Fathima Naby

Background: Pertussis is vaccine preventable, and surveillance can guide interventions. Assessing the performance of syndromic surveillance and the World Health Organization (WHO) pertussis case definitions can identify improvements to enhance detection and monitoring of Bordetella pertussis. Methods: We analyzed respiratory illness sentinel surveillance data among children aged <5 years from January 2017 through December 2023. Participants were enrolled for surveillance as outpatients with influenza-like illness (ILI) or in-patients with severe respiratory illness (SRI). Nasopharyngeal swabs were tested for B pertussis via polymerase chain reaction (PCR). Sensitivity and specificity, and performance indicators of case definitions were evaluated against PCR results. Results: Of 23 642 participants with PCR results, B pertussis was detected in 0.7% from ILI and 1.6% from SRI. When compared with the WHO pertussis case definition, a modified definition (including apnea, omitting cough duration) improved sensitivity (ILI, 30.0% vs 43.3%; SRI, 55.7% vs 60.2%) but reduced specificity (ILI, 90.5% vs 75.8%; SRI, 88.3% vs 80.9%). WHO and modified pertussis case definitions missed a large proportion of true pertussis cases (ILI, 70.0% vs 56.7%; SRI, 44.3% vs 39.8%). Conclusions: Current pertussis case definitions likely underestimate disease burden. Revising the WHO pertussis case definition and integrating pertussis into syndromic surveillance could improve detection while leveraging existing resources.

Background: Among hospital-born babies, infections account for 4% – 56% of deaths in the neonatal period, with bloodstream infections being up to 20 times more frequent in low- and middle-income countries (LMICs). The cleansing of infants with chlorhexidine (without emollient) has been the standard of care in Grey’s Hospital Neonatal Intensive Care Unit (NICU) for over a decade. Objectives: This study evaluated the impact of adding an emollient to chlorhexidine on the prevalence of microbiologically confirmed infections. Method: A retrospective observational cohort study of all microbiologically confirmed bloodstream infections in the neonatal unit before (01 June 2022 to 30 November 2022) and after (01 December 2022 to 31 May 2023) the implementation of the quality improvement project was conducted. The rates of microbiologically confirmed infections were compared between the two periods. Results: There was a total number of 2741 positive blood cultures over the study period with a significant reduction in positive cultures in the intervention group (46.1% vs. 27%, p < 0.001) but no significant reduction in the proportion of different organisms (Gram-positive, Gram-negative, and fungal isolates) in the two groups (p = 0.58) Gram-positive organisms accounted for most infections in the pre- and post-intervention study groups. There was no significant reduction in the rate of sepsis-associated mortality (p = 0.20). Conclusion: Further research evaluating the response in larger study populations is needed. Contribution: Although there was no significant reduction in sepsis-associated mortality, cleansing infants using chlorhexidine with an emollient may reduce bloodstream infections in this vulnerable population in LMICs.

Background: Neonatal sepsis remains a major cause of morbidity and mortality. Therefore, early detection and initiation of appropriate empirical antibiotic therapy are crucial. Objectives: The aim of this study was to describe the antibiogram of the neonatal intensive care unit at Grey’s Hospital, a tertiary hospital in KwaZulu-Natal. Method: This was a retrospective descriptive study, reviewing positive cultures from Grey’s Hospital tertiary neonatal intensive care unit (NICU) in KwaZulu-Natal, South Africa for a 3-year period (01 January 2017 to 31 December 2019). All positive cultures from all sites were included. Results: There were 1314 positive organisms cultured. Late-onset sepsis (89.3%) predominated over early-onset sepsis (10.7%). Blood was the source for 55.2% (725/1314) of positive cultures. Of the 1314 organisms cultured, 53.7% (706/1314) were Gram-positive, 45.7% (601/1314) were Gram-negative and 0.5% (7/1314) were Candida species. Klebsiella pneumoniae, 23.5% (313/1314) was the most frequent Gram-negative organism. It was noted to have high resistance to the unit’s first-line antibiotic regimens; 99% were resistant to ampicillin and 92% resistant to gentamicin. Conclusion: Blood cultures yielded most positive results with a predominance of Gram-positive organisms and late-onset sepsis. A significant proportion of the cultured organisms were resistant to the first-line antimicrobials utilised in the unit, ampicillin and gentamicin. Contribution: Ongoing surveillance on positive cultures is recommended to assess the effectiveness of the unit’s current empirical antimicrobial guideline.