Federation of infectious diseases societies of southern Africa guideline: Recommendations for the detection, management and prevention of healthcare-associated candida auris colonisation and disease in South Africa

Candida auris has been detected at almost 100 South African hospitals, causing large outbreaksinsome facilities, and this pathogen now accounts for approximately 1 in 10 cases of candidaemia. The objective of this guideline is to provide updated, evidence-informed recommendations outlining a best-practice approach to prevent, diagnose and manage C.auris disease in public- and private-sector healthcare settings in South Africa. The 18 practical recommendations cover five focus areas: laboratory identification and antifungal susceptibility testing, surveillance and outbreak response, infection prevention and control, clinical management and antifungal stewardship

Re-Evaluating the Role of Piperacillin-Tazobactam in the Treatment of Hospital-Acquired Infections

The objectives were to determine the minimum inhibitory concentrations (MICs) of piperacillin-tazobactam against blood culture isolates over a two-year period; and to compare the MICs with isolates from the same site upon the South African launch of piperacillin-tazobactam. The intention was to use the MIC data to evaluate and contextualise contemporary dosing strategies of piperacillin-tazobactam in South Africa. MICs were determined using broth microdilution antimicrobial susceptibility testing. A comparison of susceptibility between the two time periods was carried out using Fisher's exact test. The MIC data were then used to evaluate current dosing strategies based on current evidence-based pharmacodynamic parameters for piperacillin-tazobactam. A significant decrease in susceptibility was observed for Eschericha coli (p-value = 0.0009); Klebsiella spp. (p-value = 0.0001); Citrobacter spp. (p-value = 0.0001) and Acinetobacter baumannii (p-value = 0.0388) with MIC90 ? 128. Enterobacter spp.; Serratia marcescens; Morganella morganii and Proteus spp./Providencia spp. demonstrating reduced susceptibility (combined intermediate and resistant) of 44; 11; 20 and 0; respectively. No significant difference in susceptibility between current extended spectrum beta-lactamase (ESBL)- and non-ESBL-producing isolates was seen with a lower MIC90 for ESBL-producing Klebsiella spp. and Enterobacter spp.; compared to their non-ESBL-producing counterparts. The MIC data suggest that more targeted dosing strategies that aim to optimise pharmacodynamic parameters are needed. Piperacillin-tazobactam remains a valuable antimicrobial agent whose continued longevity will depend on appropriate optimisation of pharmacodynamic parameters. This requires the application of MIC-based susceptibility data to clinical use; with local assessment of the applicability of various dosing strategies that is based on cumulative antimicrobial susceptibility data

A Comparative in Vitro Microbiological Evaluation of Generic Meropenem Compounds against the Innovator Compound

Background: Meropenem is a broad-spectrum carbapenem widely used in the treatment of critically ill patients. A generic meropenem product has recently become available in South Africa and we aimed to compare the generic product with the innovator product using established in vitro microbiological testing methods.Method: Comparative minimum inhibitory concentrations (MICs) were determined for 115 clinically relevant isolates using the broth microdilution reference method. Comparative analysis of MIC was done using categorical and essential agreement. A subset of isolates was evaluated using minimum bactericidal concentration (MBC) testing. Results: The overall essential agreement exceeded the international standard of 90. A single major error and six minor errors were detected in 230 comparative MICs. For the 55 Enterobacteriaceae isolates tested; the MIC50 and MIC90 were 0.03 ?g/ml and 0.06 ?g/ml respectively; with no difference between extended-spectrum Beta-lactamase producers (ESBL) and non-ESBL isolates. Bactericidal activity was demonstrated for both generic and innovator products in all isolates tested. For eight of the 11 isolates; the MBC was only twice the MIC.Conclusion: Reference method MIC and MBC testing of a large sample of clinically relevant microorganisms against meropenem has demonstrated comparable in vitro activity between the innovator and generic products. Low MICs and bactericidal activity at concentrations close to the MIC indicate that meropenem remains a useful agent in the treatment of infections caused by ESBL-producing Enterobacteriaceae