Objectives To map published data of antimicrobial stewardship (AMS) interventions that are currently being carried out in hospitals and clinics in the public and private health sectors of South Africa in line with the antimicrobial resistance (AMR) strategy of South Africa. Methods A systematic scoping review was conducted to identify AMS initiatives in the public and private health sectors of South Africa for the period 1 January 2000 to 31 March 2019. An electronic search of databases was made including PubMed, Scopus, a key medical journal (South African Medical Journal), University of KwaZulu-Natal (UKZN) WorldCat iCatalogue and AMR networks: Federation of Infectious Diseases Societies in South Africa (FIDSSA). Reference lists of published articles were also reviewed for inclusion. Keywords included ‘antimicrobial antibiotic stewardship South Africa’. Findings Of a total of 411 articles, using a stepwise screening process, 18 articles were selected for inclusion in the review. The interventions/initiatives were divided into four broad categories: (i) AMS intervention: prescription audits and usage; (ii) AMS intervention: education and its impact; (iii) other AMS interventions; and (iv) the role of different healthcare professionals in AMS. Conclusions The data identifies a need for and the value of AMS in both the public and private health sectors of South Africa. Initiatives are carried out across both sectors but more attention needs to be focused on AMS implementation in line with the National AMR Strategy of South Africa. Collaboration between the different sectors will aid in overcoming the AMR challenge.
Antimicrobial resistance (AMR) is a serious global public-health threat. Evidence suggests that antimicrobial stewardship (AMS) is a valuable tool to facilitate rational antibiotic use within healthcare facilities. A cross-sectional situational analysis using a questionnaire was conducted to determine the current status of antimicrobial stewardship (AMS) activities in all public-sector hospitals in KwaZulu-Natal (KZN). The survey had a 79% (57, N = 72) response rate. A total of 75% of hospitals had an antimicrobial stewardship committee (AMSC), 47% (20, N = 43) had a formal written statement of support from leadership, and 7% (3, N = 43) had budgeted financial support. Only 37% (16, N = 43) had on-site or off-site support from a clinical microbiologist, and 5% (2, N = 43) had an on-site infectious disease (ID) physician. Microbiologist input on pathogen surveillance data (aOR: 5.12; 95% CI: 4.08–22.02; p-value = 0.001) and microbiological investigations prior to the commencement of antibiotics (aOR: 5.12; 95% CI: 1.08–42.01; p-value = 0.041) were significantly associated with having either on- or off-site microbiology support. Respondents that had a representative from microbiology on the AMSC were significantly associated with having and interrogating facility-specific antibiograms (P = 0.051 and P = 0.036, respectively). Those facilities that had access to a microbiologist were significantly associated with producing an antibiogram (aOR: 4.80; 95% CI: 1.25–18.42; p-value = 0.022). Facilities with an ID physician were significantly associated with having a current antibiogram distributed to prescribers within the facility (P = 0.010) and significantly associated with sending prescribers personalized communication regarding improving prescribing (P = 0.044). Common challenges reported by the facilities included suboptimal hospital management support; a lack of clinicians, pharmacists, nurses, microbiologists, and dedicated time; the lack of a multidisciplinary approach; low clinician buy-in; inadequate training; a lack of printed antibiotic guidelines; and financial restrictions for microbiological investigations. The survey identified the need for financial, IT, and management support. Microbiology and infectious disease physicians were recognized as scarce human resources.
BACKGROUND: Tuberculosis, a major public health problem in most of the developing countries is posing a still bigger threat with the epidemic of HIV and association has been termed as "cursed duet". There is significant difference in the clinical profile of tuberculosis in HIV infected compared to immunocompetent host. So prompt diagnosis and treatment of tuberculosis in HIV infected will improve the morbidity and mortality associated with dual infection. So the objective of the study was to determine the clinical profile of TB in HIV infected in relation to CD4 counts. MATERIALS AND METHODS:Hundred patients with HIV infection and having symptoms of tuberculosis admitted in the medical wards in Government General Hospital, Guntur were studied. Diagnosis of tuberculosis was based on clinical evaluation, sputum smears, bacteriological and biochemical examination of body fluids, histopathological studies and radiological studies. CD4 T cell counts were done in all patients. RESULTS: 51% had only pulmonary tuberculosis, 43% had only extrapulmonary involvement while 6% had disseminated disease. Sputum positivity was seen in 27.45% of pulmonary tuberculosis. Chest X-ray findings were mixed and varied with infiltrative lesions seen in 83.33% and fibrocavitatory lesions in 11.11%. 55.55% of infiltrative lesions were seen in mid and lower zones. Mean CD4 counts in this study was 133.78 ± 75 cells/μL. Most of the patients with extra pulmonary TB and disseminated TB had CD < 200 cells/μL. Sputum positivity and upper zone lesions in chest X-ray were seen more in patients with CD4 > 200 cells/μL. CONCLUSION: Tuberculosis has a varied clinical presentation in patients with HIV infection. Sputum negative TB, extrapulmonary TB and disseminated TB were common when CD4 < 200 cells/μL and chest X-ray findings were atypical when CD4 < 200 cells/μL.
Background: Acute generalized peritonitis from Gastrointestinal hollow viscus perforation is a potentially life threatening condition. The aim of the study was to assess the application of APACHE II score in assessing the severity and outcome in peritonitis due to hollow viscus perforation and to correlate morbidity and mortality patterns using the modified APACHE II Score and its significance on the outcome.Methods: A prospective survey of 50 patients with acute generalized peritonitis due to hollow viscus perforation was carried out in general surgical wards, CAIMS, Karimnagar. APACHE-II scores were assigned to all patients in order to calculate their individual risk of mortality before undergoing emergency surgery.Results: Total 50 patients were admitted during the study period. Age and sex distribution shows that perforation was common >60 years in our study. Higher modified APACHE II scores statistically influenced mortality in all the patients irrespective of aetiology with p<0.001 which is statistically significant.Conclusions: Modified APACHE II scoring predicts mortality which was significant irrespective of the aetiology.
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