Microbe Mail Vindana Chibabhai

We're back with another game of 'Would you rather?' Where we pose a scenario, and our guests give us their views. This episode really challenges the basis of some of the beliefs and practices regarding antimicrobials. Some of the questions are so tricky, who knows if there even is a correct answer. What we do know is... it depends.
About our Guest:
Prof. Andrew Whitelaw worked as a consultant pathologist in clinical microbiology at Groote Schuur Hospital from 2003 – 2012. In December 2012 took up the post of Head of Department of Medical Microbiology at the University of Stellenbosch / Tygerberg Hospital. His early research revolved around molecular characterization of ESBLs in members of the Enterobacteriaceae, and he has been involved in a number of studies and activities related to antimicrobial resistance (AMR) and infection control over the last decade, both for community as well as hospital acquired pathogens. Most relevant among these would be his involvement in the South African Antibiotic Stewardship Programme (SAASP), The Infection Control Society of Southern Africa, and the SA Ministerial Advisory Committee on AMR. 
Ongoing research interests focus on antimicrobial resistance in Enterobacteriaceae and Staphylococcus aureus, including molecular epidemiology and mechanisms of resistance as well as clinical impact and control of AMR. He is also involved in studies describing the human microbiota and in particular the effect of antimicrobials on the microbiota.
Resources from this episode:
SASCM C. difficile infection guidelines
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Don't forget to also have a listen to these featured episodes:
Episode 43: Communicating antimicrobial therapy to patients
Episode 38: Would you rather?: The mycology version
Episode 35: Would you rather?: The virology version
Episode 33: Would you rather?:The Bacterial version

The rampant emergence of antimicrobial resistance, particularly amongst Gram negative organisms, has called for both the discovery of novel agents but also for a review of therapeutics thought to have been long lost in this battle. Enter, the "BLBLIs or BLICs'. In this episode Vin and Ruan speak with the 1st author of the publication "Appropriate use of the new β-lactam - β-lactamase inhibitor combination agents: Ceftazidime-avibactam and Ceftolozane-tazobactam in South Africa", Professor Adrian Brink, and receive a welcomed masterclass on this interesting group of antimicrobials.
About our Guest:
Professor Adrian Brink is Head of the Division: Medical Microbiology, and member of the Institute of Infectious Disease & Molecular Medicine,  Faculty of Health Sciences, University of Cape Town and the National Health Laboratory Services, Groote Schuur hospital, Cape Town, South Africa. 
Prof Brink was founding President of the Federation of Infectious Diseases Societies of Southern Africa and is the founder and currently co-chairs the South African Antibiotic Stewardship Program (SAASP). Prof Brink currently serves on the South African Minister of Health’s Ministerial Advisory Committee (MAC) on Antimicrobial Resistance and representing Africa, is a member of the European Society of Clinical Microbiology and Infectious Diseases International Affairs Subcommittee.
His is main research interests are the clinical and molecular epidemiology of antibiotic-resistant infections, the mechanisms of resistance as a confounder in antibiotic stewardship, the design and implementation of large-scale antibiotic stewardship, diagnostic stewardship and infection prevention and control interventions in low- and middle-income countries. His interests also include the protective, metabolic and immune functions of the gastrointestinal and vaginal biome including the resistome and metabolome. 
Resources from this episode
Best practices: Appropriate use of Beta-lactam/Beta-lactamase inhibitor combinations Ceftazidime-Avibactam and Ceftolozane-Tazobactam)
WHO Priority Pathogens List
Table 1: Data on inhibitor classes, inhibitory mechanisms, and current clinical trial status, Kar D et al., 2023.
Table 6: β-lactam/β-lactamase inhibitor (BL/BLI) combinations in clinical trials or submitted for regulatory approval, Butler et al., 2023
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Professor Francois Venter is back in Part 3 of our HIV series in which he continues to address South Africa's battles against HIV. Here he discusses his experience on how and when to initiate antiretroviral therapy, prophylaxis against opportunistic infection, routine monitoring and what the future of HIV management looks like in South Africa.
About our Guest:
Professor WD Francois Venter, MD, FCP, PhD is Executive Director of Wits Ezintsha at the University of the Witwatersrand, Johannesburg, where he received most of his training. His work involves health systems research and clinical trials, most recently involving the antiretrovirals dolutegravir, tenofovir alafenamide, cabotegravir, and doravirine. He leads multiple antiretroviral treatment optimisation studies and is currently working on new access programmes through private pharmacies within South Africa, patient linkage-to-care interventions, self-testing projects, as well as most recently on new large-scale primary care delivery platforms addressing hypertension, diabetes, obesity, hyperlipidaemia and HIV. He has led large PEPFAR-funded HIV programmes in South Africa, focusing on men, women, children, young people, truckers, sex workers, and LGBTI communities. For over 20 years he has been an advisor to bodies such as the South African government, UNAIDS, and WHO, contributing to international, regional, and national HIV guidelines, and recently served as a member of the Ministerial Advisory Committee for COVID-19. He has an active interest in medical ethics and has been involved in several HIV-related human rights cases within the southern African region. He supervises Masters and PhD students and has over 200 publications, including first-author articles in major journals.
Resources:
SA HIV Clinicians society
ADVANCE STUDY
Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults:2023 update
Liverpool HIV Drug Interactions Checker
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Part 2 of our HIV series addresses South Africa's battles against HIV as we get an account of the complexities of diagnosis, prophylaxis, and managing opportunistic infections from a celebrated HIV clinician, Professor Francois Venter.
About our Guest:
Professor WD Francois Venter, MD, FCP, PhD is Executive Director of Wits Ezintsha at the University of the Witwatersrand, Johannesburg, where he received most of his training. His work involves health systems research and clinical trials, most recently involving the antiretrovirals dolutegravir, tenofovir alafenamide, cabotegravir, and doravirine. He leads multiple antiretroviral treatment optimisation studies and is currently working on new access programmes through private pharmacies within South Africa, patient linkage-to-care interventions, self-testing projects, as well as most recently on new large-scale primary care delivery platforms addressing hypertension, diabetes, obesity, hyperlipidaemia and HIV. He has led large PEPFAR-funded HIV programmes in South Africa, focusing on men, women, children, young people, truckers, sex workers, and LGBTI communities. For over 20 years he has been an advisor to bodies such as the South African government, UNAIDS, and WHO, contributing to international, regional, and national HIV guidelines, and recently served as a member of the Ministerial Advisory Committee for COVID-19. He has an active interest in medical ethics and has been involved in several HIV-related human rights cases within the southern African region. He supervises Masters and PhD students and has over 200 publications, including first-author articles in major journals.
Resources:
SA HIV Clinicians society website
PrEP guidelines
PEP guidelines
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Here we discuss how HIV is diagnosed and managed in the USA.
About our Guest:
Dr Ankita Kadakia, M.D. serves as the Deputy Public Health Officer for the County of San Diego.  Prior to her current role she served as the Chief and Medical Director for the County’s Tuberculosis Control and Refugee Health Branch and is the President of the California Tuberculosis Controller’s Association. Dr. Kadakia is a board-certified Internal Medicine and Infectious Disease specialist.  She has served in leading, coordinating, supervising, and managing operations for Covid-19 as well as coordinating the County Public Health Service’s Tuberculosis Elimination Initiative. Throughout the COVID-19 pandemic, she has played a critical role as a medical subject matter expert and Tri-Chair of the County COVID-19 Vaccine Clinical Advisory Group.
Prior to joining the County, Dr. Kadakia worked at the University of California, San Diego (UCSD) as an Assistant Professor of Medicine with a focus on HIV/AIDS and LGBTQ healthcare while practicing HIV medicine at UCSD Owen Clinic.  While at UCSD, Dr. Kadakia created the first Transgender HealthCare Symposium and became a co- principal investigator for the San Diego Pacific AIDS Education and Training Center. 
Dr. Kadakia’s passion, for serving underserved patients and preventing and treating Tuberculosis, STDs and HIV/AIDS, transcends borders. She has spent time in Uganda serving rural areas, partnering with Ugandans, to build and support schools for AIDS orphans and impoverished children. When she is not working, she immensely enjoys spending time with her two young children and practicing and teaching Kelee meditation.
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The spleen is a poorly understood organ that when functioning well, operates efficiently in the background, but what can happen when medical conditions or trauma result in an impairment in that function? In today's episode Vin talks to Professor Veronica Ueckermann about the spleen. They discuss its various functions including mopping up old or damaged red blood cells and its pivotal role in the immune system.
About our Guest:
Prof Veronica Ueckermann is the head of Infectious diseases at the University of Pretoria/Steve Biko Academic Hospital. She holds a PhD in Infectious diseases, a Fellowship in Critical care, and a Masters in Internal Medicine.  Her research focus is HIV, Tuberculosis, aerobiology, and antimicrobial resistance.   She is actively involved in medical education at the University of Pretoria and other platforms. 
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