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Medical Microbiologist’s Research Attracts World Attention

April 22, 2015

Clinical Microbiology Consultant Dr Yogandree Ramsamy graduates with a Masters degree.
Research conducted by newly-qualified UKZN Medical Microbiologist Dr Yogandree Ramsamy has attracted massive international attention with her name appearing on the 2014 WHO’s WHO in the World listing.
Ramsamy’s Masters dissertation was titled: Microbiological Surveillance and Antimicrobial Stewardship Minimise the Need for Ultra-Broad Spectrum Combination Therapy for Treatment of Nosocomial Infections in a Trauma-Intensive Care Unit: An Audit of an Evidence-Based Empiric Antimicrobial Policy.

The study revealed that prudent use of antimicrobials with surveillance and stewardship is the key to overcoming the problem of drug-resistant pathogens.

Ramsamy said although there had been studies conducted abroad similar to the one she completed, hers was the first of its kind carried out at a level one Trauma Intensive Care Unit (ICU) - the Trauma Intensive Care Unit at Inkosi Albert Luthuli Central Hospital in Durban.

‘The emergence of multi drug-resistant organisms necessitates new drugs and interventions to combat this serious threat.  A “nil antibiotic era” is approaching as the pipeline for new antimicrobials has run dry,’ she said.

‘Management of sepsis requires accurate empiric cover without antimicrobial overuse - a goal that may be achieved by microbiological surveillance and antimicrobial stewardship.’

Ramsamy said many ICUs employed a de-escalation strategy whereby ultra broad-spectrum therapy was used and the spectrum was then narrowed once microbiological cultures became available.

The study highlighted that surveillance, knowledge of local flora and antimicrobial susceptibility patterns made it possible to use narrow-spectrum antimicrobials. Use of broad-spectrum antimicrobials was minimal, thus curbing the emergence of multi drug-resistant pathogens.

‘Antimicrobial stewardship is a key component of the multifaceted approach to preventing antimicrobial resistance. Stewardship involves selecting an appropriate drug, optimising the dose and duration to eradicate infection, while minimising toxicity and conditions for resistant bacterial strains.

‘A surveillance programme and empiric antimicrobial policy minimises ultra-broad spectrum prescriptions. Empiric antimicrobial therapy should cover the most likely pathogens endemic to a specific location.

‘It is important to note that this does not refer to all pathogens, and prescriptions cannot be based on uncommon organisms unless the situation dictates the need,’ said Ramsamy.

Ramsamy says she learned a lot from her supervisor, Professor DJJ Muckart: ‘He mentored me through the process and was my guide throughout my project. He is the perfect example of what a supervisor should be to any masters student. He’s simply brilliant at what he does,’ she said.

Muckart said Ramsamy was one of the most diligent and enthusiastic students he had supervised. ‘Her commitment and diligence should serve as a benchmark for masters students. Her study, was retrospective and we are now embarking on a prospective study which will re-examine the concepts after five years to determine whether our organisms have changed and if we can still achieve a high success rate with our initial empiric choice of antibiotics,’ he said.

Ramsamy acknowledged her co-supervisor, Dr Khine Swe Swe Han, who also played an important role in her project.

Ramsamy, currently involved in studies taking place on antimicrobial stewardship and multi drug-resistant organisms, provides support to the Head of the Department of Medical Microbiology at Inkosi Albert Luthuli Central Hospital, Professor KP Mlisana, in the co-ordination of the Global Health Network Microbiology site. ‘Professor Mlisana has been a very positive influence with regard to my research,’ she said.

She completed her final Fellowship Examination (FCPath –Microbiology) late last year and is currently a Clinical Microbiology Consultant at Prince Mshiyeni Memorial Hospital. “It’s an extremely busy hospital but I’m so loving the new experience as I’m growing a great deal within my new profession,’ said Ramsamy.

Ramsamy’s name now appears on the WHO’s WHO in the World – 2014 listing. The publication’s editor-in-chief, Fred Marks, received Ramsamy’s name through a private nomination process and she features in the 32nd Edition.

Ramsamy is the eldest of three children, one of whom is physically disabled. ‘My sister, who has cerebral palsy, has been a blessing to the family representing someone who is able to overcome any challenge life throws her way. She has also been an inspiration to me.

‘My greatest achievement and treasure is my baby girl while my loving and supportive husband is my pillar of strength, along with my mother, brother and the in-laws. They are all amazing!’

Her previous achievements include being invited by the Australian Society for Antimicrobials to present at their 2013 conference on Antimicrobial Stewardship and Surveillance and being invited to the United States in 2013 and 2014 to deliver talks in Baltimore and Chicago on her subject of interest, Multidrug Resistant Organisms and Antimicrobial Stewardship Bacteriology.

But perhaps her greatest academic achievement thus far is being invited to present at one of Medicine’s most prestigious conferences – the 2015 American Thoracic Society Conference to be held in Denver in the United States next month.

Ramsamy is the first Clinical Microbiologist in South Africa to be invited to present at the conference. ‘All I can say is that I’m extremely excited and feel like the most blessed person on earth. I have God to thank for this opportunity!’

Nombuso Dlamini

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