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Surveillance and comparison of antimicrobial susceptibility patterns of ESKAPE organisms isolated from patients with bacteraemia in South Africa, 2016 - 2017

H Ismail, W Lowman, C N Govind, K Swe Swe-Han, M R B Maloba, C Bamford, O Perovic

Abstract


Background. In South Africa (SA), the National Department of Health has developed an Antimicrobial Resistance National Strategy Framework document to manage antimicrobial resistance (AMR). One of the strategic objectives is to optimise surveillance and early detection of AMR. At the National Institute for Communicable Diseases (NICD), an analysis of selected organisms and antimicrobial agents from both the public and the private sectors was conducted.

Objectives. The relevance of surveillance for AMR is increasingly recognised in the light of global action plans to combat resistance. In this report, we present an overview of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) organisms and Escherichia coli reported from public and private sector laboratories in SA for the period 2016 - 2017.

Methods. Antimicrobial susceptibility testing (AST) profiles on selected ESKAPE organisms and E. coli isolated from blood cultures from the public and private sectors in 2016 and 2017 were analysed. AST data were extracted from a web-based electronic platform created by the NICD. Drug-bug combinations following the World Health Organization’s Global Antimicrobial Surveillance System guidelines were included in the analysis.

Results. A total of 28 920 ESKAPE organisms and E. coli were reported in 2016 and 32 293 in 2017 across the two health sectors. Proportions of some organisms differed between the two health sectors, such as E. coli (19% in the public sector and 36% in the private sector), A. baumannii (14% public and 4% private), P. aeruginosa (7% public and 11% private) and S. aureus (27% public and 17% private). Susceptibility data indicated changing patterns in both sectors towards an increase in non-susceptibility to carbapenems in K. pneumoniae (p<0.01). However, we demonstrated an increase in susceptibility to cloxacillin in S. aureus (p<0.01) in both sectors.

Conclusions. The key clinically important finding is the rapidly decreasing carbapenem susceptibility among Enterobacteriaceae reported in SA, irrespective of sector. In addition, the analysis provides information that could be used to monitor the effectiveness of interventions implemented at a national level under the guidance and direction of the national AMR framework.

 


Authors' affiliations

H Ismail, Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa

W Lowman, Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Vermaak and Partners/Pathcare Pathologists, Johannesburg, South Africa; Wits Donald Gordon Medical Centre, Johannesburg, South Africa

C N Govind, Lancet Laboratories, Durban, South Africa; College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

K Swe Swe-Han, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; School of Laboratory Medicine and Medical Sciences, Inkosi Albert Luthuli Central Hospital Academic Complex, Durban, South Africa; National Health Laboratory Service, Durban, South Africa

M R B Maloba, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa; National Health Laboratory Service, Universitas Academic Laboratory Complex, Bloemfontein, South Africa

C Bamford, PathCare, East London, South Africa; Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa

O Perovic, Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Keywords

Surveillance; Antimicrobial resistance; Antibiotics susceptibility testing; ESKAPE organisms

Cite this article

South African Medical Journal 2019;109(12):934-940. DOI:10.7196/SAMJ.2019.v109i12.14079

Article History

Date submitted: 2019-11-27
Date published: 2019-11-27

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