Antimicrobial Management of Skin and Soft Tissue Infections among Surgical Wards in South Africa: Findings and Implications

Abstract

Skin and soft tissue infections (SSTIs) are one of the most common infectious diseases requiring antibiotics. However, complications of SSTIs may lead to the overprescribing of antibiotics and to subsequent antibiotic resistance. Consequently, monitoring the prescribing alignment with the current recommendations from the South African Standard Treatment Guidelines (STG) is necessary in order to improve future care. This study involved reviewing pertinent patients with SSTIs who were prescribed antimicrobials in the surgical ward of a leading South African tertiary public hospital from April to June 2021 using an adapted data collection tool. Sixty-seven patient files were reviewed. Among the patients with SSTIs, hypertension and chronic osteomyelitis were the most frequent co-morbidities at 22.4% and 13.4%, respectively. The most diagnosed SSTIs were surgical site infections (35.1%), wound site infections (23%), and major abscesses (16.2%). Blood cultures were performed on 40.3% of patients, with Staphylococcus aureus (32.7%) and Enterococcus spp. (21.2%) being the most cultured pathogens. Cefazolin was prescribed empirically for 46.3% of patients for their SSTIs. In addition, SSTIs were treated with gentamycin, ciprofloxacin, and rifampicin at 17.5%, 11.3%, and 8.8%, respectively, with treatment fully complying with STG recommendations in 55.2% of cases. Overall, the most common cause of SSTIs was Staphylococcus aureus, and empiric treatment is recommended as the initial management. Subsequently, culture sensitivities should be performed to enhance adherence to STGs and to improve future care.

Antimicrobial Stewardship for Outpatients with Chronic Bone and Joint Infections in the Orthopaedic Clinic of an Academic Tertiary Hospital, South Africa

“…The majority of patients in our study presented with HIV, hypertension, diabetes and as IV drug users for comorbidities. This mirrors recently published studies in a similar setting in South Africa [34]. This is also similar to the findings of Romano et al ( 2011), who reported an increased prevalence of bone and joint infections in immunocompromised individuals, as well as those with certain lifestyle habits, including intravenous drug use [35].…”

“…This could be due to the fact that there is an increase of bone and joint infections due to trauma including traffic accidents and sport injuries in our population, which is more predominant in males as they engage in more risky behaviour [33]. Similarly, a recent study for skin and soft tissue infections in South Africa showed males being more affected [34].…”

“…This needs to be addressed, especially with rifampicin being the cornerstone of treatment against biofilm S. aureus musculoskeletal infections [10]. However, whilst its effectiveness has been proven across studies [13], care is required in the South African setting as overexposure may lead to resistance [42]; and in a recent study in South Africa, rifampicin was amongst the top five antibiotics prescribed for skin and soft tissue infections [34]. This is a concern as rifampicin is currently used as one of the first-line antimicrobials in the treatment of tuberculosis in South Africa, which has a high burden of drug-resistant tuberculosis (DR-TB) [43].…”

“…This is a concern as rifampicin is currently used as one of the first-line antimicrobials in the treatment of tuberculosis in South Africa, which has a high burden of drug-resistant tuberculosis (DR-TB) [43]. The efficacy of the floroquinolones has also been proven in bone and joint infections [5,34,35]. However, in South Africa, ciprofloxacin is not used in the treatment of tuberculosis because of its weak efficacy compared to other fluoroquinolones [44][45][46].…”

Knowledge, Attitude and Practices of Self-Medication Including Antibiotics among Health Care Professionals during the COVID-19 Pandemic in Pakistan: Findings and Implications

“…The data collection tool used in our survey was developed from previous studies combined with the considerable experience of the co-authors as well as observing local practices [ 55 , 103 , 110 , 113 , 114 , 139 ]. We have used this method before when developing context-specific data collection forms [ 101 , 131 , 140 , 141 , 142 ].…”