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  1. Article ; Online: Combating antimicrobial resistance in neonatal infections: a South African perspective.

    Pillay, Dharshni

    The Lancet. Global health

    2022  Volume 10, Issue 8, Page(s) e1082–e1083

    MeSH term(s) Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Communicable Diseases ; Cross Infection ; Drug Resistance, Bacterial ; Humans ; Infant, Newborn ; South Africa/epidemiology
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-07-14
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 2723488-5
    ISSN 2214-109X ; 2214-109X
    ISSN (online) 2214-109X
    ISSN 2214-109X
    DOI 10.1016/S2214-109X(22)00288-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Neonatal sepsis in a tertiary unit in South Africa.

    Pillay, Dharshni / Naidoo, Lerusha / Swe Swe-Han, Khine / Mahabeer, Yesholata

    BMC infectious diseases

    2021  Volume 21, Issue 1, Page(s) 225

    Abstract: Background: Antimicrobial resistance (AMR) has emerged as a global threat to healthcare resulting in an increase in morbidity and mortality. Neonatal sepsis is ranked as the third highest cause of neonatal demise globally, in which AMR accounted for 31 ... ...

    Abstract Background: Antimicrobial resistance (AMR) has emerged as a global threat to healthcare resulting in an increase in morbidity and mortality. Neonatal sepsis is ranked as the third highest cause of neonatal demise globally, in which AMR accounted for 31.0% of deaths. AMR in neonates has been poorly characterised in Durban, South Africa. Thus, the resultant effect of AMR on empiric regimens for neonatal sepsis is uncertain in this setting. Therefore, this study analysed the aetiology and antimicrobial susceptibility patterns of bloodstream infections within the neonatal intensive care unit at a tertiary hospital in Durban, with the aim of establishing an effective empiric regimen for the unit.
    Methods: A retrospective data review on positive blood cultures from the neonatal intensive care unit at Inkosi Albert Luthuli Central Hospital was conducted. Three time periods were analysed: 2014, 2016 and 2018. Culture data from neonates aged 0-30 days were included and repeat cultures were de-duplicated. The frequency of common organisms and their antimicrobial susceptibilities were analysed. Fischer's exact test was used for subgroup analysis. Poisson and logistic regressions were used to assess significant trends in organisms and antimicrobial susceptibilities over time.
    Results: Late-onset sepsis (86.8%) predominated over early-onset sepsis (13.2%). A preponderance of gram-positive organisms (68.7%) over gram-negatives (26.8%) and fungi (4.5%) was detected. Common pathogens included coagulase-negative staphylococci (53.5%), Klebsiella pneumoniae (11.6%), enterococci (9.3%), and Acinetobacter baumannii (7.7%). Despite the small contribution of fungi to the microbial profile, fluconazole-resistant Candida parapsilosis predominated within that group. High rates of resistance to first- and second-line antibiotics were also noted among gram-positive and gram-negative organisms. Multidrug resistant organisms included extended-spectrum beta-lactamase (ESBL) K. pneumoniae (7.6%) and extensively-drug resistant A. baumannii (7.0%). However, a statistically significant decrease in ESBL-producing organisms was documented during the entire study period (p = 0.005).
    Conclusions: It was determined that first-line antimicrobials, advocated by the World Health Organization for treatment of neonatal sepsis, proved ineffective in this unit due to high levels of AMR. Therefore, this study advises that meropenem with or without vancomycin provides optimal empiric cover. Amphotericin B is advocated for empiric antifungal therapy. Ongoing surveillance is necessary.
    MeSH term(s) Age of Onset ; Anti-Bacterial Agents/therapeutic use ; Bacterial Typing Techniques ; Female ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Intensive Care Units, Neonatal/statistics & numerical data ; Male ; Microbial Sensitivity Tests ; Mycological Typing Techniques ; Neonatal Sepsis/drug therapy ; Neonatal Sepsis/epidemiology ; Neonatal Sepsis/microbiology ; Retrospective Studies ; South Africa/epidemiology ; Tertiary Care Centers/statistics & numerical data
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2021-02-27
    Publishing country England
    Document type Journal Article
    ISSN 1471-2334
    ISSN (online) 1471-2334
    DOI 10.1186/s12879-021-05869-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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