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3. WHO's essential medicines and AWaRe: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections

Author

Moja, Lorenzo, Zanichelli, Veronica, Mertz, Dominik, Gandra, Sumanth, Cappello, Bernadette, Cooke, Graham S., Chuki, Pem, Harbarth, Stephan, Pulcini, Celine, Mendelson, Marc, Tacconelli, Evelina, Ombajo, Loice Achieng, Chitatanga, Ronald, Zeng, Mei, Imi, Monica, Elias, Christelle, Ashorn, Per, Marata, Annamaria, Paulin, Sarah, Muller, Arno, Aidara-Kane, Awa, Wi, Teodora Elvira, Were, Wilson Milton, Tayler, Elizabeth, Figueras, Albert, Da Silva, Carmem Pessoa, Van Weezenbeek, Catharina, Magrini, Nicola, Sharland, Mike, Huttner, Benedikt, and Loeb, Mark

Published
2024
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6. WHO global research priorities for antimicrobial resistance in human health

Author

Aanensen, David, Alanio, Alexandre, Alastruey-Izquierdo, Ana, Alemayehu, Tinsae, Al-Hasan, Majdi, Allegaert, Karel, Al-Maani, Amal Saif, Al-Salman, Jameela, Alshukairi, Abeer Nizar, Amir, Afreenish, Applegate, Tanya, Araj, George F, Villalobos, Marlen Arce, Årdal, Christine, Ashiru-Oredope, Diane, Ashley, Elizabeth A, Babin, François-Xavier, Bachmann, Laura H, Bachmann, Till, Baker, Kate Susan, Balasegaram, Manica, Bamford, Colleen, Baquero, Fernando, Barcelona, Laura Isabel, Bassat, Quique, Bassetti, Matteo, Basu, Sulagna, Beardsley, Justin, Vásquez, Grey Benoit, Berkley, James A, Bhatnagar, Anuj K, Bielicki, Julia, Bines, Julie, Bongomin, Felix, Bonomo, Robert A, Bradley, John S, Bradshaw, Catriona, Brett, Ana, Brink, Adrian, Brown, Colin, Brown, Jeremy, Buising, Kirsty, Carson, Carolee, Carvalho, Anna Cristina, Castagnola, Elio, Cavaleri, Marco, Cecchini, Michele, Chabala, Chishala, Chaisson, Richard E, Chakrabarti, Arunaloke, Chandler, Clare, Chandy, Sujith John, Charani, Esmita, Chen, Lisa, Chiara, Francesca, Chowdhary, Anuradha, Chua, Arlene, Chuki, Pem, Chun, Doo Ryeon, Churchyard, Gavin, Cirillo, Daniela, Clack, Lauren, Coffin, Susan E, Cohn, Jennifer, Cole, Michelle, Conly, John, Cooper, Ben, Corso, Alejandra, Cosgrove, Sara E, Cox, Helen, Daley, Charles L, Darboe, Saffiatou, Darton, Tom, Davies, Gerry, de Egea, Viviana, Dedeić-Ljubović, Amela, Deeves, Miranda, Denkinger, Claudia, Dillon, Jo-Anne R, Dramowski, Angela, Eley, Brian, Roberta Esposito, Susanna Maria, Essack, Sabiha Y, Farida, Helmia, Farooqi, Joveria, Feasey, Nicholas, Ferreyra, Cecilia, Fifer, Helen, Finlayson, Heather, Frick, Mike, Gales, Ana Cristina, Galli, Luisa, Gandra, Sumanth, Gerber, Jeffrey S, Giske, Christian, Gordon, Bruce, Govender, Nelesh, Guessennd, Nathalie, Guindo, Ibrehima, Gurbanova, Elmira, Gwee, Amanda, Hagen, Ferry, Harbarth, Stephan, Haze, John, Heim, Jutta, Hendriksen, Rene, Heyderman, Robert Simon, Holt, Kathryn Elizabeth, Hönigl, Martin, Hook, Edward W, Hope, William, Hopkins, Heidi, Hughes, Gwenda, Ismail, Ghada, Issack, Mohammad Iqbal, Jacobs, Jan, Jasovský, Dušan, Jehan, Fyeza, Pearson, Antonieta Jimenez, Jones, Makoto, Joshi, Mohan P, Kapil, Arti, Kariuki, Samuel, Karkey, Abhilasha, Kearns, Gregory L, Keddy, Karen Helena, Khanna, Nina, Kitamura, Akiko, Kolho, Kaija-Leena, Kontoyiannis, Dimitrios P, Kotwani, Anita, Kozlov, Roman S, Kranzer, Katharina, Kularatne, Ranmini, Lahra, Monica M, Langford, Bradley J, Laniado-Laborin, Rafael, Larsson, Joakim, Lass-Flörl, Cornelia, Le Doare, Kirsty, Lee, Hyukmin, Lessa, Fernanda, Levin, Anna S, Limmathurotsakul, Direk, Lincopan, Nilton, Lo Vecchio, Andrea, Lodha, Rakesh, Loeb, Mark, Longtin, Yves, Lye, David Chien, Mahmud, Asif Mujtaba, Manaia, Célia, Manderson, Lenore, Mareković, Ivana, Marimuthu, Kalisvar, Martin, Irene, Mashe, Tapfumanei, Mei, Zeng, Meis, Jacques F, Lyra Tavares De Melo, Flávio Augusto, Mendelson, Marc, Miranda, Angelica Espinosa, Moore, David, Morel, Chantal, Moremi, Nyambura, Moro, Maria Luisa, Moussy, Francis, Mshana, Stephen, Mueller, Arno, Ndow, Francis J, Nicol, Mark, Nunn, Andrew, Obaro, Stephen, Obiero, Christina W, Okeke, Iruka N, Okomo, Uduak, Okwor, Tochi J, Oladele, Rita, Omulo, Sylvia, Ondoa, Pascale, Ortellado de Canese, Juana Medarda, Ostrosky-Zeichner, Luis, Padoveze, Maria Clara, Pai, Madhukar, Park, Benjamin, Parkhill, Julian, Parry, Christopher M, Peeling, Rosanna, Sobreira Vieira Peixe, Luísa Maria, Perovic, Olga, Pettigrew, Melinda M, Principi, Nicola, Pulcini, Céline, Puspandari, Nelly, Rawson, Timothy, Reddy, Denasha Lavanya, Reddy, Kessendri, Redner, Paulo, Rodríguez Tudela, Juan Luis, Rodríguez-Baño, Jesús, Van Katwyk, Susan Rogers, Roilides, Emmanuel, Rollier, Christine, Rollock, Leslie, Ronat, Jean-Baptiste, Ruppe, Etienne, Sadarangani, Manish, Salisbury, David, Salou, Mounerou, Samison, Luc Hervé, Sanguinetti, Maurizio, Sartelli, Massimo, Schellack, Natalie, Schouten, Jeroen, Schwaber, Mitchell J, Seni, Jeremiah, Senok, Abiola, Shafer, William M, Shakoor, Sadia, Sheppard, Donald, Shin, Jong-Hee, Sia, Sonia, Sievert, Dawn, Singh, Ishwar, Singla, Rupak, Skov, Robert Leo, Soge, Olusegun O, Sprute, Rosanne, Srinivasan, Arjun, Srinivasan, Subasree, Sundsfjord, Arnfinn, Tacconelli, Evelina, Tahseen, Sabira, Tangcharoensathien, Viroj, Tängdén, Thomas, Thursky, Karin, Thwaites, Guy, Tigulini de Souza Peral, Renata, Tong, Deborah, Tootla, Hafsah Deepa, Tsioutis, Constantinos, Turner, Katy M, Turner, Paul, Omar, Shaheed Vally, van de Sande, Wendy WJ, van den Hof, Susan, van Doorn, Rogier, Veeraraghavan, Balaji, Verweij, Paul, Wahyuningsih, Retno, Wang, Hui, Warris, Adilia, Weinstock, Hillard, Wesangula, Evelyn, Whiley, David, White, Peter J, Williams, Phoebe, Xiao, Yonghong, Moscoso, Martin Yagui, Yang, Hsu Li, Yoshida, Sachiyo, Yu, Yunsong, Żabicka, Dorota, Zignol, Matteo, Rudan, Igor, Bertagnolio, Silvia, Dobreva, Zlatina, Centner, Chad M, Olaru, Ioana Diana, Donà, Daniele, Burzo, Stefano, Huttner, Benedikt D, Chaillon, Antoine, Gebreselassie, Nebiat, Wi, Teodora, Hasso-Agopsowicz, Mateusz, Allegranzi, Benedetta, Sati, Hatim, Ivanovska, Verica, Kothari, Kavita U, Balkhy, Hanan H, Cassini, Alessandro, Hamers, Raph L, and Weezenbeek, Kitty Van

Published
2024
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8. An analysis of existing national action plans for antimicrobial resistance—gaps and opportunities in strategies optimising antibiotic use in human populations

Author

Charani, Esmita, Mendelson, Marc, Pallett, Scott J C, Ahmad, Raheelah, Mpundu, Mirfin, Mbamalu, Oluchi, Bonaconsa, Candice, Nampoothiri, Vrinda, Singh, Sanjeev, Peiffer-Smadja, Nathan, Anton-Vazquez, Vanesa, Moore, Luke S P, Schouten, Jeroen, Kostyanev, Tomislav, Vlahović-Palčevski, Vera, Kofteridis, Diamantis, Corrêa, Juliana Silva, and Holmes, Alison H

Published
2023
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9. Outcomes of laboratory-confirmed SARS-CoV-2 infection during resurgence driven by Omicron lineages BA.4 and BA.5 compared with previous waves in the Western Cape Province, South Africa

Author

Davies, Mary-Ann, Morden, Erna, Rousseau, Petro, Arendse, Juanita, Bam, Jamy-Lee, Boloko, Linda, Cloete, Keith, Cohen, Cheryl, Chetty, Nicole, Dane, Pierre, Heekes, Alexa, Hsiao, Nei-Yuan, Hunter, Mehreen, Hussey, Hannah, Jacobs, Theuns, Jassat, Waasila, Kariem, Saadiq, Kassanjee, Reshma, Laenen, Inneke, Roux, Sue Le, Lessells, Richard, Mahomed, Hassan, Maughan, Deborah, Meintjes, Graeme, Mendelson, Marc, Mnguni, Ayanda, Moodley, Melvin, Murie, Katy, Naude, Jonathan, Ntusi, Ntobeko A.B., Paleker, Masudah, Parker, Arifa, Pienaar, David, Preiser, Wolfgang, Prozesky, Hans, Raubenheimer, Peter, Rossouw, Liezel, Schrueder, Neshaad, Smith, Barry, Smith, Mariette, Solomon, Wesley, Symons, Greg, Taljaard, Jantjie, Wasserman, Sean, Wilkinson, Robert J., Wolmarans, Milani, Wolter, Nicole, and Boulle, Andrew

Published
2023
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11. Clinical features and outcomes of COVID-19 admissions in a population with a high prevalence of HIV and tuberculosis: a multicentre cohort study

Author

Parker, Arifa, Boloko, Linda, Moolla, Muhammad S., Ebrahim, Nabilah, Ayele, Birhanu T., Broadhurst, Alistair G. B., Mashigo, Boitumelo, Titus, Gideon, de Wet, Timothy, Boliter, Nicholas, Rosslee, Michael-Jon, Papavarnavas, Nectarios, Abrahams, Riezaah, Mendelson, Marc, Dlamini, Sipho, Taljaard, Jantjie J., Prozesky, Hans W., Mowlana, Abdurasiet, Viljoen, Abraham J., Schrueder, Neshaad, Allwood, Brian W., Lalla, Usha, Dave, Joel A., Calligaro, Greg, Levin, Dion, Maughan, Deborah, Ntusi, Ntobeko A. B., Nyasulu, Peter S., Meintjes, Graeme, Koegelenberg, Coenraad F. N., Mnguni, Ayanda T., and Wasserman, Sean

Published
2022
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14. COVID‐19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape, South Africa

Author

Kassanjee, Reshma, Davies, Mary‐Ann, Ngwenya, Olina, Osei‐Yeboah, Richard, Jacobs, Theuns, Morden, Erna, Timmerman, Venessa, Britz, Stefan, Mendelson, Marc, Taljaard, Jantjie, Riou, Julien, Boulle, Andrew, Tiffin, Nicki, and Zinyakatira, Nesbert

Subjects
Comorbidity -- Evaluation, Host-virus relationships, Public health administration -- Evaluation, HIV infection -- Diagnosis -- Care and treatment, Health
Abstract

: Introduction: While a large proportion of people with HIV (PWH) have experienced SARS‐CoV‐2 infections, there is uncertainty about the role of HIV disease severity on COVID‐19 outcomes, especially in lower‐income settings. We studied the association of mortality with characteristics of HIV severity and management, and vaccination, among adult PWH. Methods: We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS‐CoV‐2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with evidence of antiretroviral therapy (ART) collection, time since first HIV evidence, CD4 cell count, viral load (among those with evidence of ART collection) and COVID‐19 vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results: Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17,831 first‐diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis (especially more recent episodes of tuberculosis), chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions: Mortality was strongly associated with suboptimal HIV control, and the prevalence of these risk factors increased in later COVID‐19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimized., INTRODUCTION Three years have passed since the COVID‐19 pandemic began. A large proportion of people with HIV (PWH) have experienced SARS‐CoV‐2 infections, and this population appears to have a modestly [...]

Published
2023
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15. Investigating infection management and antimicrobial stewardship in surgery: a qualitative study from India and South Africa

Author

Ahmad, Raheelah, Castro-Sanchez, Enrique, Birgand, Gabriel, Ndoli, Jules, Sassi, Franco, Sevdalis, Nick, Moonesinghe, Ramani, Lebcir, Reda, Ferlie, Ewan, Singh, Sanjeev, Mendelson, Marc, Surendran, Surya, Bonaconsa, Candice, Mbamalu, Oluchi, Nampoothiri, Vrinda, Boutall, Adam, Hampton, Mark, Dhar, Puneet, Pennel, Tim, Tarrant, Carolyn, Leather, Andy, Holmes, Alison, and Charani, Esmita

Published
2021
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17. Joint ESCMID, FEMS, IDSA, ISID and SSI position paper on the fair handling of career breaks among physicians and scientists when assessing eligibility for early-career awards

Author

Huttner, Angela, Bricheux, Alice, Buurmeijer-van Dijk, Carianne J.M., Harvey, Matthew, Holmes, Alison, Lassmann, Britta, Lavergne, Valéry, Mailles, Alexandra, Mendelson, Marc, Muller, Nicolas, Sanguinetti, Maurizio, Sears, Cynthia, Skevaki, Chrysanthi, Syed, Uzma, Thomas, Salandra, and Swartz, Talia H.

Published
2021
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18. The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study

Author

Calligaro, Gregory L., Lalla, Usha, Audley, Gordon, Gina, Phindile, Miller, Malcolm G., Mendelson, Marc, Dlamini, Sipho, Wasserman, Sean, Meintjes, Graeme, Peter, Jonathan, Levin, Dion, Dave, Joel A., Ntusi, Ntobeko, Meier, Stuart, Little, Francesca, Moodley, Desiree L., Louw, Elizabeth H., Nortje, Andre, Parker, Arifa, Taljaard, Jantjie J., Allwood, Brian W., Dheda, Keertan, and Koegelenberg, Coenraad F.N.

Published
2020
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25. AIDS-Related Endemic Mycoses in Western Cape, South Africa, and Clinical Mimics: A Cross-Sectional Study of Adults With Advanced HIV and Recent-Onset, Widespread Skin Lesions

Author

Schwartz, Ilan S, Kenyon, Chris, Lehloenya, Rannakoe, Claasens, Saskya, Spengane, Zandile, Prozesky, Hans, Burton, Rosie, Parker, Arifa, Wasserman, Sean, Meintjes, Graeme, Mendelson, Marc, Taljaard, Jantjie, Schneider, Johann W, Beylis, Natalie, Maloba, Bonnie, Govender, Nelesh P, Colebunders, Robert, and Dlamini, Sipho

Published
2017
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31. Use of Feedback Data to Reduce Surgical Site Infections and Optimize Antibiotic Use in Surgery

Author

Ahuja, Shalini, Peiffer-Smadja, Nathan, Peven, Kimberly, White, Michelle, Leather, Andrew J. M., Singh, Sanjeev, Mendelson, Marc, Holmes, Alison, Birgand, Gabriel, and Sevdalis, Nick

Subjects
implementation science, patient safety, surveillance, Humans, Surgical Wound Infection, audit and feedback, surgical site infection, Antibiotic Prophylaxis, Review Papers, antibiotics, Drug Utilization, Anti-Bacterial Agents, Feedback
Abstract

Objective: Surgical site infection (SSI) prevention remains significant, particularly in the era of antimicrobial resistance. Feedback on practices and outcomes is known to be key to reduce SSI rates and optimize antibiotic usage. However, the optimal method, format and frequency of feedback for surgical teams remains unclear. The objective of the study is to understand how data from surveillance and audit are fed back in routine surgical practice. Methods: A systematic scoping review was conducted, using well-established implementation science frameworks to code the data. Two electronic health-oriented databases (MEDLINE, EMBASE) were searched to September 2019. We included studies that assessed the use of feedback as a strategy either in the prevention and management of SSI and/or in the use of antibiotics perioperatively. Results: We identified 21 studies: 17 focused on SSI rates and outcomes and 10 studies described antimicrobial stewardship for SSI (with some overlap in focus). Several interventions were reported, mostly multimodal with feedback as a component. Feedback was often provided in written format (62%), either individualized (38%) or in group (48%). Only 25% of the studies reported that feedback cascaded down to the frontline perioperative staff. In 65% of the studies, 1 to 5 implementation strategies were used while only 5% of the studies reported to have utilized more than 15 implementation strategies. Among studies reporting antibiotic usage in surgery, most (71%) discussed compliance with surgical antibiotic prophylaxis. Conclusions: Our findings highlight the need to provide feedback to all levels of perioperative care providers involved in patient care. Future research in this area should report implementation parameters in more detail.

Published
2021

32. Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map

Author

Rogers Van Katwyk, Susan, Grimshaw, Jeremy M., Nkangu, Miriam, Nagi, Ranjana, Mendelson, Marc, Taljaard, Monica, and Hoffman, Steven J.

Subjects
Anti-infective agents -- Usage -- Laws, regulations and rules, Health policy -- International aspects -- Evaluation, Microbial drug resistance -- Prevention, Databases, Employee performance, Drug resistance, Government regulation, Biological sciences
Abstract

Background Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidence map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans. Methods and findings Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review. Conclusions To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published. Protocol registration PROSPERO CRD42017067514., Author(s): Susan Rogers Van Katwyk 1,2,*, Jeremy M. Grimshaw 3,4, Miriam Nkangu 1, Ranjana Nagi 2, Marc Mendelson 5, Monica Taljaard 1,3, Steven J. Hoffman 2,6,7 Introduction Antimicrobial resistance (AMR) [...]

Published
2019
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33. The elephant in the room: Exploring the influence and participation of patients in infection‐related care across surgical pathways in South Africa and India.

Author

Nampoothiri, Vrinda, Mbamalu, Oluchi, Surendran, Surya, Bonaconsa, Candice, Pennel, Timothy, Boutall, Adam, Gopal, Kirun, Castro Sanchez, Enrique, Dhar, Puneet, Holmes, Alison, Singh, Sanjeev, Mendelson, Marc, Tarrant, Carolyn, and Charani, Esmita

Subjects
SURGERY & psychology, ANTIBIOTICS, CROSS infection prevention, CAREGIVER attitudes, CULTURE, ANTIMICROBIAL stewardship, RESEARCH, PATIENT participation, SCIENTIFIC observation, ECONOMIC impact, ATTITUDES of medical personnel, RESEARCH methodology, POSTOPERATIVE care, INTERVIEWING, PATIENT-centered care, MEDICAL personnel, PATIENTS, PATIENTS' attitudes, INFECTION control, ETHNOLOGY research, HEALTH literacy, PATIENTS' families, SURGICAL site infections, DECISION making, SURGICAL site, RESEARCH funding, UNOBTRUSIVE measures, FIELD notes (Science), COMMUNICATION, STATISTICAL sampling, DATA analysis software, DRUG resistance in microorganisms, PATIENT-professional relations
Abstract

Objective: The irrational use of antibiotics is a leading contributor to antibiotic resistance. Antibiotic stewardship (AS) interventions predominantly focus on prescribers. This study investigated the influence and participation of inpatients in infection‐related care, including antibiotic decision‐making, within and across two tertiary hospitals in South Africa (Cape Town) and India (Kerala). Methods: Through ethnographic enquiry of clinical practice in surgical pathways, including direct nonparticipant observation of clinical practices, healthcare worker (HCW), patient and carer interactions in surgical ward rounds and face‐to‐face interviews with participants (HCWs and patients), we sought to capture the implicit and explicit influence that patients and carers have in infection‐related care. Field notes and interview transcripts were thematically coded, aided by NVivo 12® Pro software. Results: Whilst observational data revealed the nuanced roles that patients/carers play in antibiotic decision‐making, HCWs did not recognize these roles. Patients and carers, though invested in patient care, are not routinely involved, nor are they aware of the opportunities for engagement in infection‐related decision‐making. Patients associated clinical improvement with antibiotic use and did not consider hospitalization to be associated with infection acquisition or transmission, highlighting a lack of understanding of the threat of infection and antibiotic resistance. Patients' economic and cultural positionalities may influence their infection‐related behaviours. In the study site in India, cultural norms mean that carers play widespread but unrecognized roles in inpatient care, participating in infection prevention activities. Conclusion: For patients to have a valuable role in AS and make informed decisions regarding their infection‐related care, a mutual understanding of their role in this process among HCWs and patients is crucial. The observed differences between the two study sites indicate the critical need for understanding and addressing the contextual drivers that impact effective patient‐centred healthcare delivery. Patient or Public Contribution: Ethnographic observations and interviews conducted in this study involved patients as participants. Patients were recruited for interviews after obtaining signed informed consent forms. Patients' identities were completely anonymized when presenting the study findings. [ABSTRACT FROM AUTHOR]

Published
2023
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37. Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa

Author

Boulle, Andrew, Davies, Mary-Ann, Hussey, Hannah, Ismail, Muzzammil, Morden, Erna, Vundle, Ziyanda, Zweigenthal, Virginia, Mahomed, Hassan, Paleker, Masudah, Pienaar, David, Tembo, Yamanya, Lawrence, Charlene, Isaacs, Washiefa, Mathema, Hlengani, Allen, Derick, Allie, Taryn, Bam, Jamy-Lee, Buddiga, Kasturi, Dane, Pierre, Heekes, Alexa, Matlapeng, Boitumelo, Mutemaringa, Themba, Muzarabani, Luckmore, Phelanyane, Florence, Pienaar, Rory, Rode, Catherine, Smith, Mariette, Tiffin, Nicki, Zinyakatira, Nesbert, Cragg, Carol, Marais, Frederick, Mudaly, Vanessa, Voget, Jacqueline, Davids, Jody, Roodt, Francois, van Zyl Smit, Nellis, Vermeulen, Alda, Adams, Kevin, Audley, Gordon, Bateman, Kathleen, Beckwith, Peter, Bernon, Marc, Blom, Dirk, Boloko, Linda, Botha, Jean, Boutall, Adam, Burmeister, Sean, Cairncross, Lydia, Calligaro, Gregory, Coccia, Cecilia, Corin, Chadwin, Daroowala, Remy, Dave, Joel A, De Bruyn, Elsa, De Villiers, Martin, Deetlefs, Mimi, Dlamini, Sipho, Du Toit, Thomas, Endres, Wilhelm, Europa, Tarin, Fieggan, Graham, Figaji, Anthony, Frankenfeld, Petro, Gatley, Elizabeth, Gina, Phindile, Govender, Evashan, Grobler, Rochelle, Gule, Manqoba Vusumuzi, Hanekom, Christoff, Held, Michael, Heynes, Alana, Hlatswayo, Sabelo, Hodkinson, Bridget, Holtzhausen, Jeanette, Hoosain, Shakeel, Jacobs, Ashely, Kahn, Miriam, Kahn, Thania, Khamajeet, Arvin, Khan, Joubin, Khan, Riaasat, Khwitshana, Alicia, Knight, Lauren, Kooverjee, Sharita, Krogscheepers, Rene, Kruger, Jean Jacque, Kuhn, Suzanne, Laubscher, Kim, Lazarus, John, Le Roux, Jacque, Lee Jones, Scott, Levin, Dion, Maartens, Gary, Majola, Thina, Manganyi, Rodgers, Marais, David, Marais, Suzaan, Maritz, Francois, Maughan, Deborah, Mazondwa, Simthandile, Mbanga, Luyanda, Mbatani, Nomonde, Mbena, Bulewa, Meintjes, Graeme, Mendelson, Marc, Möller, Ernst, Moore, Allison, Ndebele, Babalwa, Nortje, Marc, Ntusi, Ntobeko, Nyengane, Funeka, Ofoegbu, Chima, Papavarnavas, Nectarios, Peter, Jonny, Pickard, Henri, Pluke, Kent, Raubenheimer, Peter J, Robertson, Gordon, Rozmiarek, Julius, Sayed, A, Scriba, Matthias, Sekhukhune, Hennie, Singh, Prasun, Smith, Elsabe, Soldati, Vuyolwethu, Stek, Cari, van den berg, Robert, van der Merwe, Le Roux, Venter, Pieter, Vermooten, Barbra, Viljoen, Gerrit, Viranna, Santhuri, Vogel, Jonno, Vundla, Nokubonga, Wasserman, Sean, Zitha, Eddy, Lomas-Marais, Vanessa, Lombard, Annie, Stuve, Katrin, Viljoen, Werner, Basson, De Vries, Le Roux, Sue, Linden-Mars, Ethel, Victor, Lizanne, Wates, Mark, Zwanepoel, Elbe, Ebrahim, Nabilah, Lahri, Sa’ad, Mnguni, Ayanda, Crede, Thomas, de Man, Martin, Evans, Katya, Hendrikse, Clint, Naude, Jonathan, Parak, Moosa, Szymanski, Patrick, Van Koningsbruggen, Candice, Abrahams, Riezaah, Allwood, Brian, Botha, Christoffel, Botha, Matthys Henndrik, Broadhurst, Alistair, Claasen, Dirkie, Daniel, Che, Dawood, Riyaadh, du Preez, Marie, Du Toit, Nicolene, Erasmus, Kobie, Koegelenberg, Coenraad F N, Gabriel, Shiraaz, Hugo, Susan, Jardine, Thabiet, Johannes, Clint, Karamchand, Sumanth, Lalla, Usha, Langenegger, Eduard, Louw, Eize, Mashigo, Boitumelo, Mhlana, Nonte, Mnqwazi, Chizama, Moodley, Ashley, Moodley, Desiree, Moolla, Saadiq, Mowlana, Abdurasiet, Nortje, Andre, Olivier, Elzanne, Parker, Arifa, Paulsen, Chané, Prozesky, Hans, Rood, Jacques, Sabela, Tholakele, Schrueder, Neshaad, Sithole, Nokwanda, Sithole, Sthembiso, Taljaard, Jantjie J, Titus, Gideon, Van Der Merwe, Tian, van Schalkwyk, Marije, Vazi, Luthando, Viljoen, Abraham J, Yazied Chothia, Mogamat, Naidoo, Vanessa, Wallis, Lee Alan, Abbass, Mumtaz, Arendse, Juanita, Armien, Rizqa, Bailey, Rochelle, Bello, Muideen, Carelse, Rachel, Forgus, Sheron, Kalawe, Nosi, Kariem, Saadiq, Kotze, Mariska, Lucas, Jonathan, McClaughlin, Juanita, Murie, Kathleen, Najjaar, Leilah, Petersen, Liesel, Porter, James, Shaw, Melanie, Stapar, Dusica, Williams, Michelle, Aldum, Linda, Berkowitz, Natacha, Girran, Raakhee, Lee, Kevin, Naidoo, Lenny, Neumuller, Caroline, Anderson, Kim, Begg, Kerrin, Boerlage, Lisa, Cornell, Morna, de Waal, Renée, Dudley, Lilian, English, René, Euvrard, Jonathan, Groenewald, Pam, Jacob, Nisha, Jaspan, Heather, Kalk, Emma, Levitt, Naomi, Malaba, Thoko, Nyakato, Patience, Patten, Gabriela, Schneider, Helen, Shung King, Maylene, Tsondai, Priscilla, Van Duuren, James, van Schaik, Nienke, Blumberg, Lucille, Cohen, Cheryl, Govender, Nelesh, Jassat, Waasila, Kufa, Tendesayi, McCarthy, Kerrigan, Morris, Lynn, Hsiao, Nei-yuan, Marais, Ruan, Ambler, Jon, Ngwenya, Olina, Osei-Yeboah, Richard, Johnson, Leigh, Kassanjee, Reshma, and Tamuhla, Tsaone

Subjects
sub-Saharan Africa, 0301 basic medicine, Microbiology (medical), Adult, Male, Tuberculosis, antiretroviral, 030106 microbiology, Population, HIV Infections, HIV Infections/complications, Cohort Studies, South Africa, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Major Article, Medicine, Humans, 030212 general & internal medicine, education, Proportional Hazards Models, education.field_of_study, South Africa/epidemiology, business.industry, Proportional hazards model, SARS-CoV-2, Hazard ratio, HIV, Correction, COVID-19, medicine.disease, Confidence interval, AcademicSubjects/MED00290, Infectious Diseases, Standardized mortality ratio, tuberculosis, Attributable risk, business, Viral load, Demography
Abstract

Background Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. Methods We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates. Results Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID-19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1). Conclusions While our findings may overestimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both living with HIV and having current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex, and other comorbidities and COVID-19 mortality were similar to those in other settings.

Published
2021

38. Regional variation in travel-related illness acquired in Africa, March 1997-May 2011

Author

Mendelson, Marc, Han, Pauline V., Vincent, Peter, von Sonnenburg, Frank, Cramer, Jakob P., Loutan, Louis, Kain, Kevin C., Parola, Philippe, Hagmann, Stefan, Gkrania-Klotsas, Effrossyni, Sotir, Mark, and Schlagenhauf, Patricia

Subjects
Travel -- Health aspects -- Africa, Diseases -- Risk factors -- Demographic aspects -- Africa, Travelers -- Health aspects, Health
Abstract

Africa is a popular tourist destination and a focus for international aid work, research, and business travel. In 2011, compared with 2010, international arrivals on the African continent remained relatively [...]

Published
2014
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39. A case of pericardial schistosomiasis and non-Hodgkin high grade B-cell lymphoma.

Author

Boyd, Michael J., Mendelson, Marc, Dlamini, Sipho K., Wasserman, Sean, Fakier, Ghaalied, Roberts, Riyaadh, and Papavarnavas, Nectarios S.

Abstract

Chronic schistosomiasis affects either the genitourinary or gastrointestinal tract. Rarely, schistosomes cause ectopic disease, such as in the case of a South African woman from a non-endemic province, who presented with suspected pericardial tamponade because of tuberculosis. However, histology and polymerase chain reaction from pericardial biopsy confirmed Schistosoma haematobium. A finding of mediastinal non-Hodgkin lymphoma came to light when our patient's clinical condition unexpectedly deteriorated. Contribution: This case highlights an unusual manifestation of schistosomiasis. [ABSTRACT FROM AUTHOR]

Published
2023
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40. Macro level influences on strategic responses to the COVID-19 pandemic - an international survey and tool for national assessments

Author

Ahmad, Raheelah, Atun, Rifat A, Birgand, Gabriel, Castro-Sánchez, Enrique, Charani, Esmita, Ferlie, Ewan B, Hussain, Izhar, Kambugu, Andrew, Labarca, Jaime, Hara, Gabriel Levy, McKee, Martin, Mendelson, Marc, Singh, Sanjeev, Varma, Jay, Zhu, Nina J, Zingg, Walter, Holmes, Alison H, and COMPASS (COntrol and Management of PAndemicS through Strategic a

Abstract

BACKGROUND: Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning. METHODS: A cross-sectional electronic survey of health and non-health care professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains - Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks. RESULTS: 928 respondents from 66 countries (57% health care professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains. CONCLUSIONS: The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.

Published
2021

43. Outcomes of laboratory‐confirmed SARS‐CoV‐2 infection in the Omicron‐driven fourth wave compared with previous waves in the Western Cape Province, South Africa.

Author

Davies, Mary‐Ann, Kassanjee, Reshma, Rousseau, Petro, Morden, Erna, Johnson, Leigh, Solomon, Wesley, Hsiao, Nei‐Yuan, Hussey, Hannah, Meintjes, Graeme, Paleker, Masudah, Jacobs, Theuns, Raubenheimer, Peter, Heekes, Alexa, Dane, Pierre, Bam, Jamy‐Lee, Smith, Mariette, Preiser, Wolfgang, Pienaar, David, Mendelson, Marc, and Naude, Jonathan

Abstract

OBJECTIVES: The objective was to compare COVID‐19 outcomes in the Omicron‐driven fourth wave with prior waves in the Western Cape, assess the contribution of undiagnosed prior infection to differences in outcomes in a context of high seroprevalence due to prior infection and determine whether protection against severe disease conferred by prior infection and/or vaccination was maintained. METHODS: In this cohort study, we included public sector patients aged ≥20 years with a laboratory‐confirmed COVID‐19 diagnosis between 14 November and 11 December 2021 (wave four) and equivalent prior wave periods. We compared the risk between waves of the following outcomes using Cox regression: death, severe hospitalisation or death and any hospitalisation or death (all ≤14 days after diagnosis) adjusted for age, sex, comorbidities, geography, vaccination and prior infection. RESULTS: We included 5144 patients from wave four and 11,609 from prior waves. The risk of all outcomes was lower in wave four compared to the Delta‐driven wave three (adjusted hazard ratio (aHR) [95% confidence interval (CI)] for death 0.27 [0.19; 0.38]. Risk reduction was lower when adjusting for vaccination and prior diagnosed infection (aHR: 0.41, 95% CI: 0.29; 0.59) and reduced further when accounting for unascertained prior infections (aHR: 0.72). Vaccine protection was maintained in wave four (aHR for outcome of death: 0.24; 95% CI: 0.10; 0.58). CONCLUSIONS: In the Omicron‐driven wave, severe COVID‐19 outcomes were reduced mostly due to protection conferred by prior infection and/or vaccination, but intrinsically reduced virulence may account for a modest reduction in risk of severe hospitalisation or death compared to the Delta‐driven wave. [ABSTRACT FROM AUTHOR]

Published
2022
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45. Antibiotic resistance has a language problem

Author

Mendelson, Marc, Balasegaram, Manica, Jinks, Tim, Pulcini, Céline, and Sharland, Mike

Subjects
Microbial drug resistance -- Drug therapy -- Health aspects -- Research, Medical research -- Terminology -- Social aspects, Environmental issues, Science and technology, Zoology and wildlife conservation, World Health Organization -- Reports
Abstract

Author(s): Marc Mendelson (corresponding author) [1]; Manica Balasegaram [2]; Tim Jinks [3]; Céline Pulcini [4]; Mike Sharland [5] Clinicians have long known that microbes such as bacteria, viruses and fungi [...]

Published
2017
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46. Cutaneous and mucocutaneous leishmaniasis in travellers and migrants: a 20-year GeoSentinel Surveillance Network analysis

Author

Boggild, Andrea, Caumes, Eric, Grobusch, Martin, Schwartz, Eli, Hynes, Noreen, Libman, Michael, Connor, Bradley, Chakrabarti, Sumontra, Parola, Philippe, Keystone, Jay, Nash, Theodore, Showler, Adrienne, Schunk, Mirjam, Asgeirsson, Hilmir, Hamer, Davidson, Kain, Kevin, Von Sonnenburg, Frank, Rothe, Camilla, Jordan, Sabine, Vinnemeier, Christof, Yansouni, Cedric, McCarthy, Anne, Jensenius, Mogens, Goorhuis, Abraham, Coyle, Christina, Mockenhaupt, Frank, Harms-Zwingengerger, Gundel, Leung, Daniel, Benson, Scott, Gautret, Philippe, Javelle, Emilie, Chappuis, François, Rapp, Christophe, Ficko, Cécile, Van Genderen, Perry, Glans, Hedvig, Beadsworth, Michael, Beeching, Nicholas, Castelli, Francesco, Matteelli, Alberto, Plewes, Katherine, Mirzanejad, Yazdan, López-Vélez, Rogelio, Chamorro, Sandra, Waggoner, Jesse, Wu, Henry, Leder, Karin, Torresi, Joseph, Bottieau, Emmanuel, Huits, Ralph, Chen, Lin, Bourque, Daniel, Alpern, Jonathan, Stauffer, William, Cahill, John, Wyler, Ben, Haulman, Jean, Terry, Anne, Licitra, Carmelo, Taylor, Ashley, Perret Perez, Cecilia, Weitzel, Thomas, Gkrania-Klotsas, Effrossyni, Warne, Ben, Schlagenhauf, Patricia, Weber, Rainer, Schade Larsen, Carsten, Wejse, Christian, Barnett, Elizabeth, Hochberg, Natasha, Barkati, Sapha, Vincelette, Jean, Molina, Israel, Malvy, Denis, Duvignaud, Alexandre, Mendelson, Marc, Parker, Salim, Johnston, Victoria, Field, Vanessa, Kuhn, Susan, Piyaphanee, Watcharapong, Silachamroon, Udomsak, Diaz-Menendez, Marta, Kelly, Paul, Blumberg, Lucille, de Frey, Albie, Pandey, Prativa, Amatya, Bhawana, Mavunda, Kunjana, Saio, Mauro, CHU Pitié-Salpêtrière [APHP], Department of Infectious Diseases [Amsterdam, Netherlands] (Academic Medical Center), University of Amsterdam [Amsterdam] (UvA)-Center for Tropical and Travel Medicine [Amsterdam, Netherlands], Laboratoire de Photophysique et Photochimie Supramoléculaires et Macromoléculaires (PPSM), École normale supérieure - Cachan (ENS Cachan)-Centre National de la Recherche Scientifique (CNRS), Centre for Tropical Diseases [Montréal] (TDC), McGill University, Vecteurs - Infections tropicales et méditerranéennes (VITROME), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées (IRBA), Department of Tropical Medicine and Infectious Diseases, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany, Bernhard-Nocht-Institute for Tropical Medicine, Tropical Disease Unit [Toronto, Canada], University of Toronto, Hôpital d'Instruction des Armées Laveran, Service de Santé des Armées, Geneva University Hospitals - HUG [Switzerland], Hôpital d'Instruction des Armées Begin, Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia, Monash University [Clayton], Addenbrooke's Hospital, Cambridge University NHS Trust, Service de médecine interne et maladies infectieuses, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Université Paris Descartes - Paris 5 (UPD5), University of Cape Town, National Institute for Communicable Diseases (NICD), CIWEC Clinic Travel Medicine Center, Katmandu, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), École normale supérieure - Cachan (ENS Cachan)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), McGill University = Université McGill [Montréal, Canada], Bernhard Nocht Institute for Tropical Medicine - Bernhard-Nocht-Institut für Tropenmedizin [Hamburg, Germany] (BNITM), National Institute for Communicable Diseases [Johannesburg] (NICD), Infectious diseases, AII - Infectious diseases, APH - Aging & Later Life, APH - Global Health, and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA)

Subjects
Leishmaniasis, Mucocutaneous, Male, Immigration, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Epidemiology, Species identification, 030212 general & internal medicine, Political instability, Child, ComputingMilieux_MISCELLANEOUS, media_common, Aged, 80 and over, Transients and Migrants, Cutaneous leishmaniasis, Geosentinel, Mucosal leishmaniasis, Skin lesions after travel, Tegumentary leishmaniasis, Vector-borne disease, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, General Medicine, Middle Aged, 3. Good health, Child, Preschool, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Female, Original Article, Travel-Related Illness, Adult, Costa Rica, Bolivia, Canada, medicine.medical_specialty, Adolescent, media_common.quotation_subject, 030231 tropical medicine, Young Adult, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine, Leishmania (Viannia) braziliensis, Humans, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, Aged, Syria, business.industry, Afghanistan, Infant, Leishmaniasis, Mucocutaneous leishmaniasis, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, business, Demography
Abstract

Background Cutaneous leishmaniasis (CL) may be emerging among international travellers and migrants. Limited data exist on mucocutaneous leishmaniasis (MCL) in travellers. We describe the epidemiology of travel-associated CL and MCL among international travellers and immigrants over a 20-year period through descriptive analysis of GeoSentinel data. Methods Demographic and travel-related data on returned international travellers diagnosed with CL or MCL at a GeoSentinel Surveillance Network site between 1 September 1997 and 31 August 2017 were analysed. Results A total of 955 returned travellers or migrants were diagnosed with travel-acquired CL (n = 916) or MCL during the study period, of whom 10% (n = 97) were migrants. For the 858 non-migrant travellers, common source countries were Bolivia (n = 156, 18.2%) and Costa Rica (n = 97, 11.3%), while for migrants, they were Syria (n = 34, 35%) and Afghanistan (n = 22, 22.7%). A total of 99 travellers (10%) acquired their disease on trips of ≤ 2 weeks. Of 274 cases for which species identification was available, Leishmania Viannia braziliensis was the most well-represented strain (n = 117, 42.7%), followed by L. major (n = 40, 14.6%) and L. V. panamensis (n = 38, 13.9%). Forty cases of MCL occurred, most commonly in tourists (n = 29, 72.5%) and from Bolivia (n = 18, 45%). A total of 10% of MCL cases were acquired in the Old World. Conclusions Among GeoSentinel reporting sites, CL is predominantly a disease of tourists travelling mostly to countries in Central and South America such as Bolivia where risk of acquiring L. V. braziliensis and subsequent MCL is high. The finding that some travellers acquired leishmaniasis on trips of short duration challenges the common notion that CL is a disease of prolonged travel. Migrants from areas of conflict and political instability, such as Afghanistan and Syria, were well represented, suggesting that as mass migration of refugees continues, CL will be increasingly encountered in intake countries.

Published
2019

48. Best practices: Appropriate use of the new β-lactam/ β-lactamase inhibitor combinations, ceftazidimeavibactam and ceftolozane-tazobactam in South Africa.

Author

Brink, Adrian J., Coetzee, ennifer, Richards, Guy A., Feldman, Charles, Lowman, Warren, Tootla, Hafsah D., Miller, Malcolm G.A., Niehaus, Abraham J., Wasserman, Sean, Perovic, Olga, Govind, Chetna N., Schellack, Natalie, and Mendelson, Marc

Abstract

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. [ABSTRACT FROM AUTHOR]

Published
2022
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49. Adherence to a care bundle for Staphylococcus aureus bacteraemia: A retrospective cohort study.

Author

Gatley, Elizabeth M., Boyles, Tom, Dlamini, Sipho, Mendelson, Marc, Namale, Phiona E., Raubenheimer, Peter J., and Wasserman, Sean

Abstract

Background: Staphylococcus aureus bacteraemia is associated with high hospital mortality. Improvements in outcome have been described with standardised bundles of care. Objectives: To study the adherence of a standardised bundle of care (BOC) recommendations using a consultation pro forma, for all patients admitted with S. aureus bacteraemia to Groote Schuur Hospital over a year. The study further aimed to describe the 90-day mortality in these patients and to assess for an association between adherence to the bundle of care and outcome. Method: A retrospective audit of all unsolicited infectious disease consultations for patients with S. aureus bacteraemia admitted to Groote Schuur Hospital during 2018. Adherence to recommendations of a standard bundle of care was audited. Results: A total of 86 patients were included in the study: 61 (71%) with hospital-associated infection and 25 (29%) with community-associated infection. Over 80% of adherence to treatment recommendations was achieved regarding antibiotic (including vancomycin) usage, source control and use of echocardiography as required. In-hospital mortality was 16%, while the overall 90-day mortality was 18%, with only age as an independent predictor of mortality. No association between adherence to the bundle of care and outcome was found. Conclusion: Adherence to a simple, structured bundle of care was good when using standardised pro forma as communication tools for advice and a structured antibiotic chart for vancomycin administration. Although adherence was not associated with outcome, the overall mortality for S. aureus bacteraemia was improving in the institution under study. Contribution: Our findings support feasibility and ongoing use of bundles of care for S. aureus bacteraemia in similar settings. [ABSTRACT FROM AUTHOR]

Published
2022
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