Paediatric chronic suppurative otitis media in the Free State Province: Clinical and audiological features

Background. Chronic suppurative otitis media (CSOM) is a chronic infection of the middle ear cleft. In sub-Saharan Africa >50% of cases occur in children <10 years of age.Objectives. To describe the otological, audiological and bacteriological findings in children with CSOM.Methods. We conducted a prospective study at the Ear, Nose and Throat (ENT) Clinic at Universitas Academic Hospital between August 2009 and December 2010. We included all children with CSOM over this period. Patients underwent ENT and paediatric examination, and were tested for HIV. Pus swabs were taken after an ear toilet for routine microbiology, fungal and Mycobacterium tuberculosis culture. We performed audiological testing after the otorrhoea had resolved.Results. Eighty-six children (113 ears) were included, with a median age of 4.6 years (range 1 - 12 years). The mean duration of otorrhoea was 161.7 weeks (range 4 - 572 weeks). Nine patients (10.5%) presented with coalescent mastoiditis and/or intracranial complications of CSOM. Of the 153 organisms identified; Gram-negative bacteria were present in 93 (82.3%) ears, with 94.8% of these being sensitive to quinolones. Only 1 case of tuberculous otitis media was identified. HIV infection was present in 54.6% of patients tested. There was a hearing loss in 44 (66.7%) of the tested affected ears.Conclusions. There was a long delay between the onset of symptoms and accessing ENT services. Most cases of CSOM were due to quinolone-sensitive Gram-negative aerobes. There was a high prevalence of cholesteatoma, hearing loss and other complications in children in this study

Antimicrobial Susceptibility Patterns of Selected Bacteraemic Isolates from South African Public Sector Hospitals, 2010

We report on antimicrobial susceptibility surveillance data for six key bloodstream pathogens (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus) identified in public sector hospitals in South Africa during 2010. Major findings include the accelerated emergence of carbapenem resistance among K. pneumoniae and Enterobacter species, with overall susceptibility rates of 98% and 96% for ertapenem, and above 99% for meropenem and imipenem. Levels of resistance among P. aeruginosa and A. baumannii remain high in all centres, with few changes since 2009. Large decreases in piperacillin-tazobactam susceptibility rates were noted at three institutions, probably related to methodological issues. S. aureus remains a major pathogen countrywide, with between 30-60% of isolates resistant to cloxacillin [methicillin-resistant S. aureus (MRSA)]. Ongoing surveillance for antimicrobial resistance is vital, and the use of a centralised data extraction system may aid in this.http://www.sajei.co.za/index.php/SAJE

Systemic shigellosis in South Africa

BACKGROUND: Systemic disease due to shigellae is associated with human immunodeficiency virus (HIV), malnutrition, and other immunosuppressed states. We examined the clinical and microbiologic characteristics of systemic shigellosis in South Africa, where rates of HIV infection are high. METHODS: From 2003 to 2009, 429 cases of invasive shigellosis were identified through national laboratory-based surveillance. At selected sites, additional information was captured on HIV serostatus and outcome. Isolates were serotyped and antimicrobial susceptibility testing performed. RESULTS: Most cases of systemic shigellosis were diagnosed on blood culture (408 of 429 cases; 95%). HIV prevalence was 67% (80 of 120 cases), highest in patients aged 5–54 years, and higher among females (55 of 70 cases; 79%) compared with males (25 of 48 cases; 52%; P 5 .002). HIV-infected people were 4.1 times more likely to die than HIV-uninfected cases (case-fatality ratio, 29 of 78 HIV-infected people [37%] vs 5 of 40 HIV-uninfected people [13%]; P 5 .008; 95% confidence interval [CI], 1.5–11.8). The commonest serotype was Shigella flexneri 2a (89 of 292 serotypes [30.5%]). Pentavalent resistance occurred in 120 of 292 isolates (41.1%). There was no difference in multidrug resistance between HIV-infected patients (33 of 71 [46%]) and uninfected patients (12 of 33 [36%]; 95% CI, .65–3.55). CONCLUSIONS: Systemic shigellosis is associated with HIV-infected patients, primarily in older girls and women, potentially due to the burden of caring for sick children in the home; interventions need to be targeted here. Death rates are higher in HIV-infected versus uninfected individuals.The US Agency for International Development’s Antimicrobial Resistance Initiative, transferred via a cooperative agreement (grant U60/CCU022088) from the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia. For 2007–2009, it was supported by the Departments of Health and Human Services (HHS) CDC, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), the Global AIDS Program (GAP) Cooperative Agreement (U62/PSO022901). P. C.-G. and S. M. are funded through grant U60/CCU022088.http://cid.oxfordjournals.org

Antimicrobial susceptibility patterns of selected bacteraemic isolates from South African public sector hospitals, 2010

We report on antimicrobial susceptibility surveillance data for six key bloodstream pathogens (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus) identified in public sector hospitals in South Africa during 2010. Major findings include the accelerated emergence of carbapenem resistance among K. pneumoniae and Enterobacter species, with overall susceptibility rates of 98% and 96% for ertapenem, and above 99% for meropenem and imipenem. Levels of resistance among P. aeruginosa and A. baumannii remain high in all centres, with few changes since 2009. Large decreases in piperacillin-tazobactam susceptibility rates were noted at three institutions, probably related to methodological issues. S. aureus remains a major pathogen countrywide, with between 30-60% of isolates resistant to cloxacillin [methicillin-resistant S. aureus (MRSA)]. Ongoing surveillance for antimicrobial resistance is vital, and the use of a centralised data extraction system may aid in this.http://www.sajei.co.za/index.php/SAJE