Factors affecting bacteriology of hand sepsis in South Africa.

BACKGROUND: Hand sepsis is a common cause of morbidity. The study was conducted in the KwaZulu-Natal province of South Africa, investigating the bacteriological profile and aetiology of hand sepsis, aiming at optimising empiric antibiotic therapy. METHODS: This is a descriptive study of 120 patients who presented to the plastic surgery department of Inkosi Albert Luthuli Central Hospital with hand sepsis, from January 2017 to April 2019, that required surgical drainage. Data recorded included: aetiology of sepsis, underlying comorbidities, length of hospital stay, and outcome. A pus swab was taken during surgical drainage for microscopy, culture and sensitivity (MCS) analysis. The relationship between clinical factors and microbiological findings was analysed. RESULTS: The predominant bacterial strains cultured from infected patients, excluding methicillin-resistant Staphylococcus aureus, were Staphylococcus aureus (80.8%) and Streptococcus spp. (20.0%), mostly due to spontaneous onset infection (58.3%). Cultures of the more problematic Streptococcus spp. were more frequently associated in patients with diabetes mellitus (60.0%), penetrating trauma (41.9%), or blunt trauma (31.3%). The diabetes group in isolation had the longest median hospital stay of 8 (5-15) days, the most need for multiple procedures (60.0%), amputations (30.0%), and skin grafts (20.0%). The most effective antimicrobial drug particularly in mixed cultures was amoxicillin-clavulanic acid. CONCLUSION: Staphylococcus aureus infection was the most common. Streptococcus spp. occurred more frequently in patients with traumatic injury and diabetes mellitus. The latter required further surgical procedures and an increased hospital stay. Amoxicillin-clavulanic acid is the preferred empiric antimicrobial agent.

Prevention and treatment of cardiovascular instability during spinal anaesthesia for caesarean section.

Spinal anaesthesia is the method of choice for caesarean section. There is however a significant associated morbidity and mortality in South Africa, particularly in inexperienced hands. This review provides recommendations for safe practice for anaesthetists at all levels of expertise, with particular reference to the management of haemodynamic instability.

The prevention of intrapartum HIV/AIDS transmission from mother to child.

The transmission of HIV/AIDS from mother to child is the main cause of HIV/AIDS in children and child mortality. Two-thirds of children with HIV/AIDS are infected in the intrapartum period (Farley, 2000:1-2). Midwives, through effective practices, can lower the transmission of HIV/AIDS from mother to child in the intrapartum period. The aim of the study was to determine which preventive practices registered midwives in provincial labour wards in Bloemfontein, implement to lower the risk of mother to child transmission of HIV/AIDS and in doing so to lower child mortality. A descriptive research design was used. Fifty-one midwives completed questionnaires to determine what preventive practices are used. The study showed that most of the midwives did not implement the interventions that could lower the chances of HIV/Aids transmission from mother to child during the intrapartum period. Midwives therefore may not have a positive impact on child mortality. The researchers concluded that midwives do not implement the interventions mentioned in the study because of a lack of knowledge and skills. Of the midwives who completed questionnaires, 67% completed their training between 1990 and 2000. This lack of knowledge may be due to a lack in the curriculum of training institutions and of an up-to-date policy concerning the transmission of HIV/Aids in provincial institutions in Bloemfontein. It is recommended that all affordable interventions should be incorporated in the policy.

Patient-controlled epidural analgesia versus continuous infusion for labour analgesia: a meta-analysis.

BACKGROUND: Patient-controlled epidural analgesia (PCEA) is a relatively new method of maintaining labour analgesia. There have been many studies performed that have compared the efficacy of PCEA with continuous epidural infusion (CEI). The purpose of this systematic review is to compare the efficacy and safety of PCEA and CEI. METHODS: All randomized controlled trials that compared PCEA, without background infusion, with CEI were sought from the literature. These were rated for quality using a validated, five-point scale. The primary outcome was the number of patients who received anaesthetic interventions. Secondary outcomes included the dose of local anaesthetic, incidence of motor block, quality of analgesia, obstetric and safety outcomes. Where feasible, the data were combined using meta-analytical techniques. For dichotomous data, the risk difference (RD) and 95% confidence intervals (CI) were calculated. For continuous data, the weighted mean differences (WMD) were calculated. The differences were statistically significant when the 95% CI excluded 0. RESULTS: Nine studies comprised of 640 patients were found. There were fewer anaesthetic interventions in the PCEA group (RD, 27%; 95% CI, 18-36%; P < 0.00001). This group also received less local anaesthetic (WMD, -3.92; 95% CI, -5.38 to -2.42; P < 00001) and less motor block (RD, 18%; 95% CI, 6-31%; P = 0.003). Both methods were safe for mother and newborn. CONCLUSION: Patients who receive PCEA are less likely to require anaesthetic interventions, require lower doses of local anaesthetic and have less motor block than those who receive CEI. Future research should be directed at determining differences in maternal satisfaction and obstetric outcome.