Comparison of causes of stillbirth and child deaths as determined by verbal autopsy and minimally invasive tissue sampling.

In resource-limited settings where vital registration and medical death certificates are unavailable or incomplete, verbal autopsy (VA) is often used to attribute causes of death (CoD) and prioritize resource allocation and interventions. We aimed to determine the CoD concordance between InterVA and CHAMPS's method. The causes of death (CoDs) of children <5 were determined by two methods using data from seven low- and middle-income countries (LMICs) enrolled in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. The first CoD method was from the DeCoDe panel using data from Minimally Invasive Tissue Sampling (MITS), whereas the second method used Verbal Autopsy (VA), which utilizes the InterVA software. This analysis evaluated the agreement between the two using Lin's concordance correlation coefficient. The overall concordance of InterVA4 and DeCoDe in assigning causes of death across surveillance sites, age groups, and causes of death was poor (0.75 with 95% CI: 0.73-0.76) and lacked precision. We found substantial differences in agreement by surveillance site, with Mali showing the lowest and Mozambique and Ethiopia the highest concordance. The InterVA4 assigned CoD agrees poorly in assigning causes of death for U5s and stillbirths. Because VA methods are relatively easy to implement, such systems could be more useful if algorithms were improved to more accurately reflect causes of death, for example, by calibrating algorithms to information from programs that used detailed diagnostic testing to improve the accuracy of COD determination.

Non-fermenter Gram-negative bacilli at a tertiary hospital, South Africa.

Background: Non-fermenting Gram-negative bacilli (NFGNB) are a significant cause of healthcare-associated infections and are often implicated in nosocomial outbreaks. Non- fermenting Gram-negative bacilli tend to have variable susceptibility patterns that make the choice of empiric therapy difficult and thus treatment must be based on in vitro susceptibility testing of each antimicrobial agent. Objectives: To describe the epidemiology of the NFGNB isolated from adult patients at Chris Hani Baragwanath Hospital (CHBAH) and to assess their antimicrobial susceptibility patterns in order to guide empiric therapy and inform infection prevention and control practices. Method: Organisms isolated from sterile sites of adult in-patients between 01 January 2016 to 31 December 2018 were retrospectively analysed. Results: A total of 2005 NFGNB isolated. Blood cultures were the most common specimen type (91.4%). Acinetobacter species were the most commonly isolated organisms (65.1%), followed by Pseudomonas species (26.5%). The majority of NFGNB were isolated from patients in surgical wards (38.9%) followed by medical wards (35.2%). Most (60%) of the Acinetobacter species were extremely drug resistant. Pseudomonas species were more susceptible than the Acinetobacter species with an overall susceptibility rate of 86% for Pseudomonas species. Conclusion: The rates of antimicrobial resistance demonstrated among Acinetobacter and Pseudomonas species were high, which illustrates the threat of antimicrobial resistance also seen worldwide. An emergence of NFGNB with intrinsic multidrug resistance (Stenotrophomonas maltophilia and Burkholderia cepacia) was noted. We suggest empiric therapy with a carbapenem sparing regimen of piperacillin-tazobactam in combination with amikacin and that empiric therapy be reviewed annually when cumulative antibiograms are done. Contribution: Understanding of the distribution and antimicrobial susceptibility patterns of NFGNB at CHBAH.

Fosfomycin susceptibility of uropathogens at Charlotte Maxeke Johannesburg Academic Hospital.

BACKGROUND: Multidrug-resistant uropathogens are becoming widespread both in community and hospital setting. Safe yet effective treatments are a priority. Fosfomycin is an antibacterial that displays good activity against most bacteria causing urinary tract infections (UTIs), including multidrug-resistant bacteria. The aim of this study was to evaluate fosfomycin susceptibility for uropathogens isolated from a microbiology laboratory at a tertiary academic hospital. In addition, this was compared to the susceptibility of other oral antimicrobials. METHODS: We conducted a retrospective analysis of laboratory reports for uropathogens isolated at Charlotte Maxeke Johannesburg Academic Hospital from September 2015 to August 2017. Antimicrobial susceptibility testing of the isolates was performed using the Kirby-Bauer disk diffusion method or the Vitek® 2 system according to the Clinical and Laboratory Standards Institute. RESULTS: Overall susceptibility of fosfomycin for the 4700 Enterobacteriaceae isolates was 95.7%; 95% confidence interval (CI) 95.1-96.2. The overall susceptibility for fosfomycin against the gram-positives was 98.6%. There were 37.9% multidrug-resistant Enterobacteriaceae (MDRE) isolated during the study period. Fosfomycin displayed activity against 94.4% of extended-spectrum ß-lactamase (ESBL) producers and 90.7% for carbapenem-resistant Enterobacteriaceae (CRE). None of the methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus isolates tested was fosfomycin resistant. The overall in vitro susceptibility was significantly higher for fosfomycin (p = 0.0001) compared to amoxicillin/clavulanic acid, cephalexin, cefuroxime, ciprofloxacin, trimethoprim/sulfamethoxazole and nitrofurantoin. CONCLUSION: This study confirmed the high susceptibility of fosfomycin against UTI pathogens isolated at our institution. In an era of increasing antimicrobial resistance, fosfomycin represents a potential option for the treatment of UTIs at Charlotte Maxeke Johannesburg Academic Hospital.