The Global Antibiotic Resistance Partnership (GARP)

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Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates from South Africa

Objectives: Trends in the antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) are regularly investigated in many countries, but few country-wide data are available for South Africa. The aim of this study was to describe the antibiotic susceptibility patterns of MRSA isolates collected in South Africa. Design: Susceptibility testing of 248 MRSA isolates collected from 15 National Health Laboratory Service (NHLS) and 8 private laboratories against 17 antibiotics was performed using the disk diffusion method. Demographic data was collected and correlated with antibiotic resistance patterns. Results: Antibiotic resistance of MRSA to erythromycin, tetracycline, trimethoprim/sulfamethoxazole, gentamicin and ciprofloxacin ranged between 55%-78%, while all isolates were susceptible to teicoplanin, linezolid, vancomycin and quinopristin/dalfopristin. A significant difference in the resistance pattern of the isolates to certain antimicrobial agents was identified amongst adults and children, as well as between isolates collected from the private and NHLS sectors. Conclusions: This is the first extensive report of antimicrobial susceptibilities of South African MRSA isolates. These data can assist with treatment decisions and form a baseline for further surveillance

Prevalence and trends of staphylococcus aureus bacteraemia in hospitalized patients in South Africa, 2010 to 2012: laboratory-based surveillance mapping of antimicrobial resistance and molecular epidemiology.

CAPRISA, 2015.Abstract available in pdf

Development of standardized laboratory methods and quality processes for a phase III study of the RTS, S/AS01 candidate malaria vaccine

BACKGROUND\ud \ud A pivotal phase III study of the RTS,S/AS01 malaria candidate vaccine is ongoing in several research centres across Africa. The development and establishment of quality systems was a requirement for trial conduct to meet international regulatory standards, as well as providing an important capacity strengthening opportunity for study centres.\ud \ud METHODS\ud \ud Standardized laboratory methods and quality assurance processes were implemented at each of the study centres, facilitated by funding partners.\ud \ud RESULTS\ud \ud A robust protocol for determination of parasite density based on actual blood cell counts was set up in accordance with World Health Organization recommendations. Automated equipment including haematology and biochemistry analyzers were put in place with standard methods for bedside testing of glycaemia, base excess and lactacidaemia. Facilities for X-rays and basic microbiology testing were also provided or upgraded alongside health care infrastructure in some centres. External quality assurance assessment of all major laboratory methods was established and method qualification by each laboratory demonstrated. The resulting capacity strengthening has ensured laboratory evaluations are conducted locally to the high standards required in clinical trials.\ud \ud CONCLUSION\ud \ud Major efforts by study centres, together with support from collaborating parties, have allowed standardized methods and robust quality assurance processes to be put in place for the phase III evaluation of the RTS, S/AS01 malaria candidate vaccine. Extensive training programmes, coupled with continuous commitment from research centre staff, have been the key elements behind the successful implementation of quality processes. It is expected these activities will culminate in healthcare benefits for the subjects and communities participating in these trials.\ud \ud TRIAL REGISTRATION\ud \ud Clinicaltrials.gov NCT00866619

National sentinel site surveillance for antimicrobial resistance in Klebsiella pneumoniae isolates in South Africa, 2010-2012

Please cite as follows: Perovic, O. et al. 2014. National sentinel site surveillance for antimicrobial resistance in Klebsiella pneumoniae isolates in South Africa, 2010-2012. South African Medical Journal, 104(8):563-568, doi:10.7196/SAMJ.7617.The original publication is available at http://www.samj.org.zaBackground. The increasing rates of antimicrobial resistance observed in the nosocomial pathogen Klebsiella pneumoniae are of major public health concern worldwide. Objectives. To describe the antibiotic susceptibility profiles of K. pneumoniae isolates from bacteraemic patients submitted by sentinel laboratories in five regions of South Africa from mid-2010 to mid-2012. Molecular methods were used to detect the most commonly found extended-spectrum beta-lactamase (ESBL) and carbapenemase resistance genes. Methods. Thirteen academic centres serving the public healthcare sector in Gauteng, KwaZulu-Natal, Free State, Limpopo and Western Cape provinces submitted K. pneumoniae isolates from patients with bloodstream infections. Vitek 2 and MicroScan instruments were used for organism identification and susceptibility testing. Multiplex polymerase chain reactions (PCRs) were used to detect blaCTX-M, blaSHV and blaTEM genes in a proportion of the ESBL isolates. All isolates exhibiting reduced susceptibility to carbapenems were PCR tested for blaKPC and blaNDM-1 resistance genes. Results. Overall, 68.3% of the 2 774 isolates were ESBL-positive, showing resistance to cefotaxime, ceftazidime and cefepime. Furthermore, 46.5% of all isolates were resistant to ciprofloxacin and 33.1% to piperacillin-tazobactam. The major ESBL genes were abundantly present in the sample analysed. Most isolates (95.5%) were susceptible to the carbapenems tested, and no isolates were positive for blaKPC or blaNDM-1. There was a trend towards a decrease in susceptibility to most antibiotics. Conclusion. The high proportion of ESBL-producing K. pneumoniae isolates observed, and the prevalence of ESBL genes, are of great concern. Our findings represent a baseline for further surveillance in SA, and can be used for policy and treatment decisions.http://www.samj.org.za/index.php/samj/article/view/7617Publisher's versio

National sentinel site surveillance for antimicrobial resistance in Klebsiella pneumoniae isolates in South Africa, 2010 - 2012

BACKGROUND. The increasing rates of antimicrobial resistance observed in the nosocomial pathogen Klebsiella pneumoniae are of major public health concern worldwide. Objectives. To describe the antibiotic susceptibility profiles of K. pneumoniae isolates from bacteraemic patients submitted by sentinel laboratories in five regions of South Africa from mid-2010 to mid-2012. Molecular methods were used to detect the most commonly found extended-spectrum beta-lactamase (ESBL) and carbapenemase resistance genes. METHODS. Thirteen academic centres serving the public healthcare sector in Gauteng, KwaZulu-Natal, Free State, Limpopo and Western Cape provinces submitted K. pneumoniae isolates from patients with bloodstream infections. Vitek 2 and MicroScan instruments were used for organism identification and susceptibility testing. Multiplex polymerase chain reactions (PCRs) were used to detect blaCTX-M, blaSHV and blaTEM genes in a proportion of the ESBL isolates. All isolates exhibiting reduced susceptibility to carbapenems were PCR tested for blaKPC and blaNDM-1 resistance genes. RESULTS. Overall, 68.3% of the 2 774 isolates were ESBL-positive, showing resistance to cefotaxime, ceftazidime and cefepime. Furthermore, 46.5% of all isolates were resistant to ciprofloxacin and 33.1% to piperacillin-tazobactam. The major ESBL genes were abundantly present in the sample analysed. Most isolates (95.5%) were susceptible to the carbapenems tested, and no isolates were positive for blaKPC or blaNDM-1. There was a trend towards a decrease in susceptibility to most antibiotics. CONCLUSION. The high proportion of ESBL-producing K. pneumoniae isolates observed, and the prevalence of ESBL genes, are of great concern. Our findings represent a baseline for further surveillance in SA, and can be used for policy and treatment decisions.http://www.samj.org.zaam201

Nosocomial Outbreak of Novel Arenavirus Infection, Southern Africa

This case reinforces the need for strict screening of internationally transferred patients

Comparison of 14-day catheter-related infection rates between standard and antiseptic-impregnated central venous catheters in intensive care patients

The most frequent life-threatening complication of central venous catheters (CVCs) is septicaemia. Most CVC-related septicaemias derive from invasion of the catheter wound by microorganisms from the patient’s own cutaneous microflora. To decrease the rates of CVC related sepsis, it has been the practice of many intensive care units to re-sito CVCs at specified intervals (e.g., every seven days). However, there is good evidence to suggest that CVCs should remain in place until there is a clinical indication (e.g., fever without a known source) for change. In recent years, antisepticand antibiotic- impregnated catheters have been studied to determine whether they substantially reduce the incidence o f catheter-related infection, extend the time that CVCs can be left in place safely, and are, overall, cost-effective. The purpose o f this study was to compare standard CVCs (ARROW Standard Triple Lumen catheter, Arrow International, Inc., Reading, Pa, US) with chlorhexidine gluconate/silver sulfadiazine-impregnated CVCs (ARROWgard™ Triple Lumen Catheter, Arrow International, Inc., Reading, Pa, US) left in situ for 14 days in adult intensive care unit (ICU) patients. Clinical data were collected and microbiological analyses were performed to determine the following: 1) the epidemiology of CVCrelated infections (CRIs) in the General Intensive Care Unit, Johannesburg Hospital; 2) whether the use o f antiseptic-impregnated (ARROWgard) catheters can significantly decrease the incidence of catheter-related infection as compared to the ARROW Standard CVC at 14 days; and 3) whether the duration of catheter insertion can be safely increased to 14 days. This is the first study conducted in South Africa documenting the epidemiology and rates o f CVC-related infections (expressed per 1000 CVC days) in ICU patients, using the synthesis o f both clinical and microbiological definitions as proposed by the Centers for Disease Control and Prevention (CDC), US. The General ICU of the Johannesburg Hospital is a multidisciplinary unit that admits trauma, medical,gynaecology and surgical patients. Of the original sample of 149 patients receiving CVCs, only 118 CVCs were evaluable. Sixty-two patients received ARROW Standard CVCs and 56 received ARROWgard ™ CVCs. Data presented in this report on the types o f colonising organisms (predominantly skin colonisers) and those causing infections via the transcutaneous route are consistent with those described in other studies. The routes of catheter infection in our patients, viz., mainly transcutaneous and the catheter hub,are likewise well documented in the literature. Molecular techniques (macrorestriction analysis using PFGE) were found to be useful in elucidating the aetiological role of coagulase-negative staphylococci in CRIs. There was no statistically significant difference in total bloodstream infection rates between the group of patients who received ARROW Standard catheters (14.1 CRB s/1000 CVC days) and those who received ARROWgard catheters (10.8 CRBsZ 1000 CVC days). If only primary bloodstream infections are considered (i.e., excluding haematogenous seeding o f the CVC) there is still no statistically significant difference in CRI rates between the 2 catheter groups (12.7 CRTs/1000 CVC days and 8.1 CRTs/1000 CVC days for the ARROW Standard and ARROWgard ™ CVCs respectively). It is pertinent to note that the absence of statistical significance between the 2 groups was noted despite the fact that the ARROW Standard CVC group included more than double the number of trauma patients than the ARROWgard ™ group (20/62 [69%] versus 9/56 [31%] respectively). Furthermore, all patients with an additional intravascular catheter other than a CVC (6/118 [5.1%]) all belonged to the ARROW Standard group. Trauma patients as well as patients with other intravascular devices are, for obvious reasons, more likely to be susceptible to CRTs. Statistical analyses showed, in this study, that it was significant that more than double the number of trauma patients (p = 0.04) and all patients with other intravascular devices (p - 0.016) belonged to the ARROW Standard group with no apparent difference in infection rates in the 2 groups. The mean duration of catheter placement for the full sample of 118 CVCs was 12.31 days. The relatively high rates of CRTs documented in our ICU should caution practitioners against leaving catheters in situ for periods longer than absolutely necessary. Further studies carried out in multi-disciplinary ICUs are required to determine an acceptable range of sepsis rates in this setting. Such studies should also investigate the optimal duration of CVC placement. This study adds to the growing body of literature that suggests that chlorhexidine gluconate/silver sulfadiazine-impregnated CVCs are marginally, if at all, more effective than standard catheters in reducing CRIs. Until such time that more data become available to confirm or refute the anti-infective benefits, and therefore the cost-effectiveness, of chlorhexidine gluconate /silver-sulfadiazine impregnated CVCs, it seems reasonable to reduce CRTs by concentrating on meticulous infection control practice