Outbreak of NDM-1- and OXA-181-Producing Klebsiella pneumoniae Bloodstream Infections in a Neonatal Unit, South Africa.

After an increase in carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections and associated deaths in the neonatal unit of a South Africa hospital, we conducted an outbreak investigation during October 2019-February 2020 and cross-sectional follow-up during March 2020-May 2021. We used genomic and epidemiologic data to reconstruct transmission networks of outbreak-related clones. We documented 31 cases of culture-confirmed CRKP infection and 14 deaths. Two outbreak-related clones (blaNDM-1 sequence type [ST] 152 [n = 16] and blaOXA-181 ST307 [n = 6]) cocirculated. The major clone blaNDM-1 ST152 accounted for 9/14 (64%) deaths. Transmission network analysis identified possible index cases of blaOXA-181 ST307 in October 2019 and blaNDM-1 ST152 in November 2019. During the follow-up period, 11 new cases of CRKP infection were diagnosed; we did not perform genomic analysis. Sustained infection prevention and control measures, adequate staffing, adhering to bed occupancy limits, and antimicrobial stewardship are key interventions to control such outbreaks.

Time to tackle domestic violence: identifying and supporting families.

Domestic violence and abuse (DVA) is a serious societal and public health issue that takes place within family-type intimate relationships and forms a pattern of coercive and controlling behaviours, which can escalate over time. DVA rarely exists in isolation from other social 'ills' and can have an enormous impact on people's health and wellbeing. Recently, family violence has become more visible to health visitors and increasingly presents challenges to practice. Some are practical challenges faced by practitioners who seek to comprehend the evolving phenomenon and others involve the clinical dilemmas surrounding service delivery. The deeply vexed question is how health visitors can work towards ending the cycle of DVA, especially where there are unclear parameters between the victim and perpetrator, and when clients are accepting of, and dismissive about, DVA. The recent government strategy-based move towards greater emphasis on prevention has provided an opportunity for health visitors to intervene in DVA. In light of the nature of safeguarding responsibilities, and a wider public health role as providers of universal health services, health visitors are well placed to offer early support to families.

Attention deficit hyperactivity disorder: parents' and professionals' perceptions.

Attention deficit hyperactivity disorder (ADHD) is a prevalent childhood psychiatric condition. This study was a qualitative investigation with parents and professionals conducted in two north London boroughs, using focus groups as well as semi-structured and narrative interviews. The aim was to explore parents' and professionals' beliefs regarding the causes of ADHD and their perceptions of service provision. The sample was drawn purposively from GP practices and voluntary support groups. Professionals were recruited via professional networks. Analysis was thematic. It was found that the views of parents and professionals differed. Professionals were more likely to see ADHD as a medical condition, while parents were more likely to see ADHD in association with socio-environmental causes. Delayed diagnosis, inadequate access to information and a lack of co-ordinated care are stated as some of the reasons for parental dissatisfaction with services. Professionals emphasised the need for multidisciplinary input into the management of ADHD. The implications of these findings were that parents often battled with professionals to encourage them to see their viewpoint, access to treatment was influenced by the views of parents and professionals, and noncompliance occurred when parents had different views from professionals.