Bacterial and Candida Colonization of Neonates in a Regional Hospital in South Africa.

BACKGROUND: Neonatal colonization with multidrug-resistant (MDR) Enterobacter spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterococcus faecium (ESKAPE) and Candida spp. often precedes invasive hospital-acquired infections. We investigated the prevalence and dynamics of neonatal ESKAPE and Candida spp. colonization from hospital admission until discharge (or death) and followed up for invasive disease. METHODS: Prospective longitudinal surveillance for neonatal ESKAPE and Candida spp. colonization was conducted over 6 months at a South African regional hospital. Neonates enrolled at birth had swabs (nasal, 2× skin and rectal) collected within 24 hours and every 48-96 hours thereafter, until discharge or death. ESKAPE and Candida spp. were cultured for and antimicrobial susceptibility was performed on bacterial isolates. Whole-genome sequencing was undertaken on paired samples with the same bacterial species from colonizing and invasive disease episodes in the same child. RESULTS: Of 102 enrolled neonates, 79% (n = 81) were colonized by ≥1 ESKAPE organism by time of discharge or death. Forty-four percent (36/81) were colonized within 24 hours of birth. Common colonizers were K. pneumoniae (70%; n = 57) and Enterobacter spp. (43%; n = 35). Almost all MDR organisms (93%) were Gram-negative. Forty-two (45%, 42/93) newborns acquired Candida spp. (skin only) colonization, commonly Candida parapsilosis (69%; n = 29). For 2 children with K. pneumoniae colonization and sepsis, the bloodstream and colonizing isolates were genetically different, whereas the single A. baumannii colonizing and blood isolate pair were genetically identical. CONCLUSIONS: We report a high prevalence of MDR ESKAPE and Candida spp. colonization in a regional neonatal unit. Interventions to reduce the high incidence of hospital-acquired neonatal infections should include reducing high colonization rates.

Prevalence and Characterization of Campylobacter Species from Chickens Sold at Informal Chicken Markets in Gauteng, South Africa.

ABSTRACT: This study determined the prevalence, characteristics, and risk factors of Campylobacter species contamination of chicken carcasses sold at informal poultry outlets in Gauteng province, South Africa. Within six townships, 151 chicken carcasses were collected from 47 outlets. Carcass swab, cloacal swab, and carcass drip samples were collected from each chicken, along with a matched questionnaire on risk factors regarding Campylobacter contamination. Sample-inoculated Bolton broth (BB) was cultured to isolate Campylobacter species by bacteriological methods. Subsequent confirmation and characterization of Campylobacter were conducted using polymerase chain reaction (PCR). Isolated Campylobacter strains were evaluated for the presence of six virulence genes (ciaB, dnaj, pldA, racR, flaA, and flaB), three toxin genes (cdtA, cdtB, and cdtC), and one antimicrobial resistance gene (tetO). The overall prevalence of Campylobacter was 23.4% (106 of 453), with sample type-specific prevalence being 17.2% (26 of 151), 25.8% (39 of 151), and 27.2% (41 of 151) for the carcass swabs, cloacal swabs, and carcass drip, respectively, following bacteriological isolation and confirmation by PCR. The overall prevalence of Campylobacter species was 93.5% by PCR, which varied significantly (P = 0.000) by sample: 99.2, 98.4, and 82.8% for carcass swabs, cloacal swabs, and carcass drip, respectively, by using PCR to detect Campylobacter in BB. Important risk factors for carcass contamination by Campylobacter included the slaughter of culled breeders and spent chickens, the use of stagnant water, and poor sanitation. Virulence and toxin gene frequencies were higher in C. jejuni-positive (82.5%) than in C. coli-positive (71.4%) BB cultures, but tetracycline resistance gene (tetO) frequency was higher in C. coli (75.9%) than in C. jejuni (48.10%). The observed high frequencies in C. jejuni recovered from street-vended chickens may pose food safety and therapeutic concerns to consumers.

Occurrence and Concentrations of Residues of Tetracyclines, Polyether Ionophores, and Anthelmintics in Livers of Chickens Sold in the Informal Market in Gauteng Province, South Africa.

ABSTRACT: The occurrence, concentrations, and variables associated with tetracycline, polyether ionophore, and anthelmintic residues in the livers of chickens sold in the informal market in South Africa were determined. Ultrahigh-performance liquid chromatography-tandem mass spectrometry was used to simultaneously analyze for four tetracyclines, five polyether ionophores, and six anthelmintic residues. The study determined the presence of residues in liver samples at both the limit of quantifications (LOQ) and concentrations over the maximum residue limit (MRL), i.e., noncompliant. Doxycycline (tetracycline group) was detected in 24 (24.5%) of 98 chicken livers, and 15 (15.3%) of the 98 were noncompliant. Mean ± standard deviation (SD) concentrations of 919.04 ± 1,081.30 ppb (LOQ) and 1,410.57 ± 108.89 ppb (MRL) were obtained. Maduramicin was detected in 27 (27.6%) of 98 chicken livers, and 19 (19.4%) of 98 were noncompliant. The mean ± SD for LOQ was 117.96 ± 84.56 ppb, and MRL was 153.21 ± 76.29 ppb. The concentrations of residues of doxycycline and maduramicin in chicken livers varied significantly across townships. Lasalocid was found in 31 (31.6%) of 98 samples, of which 5 (5.1%) had concentrations above the MRL. The mean ± SD concentration of lasalocid was 62.90 ± 170.84 ppb for samples in which lasalocid was quantified and 310.16 ± 356.68 ppb for noncompliant samples. Detectable concentrations of praziquantel, closantel, and rafoxanide (anthelmintics) residues were found in 3 (3.1%), 1 (1.0%), and 2 (2.0%) of 98 chicken livers, respectively. The presence of residues of three classes of veterinary drugs in chicken livers poses food safety implications to consumers and indicates a need for enhanced regulatory enforcement in controlling these drugs in South Africa.