Browsing by Author "Rout, Joan Allison."

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Exploring the role of the intensive care nurse in the antimicrobial stewardship team at a private hospital, eThekwini, South Africa.
(2015) Rout, Joan Allison.; Brysiewicz, Petra.
Background: The care of the critically ill patient across the world has become progressively challenging with increasingly resistant pathogens resulting in difficult to treat infections. This is compounded by the decreasing effectiveness of many antibiotics. Severe infections increases the length of time spent in an ICU, increases morbidity and mortality, and increases healthcare costs. Antimicrobial stewardship (AS) has the aims of slowing resistance and the protection of patients and the wider community through the promotion of correct antimicrobial use by education and guidelines. Infection control measures are an essential part of AS in preventing emergent resistant pathogens and hospital-acquired infections. Research purpose: The identification of the role of the ICU nurse in an AS team in a private ICU in South Africa. Research approach: A qualitative approach was used in this study in order to obtain meaningful contributions that a questionnaire may not have been able to provide. Purposive sampling was used to identify participants from an ICU multidisciplinary AS team in a hospital in the private healthcare sector. Semi-structured interviews were conducted with fifteen participants; ICU clinical nurses, nursing management, surgeons, anaesthetists, physicians, microbiologists and pharmacists. Data were analysed and categorised using content analysis. Findings: Perspectives of the various members of the multidisciplinary AS team identified the role of the ICU nurse in an AS team as being organisational, advocatory, clinical and collaborative. Suggestions were made to further develop this nursing role by supporting proactive behaviour, teaching and learning, and teamwork. Concerns were raised about this role relating to resource barriers, knowledge deficit, poor attitude towards work, ineffective teamwork, working in isolation, and economic pressures. A limitation to this study is that it is a small study in a single setting, which may limit generalizability. Conclusion: The ICU nurse’s role in AS is essential for the successful implementation of an AS programme. Recommendations to develop this role are made for clinical practice, education, research and policy development.
Molecular epidemiology of carbapenem-resistant Enterobacterales colonization in an intensive care unit.
(2021) Madni, Osama.; Essack, Sabiha Yusuf.; Rout, Joan Allison.; Amoako, Daniel Gyamfi.; Akebe, Luther King Abia.
Background: Due to the high association with mortality and morbidity, carbapenem-resistant Enterobacterales (CRE) in general, and carbapenem-resistant Klebsiella pneumoniae, in particular, have been listed as high-priority pathogens by the World Health Organization (WHO) for the research and development of new antibiotics. Concomitant resistance to multiple antibiotics of different classes, impedes efficient clinical management of CRE infections. We characterized carbapenemase-producing K. pneumoniae (CPKP) isolates from sequential rectal screening of patients in a single intensive care unit (ICU) in a public hospital in the uMgungundlovu District of Kwazulu-Natal, South Africa, collected over one month. Method: Ninety-seven rectal swabs collected from consenting adult patients (n=31) on day 1, 3, 7 and weekly thereafter were screened for carbapenemase-production using Chrome-ID selective media. Fourteen CPKP were subjected to speciation and antibiotic susceptibility testing using the VITEK 2® automated system and their clonality was ascertained by ERIC/PCR. A sub-sample of eight isolates from five patients underwent whole genome sequencing (WGS) on the Illumina MiSeq platform followed by bioinformatics analysis to delineate the resistome, virulome, mobilome, clonality and phylogeography. Results: All isolates (100%) were resistant to ertapenem and meropenem and 71.4% (n=10) were resistant to imipenem. All isolates harbored the blaOXA-181 carbapenemase (100%, n=8) and also carried other β-lactamase genes such as OXA-1, CTX-M-15, TEM-1B and SHV-1. IncF, IncX3, and Col plasmid replicons groups and class I integrons (ln191 and ln27) were detected. All isolates belonged to the same sequence type ST307 and capsular serotypes (K102, O2v2) and several were associated with a single bed located in the ICU. All but one isolate carried the same plasmid multilocus sequence type [K7:A-:B-] and the same virulence repertoire was identified reflecting the epidemiological relationships between isolates. BlaOXA-181 were presumably located on a multi-replicon plasmid similar to that of E. coli p010_B-OXA181, and isolates were aligned with several South African and international clades, demonstrating horizontal and vertical transboundary distribution. Conclusion: OXA-181-producing K. pneumoniae belonging to ST307 was found to be potentially endemic in the hospital ICU environment of a public hospital in KwaZulu-Natal South Africa. The presence of a myriad of antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) in different permutations and combinations presents challenges to clinical management and infection prevention and control measures. This necessitates a CRE screening programme and strict infection prevention and control measures to detect and eliminate this endemic clone.