Rates of healthcare-associated infections (HAIs) among babies born in hospitals in developing countries are 3 -20 times higher than among those born in resource-rich countries. [1] While poor infection prevention and control (IPC) practices are most proximally associated with transmission of HAIs and high infection rates, contributing factors include ageing hospital infrastructure, overcrowded neonatal units, inappropriate use of antimicrobial agents and inadequate institutional support for IPC and antimicrobial stewardship programmes. [2] Klebsiella pneumoniae is a common pathogen causing invasive HAIs in neonates. [1] Factors that predispose neonates to K. pneumoniae infection include prematurity and low birth weight. [3] The emergence of carbapenem-resistant K. pneumoniae in neonatal units has rendered recommended first-line empirical regimens for neonatal sepsis ineffective. [4] OXA-48-producing K. pneumoniae strains, which may remain phenotypically susceptible to carbapenems, can be missed in routine laboratories if not confirmed with molecular testing. [5] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Background We aimed to describe an outbreak of cutaneous abscesses caused by Panton-Valentine leukocidin (PVL)-producing methicillin-susceptible Staphylococcus aureus (MSSA) among gold mine workers. Methods In February 2018, we retrospectively reviewed a random sample of 50 medical records from 243 cases and conducted face-to-face interviews using a structured questionnaire. Pus aspirates were sent to the National Institute for Communicable Diseases from prospectively-identified cases (November 2017–March 2018). Nasopharyngeal swabs were collected during a colonisation survey in February 2018. Staphylococcus aureus isolates were screened with a conventional PCR for lukS/F -PV. Pulsed-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness among the isolates. A sample of isolates were selected for whole genome sequencing (WGS). We conducted an assessment on biological risks associated with mining activities. Results From January 2017 to February 2018, 10% (350/3582) of mine workers sought care for cutaneous abscesses. Forty-seven medical files were available for review, 96% were male ( n = 45) with a mean age of 43 years (SD = 7). About 52% (24/46) were involved in stoping and 28% (13/47) worked on a particular level. We cultured S. aureus from 79% (30/38) of cases with a submitted specimen and 14% (12/83) from colonisation swabs. All isolates were susceptible to cloxacillin. Seventy-one percent of S. aureus isolates (30/42) were PVL-PCR-positive. Six PFGE clusters were identified, 57% (21/37) were closely related. WGS analysis found nine different sequence types. PFGE and WGS analysis showed more than one cluster of S. aureus infections involving closely related isolates. Test reports for feed and product water of the mine showed that total plate counts were above the limits of 1000 cfu/ml, coliform counts > 10 cfu/100 ml and presence of faecal coliforms. Best practices were poorly implemented as some mine workers washed protective clothing with untreated water and hung them for drying at the underground surface. Conclusions PVL-producing MSSA caused an outbreak of cutaneous abscesses among underground workers at a gold mining company. To our knowledge, no other outbreaks of PVL-producing S. aureus involving skin and soft tissue infections have been reported in mining facilities in South Africa. We recommend that worker awareness of infection prevention and control practices be strengthened.
Purpose: A cluster of necrotising enterocolitis (NEC) cases among newborns admitted to neonatal ward at a Gauteng Province hospital was reported to the National Institute for Communicable Diseases on 4/4/2018. An investigation was conducted to determine the possible cause/source of the outbreak and implement prevention and control measures and make recommendation for prevention of future outbreaks in this setting. Methods & Materials:A cross-sectional study was conducted to describe the clinical, epidemiological and environmental characteristics and determine possible source/cause of the outbreak among newborns admitted to a neonatal ward in March to June 2018. Blood cultures (Bacterial/fungal blood stream infections), bacterial (Salmonella, Shigella and Campylobacter and enterohemorrhagic Escherichia coli species) stool cultures and real-time polymerase chain reaction for enteric viruses (rotavirus, astrovirus, sapovirus, norovirus and adenovirus) was carried out.Results: A total of 37 cases, including 35 (95%) premature and two (5%) full-term babies were reported. Of the 37; eight (22%) died, 20 (54%) discharged, three (8%) transferred to other hospitals, six (16%) were still admitted. Twenty-one (57%) had stage IIA disease, nine (24%) stage IIB, three (8%) stage IIIA and four (11%) stage IIIB. Children aged <1 month accounted for 89% (n = 33) of the cases. Eleven (30%) cases were fed breast milk, 10 (27%) were formula fed and 12 (32%) were on mixed feeding, while feeding type was unknown in four cases (11%). Blood cultures were performed in 33 cases (89%); no bacterial/fungal growth in 16 cases (48%), various pathogens were isolated in 16 cases (48%). Stool samples were tested in 17 cases (46%), none of the enteric pathogens tested for were isolated. Bacillus cereus and Streptococcus species were isolated in different brands of prepared and unprepared formula milk.Conclusion: Although the aetiology and source of the outbreak has not been established, the isolation of B. cereus and Streptococcus species in formula milk is concerning. However, these findings should be interpreted with caution as toxin production tests were not done, B. cereus and Streptococcus species were not tested for in stools and the investigations are ongoing. Strengthening and strict adherence to infection prevention and control practices are recommended to prevent horizontal spread of potential pathogens.
Background:The Vasoactive Inotropic Score (VIS) is an objective clinical tool that was used to quantify the need for cardiovascular support and used as a predictor of morbidity and mortality in children with septic shock.Methods and materials: This is a prospective cohort study of all septic shock patients aged 1 m to 18 y who were admitted at the PICU. Vasoactive Inotropic Score was calculated at initial, 6, 12, 24, and 48 h post PICU admission as described by Gaies, et. al. Demographic and clinical data were collected. Primary outcomes were ventilator days and ICU length of stay while secondary outcomes were death during hospitalization, cardiac arrest, and need for intubation. STATA 13.1 was used for data analysis. Appropriate descriptive and analytical statistical tests were applied for this data and a P-value <0.05 was considered significant.Results: Eighty-four patients met the inclusion criteria and were enrolled in the study. Sixty-two (73.81%) patients were intubated, 34 (40.48%) went into cardiac arrest and 33 (39.29%) died during hospitalization. Fourteen (22.22%) patients were ventilated for 6 days or more and 20 (23.81%) stayed in the PICU for 12 d or more. This study showed a strong association between VIS at initial, 6, 12, 24, 48 h and maximum VIS with the risk of intubation (P-value of 0.047, 0.007, 0.012, 0.026, 0.012, and 0.009), cardiac arrest (P-value of 0.001-initial; <0.001-6 to 48 h and maximum VIS) and death during hospitalization (P-value of 0.002-initial; <0.001-6 to 48 h and maximum VIS). Results showed that initial upto maximum VIS within 48 h may capture a component of illness in pediatric septic shock and served as a surrogate outcome that highlights cardiovascular instability.Conclusion: This study showed that VIS is independently associated with poor outcomes such as risk for intubation, cardiac arrest, and death during hospitalization. VIS is easily measured and, if validated in pediatric sepsis, has the potential to standardize the quantification of hemodynamic support, identify, and stratify high-risk patient populations, and be used as a surrogate outcome measure.
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