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Surgical Infections | 2012

Antimicrobial Susceptibility of Gram-Negative Pathogens Isolated from Patients with Complicated Intra-Abdominal Infections in South African Hospitals (SMART Study 2004–2009): Impact of the New Carbapenem Breakpoints

Adrian Brink; Roelof F. Botha; Xoliswa Poswa; Marthinus Senekal; Robert E. Badal; D C Grolman; Guy A. Richards; Charles Feldman; Kenneth D. Boffard; Martin Veller; Ivan Joubert; Jan P. Pretorius

BACKGROUND The Study for Monitoring Antimicrobial Resistance Trends (SMART) follows trends in resistance among aerobic and facultative anaerobic gram-negative bacilli (GNB) isolated from complicated intra-abdominal infections (cIAIs) in patients around the world. METHODS During 2004-2009, three centralized clinical microbiology laboratories serving 59 private hospitals in three large South African cities collected 1,218 GNB from complicated intra-abdominal infections (cIAIs) and tested them for susceptibility to 12 antibiotics according to the 2011 Clinical Laboratory Standards Institute (CLSI) guidelines. RESULTS Enterobacteriaceae comprised 83.7% of the isolates. Escherichia coli was the species isolated most commonly (46.4%), and 7.6% of these were extended-spectrum β-lactamase (ESBL)-positive. The highest ESBL rate was documented for Klebsiella pneumoniae (41.2%). Overall, ertapenem was the antibiotic most active against susceptible species for which it has breakpoints (94.6%) followed by amikacin (91.9%), piperacillin-tazobactam (89.3%), and imipenem-cilastatin (87.1%), whereas rates of resistance to ceftriaxone, cefotaxime, ciprofloxacin, and levofloxacin were documented to be 29.7%, 28.7%, 22.5%, and 21.1%, respectively. Multi-drug resistance (MDR), defined as resistance to three or more antibiotic classes, was significantly more common in K. pneumoniae (27.9%) than in E. coli (4.9%; p<0.0001) or Proteus mirabilis (4.1%; p<0.05). Applying the new CLSI breakpoints for carbapenems, susceptibility to ertapenem was reduced significantly in ESBL-positive E. coli compared with ESBL-negative isolates (91% vs. 98%; p<0.05), but this did not apply to imipenem-cilastatin (95% vs. 99%; p=0.0928). A large disparity between imipenem-cilastatin and ertapenem susceptibility in P. mirabilis and Morganella morganii was documented (24% vs. 96% and 15% vs. 92%, respectively), as most isolates of these two species had imipenem-cilastatin minimum inhibitory concentrations in the 2-4 mcg/mL range, which is no longer regarded as susceptible. CONCLUSIONS This study documented substantial resistance to standard antimicrobial therapy among GNB commonly isolated from cIAIs in South Africa. With the application of the new CLSI carbapenem breakpoints, discrepancies were noted between ertapenem and imipenem-cilastatin with regard to the changes in their individual susceptibilities. Longitudinal surveillance of susceptibility patterns is useful to guide recommendations for empiric antibiotic use in cIAIs.


South African Medical Journal | 2010

Guideline: appropriate use of tigecycline

Andries J. Brink; Damon Bizos; Kenneth D. Boffard; Charles Feldman; D C Grolman; Jan P. Pretorius; Guy A. Richards; Marthinus Senekal; E. Steyn; N. Welkovic

INTRODUCTION Tigecycline, the first of a new class of antibiotics, the glycylcyclines, was licensed in South Africa for the parenteral treatment of adult patients with complicated intra-abdominal infections (cIAIs) and complicated skin and soft-tissue infections (cSSTIs). METHODS A multidisciplinary meeting representative of the Association of Surgeons of South Africa, the Critical Care Society of Southern Africa, the Federation of Infectious Diseases Societies of Southern Africa, the South African Thoracic Society and the Trauma Society of South Africa was held to draw up a national guideline for the appropriate use of tigecycline. Background information reviewed included randomised controlled trials, other relevant publications and local antibiotic susceptibility patterns. The initial document was drafted at the meeting. Subsequent drafts were circulated to members of the working group for modification. OUTPUT The guideline addresses several important aspects of the new agent, summarising key clinical data and highlighting important considerations with the use of the drug. The recommendations in this guideline are based on currently available scientific evidence together with the consensus opinion of the authors. CONCLUSION This statement was written out of concern regarding the widespread misuse of antibiotics. Its primary intention is to facilitate heterogeneous use of antibiotics as a component of antibiotic stewardship and to highlight the appropriate use of tigecycline in particular.


The Southern African journal of critical care | 2014

The need for pharmaceutical care in an intensive care unit at a teaching hospital in South Africa

E. Bronkhorst; Natalie Schellack; Andries Gous; Jan P. Pretorius

Background. The role of the pharmacist has evolved over the last 2 decades beyond traditional functions such as stock control and dispensing. Objectives. To describe the functions performed by a clinical pharmacist while based in a surgical and trauma intensive care unit of a teaching hospital. Methods. An operational research study that included indications of programme success was conducted. Interventions to assess therapy and achieve definite outcomes to satisfy patients’ medicine needs were documented for 51 patients over a study period of 8 weeks. Results. A total of 181 interventions were suggested by the pharmacist, with 127 (70%) accepted and implemented by the medical and nursing staff of the unit. The most frequent interventions were related to: untreated medical conditions (15.5%), appropriate therapy or course (13.8%), investigations indicated or outstanding (12.2%), and inappropriate doses and dosing frequency (11%). Interventions were also made regularly to address system errors or non-compliance and factors hindering therapeutic effect. Of the 250 h the pharmacist spent in the ward, most time was used for pharmaceutical care (28%) and ward rounds (21%) with members of the multidisciplinary team. Conclusions. The study results demonstrated that a clinical pharmacist’s contribution to patient care at ward level resulted in improved monitoring of pharmacotherapy. Medicine-related problems were identified and addressed.


The Southern African Journal of Epidemiology and infection | 2010

Guideline Summary: Appropriate use of tigecycline

Adrian Brink; Damon Bizos; Kenneth D. Boffard; Charles Feldman; D C Grolman; Jan P. Pretorius; Guy A. Richards; E. Steyn

Tigecycline, the first of a new class of broad-spectrum antibiotics (the glycylcyclines), has been licensed in South Africa for the parenteral treatment of adult patients with complicated intra-abdominal infections (cIAIs) and complicated skin and soft-tissue infections (cSSTIs). This article serves as a summary of the guideline on the appropriate use of tigecycline, published in mid-2010 as a collaborative effort by representatives of the Association of Surgeons of South Africa, the Critical Care Society of Southern Africa, the Federation of Infectious Diseases Societies of Southern Africa, the South African Thoracic Society and the Trauma Society of South Africa.


South African Medical Journal | 2004

Appropriate Use of the Carbapenems

Andries J. Brink; Charles Feldman; D C Grolman; D Muckart; Jan P. Pretorius; Guy A. Richards; Marthinus Senekal; W Sieling


Wound Healing Southern Africa | 2011

The open abdomen Part 3: Management of the Grade 3 open abdomen with entero-atmospheric fistulae

Jan P. Pretorius; C Liebenberg; D Piek; M Smith


Wound Healing Southern Africa | 2011

The utilisation of maggot debridement therapy in Pretoria, South Africa

Herman J.C. Du Plessis; Jan P. Pretorius


South African Medical Journal | 2017

Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study

David Lee Skinner; K De Vasconcellos; Robert Wise; Tonya M. Esterhuizen; C. Fourie; A. Goolam Mahomed; Pd Gopalan; I. Joubert; Hyla-Louise Kluyts; L.R. Mathivha; Busi Mrara; Jan P. Pretorius; Guy A. Richards; Oi Smith; M.G.L. Spruyt; Rupert M Pearse; Thandinkosi E Madiba; Bruce Biccard


South African Medical Journal | 2013

Starch safety in resuscitation.

R.E. Hodgson; Guy A. Richards; A.C. Lundgren; M.G.L. Spruyt; Jan P. Pretorius; L.R. Mathiva; Roger Dickerson; Pd Gopalan


Continuing Medical Education | 2010

Skin and soft-tissue infections

Jan P. Pretorius

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Guy A. Richards

University of the Witwatersrand

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Charles Feldman

University of the Witwatersrand

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D C Grolman

University of the Witwatersrand

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D Piek

University of Pretoria

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Kenneth D. Boffard

University of the Witwatersrand

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M Smith

University of Pretoria

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Damon Bizos

University of the Witwatersrand

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