#Genome #Sequencing of a #SARS-CoV-2 Isolate Obtained from a #SouthAfrican Patient with #Coronavirus Disease 2019 (Microbiol Res Announc., abstract)

[Source: Microbiology Resource Announcements, full page: (LINK). Abstract, edited.]

Genome Sequencing of a Severe Acute Respiratory Syndrome Coronavirus 2 Isolate Obtained from a South African Patient with Coronavirus Disease 2019

Mushal Allam, Arshad Ismail, Zamantungwa T. H. Khumalo, Stanford Kwenda, Peter van Heusden, Ruben Cloete, Constantinos Kurt Wibmer, Phillip Senzo Mtshali, Florah Mnyameni, Thabo Mohale, Kathleen Subramoney, Sibongile Walaza, Wendy Ngubane, Nevashan Govender, Nkengafac V. Motaze, Jinal N. Bhiman; on behalf of the SA-COVID-19 response team

Simon Roux, Editor

DOI: 10.1128/MRA.00572-20

 

ABSTRACT

As a contribution to the global efforts to track and trace the ongoing coronavirus pandemic, here we present the sequence, phylogenetic analysis, and modeling of nonsynonymous mutations for a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome that was detected in a South African patient with coronavirus disease 2019 (COVID-19).

Keywords: SARS-CoV-2; COVID-19; South Africa.

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The role of #remdesivir in #SouthAfrica: preventing #COVID19 #deaths through increasing #ICU capacity (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

The role of remdesivir in South Africa: preventing COVID-19 deaths through increasing ICU capacity

Brooke E Nichols, Lise Jamieson, Sabrina R C Zhang, Gabriella A Rao, Sheetal Silal, Juliet R C Pulliam, Ian Sanne, Gesine Meyer-Rath

Clinical Infectious Diseases, ciaa937, https://doi.org/10.1093/cid/ciaa937

Published: 06 July 2020

 

Abstract

Countries such as South Africa have limited intensive care unit (ICU) capacity to handle the expected number of COVID-19 patients requiring ICU care. Remdesivir can prevent deaths in countries such as South Africa by decreasing the number of days people spend in ICU, therefore freeing up ICU bed capacity.

SARS-CoV-2, COVID-19, mathematical model, hospital bed capacity, intensive care

Issue Section: Brief Report

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: SARS-CoV-2; COVID-19; Intensive Care; Antivirals; Remdesivir; South Africa.

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The South African #Response to the #Pandemic (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

The South African Response to the Pandemic

Comment

To rapidly communicate short reports of innovative responses to Covid-19 around the world, along with a range of current thinking on policy and strategy relevant to the pandemic, the Journal has initiated the Covid-19 Notes series.

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The first person with confirmed Covid-19 in South Africa was a traveler who had returned from Italy and was diagnosed on March 5, 2020. When 402 cases had been identified after 18 days, the government announced a national lockdown, which was implemented 4 days later when the doubling time was 2 days and there were 1170 identified cases (Figure 1A). During 35 days of strict lockdown, the doubling time slowed to 15 days, and there were 5647 cases (including 103 deaths) by April 30. As of May 19, when a less strict lockdown was in place, South Africa had recorded 17,200 cases and 312 deaths and had conducted 488,609 tests (www.gov.za/Coronavirus. opens in new tab).

(…)

Keywords: SARS-CoV-2; COVID-19; South Africa.

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#Social #dimensions of #COVID19 in #SouthAfrica : a neglected element of the treatment plan (Wits J Clin Med., abstract)

[Source: Sabinet, full page: (LINK). Abstract, edited.]

Wits Journal of Clinical Medicine

Social dimensions of COVID-19 in South Africa : a neglected element of the treatment plan

ISSN : 2618-0189 | E-ISSN: 2618-0197

Author: Laurel Baldwin-Ragaven1

Affiliations : 1 University of the Witwatersrand

Source : Wits Journal of Clinical Medicine, Volume 2 Number Si1, Apr 2020, p. 33 – 38

 

Abstract

Notwithstanding moments of shared elation – Nelson Mandela’s triumphant release from prison 30 years ago, those halcyon weeks in 2010 when we were hosts to the Soccer World Cup, or more recently Siya Kolisi’s diverse team of players overcoming enormous odds to achieve a global rugby victory – the unity and transcendence of the rainbow nation largely have eluded us. While a pandemic is not the occasion to point fingers, it does expose the structural fault lines that undermine social cohesion. In “normal” times, these fissures are mostly tucked away safely in the recesses of our national collective consciousness. It is as if the virus, anthropomorphised, has pulled back the veil, baring the naked truth of our imperfect realities. There is no place to hide; and, to be totally honest, we are afraid.

© Publisher

© Publisher: Wits University Press

Persistent Link : https://hdl.handle.net/10520/EJC-1c8cbb6178

DOI : 10.18772/26180197.2020.v2nSIa6

Language : English

Keywords: SARS-CoV-2; COVID-19; Society; Poverty; S. Africa.

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Continuing #evolution of #H6N2 #influenza a virus in South #African #chickens and the implications for #diagnosis and control (BMC Vet Res., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Vet Res. 2019 Dec 18;15(1):455. doi: 10.1186/s12917-019-2210-4.

Continuing evolution of H6N2 influenza a virus in South African chickens and the implications for diagnosis and control.

Abolnik C1, Strydom C2, Rauff DL2, Wandrag DBR3, Petty D4.

Author information: 1 Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Old Soutpan Road, Onderstepoort, 0110, South Africa. celia.abolnik@up.ac.za. 2 Deltamune (Pty) Ltd, 248 Jean Avenue, Lyttleton, Centurion, 0140, South Africa. 3 Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Old Soutpan Road, Onderstepoort, 0110, South Africa. 4 The Poultry Practice, PO Box 5615, Walmer, Port Elizabeth, 6065, South Africa.

 

Abstract

BACKGROUND:

The threat of poultry-origin H6 avian influenza viruses to human health emphasizes the importance of monitoring their evolution. South Africa’s H6N2 epidemic in chickens began in 2001 and two co-circulating antigenic sub-lineages of H6N2 could be distinguished from the outset. The true incidence and prevalence of H6N2 in the country has been difficult to determine, partly due to the continued use of an inactivated whole virus H6N2 vaccine and the inability to distinguish vaccinated from non-vaccinated birds on serology tests. In the present study, the complete genomes of 12 H6N2 viruses isolated from various farming systems between September 2015 and February 2019 in three major chicken-producing regions were analysed and a serological experiment was used to demonstrate the effects of antigenic mismatch in diagnostic tests.

RESULTS:

Genetic drift in H6N2 continued and antigenic diversity in sub-lineage I is increasing; no sub-lineage II viruses were detected. Reassortment patterns indicated epidemiological connections between provinces as well as different farming systems, but there was no reassortment with wild bird or ostrich influenza viruses. The sequence mismatch between the official antigens used for routine hemagglutination inhibition (HI) testing and circulating field strains has increased steadily, and we demonstrated that H6N2 field infections are likely to be missed. More concerning, sub-lineage I H6N2 viruses acquired three of the nine HA mutations associated with human receptor-binding preference (A13S, V187D and A193N) since 2002. Most sub-lineage I viruses isolated since 2015 acquired the K702R mutation in PB2 associated with the ability to infect humans, whereas prior to 2015 most viruses in sub-lineages I and II contained the avian lysine marker. All strains had an unusual HA0 motif of PQVETRGIF or PQVGTRGIF.

CONCLUSIONS:

The H6N2 viruses in South African chickens are mutating and reassorting amongst themselves but have remained a genetically pure lineage since they emerged more than 18 years ago. Greater efforts must be made by government and industry in the continuous isolation and characterization of field strains for use as HI antigens, new vaccine seed strains and to monitor the zoonotic threat of H6N2 viruses.

KEYWORDS: Chickens; Evolution; H6N2 avian influenza; Human markers; Serological diagnosis

PMID: 31852473 DOI: 10.1186/s12917-019-2210-4

Keywords: Avian Influenza; H6N2; Reassortant Strain; Poultry; South Africa.

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#Outbreaks of Clade 2.3.4.4 #H5N8 highly pathogenic #avian #influenza in 2018 in the northern regions of South Africa [#ZA] were unrelated to those of 2017 (Transbound Emerg Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Transbound Emerg Dis. 2019 Dec 13. doi: 10.1111/tbed.13448. [Epub ahead of print]

Outbreaks of Clade 2.3.4.4 H5N8 highly pathogenic avian influenza in 2018 in the northern regions of South Africa were unrelated to those of 2017.

Abolnik C1.

Author information: 1 Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Old Soutpan Road, Onderstepoort, 0110, South Africa.

 

Abstract

Asian-origin H5N8 highly pathogenic avian influenza (HPAI) viruses of the H5 Goose/Guangdong/96 lineage, clade 2.3.4.4 group B reached South Africa by June 2017. By the end of that year, 5.4 million layers and broiler chickens died or were culled, with total losses in the poultry industry estimated at US$ 140 million, and thousands of exotic birds in zoological collections, endangered endemic species and backyard poultry and pet birds also perished. The 2017 H5N8 HPAI outbreaks were characterised by two distinct spatial clusters, each associated with specific reassortant viral genotypes. Genotypes 1, 2, 3 and 5 were restricted to the northern regions, spanning the provinces of Limpopo, Gauteng, North West, Mpumalanga, KwaZulu-Natal and Free State. The second, much larger cluster of outbreaks was in the south, in the Western and Eastern Cape provinces, where in 2017 and 2018 outbreaks were caused solely by genotype 4. The last confirmed case of H5N8 HPAI in the northern region in 2017 was in early October, and the viruses seemed to disappear over the summer. However, starting in mid-February 2018, H5N8 HPAI outbreaks resurged in the north. Viruses from two of the eight outbreaks were sequenced, one from an outbreak in quails (Coturnix japonica) in the North West Province, and another from commercial pullets in the Gauteng province. Phylogenetic analysis identified the viruses as a distinct sixth genotype that was most likely a new introduction to South Africa in early 2018.

© 2019 Blackwell Verlag GmbH.

KEYWORDS: H5N8; Highly pathogenic avian influenza; poultry; quail; wild birds

PMID: 31833671 DOI: 10.1111/tbed.13448

Keywords: Avian Influenza; H5N8; Reassortant strain; Poultry; Wild Birds; South Africa.

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Heterogeneity in #influenza seasonality and #vaccine #effectiveness in #Australia, #Chile, #NZ and #ZA: early #estimates of the 2019 influenza season (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Heterogeneity in influenza seasonality and vaccine effectiveness in Australia, Chile, New Zealand and South Africa: early estimates of the 2019 influenza season

Sheena G Sullivan1, Carmen S Arriola2, Judy Bocacao3, Pamela Burgos4, Patricia Bustos5, Kylie S Carville6, Allen C Cheng7,8, Monique BM Chilver9, Cheryl Cohen10, Yi-Mo Deng11, Nathalie El Omeiri12, Rodrigo A Fasce13, Orienka Hellferscee10, Q Sue Huang3, Cecilia Gonzalez4, Lauren Jelley3, Vivian KY Leung1, Liza Lopez14, Johanna M McAnerney10, Andrea McNeill14, Maria F Olivares15, Heidi Peck11, Viviana Sotomayor15, Stefano Tempia2,10,16,17, Natalia Vergara15, Anne von Gottberg10, Sibongile Walaza10, Timothy Wood14

Affiliations: 1 World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; 2 Influenza Division, Centers for Disease Control and Prevention, Atlanta, United States; 3 National Influenza Centre, Institute of Environmental Science and Research, Wellington, New Zealand; 4 Programa Nacional de Inmunizaciones, Ministerio de Salud, Santiago, Chile; 5 Sección de Virus Respiratorios y Exantematicos, Instituto de Salud Publica de Chile, Santiago, Chile; 6 Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; 7 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; 8 Department of Infectious Diseases, Alfred Health, and Central Clinical School, Monash University, Melbourne, Australia; 9 Discipline of General Practice, University of Adelaide, Adelaide, Australia; 10 National Institute for Communicable Diseases, Johannesburg, South Africa; 11 WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Reference and Research on Influenza, Melbourne, Australia; 12 Pan American Health Organization(PAHO)/WHO Regional Office for the Americas, Washington, United States; 13 Subdepartamento de Enfermedades Virales, Instituto de Salud Publica de Chile, Santiago, Chile; 14 Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand; 15 Departamento de Epidemiologia, Ministerio de Salud, Santiago, Chile; 16 Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; 17 MassGenics, Duluth, United States

Correspondence:  Sheena G Sullivan

Citation style for this article: Sullivan Sheena G, Arriola Carmen S, Bocacao Judy, Burgos Pamela, Bustos Patricia, Carville Kylie S, Cheng Allen C, Chilver Monique BM, Cohen Cheryl, Deng Yi-Mo, El Omeiri Nathalie, Fasce Rodrigo A, Hellferscee Orienka, Huang Q Sue, Gonzalez Cecilia, Jelley Lauren, Leung Vivian KY, Lopez Liza, McAnerney Johanna M, McNeill Andrea, Olivares Maria F, Peck Heidi, Sotomayor Viviana, Tempia Stefano, Vergara Natalia, von Gottberg Anne, Walaza Sibongile, Wood Timothy. Heterogeneity in influenza seasonality and vaccine effectiveness in Australia, Chile, New Zealand and South Africa: early estimates of the 2019 influenza season. Euro Surveill. 2019;24(45):pii=1900645. https://doi.org/10.2807/1560-7917.ES.2019.24.45.1900645

Received: 23 Oct 2019;   Accepted: 06 Nov 2019

 

Abstract

We compared 2019 influenza seasonality and vaccine effectiveness (VE) in four southern hemisphere countries: Australia, Chile, New Zealand and South Africa. Influenza seasons differed in timing, duration, intensity and predominant circulating viruses. VE estimates were also heterogeneous, with all-ages point estimates ranging from 7–70% (I2: 33%) for A(H1N1)pdm09, 4–57% (I2: 49%) for A(H3N2) and 29–66% (I2: 0%) for B. Caution should be applied when attempting to use southern hemisphere data to predict the northern hemisphere influenza season.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Seasonal Influenza; Vaccines; Australia; Chile; New Zealand; South Africa.

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Pre-detection history of #XDR #tuberculosis in #KwaZulu-Natal, South Africa (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Pre-detection history of extensively drug-resistant tuberculosis in KwaZulu-Natal, South Africa

Tyler S. Brown, Lavanya Challagundla, Evan H. Baugh, Shaheed Vally Omar, Arkady Mustaev, Sara C. Auld, N. Sarita Shah, Barry N. Kreiswirth, James C. M. Brust, Kristin N. Nelson, Apurva Narechania, Natalia Kurepina, Koleka Mlisana, Richard Bonneau, Vegard Eldholm, Nazir Ismail, Sergios-Orestis Kolokotronis, D. Ashley Robinson, Neel R. Gandhi, and Barun Mathema

PNAS first published October 28, 2019 / DOI: https://doi.org/10.1073/pnas.1906636116

Edited by Erwin Schurr, McGill University, Montreal, QC, Canada, and accepted by Editorial Board Member Carl F. Nathan October 3, 2019 (received for review April 17, 2019)

 

Significance

Epidemics of AMR pathogens are often only identified years or decades after they first evolved and distant from their place of origin. Consequently, evidence-based strategies for early containment of AMR epidemics are limited. This study employs whole-genome sequence data to reconstruct the “pre-detection” evolutionary and epidemiological history of an extensively drug-resistant Mycobacterium tuberculosis strain in KwaZulu-Natal, South Africa. We localize the geographic origin of this strain to an area hundreds of kilometers away from where the first clinical cases were reported and identify key host- and pathogen-specific factors that contributed to the rise of this important threat to global tuberculosis control. We propose that similar strategies can support the early identification and containment of AMR pathogens in the future.

 

Abstract

Antimicrobial-resistant (AMR) infections pose a major threat to global public health. Similar to other AMR pathogens, both historical and ongoing drug-resistant tuberculosis (TB) epidemics are characterized by transmission of a limited number of predominant Mycobacterium tuberculosis (Mtb) strains. Understanding how these predominant strains achieve sustained transmission, particularly during the critical period before they are detected via clinical or public health surveillance, can inform strategies for prevention and containment. In this study, we employ whole-genome sequence (WGS) data from TB clinical isolates collected in KwaZulu-Natal, South Africa to examine the pre-detection history of a successful strain of extensively drug-resistant (XDR) TB known as LAM4/KZN, first identified in a widely reported cluster of cases in 2005. We identify marked expansion of this strain concurrent with the onset of the generalized HIV epidemic 12 y prior to 2005, localize its geographic origin to a location in northeastern KwaZulu-Natal ∼400 km away from the site of the 2005 outbreak, and use protein structural modeling to propose a mechanism for how strain-specific rpoB mutations offset fitness costs associated with rifampin resistance in LAM4/KZN. Our findings highlight the importance of HIV coinfection, high preexisting rates of drug-resistant TB, human migration, and pathoadaptive evolution in the emergence and dispersal of this critical public health threat. We propose that integrating whole-genome sequencing into routine public health surveillance can enable the early detection and local containment of AMR pathogens before they achieve widespread dispersal.

infectious disease – epidemics – tuberculosis – antimicrobial resistance – population genetics

Keywords: Antibiotics; Drugs Resistance; Rifampin; XDR-TB; Mycobacterium tuberculosis; TB; South Africa.

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#Evidence of the Presence of Low Pathogenic #Avian #Influenza A Viruses in Wild #Waterfowl in 2018 in South #Africa (Pathogens, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pathogens. 2019 Sep 25;8(4). pii: E163. doi: 10.3390/pathogens8040163.

Evidence of the Presence of Low Pathogenic Avian Influenza A Viruses in Wild Waterfowl in 2018 in South Africa.

Poen MJ1, Fouchier RAM2, Webby RJ3, Webster RG4, El Zowalaty ME5,6.

Author information: 1 Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015GE Rotterdam, The Netherlands. m.poen@erasmusmc.nl. 2 Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015GE Rotterdam, The Netherlands. r.fouchier@erasmusmc.nl. 3 Division of Virology, Department of Infectious Diseases, Center of Excellence for Influenza Research and Surveillance (CEIRS), St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. Richard.webby@stjude.org. 4 Division of Virology, Department of Infectious Diseases, Center of Excellence for Influenza Research and Surveillance (CEIRS), St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. Robert.webster@stjude.org. 5 Division of Virology, Department of Infectious Diseases, Center of Excellence for Influenza Research and Surveillance (CEIRS), St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. elzow005@gmail.com. 6 Virology and Microbiology Research Group, Department of Pharmacy, City University College of Ajman, Sheikh Amaar Road, Al Tallah 2, P.O. Box 18484 Ajman, United Arab Emirates. elzow005@gmail.com.

 

Abstract

Avian influenza viruses are pathogens of global concern to both animal and human health. Wild birds are the natural reservoir of avian influenza viruses and facilitate virus transport over large distances. Surprisingly, limited research has been performed to determine avian influenza host species and virus dynamics in wild birds on the African continent, including South Africa. This study described the first wild bird surveillance efforts for influenza A viruses in KwaZulu-Natal Province in South Africa after the 2017/2018 outbreak with highly pathogenic avian influenza virus H5N8 in poultry. A total of 550 swab samples from 278 migratory waterfowl were tested using real-time RT-PCR methods. Two samples (0.7%) were positive for avian influenza virus based on the matrix gene real-time RT-PCR but were negative for the hemagglutinin subtypes H5 and H7. Unfortunately, no sequence information or viable virus could be retrieved from the samples. This study shows that avian influenza viruses are present in the South African wild bird population, emphasizing the need for more extensive surveillance studies to determine the South African avian influenza gene pool and relevant local host species.

KEYWORDS: South Africa; avian influenza; epidemiology; influenza A virus; migratory waterfowl; real-time RT-PCR; surveillance; wild birds; zoonosis

PMID: 31557802 DOI: 10.3390/pathogens8040163

Keywords: Avian Influenza; Wild Birds; South Africa.

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A ten-year review of #ESBL and non-ESBL #Escherichia coli #bloodstream #infections among #children at a tertiary referral #hospital in South Africa [#ZA] (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa

Oliver Ombeva Malande , James Nuttall, Vashini Pillay, Colleen Bamford, Brian Eley

Published: September 24, 2019 / DOI: https://doi.org/10.1371/journal.pone.0222675

 

Abstract

Introduction

There are few studies describing Escherichia coli (E. coli) bloodstream infection (BSI) among children in Africa, yet E.coli is increasing in importance as a cause of antibiotic resistant infection in paediatric settings.

Methods

In this retrospective, descriptive study aspects of E. coli BSI epidemiology are described over a 10-year period including incidence risk, risk factors for extended-spectrum β-lactamase (ESBL)-producing E. coli BSI, antibiotic susceptibility of the bacterial isolates and outcome including risk factors for severe disease.

Results

There were 583 new E. coli BSI episodes among 217,483 admissions, an overall incidence risk of 2.7 events/1,000 hospital admissions. Of 455 of these E. coli BSI episodes that were analysed, 136 (29.9%) were caused by ESBL-producing isolates. Risk factors for ESBL-producing E. coli BSI included hospitalization in the 28-day period preceding E. coli BSI episodes, having an underlying chronic illness other than HIV infection at the time of the E. coli BSI and having a temperature of 38° Celsius or higher at the time of the E. coli BSI. None of the E. coli isolates were resistant to carbapenems or colistin. The mortality rate was 5.9% and admission to the intensive care unit was required in 12.3% of BSI episodes. Predictors of severe disease included age less than 1 month, hospitalization in the 28-day period preceding E. coli BSI and BSI without a definable focus.

Conclusions

These findings extend our understanding of E. coli BSI in a sub-Saharan African setting, provide useful information that can guide empiric treatment choices for community- and hospital-acquired BSI and help inform prevention strategies.

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Citation: Malande OO, Nuttall J, Pillay V, Bamford C, Eley B (2019) A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa. PLoS ONE 14(9): e0222675. https://doi.org/10.1371/journal.pone.0222675

Editor: Surbhi Leekha, University of Maryland School of Medicine, UNITED STATES

Received: April 30, 2019; Accepted: September 3, 2019; Published: September 24, 2019

Copyright: © 2019 Malande et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: There was no special funding for this work, except patient folders and clinical records and staff input from the Red Cross Hospital Children’s Hospital – Paediatric infectious Diseases unit and University of Cape Town.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Antibiotics; Drugs Resistance; E. Coli; Carbapenem; Colistin; Beta-lactams; Bacteremia; Pediatrics; South Africa.

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