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Prof Adrian Brink

Professor Adrian Brink

• Bio Sketch

Dr Adrian Brink is Professor of the Division Medical Microbiology, National Health Laboratory Services, University of Cape Town. He studied Medicine at the University of Pretoria and specialized in Medical Microbiology at the same institution. Prior to moving to UCT in 2019, he was deployed in a large tertiary critical care hospital in Johannesburg, where he focused on innovative infection prevention and antibiotic stewardship research initiatives. Prof Brink was founding President of the Federation of Infectious Diseases Societies of Southern Africa and is the founder and current co-chair of the South African Antibiotic Stewardship Program (SAASP). Prof Brink serves on the South African Minister of Health’s Ministerial Advisory Committee (MAC) on Antimicrobial Resistance.

 

• Research Interests

o The clinical and molecular epidemiology of antibiotic-resistant  infections
o The mechanisms of antibiotic resistance as a confounder in antibiotic stewardship
o The design and implementation of large-scale antibiotic stewardship and infection prevention and control interventions in low and middle-income countries. 
o The protective, metabolic and immune functions of the gastro-intestinal and - vaginal biome, resistome and metabolome

 

• Publications (ORCID)

• Brink AJ, Huygens F, van Rensburg AJ. Alternate options in multiply resistant Staphylococcus aureus. J. Antimicrob Chemother 1993: 31: 180 –182

• Brink AJ, van Straten A, van Rensburg AJ. Pseudomonas (Shewanella) putrefaciens bacteremia. Clinical Infectious Diseases 1995: 20: 1327-32

• Brink AJ, Feldman C, Richards GA. Comment on: Best in class: a good principle for antibiotic usage to limit resistance development? J of Antimicrobial Chemotherapy 2007; 60, 901–909

• Brink AJ, Richards GA, Cummins RR, et al. Recommendations to achieve rapid therapeutic teicoplanin plasma concentrations of teicoplanin in adult hospitalized patients treated for sepsis. Int J Antimicrobial Agents 2008;32:455-458

• Brink AJ, Richards GA, Schillack V, et al. The pharmacokinetics of once-daily dosing of ertapenem in critically ill patients with severe sepsis.  Int J Antimicrob Agents 2009:33: 432-436

• Brink AJ. Review. Does resistance in severe infections caused by methicillin-resistant Staphylococcus aureus give you the ‘creeps’? Curr Opin Crit Care 2012, 18:451–459

• Brink AJ, Coetzee J, Clay CG, et al. Emergence of New Delhi Metallo-beta-lactamase (NDM-1) and Klebsiella pneumoniae Carbapenemase (KPC) in South Africa. J Clin Micro 2012;50:525-527

• Brink AJ, Botha RF, Poswa X, et al. Antimicrobial susceptibility of Gram-negative pathogens Isolated from patients with complicated intra-abdominal infections in South African hospitals (SMART Study 2004–2009): Impact of the new carbapenem breakpoints. Surg Infections 2012;13:1-7

• Brink AJ, Coetzee J, Corcoran C, et al. Emergence of OXA-48 and OXA-181 carbapenemases among Enterobacteriaceae in South Africa and evidence of in vivo selection of colistin resistance as a consequence of selective decontamination of the gastrointestinal tract. J Clin Micro 2013;51:369-372

• Brink AJ, Richards GA, Colombo G, et al. Multicomponent antibiotic substances produced by fermentation: Implications for regulatory authorities, critically ill patients and generics. Int J Antimicrob Agents 2014:43: 1-6

• Brink AJ, Richards GA, Lautenbach EEG, et al. Albumin concentration significantly impacts on free teicoplanin plasma concentrations in non-critically ill patients with chronic bone sepsis. Int J Antimicrob Agents 2015:45:647-651

• Brink AJ. Antimicrobial Stewardship (AMS) in the community: a multi-modal strategy. Clin Pulm Med 2016;23:1–10

• Brink AJ, Messina A, Feldman C, et al. Antimicrobial stewardship across 47 South African hospitals: an implementation study. Lancet Infect Dis 2016; 16: 1017–25.  http://dx.doi.org/10.1016/S1473-3099(16)30012-3

• Brink AJ, Messina AP, Feldman C, et al. From guidelines to practice - A pharmacist-driven prospective audit and feedback improvement model for peri-operative antibiotic prophylaxis in 34 South African hospitals. J Antimicrob Chemother 2017; 72: 1227–1234. doi:10.1093/jac/dkw523

• Brink AJ, Mendelson M. Be AWaRe: new metrics for paediatric antibiotic stewardship. Lancet Infect Dis 2019;19(1):6-7. doi: 10.1016/S1473-3099(18)30557-7.  

• Brink AJ. Epidemiology of carbapenem-resistant Gram-negative infections globally. Curr Opin Infect Dis. 2019 Dec;32(6):609-616. doi: 10.1097/QCO.0000000000000608.

• Brink AJ, Messina AP, Maslo et al. Implementing a multi-faceted framework for proprietorship of hand hygiene compliance in a network of South African hospitals – Leveraging the Ubunthu philosophy.  J Hospital Infection 2020;104:404-413. doi.org/10.1016/j.jhin.2019.11.004 

• Brink AJ, Richards GA. The role of multi-drug and extensive-drug resistant Gam-negative bacteria in skin and soft tissue infections. Curr Opin Infect Dis 2020;33:93-100. doi: 10.1097/QCO.0000000000000636.

• Brink AJ, Richards GA. Best practice - Antibiotic decision making in intensive care units (antibiotic stewardship). Curr Opin Critical Care 2020 (In Print)

 

International journals – Co-author

• Widgerow AD, Brink AJ, Koornhof HJ. Atypical mycobacterium and breast surgery. Annals of Plastic Surgery 1995;35:204-207

• Von Gottberg A, van Nierop W, Duse A, et al. Epidemiology of glycopeptide-resistant enterococci colonizing high-risk patients in hospitals in Johannesburg, Republic of South Africa. J Clin Microbiol 2000: 38; 905-909

• McGee L, Klugman KP, Wasas A, et al. Serotype 19F multi-resistant pneumococcal clone harboring two erythromycin resistance determinants (ermB and mefA) in South Africa. Antimicrob Agents Chemother 2001;45:1595-1598

• Schleischer GK, Herbert V, Brink AJ, et al. Procalcitonin and C-reactive protein in HIV-positive subjects with tuberculosis and pneumonia Eur Resp J 2005;25:688-692

• Elliott E, Brink AJ, van Greune J, et al. In vivo development of ertapenem resistance in a case of pneumonia caused by Klebsiella pneumoniae with an extended spectrum beta-lactamase. Clin Infect Dis 2006;42;e95-98

• Anderson R, Steel HC, Cockeran R, et al. Clarithromycin alone and in combination with ceftriaxone inhibits the production of pneumolysin by both macrolide-susceptible and – resistant strains of Streptococcus pneumoniae. J Antimicrob Chemother 2007; 59:224-229 

• Feldman C, Brink AJ, von Gottberg A, et al. Antimicrobial susceptibility of pneumococcal isolates causing bacteraemic pneumococcal pneumonia: analysis using current breakpoints and fluoroquinolone pharmacodynamics. Int J Antimicrob Agents 2010; 36: 95 – 97

• Richards GA, Brink AJ. Therapeutic drug monitoring: linezolid too? Critical Care 2014;18:525

• Richards GA, Brink AJ, Mcintosh R, et al. Investigation of biofilm formation on a charged intravenous catheter relative to that on a similar but uncharged catheter. Medical Devices: Evidence and Research 2014:7 219–224

• Jayol A, Poirel L, Brink AJ, et al. Resistance to colistin associated with a single amino acid change in protein PmrB among Klebsiella pneumoniae isolates of worldwide origin. Antimicrob Agents Chemother 2014; 58:4762-4766

• Jayol A, Nordmann P, Brink AJ, et al. Heteroresistance to colistin in Klebsiella pneumoniae associated with alterations in the PhoPQ regulatory system. Antimicrob Agents Chemother 2015; 59:2780–2784

• Sartelli M, De Waele J, Abu-Zidan F, et al. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).  World J Emergency Surgery 2016;11:33

• Poirel L, Kieffer N, Brink AJ, et al. Genetic features of MCR-1-producing colistin-resistant Escherichia coli isolates, South Africa. Antimicrob Agents Chemother 2016; 60:4394–4397. doi:10.1128/AAC.00444-16

• Goff DA, Kullar R, Goldstein EJC, et al. A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fail. Lancet Infect Dis 2016. dx.doi.org/10.1016/S1473-3099(16)30386-3

• Richards GA, Brink AJ, Messina AP, et al. Stepwise introduction of the “Best Care Always” central line associated bloodstream infection prevention bundle in a network of South African hospitals. J Hosp Infect 2017;97: 86-92 https://doi.org/10.1016/j.jhin.2017.05.013

• Boyles TH, Brink AJ, Calligaro G, et al. South African guideline for the management of community acquired pneumonia in adults. J of Thoracic Disease 2017 ;9(6):1469-1502 doi: 10.21037/jtd.2017.05.31

• Jayol A, Nordmann P, Dubois V, Brink AJ, Villegas M, Poirel L. High level resistance to colistin mediated by various mutations in the crrB gene among carbapenemase-producing Klebsiella pneumoniae. Antimicrob Agents Chemother 2017;61(11). pii: e01423-17. doi: 10.1128/AAC.01423-17

• Sartelli et al. A global declaration on appropriate use of antimicrobial agents across the surgical pathway. Surg Infections 2017;18: 846-853. DOI: 10.1089/sur.2017.219

• Sartelli M, Labricciosa FM, Barbadoro P, et al. The Global Alliance for Infections in Surgery. Defining a model for antimicrobial stewardship. Results from an international cross-sectional survey. World Journal of Emergency Surgery 2017; 12:34. DOI 10.1186/s13017-017-0145-2

• Bassetti M, Poulakou G, Ruppe E, Bouza E, van Hal S, Brink AJ. Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach. Int Care Med 2017;43(10):1464-1475. DOI 10.1007/s00134-017-4878-x

• Schellack N, Benjamin D, Brink A, et al.  A situational analysis of current antimicrobial governance, regulation and utilisation in South Africa. International Journal of Infectious Diseases 2017;64:100-106. http://dx.doi.org/10.1016/j.ijid.2017.09.002

• Sneddon J, Barlow G, Bradley S, Brink A, Chandy S,Nathwani D. Development and impact of a massive open on line course [MOOC] for antimicrobial stewardship. J Antimicrob Chemother 2018; 73: 1091–1097. doi:10.1093/jac/dkx493

• Mendelson M, Brink AJ, Gouws J, et al. The One Health stewardship of colistin as an antibiotic of last resort for human health in South Africa. Lancet Infect Dis 2018. 18(9):e288-e294. http://dx.doi.org/10.1016/S1473-3099(18)30119-1

• Tacconelli et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis 2018:18; 318–27

• Bassetti M, Giacobbe DR, Vena A, Brink A. Challenges and research priorities to progress the impact of antimicrobial stewardship. Drugs in Context 2019; 8: 212600. DOI: 10.7573/dic.212600

• Tebano G, Li G, Beovic B, et al. Essential and Forgotten antibiotics: an inventory in low- and middle-income countries. Int J Antimicrob Agents 2019 Sep;54(3):273-282. doi: 10.1016/j.ijantimicag.2019.06.017. 

• Goff DA, Bauer KA, Brink AJ, et al. International Train the Trainer antibiotic stewardship program for pharmacists: Implementation, sustainability, and outcomes. J Am Coll Clin Pharm 2020;1-8. doi.org/10.1002/jac5.1228

• Van den Bergh D, Messina A, Goff DA, et al. A cross-sector, pharmacist-led prospective antibiotic stewardship intervention improves compliance to national community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa. Int J Antimicrob Agents 2020 (In print)

• Taku O, Brink AJ, Meiring T, et al. Detection of sexually transmitted pathogens and co-infection with Human papillomavirus in women residing in rural Eastern Cape, South Africa. (Submitted for publication)

• Vosloo MN, Opperman CJ, Geyer HDW, et al. A South African case of infant botulism with a dual toxin producing Clostridium botulism strain (Submitted for publication)

• Mokwele NR, Schellack N, Brink AJ. Determinants of practices pertaining to antibiotic dispensing without a prescription in community pharmacies and prescribing in General Practitioners in Gauteng Province. J Antimicrob Agents-AMR 2020 (In print).

• Mokoena TW, Schellack N, Brink AJ. Driving antimicrobial stewardship and awareness through the taxi community across the Tshwane District, South Africa- a baseline evaluation. J Antimicrob Agents-AMR 2020 (In print).

 

Local journals – Principle author

• Brink AJ, Giannakopolous E, Viljoen HG. Fish tank water as a source of a rare case of Aeromonas hydrophylia septicemia. S Afr Med J 1998: 88:7;1011-1012

• Brink AJ, van den Ende J, Routier R, et al. A case of vancomycin resistant enterococcal endocarditis. S Afr Med J  2000:  90:11; 1113 – 1115

• Brink AJ, Botha M, van den Ende J, et al. Carbapenem resistance –mechanisms and strategies that might impact on resistance. SA J Crit Care 2003;19:11-19

• Brink AJ, Feldman C, Grolman DC, et al. Position statement: Appropriate use of the carbapenems. S Afr Med J  2004;94:857-861

• Brink AJ and the Working Group of the Infectious Diseases Society of Southern Africa. Guideline for the management of upper respiratory tract infections. S Afr Med J  2004;94:475-483

• Brink AJ, Feldman C, Duse A, et al. Guidelines for the management of nosocomial infections in South Africa. S Afr Med J  2006;96:642-652

• Brink AJ, van Rooyen C. Gamma interferon assays as a diagnostic tool in tuberculosis infections. SA J Epidemiology Inf 2007; 22 (4):107-108

• Brink AJ, Moolman J, da Silva M, et al. Antimicrobial susceptibility profile of selected bacteraemic pathogens from private institutions in South Africa: January-June 2006. S Afr Med J  2007;4:630-636

• Brink AJ. Multidrug-resistant (MDR) Gram negative fermenters: “Our worst nightmare? SA J Epidemiol Infect 2007;22:1-4

• Brink AJ, Feldman C, Richards G, et al. Emergence of extensive drug-resistance XDR) among Gram-negative bacilli – Moving a step closer. S Afr Med J  2008;98:586-592

• Brink AJ and the Working Group of the Infectious Diseases Society of Southern Africa. Updated Guideline for the Management of Upper Respiratory Tract Infections. SA J Epidemiol Inf 2009;24:1-8

• Brink AJ and the Working Group of the Infectious Diseases Society of Southern Africa, CritiCare Society of Southern Africa, South African Thoracic Society and Association of Surgeons of South Africa. Position statement: Appropriate use of Tigecycline. S Afr Med J  2010; 100: 388-394

• Brink AJ, Coetzee J, Clay C, et al. The spread of carbapenem-resistant Enterobacteriaceae in South Africa: Risk factors for acquisition and prevention. S Afr Med J  2012;102:599-601.

• Brink AJ, Bizos D, Boffard K, et al. Guideline summary: Appropriate use of tigecycline. SA J Surg 2012;50:20-21

• Brink AJ, Cotton MF, Feldman C, et al. Updated recommendations for the management of upper respiratory tract infections in South Africa. S Afr Med J 2015;105:345-352

• Brink AJ, Richards GA. Use of vaccines as a key antimicrobial stewardship strategy. S Afr Med J 2015;105(5):421

• Brink AJ, van Wyk J, Moodley M, et al. The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimize diagnostic uncertainty in primary care. S Afr Med J 2016;106(6):554-561. DOI:10.7196/SAMJ.2016.v106i6.10857

• Brink AJ, van den Bergh D, Mendelson M, et al. Passing the baton to pharmacists and nurses: New models of antibiotic stewardship for South Africa? S Afr Med J 2016; 106:947-948

• Brink AJ, Schoeman J, Muntingh G. Undergraduate antibiotic stewardship training: Are we leaving our future prescribers ‘flapping in the wind’? S Afr Med J 2017;107:5

 

Local journals – Co-author

• Gromkova RC, Cronje ES, Brink AJ. Study of relatedness between H. parahaemolytics and H. parainfluenzae by DNA transformation. SA J Epidem Infect 1997: 11:107 –111

• Durrheim DN, Becker PJ, Billinghurst K, et al. Diagnostic disagreement – the lessons learnt from malaria diagnosis in Mpumalanga, South Africa. S Afr Med J 1997: 87: 609 – 611

• Birkholtz L, Visser L, Louw A, et al. The prevalence of mixed species and anti-folate resistance malaria infections in Mpumalanga, South Africa.  S Afr Med J 1998:88: 58-59

• Feldman C, Brink AJ, Richards G, et al. Clinical guideline: Management of community-acquired pneumonia in adults. S Afr Med J 2002;92:647-655

• Feldman et al. Editorial: Antimicrobial resistance in nosocomial infections. SA J Epidemiol Infect 2005;20:42-45

• Van Rooyen C, Brink AJ. Gamma-interferon assays as a diagnostic tool in tuberculosis infections. SA J of Epidem and Inf 2007;22:107-108

• Feldman C, Brink AJ, Richards G, et al. Clinical guideline: Management of community-acquired pneumonia in adults. S Afr Med J 2007;97:1296-1306

• Crowther¬Gibson P, Govender N, Lewis DA, et al. The Global Antibiotic Resistance Partnership. Part IV. GARP: Human infections and antibiotic resistance. S Afr Med J 2011;101:567-578

• Bamford C, Brink AJ, Govender N, et al. The Global Antibiotic Resistance Partnership. Part V. GARP: Surveillance activities. S Afr Med J 2011;101:579-582

• Visser A, Moore DP, Whitelaw A, et al. The Global Antibiotic Resistance Partnership (GARP). Part VII. GARP: Interventions. S Afr Med J  2011;101:587-595

• Zietsman I, Brink AJ. National surveillance of private sector respiratory tract pathogens in South Africa, 2010. SA J Epidem Infect 2011;26:51-53

• Mendelson M, Whitelaw A, Nichol M, et al. Wake up, South Africa! The antibiotic ‘horse’ has bolted. S Afr Med J 2012;102:607-608

• Lowman W, Bamford C, Govind C, et al. The South African Society of Clinical Microbiology (SASCM) Carbapemem-resistant Enterobacteriaceae (CRE)-Working group: consensus statement and working guidelines for the screening and laboratory detection of carbapenemase-producing Enterobacteriaceae. S Afr J Infect Dis 2014;29:5-11

• Richards GA, Joubert IA, Brink AJ. Optimising the administration of antibiotics in critically ill patients. S Afr Med J 2015;105(5):419

• Coetzee J, Corcoran C, Prentice E, et al. Emergence of plasmid-mediated colistin resistance (MCR-1) among Escherichia coli isolated from South African patients. S Afr Med J 2016;106:449-450

• Messina AM, Brink AJ, Richards, et al. Opportunities to optimise colistin stewardship in hospitalised patients in South Africa: Results of a multisite utilisation audit. S Afr Med J 2018;108(1):28-32

• Richards GA, Brink AJ. Rational use of the systemic fluoroquinolones. S Afr Med J 2019;109(6):378¬381. DOI:10.7196/SAMJ.2019.v109i6.14002

• Fredericks E, Hoosien E, Brink AJ. The case for stool banks in South Africa. S Afr Med J 2019;109(8):546-547. DOI:10.7196/SAMJ.2019.v109i8.14169

• Govender NP, Avenant T, Brink A, et al. Federation of Infectious Diseases Societies of Southern Africa guideline: Recommendations for the detection, management and prevention of healthcare-associated Candida auris colonisation and disease in South Africa. S Afr J Infect Dis. 2019;34(1), a163. https://doi.org/10.4102/sajid.v34i1.163

• Lowman W, Nana T, Moore C, et al. SASCM Clostridiodes difficile Infection Diagnosis, Management and Infection Prevention and Control Guideline. S Afr J Infect Dis 2020 (In print)

• Labuschaigne M, Slabbert M, Hoosien E, Budree S, Blockman M, Brink AJ. A human faecal microbiota transplant in South Africa: a legal vacuum (Part 1). S Afr Med J 2020 (in print)

• Labuschaigne M, Slabbert M, Hoosien E, Budree S, Blockman M, Brink AJ.The ethico-legal framework relevant to human faecal microbiota transplants in South Africa: human stool as tissue? (Part 2). S Afr Med J 2020 (in print)

• Labuschaigne M, Slabbert M, Hoosien E, Budree S, Blockman M, Brink A.J The ethico-legal framework relevant to faecal microbialta transplants in South Africa: human stool as a ‘drug’ or medicine (Part 3). S Afr Med J 2020 (In print)

• Budree S, Hoosien E, Osman M, et al. Operationalising Universal Donor Stool Banks in Low-middle Income Countries (LMIC). S Afr Med J  2020 (In print)