Tweet: "molecular screening of patient samples collected at a national reference laboratory in Pretoria shows endemicity of carbapenemases and rarity of mcr colistin resistance genes" Impacts: Carbapenems and colistin are the last resort antibiotics available for the treatment and eradication of multidrug resistant gram-negative bacteria. Resistance in these antibiotics threaten the public health as it reduces the efficacy of these therapeutics. Klebsiella pneumoniae was identified to harbour all the identified carbapenemases. This is of concern as K. pneumoniae has a history of causing outbreaks and being endemic in healthcare facilities in South Africa. It is important to understand how common carbapenem and colistin-resistant GNB are in the healthcare facilities, as it identifies areas that require attention.
Introduction. Disseminated sporotrichosis is an incapacitating infection caused by the dimorphic fungus Sporothrix schenckii. Because this condition may mimic the presentation of tuberculosis, syphilis and other bacterial infections, the diagnosis may be missed or delayed. Case Presentation. We describe a case of disseminated sporotrichosis in a patient with poorly controlled human immunodeficiency virus infection. The patient was initially treated for bacterial skin infections. The differential diagnosis also included tuberculosis and syphilis. Only after appropriate specimens had been sent for microbiological and histopathological investigations was the diagnosis of disseminated sporotrichosis made and appropriate treatment started. The patient showed a good clinical response to itraconazole. Conclusion. This report highlights the importance of having a high index of suspicion of endemic mycoses when managing immunocompromised patients. The report also demonstrates that a delay in the diagnosis of sporotrichosis increases morbidity and results in unnecessary and inappropriate treatment with associated costs and adverse effects.
Objective: In this study, we sought to determine the source of an outbreak of Achromobacter denitrificans infections in patients at a tertiary-care academic hospital. Design: Outbreak report study with intervention. The study period extended from February 2018 to December 2018. Setting: The study was conducted at a tertiary-care academic hospital in Pretoria, South Africa. Patients and participants: All patients who cultured A. denitrificans from any site were included in this study. During the study period, 43 patients met this criterion. Interventions: Once an outbreak was confirmed, the microbiology laboratory compiled a list of affected patients. A common agent, chlorhexidine-and-water solution, was used as a disinfectant–antiseptic for all affected patients. The laboratory proceeded to culture this solution. Environmental and surface swabs were also cultured from the hospital pharmacy area where this solution was prepared. Repetitive-element, sequence-based, polymerase chain reaction (rep-PCR) was performed on the initial clinical isolates to confirm the relatedness of the isolates. Results: In total, 43 isolates of A. denitrificans were cultured from patient specimens during the outbreak. The laboratory cultured A. denitrificans from all bottles of chlorhexidine-and-water solutions sampled from the wards and the pharmacy. The culture of the dispenser device used to prepare this solution also grew A. denitrificans. The rep-PCR confirmed the clonality of the clinical isolates with 2 genotypes dominating. Conclusions: Contaminated chlorhexidine-and-water solutions prepared at the hospital pharmacy was determined to be the source of the outbreak. Once this item was removed from the hospital, the laboratory did not culture any further A. denitrificans isolates from patient specimens.
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