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

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.

NDM-1 imported from India--first reported case in South Africa.

Carbapenem-resistant Enterobacteriaceae have been increasingly reported throughout the world. The first South African report of a New Delhi metallo-beta-lactamase was from Gauteng in August 2011. Despite maintaining a high degree of vigilance, the first such case was seen in KwaZulu-Natal almost a year later. Other cases have been unable to confirm a definite link to any other affected areas; this is the first case in South Africa showing this direct epidemiological link.

Antimicrobial Susceptibility Patterns of Escherichia Coli Strains Isolated From Urine Samples in South Africa from 2007-2011

Escherichia coli is the most common cause of urinary tract infections. Knowledge of its local antimicrobial susceptibility patterns can be used to inform choice of empiric antimicrobial therapy. In this article; we review data on antimicrobial susceptibility patterns of E. coli isolated from unselected urine specimens; in both the private and public sectors of South Africa from 2007-2011. Between 65 000-84 000 E. coli urinary isolates were reported annually from 19 laboratories located across South Africa. Susceptibility to fluoroquinolone and beta-lactam antibiotics decreased significantly and steadily in both private and public sectors over the five-year period; although laboratory-based surveillance data may underestimate susceptibility rates due to selection bias and lack of differentiation between community- and hospital-acquired infections. Our data suggest that fluoroquinolones; co-amoxiclav and first- and second-generation cephalosporins can still be used for empiric treatment in many local settings; but clinicians should be alert to the risk of treatment failure. With the withdrawal of nitrofurantoin from the local market; other oral antibiotic options are limited; and fosfomcyin may become increasingly important. Given their sustained high susceptibility rates; aminoglycosides should be considered to treat pyelonephritis more often. Judicious use of laboratory testing is advised and further research and surveillance is warranted