Browsing by Author "Dramowski, Angela"

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    Cultureconfirmed neonatal bloodstream infections and meningitis in South Africa 201419 a crosssectional study
    Mashau, Rudzani C.; Meiring, Susan ; Dramowski, Angela; Magobo, Rindidzani E.; Quan, Vanessa C. ; Von Gottberg, Anne ; Cohen, Cheryl ; Velaphi, Sithembiso ; Govender, Nelesh; Perovic, Olga
    Background: Few population-level estimates of invasive neonatal infections have been reported from sub-Saharan Africa. We estimated the national incidence risk, aetiology, and pathogen antimicrobial susceptibility for cultureconfirmed neonatal bloodstream infections and meningitis in South Africa. Methods: We conducted a cross-sectional study of neonates (<28 days of life) admitted to neonatal or paediatric wards of 256 public sector health facilities in South Africa during 2014–19. Diagnostic pathology records from Jan 1, 2014, to Dec 31, 2019, were extracted from a national pathology data warehouse. A case was defined as a neonate with at least one positive blood or cerebrospinal fluid culture during a 14-day period. Incidence risk was calculated using annual numbers of registered livebirths. Among the causative pathogens identified, we calculated the proportion of cases attributed to each of them, as well as the rates of antibiotic susceptibility of Gram-positive and Gram-negative bacteria. Findings: Among 43 438 records of positive cultures, there were 37 631 incident cases of neonatal infection with at least one pathogen isolated. The overall incidence risk of culture-confirmed infections was 6·0 per 1000 livebirths (95% CI 6·0–6·1). The incidence risk of late-onset sepsis (days 3–27 of life) was 4·9 per 1000 livebirths (4·9–5·0) and that of early-onset sepsis (days 0–2 of life) was 1·1 per 1000 livebirths (1·1–1·1); risk ratio 4·4 (95% CI 4·3–4·5). The cause of infection differed by syndrome, timing of infection onset, facility, and province, although Klebsiella pneumoniae (26%), Acinetobacter baumannii (13%), and Staphylococcus aureus (12%) were the dominant pathogens overall. Gram-negative bacteria had declining susceptibility to most antibiotics over the study period. Interpretation We found a high incidence risk of late-onset sepsis with provincial variations, predominance of K pneumoniae, and declining antibiotic susceptibility among Gram-negative bacteria. This national surveillance in an upper-middle-income country provides a baseline burden of neonatal infections against which the impact of future clinical and public health interventions can be measured.
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    A profile of HIV-related paediatric admissions at Chris Hani Baragwanath Hospital, Johannesburg, South Africa
    (2010-02-24T06:24:37Z) Dramowski, Angela
    Aim: To describe the prevalence of HIV infection, and the disease profile and outcome of 440 HIV-infected children admitted to the general paediatric wards at Chris Hani Baragwanath Hospital (CHBH). Methods: A comprehensive list of all paediatic patients admitted to the general wards between October and December 2007 was compiled using hospital admission records. Hospital folder and laboratory records were used to determine HIV prevalence. A retrospective review of inpatient hospital records was conducted for all confirmed HIV-infected paediatric patients admitted during the study period. Results: The prevalence of confirmed HIV infection amongst paediatric admissions at CHBH during the study period was 29.5% (95% CI 27.2 -31.9%). Of these children, 54.1% were newly diagnosed with HIV during the current hospital admission. Despite the majority (92.7%) of admissions having advanced HIV disease (WHO Stage 3 or 4), only 17% were accessing ART. Of the 202/440 (45.9%) children known to be HIV-infected before hospital admission, only 74/202 (36.6%) were currently receiving ART. Of the remaining 128/202 children known to be HIV-infected before hospital admission, 121/128 (94.5%) had WHO HIV stage 3 or 4 disease and thus were eligible for ART. Only 19% of children had a normal weight. Amongst infants aged less than 6 months uptake of PMTCT interventions was poor - only 36% of mother-infant pairs received single dose nevirapine and 28% of infants received cotrimoxazole prophylaxis. Respiratory illness was the principal reason for hospitalization in 37.5% of admissions. Gastroenteritis, sepsis and tuberculosis accounted for 22%, 19.5% and 21% of principal diagnoses respectively. The overall case fatality rate was 12% (95% CI 9.2–15.5%), with deaths in HIV-infected children contributing 58% of all deaths in the general paediatric wards. Over half (52%) of all deaths in the HIV-infected group occurred in infants younger than 6 months of age. vi Conclusion: HIV infection remains a major contributor to morbidity and mortality among paediatric admissions at CHBH. Poor uptake of PMTCT interventions, late diagnosis of HIV infection and delay in accessing ART are immediate barriers to improved care in HIV-infected children at CHBH. The underlying reasons for poor accessibility and under- utilisation of paediatric HIV-related services requires further investigation. Efforts to reduce mortality amongst HIV-infected paediatric admissions at CHBH should focus on early diagnosis of HIV infection and prompt initiation of antiretroviral treatment, especially in infants under 6 months of age.