Southern African Journal of Infectious Diseases最新文献

Background: Group A Streptococcus (GAS) is a human pathogen that causes various diseases ranging from localised infections to toxin- and immune-mediated conditions.

Objectives: We aimed to describe the prevalence of GAS pharyngitis in northwestern Tshwane and to characterise GAS isolates from this region.

Method: GAS isolates were obtained from throat swabs of patients presenting with symptoms of pharyngitis. Clinical isolates were also collected from the DGM Laboratory. Minimum inhibitory concentrations for penicillin, erythromycin and clindamycin were determined using the E-test method. M-protein (emm) typing and superantigens (SAgs) profiles were determined using conventional PCR and sequencing.

Results: Among the 400 throat swabs collected, 33 (8%) tested positive for GAS on culture. Additionally, 72 clinical isolates were obtained. Overall, 105 isolates were available, of which 8 (7.6%) were invasive and 97 (92.4%) were non-invasive. All the isolates were susceptible to the tested antibiotics. Twenty-seven emm types were identified, with emm82 being the most prevalent (15%). The potential vaccine coverage among the isolates was 11%. The SAg profiles identified were K and Q.

Conclusion: The prevalence of GAS pharyngitis was 8%. No antimicrobial resistance detected. Emm typing showed significant diversity, with more than half of the isolates not covered by the 30-valent M-protein vaccine. The most prevalent was emm82, with speH and speI SAgs equally prevalent in these isolates. The main SAg profiles identified were K and Q. The diversity of these virulence factors suggests that it would be a challenge to consider them as potential vaccine candidates in this region.

Contribution: These epidemiological findings offer significant data on the emm types and SAgs in GAS isolates circulating in the region, which may inform the development of an effective vaccine.

We describe the case of a middle-aged man and long-term smoker, presenting in cardiac tamponade with paroxysmal atrial flutter, with translocation of Candida glabrata into the pericardial space as a result of an erosive malignant oesophago-pericardial fistula.

Contribution: The isolation of Candida species from the pericardial space is a rare manifestation of invasive candida infection, carrying a high mortality rate, and requires interrogation for possible underlying immune aberrations or mechanical portals of entry.

Background: Increasing multidrug-resistant bacterial infections are a global health challenge. Colistin, a polymyxin antimicrobial, has activity against some resistant strains, and despite its adverse effects, it presents a last-line option to treat resistant Gram-negative pathogens. However, paediatric colistin prescribing guidelines are lacking.

Objectives: To determine paediatric colistin prescribing practices and challenges in South Africa (SA) to aid the development of a paediatric colistin guideline.

Method: We conducted an anonymous online survey of registered medical practitioners in SA who prescribed colistin to patients aged ≤ 14 years in the past 12 months.

Results: Of 196 participants, 71.9% (n = 141/196) completed the survey. Eighty-six respondents (n = 86/146; 58.9%) reported prescribing loading doses (LD), with the median LD and maintenance doses of 150 000 IU/kg/dose (interquartile range (IQR), 75 000-150 000) and 50 000 IU/kg/dose (IQR, 40 000-50 000), respectively. Empiric colistin use was reported by 47.2% (n = 69/146), of whom 46.3% (n = 32/69) continued empiric colistin for ≥ 72 h. Using the Likert scale, respondents highly perceived that therapeutic drug monitoring should be readily available (mean = 3.97). The perception that prescribing colistin should be advised by a microbiologist or infectious disease specialist had a mean score of 2.97, indicating moderate agreement.

Conclusion: This survey demonstrated varied paediatric colistin prescribing practices. Recently, a new evidence-based paediatric guideline for colistin use in SA has been published. A follow-up survey will be conducted to assess the impact of the guideline on paediatric colistin prescribing practices in SA.

Contribution: This study highlighted paediatric colistin dosing practices in the absence of a paediatric colistin guideline in South Africa.

Background: Adolescents living with HIV face barriers that impede adherence and retention. Differentiated service delivery (DSD) models aim to improve retention and viral suppression (VS), but there is limited programmatic evidence from South Africa on DSD outcomes.

Objectives: This study aimed to measure 12 month retention and VS proportions in adolescents enrolled in DSD and clinic-based care, and measure the association between 12 month retention, VS and covariates.

Method: A retrospective cohort study was conducted in the Mopani District, Limpopo province, using TIER.Net data. The study included adolescents aged 10-19 years enrolled in DSD between 01 September 2019 and 30 September 2022, and those eligible for DSD with viral load < 50 copies/mL. The study measured 12-month retention and VS proportions. Multivariable logistic regression measured association among 12-month retention, VS and exposure variables.

Results: A total of 646 adolescents in DSD and 1282 in clinic-based care were included. Twelve-month retention was 92.7% (599/646) in DSD and 89.0% (1141/1282) in clinic-based care. There was no association between 12-month retention and being enrolled in DSD versus clinic-based care. Twelve-month VS (< 50 copies/mL) was 63.5% (251/395) in DSD, compared to clinic-based care 51.0% (494/969). In multivariable regression, being on DSD was associated with higher VS at < 50 copies/mL (Adjusted Odds Ratio [AOR] 1.6; 95% confidence interval: 1.2-2.1; p < 0.001) than clinic-based care.

Conclusion: Differentiated service delivery improved VS in adolescents in a rural setting and should be prioritised to improve outcomes.

Contribution: Differentiated service delivery improves adolescent VS in a rural setting.

Background: Influenza outbreaks rapidly threaten public health, making vaccination a critical tool in reducing transmission. Health care workers (HCWs), especially those in direct patient care roles within all health care settings, are encouraged to receive annual influenza vaccinations to enhance their immunity and ensure patient safety.

Objectives: This study aimed to identify and describe the factors associated with HCWs' adherence to annual influenza vaccination within a United Arab Emirates (UAE) hospital and provide recommendations to improve adherence rates.

Method: Using a quantitative approach, a questionnaire based on the Health Belief Model and existing literature was administered to all 2,080 staff members of the UAE hospital under study. Of these, 1018 participants completed the questionnaire.

Results: The study uncovered several key factors influencing HCWs' influenza vaccine uptake. Notably, social influence from colleagues emerged as a significant factor, alongside barriers, such as inconvenient vaccination times, limited awareness of hospital policies, an absence of follow-up by the hospital administration, a lack of prior influenza cases and fear of injections. Motivational factors included the desire to protect friends and family, employer recommendations, mandatory policies and HCWs' intrinsic motivation to safeguard patients.

Conclusion: The findings of the study informed recommendations to enhance vaccination rates. These recommendations include health education materials, social media awareness campaigns, mandatory vaccination policies, on-duty vaccination services, free vaccination, flexible post-vaccination recovery time, special sick leave policies and vaccine benefit awareness.

Contribution: These suggestions enable health care organisations to boost employee influenza vaccination rates, aiding public health efforts to cope with seasonal influenza outbreaks.

Background: Carbapenem-resistant Enterobacterales (CRE) are important healthcare-associated pathogens in resource-limited paediatric intensive care units (PICUs). The prevalence and clinical predictors of CRE colonisation in South African PICUs are unknown.

Objectives: To determine CRE colonisation status in a South African PICU.

Method: Between 01 January 2022 and 31 December 2022, we collected admission and exit rectal swabs from children admitted to Tygerberg Hospital PICU, Cape Town. Prevalent CRE was defined as CRE-colonised at PICU admission, including children isolating CRE in the preceding 6 months. Incident CRE was defined as acquisition of CRE colonisation during the PICU stay.

Results: Among 638 PICU admissions, we included 552 children (median age 9 months, 54% male) with an entry swab and/or known positive CRE colonisation status; 237 (42.9%) had exit rectal swabs collected. Prevalent CRE was identified in 8% (44/552) on admission, with 29/44 (65.9%) newly identified as CRE-colonised. Incident CRE was identified in 24/227 (10.6%) admissions. Children with prevalent CRE were younger than those not CRE-colonised at PICU entry (median 4.5 months vs 10 months; p < 0.05). Children with incident CRE were younger (median 3 months vs 8 months; p < 0.05), and had longer PICU stays (median 7 vs 4 days; p < 0.05) compared to those who remained CRE-non-colonised.

Conclusion: CRE colonisation is common in PICU patients with implications for admission, isolation and antibiotic policies. Better understanding of clinical predictors of CRE colonisation will support the development of appropriate CRE screening recommendations and interventions.

Contribution: This study provides insight into the burden and predictors of CRE colonisation in a South African PICU setting.

Background: Maternal syphilis (MS) is of special concern because of the risks of vertical transmission resulting in high rates of stillbirths and neonatal infections, especially in low- and middle-income countries (LMICs), such as South Africa (SA).

Objectives: To assess the clinical management of MS at two primary healthcare clinics.

Method: This was a retrospective evaluation of the antenatal records from 2020 to 2023 at two clinics in the Free State, SA. Demographic and clinical data, including MS mono rapid plasma reagin test and HIV status measured using the mono rapid HIV test, foetal and perinatal outcomes were collected.

Results: 668 records were reviewed. Fifteen tested (2.3%) positive for MS, but only 12/15 received complete treatment. Of the syphilis negative women, only 365 (55.3%) were retested. 28% of all pregnant women were HIV-positive. Four of the 15 (27%) women with MS had HIV, while 11 of the 15 (73%) of the HIV-negative pregnant women had syphilis. Among syphilis-exposed neonates, two had complications due to syphilis exposure and one had low birthweight despite maternal treatment.

Conclusion: The prevalence of MS at the study sites was 2.3%. 44.7% of the women who tested negative for syphilis were not retested, and three women with syphilis did not receive complete treatment. Incomplete treatment of the mothers' results in complications in syphilis-exposed neonates. There is an urgent need for continuing training for the nurses and midwives on antenatal screening and treatment protocols for MS at primary healthcare settings in the Free State, SA.

Contribution: This work will benefit the community by alerting the Department of Health on the short comings found at antenatal care clinics, with the goal to improve the management of pregnant women.

Background: Carbapenem-resistant Enterobacterales (CRE) have emerged as major healthcare-associated infection (HAI) pathogens globally with substantial associated mortality and morbidity.

Objectives: We conducted a retrospective cohort study to determine the prevalence of rectal CRE colonisation in neonates referred from a central hospital, to a regional and a district hospital in the Western Cape Province of South Africa (01 March 2019 - 30 September 2020).

Method: Clinical data and laboratory records were reviewed to identify possible factors associated with CRE colonisation using stepwise forward logistic regression analysis.

Results: Among 291 neonates transferred to the regional and district hospitals, the median birth weight and gestational age were 1360 (interquartile range [IQR]: 1080 g - 1690 g) and 31 (IQR: 29-33) weeks. The overall CRE rectal colonisation prevalence at the time of transfer from the central hospital was 22.3% (65/291), with colonising species including Klebsiella pneumoniae (59/65, 90.8%) and Serratia marcescens (6/65; 9.2%). There were no factors significantly associated with CRE colonisation. No CRE-colonised neonate subsequently developed CRE infection. Post-discharge mortality rates were similar in the CRE-colonised versus the non-colonised neonates (2/65 [3.1%] vs. 9/226 [4.0%]; p = 0.737).

Conclusion: There was no increased risk of subsequent CRE infection or mortality in the 12 months post-discharge in neonates who were CRE colonised.

Contribution: Rectal colonisation with CRE was highly prevalent in preterm neonates being transferred for step-down hospital care. Carbapenem-resistant Enterobacterales-colonised neonates had similar demographic characteristics to non-colonised neonates, with no factors significantly associated with CRE colonisation.

This study evaluated six DNA (Deoxyribonucleic acid) extraction methods for Mycobacterium avium, focusing on cost, procedure time, yield, quality, DNA integrity, and suitability for amplicon-based sequencing. The extracted DNA was used in the GenoType^® Mycobacterium Common Mycobacterium (CM) line probe assay (LPA), which is routinely used for nontuberculous mycobacteria (NTM) identification in South Africa.

Contribution: The findings demonstrate that the currently used DNA extraction method, GenoLyse^® Version 1.0, remains the fastest, simplest, and most cost-effective approach for routine NTM identification, despite lower DNA yields. GenoLyse also shows potential for implementation in amplicon-based sequencing of NTM, specifically when amplifying the 16S rRNA gene.

We present a case of severe cefepime-induced neurotoxicity following acute kidney injury in a patient with a fracture-related infection. Despite stopping cefepime, the patient required intubation, ventilation, multiple antiepileptic drugs for seizure control, and haemodialysis.

Contribution: Cefepime-induced neurotoxicity is a reversible cause of encephalopathy. Early recognition and cefepime withdrawal are crucial. As cefepime use in South Africa increases due to antimicrobial resistance, healthcare workers must be aware of this under-recognised, under-reported serious adverse drug reaction.