Browsing by Author "Finlayson, H."

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    Neonatal listeriosis during a countrywide epidemic in South Africa : a tertiary hospital’s experience
    (Health & Medical Publishing Group, 2018) Dramowski, Angela; Lloyd, L. G.; Bekker, A.; Holgate, S.; Aucamp, M.; Reddy, K.; Finlayson, H.
    Background. A countrywide epidemic of Listeria monocytogenes (LM) in South Africa began in the first quarter of 2017, rapidly becoming the world’s largest LM outbreak to date. Methods. We describe the clinical course of neonates with culture-confirmed LM infection admitted to a tertiary neonatal unit at Tygerberg Hospital, Cape Town (1 January 2017 - 31 January 2018). Current epidemic LM cases were compared with a historical cohort of sporadic neonatal LM cases at our institution (2006 - 2016). The global literature on epidemic neonatal LM outbreaks (1 January 1978 - 31 December 2017) was reviewed. Results. Twelve neonates (median gestational age 35 weeks, median birth weight 2 020 g) were treated for confirmed LM bacteraemia in 2017/18, presenting at a median age of 0.5 days. In 5 cases, neurolisteriosis was suspected. Three neonates died (25.0%) v. 8/13 neonatal deaths (61.6%) in the sporadic listeriosis cohort (2006 - 2016) (p=0.075). The institution’s neonatal LM infection incidence increased significantly in 2017 from a historical rate of 0.17/1 000 live births to 1.4/1 000 (p<0.001). During the current LM epidemic, the crude neonatal fatality rate exceeded the average calculated global epidemic neonatal LM mortality (3/12 (25.0%) v. 50/290 (17.2%); p=0.448). Possible factors contributing to the high mortality rate in this epidemic LM neonatal cohort may include more virulent disease associated with sequence type 6 and the predominance of early-onset disease. Conclusions. Epidemic neonatal listeriosis at Tygerberg Hospital was associated with a predominance of bacteraemic, early-onset disease. Listeriosis-associated mortality rates were higher than previously published, but lower than the rate in a historical institutional cohort.
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    Paediatric antimicrobial use at a South African hospital
    (Elsevier, 2018) Koopmans, L. R.; Finlayson, H.; Whitelaw, A.; Decloedt, E. H.; Dramowski, Angela
    Background: Data on antimicrobial use among hospitalized children in Africa are very limited due to the absence of electronic prescription tracking. Methods: This study evaluated antimicrobial consumption rates, the antimicrobial spectrum used, and the indications for therapy on a paediatric ward and in the paediatric intensive care unit (PICU) at Tygerberg Hospital, Cape Town, South Africa. Antimicrobial prescription and patient demographic data were collected prospectively from May 10, 2015 to November 11, 2015. For the same period, data on antimicrobials dispensed and costs were extracted from the pharmacy electronic medicine management system. The volume of antimicrobials dispensed (dispensing data) was compared with observed antimicrobial use (prescription data). Results: Of the 703 patients admitted, 415/451 (92%) paediatric ward admissions and 233/252 (92%) PICU admissions received ≥1 antimicrobials. On the ward, 89% of prescriptions were for community-acquired infections; 29% of PICU antimicrobials were prescribed for healthcare-associated infections. Ampicillin and third-generation cephalosporins were the most commonly prescribed agents. Antimicrobial costs were 67 541 South African Rand (ZAR) (5680 United States Dollars (USD)) on the ward and 210 484 ZAR (17 702 USD) in the PICU. Ertapenem and meropenem were the single largest contributors to antimicrobial costs on the ward (43%) and PICU (30%), respectively. The volume of antimicrobials dispensed by the pharmacy (dispensing data) differed considerably from observed antimicrobial use (prescription data). Conclusions: High rates of antimicrobial consumption were documented. Community-acquired infections were the main indication for prescription. Although pharmacy dispensing data did not closely approximate observed use, this represents a promising method for antimicrobial usage tracking in the future.
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    A retrospective review of Listeria monocytogenes infection at Tygerberg Children’s Hospital, Cape Town, South Africa, from 2006 to 2016 : is empirical ampicillin still indicated after the first month of life?
    (Health & Medical Publishing Group, 2018) Oppel, K. B.; Holgate, S. L.; Finlayson, H.
    Background. Ampicillin to treat Listeria monocytogenes (LM) infection is empirically added to the treatment of infants (<3 months) with suspected sepsis or meningitis. Objectives. In view of limited LM cases, the paucity of South African (SA) data and an ampicillin shortage, our objective was to describe the occurrence of LM infections at Tygerberg Hospital (TBH), Cape Town, with the aim of rationalising the paediatric antibiotic policy. Methods. An 11-year (2006 - 2016) retrospective descriptive study of children (<13 years) from TBH and referral hospitals with a positive blood or cerebrospinal fluid (CSF) culture for LM was conducted. Results. Of 26 children with positive cultures for LM, 23 (88.5%) were <3 months of age; all were <10 days old. Approximately half (56.5%, 13/23) were born at or referred to TBH. Presentation was on the day of delivery in 46.2% (6/13), 92.3% were admitted to the neonatal intensive care unit (NICU), and 61.5% (8/13) died. Neonates treated at peripheral hospitals were statistically more likely than those treated at TBH to have a CSF culture obtained (90.0% v. 30.8%; p=0.005), and had higher platelet counts (239 × 109/L v. 107 × 109/L; p=0.004), lower C-reactive protein levels (64 mg/L v. 137 mg/L; p=0.013) and a lower mortality rate (0% v. 61.5%; p=0.002). The incidence of LM at TBH was 0.04/1 000 live births and 2.3/1 000 NICU admissions. Conclusions. As in other countries, the local neonatal LM incidence is low. Neonates present in the first week of life with severe disease and a high mortality rate. These data support a change in antibiotic policy, in keeping with international guidelines, limiting empirical ampicillin prescription to infants <1 month of age.
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    The Antibiotic Resistance and Prescribing in European Children Project: a neonatal and pediatric antimicrobial web-based point prevalence survey in 73 hospitals worldwide
    (LIPPINCOTT WILLIAMS & WILKINS, 530 WALNUT ST, PHILADELPHIA, USA, PA,19106-3621, 2013) Versporten, A.; Sharland, M.; Bielicki, J.; Drapier, N.; Vankerckhoven, V.; Goossens, H.; Cooper, C.; Lee, L. Y.; Whitehouse, J.; Bryant, P. A.; Haeusler, G.; Curtis, N.; Finlayson, H.; Rabie, H.; Cotton, M. F.; Dramowski, Angela
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    Vital signs for children at triage : a multicentre validation of the revised South African Triage Scale (SATS) for children
    (Health & Medical Publishing Group, 2013-03-22) Twomey, M.; Cheema, B.; Buys, H.; Cohen, K.; De Sa, A.; Louw, P.; Ismail, M.; Finlayson, H.; Cunningham, C.; Westwood, A.
    Objective. To validate a revised version of the paediatric South African Triage Scale (SATS) against admission as a reference standard and compare the sensitivity of triage using: (i) clinical discriminators; (ii) an age-appropriate physiological composite score; and (iii) a combination of both. Methods. A prospective cohort study was undertaken validating the revised paediatric SATS against outcome markers of children at six emergency centres during a 2-month period in 2011. The primary outcome marker was the proportion of children admitted. Validity indicators including sensitivity (Se), specificity, positive predictive value and negative predictive value (NPV) were used to estimate the validity. Associated percentages for over-/under-triage were used to further assess practical application of the paediatric SATS. Results. A total of 2 014 children were included. The percentage of hospital admissions increased with an increase in the level of urgency from 5% in the non-urgent patients to 73% in the emergency patients. The data demonstrated that sensitivity increased substantially when using the SATS, which is a combination of clinical discriminators and the Triage Early Warning Score (TEWS) (Se 91.0%, NPV 95.3%), compared with use of clinical discriminators in isolation (Se 57.1%, NPV 86.3%) or the TEWS in isolation (Se 75.6%, NPV 89.1%). Conclusion. The results of this study illustrate that the revised paediatric SATS is a safe and robust triage tool.