johannesburg hospital annual report

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Annual Report March 2006 – March 2007

Microbiology Laboratory - Johannesburg Hospital

Head: Prof AG Duse

Departmental Staff Compliment

Academic Staff

Principal Pathologist: Dr Olga Perovic. Qualifications: MD, DTM&H, FSPath (SA) Micro, MMED (Wits).

Appointed 1/06/2001.

Administrative Staff

Laboratory Manager: Mrs Debra Antelme. Qualifications: MT. Appointed 1/05/1992.

Support/Laboratory Staff

Chief Technologist: Mrs Robyn Barriere. Qualifications: MT. Appointed 1/04/1985. Section Supervisor: Mrs

Nishie Naidoo. Qualifications: MT. Appointed 1/02/1987. Section Supervisor: Mrs Cecilia de Abreu.

Qualifications: MT. Appointed 1/08/1990.

Section Supervisor: Mr Thebe Tsheola. Qualifications: MT. Appointed 10/06/1996.

Section Supervisor: Mr

Jacob Kolodi. Qualifications: MT. Appointed 1/06/1998. Unit Supervisor: Mrs Debbie Orton. Qualifications: MT

& BcT. Appointed 1/02/1998. Chief Technologist: Mrs Lindy Scott. Qualifications: MT. Appointed 9/03/1995

(Left in October 2006) Chief Technologist: Ms Deborah Mothiba. Qualifications: MT. Appointed 1/07/1998.

Senior Technologist: Mrs Rosinah Sibiya. Qualifications: BT. Appointed 1/02/2002.

Senior Technologist: Ms

Sudeshni Naidoo. Qualifications: BT & BcT. Appointed 1/08/2002. Senior Technologist: Ms Zazi Tshabalala.

Qualifications: BT. Appointed 1/08/2002. Senior Technologist: Ms Tiisetso Lebaka. Qualifications: BT.

Appointed 1/03/2003. .

Senior Technologist: Ms Nambitha Ndungane. Qualifications: BT. Appointed

1/10/2003. Senior Technologist: Mrs Rosinah Kganakga. Qualifications: BT. Appointed 1/10/2003.

Medical

Technologist: Mrs Robeina Badat. Qualifications: BT. Appointed 1/08/2004. Medical Technologist: Ms Crystal

Viljoin. Qualifications: BT & BcT. Appointed 1/08/2005. Medical Technologist: Ms Mary Mothiba. Qualifications:

BT. Appointed 1/11/2005. (Left in July 2006). Technician: Sarah Msimanga Qualifications: Technician.

Appointed 16/05/1994.

Central Research Areas

The Johannesburg Hospital Microbiology Laboratory, as part of the Clinical Microbiology and Infectious Diseases

Department has been recognized as an academic and diagnostic department and as a research centre of quality.

Research Projects

Antimicrobial susceptibility of anaerobic organisms isolated from patients admitted for communityacquired infections at the Johannesburg Hospital.

Researchers: Olga Perovic,( Department of Clinical Microbiology and Infectious diseases), NHLS, WITS,

Guy Richards( Department of Medicine and Critical Care, Wits School of Medicine), Adrian

Duse(Department of Clinical Microbiology and Infectious diseases).Commenced: 1/11/2004 and is ongoing. Collaborators: Debra Antelme (Department of Clinical Microbiology and Infectious diseases)

NHLS Janet Loakes (Department of Clinical Microbiology and Infectious diseases), NHLS Sudeshni

Naidoo (Johannesburg Hospital Microbiology Laboratory), NHLS. Sources of Funding: MSD.

Anaerobes are bacteria commonly isolated from the mouth, from the abdominal area, soft tissue, pelvic area and pulmonary infections and from the liver, brain and pancreatic abscesses. Treatment of such infections is empirical, including both aerobic and anaerobic cover. Antimicrobial susceptibility testing for anaerobic organisms is not performed routinely because it is costly and requires special expertise and experience in methodology. The Johannesburg Hospital ’s Microbiology Laboratory routinely processes anaerobic specimens

and epidemiological surveillance performed over a three- month period in 2001 showed that out of a total number of 982 specimens submitted for anaerobic culture from different sites, 4.6% were anaerobes. This study aimed to: determine the antimicrobial susceptibility patterns of community acquired anaerobic organisms isolated in the Johannesburg area: and to initiate and organize this survey such that it can be performed on a regular periodic. Design of this study is prospective, descriptive and analytical study. Setting is at Johannesburg Hospital

Microbiology Laboratory, NHLS. Number of 180 anaerobic isolates from patients with suspected communityacquired mixed aerobic/anaerobic infections will be tested. Antimicrobial susceptibility testing to estimate MIC

(minimum inhibitory concentration) profile will be determined on all isolates using Etest strip method.

The Pfizer Global Hospital Antifungal Surveillance Study

Researchers: Debra Antelme and Debbie Orton. Commenced in 1996 and is on-going. Sources of

Funding: Pfizer

Pfizer Biomic Trial has been in place since 1996. The BIOMIC Systems provide the electronic reading of plates.

The primary objective of this study is to asses patters and trends in antifungal susceptibility test results from clinical isolates. The second objective is to asses the performance of the fluconazole disk test method, and third is to provide information to clinicians, microbiologists and to the manufacturer.

Surveillance for trimethoprim-sulfamethoxazole resistant invasive respiratory, meningeal and diarrhoeal diseases in South Africa in addition to Cryptococcus neoformans.

Researchers: GERMS-SA; Co-coordinator: Olga Perovic. Commenced in 2000 and is on-going.

Collaborators: Anne Schuchat (National Centre for Infectious Diseases (NCID), Centre for Disease

Control and Prevention (CDC) and Atlanta For Johannesburg Hospital Site: Olga Perovic. Sources of

Funding: CDC

This surveillance will involve clinicians and laboratory staff directly, as well as provide funds for the hiring of an adequately trained surveillance officer in 10 centers in the country, over a period of 5 years to improve the national surveillance for invasive disease caused by Streptococcus pneumoniae, Haemophilus influenzae,

Neisseria meningitides and Salmonella spp. As from January 2005 additional surveillance of patients with

Cryptococcus neoformans bacteraemia and meningitis was included. The important clinical data that would need to be captured are patient demographics and history of previous antibiotic use. The major issue to be evaluated will be the change in trimethoprim-sulfamethoxazole susceptibility in the above organisms and the possible association with the use of the antibiotic for prophylaxis in HIV-infected individuals. The other aspect will be to evaluate issues in each hospital that make data capture difficult, so that sustainable solutions can be put in place for the on-going national surveillance. Identified centers in South Africa: Cape Town, Durban, Johannesburg,

Bloemfontein, Ga Rankuwa, Nelspruit, Umtata, Mafikeng and Plokwane: together with the RMPRU in

Johannesburg and the DOH.

The bacteriological and clinical outcome of infections due to extended spectrum Beta-lactamase producing (ESBL) Enterobacteriaceae treated with ertapenem.

Researchers: Olga Perovic. Commenced: July 2006 and is on-going. Collaborators: A.Brink, Ampath, GA

Richards, Department of Medicine, Wits, C Feldman, Department of Medicine, Wits, DM Livermore,

Health Protection Agency Colindale, London. Sources of Funding: Health Protection Agency Colindale for molecular testing.

Evaluation of urine microscopy using the manual method and IQ200 instrument.

Researchers: N Naidoo, D Antelme and O Perovic. Commenced January 2007 and Completed March

2007. Collaborators: K King. Sources of Funding: Pro-Gen Diagnostics.

Evaluation of the Microscan synergy panels for the identification and susceptibility testing of mucoid and non-mucoid Pseudomonas aeruginosa

Researchers: Trusha Nana, Chrystal Viljoen, Debra Antelme and Olga Perovic. Commenced November

2006 and is on-going. Sources of Funding: NHLS.

Evaluation of the Microscan rapid yeast identification panel.

Researchers: Cecilia de Abreu, Debbie Orton and Debra Antelme. Commenced March 2007 and is ongoing. Sources of Funding: NHLS.

Comparison of Antifungal Susceptibility Test Methods for Yeasts using Broth Micro dilution, Etest and

Fungitest.

Researchers: Olga Perovic, Caryn Rosmarin, Jeannette Wadula, Susan Gould, Kerrigan McCarthy,

Debbie Orton, Debra Antelme, Latta Bhagoobhai and A Duse. 2006. Sources of Funding: Davis

Diagnostics.

Evaluation of the Syphagen TPHA REC plus kit for the detection of Treponema palladium antibodies.

Researchers: Debbie Orton. 2006. Sources of Funding: Omega Diagnostics.

Evaluation of Assure Malaria PF antigen kit.

Researchers: Debbie Orton. 2006.

Evaluation of Diagnostic media products-Sputa lysis Buffer vs. Mast Sputagest Selectival.

Researchers: Debbie Orton. 2006. Sources of Funding: Mast Diagnostics.

Research Publications in Local (South African) Journals/ Books

Title of Article/Book: Staphylococcal Resistance: Is there a need to change First Choice Antimicrobials?

Disease Review.

Authors: V Black and O Perovic. Title of Book if Chapter: MMS Disease Review . Publication Date: 2006.

Editors if Chapter: Prof Jacques R Snyman. Title of Article/Book: Guide for the Management of Nosocomial

Infections in South Africa.

Authors: Adrian Brink; Charles Feldman; Adriano Duse; Dean Gopalan; David Grolman; Mervyn Mer; Sarla

Naicker; Graham Paget, Olga Perovic and Guy Richards. Title of Book if Chapter: SAMJ Julu 2006, vol 96

No.7. Publication Date: 2006.

Publications at International Conferences/Meetings

Title of Presentation: Genotype and phenotypic analysis of Pseudomonas aeruginosa isolates from sputum of patients with cystic fibrosis following antimicrobial treatment.

Authors:

O Perovic. E Marais, A Duse, M Mer and G Richards. Conference: ECCMID 2006.

Conference Date : 01-04

April 2006.

Location: Nice

Title of Presentation: Invasive pneumococcal disease in the era of human immunodeficiency virus infection.

Authors:

O Perovic, a von gottenburg and C Feldman. Conference: ECCMID 2006.

Conference Date : 01-04 April 2006.

Location: Nice

Title of Presentation: Comparison of Antifungal Susceptibility Test Methods for Yeasts using Broth

Microdilution, Etest and Fungitest. Authors: Olga Perovic, Caryn Rosmarin, Jeannette Wadula, Susan Gould,

Kerrigan McCarthy, Debbie Orton, Debra Antelme, Latta Bhagoobhai and A Duse . Conference: ECCMID 2007

Conference Date : 31 March-03 April 2007.

Location: Munich.

Diagnostic Services

The Microbiology Laboratory at the Johannesburg Hospital is a routine Diagnostic Laboratory. Laboratory test procedures are: processing specimens for bacterial and fungal isolation and identification; antimicrobial susceptibility testing; serological procedures and bacterial, fungal and viral antigen detection. In addition to diagnostic services, laboratory staff are involved in teaching and research activity.

Diagnostic Services and Workload

Bilharzia(470); Clostridium difficile(458); CSF(4902); CFS Latex(435); Blood Culture(33558); Culture ear(46);

Culture Eye(91); Culture stool(1191); Culture fluid(3451); Culture genital(106); Culture pus(3685); Culture rectal swab(22); Culture Sputum(3678); Culture Throat(394); Culture tissue(905); Culture S.Typhi(123); Culture urine(1381); Deep peritoneal lavage(116); FCELL(208); ETEST(570); HIVR&C(10490); HIVI&C(14715); Malaria

Antigen(1385); Mycology(3197); Parasitology(46); RPR(14154); Urine Microbiology(288); UDYS(588);

TBA(5179); TPHA(6169); VDRL(1635); WIDAL(112); BRUC(58); HBCAB(365); HBCIM(1699); HBEAB(161);

HBEAG(243); HBSAB(1533); HBSAG(3023); HEPA(2334); HEPAG(208); HEPC(2399); HEPSC(992);

ROTA(77); TOTAL UNITS(139370)

University Undergraduate Teaching

Course: AST Number of Students: 30 Course: Basic Mycology

Number of Students: 30 Course: AAST Number of Students: 20

External Teaching Activities

Company: Department of Pediatrics 24 th May 2006 Teaching Topic: Updating of new antibiotics. Company:

Edenvale Hospital 26 th June 2006.

Teaching Topic: Rationale use of antibiotics.

Company: Aventis-Pharmaceuticals. Teaching Topic: Empirical antimicrobial for community acquired infections.

Courses obtained from External Institutions

Lindy Scott attended training courses: ISO Guide 15189&GLP. Sudeshni Naidoo attended training course:

Management of a Microbiology Lab 14-15 August 2006. Rosah Kganakga attended training course: Advanced

Antimicrobial Testing. 2-3 August 2006. Chrystal Viljoin attended training course: TB Microscopy. Rubeina Badat attended training course: TB Microscopy. Zazi Tshabalala attended training course: Basic Immunology. Nambita attended training course: Stool and Urine Parisitology. Debra Altelme attended training courses: Good Clinical

Laboratory Practice, CLS, January 2007; Test and Measurement Conference, 23-24 October 2006;

Management Skills 22 nd November 2006; Microscan Workshop; Westguard Rules and Advanced Disa Lab

Training Course May 2006. Olga Perovic attended training courses: Internal auditing course by SANAS;

Advanced Disa Lab Training Course May 2006; Test and Measurement Conference, 23-24 October 2006;

Microscan User Group Meeting November 2006. Debbie Orton attended training courses: Thistle QA Workshop

4 th November 2006; Microscan Workshop; West guard Rules and Advanced Disa Lab Training Course May

2006. Nishie Naidoo attended training course Dade Behring Microscan 24-26 August 2006.

Accolades/Awards/Honours/

Appointments/Committees/Task Forces

Olga Perovic – Chairperson National Antimicrobial Surveillance Forum, as part of the Federation of

Infectious Diseases Societies of Southern Africa.

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