Department of Paediatrics and Child Health

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Browsing Department of Paediatrics and Child Health by browse.metadata.advisor "Dramowski, Angela"

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    Burden, spectrum and outcome of community-acquired infections among paediatric ward admissions to Tygerberg Hospital
    (Stellenbosch : Stellenbosch University, 2020-12) Mapala, Lydia; Bekker, Adrie; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Introduction: Community acquired infections (CAIs), both bacterial and viral in origin, are the most common reason for hospitalization in general paediatric wards. Data from South Africa on the burden, pathogen spectrum, antimicrobial therapy and outcome of paediatric CAIs is limited. Methods: We conducted secondary analysis of data from a prospective cohort of consecutive paediatric admissions to a general ward at Tygerberg Hospital (May - November 2015). Demographics, admission history, laboratory investigations, antimicrobial prescription and hospital outcome data were collected. Results: Of 451 admissions, 364 (81%) were for CAI episodes. Median age and weight of patients with CAI was 4.8 months (IQR 1.5-17.5) and 5.4 kg (IQR 3.6-9.0) respectively. Male gender predominated (210/364; 58%), and HIV-infection prevalence was 6.0% (22/364). Sources of referral were: home (139/364, 38%), other hospitals (113/364, 31%) and clinics (112/364, 31%). Pre-hospital antibiotics (commonly ceftriaxone) were given to 152/364 (42%) of patients. The most prevalent CAI types (n=364) were: respiratory tract infections (197; 54%), gastroenteritis (51; 14%), bloodstream/serious bacterial infections (33; 9%), meningitis (17; 5%) and urinary tract infections (8; 2%). Of 274 blood cultures submitted, 5% yielded a pathogen and 8% were contaminated. Of 140 cerebrospinal fluid samples sent, only 2% yielded a pathogen. Of investigations for respiratory infection, respiratory syncytial virus (RSV), adenovirus (AV) and parainfluenza virus predominated from shell vial culture, whereas RSV, cytomegalovirus and rhinovirus were most frequently identified on polymerase chain reaction testing. Most frequent CAI antibiotic treatment regimens included: ampicillin alone (53%); ampicillin plus gentamicin (25%) and ampicillin plus cefotaxime (20%). Unfavourable outcomes were uncommon (1% died; 4% required re-admission within 30 days of discharge). The majority of antibiotic prescriptions for CAI (323/364; 89%) were compliant with the Essential Drug List (EDL) guidelines. The overall estimated cost of CAI episode management was R 8.2 million or R22,527 per CAI admission episode. Conclusion: CAI's are the most frequent reason for hospitalization and a major driver of antimicrobial use and hospital costs in general paediatric wards. Improved diagnostic stewardship should be implemented in South African paediatric wards to reduce culture contamination, improve pathogen yield, minimize use of unnecessary investigations and reduce inappropriate antimicrobial prescriptions. Despite a high burden and hospital cost of CAI admissions, paediatric clinical outcomes were generally favourable.
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    Central line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit
    (Stellenbosch : Stellenbosch University, 2016-12) Geldenhuys, Chandre; Bekker, Adrie; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH SUMMARY: Background: The rate of central line-associated bloodstream infection (CLABSI) in South African public sector neonatal intensive care units (NICU) is unknown. Tygerberg Children’s Hospital (TCH) introduced a neonatal CLABSI surveillance and prevention programme in August 2012. Objectives: To describe CLABSI events and identify risk factors for development of CLABSI in a resource-limited NICU. Methods: A retrospective case-control study was conducted using prospectively collected NICU CLABSI events matched to four randomly selected controls, sampled from the NICU registry between 9 August 2012 and 31 July 2014. Clinical data and laboratory records were reviewed to identify possible risk factors using stepwise forward logistic regression analysis. Results: Seven hundred and six central lines were inserted in 530 neonates during the first two years of the programme. Nineteen CLABSI events were identified with a CLABSI rate of 5.9/1000 line days. CLABSI cases were of lower gestational age (28 vs 34 weeks; p=0.003), lower median birth weight (1170g vs 1975g; p=0.014), had longer catheter dwell times (> 4 days) (OR 5.1 [95% CI 1.0-25.4]; p=0.04) and were more likely to have surgery during their NICU stay (OR 3.5 [95% CI 1.26-10]; p=0.01). Significant risk factors for CLABSI were length of stay > 30 days (OR 20.7 [95% CI 2.1-203.2]; p=0.009) and central line insertion in the operating theatre (OR 8.1; [95% CI 1.2-54.7]; p=0.03). Gram-negative pathogens predominated (12/22; 54%), with most isolates 10/12 (83%) exhibiting multi-drug resistance. Conclusion: The TCH NICU CLABSI rate is similar to that reported from resource-limited settings but far exceeds that of high-income countries. Prolonged NICU stay and central line insertion in the operating theatre were important risk factors for CLABSI development. Intensified neonatal staff training regarding CLABSI maintenance bundle elements and hand hygiene is key to reducing CLABSI rates.
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    Clinical presentation and treatment outcomes of infants with tuberculosis in Cape Town, South Africa
    (Stellenbosch : Stellenbosch University, 2020-12) Aryao, Ruth; Bekker, Adrie; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Introduction: Limited data are available regarding the presentation, clinical course and outcome of infants (<12 months of age) treated for drug-susceptible tuberculosis. Methods: Infants with tuberculosis admitted at Tygerberg, Khayelitsha District and Brooklyn Chest Hospitals (March 2014-March 2015) were prospectively enrolled with follow-up evaluations at 3- and 6-months post-treatment initiation. Results: Among 39 infants diagnosed with tuberculosis, 21 (54%) had known contact with an adult tuberculosis source case. The median age of infants at diagnosis was 6 months (IQR 3-7) and median weight 5.2 kg (IQR 3.2–10.2). Twenty-two of 39 (56%) were exposed to HIV of whom 5 were HIV infected. Growth faltering (25; 68%) and persistent cough (13; 33%) were frequent presenting symptoms. Most infants were diagnosed with intrathoracic tuberculosis (37/39; 95%) while 5% had disseminated tuberculosis and (14/39; 36%) had culture-confirmed tuberculosis. Alveolar opacification (22; 56%), mediastinal lymphadenopathy (13; 33%) and large airway obstruction (8; 20%) were common chest radiography findings. Tuberculosis treatment outcomes were favourable in 33/39 (85%) infants, but with additional intervention 37 (95%) completed treatment. Conclusions: Intrathoracic tuberculosis was the predominant disease type and one-third of the cohort had culture-confirmed tuberculosis. More than half on the infants were born to a mother with HIV. An adult tuberculosis source case was identifiable in half of the cases. Additional interventions improved favourable treatment outcomes.
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    Epidemiology of healthcare-associated bloodstream infections in the paediatric intensive care unit
    (Stellenbosch : Stellenbosch University, 2021-12) Ramsunder, Prishani; Appel, Ilse; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Abstract Background: Limited data is available from African country paediatric intensive care units (PICU) on the burden, pathogen profile and outcome of healthcare-associated bloodstream infections (HA-BSI). Methods: A retrospective record review was conducted in the PICU at Tygerberg Hospital, South Africa between January 2015 and December 2017. Data on infection rate, pathogen profile, patient demographics and outcome were collected for all children diagnosed with HA-BSI (a laboratory-confirmed BSI arising > 48 hours after admission to the PICU). Results: Over the 3-year study period 2643 patients were admitted to PICU and 1116 blood cultures were collected. The blood culture pathogen yield was 7.5% (84/1116) comprising 27 community-acquired BSI (32.1%), 11 HA-BSI acquired prior to PICU admission (13.1%) and 46 HA-BSI acquired in PICU (54.8%). The incidence rate of HA-BSI acquired in the PICU was 4.7/1000 patient days. No source of infection was identified for 62.5% of HA-BSI cases. The majority of patients affected by HA-BSI were infants (24/46; 52.2%), malnourished (50%) and HIV-uninfected (91.3%). The clinical impact of HA-BSI was severe, with 41% developing a new requirement for mechanical ventilation. K. pneumoniae, A. baumannii and Candida species were the most prevalent HA-BSI pathogens and exhibited substantial antimicrobial resistance. Patient outcomes were poor with a crude mortality rate of 41.3% and a median length of PICU stay of 15 days. Conclusion: Rates of HA-BSI were comparable to that reported from high-income country PICU’s, but most HA-BSI pathogens exhibited substantial antimicrobial resistance, similar to that reported from other LMIC PICUs.
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    Knowledge, attitudes and practices of COVID-19 infection prevention and control among nurses in the intensive care unit at Groote Schuur Hospital, Cape Town
    (Stellenbosch : Stellenbosch University, 2022-03) Onga, Bangani; English, Rene; Dramowski, Angela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH ABSTRACT: Introduction: Critical care environments rapidly adapted infection prevention and control (IPC) practices in response to the COVID-19 pandemic. Critical care nurse’s knowledge, attitudes, and practices (KAP) regarding COVID-19 IPC may impact the risk of healthcare-associated COVID-19 transmission. Methods: A mixed-methods study was conducted among intensive care unit (ICU) nurses at Groote Schuur Hospital, Cape Town, South Africa between 20 April and 30 May 2021. Participants completed anonymous, self-administered, 33-item KAP questionnaires and individual interviews regarding their lived experiences and perceptions of COVID-19 IPC in critical care. Results: One hundred and sixteen ICU nurses participated (93.5% response rate) including 57 professional nurses (49.0%), 34 enrolled nurses (29.0%) and 25 enrolled nursing assistants (22.0%) with young females (31-49 years) predominating (99; 85.3%). Nurses’ overall COVID-19 IPC knowledge scores were moderate-good (78%), with professional nurses having significantly better knowledge regarding the route of SARS-CoV-2 transmission (p<0.001). ICU nurses’ attitude scores to COVID-19 IPC were low (55%), influenced by limited IPC training, insufficient time to implement IPC precautions and shortages of personal protective equipment (PPE). Respondents’ scores for self-reported COVID-19 IPC practices were moderate (65%); the highest compliance was reported for performing hand hygiene after touching patient surroundings (68%). Only half of the respondents (47%) had undergone N95 respirator fit-testing, despite working in a high-risk environment for COVID-19 transmission. Conclusion: Regular and intensive training on COVID-19 IPC precautions should be provided to equip ICU nurses with the requisite knowledge and skills to prevent healthcare-associated COVID-19 transmission. Enhanced IPC training and consistent PPE availability may contribute to more favourable attitudes and better IPC practices among ICU nurses.