9 research outputs found
Federation of Infectious Diseases Societies of Southern Africa guideline : recommendations for the detection, management and prevention of healthcare-associated Candida auris colonisation and disease in South Africa
Candida auris has been detected at almost 100 South African hospitals, causing large
outbreaks in some facilities, and this pathogen now accounts for approximately 1 in 10 cases
of candidaemia. The objective of this guideline is to provide updated, evidence-informed
recommendations outlining a best-practice approach to prevent, diagnose and manage
C. auris disease in public- and private-sector healthcare settings in South Africa. The 18
practical recommendations cover five focus areas: laboratory identification and antifungal
susceptibility testing, surveillance and outbreak response, infection prevention and control,
clinical management and antifungal stewardship.The South African Society for Clinical Microbiology and the Federation of Infectious Diseases Societies of Southern Africa.https://sajid.co.za/index.php/sajidpm2020School of Health Systems and Public Health (SHSPH
Native valve endocarditis due to Candida parapsilosis in an adult patient
Candida endocarditis is rare, but associated with a high mortality. The most common species implicated is Candida albicans. The epidemiology of invasive Candida infections is changing, with a predominance of non-albicans species causing invasive disease. We describe a case of Candida parapsilosis endocarditis in an HIV-positive patient with pre-existing mitral valve disease and renal failure on haemodialysis. The patient presented with fever and malaise. Clinical examination revealed pulmonary oedema and severe mitral regurgitation. Blood cultures were positive for C. parapsilosis. β-D-glucan assay levels were elevated. An echocardiogram showed large, friable vegetations on the mitral valve. C. parapsilosis was cultured from the haemodialysis tip and the vegetations. The patient responded well to mitral valve replacement and antifungal therapy. A high index of suspicion and aggressive diagnostic modalities and therapy are essential in patients with candidaemia, to decrease mortality due to this condition
Candida auris in South Africa, 2012–2016
To determine the epidemiology of Candida auris in South Africa, we reviewed data from public- and private-sector diagnostic laboratories that reported confirmed and probable cases of invasive disease and colonization for October 2012–November 2016. We defined a case as a first isolation of C. auris from any specimen from a person of any age admitted to any healthcare facility in South Africa. We defined probable cases as cases where the diagnostic laboratory had used a nonconfirmatory biochemical identification method and C. haemulonii was cultured. We analyzed 1,692 cases; 93% were from private-sector healthcare facilities, and 92% of cases from known locations were from Gauteng Province. Of cases with available data, 29% were invasive infections. The number of cases increased from 18 (October 2012–November 2013) to 861 (October 2015–November 2016). Our results show a large increase in C. auris cases during the study period, centered on private hospitals in Gauteng Province
First detection of human dirofilariasis in South Africa
Humans are occasionally inadvertently infected with dirofilariae, the zoonotic nematodes. We report two cases of human dirofilariasis in South Africa, an area apparently non-endemic for this infection. Dirofilariasis is frequently misdiagnosed, so increased awareness of this entity in areas that are non-endemic is essential for prevention of inappropriate investigations and invasive therapy
Best practices : appropriate use of the new β-lactam/ β-lactamase inhibitor combinations, ceftazidimeavibactam and ceftolozane-tazobactam in South Africa
Antibiotic stewardship of hospital-acquired infections because of difficult-to-treat resistant
(DTR) Gram-negative bacteria is a global challenge. Their increasing prevalence in South
Africa has required a shift in prescribing in recent years towards colistin, an antibiotic of
last resort. High toxicity levels and developing resistance to colistin are narrowing treatment
options further. Recently, two new β-lactam/β-lactamase inhibitor combinations,
ceftazidime-avibactam and ceftolozane-tazobactam were registered in South Africa,
bringing hope of new options for management of these life-threatening infections. However,
with increased use in the private sector, increasing levels of resistance to ceftazidimeavibactam
are already being witnessed, putting their long-term viability as treatment
options of last resort, in jeopardy. This review focuses on how these two vital new antibiotics
should be stewarded within a framework that recognises the resistance mechanisms
currently predominant in South Africa’s multi-drug and DTR Gram-negative bacteria.
Moreover, the withholding of their use for resistant infections that can be treated with
currently available antibiotics is a critical part of stewardship, if these antibiotics are to be
conserved in the long term.http://www.sajid.co.zaam2023Pharmacolog
Epidemiologic shift in Candidemia driven by Candida auris, South Africa, 2016–2017
Candida 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