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TIMES LIVE An average of between 60 and 80 cases of drug-resistant fungal infections are detected in SA every month, mainly in Gauteng private hospitals, according to the National Institute for Communicable Diseases (NICD). Prof Nelesh Govender, the NICD head of the centre for healthcare-associated infections, antimicrobial resistance and mycoses, said these infections are of great concern. He was speaking after The New York Times reported on the worldwide rise of candidia auris infections, naming four countries where outbreaks had been reported, including SA. The germ is resistant to at least one class of medication and infects the sickest people in hospitals. Govender said the NICD had been monitoring these fungal infections in SA through laboratory data since 2009. He said an average of 60 to 80 such cases were reported in the country every month, with Gauteng – mainly private hospitals in Johannesburg and Pretoria – the most affected. Once the fungus is inside a hospital it lives on surfaces and is very difficult to get rid of and can become resistant to some cleaning agents. In about a third of these cases infection spread to the bloodstream, and four in 10 of those patients died. Those who contracted it were already very ill since mainly patients with a compromised immune system were affected. Classically, fungi don’t behave in this way. We have not seen this pattern of disease caused by a fungus before. Other risk factors in SA included old age, having a central line (a catheter into a large vein) and staying in an intensive care unit for a long period. Govender said that while it was a fungal infection, antibiotic-resistant infections caused by bacteria are often taken more seriously. It is the first time in history that a fungal infection has started behaving like an antibiotic-resistant bacterial infection. Like bacterial infections, Govender said it was easy to transmit from one person to another in a hospital. A patient could spread the fungus to the bed, bed linen, hospital curtains and window sills. If it contaminates environments and if the room is not disinfected, the next patient admitted to the room could potentially contract it. The New York Times reported on an outbreak in SA in 2016, but Govender said hospital outbreaks did occur from time to time. There had been an outbreak among four newborns in a private hospital at the end of 2017. In 10 years in SA, the NICD has only detected two strains that are resistant to three types of medicines (triply resistant), leaving almost no treatments. Most infections in SA are only resistant to the first class of drugs to treat them but respond to other medications. Experts have just completed guidelines on the best way to manage such infections, but these are not yet publicly available. Govender said there was a theory that the first infections in SA occurred in Gauteng hospitals. He said private hospitals have more ICU beds, so it may biased in that way. Wits professor and intensive care expert Guy Richards said the infection occurred more commonly in hospitals where doctors may use more broad-spectrum antibiotics that do not target specific bacteria. The most important way to prevent the infection is for hospital staff to wash their hands often. Richards said healthy people cannot get this disease. He said doctors put tubes and catheters into patients’ bodies and veins, which allowed an entry point into the body. In addition, plastic devices had a much higher propensity than human tissue for attracting organisms and allowing them to grow on them. Another issue is, South Africa and hospitals have been very good at setting up antimicrobial stewardship programmes monitoring the after-use of antibiotics. However, SA was behind in antifungal stewardship - managing medicines used to treat fungi. Richards said while South Africa’s candida auris is resistant to firstline drugs, called azoles, and treated by another kind, called echinocandins, if we keep using these there will eventually be a resistance. He said it is the new superbug.
Created at 2019/04/16 09:05 AM by Mediclinic
Last modified at 2019/04/16 09:05 AM by Mediclinic