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

Guidelines for the promotion of the well-being of South African psychologists

In hierdie artikel word riglyne aangebied om ’n program wat gemik is op die beskerming en bevordering van Suid-Afrikaanse sielkundiges se welstand te ontwikkel. Die sosio-ekonomiese situasie in Suid-Afrika lei daartoe dat sielkundiges leef en werk in gemeenskappe wat gekenmerk word deur misdaad, armoede, siekte en maatskaplike euwels, wat hierdie riglyne vir die verryking van sielkundiges se welstand ’n noodsaaklikheid maak. Hierdie studie benadruk dat welstand nie outomaties plaasvind nie, maar dat dit strategies ontwikkel moet word. Die navorsers het die welstandskonsepte betekenis, veerkragtigheid en positiewe affek van Suid-Afrikaanse sielkundiges ondersoek en waardevolle temas geïdentifiseer wat aanduidend is daarvan dat spesifieke bevoegdhede, soos selfsorg, bewustheid, liefdevolle goedheid en selfdeernis, noodsaaklik is vir die bevordering van welstand. Deur die bevordering van welstand tot op ’n vlak van florering, kan sielkundiges net blote bestaan verbysteek en ’n rykdom van lewenservaring ondervindThe question in well-being research has changed from why people become ill to how people can experience a good and full life despite life problems, and this article addresses that specific question in relation to South African psychologists. Investment in the well-being of health professionals is crucial, as their professional contribution is vital to the effective provision of health services. Psychologists have been referred to as happiness facilitators and their work involves assisting with clients’ well-being and mental health. It is therefore important to provide guidelines for South African psychologists to sustain and enhance their own well-being, and this makes the present research necessary and important. Social, economic and political problems are endemic to South Africa, while there exists a severe shortage of qualified health-care professionals, with a mere 0,32 psychologists per 100 000 people of the population. In addition, mental health-care budgets are disproportionately low in comparison with the high prevalence of mental disorders in South Africa. While the availability of psychologists as a resource in the South African health care sector is rather low, mental illness is very prevalent, with an estimated 16,5% of the population requiring mental health services, of whom a mere 25% actually receive mental health-care. This information clearly needs to be taken into account considering the impact that it may have on psychologists in terms of workload and functioning. Many researchers have investigated the spill-over effect between people’s work and personal lives. Although psychologists implement strategies such as professional boundaries to prevent spill-over, certain types of spill-over still occur. Spill-over is an especial reality for psychologists, as they bring the tools of their trade, namely themselves, to each of their life roles. Psychotherapy works in two directions: while psychologists affect their clients they are also affected by their clients, which may impact psychologists’ well-being. The American Psychological Association (APA) indicated that psychologists need measures to protect them against occupational stress. However, despite the clear need for such measures, this need is often ignored. The recommendations of the APA for psychologists towards self-care include awareness in order to avoid becoming overwhelmed by the challenges posed by their profession. Psychologists are also encouraged to identify mechanisms to reduce stress and foster proper self-care. In South Africa the word self-care does not even appear in the Health Professions Act (1974) that regulates psychologists’ professional behaviour. Although many psychologists dedicate themselves to caring for others, it is questionable whether they are able to create a sustainable balance between client care and self-care with a view to experiencing well-being. Psychologists work long and inconvenient hours, have an unstable income when working in private practice, work with difficult cases such as homicide and suicide and are frequently faced with clients’ exhausted medical aids. The limitations and problems experienced by psychologists as a result of scope of practice in psychology has led to legal action on the part of practitioners to attempt to have their experience and knowledge acknowledged and to be reimbursed for their services by medical aids. Complete mental health protects people against physical disease. The maintenance and promotion of mental health is therefore as important as the prevention and treatment of mental illness. Well-being can be promoted and protected via the strengthening of psychological capacity and by paying attention to possible threats to health. When such efforts are undertaken, it may ensure the experience of psychologists’ well-being, as well as impact the level of service delivery to clients. Enhancing the well-being of psychologists will therefore contribute positively to the mental health sector in South Africa. The big question in positive psychology is how well-being can be advanced and how life problems can be survived. The central question of this article corresponds to the stated question of positive psychology: How can the well-being of South African psychologists be promoted while practical solutions are found for the career-specific problems experienced by them? This focus on well-being and intentional activities makes positive psychology an ideal paradigm for the development of guidelines for enhancing South African psychologists’ well-being. This article is based on a thesis titled “The well-being of South African psychologists: a mixed method study” by the first author, Erika Hitge. The thesis consisted of a literature study and a qualitative and quantitative study pertaining to the well-being of South African psychologists (henceforth “psychologists”, unless stated otherwise) and conclusions and recommendations. The researcher investigated well-being constructs namely meaning, resilience and positive affect of psychologists and valuable themes were identified indicating that specific skills and competencies are crucial aspects relative to the enhancement of well-being. The study emphasised that well-being does not occur automatically, but has to be strategically cultivated. It is suggested that enhancing well-being and experiencing flourishing can assist people in moving beyond mere existence to experiencing a well-lived life. The guidelines for the promotion of the well-being of psychologists are based on data forthcoming from the results of the mixed-method study, along with existing literature. Psychologists’ well-being and character strengths need to be compared through pre- and post-testing to establish whether the guidelines and the resulting programme do indeed promote the well-being of local psychologists. Participants in the programme should be interviewed to establish the strengths and limitations of the programme. Once a pilot study has been conducted and the above steps have been executed to refine the programme, it will be possible to make recommendations to the Health Professions Council of South Africa (HPCSA) and the Psychological Society of South Africa (PSYSSA) with a view to national application of this well-being programme. Aspects that should be incorporated into a well-being programme for psychologists are flourishing, character strengths, self-care, self-compassion, mindfulness, lovingkindness, work content and context, relationships and personal resources. The suggested programme consists of 13 sessions. These guidelines constitute an attempt to avoid focusing on what is negative and problematic regarding the work of psychologists, such as exhaustion, burnout, isolation and compassion fatigue. Instead, these guidelines focus on well-being as a motivation to accept the positive and negative dimensions of life and still to experience well-being through enhanced self-care. Practising these guidelines may result in a more meaningful life in which people use their best strengths in the service of both their own and others’ well-being. Deciding to use these guidelines may require a willingness to be flexible and to grow increasingly towards acting on life, as opposed to merely consuming wellness. Designing a well-being programme for South African psychologists can also assist in promoting and protecting the well-being of these healthcare professionals through enabling psychologists to apply specific skills, such as practising of character strengths, career-sustaining behaviours and self-care, mindfulness, lovingkindness and self-compassion, with due consideration of the relevant contex

Molecular type distribution and fluconazole susceptibility of clinical Cryptococcus gattii isolates from South African laboratory-based surveillance, 2005–2013

Como es el caso a nivel mundial, Cryptococcus gattii es una causa menos frecuente de criptococosis que Cryptococcus neoformans en Sudáfrica. Realizamos tipificación de secuencias multilocus (MLST) y pruebas de susceptibilidad a fluconazol de 146 aislamientos seleccionados al azar de 750 Pacientes sudafricanos con enfermedad por C. gattii identificados mediante vigilancia de laboratorio mejorada, de 2005 a 2013. El tipo molecular dominante fue VGIV (101/146, 70 %), seguido de VGI (40/146, 27%), VGII (3/146, 2%) y VGIII (2/146, 1%). Entre los 146 aislamientos de C. gattii, se identificaron 99 tipos de secuencia (ST) diferentes, con ST294 (14/146, 10 %) y ST155 (10/146, 7%) siendo el más comúnmente observado. Los valores de CIM50 y CIM90 de fluconazol de 105 (de 146) aislados de C. gattii seleccionados al azar fueron de 4 μg/ml y 16 μg/ml, respectivamente. Los aislamientos VGIV tenían un valor MIC50 más bajo en comparación con los aislamientos no VGIV, pero estos los valores estaban dentro de una dilución doble uno del otro. Los pacientes seropositivos para el VIH tenían una probabilidad ajustada diez veces mayor de una infección por VGIV en comparación con los pacientes seronegativos para el VIH. aunque con números pequeños (99/136; 73% vs. 2/10; 20%), el intervalo de confianza (IC) fue ancho (IC 95%: 1,93-55,31, p = 0,006). La filogenia del genoma completo de 98 aislamientos del tipo molecular más prevalente de Sudáfrica, VGIV, identificó que este tipo molecular es altamente diversos, con dos grupos interesantes de diez y seis aislamientos estrechamente relacionados identificados respectivamente. Uno de estos grupos consistía únicamente en pacientes de la provincia de Mpumalanga en Sudáfrica, lo que sugiere una fuente ambiental similar. Este estudio aportó nuevos conocimientos sobre la estructura de la población mundial de este importante patógeno humano.As is the case globally, Cryptococcus gattii is a less frequent cause of cryptococcosis than Cryptococcus neoformans in South Africa. We performed multilocus sequence typing (MLST) and fluconazole susceptibility testing of 146 isolates randomly selected from 750 South African patients with C. gattii disease identified through enhanced laboratory surveil lance, 2005 to 2013. The dominant molecular type was VGIV (101/146, 70%), followed by VGI (40/146, 27%), VGII (3/146, 2%) and VGIII (2/146, 1%). Among the 146 C. gattii iso lates, 99 different sequence types (STs) were identified, with ST294 (14/146, 10%) and ST155 (10/146, 7%) being most commonly observed. The fluconazole MIC50 and MIC90 val ues of 105 (of 146) randomly selected C. gattii isolates were 4 μg/ml and 16 μg/ml, respec tively. VGIV isolates had a lower MIC50 value compared to non-VGIV isolates, but these values were within one double-dilution of each other. HIV-seropositive patients had a ten fold increased adjusted odds of a VGIV infection compared to HIV-seronegative patients, though with small numbers (99/136; 73% vs. 2/10; 20%), the confidence interval (CI) was wide (95% CI: 1.93–55.31, p = 0.006). Whole genome phylogeny of 98 isolates of South Afri ca’s most prevalent molecular type, VGIV, identified that this molecular type is highly diverse, with two interesting clusters of ten and six closely related isolates being identified respectively. One of these clusters consisted only of patients from the Mpumalanga Prov ince in South Africa, suggesting a similar environmental source. This study contributed new insights into the global population structure of this important human pathogen

Molecular type distribution and fluconazole susceptibility of clinical Cryptococcus gattii isolates from South African laboratory-based surveillance, 2005-2013.

As is the case globally, Cryptococcus gattii is a less frequent cause of cryptococcosis than Cryptococcus neoformans in South Africa. We performed multilocus sequence typing (MLST) and fluconazole susceptibility testing of 146 isolates randomly selected from 750 South African patients with C. gattii disease identified through enhanced laboratory surveillance, 2005 to 2013. The dominant molecular type was VGIV (101/146, 70%), followed by VGI (40/146, 27%), VGII (3/146, 2%) and VGIII (2/146, 1%). Among the 146 C. gattii isolates, 99 different sequence types (STs) were identified, with ST294 (14/146, 10%) and ST155 (10/146, 7%) being most commonly observed. The fluconazole MIC50 and MIC90 values of 105 (of 146) randomly selected C. gattii isolates were 4 μg/ml and 16 μg/ml, respectively. VGIV isolates had a lower MIC50 value compared to non-VGIV isolates, but these values were within one double-dilution of each other. HIV-seropositive patients had a ten-fold increased adjusted odds of a VGIV infection compared to HIV-seronegative patients, though with small numbers (99/136; 73% vs. 2/10; 20%), the confidence interval (CI) was wide (95% CI: 1.93-55.31, p = 0.006). Whole genome phylogeny of 98 isolates of South Africa's most prevalent molecular type, VGIV, identified that this molecular type is highly diverse, with two interesting clusters of ten and six closely related isolates being identified, respectively. One of these clusters consisted only of patients from the Mpumalanga Province in South Africa, suggesting a similar environmental source. This study contributed new insights into the global population structure of this important human pathogen

Genotype, Antifungal Susceptibility, and Virulence of Clinical South African Cryptococcus neoformans Strains from National Surveillance, 2005–2009

In South Africa, Cryptococcus neoformans is the most common cause of adult meningitis. We performed multi locus sequence typing and fluconazole susceptibility testing of clinical C. neoformans isolates collected from 251 South African patients with cryptococcosis through national surveillance from 2005 to 2009. We examined the association between clinical characteristics of patients and genotype, and the effect of genotype on in-hospital mortality. We performed whole genome phylogenetic analysis of fifteen C. neoformans isolates with the molecular type VNB and tested their virulence in a Galleria mellonella model. Most isolates had the molecular type VNI (206/251, 82%), followed by VNII (25/251, 10%), VNB (15/251, 6%), and VNIV (5/251, 2%); 67 sequence types were identified. There were no differences in fluconazole minimum inhibitory concentration (MIC) values among molecular types and the majority of strains had low MIC values (MIC50 of 1 µg/mL and MIC90 of 4 µg/mL). Males were almost twice as likely of being infected with a non-VNI genotype (adjusted odds ratio [OR]: 1.65, 95% confidence interval [CI]: 0.25–10.99; p = 0.61). Compared to patients infected with a VNI genotype, those with a non-VNI genotype had a 50% reduced adjusted odds of dying in hospital (95% CI: 0.03–7.57; p = 0.62). However, for both these analyses, our estimates had wide confidence intervals spanning 1 with large p-values. Fifteen VNB strains were not as virulent in a G. mellonella larval model as the H99 reference strain. A majority of these VNB strains belonged to the VNBII clade and were very closely related by phylogenetic analysis

Large Outbreaks of Fungal and Bacterial Bloodstream Infections in a Neonatal Unit, South Africa, 2012–2016

Candidemia is a major cause of healthcare-associated infections. We describe a large outbreak of Candida krusei bloodstream infections among infants in Gauteng Province, South Africa, during a 4-month period; a series of candidemia and bacteremia outbreaks in the neonatal unit followed. We detected cases by using enhanced laboratory surveillance and audited hospital wards by environmental sampling and epidemiologic studies. During July–October 2014, among 589 patients, 48 unique cases of C. krusei candidemia occurred (8.2% incidence). Risk factors for candidemia on multivariable analyses were necrotizing enterocolitis, birthweight <1,500 g, receipt of parenteral nutrition, and receipt of blood transfusion. Despite initial interventions, outbreaks of bloodstream infection caused by C. krusei, rarer fungal species, and bacterial pathogens continued in the neonatal unit through July 29, 2016. Multiple factors contributed to these outbreaks; the most functional response is to fortify infection prevention and control

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