitudes towards immigrants in Cape Town. Using a series of vignettes, that is, descriptions of situations in which the details are varied systematically, the researcher examines the extent to which the nationality and individual circumstances of immigrants affect support for deportation or the legitimacy of illegal direct action against them
