{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T11:24:57Z","timestamp":1791717897425,"version":"4.3.4"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T00:00:00Z","timestamp":1614384000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T00:00:00Z","timestamp":1614384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Antimicrobial resistance (AMR) has emerged as a global threat to healthcare resulting in an increase in morbidity and mortality. Neonatal sepsis is ranked as the third highest cause of neonatal demise globally, in which AMR accounted for 31.0% of deaths. AMR in neonates has been poorly characterised in Durban, South Africa. Thus, the resultant effect of AMR on empiric regimens for neonatal sepsis is uncertain in this setting. Therefore, this study analysed the aetiology and antimicrobial susceptibility patterns of bloodstream infections within the neonatal intensive care unit at a tertiary hospital in Durban, with the aim of establishing an effective empiric regimen for the unit.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A retrospective data review on positive blood cultures from the neonatal intensive care unit at Inkosi Albert Luthuli Central Hospital was conducted. Three time periods were analysed: 2014, 2016 and 2018. Culture data from neonates aged 0\u201330\u2009days were included and repeat cultures were de-duplicated. The frequency of common organisms and their antimicrobial susceptibilities were analysed. Fischer\u2019s exact test was used for subgroup analysis. Poisson and logistic regressions were used to assess significant trends in organisms and antimicrobial susceptibilities over time.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Late-onset sepsis (86.8%) predominated over early-onset sepsis (13.2%). A preponderance of gram-positive organisms (68.7%) over gram-negatives (26.8%) and fungi (4.5%) was detected. Common pathogens included coagulase-negative staphylococci (53.5%), <jats:italic>Klebsiella pneumoniae<\/jats:italic> (11.6%)<jats:italic>,<\/jats:italic> enterococci (9.3%), and <jats:italic>Acinetobacter baumannii<\/jats:italic> (7.7%). Despite the small contribution of fungi to the microbial profile, fluconazole-resistant <jats:italic>Candida parapsilosis<\/jats:italic> predominated within that group. High rates of resistance to first- and second-line antibiotics were also noted among gram-positive and gram-negative organisms. Multidrug resistant organisms included extended-spectrum beta-lactamase (ESBL) <jats:italic>K. pneumoniae<\/jats:italic> (7.6%) and extensively-drug resistant <jats:italic>A. baumannii<\/jats:italic> (7.0%). However, a statistically significant decrease in ESBL-producing organisms was documented during the entire study period (<jats:italic>p<\/jats:italic>\u2009=\u20090.005).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>It was determined that first-line antimicrobials, advocated by the World Health Organization for treatment of neonatal sepsis, proved ineffective in this unit due to high levels of AMR. Therefore, this study advises that meropenem with or without vancomycin provides optimal empiric cover. Amphotericin B is advocated for empiric antifungal therapy. Ongoing surveillance is necessary.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-05869-3","type":"journal-article","created":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T08:02:26Z","timestamp":1614412946000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Neonatal sepsis in a tertiary unit in South Africa"],"prefix":"10.1186","volume":"21","author":[{"given":"Dharshni","family":"Pillay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lerusha","family":"Naidoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khine","family":"Swe Swe-Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yesholata","family":"Mahabeer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,27]]},"reference":[{"key":"5869_CR1","unstructured":"World Health Organization. Antimicrobial resistance: global report on surveillance: World Health Organization; 2014."},{"issue":"1","key":"5869_CR2","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1136\/archdischild-2019-316816","volume":"105","author":"G Li","year":"2020","unstructured":"Li G, Bielicki JA, Ahmed ANU, Islam MS, Berezin EN, Gallacci CB, et al. Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network. Arch Dis Child. 2020;105(1):26\u201331.","journal-title":"Arch Dis Child"},{"issue":"10063","key":"5869_CR3","doi-asserted-by":"publisher","first-page":"3027","DOI":"10.1016\/S0140-6736(16)31593-8","volume":"388","author":"L Liu","year":"2016","unstructured":"Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000\u201315: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388(10063):3027\u201335.","journal-title":"Lancet"},{"issue":"1","key":"5869_CR4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000347","volume":"3","author":"SL Ranjeva","year":"2018","unstructured":"Ranjeva SL, Warf BC, Schiff SJ. Economic burden of neonatal sepsis in sub-Saharan Africa. BMJ Glob Health. 2018;3(1):e000347. https:\/\/doi.org\/10.1136\/bmjgh-2017-000347 Accessed on 19 Sept 2018.","journal-title":"BMJ Glob Health"},{"key":"5869_CR5","unstructured":"Fuchs A, Bielicki J, Mathur S, Sharland M, Van Den Anker J. Antibiotic use for sepsis in neonates and children: 2016 evidence update. WHO Reviews 2016."},{"issue":"2","key":"5869_CR6","doi-asserted-by":"publisher","first-page":"99","DOI":"10.7196\/SAJCH.2017.v11i2.1244","volume":"11","author":"M Coetzee","year":"2017","unstructured":"Coetzee M, Mbowane N, de Witt T. Neonatal sepsis: Highlighting the principles of diagnosis and management. S Afr J Child Health. 2017;11(2):99\u2013103.","journal-title":"S Afr J Child Health"},{"key":"5869_CR7","doi-asserted-by":"crossref","unstructured":"Shane AL, Stoll B. Neonatal sepsis: progress towards improved outcomes. Journal of Infection. 2014;68:24-32.","DOI":"10.1016\/j.jinf.2013.09.011"},{"issue":"1","key":"5869_CR8","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1186\/s12887-018-1176-x","volume":"18","author":"B Pokhrel","year":"2018","unstructured":"Pokhrel B, Koirala T, Shah G, Joshi S, Baral P. Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal. BMC Pediatr. 2018;18(1):208.","journal-title":"BMC Pediatr"},{"issue":"2","key":"5869_CR9","doi-asserted-by":"publisher","first-page":"75","DOI":"10.4103\/0974-777X.154444","volume":"7","author":"VA Muley","year":"2015","unstructured":"Muley VA, Ghadage DP, Bhore AV. Bacteriological profile of neonatal septicemia in a tertiary care hospital from Western India. J Global Infect Dis. 2015;7(2):75.","journal-title":"J Global Infect Dis"},{"key":"5869_CR10","doi-asserted-by":"publisher","unstructured":"Ballot DE, Nana T, Sriruttan C, Cooper PA. Bacterial bloodstream infections in neonates in a developing country. ISRN Pediatr. 2012:508512. https:\/\/doi.org\/10.5402\/2012\/5085122012.","DOI":"10.5402\/2012\/5085122012"},{"issue":"3","key":"5869_CR11","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1080\/10158782.2005.11441243","volume":"20","author":"F Motara","year":"2005","unstructured":"Motara F, Ballot D, Perovic O. Epidemiology of neonatal sepsis at Johannesburg Hospital. South Afr J Epidemiol Infect. 2005;20(3):90\u20133.","journal-title":"South Afr J Epidemiol Infect"},{"issue":"4","key":"5869_CR12","first-page":"170","volume":"11","author":"MM Lebea","year":"2017","unstructured":"Lebea MM, Davies V. Evaluation of culture-proven neonatal sepsis at a tertiary care hospital in Johannesburg, South Africa. S Afr J Child Health. 2017;11(4):170\u20133.","journal-title":"S Afr J Child Health"},{"issue":"1","key":"5869_CR13","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s40748-017-0071-z","volume":"4","author":"FY Aku","year":"2018","unstructured":"Aku FY, Akweongo P, Nyarko K, Sackey S, Wurapa F, Afari EA, et al. Bacteriological profile and antibiotic susceptibility pattern of common isolates of neonatal sepsis, Ho Municipality, Ghana-2016. Matern Health Neonatol Perinatol. 2018;4(1):2.","journal-title":"Matern Health Neonatol Perinatol"},{"key":"5869_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2015\/509484","volume":"2015","author":"S El-Din","year":"2015","unstructured":"El-Din S, Rabie EM, El-Sokkary MMA, Bassiouny MR, Hassan R. Epidemiology of neonatal sepsis and implicated pathogens: a study from Egypt. Biomed Res Int. 2015;2015:1\u201311. https:\/\/doi.org\/10.1155\/2015\/509484.","journal-title":"Biomed Res Int"},{"issue":"4","key":"5869_CR15","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1080\/21548331.2019.1650608","volume":"47","author":"P Mpinda-Joseph","year":"2019","unstructured":"Mpinda-Joseph P, Anand Paramadhas BD, Reyes G, Maruatona MB, Chise M, Monokwane-Thupiso BB, et al. Healthcare-associated infections including neonatal bloodstreamFshe infections in a leading tertiary hospital in Botswana. Hosp Pract. 2019;47(4):203\u201310.","journal-title":"Hosp Pract"},{"issue":"3","key":"5869_CR16","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1179\/2046905515Y.0000000029","volume":"35","author":"A Dramowski","year":"2015","unstructured":"Dramowski A, Madide A, Bekker A. Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: burden, pathogens, antimicrobial resistance and mortality. Paediatr Int Child Health. 2015;35(3):265\u201372.","journal-title":"Paediatr Int Child Health"},{"key":"5869_CR17","first-page":"128","volume-title":"Intensive Care Nursery House Staff Manual","author":"University of California San Francisco (UCSF) Children\u2019s Hospital","year":"2004","unstructured":"University of California San Francisco (UCSF) Children\u2019s Hospital. Candidiasis in the newborn. In:  Intensive Care Nursery House Staff Manual; 2004. p. 128\u20139. Accessed on 25 Apr 2020 from https:\/\/www.ucsfbenioffchildrens.org."},{"issue":"6","key":"5869_CR18","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1093\/tropej\/fmt053","volume":"59","author":"DE Ballot","year":"2013","unstructured":"Ballot DE, Bosman N, Nana T, Ramdin T, Cooper PA. Background changing patterns of neonatal fungal sepsis in a developing country. J Trop Pediatr. 2013;59(6):460\u20134.","journal-title":"J Trop Pediatr"},{"issue":"7","key":"5869_CR19","doi-asserted-by":"publisher","first-page":"e0219352","DOI":"10.1371\/journal.pone.0219352","volume":"14","author":"BK Cole","year":"2019","unstructured":"Cole BK, Ilikj M, McCloskey CB, Chavez-Bueno S. Antibiotic resistance and molecular characterization of bacteremia Escherichia coli isolates from newborns in the United States. PLoS One. 2019;14(7):e0219352. https:\/\/doi.org\/10.1371\/journal.pone.0219352 Accessed on 16 Apr 2020.","journal-title":"PLoS One"},{"issue":"2","key":"5869_CR20","doi-asserted-by":"publisher","first-page":"99","DOI":"10.7196\/SAMJ.2018.v108i2.12601","volume":"108","author":"H Crichton","year":"2018","unstructured":"Crichton H, O\u2019Connell N, Rabie H, Whitelaw A, Dramowski A. Neonatal and paediatric bloodstream infections: Pathogens, antimicrobial resistance patterns and prescribing practice at Khayelitsha District Hospital, Cape Town, South Africa. S Afr Med J. 2018;108(2):99\u2013104.","journal-title":"S Afr Med J"},{"issue":"3","key":"5869_CR21","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","volume":"18","author":"AP Magiorakos","year":"2012","unstructured":"Magiorakos AP, Srinivasen A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268\u201381.","journal-title":"Clin Microbiol Infect"},{"issue":"3","key":"5869_CR22","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1136\/adc.2002.022863","volume":"90","author":"S Vergnano","year":"2005","unstructured":"Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath P. Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed. 2005;90(3):220\u20134.","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"5869_CR23","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.jpeds.2018.05.048","volume":"201","author":"E Giannoni","year":"2018","unstructured":"Giannoni E, Agyeman PKA, Stocker M, Posfay-Barbe KM, Heininger U, Spycher BD, et al. Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study. J Pediatr. 2018;201:106\u201314.","journal-title":"J Pediatr"},{"issue":"4","key":"5869_CR24","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.pedneo.2015.09.007","volume":"57","author":"F Cortese","year":"2016","unstructured":"Cortese F, Scicchitano P, Gesualdo M, Filaninno A, De Giorgi E, Schettini F, et al. Early and Late Infections in Newborns: Where Do We Stand? A Review. Pediatr Neonatol. 2016;57(4):265\u201373.","journal-title":"Pediatr Neonatol"},{"issue":"1","key":"5869_CR25","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1186\/s12879-016-1913-4","volume":"16","author":"AK Labi","year":"2016","unstructured":"Labi AK, Obeng-Nkrumah N, Bjerrum S, Enweronu-Laryea C, Newman MJ. Neonatal bloodstream infections in a Ghanaian Tertiary Hospital: Are the current antibiotic recommendations adequate? BMC Infect Dis. 2016;16(1):598.","journal-title":"BMC Infect Dis"},{"issue":"7","key":"5869_CR26","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1128\/JCM.36.7.1923-1926.1998","volume":"36","author":"D Souvenir","year":"1998","unstructured":"Souvenir D, Anderson DE, Palpant S, Mroch H, Askin S, Anderson J, et al. Blood Cultures Positive for Coagulase-Negative Staphylococci: Antisepsis, Pseudobacteremia, and Therapy of Patients. J Clin Microbiol. 1998;36(7):1923.","journal-title":"J Clin Microbiol"},{"key":"5869_CR27","volume-title":"Epidemiology and prevention of sepsis in young infants and the potential impact of maternal HIV infection on neonatal sepsis","author":"CL Cutland","year":"2016","unstructured":"Cutland CL. Epidemiology and prevention of sepsis in young infants and the potential impact of maternal HIV infection on neonatal sepsis. 2016. Accessed from: http:\/\/hdl.handle.net\/10539\/22516 on 12 January 2020."},{"issue":"4","key":"5869_CR28","doi-asserted-by":"publisher","first-page":"211","DOI":"10.3855\/jidc.9543","volume":"12","author":"R Thomas","year":"2018","unstructured":"Thomas R, Wadula J, Seetharam S, Velaphi S. Prevalence, antimicrobial susceptibility profiles and case fatality rates of Acinetobacter Baumannii sepsis in a neonatal unit. J Infect Dev Ctries. 2018;12(4):211\u20139.","journal-title":"J Infect Dev Ctries"},{"issue":"4","key":"5869_CR29","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s12098-010-0272-1","volume":"78","author":"R Viswanathan","year":"2011","unstructured":"Viswanathan R, Singh AK, Mukherjee S, Mukherjee R, Das P, Basu S. Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre in eastern India: a 3 year study. Indian J Pediatr. 2011;78(4):409\u201312.","journal-title":"Indian J Pediatr"},{"issue":"7","key":"5869_CR30","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.1093\/jac\/dkw091","volume":"71","author":"NP Govender","year":"2016","unstructured":"Govender NP, Patel J, Magobo RE, Naicker S, Wadula J, Whitelaw A, et al. Emergence of azole-resistant Candida parapsilosis causing bloodstream infection: results from laboratory-based sentinel surveillance in South Africa. J Antimicrob Chemother. 2016;71(7):1994\u20132004.","journal-title":"J Antimicrob Chemother"},{"issue":"2","key":"5869_CR31","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1179\/2046905513Y.0000000082","volume":"34","author":"G Morkel","year":"2014","unstructured":"Morkel G, Bekker A, Marais B, Kirsten G, Van Wyk J, Dramowski A. Bloodstream infections and antimicrobial resistance patterns in a South African neonatal intensive care unit. Paediatr Int Child Health. 2014;34(2):108\u201314.","journal-title":"Paediatr Int Child Health"},{"issue":"3","key":"5869_CR32","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/j.clp.2010.06.004","volume":"37","author":"SJ Patel","year":"2010","unstructured":"Patel SJ, Saiman L. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship. Clin Perinatol. 2010;37(3):547\u201363.","journal-title":"Clin Perinatol"},{"issue":"1","key":"5869_CR33","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1186\/s12887-019-1709-y","volume":"19","author":"DE Ballot","year":"2019","unstructured":"Ballot DE, Bandini R, Nana T, Bosman N, Thomas T, Davies VA, et al. A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa. BMC Pediatr. 2019;19(1):320.","journal-title":"BMC Pediatr"},{"issue":"5","key":"5869_CR34","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1542\/peds.2008-2055","volume":"123","author":"CC Blyth","year":"2009","unstructured":"Blyth CC, Chen SCA, Slavin MA, Serena C, Nguyen Q, Marriott D, et al. Not Just Little Adults: Candidemia Epidemiology, Molecular Characterization, and Antifungal Susceptibility in Neonatal and Pediatric Patients. Pediatrics. 2009;123(5):1360.","journal-title":"Pediatrics."},{"issue":"2","key":"5869_CR35","doi-asserted-by":"publisher","first-page":"53","DOI":"10.4103\/0974-2727.59699","volume":"1","author":"N Goel","year":"2009","unstructured":"Goel N, Ranjan PK, Aggarwal R, Chaudhary U, Sanjeev N. Emergence of non-albicans Candida in neonatal septicemia and antifungal susceptibility: experience from a tertiary care center. J Lab Physicians. 2009;1(2):53\u20135.","journal-title":"J Lab Physicians"},{"issue":"3","key":"5869_CR36","doi-asserted-by":"publisher","first-page":"162","DOI":"10.4103\/0022-3859.201425","volume":"63","author":"MP Roy","year":"2017","unstructured":"Roy MP, Bhatt M, Maurya V, Arya S, Gaind R, Chellani HK. Changing trend in bacterial etiology and antibiotic resistance in sepsis of intramural neonates at a tertiary care hospital. J Postgrad Med. 2017;63(3):162\u20138.","journal-title":"J Postgrad Med"},{"issue":"11","key":"5869_CR37","first-page":"2511","volume":"7","author":"CM Sharma","year":"2013","unstructured":"Sharma CM, Agrawal RP, Sharan H, Kumar B, Sharma D, Bhatia SS. \u201cNeonatal Sepsis\u201d: Bacteria and their Susceptibility Pattern towards Antibiotics in Neonatal Intensive Care Unit. J Clin Diagn Res. 2013;7(11):2511\u20133.","journal-title":"J Clin Diagn Res"},{"issue":"4","key":"5869_CR38","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/civ933","volume":"62","author":"PG Pappas","year":"2016","unstructured":"Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1\u2013e50. https:\/\/doi.org\/10.1093\/cid\/civ933 Accessed 02 Jan 2020.","journal-title":"Clin Infect Dis"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-05869-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12879-021-05869-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-05869-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T08:03:59Z","timestamp":1614413039000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-05869-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,27]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["5869"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-05869-3","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,27]]},"assertion":[{"value":"15 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study has received approval from the University of KwaZulu-Natal Biomedical Research Ethics Committee (BE019\/19), National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, and the KwaZulu-Natal Department of Health (South Africa). The National Health Laboratory Service granted permission and provided access to the raw data utilised in this study. The data was anonymised prior to use.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"225"}}