The role of the Infectious Diseases unit at Groote Schuur Hospital in addressing South Africa’s greatest burden of disease

Pandie, Mishal; Plas, Helen van der; Maartens, Gary; Mendelson, Marc

doi:10.7196/samj.5730

Cited by 4 publications

(9 citation statements)

References 6 publications

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“…Previous reports indicated that in this age group traumatic injuries from road traffic crashes or assault were the second most common cause of morbidity and mortality after HIV infection, particularly in males (Hanekom, Coetzee and Faure 2006 , Ntumba and Juma 2011 ). However, our study sample showed lower prevalence of HIV in both elective and traumatic surgery patients when compared to reports from other African countries (Hanekom, Coetzee and Faure 2006 , Odimba 2010 , Pandie et al, 2012 ).…”

Section: Discussioncontrasting

confidence: 81%

“…The most common comorbidities present in our study were HIV and hypertension. These comorbidities have been reported in South Africa (Hanekom, Coetzee and Faure 2006 , Pandie et al, 2012 ). The greatest burden of disease in Africa comes from infectious diseases, with HIV and tuberculosis (TB) dominating the health landscape but now there is an increase in non-communicable diseases, with hypertension and diabetes dominating (Pandie et al, 2012 ).…”

Section: Discussionsupporting

confidence: 59%

“…These comorbidities have been reported in South Africa (Hanekom, Coetzee and Faure 2006 , Pandie et al, 2012 ). The greatest burden of disease in Africa comes from infectious diseases, with HIV and tuberculosis (TB) dominating the health landscape but now there is an increase in non-communicable diseases, with hypertension and diabetes dominating (Pandie et al, 2012 ). There is sufficient evidence to support that exercise capacity, diabetes, and HIV infection are independent risk factors for postoperative pulmonary complications (Hulzebos et al, 2003 ; Rudra and Das 2006 ).…”

Section: Discussionsupporting

confidence: 59%

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The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study

et al. 2017

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BackgroundThe burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal anatomy and activity of the respiratory muscles leading to reduced lung volumes and putting the patients at greater risk of developing post-operative pulmonary complications (PPCs). PPCs remain an important cause of post-operative morbidity, mortality, and impacts on the long-term outcomes of patients post hospital discharge. The objective of the study was to determine the pulmonary complications developing after abdominal and thoracic surgery and the associated risks factors.MethodsA retrospective records review of all abdominal and thoracic surgery patients admitted at a central hospital from January 2014 to October 2014 was done. Data collected included demographic data, surgical history, comorbidities and the PPCs present.ResultsOut of the 92 patients whose records were reviewed, 55 (59.8%) were males and 84 (91.3%) had abdominal surgery. The mean age of the patients was 42.6 years (SD = 18.4). The common comorbidities were HIV infection noted in 14(15.2%) of the patients and hypertension in 10 (13.0%). Thirty nine (42.4%) developed PPCs and the most common complications were nosocomial pneumonia in 21 (22.8%) patients, ventilator associated pneumonia in 11 (12.0%), and atelectasis in 6 (6.5%) patients. Logistic regression showed that a history of alcohol consumption, prolonged surgery, prolonged stay in hospital or critical care unit, incision type, and comorbidities were significant risk factors for PPCs (p < 0.05). The mortality rate was 10.9%.ConclusionPPCs like nosocomial and ventilator associated pneumonia were common and were associated with increased morbidity and adversely affected clinical outcomes of patients. HIV and hypertension presented significant comorbidities which the health team needed to recognize and address. Strategies to reduce the occurrence of PPCs have to be implemented through coordinated efforts by the health practitioners as a team during the entire perioperative period.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionsupporting

confidence: 59%

Section: Discussionsupporting

confidence: 59%

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The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study

et al. 2017

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“…Formal infectious diseases consultative activity in developing countries may differ significantly. For example, between 2008 and 2011 at a South African tertiary hospital, 80% of consultations involved HIV-positive patients, and tuberculosis and malaria were the most frequent diagnoses amongst patients without HIV [24]. We acknowledge certain factors may bias our results, including seasonality and non-participation, particularly of physicians in private hospitals.…”

Section: Discussionmentioning

confidence: 94%

What do infectious diseases physicians do? A 2-week snapshot of inpatient consultative activities across Australia, New Zealand and Singapore

Ingram

Cheng

Murray

et al. 2014

Clinical Microbiology and Infection

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The practice of an infectious diseases (ID) physician is evolving. A contemporary understanding of the frequency and variety of patients and syndromes seen by ID services has implications for training, service development and setting research priorities. We performed a 2-week prospective survey of formal ID physician activities related to direct inpatient care, encompassing 53 hospitals throughout Australia, New Zealand and Singapore, and documented 1722 inpatient interactions. Infections involving the skin and soft tissue, respiratory tract and bone/joints together accounted for 49% of all consultations. Suspected/confirmed pathogens were primarily bacterial (60%), rather than viral (6%), fungal (4%), mycobacterial (2%) or parasitic (1%). Staphylococcus aureus was implicated in 409 (24%) episodes, approximately four times more frequently than the next most common pathogen. The frequency of healthcare-related infections (35%), immunosuppression (21%), diabetes mellitus (19%), prosthesis-related infections (13%), multiresistant pathogens (13%) and non-infectious diagnoses (9%) was high, although consultation characteristics varied between geographical settings and hospital types. Our study highlights the diversity of inpatient-related ID activities and should direct future teaching and research. ID physicians' ability to offer beneficial consultative advice requires broad understanding of, and ability to interact with, a wide range of referring specialities.

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“…1 The value of a physician specially trained in IDs and the management thereof is becoming increasingly apparent as ID dominates the SA disease profile. 2 Specialist ID consultation has been shown to decrease mortality, improve patient outcomes and reduce expenditure on care. 3,4,5,6,7 Antimicrobial resistance threatens the ability to manage common IDs and this has been exacerbated by the paucity of new antimicrobial agents.…”

Section: Introductionmentioning

confidence: 99%

Infectious disease consultations at a South African academic hospital: A 6-month assessment of inpatient consultations

Richards

Spencer

Nel

et al. 2020

Southern African Journal of Infectious Diseases

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Results: 749 ID consultations were analysed, 4.8% of hospital admissions. Most consultations included initiation of antiretroviral therapy (ART) (27.8%), lipoarabinomannan antigen testing (24.8%) and change of ART (21.6%). Of patients reviewed, 93.3% were human immunodeficiency virus (HIV) positive and the median CD4 count was 52 cells/mm 3 . The infectious diagnoses (excluding HIV) most frequently encountered were pulmonary and abdominal tuberculosis (TB) and acute gastroenteritis. When all subcategories of TB infection were combined, 42.9% were found to have TB. Patients had predominantly one (45.4%) or two (30.2%) infectious diagnoses in addition to HIV. Some (12%) had three infectious diagnoses during their admission. The number of diagnoses, both infectious (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.11-3.60) and non-infectious (OR 2.27; 95% CI 1.25-4.11), was associated with increased odds of death. Conclusion:The IDs department sees a high volume of patients compared to most developed countries. HIV, TB and their management dominate the workload. This study shows that HIV patients still have significant morbidity and mortality. The complexity of these patients indicates that specific expertise is required beyond that of the general physician.

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The role of the Infectious Diseases unit at Groote Schuur Hospital in addressing South Africa’s greatest burden of disease

Cited by 4 publications

References 6 publications

The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study

The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study

What do infectious diseases physicians do? A 2-week snapshot of inpatient consultative activities across Australia, New Zealand and Singapore

Infectious disease consultations at a South African academic hospital: A 6-month assessment of inpatient consultations

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