Browsing by Author "Piercy, Jenna"

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    Compliance with surgical antibiotic prophylaxis guidelines: a prospective descriptive study at a tertiary level hospital in Cape Town, South Africa
    (2020) Schuster, Delia; Piercy, Jenna; Fagan Johannes
    Background: The aim of surgical antibiotic prophylaxis (SAP) is to prevent surgical site infection (SSI) by administering an appropriate antimicrobial agent perioperatively. However, SAP may be associated with adverse effects and incurs added costs. The primary objective of this prospective study is to establish whether clinicians are adhering to existing perioperative antibiotic prophylaxis guidelines in terms of indication, dosage and timing of SAP. Secondary objectives are to determine the proportion of patients receiving inappropriate antibiotics; and to evaluate correct practice concerning re-dosing and duration of SAP. Methods: A cross-sectional prospective audit of the anaesthetic records and prescription charts of surgical patients was conducted at Groote Schuur Hospital, a tertiary level teaching hospital in Cape Town, South Africa, over a period of one week. Data were collected by anaesthetists – blinded to the study objectives – and the investigators; then captured on Excel spread sheets and compared to existing SAP guidelines. Descriptive statistics and binary logistic regression were used for analysis. Results: Of the 192 patients consented, 180 questionnaires were completed for data analysis. The median age of participants was 44.5 years (IQR: 31.5-58), with a preponderance of females (58.7%). SAP was administered in 149 cases (82.8%) and withheld in 31 (17.2%). This was appropriate in 91.9% (137/149) and 77.4% (24/31) respectively. Twelve patients (6.7%) received inappropriate antibiotics and in seven (3.9%) it was inappropriately withheld. Of the 156 patients who should have received SAP, choice of drug was correct in 121 (77.6%), dosage in 110 (70.5%) and timing in 87 (55.8%). Absolute compliance was achieved in 44.4% (80/180). Errors were mostly related to timing, re-dosing and duration of SAP. Conclusion: Anaesthetists and surgeons at Groote Schuur Hospital demonstrate variable adherence to surgical antibiotic prophylaxis guidelines. Interventions aimed at improving compliance are warranted.
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    ICU-Associated Acinetobacter baumannii Colonisation/Infection in a High HIV-Prevalence Resource-Poor Setting
    (Public Library of Science, 2012) Ntusi, Ntobeko B A; Badri, Motasim; Khalfey, Hoosain; Whitelaw, Andrew; Oliver, Stephen; Piercy, Jenna; Raine, Richard; Joubert, Ivan; Dheda, Keertan
    BACKGROUND: There are hardly any data about the incidence, risk factors and outcomes of ICU-associated A.baumannii colonisation/infection in HIV-infected and uninfected persons from resource-poor settings like Africa. METHODS: We reviewed the case records of patients with A.baumannii colonisation/infection admitted into the adult respiratory and surgical ICUs in Cape Town, South Africa, from January 1 to December 31 2008. In contrast to colonisation, infection was defined as isolation of A.baumannii from any biological site in conjunction with a compatible clinical picture warranting treatment with antibiotics effective against A.baumannii . RESULTS: The incidence of A.baumannii colonisation/infection in 268 patients was 15 per 100 person-years, with an in-ICU mortality of 26.5 per 100 person-years. The average length of stay in ICU was 15 days (range 1-150). A.baumannii was most commonly isolated from the respiratory tract followed by the bloodstream. Independent predictors of mortality included older age (p = 0.02), low CD4 count if HIV-infected (p = 0.038), surgical intervention (p = 0.047), co-morbid Gram-negative sepsis (p = 0.01), high APACHE-II score (p = 0.001), multi-organ dysfunction syndrome (p = 0.012), and a positive blood culture for A.baumannii (p = 0.017). Of 21 A.baumannii colonised/infected HIV-positive persons those with clinical AIDS (CD4<200 cells/mm 3 ) had significantly higher in-ICU mortality and were more likely to have a positive blood culture. Conclusion In this resource-poor setting A.baumannii infection in critically ill patients is common and associated with high mortality. HIV co-infected patients with advanced immunosuppression are at higher risk of death.
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    Outcomes of patients with COVID-19 Acute Respiratory Distress Syndrome requiring Invasive Mechanical Ventilation admitted to an Intensive Care Unit in South Africa
    (2022) Arnold-Day, Christel; Piercy, Jenna; Van Zyl-Smit, Richard
    Background Up to 30% of patients with COVID-19 pneumonia may require ICU admission or mechanical ventilation [Guan et al., 2020; Huang et al., 2020]. Data from low- and middle-income countries for COVID-19 ARDS are limited. Groote Schuur Hospital in Cape Town, South Africa expanded its ICU service to support patients with COVID-19 ARDS requiring invasive mechanical ventilation (IMV). We report on patients' characteristics and outcomes from two pandemic waves. Methods All patients with COVID-19 ARDS admitted to the ICU for IMV were included in this prospective cohort study. Data were collected from 5th April 2020 to 5th April 2021. Ethical approval was granted (HREC: 362/2020), consent was waived for deceased patients and deferred for survivors. Results Over the 12-month study period 461 patients were admitted to the designated COVID-19 ICU. Of these, 380 patients met study criteria and 377 had confirmed hospital discharge outcomes. The median age of patients was 51 years (range 17-71), 50.5% were female and the median BMI was 32kg/m2 (IQR 28-38). The median P/F ratio was 97 (IQR 71.5-127.5) after IMV was initiated. Comorbidities included diabetes (47.6%), hypertension (46.3%) and HIV infection (10%). Of the patients admitted, 30.8% survived to hospital discharge with a median ICU length of stay of 19.5 days (IQR 9- 36). Predictors of mortality after adjusting for confounders were: male (OR:1.79), increasing age (OR:1.04) and SOFA score (OR:1.29). Conclusion In a resource limited environment, escalation of ICU IMV support achieved a 30.8% hospital survival in patients with COVID-19 ARDS. The ability to predict survival remains difficult given this complex disease.
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    Twelve Month outcome analysis of a South African Intensive Care Unit.
    (2023) Erwee, Daniel; Piercy, Jenna
    Abstract Background: The description of outcomes after admission to Critical Care Units in Africa is sparse, reporting mortality rates between 23.6% and 53.6%. South African data, thus far, show in-ICU mortality rates between 9% and 19.7%. To our knowledge, no evaluation of ICU outcomes has ever been performed on a population group in the Western Cape Province. Objectives: To describe patients admitted to an 8-bed ICU unit over one calendar year with regards to demographics and outcomes situated in Groote Schuur Hospital with regard to inICU and 1-year mortality rates. Methods: This is a retrospective descriptive review of adult patients (>18 years old) from 1 January 2019 to 31 December 2019. Data were collected on age, sex, primary admission diagnosis, length of stay and mortality. Results: A total of 338 patients were included; 61.2% (n=207) with a primary medical diagnosis and 38.2% (n=129) with a non-medical diagnosis. Trauma accounted for 13.6% of all admissions. The burden of known HIV infection as a comorbidity was 16.9% (n=57). The overall in-ICU mortality rate was 25.7% (n=87), and the one-year mortality rate was 18.0% (n=25), but with a significant loss to follow-up of 33.1%. Conclusion: The overall in-ICU mortality was 25.7%. A large proportion of patients admitted had a trauma diagnosis, despite it historically accepting mostly medical and complicated obstetric patients.