ORCID Profile
0000-0002-5238-9260
Current Organisations
University of Sydney
,
Royal Australasian College of Physicians
,
Concord Repatriation General Hospital
,
Royal College of Pathologists of Australasia
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Publisher: Microbiology Society
Date: 06-08-2021
Abstract: Background. Infections due to metallo-beta-lactamase (MBL)-producing organisms are becoming a significant problem, and antibiotic treatment options are limited. Aztreonam inhibits MBLs, and its use in combination with ceftazidime–avibactam (CAZ–AVI–AZT) to inhibit other beta-lactamases shows promise. Methods. A 45-year-old woman suffered from recurrent and sustained MBL ( bla IMP-4)+ Enterobacter cloacae complex bacteraemia from an undrainable biliary source, and had failed nine alternative antibiotic regimens over a 5-month period. The 10th episode was successfully treated with CAZ–AVI–AZT, and she has had no further relapses. Three of the isolates underwent whole-genome sequencing (WGS) on the MiSeq platform and were analysed with the Nullarbor pipeline. Results. A layered Etest method for synergy between CAZ–AVI and aztreonam demonstrated an MIC of 2 mg l −1 for the combination. Isolates were identified by WGS as Enterobacter hormaechei subsp. oharae . All three of the isolates had bla TEM-4 ESBL, bla OXA-1 and bla ACT-25. Two of the carbapenem-resistant isolates contained bla IMP-4. Conclusion. While aztreonam inhibits MBLs, MBL-positive isolates often express other beta-lactamase enzymes. Avibactam inhibits ESBLs and other beta-lactamases, and its use in this case possibly contributed to therapeutic success due to inhibition of the concomitant bla TEM-4 in the isolates. This case demonstrates that phenotypic antimicrobial susceptibility testing (layered Etests for synergy), backed up by WGS, can produce results that allow tailored antimicrobial therapy in difficult infections. This case adds to the evidence for using CAZ–AVI–AZT in serious MBL infections.
Publisher: PeerJ
Date: 23-02-2022
DOI: 10.7717/PEERJ.12982
Abstract: Most herbivorous mammals have symbiotic microbes living in their gastrointestinal tracts that help with harvesting energy from recalcitrant plant fibre. The bulk of research into these microorganisms has focused on s les collected from faeces, representing the distal region of the gastrointestinal (GI) tract. However, the GI tract in herbivorous mammals is typically long and complex, containing different regions with distinct physico-chemical properties that can structure resident microbial communities. Little work has been done to document GI microbial communities of herbivorous animals at these sites. In this study, we use 16S rRNA gene sequencing to characterize the microbial biogeography along the GI tract in two species of wombats. Specifically, we survey the microbes along four major gut regions (stomach, small intestine, proximal colon, distal colon) in a single bare-nosed wombat ( Vombatus ursinus ) and a single southern hairy-nosed wombat ( Lasiorhinus latifrons ). Our preliminary results show that GI microbial communities of wombats are structured by GI region. For both wombat in iduals, we observed a trend of increasing microbial ersity from stomach to distal colon. The microbial composition in the first proximal colon region was more similar between wombat species than the corresponding distal colon region in the same species. We found several microbial genera that were differentially abundant between the first proximal colon (putative site for primary plant fermentation) and distal colon regions (which resemble faecal s les). Surprisingly, only 10.6% (98) and 18.8% (206) of licon sequence variants (ASVs) were shared between the first proximal colon region and the distal colon region for the bare-nosed and southern hairy-nosed wombat, respectively. These results suggest that microbial communities in the first proximal colon region—the putative site of primary plant fermentation in wombats—are distinct from the distal colon, and that faecal s les may have limitations in capturing the ersity of these communities. While faeces are still a valuable and effective means of characterising the distal colon microbiota, future work seeking to better understand how GI microbiota impact the energy economy of wombats (and potentially other hindgut-fermenting mammals) may need to take gut biogeography into account.
Publisher: Wiley
Date: 03-2023
DOI: 10.1111/IMJ.16032
Publisher: Frontiers Media SA
Date: 30-06-2022
DOI: 10.3389/FMICB.2022.687115
Abstract: The gut microbiome plays a vital role in health and wellbeing of animals, and an increasing number of studies are investigating microbiome changes in wild and managed populations to improve conservation and welfare. The short-beaked echidna ( Tachyglossus aculeatus ) is an iconic Australian species, the most widespread native mammal, and commonly held in zoos. Echidnas are cryptic animals, and much is still unknown about many aspects of their biology. Furthermore, some wild echidna populations are under threat, while echidnas held in captivity can have severe gastric health problems. Here, we used citizen science and zoos to collect echidna scats from across Australia to perform the largest gut microbiome study on any native Australian animal. Using 16S rRNA gene metabarcoding of scat s les, we characterised and compared the gut microbiomes of echidnas in wild ( n = 159) and managed ( n = 44) populations, which were fed four different diets. Wild echidna s les were highly variable, yet commonly dominated by soil and plant-fermenting bacteria, while echidnas in captivity were dominated by gut commensals and plant-fermenting bacteria, suggesting plant matter may play a significant role in echidna diet. This work demonstrates significant differences between zoo held and wild echidnas, as well as managed animals on different diets, revealing that diet is important in shaping the gut microbiomes in echidnas. This first analysis of echidna gut microbiome highlights extensive microbial ersity in wild echidnas and changes in microbiome composition in managed populations. This is a first step towards using microbiome analysis to better understand diet, gastrointestinal biology, and improve management in these iconic animals.
Publisher: Springer Science and Business Media LLC
Date: 21-10-2016
DOI: 10.1038/SREP35527
Abstract: Carbapenem-resistant Enterobacteriaceae (CRE) are a pressing public health issue due to limited therapeutic options to treat such infections. CREs have been predominantly isolated from humans and environmental s les and they are rarely reported among companion animals. In this study we report on the isolation and plasmid characterization of carbapenemase (IMP-4) producing Salmonella enterica Typhimurium from a companion animal. Carbapenemase-producing S. enterica Typhimurium carrying bla IMP-4 was identified from a systemically unwell (index) cat and three additional cats at an animal shelter. All isolates were identical and belonged to ST19. Genome sequencing revealed the acquisition of a multidrug-resistant IncHI2 plasmid (pIMP4-SEM1) that encoded resistance to nine antimicrobial classes including carbapenems and carried the bla IMP-4 - qacG - aacA4 - catB3 cassette array. The plasmid also encoded resistance to arsenic (MIC-150 mM). Comparative analysis revealed that the plasmid pIMP4-SEM1 showed greatest similarity to two bla IMP-8 carrying IncHI2 plasmids from Enterobacter spp. isolated from humans in China. This is the first report of CRE carrying a bla IMP-4 gene causing a clinical infection in a companion animal, with presumed nosocomial spread. This study illustrates the broader community risk entailed in escalating CRE transmission within a zoonotic species such as Salmonella , and in a cycle that encompasses humans, animals and the environment.
Publisher: BMJ
Date: 27-08-2014
DOI: 10.1136/JCLINPATH-2014-202464
Abstract: Little has been published on the performance of tuberculosis PCR with respect to the quality of tissue specimens. Laboratories often receive liquid s les from fine-needle aspirates with no visible tissue for testing. The sensitivity of tuberculosis (TB) PCR on these specimens is unknown. TB PCR was compared to culture or a combination of clinical and histopathological evidence of tuberculosis a separate analysis excluded patients with current or previous treatment. Sixty-five patients had 81 positive s les 69 by PCR and 43 by culture. Excluding those on treatment, 51 of 57 (89%) were PCR positive versus 43 of 61 (70%) by culture. 44 s les had ‘no visible tissue’ noted. Five were PCR positive only one was culture positive. At least two s les were falsely negative. Sensitivity of TB PCR is superior to culture on tissue. Five of seven TB cases with no visible tissue were PCR positive. The quality of the specimen deserves comment, as the two (5%) known false negatives are of concern.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Oxford University Press (OUP)
Date: 25-06-2020
DOI: 10.1093/JAC/DKAA229
Abstract: Implementation of EUCAST susceptibility testing in an Australian hospital laboratory demonstrated higher rates of aminopenicillin and amoxicillin/clavulanate resistance in Haemophilus influenzae than previously recognized. This study aimed to better define the variability in the detection of β-lactam resistance based on EUCAST and CLSI disc diffusion (DD) methodology, by comparison with the recommended reference method, broth microdilution (BMD), and by concordance with genomic analysis. A total of 100 random H. influenzae isolates were assessed for icillin and amoxicillin/clavulanate susceptibility by EUCAST and CLSI DD and BMD. WGS was used to analyse the ftsI gene of a subset of isolates with β-lactam resistance, other than that due to isolated β-lactamase production. Of the 100 isolates, 32 were categorized as either β-lactamase negative, icillin resistant (BLNAR) (n = 18) or β-lactamase positive, amoxicillin/clavulanate resistant (BLPACR) (n = 14) by EUCAST DD. All 18 EUCAST BLNAR isolates were genotypically confirmed by WGS. Five of 18 BLNAR isolates were concordant by CLSI DD, 12 by EUCAST BMD and 4 by CLSI BMD. Nine of 14 EUCAST BLPACR isolates were confirmed by WGS the remaining 5 were 1 mm below the EUCAST DD breakpoint. Only one isolate was detected as BLPACR by CLSI DD. Group III mutations associated with high-level icillin resistance were identified in 10/32 isolates. The EUCAST DD susceptibility method is more reliable than either CLSI or BMD for the detection of genotypically defined BLNAR resistance. However, accurate categorization of amoxicillin/clavulanate resistance remains problematic. Continuous and reproducible surveillance of resistance is needed for this to be possible, robust susceptibility methods are required.
Publisher: American Society for Microbiology
Date: 05-2013
DOI: 10.1128/JCM.03358-12
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.JDIACOMP.2014.07.012
Abstract: Propolis is a naturally occurring anti-inflammatory bee derived protectant resin. We have previously reported that topically applied propolis reduces inflammation and improves cutaneous ulcer healing in diabetic rodents. The aim of this study was to determine if propolis shows efficacy in a pilot study of human diabetic foot ulcer (DFU) healing and if it is well tolerated. Serial consenting subjects (n=24) with DFU ≥4 weeks' duration had topical propolis applied at each clinic review for 6 weeks. Post-debridement wound fluid was analyzed for viable bacterial count and pro-inflammatory MMP-9 activity. Ulcer healing data were compared with a matched control cohort of n=84 with comparable DFU treated recently at the same center. Ulcer area was reduced by a mean 41% in the propolis group compared with 16% in the control group at week 1 (P<0.001), and by 63 vs. 44% at week 3, respectively (P<0.05). In addition, 10 vs. 2% (P<0.001), then 19 vs. 12% (P<0.05) of propolis treated vs. control ulcers had fully healed by weeks 3 and 7, respectively. Post-debridement wound fluid active MMP-9 was significantly reduced, by 18.1 vs. 2.8% week 3 from baseline in propolis treated ulcers vs. controls (P<0.001), as were bacterial counts (P<0.001). No adverse effects from propolis were reported. Topical propolis is a well-tolerated therapy for wound healing and this pilot in human DFU indicates for the first time that it may enhance wound closure in this setting when applied weekly. A multi-site randomized controlled of topical propolis now appears to be warranted in diabetic foot ulcers.
Publisher: Springer Science and Business Media LLC
Date: 13-09-2022
DOI: 10.1186/S13071-022-05452-Y
Abstract: Sarcoptes scabiei is globally distributed and one of the most impactful mammalian ectoparasites. Sarcoptic mange, caused by infection with S. scabiei , causes disruption of the epidermis and its bacterial microbiota, but its effects on host fungal microbiota and on the microbiota of marsupials in general have not been studied. Here, we (i) examine bacterial and fungal microbiota changes associated with mange in wild bare-nosed wombats (BNWs) and (ii) evaluate whether opportunistic pathogens are potentiated by S. scabiei infection in this species. Using Amplicon Sequencing of the 16S rRNA and ITS2 rDNA genes, we detected skin microbiota changes of the bare-nosed wombat ( Vombatus ursinus ). We compared the alpha and beta ersity among healthy, moderate, and severe disease states using ANOVA and PERMANOVA with nesting. Lastly, we identified taxa that differed between disease states using analysis of composition of microbes (ANCOM) testing. We detected significant changes in the microbial communities and ersity with mange in BNWs. Severely affected BNWs had lower licon sequence variant (ASV) richness compared to that of healthy in iduals, and the microbial communities were significantly different between disease states with higher relative abundance of potentially pathogenic microbial taxa in mange-affected BNWs including Staphylococcus sciuri , Corynebacterium spp., Brevibacterium spp., Brachybacterium spp., and Pseudogymnascus spp. and Debaryomyces spp. This study represents the first investigation of microbial changes in association with sarcoptic mange in a marsupial host, as well as the first investigation of fungal microbial changes on the skin of any host suffering from sarcoptic mange. Our results are broadly consistent with bacterial microbiota changes observed in humans, pigs, canids, and Iberian ibex, suggesting the epidermal microbial impacts of mange may be generalisable across host species. We recommend that future studies investigating skin microbiota changes include both bacterial and fungal data to gain a more complete picture of the effects of sarcoptic mange.
Publisher: Wiley
Date: 23-10-2021
DOI: 10.1111/IMJ.14979
Abstract: Current methods of antimicrobial usage surveillance have limited efficacy in changing practice due to delayed reporting to clinicians and the inability to stratify by medical specialty. This study was undertaken in a tertiary teaching hospital with a well established antimicrobial stewardship (AMS) programme and electronic medicines management (eMM) system in Sydney, Australia. To describe and analyse the implementation of a novel AMS audit and feedback method, in the context of an eMM system. The AMS team conducted the audit weekly, and the study design was a prospective, observational study. All acute, adult inpatients were included in this intervention. All active systemic antimicrobial prescriptions on the day of the rounds were included. The prevalence of patients on antimicrobial therapy was 37%. The median time taken per round was 44 min for eMM compared to 58 min for paper. All key performance indicators improved over the study period. Appropriateness compared to guidelines increased from 55% to 71%, and documentation of an indication increased from 75% to 98%. There were 1413 recommendations made, with the most common being to cease an antimicrobial agent. The recommendation uptake rate was 47% at 24 h post‐round. AMS rounds are an effective tool for auditing and providing feedback on antimicrobial use and should include all antimicrobials rather than solely ‘restricted’ agents. These rounds had a high uptake rate, improvements in the appropriateness of antimicrobial use, and a planned duration or review date. A benefit of eMM was improvement in the documentation of indication for antimicrobial agents, and reduced time taken to audit.
Publisher: Cold Spring Harbor Laboratory
Date: 28-01-2022
DOI: 10.1101/2022.01.26.472964
Abstract: This manuscript is discussing the method of Weyrich et al ., 2017, “Neanderthal behaviour, diet, and disease inferred from ancient DNA in dental calculus”. When studying the dietary profile of a Neanderthal specimen from El Sidrón cave (Spain) by sequencing ancient DNA present in calcified dental plaque (calculus) the authors identified a wide-range of potential food sources, including woolly rhinoceros, mushrooms, pine nuts, and moss – namely the less-than-abundant model species Physcomitrium patens . We doubted that Neanderthals were actually eating P. patens . By analyzing the ancient DNA reads using different mapping methods, we show likely a misinterpretation based on the previously used methods. The probability of Neanderthals eating P. patens is the same as eating rice or tomato. However, neither crop was grown in Europe at the time Neanderthals thrived.
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1071/HI11026
Publisher: American Medical Association (AMA)
Date: 11-02-2020
Publisher: Microbiology Society
Date: 18-10-2022
Abstract: Introduction Administering daptomycin with β-lactams may prevent resistance or achieve synergy in enterococcal infections. Daptomycin-non-susceptibility (DAP-NS) phenotype is commonly associated with mutations in the liaFSR and YycFGHIJ systems. Cardiolipin synthase (cls) mutations have been found in conjunction with liaFSR mutations, associated with higher MICs, suggesting they are stepwise mutations. In vitro, icillin restores daptomycin bactericidal activity in Enterococcus faecium isolates with liaFSR mutations, but not when they occur in the cls gene cls-only Enterococcus faecalis mutants have not yet been reported. Aim The aim was to explore daptomycin synergy with β-lactams for high-MIC DAP-NS E. faecalis and E. faecium cls mutants. Methodology Experimentally-induced DAP-NS E. faecalis (A7) and DAP-NS E. faecium (C_002) from a persistent infection on daptomycin- icillin therapy had whole-genome sequencing (AB SOLiD 5500, CLC Genomics Workbench 9). Time-kill studies were performed with DAP, icillin, and DAP-AMP and ceftriaxone and DAP-ceftriaxone for E. faecalis. Results Both isolates’ only DAP-NS-associated mutation was in cls. DAP-ceftriaxone demonstrated bactericidal activity and synergy for E. faecalis A7, whereas E. faecium C_002 grew in the presence of DAP and DAP-AMP. Conclusion High-level DAP-NS arose in association with a cls mutation alone in E. faecalis A7, and in the absence of other documented DAP-NS-associated genetic mutations in E. faecium C_002. DAP-ceftriaxone combination therapy may be a useful salvage option in DAP-NS E. faecalis infections carrying the cls mutation identified in this study. There was no in vitro DAP- icillin synergy for cls-associated DAP-NS E. faecium C_002.
Publisher: Microbiology Society
Date: 25-05-2023
Abstract: Introduction: Administering daptomycin with b-lactams may prevent resistance or achieve synergy in enterococcal infections. Daptomycin-non-susceptibility (DAP-NS) phenotype is commonly associated with mutations in the liaFSR and YycFGHIJ systems. Cardiolipin synthase (cls) mutations have been found in conjunction with liaFSR mutations, associated with higher MICs, suggesting they are stepwise mutations. In vitro, icillin restores daptomycin bactericidal activity in Enterococcus faecium isolates with liaFSR mutations, but not when they occur in the cls gene cls-only Enterococcus faecalis mutants have not yet been reported. Aim: The aim was to explore daptomycin synergy with b-lactams for high-MIC DAP-NS E. faecalis and E. faeciumcls mutants. Methodology: Experimentally-induced DAP-NS E. faecalis (A7) and DAP-NS E. faecium (C_002) from a persistent infection on daptomycin- icillin therapy had whole-genome sequencing (AB SOLiD 5500, CLC Genomics Workbench 9). Time-kill studies were performed with DAP, icillin, and DAP-AMP for both isolates and ceftriaxone and DAP-ceftriaxone for E. faecalis. Results: Both isolates’ only DAP-NS-associated mutation was in cls. DAP-ceftriaxone demonstrated bactericidal activity and synergy for E. faecalis A7, whereas E. faecium C_002 grew in the presence of DAP and DAP-AMP. Conclusion: High-level DAP-NS arose in association with a cls mutation alone in E. faecalis A7, and in the absence of other documented DAP-NS-associated genetic mutations in E. faecium C_002. DAP-ceftriaxone combination therapy may be a useful salvage option in DAP-NS E. faecalis infections carrying the cls mutation identified in this study. There was no in vitro DAP- icillin synergy for cls-associated DAP-NS E. faecium C_002.
Publisher: Research Square Platform LLC
Date: 08-09-2022
DOI: 10.21203/RS.3.RS-1955526/V2
Abstract: Inferring the functional capabilities of bacteria from metagenome-assembled genomes (MAGs) is becoming a central process in microbiology. Here we show that the completeness of genomes has a significant impact on the recovered functional signal, spanning all domains of metabolic functions. We identify factors that affect this relationship between genome completeness and function fullness, and provide baseline knowledge to guide efforts to correct for this new-found bias in functional metagenomic analyses.
Publisher: Cureus, Inc.
Date: 19-12-2017
DOI: 10.7759/CUREUS.1967
Publisher: Research Square Platform LLC
Date: 20-04-2022
DOI: 10.21203/RS.3.RS-1567786/V1
Abstract: Background Gut microbiota studies often rely on a single s le taken per in idual, representing a snapshot in time. However, we know that gut microbiota composition in many animals exhibits intra-in idual variation over the course of days to months. Such temporal variations can be a confounding factor in studies seeking to compare the gut microbiota of different wild populations, or to assess the impact of medical/veterinary interventions. To date, little is known about the variability of the koala ( Phascolarctos cinereus ) gut microbiota through time. Here, we characterise the gut microbiota from faecal s les collected at 8 timepoints over a month for a captive population of South Australian koalas (n in iduals = 7), and monthly over 7 months for a wild population of New South Wales koalas (n in iduals = 5). Results Using 16S rRNA gene sequencing, we found that microbial ersity was stable over the course of days to months. Each koala had a distinct faecal microbiota composition which in the captive koalas was stable across days. The wild koalas showed more variation across months, although each in idual still maintained a distinct microbial composition. Per koala, an average of 57 (± 16) licon sequence variants (ASVs) were detected across all time points these ASVs accounted for an average of 97% (± 1.9%) of the faecal microbial community per koala. Conclusion The koala faecal microbiota exhibits stability over the course of days to months. Such knowledge will be useful for future studies comparing koala populations and developing microbiota interventions for this regionally endangered marsupial.
Publisher: Elsevier BV
Date: 06-2022
Publisher: BMJ
Date: 12-04-2018
DOI: 10.1136/PRACTNEUROL-2017-001844
Abstract: A 63-year-old man presented with a 2-month history of progressive right-sided exophthalmos, painful ophthalmoplegia and fevers. As more features developed, he was diagnosed with giant cell arteritis, then Tolosa-Hunt syndrome, and transiently responded to corticosteroids. A bland cerebrospinal fluid and highly metabolically active brain ( 18 F)-fluoro-D-glucose-positron emission tomography suggested lymphoma. Biopsy of the mass showed sulphur granules with Gram-positive filamentous bacteria with Actinomyces -like colonies. Actinomyces cavernous sinus infections are rare and indolent. They often mimic non-infective causes including other inflammatory and infiltrative conditions, vascular and neoplastic causes, particularly lymphoma. Clinicians should consider infective cavernous sinus syndromes in people with a fluctuating painful ophthalmoplegia that responds poorly to corticosteroids. The term Tolosa-Hunt syndrome is problematic and should be retired or used only with reservation.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.BURNS.2015.03.003
Abstract: MRSA is an on-going problem for burn patients. To analyze risk factors for, and the effect of MRSA colonization on burn patients' outcome. During 21 months burn patients' details and MRSA isolates were analyzed, and a case-control study performed. Of 357 burn patients, 57 (16%) tested positive for MRSA. Compared to the MRSA negative group, MRSA positive patients had a higher median total burn surface area (15%[IQR 5-17%] vs. 5%[IQR 2-8%] p<0.001), more admissions to ICU (54% vs. 26% p<0.001), longer ICU length of stay (4.3 vs. 1.0 days p<0.001), required more operations (1.6 vs. 0.8 p<0.001), and had longer total hospital length of stay (25.5 vs. 8.0 days p<0.001). MRSA positivity was a significant independent predictor of increased length of stay (6.0 days, 95%CI 2.39-9.6 days p=0.001) in a multivariable regression model correcting for patients TBSA and co-morbidities. Cardiac comorbidities (OR 5.14, 95%CI 1.76-15.62 p<0.001) and a longer exposure to the hospital environment (OR 1.05, 95%CI 1.02-1.09, p=0.005) increased the likelihood for MRSA positivity. The negative impact of MRSA positivity on burn patients outcome indicates the need for improved screening procedures for early identification and further efforts toward MRSA infection control to prevent cross-infection as this may significantly impair patients' outcome.
Publisher: Oxford University Press (OUP)
Date: 23-03-2017
DOI: 10.1093/CID/CIX227
Abstract: Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse ersistence of infection, or the need for salvage therapy. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rif in. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1% 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rif in (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rif in (0.34). This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rif in.
Publisher: Hindawi Limited
Date: 16-01-2020
DOI: 10.1155/2020/2150314
Abstract: It has long been acknowledged that syphilis is a disease with a erse range of presentations. We herein describe a case of a young man who presented with fever, rash, and eosinophilia following the commencement of allopurinol, only to be diagnosed with secondary syphilis on histopathology. His treatment was complicated by a severe exacerbation of his cutaneous eruption following the commencement of penicillin, likely secondary to a Jarisch–Herxheimer reaction, an entity often overlooked by clinicians managing syphilis.
Publisher: BMJ
Date: 11-02-2020
DOI: 10.1136/GUTJNL-2019-320260
Abstract: Faecal microbiota transplantation (FMT) has proved to be an extremely effective treatment for recurrent Clostridioides difficile infection, and there is interest in its potential application in other gastrointestinal and systemic diseases. However, the recent death and episode of septicaemia following FMT highlights the need for further appraisal and guidelines on donor evaluation, production standards, treatment facilities and acceptable clinical indications. For these consensus statements, a 24-member multidisciplinary working group voted online and then convened in-person, using a modified Delphi approach to formulate and refine a series of recommendations based on best evidence and expert opinion. Invitations to participate were directed to Australian experts, with an international delegate assisting the development. The following issues regarding the use of FMT in clinical practice were addressed: donor selection and screening, clinical indications, requirements of FMT centres and future directions. Evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Consensus was reached on 27 statements to provide guidance on best practice in FMT. These include: (1) minimum standards for donor screening with recommended clinical selection criteria, blood and stool testing (2) accepted routes of administration (3) clinical indications (4) minimum standards for FMT production and requirements for treatment facilities acknowledging distinction between single-site centres (eg, hospital-based) and stool banks and (5) recommendations on future research and product development. These FMT consensus statements provide comprehensive recommendations around the production and use of FMT in clinical practice with relevance to clinicians, researchers and policy makers.
Publisher: American Society for Microbiology
Date: 11-2014
DOI: 10.1128/JCM.01691-14
Abstract: Chryseobacterium indologenes is an environmental organism which is usually an opportunistic pathogen, most usually associated with nosocomial or device-related infections. This case, affecting a fit and well adventure traveler, demonstrates that it may be an agent of severe sepsis in otherwise healthy humans.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2019
Publisher: Elsevier BV
Date: 2013
Publisher: American Society for Microbiology
Date: 08-2015
DOI: 10.1128/JCM.00754-15
Abstract: Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis .
Publisher: Informa UK Limited
Date: 13-12-2018
Publisher: Microbiology Society
Date: 10-12-2021
Abstract: Coxiella burnetii , the causative agent of Q fever, is known to cause acute and persistent infection, but reactivation of infection is rarely reported. This case demonstrates reactivation of a distant, untreated Q fever infection after a relatively innocuous soft tissue injury in an adjacent joint without pre-existing pathology. A 52-year-old male abbatoir worker sustained an adductor muscle tear in a workplace injury. He was unable to walk thereafter, and developed a chronic, progressive, destructive septic arthritis of the adjacent hip with surrounding osteomyelitis of the femur and acetabulum. He had evidence of prior Q fever infection, with a positive skin test and serology 15 years beforehand. He was diagnosed with chronic osteoarticular Q fever on the basis of markedly elevated phase I antibodies, and symptomatic and serological response to prolonged antibiotic treatment with doxycycline and hydroxychloroquine. He required a two-stage hip arthroplasty. This case illustrates reactivation of latent C. burnetii infection at the site of a soft tissue injury. Clinicians need to be aware of this possibility in patients with previous Q fever infection, and in the setting of undiagnosed osteoarticular pathology following soft tissue injury.
Publisher: Microbiology Society
Date: 27-05-2022
Abstract: The QuickGene-810 Nucleic Acid Isolation System is a semi-automated extraction platform which may be used for RNA extraction. New methods were required to support the rapid increase in respiratory virus testing during the SARS-CoV-2 pandemic. The aim of this study was to assess SARS-CoV-2 RNA extraction using the QuickGene-810 kit compared to the EZ1 Advanced Extraction Platform for use on the AusDiagnostics SARS-CoV-2, Influenza and RSV 8-well RT-PCR assay. Qualitative results from all clinical s les were concordant between the QuickGene-810 and the EZ1 extraction methods, demonstrating that the QuickGene-810 kit is suitable for use in pathogen diagnostics. However, there was an average difference of approximately two cycles between the cycle threshold (Ct) values for both SARS-CoV-2 targets, suggesting that the EZ1 kit yields a higher concentration of nucleic acid extract, possibly related to its use of carrier RNA and/or smaller elution volume, which infers the possibility of false negative results for s les with very low viral loads.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.BURNS.2016.06.019
Abstract: Infection is one of the most common causes of mortality and morbidity in burn patients. The incidence and frequency of microbiological micro-organisms are known to vary across different models of intensive care units. To date, no study has attempted to describe the different findings in burn patients treated in an open, general intensive care unit (GICU) versus a dedicated burns intensive care unit (BICU). Only limited data is available on the effect of these microbiological micro-organisms on patients' length of stay. To characterize and compare the microbiological flora and antibiotic resistance patterns encountered in two different models of burn intensive care and to determine the effect of specific microbiological types on length of intensive care unit (ICU) and overall stay. A retrospective case-control study of 209 burn patients treated in two highly specialized, Western burn referral centres between September 2009 and March 2014. 9710 culture results were analysed, of which 2590 (26.7%) yielded positive results (1537 in the GICU and 1050 in the BICU). Gram-positive cultures were more frequently found in the GICU, whereas Gram-negative and yeast cultures were more prevalent in the BICU. The most frequently encountered micro-organisms in both units were similar and included Staphylococcus aureus, Pseudomonas aeruginosa, coagulase-negative staphylococci (CoNS) and Candida albicans. Significantly more resistant bacteria were detected in the BICU. Testing positive across all types of microbiological isolates, as well as for both Gram-positive and -negative bacteria significantly prolonged patient length of stay. This effect was even more pronounced if the micro-organisms were resistant to antimicrobial therapy. There are notable differences in the microbiological isolate and antibiotic resistance patterns between burn patients treated in a GICU compared to a designated BICU. In both units, testing positive for resistant microbiological micro-organisms is significantly associated with longer hospital stay.
No related grants have been discovered for Genevieve McKew.