ORCID Profile
0000-0002-6155-8353
Current Organisations
Royal Australasian College of Physicians
,
Royal College of Pathologists of Australasia
,
Monash University
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Publications
Clinical evaluation of AusDiagnostics SARS-CoV-2 multiplex tandem PCR assay
Publisher: Elsevier BV
Date: 07-2020
Vancomycin AUC/MIC Ratio and 30-Day Mortality in Patients with Staphylococcus aureus Bacteremia
Publisher: American Society for Microbiology
Date: 04-2013
DOI: 10.1128/AAC.01485-12
Abstract: A ratio of the vancomycin area under the concentration-time curve to the MIC (AUC/MIC) of ≥400 has been associated with clinical success when treating Staphylococcus aureus pneumonia, and this target was recommended by recently published vancomycin therapeutic monitoring consensus guidelines for treating all serious S. aureus infections. Here, vancomycin serum trough levels and vancomycin AUC/MIC were evaluated in a “real-world” context by following a cohort of 182 patients with S. aureus bacteremia (SAB) and analyzing these parameters within the critical first 96 h of vancomycin therapy. The median vancomycin trough level at this time point was 19.5 mg/liter. There was a significant difference in vancomycin AUC/MIC when using broth microdilution (BMD) compared with Etest MIC (medians of 436.1 and 271.5, respectively P 0.001). Obtaining the recommended vancomycin target AUC/MIC of ≥400 using BMD was not associated with lower 30-day all-cause or attributable mortality from SAB ( P = 0.132 and P = 0.273, respectively). However, an alternative vancomycin AUC/MIC of , derived using classification and regression tree analysis, was associated with reduced mortality ( P = 0.043) and remained significant in a multivariable model. This study demonstrated that we obtained vancomycin trough levels in the target therapeutic range early during the course of therapy and that obtaining a higher vancomycin AUC/MIC (in this case, ) within 96 h was associated with reduced mortality. The MIC test method has a significant impact on vancomycin AUC/MIC estimation. Clinicians should be aware that the current target AUC/MIC of ≥400 was derived using the reference BMD method, so adjustments to this target need to be made when calculating AUC/MIC ratio using other MIC testing methods.
Treatment Outcomes for Serious Infections Caused by Methicillin‐ResistantStaphylococcus aureuswith Reduced Vancomycin Susceptibility
Publisher: Oxford University Press (OUP)
Date: 15-02-2004
DOI: 10.1086/381202
Case Report: Japanese Encephalitis Associated with Chorioretinitis after Short-Term Travel to Bali, Indonesia.
Publisher: American Society of Tropical Medicine and Hygiene
Date: 07-10-2020
Pilot study of a combined genomic and epidemiologic surveillance program for hospital-acquired multidrug-resistant pathogens across multiple hospital networks in Australia
Publisher: Cambridge University Press (CUP)
Date: 26-11-2020
Abstract: To conduct a pilot study implementing combined genomic and epidemiologic surveillance for hospital-acquired multidrug-resistant organisms (MDROs) to predict transmission between patients and to estimate the local burden of MDRO transmission. Pilot prospective multicenter surveillance study. The study was conducted in 8 university hospitals (2,800 beds total) in Melbourne, Australia (population 4.8 million), including 4 acute-care, 1 specialist cancer care, and 3 subacute-care hospitals. All clinical and screening isolates from hospital inpatients (April 24 to June 18, 2017) were collected for 6 MDROs: vanA VRE, MRSA, ESBL Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) and Acinetobacter baumannii (CRAb). Isolates were analyzed and reported as routine by hospital laboratories, underwent whole-genome sequencing at the central laboratory, and were analyzed using open-source bioinformatic tools. MDRO burden and transmission were assessed using combined genomic and epidemiologic data. In total, 408 isolates were collected from 358 patients 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%), and ESBL-Kp (7.6%). Most MDROs (88.3%) were isolated from patients with recent healthcare exposure. Combining genomics and epidemiology identified that at least 27.1% of MDROs were likely acquired in a hospital most of these transmission events would not have been detected without genomics. The highest proportion of transmission occurred with vanA VRE (88.4% of patients). Genomic and epidemiologic data from multiple institutions can feasibly be combined prospectively, providing substantial insights into the burden and distribution of MDROs, including in-hospital transmission. This analysis enables infection control teams to target interventions more effectively.
The dominant Australian community-acquired methicillin-resistant Staphylococcus aureus clone ST93-IV [2B] is highly virulent and genetically distinct
Publisher: Public Library of Science (PLoS)
Date: 03-10-2011
Molecular typing of Australian Scedosporium isolates showing genetic variability and numerous S. aurantiacum
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 02-2008
Human Wound Infection with Mannheimia glucosida following Lamb Bite
Publisher: American Society for Microbiology
Date: 10-2015
DOI: 10.1128/JCM.01249-15
Abstract: Mannheimia spp. are veterinary pathogens that can cause mastitis and pneumonia in domestic cattle and sheep. While Mannheimia glucosida can be found as normal flora in oral and respiratory mucosa in sheep, there have been no reported cases of human infection with this organism.
New HIV diagnosis after occupational exposure screening: the importance of reporting needlestick injuries
Publisher: Wiley
Date: 02-2012
DOI: 10.1111/J.1445-5994.2011.02616.X
Abstract: We describe three new diagnosis of HIV infection as a direct result of testing following occupational exposures (NSIs) in a low-prevalence setting. In each case the finding was unexpected. Our series provides a reminder of the importance of prompt reporting of NSIs by healthcare workers, access to rapid HIV testing and post-exposure prophylaxis with antiretrovirals to prevent transmission.
Combination Therapy Did Not Reduce 30-Day Treatment Failure in Patients With Staphylococcus aureus Bacteremia (SAB)
Publisher: Oxford University Press (OUP)
Date: 2016
Influence of the Timing of Cardiac Surgery on the Outcome of Patients With Infective Endocarditis and Stroke
Publisher: Oxford University Press (OUP)
Date: 16-10-2012
DOI: 10.1093/CID/CIS878
Abstract: The timing of cardiac surgery after stroke in infective endocarditis (IE) remains controversial. We examined the relationship between the timing of surgery after stroke and the incidence of in-hospital and 1-year mortalities. Data were obtained from the International Collaboration on Endocarditis-Prospective Cohort Study of 4794 patients with definite IE who were admitted to 64 centers from June 2000 through December 2006. Multivariate logistic regression and Cox regression analyses were performed to estimate the impact of early surgery on hospital and 1-year mortality after adjustments for other significant covariates. Of the 857 patients with IE complicated by ischemic stroke syndromes, 198 who underwent valve replacement surgery poststroke were available for analysis. Overall, 58 (29.3%) patients underwent early surgical treatment vs 140 (70.7%) patients who underwent late surgical treatment. After adjustment for other risk factors, early surgery was not significantly associated with increased in-hospital mortality rates (odds ratio, 2.308 95% confidence interval [CI], .942-5.652). Overall, probability of death after 1-year follow-up did not differ between 2 treatment groups (27.1% in early surgery and 19.2% in late surgery group, P = .328 adjusted hazard ratio, 1.138 95% CI, .802-1.650). There is no apparent survival benefit in delaying surgery when indicated in IE patients after ischemic stroke. Further observational analyses that include detailed pre- and postoperative clinical neurologic findings and advanced imaging data (eg, ischemic stroke size), may allow for more refined recommendations on the optimal timing of valvular surgery in patients with IE and recent stroke syndromes.
Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia
Publisher: Springer Science and Business Media LLC
Date: 05-03-2018
Surveillance of life-long antibiotics: A review of antibiotic prescribing practices in an Australian Healthcare Network
Publisher: Springer Science and Business Media LLC
Date: 18-01-2017
Reductions in Antibiotic Prescribing in Australia During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic: National Prescribing Data
Publisher: Oxford University Press (OUP)
Date: 11-04-2022
DOI: 10.1093/CID/CIAC277
Eosinophilic folliculitis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2004
Outbreak of vanB vancomycin-resistant Enterococcus faecium colonization in a neonatal service.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.AJIC.2015.05.047
Abstract: To describe successful termination of an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) colonization within a neonatal service. Multisite neonatal intensive care unit and special care nurseries within a single health care service. Forty-four cases of VREfm-colonized neonatal inpatients-including 2 clinical isolates (eye swab and catheter-urine specimen) and 42 screening isolates. Active surveillance cultures, patient isolation, contact precautions, enhanced environment cleaning, and staff and parent education. Whole genome sequencing and multilocus sequence typing were used to characterize the outbreak and refine infection control procedures. Peak prevalence of VREfm colonization across all sites was 31% upon discovery of the outbreak. Subsequent to the intervention, transmission was halted within 8 weeks and no further isolates of the outbreak strain have been detected as of 12 months following outbreak cessation. Environmental swabs revealed VREfm colonization of baby-weighing scales, a baby bath, and a pharmacy refrigerator within the neonatal intensive care unit. All isolates were of a single multilocus sequence type (sequence type 796) and highly clonal at the core genome level. Bundled infection control interventions were effective in rapidly terminating a clonal outbreak of sequence type 796 VREfm colonization within a neonatal inpatient service. Strain-typing and active surveillance cultures were critical in guiding the management of this outbreak. The closed environment of a neonatal unit likely facilitated eradication of the patient and environment reservoirs of VREfm colonization.
A simplified, amplicon-based method for whole genome sequencing of human respiratory syncytial viruses
Publisher: Elsevier BV
Date: 04-2023
Lichenoid drug eruption to tenofovir in an HIV/hepatitis B virus co-infected patient [1]
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2004
Myocarditis Caused by Human Parechovirus in Adult
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 09-2017
The 1-month outcome of patients with a low probability technegas ventilation/perfusion lung scan
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-1994
DOI: 10.1097/00006231-199407000-00003
Abstract: The objective was to study the 1-month outcome of patients who had a low probability ventilation erfusion lung scan using Technegas radioaerosol as the inhalational agent and who did not receive anticoagulation. One hundred consecutive patients with suspected pulmonary embolism were studied retrospectively. Their Technegas lung scans were classified by two blinded and independent nuclear medicine physicians and the medical records of all patients with a low probability scan were reviewed. One hundred inpatients (42 males and 58 females) with a mean age of 63 years were studied. The three most common clinical presentations leading to lung scintigraphy were unexplained dyspnoea (30 cases), unexplained dyspnoea with pleuritic chest pain (26 cases) and pleuritic chest pain only (15 cases). Nine patients had been judged by their managing medical team to have a high clinical probability of true pulmonary embolism, 32 had an intermediate probability clinical presentation and 59 a low clinical probability of pulmonary embolism. None of the 100 patients experienced further episodes of suspected or proven pulmonary embolism during the follow-up period. Six patients died. In none of them was pulmonary embolism either the cause of or a major contributing factor to death. The finding of a low probability scan using Technegas as the ventilation scintigram agent of choice describes a group of patients who, even in the absence of therapeutic anticoagulation, have a favourable 1-month outcome free of either true or suspected clinical pulmonary embolism. Invasive, pulmonary angiography-based diagnostic strategies may not be needed in this group of patients.
Infection is an Independent Predictor of Death in Diffuse Large B Cell Lymphoma
Publisher: Springer Science and Business Media LLC
Date: 30-06-2017
DOI: 10.1038/S41598-017-04495-X
Abstract: To identify risk factors for infection in patients with diffuse large B cell lymphoma (DLBCL) undergoing rituximab, cyclophosphamide, vincristine, adriamycin and prednisolone (R-CHOP) treatment. All patients with DLBCL who received R-CHOP from 2004–2014 in a tertiary Australian hospital were identified and information collected from hospital admission data, laboratory results and medical record review. Infection was defined as hospitalisation with an ICD-10-AM diagnostic code for infection. Risk factors for infection and association between infection and survival were modelled using Cox proportional hazards regression. Over the 10-year period there were 325 patients 191 (58.8%) males, median age 66 years. 206 (63.4%) patients experienced ≥1 infection. Independent predictors of infection were Charlson comorbidity index score (hazard ratio [HR] 3.60, p = 0.002), Eastern Cooperative Oncology Group (ECOG) performance status (HR 2.09 p = .001) and neutropenia (HR 2.46, p = .001). 99 (31%) patients died. Infection was an independent predictor of survival (HR 3.27, p = .001, as were age (HR 2.49, p = 0.001), Charlson comorbidity index (HR 4.34, p = .001), ECOG performance status (HR 4.33, p = 0.045) and neutropenia (HR 1.95, p = 0.047). Infections are common and infection itself is an independent predictor of survival. Patients at highest risk of infection and death are those with multiple comorbidities, poor performance status and neutropenia.
Management of gonorrhoea in a hospital network: Are we following best practice?
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH19018
Abstract: Background Gonorrhoea is usually managed in community sexual health or general practice, but a proportion of cases present to hospital settings. In this study, we examined how gonorrhoea was managed through a large hospital network and what the implications may be for public health management. Methods: A retrospective chart review was performed of the management of patients with Neisseria gonorrhoeae infection diagnosed at a large Australian healthcare network from January 2015 to May 2018. Documentation rates of five parameters of care were assessed: (1) the presence (or absence) of previous sexually transmissible infections (STIs) (2) recent travel (3) discussion of HIV testing (4) contact tracing and (5) public health notification. Results: In all, 110 cases (48 male, 62 female) were analysed. Most cases were in the 15–39 years age group 98 cases (89%) were symptomatic, and 12 (11%) were screening tests. The most common presenting syndromes were pelvic inflammatory disease (32% 31/98 symptomatic cases), urethritis (26% 25/98) and epididymo-orchitis (13% 13/98). None of the five parameters assessed were documented in most cases. Documentation was most likely to occur in patients admitted to hospital. When HIV testing was performed, no new cases of HIV were identified. Conclusion: Infections with gonorrhoea present on a regular basis to hospital practice, but overall management is suboptimal. Automated prompts for other recommended tests, including HIV testing when testing for other sexually transmissible diseases is ordered, may improve management. Better awareness of best practice is needed, which can be facilitated with ongoing education. However, the greatest benefit is likely achieved by linking patients back to community-based services, which are best placed to provide ongoing long-term care.
The etiology of community-acquired pneumonia in Australia: Why penicillin plus doxycycline or a macrolide is the most appropriate therapy
Publisher: Oxford University Press (OUP)
Date: 15-05-2008
DOI: 10.1086/586749
Abstract: Available data on the etiology of community-acquired pneumonia (CAP) in Australia are very limited. Local treatment guidelines promote the use of combination therapy with agents such as penicillin or amoxycillin combined with either doxycycline or a macrolide. The Australian CAP Study (ACAPS) was a prospective, multicenter study of 885 episodes of CAP in which all patients underwent detailed assessment for bacterial and viral pathogens (cultures, urinary antigen testing, serological methods, and polymerase chain reaction). Antibiotic agents and relevant clinical outcomes were recorded. The etiology was identified in 404 (45.6%) of 885 episodes, with the most frequent causes being Streptococcus pneumoniae (14%), Mycoplasma pneumoniae (9%), and respiratory viruses (15% influenza, picornavirus, respiratory syncytial virus, parainfluenza virus, and adenovirus). Antibiotic-resistant pathogens were rare: only 5.4% of patients had an infection for which therapy with penicillin plus doxycycline would potentially fail. Concordance with local antibiotic recommendations was high (82.4%), with the most commonly prescribed regimens being a penicillin plus either doxycycline or a macrolide (55.8%) or ceftriaxone plus either doxycycline or a macrolide (36.8%). The 30-day mortality rate was 5.6% (50 of 885 episodes), and mechanical ventilation or vasopressor support were required in 94 episodes (10.6%). Outcomes were not compromised by receipt of narrower-spectrum beta-lactams, and they did not differ on the basis of whether a pathogen was identified. The vast majority of patients with CAP can be treated successfully with narrow-spectrum beta-lactam treatment, such as penicillin combined with doxycycline or a macrolide. Greater use of such therapy could potentially reduce the emergence of antibiotic resistance among common bacterial pathogens.
Antimicrobial surveillance: A 20-year history of the SMART approach to addressing global antimicrobial resistance into the future
Publisher: Elsevier BV
Date: 10-2023
Antiretroviral treatment change among HIV, hepatitis B virus and hepatitis C virus co-infected patients in the Australian HIV Observational Database
Publisher: Wiley
Date: 05-2005
DOI: 10.1111/J.1468-1293.2005.00280.X
Abstract: To assess the impact of highly active antiretroviral therapy (HAART) on rates of change of antiretroviral treatment among patients co-infected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in the Australian HIV Observational Database (AHOD). Analysis was based on 805 of the 2218 patients recruited to the AHOD by March 2003, who had commenced HAART after 1 January 1997, who had recorded test results for HBV surface antigen and anti-HCV antibody, and who had follow-up of more than 3 months. The effect of hepatitis co-infection on the rate of antiretroviral treatment change after commencing HAART was assessed using a random-effect Poisson regression model. Among those included in the analyses, the prevalences of HBV and HCV were 4.8% and 12.8%, respectively. The overall rate of combination antiretroviral treatment change was 0.74 combinations per year. Factors independently associated with an increased rate of change of combination antiretroviral treatment were: prior AIDS-defining illness prior exposure to double combination antiretroviral therapy and antiretroviral treatment class. Co-infection with HBV and/or HCV was not found to be significantly associated with the rate of combination antiretroviral treatment change. While both HBV and HCV co-infections are relatively common in the AHOD, they do not appear to be serious impediments to the treatment of HIV-infected patients.
The clinical efficacy of continuous-infusion flucloxacillin in serious staphylococcal sepsis
Publisher: Oxford University Press (OUP)
Date: 1999
DOI: 10.1093/JAC/43.1.113
Abstract: Since the efficacy of beta-lactams against pathogens such as methicillin-susceptible Staphylococcus aureus (MSSA) is related to the time for which serum drug concentrations exceed the MIC for the pathogen, administration of anti-staphylococcal beta-lactams by continuous infusion may provide a more suitable means of drug delivery than intermittent dosing. To assess the clinical efficacy of continuous-infusion therapy, we reviewed the outcomes for 20 consecutive patients with proven serious MSSA sepsis (three with endocarditis, ten osteomyelitis, one endocarditis plus osteomyelitis and six deep abscess) treated with continuous-infusion flucloxacillin (8-12 g/day). Patients initially receiving routine intermittent-dose flucloxacillin therapy were changed to continuous-infusion flucloxacillin (mean duration 29 days range 4-60 days) for completion of their treatment course. In the majority of cases this was given at home. Serum flucloxacillin concentrations during continuous-infusion flucloxacillin 12 g/day were 11.5->40 mg/L (ten patients) and those during continuous-infusion flucloxacillin 8 g/day were 8->40 mg/L (five patients), these concentrations being well above the expected MIC of flucloxacillin for MSSA. Continuous-infusion flucloxacillin was well tolerated by most patients, and 14/17 patients (82%) who completed their course of continuous-infusion flucloxacillin were judged clinically and microbiologically cured at long-term follow-up (mean 67 weeks range 4-152 weeks). These preliminary data suggest that, following initial intermittent-dose flucloxacillin therapy, continuous-infusion flucloxacillin is an effective treatment option for serious MSSA sepsis, and forms a feasible and possibly preferable alternative to glycopeptides when considering home-based parenteral therapy for these infections. Further studies are needed to identify whether continuous-infusion flucloxacillin can entirely replace intermittent-dose therapy for such infections.
Local acquisition and nosocomial transmission of Klebsiella pneumoniae harbouring the blaNDM‐1 gene in Australia
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.01637
Non-HACEK Gram-Negative Bacillus Endocarditis
Publisher: American College of Physicians
Date: 18-12-2007
DOI: 10.7326/0003-4819-147-12-200712180-00002
Abstract: Infective endocarditis caused by non-HACEK (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella species) gram-negative bacilli is rare, is poorly characterized, and is commonly considered to be primarily a disease of injection drug users. To describe the clinical characteristics and outcomes of patients with non-HACEK gram-negative bacillus endocarditis in a large, international, contemporary cohort of patients. Observations from the International Collaboration on Infective Endocarditis Prospective Cohort Study (ICE-PCS) database. 61 hospitals in 28 countries. Hospitalized patients with definite endocarditis. Characteristics of non-HACEK gram-negative bacillus endocarditis cases were described and compared with those due to other pathogens. Among the 2761 case-patients with definite endocarditis enrolled in ICE-PCS, 49 (1.8%) had endocarditis (20 native valve, 29 prosthetic valve or device) due to non-HACEK, gram-negative bacilli. Escherichia coli (14 patients [29%]) and Pseudomonas aeruginosa (11 patients [22%]) were the most common pathogens. Most patients (57%) with non-HACEK gram-negative bacillus endocarditis had health care-associated infection, whereas injection drug use was rare (4%). Implanted endovascular devices were frequently associated with non-HACEK gram-negative bacillus endocarditis compared with other causes of endocarditis (29% vs. 11% P < 0.001). The in-hospital mortality rate of patients with endocarditis due to non-HACEK gram-negative bacilli was high (24%) despite high rates of cardiac surgery (51%). Because of the small number of patients with non-HACEK gram-negative bacillus endocarditis in each treatment group and the lack of long-term follow-up, strong treatment recommendations are difficult to make. In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.
Outcomes in Medicare-ineligible people living with human immunodeficiency virus in a large healthcare network in Melbourne 2004–2019
Publisher: Wiley
Date: 05-2022
DOI: 10.1111/IMJ.15775
Abstract: Australia has approximately 1.6 million Medicare‐ineligible residents, of whom around 450 are living with human immunodeficiency virus (PLHIV). We examined the outcomes in a cohort of 50 Medicare‐ineligible patients presenting to our hospital network over a 15‐year period: 31 women (62%) and 19 men. Twenty‐four were newly diagnosed. Sixteen of 24 remained in Australia more than 1 year after diagnosis. Although the mean CD4 count at initial contact was 353 cells/mm 3 (range 3–2228 standard deviation (SD) = 452.88), 13 people required treatment for opportunistic infections and 21 people required hospital admissions related to HIV, incurring total estimated hospital costs of $886 310. The mean number of contact years spent with the service was 2.2 (range 0–12 SD = 2.6) and 20 people remain under care. Twenty‐seven PLHIV remain in Australia, seven have transferred care within Australia, two people are known to have died and eight are lost to follow up. The median number of admissions was 0 (range 0–4 SD = 1) and median length of admission was 5 days (range 0–73 SD = 19). Many people leave Australia shortly after a diagnosis of HIV, but most Medicare‐ineligible PLHIV remain. Delays in diagnosing HIV and acquiring Medicare status are associated with a significant burden of disease and cost. Keeping people well, on therapy and out of hospital is likely to be cost‐saving in addition to good clinical practice.
Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study
Publisher: Oxford University Press (OUP)
Date: 20-05-2017
DOI: 10.1093/CID/CIX480
Reply to: 'Prevalence of HIV indicator conditions in late presenting patients with HIV: a missed opportunity for diagnosis?'
Publisher: Oxford University Press (OUP)
Date: 10-01-2019
DOI: 10.1093/QJMED/HCZ016
Refractory Bartonella quintana bacillary angiomatosis following chemotherapy for chronic lymphocytic leukaemia
Publisher: Microbiology Society
Date: 2011
Abstract: Bacillary angiomatosis is a well-recognized infection with cutaneous and systemic manifestations caused by Bartonella henselae or Bartonella quintana and occurs in immunocompromised patients. We report a case of B. quintana bacillary angiomatosis following fludarabine-based chemotherapy for chronic lymphocytic leukaemia that was refractory to standard treatment and was complicated by lymphadenopathy and osteomyelitis.
Rapid time to results and high sensitivity of the CarbaNP test on early cultures
Publisher: American Society for Microbiology
Date: 11-2014
DOI: 10.1128/JCM.01682-14
Abstract: For rapid results, we adapted the CarbaNP test by using 5-hour-old cultures the sensitivity and specificity for detection of carbapenemase production were 100% for non-OXA-producing organisms. The sensitivity from early cultures was 94% for detection of carbapenemase production in Enterobacteriaceae strains. Utilizing younger cultures allows the test to be incorporated into a single day's workflow, facilitating timely patient care and antimicrobial stewardship.
HIV presenting as AIDS in previously undiagnosed tourists in a low-prevalence setting
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2019
Active surveillance for candidemia, Australia
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 10-2006
Abstract: Population-based surveillance for candidemia in Australia from 2001 to 2004 identified 1,095 cases. Annual overall and hospital-specific incidences were 1.81/100,000 and 0.21/1,000 separations (completed admissions), respectively. Predisposing factors included malignancy (32.1%), indwelling vascular catheters (72.6%), use of antimicrobial agents (77%), and surgery (37.1%). Of 919 episodes, 81.5% were inpatient healthcare associated (IHCA), 11.6% were outpatient healthcare associated (OHCA), and 6.9% were community acquired (CA). Concomitant illnesses and risk factors were similar in IHCA and OHCA candidemia. IHCA candidemia was associated with sepsis at diagnosis (p<0.001), death <30 days after infection (p<0.001), and prolonged hospital admission (p or =65 years of age. Adult critical care stay, sepsis syndrome, and corticosteroid therapy were associated with the greatest risk for death. Systematic epidemiologic studies that use standardized definitions for IHCA, OHCA, and CA candidemia are indicated.
Anti-Helicobacter pylori activity of ethoxzolamide
Publisher: Informa UK Limited
Date: 2019
Rat bite fever as a presenting illness in a patient with AIDS
Publisher: Springer Science and Business Media LLC
Date: 30-08-2012
DOI: 10.1007/S15010-011-0181-X
Abstract: The etiology of culture-negative septic arthritis is poorly characterised in persons infected with human immunodeficiency virus (HIV). New molecular methods may assist in the investigation of culture-negative infections of sterile sites, including septic arthritis. We describe the first case of septic arthritis due to the cause of rat bite fever (RBF), Streptobacillus moniliformis, confirmed by 16S rRNA sequence analysis, in a patient with newly diagnosed HIV infection.
Genotypic Diversity of Coagulase-Negative Staphylococci Causing Endocarditis: a Global Perspective
Publisher: American Society for Microbiology
Date: 05-2008
DOI: 10.1128/JCM.02405-07
Abstract: Coagulase-negative staphylococci (CNS) are important causes of infective endocarditis (IE), but their microbiological profiles are poorly described. We performed DNA target sequencing and susceptibility testing for 91 patients with definite CNS IE who were identified from the International Collaboration on Endocarditis—Microbiology, a large, multicenter, multinational consortium. A hierarchy of gene sequences demonstrated great genetic ersity within CNS from patients with definite endocarditis that represented erse geographic regions. In particular, rpoB sequence data demonstrated unique genetic signatures with the potential to serve as an important tool for global surveillance.
Vancomycin vintage: My favourite DRESS
Publisher: Wiley
Date: 02-2015
DOI: 10.1111/IMJ.12660
Constructing clinical indicators for multiresistant organisms. Where do we begin?
Publisher: Elsevier BV
Date: 03-2008
DOI: 10.1071/HI08004
Increasing tolerance of hospital Enterococcus faecium to handwash alcohols
Publisher: American Association for the Advancement of Science (AAAS)
Date: 08-2018
DOI: 10.1126/SCITRANSLMED.AAR6115
Abstract: Alcohol-based disinfectants and particularly hand rubs are a key way to control hospital infections worldwide. Such disinfectants restrict transmission of pathogens, such as multidrug-resistant
Report of oral clarithromycin desensitization
Publisher: Wiley
Date: 14-07-2008
Genomic characterisation of CC398 MRSA causing severe disease in Australia
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.IJANTIMICAG.2022.106577
Abstract: Clonal complex 398 (CC398) livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) has been reported worldwide in a variety of food-animal species. Although CC398 is synonymous with LA-MRSA, community-associated MRSA (CA-MRSA) variants have emerged, including the Panton-Valentine leukocidin (PVL)-positive ST398-V and ST398 single-locus variant ST1232-V, and the PVL-negative ST398-V clones. Using comparative genomic analysis, we determined whether ten CC398 MRSA bacteraemia episodes recently identified in Australia were due to LA-MRSA or CA-MRSA CC398. Isolates were sourced from the Australian Group on Antimicrobial Resistance S. aureus surveillance programme and episodes occurred across Australia. Whole-genome sequencing (WGS) and phylogenetic comparison of the ten CC398 bacteraemia isolates with previously published CC398 MRSA whole-genome sequences identified that the Australian CC398 isolates were closely related to the human-associated II-GOI clade and the livestock-associated IIa clade. The identified CC398 MRSA clones were: PVL-positive ST1232-V (5C2 ), PVL-negative community-associated ST398-V (5C2 ) and livestock-associated ST398-V (5C2 ). Our findings demonstrate the importance of using WGS and comparing the sequences with international sequences to distinguish between CC398 CA-MRSA and LA-MRSA and to determine the isolates' origin. Furthermore, our findings suggest that CC398 CA-MRSA has become established in the Australian community and that ST398-V (5C2 ) LA-MRSA is now widespread in Australian piggeries. Our study emphasises the need for national One Health antimicrobial resistance surveillance programmes to assist in monitoring the ongoing epidemiology of MRSA and other clinically significant antimicrobial-resistant organisms.
Disinfection of Burkholderia cepacia complex from non-touch taps in a neonatal nursery
Publisher: Walter de Gruyter GmbH
Date: 2008
DOI: 10.1515/JPM.2008.038
Disseminated Enteroviral Infection Associated with Obinutuzumab
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 09-2015
The impact of changes in HIV management guidelines on time to treatment initiation in Australia
Publisher: Wiley
Date: 22-02-2017
DOI: 10.1111/HIV.12504
HIV and aging: Insights from the Asia Pacific HIV Observational Database (APHOD)
Publisher: Wiley
Date: 18-11-2015
DOI: 10.1111/HIV.12188
Influenza Vaccine Effectiveness against Hospitalisation with Confirmed Influenza in the 2010-11 Seasons: A Test-negative Observational Study
Publisher: Public Library of Science (PLoS)
Date: 16-07-2013
Continuous-infusion penicillin home-based therapy for serious infections due to penicillin-susceptible pathogens
Publisher: Elsevier BV
Date: 05-2007
DOI: 10.1016/J.IJANTIMICAG.2006.10.018
Abstract: To evaluate the feasibility of continuous-infusion (CI) penicillin in the treatment of serious bacterial infections, consecutive adult patients with deep-seated infections due to penicillin-susceptible pathogens were treated with CI aqueous penicillin G in a home-based programme, and their treatment outcomes were reviewed. Thirty-one patients with microbiologically proven infections completed the planned course of treatment. Twenty of 31 (65%) were followed for at least 2 months thereafter, and all remained free of relapse. One patient had fever attributable to penicillin hypersensitivity, two patients developed catheter-site infections and one patient developed catheter-related bacteraemia. Thus, CI penicillin is feasible for the home-based treatment of a variety of deep-seated infections with minimal toxicity.
Prediction Model to Identify Patients at Risk of 30-Day Treatment Failure in Patients With Staphylococcus aureus Bacteremia
Publisher: Oxford University Press (OUP)
Date: 2016
Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand
Publisher: Wiley
Date: 04-2016
DOI: 10.1111/IMJ.13027
Abstract: The incidence of Clostridium difficile infection (CDI) continues to rise, whilst treatment remains problematic due to recurrent, refractory and potentially severe nature of disease. The treatment of C. difficile is a challenge for community and hospital-based clinicians. With the advent of an expanding therapeutic arsenal against C. difficile since the last published Australasian guidelines, an update on CDI treatment recommendations for Australasian clinicians was required. On behalf of the Australasian Society of Infectious Diseases, we present the updated guidelines for the management of CDI in adults and children.
Coronavirus testing in women attending antenatal care
Publisher: Elsevier BV
Date: 09-2021
Rapid Gel Card Agglutination Assays for Serological Analysis Following SARS-CoV-2 Infection in Humans
Publisher: American Chemical Society (ACS)
Date: 16-07-2020
Influenza epidemiology in patients admitted to sentinel Australian hospitals in 2019: the Influenza Complications Alert Network (FluCAN)
Publisher: Australian Government Department of Health
Date: 26-04-2022
Abstract: Influenza is a common cause of acute respiratory infection, and is a major cause of morbidity and mortality. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2019 influenza season. The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. Cases were defined as patients hospitalised at any of the 17 sentinel hospitals with influenza confirmed by nucleic acid detection. Data were also collected on a frequency matched control group of influenza-negative patients admitted with acute respiratory infection. During the period 1 April to 31 October 2019 (the 2019 influenza season), there were 4,154 patients admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 44% were elderly (≥ 65 years), 21% were children ( 16 years), 7.7% were Aboriginal and Torres Strait Islander peoples, 1.7% were pregnant and 73% had chronic comorbidities. Most admissions were due to influenza A infection (85%). Estimated vaccine coverage was 75% in the elderly, 49% in non-elderly adults with medical comorbidities, and 27% in young children ( 5 years). The estimated vaccine effectiveness in the target adult population was 42% (95% confidence interval [95% CI]: 36%, 49%). There were a larger number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2019 than in 2018.
Communicable Diseases Intelligence Surveillance for severe influenza and COVID-19 in patients admitted to sentinel Australian hospitals in 2020: the Influenza Complications Alert Network (FluCAN)
Publisher: Australian Government Department of Health
Date: 2022
Abstract: Introduction Influenza is a common cause of acute respiratory infection, and is a major cause of morbidity and mortality. Coronavirus disease 2019 (COVID-19) is an acute respiratory infection that emerged as a pandemic worldwide before the start of the 2020 Australian influenza season. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza and COVID-19 during the 2020 influenza season in a sentinel surveillance system. Methods The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. Influenza and COVID-19 cases were defined as patients hospitalised at sentinel hospitals and confirmed by nucleic acid detection. Results There were 448 patients with COVID-19 admitted between 16 March and 31 December 2020, and only 20 patients with influenza admitted between 1 April and 30 November 2020, to one of 22 FluCAN hospitals. Of the COVID-19 cases, 173 (39%) were 65 years of age, 36 (8%) were children ( 16 years), 6 (1%) were Aboriginal and Torres Strait Islander peoples, 4 (1%) were pregnant and 289 (65%) had chronic comorbidities. COVID-19 hospital admissions peaked between weeks 13 and 15 (first wave) nationally, and again between weeks 31 and 35 (Victoria), with most admissions represented by those above 40 years of age. Discussion There was an unusually low number of hospital admissions with laboratory-confirmed influenza in this season, compared to recent seasons. This is likely to be due to effective public health interventions and international border closures as a result of a rise in COVID-19 respiratory infections and associated hospitalisations.
Clinical and Microbiological Characteristics of Eggerthella lenta Bacteremia
Publisher: American Society for Microbiology
Date: 02-2015
DOI: 10.1128/JCM.02926-14
Abstract: Eggerthella lenta is an emerging pathogen that has been underrecognized due to historical difficulties with phenotypic identification. Until now, its pathogenicity, antimicrobial susceptibility profile, and optimal treatment have been poorly characterized. In this article, we report the largest cohort of patients with E. lenta bacteremia to date and describe in detail their clinical features, microbiologic characteristics, treatment, and outcomes. We identified 33 patients the median age was 68 years, and there was no gender predominance. Twenty-seven patients (82%) had serious intra-abdominal pathology, often requiring a medical procedure. Of those who received antibiotics (28/33, 85%), the median duration of treatment was 21.5 days. Mortality from all causes was 6% at 7 days, 12% at 30 days, and 33% at 1 year. Of 26 isolates available for further testing, all were identified as E. lenta by both commercially available matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) systems, and none were found to harbor a vanA or vanB gene. Of 23 isolates which underwent susceptibility testing, all were susceptible to amoxicillin-clavulanate, cefoxitin, metronidazole, piperacillin-tazobactam, ertapenem, and meropenem, 91% were susceptible to clindamycin, 74% were susceptible to moxifloxacin, and 39% were susceptible to penicillin.
Polymicrobial septicaemia with Pseudomonas aeruginosa and Streptococcus pyogenes following traditional tattooing [4]
Publisher: Elsevier BV
Date: 09-1997
DOI: 10.1016/S0163-4453(97)92172-1
Abstract: Non-crossover (NCO) refers to a mechanism of homologous recombination in which short tracks of DNA are copied between homologue chromatids. The allelic changes are typically restricted to one or few SNPs, which potentially allow for the gradual adaptation and maturation of haplotypes. It is assumed to be a stochastic process but the analysis of archaic and modern human haplotypes revealed a striking variability in local NCO recombination rates. NCO recombination rates of 1.9 million archaic SNPs shared with Denisovan hominids were defined by a linkage study and correlated with functional and genomic annotations as well as ChIP-Seq data from modern humans. We detected a strong correlation between NCO recombination rates and the function of the respective region: low NCO rates were evident in introns and quiescent intergenic regions but high rates in splice sites, exons, 5'- and 3'-UTRs, as well as CpG islands. Correlations with ChIP-Seq data from ENCODE and other public sources further identified epigenetic modifications that associated directly with these recombination events. A particularly strong association was observed for 5-hydroxymethylcytosine marks (5hmC), which were enriched in virtually all of the functional regions associated with elevated NCO rates, including CpG islands and 'poised' bivalent regions. Our results suggest that 5hmC marks may guide the NCO machinery specifically towards functionally relevant regions and, as an intermediate of oxidative demethylation, may open a pathway for environmental influence by specifically targeting recently opened gene loci.
Improved standardization and potential for shortened time to results with BD Kiestra™ total laboratory automation of early urine cultures: A prospective comparison with manual processing
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.DIAGMICROBIO.2016.06.020
Abstract: We compared the results of 505 urine specimens prospectively processed by both conventional manual processing (MP) with 16-24h incubation to BD Kiestra™ Total Laboratory Automation (TLA) system with a shortened incubation of 14h: 97% of culture results were clinically concordant. TLA processing was associated with improved standardization of time of first culture reading and total incubation time.
Moving beyond red Man Syndrome
Publisher: Massachusetts Medical Society
Date: 08-07-2021
DOI: 10.1056/NEJMC2107779
Herpes simplex virus‐2 transmission following solid organ transplantation: Donor‐derived infection and transplantation from prior organ recipients
Publisher: Wiley
Date: 31-07-2017
DOI: 10.1111/TID.12739
Abstract: Owing to limited availability of donor organs, previous solid organ transplant (SOT) recipients are increasingly considered as potential organ donors. We report donor-derived transmission of herpes simplex virus type-2 (HSV-2) to two clusters of SOT recipients with transmission from the original donor and an HSV-2-infected recipient who subsequently became a donor. We reviewed medical records of the donors and recipients in both clusters. Pre-transplant serology and virological features of HSV-2 were characterized. Genotyping of HSV-2 isolates to determine potential for donor transmission of HSV-2 through transplantation of organs from prior organ recipients was performed. A kidney-pancreas recipient died day 9 post transplant. Following confirmation of brain death, the lungs and recently transplanted kidney were donated to two further recipients. The liver was not retrieved, but biopsy confirmed HSV-2 infection. Testing on the original donor showed negative HSV-2 polymerase chain reaction and HSV immunoglobulin (Ig)M, but positive HSV-2 IgG. The liver recipient from the original donor developed HSV-2 hepatitis and cutaneous infection that responded to treatment with intravenous acyclovir. In the second cluster, lung and kidney recipients both developed HSV-2 viremia that was successfully treated with antiviral therapy. Genotyping of all HSV-2-positive s les showed 100% sequence homology for three recipients. Donor-derived HSV infection affected two clusters of recipients because of transplantation of organs from a prior organ recipient. HSV should be considered as a possible cause of illness in febrile SOT recipients in the immediate post-transplant period and may cause disseminated disease and re-infection in HSV-2-seropositive recipients. Testing of HSV serology and prophylaxis may be considered in SOT recipients not receiving cytomegalovirus prophylaxis.
Methicillin-Susceptible Staphylococcus aureus Endocarditis Isolates Are Associated With Clonal Complex 30 Genotype and a Distinct Repertoire of Enterotoxins and Adhesins
Publisher: Oxford University Press (OUP)
Date: 09-2011
Erratum: Changing epidemiology of candidaemia in Australia [J Antimicrob Chemother, 72, (2017) (1103-1108)] DOI:10.1093/jac/dkw422
Publisher: Oxford University Press (OUP)
Date: 13-02-2017
DOI: 10.1093/JAC/DKX047
Corynebacterium kutscheri infection of skin and soft tissue following rat bite
Publisher: American Society for Microbiology
Date: 10-2007
DOI: 10.1128/JCM.00607-07
Abstract: Corynebacterium kutscheri is a common bacterium isolated from the oral cavity of healthy mice and rats. We report the first well-documented case of C. kutscheri human infection which followed a rat bite. The microorganism was identified by conventional biochemical tests and confirmed by 16S rRNA gene sequence analysis.
Sequential cutaneous drug reactions to protease inhibitors in the context of occupational post-exposure prophylaxis [1]
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2003
HACEK Infective Endocarditis: Characteristics and Outcomes from a Large, Multi-National Cohort
Publisher: Public Library of Science (PLoS)
Date: 17-05-2013
Intermittent negative blood cultures in Staphylococcus aureus bacteremia; A retrospective study of 1071 episodes
Publisher: Oxford University Press (OUP)
Date: 18-11-2019
DOI: 10.1093/OFID/OFZ494
Abstract: Recommended management of Staphylococcus aureus bacteremia (SAB) includes follow up blood culture sets (BCs) to determine the duration of bacteremia. Duration of bacteremia is an important prognostic factor in SAB and follow up BCs have a critical role in differentiation of uncomplicated and complicated SAB. However, intermittent negative BCs occur in SAB. Clinical guidelines for SAB management do not specify an approach to follow up BCs collection or define the number of negative BCs required to demonstrate resolution of bacteremia. This study assessed the frequency of intermittent negative BCs in SAB and used these finding to formulate a recommendation for collection of follow up BCs. This retrospective study reviewed 1071 episodes of SAB. Clinical and microbiological data including the duration of bacteremia and the occurrence of intermittent negative BCs (those preceded and followed by positive cultures) were considered. Intermittent bacteremia occurred in 13% (140/1071) of episodes. A single negative BCs on days 1-3 had a predictive value of 87-93% for resolution of bacteremia although this was improved if all BCs collected within the same day were considered. Intermittent negative BCs are common in SAB. Given this we would not recommend accepting a single negative BCs as demonstrating resolution of the bacteremia. This is particularly important if a patient is to be classified as having an uncomplicated SAB.
Etymologia: Buruli Ulcer
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 12-2020
Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012
Publisher: European Centre for Disease Control and Prevention (ECDC)
Date: 12-03-2015
DOI: 10.2807/1560-7917.ES2015.20.10.21059
Abstract: We describe an Australia-wide Clostridium difficile outbreak in 2011 and 2012 involving the previously uncommon ribotype 244. In Western Australia, 14 of 25 cases were community-associated, 11 were detected in patients younger than?65 years, 14 presented to emergency/outpatient departments, and 14 to non-tertiary/community hospitals. Using whole genome sequencing, we confirm ribotype 244 is from the same C. difficile clade as the epidemic ribotype 027. Like ribotype 027, it produces toxins A, B, and binary toxin, however it is fluoroquinolone-susceptible and thousands of single nucleotide variants distinct from ribotype 027. Fifteen outbreak isolates from across Australia were sequenced. Despite their geographic separation, all were genetically highly related without evidence of geographic clustering, consistent with a point source, for ex le affecting the national food chain. Comparison with reference laboratory strains revealed the outbreak clone shared a common ancestor with isolates from the United States and United Kingdom (UK). A strain obtained in the UK was phylogenetically related to our outbreak. Follow-up of that case revealed the patient had recently returned from Australia. Our data demonstrate new C. difficile strains are an on-going threat, with potential for rapid spread. Active surveillance is needed to identify and control emerging lineages.
Laboratory-Based Surveillance of Clostridium difficile Infection in Australian Health Care and Community Settings, 2013 to 2018
Publisher: American Society for Microbiology
Date: 21-10-2020
DOI: 10.1128/JCM.01552-20
Abstract: In the early 2000s, a binary toxin (CDT)-producing strain of Clostridium difficile , ribotype 027 (RT027), caused extensive outbreaks of diarrheal disease in North America and Europe. This strain has not become established in Australia, and there is a markedly different repertoire of circulating strains there compared to other regions of the world. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is a nationwide longitudinal surveillance study of C. difficile infection (CDI) in Australia.
Acute HIV infection presenting as erythema multiforme in a 45-yearold heterosexual man
Publisher: AMPCo
Date: 08-2015
DOI: 10.5694/MJA15.00334
“Down the drain”: carbapenem‐resistant bacteria in intensive care unit patients and handwashing sinks
Publisher: AMPCo
Date: 03-2013
DOI: 10.5694/MJA12.11757
Abstract: Clinical utility of carbapenem antibiotics is under threat because of the emergence of acquired metallo-β-lactamase (MBL) genes. We describe an outbreak in an intensive care unit (ICU) possibly associated with contaminated sinks. Four clusters of gram-negative bacteria harbouring the MBL gene blaIMP-4 were detected in the ICU at Dandenong Hospital between November 2009 and July 2012. Epidemiological investigations were undertaken in order to identify a common point source. During September 2012, screening using rectal swabs for all ICU patients, and environmental swabs targeting all ICU handwashing sinks and taps were collected. S les were cultured onto selective carbapenem-resistant Enterobacteriaceae (CRE) agar. Suspected CRE isolates were further characterised using the modified Hodge test and VITEK 2 and confirmed by polymerase chain reaction and sequencing of MBL genes. Clinical and environmental CRE isolates were typed by pulsed-field gel electrophoresis. Ten clinical isolates and one screening isolate of CRE (consisting of Klebsiella pneumoniae [5], Serratia marcescens [4], Enterobacter cloacae [1] and Escherichia coli [1]) were detected with the blaIMP-4 gene over the 30-03 period. S. marcescens was isolated persistently from the grating and drain of eight central sinks. Molecular typing confirmed that clinical and environmental isolates were related. Tap water cultures were negative. Several attempts to clean and decontaminate the sinks using detergents and steam cleaning proved unsuccessful. This report highlights the importance of identification of potential environmental reservoirs, such as sinks, for control of outbreaks of environmentally hardy multiresistant organisms.
Prevalence of antimicrobial‐resistant organisms in residential aged care facilities
Publisher: AMPCo
Date: 11-2011
DOI: 10.5694/MJA11.10724
Abstract: To assess the frequency of, and risk factors for, colonisation with vancomycin-resistant enterococci (VRE), Clostridium difficile and extended-spectrum β-lactamase (ESBL)-producing organisms in residential aged care facilities (RACFs). We conducted a point prevalence survey in October-November 2010 in three RACFs associated with our health service. A single faecal s le was collected from each participating resident and screened for the presence of VRE, C. difficile and ESBL-producing organisms. Presence of risk factors for antibiotic-resistant organisms was identified using a questionnaire. Prevalence of colonisation with VRE, C. difficile and ESBL-producing organisms molecular typing of ESBL-producing organisms prevalence of risk factors including presence of a urinary catheter, recent inpatient stay in an acute care setting and recent antibiotic consumption. Of 164 residents in the three facilities, 119 (73%) were screened. Mean age of screened residents was 79.2 years, and 61% were women 74% had resided in the RACF for > 12 months, 21% had been given antibiotics within the past month and 12% had been in an acute care centre within the past 3 months. Overall rates of VRE (2%) and C. difficile (1%) colonisation were low, but ESBL-producing Escherichia coli was detected in 14 residents (12%) overall, with half of these residing in one wing of an RACF (27% of wing residents tested). Ten of the 14 ESBL-producing isolates had identical molecular typing patterns and belonged to genotye CTX-M-9. Eight of 13 residents had persistent colonisation on repeat testing 3 months later. We found a high prevalence of multiresistant ESBL-producing E. coli in RACF residents. A clonal relatedness of isolates suggests possible transmission within the facility. RACFs should have programs emphasising processes that will limit spread of these organisms, namely good hand hygiene compliance, enhanced environmental cleaning and dedicated antimicrobial stewardship programs.
Genomic interrogation of the burden and transmission of multidrug-resistant pathogens within and across hospital networks
Publisher: Cold Spring Harbor Laboratory
Date: 10-09-2019
DOI: 10.1101/764787
Abstract: Multidrug-resistant organisms (MDROs) disproportionately affect hospitalized patients due to the combination of comorbidities, frequent antimicrobial use, and in-hospital MDRO transmission. Identification of MDRO transmission by hospital microbiology laboratories is difficult due to limitations of existing typing methods. We conducted a prospective multicenter genomics implementation study (8 hospitals, 2800 beds) from 24 th April to 18 th June 2017 in Melbourne, Australia. Clinical and screening isolates from hospital inpatients were collected for six MDROs ( vanA VRE, MRSA, ESBL E. coli [ESBL-Ec] and Klebsiella pneumoniae [ESBL-Kp], and carbapenem-resistant Pseudomonas aeruginosa [CRPa] and Acinetobacter baumannii [CRAb]), sequenced (Illumina NextSeq) and analyzed using open-source tools. MDRO transmission was assessed by genomics (core SNP phylogeny, grouped by species and ST) and compared to epidemiologic data. 408 isolates were collected from 358 patients 47.5% were screening isolates. ESBL-Ec was most common (52.5%), then MRSA (21.6%), vanA VRE (15.7%) and ESBL-Kp (7.6%). We define the transmission rate for each MDRO by genomics and epidemiology 31.6% of all study patients had potential genomic links to other study isolates 86% of these were confirmed by epidemiologic links (probable or possible transmission). The highest transmission rates occurred with van A VRE (88.4% of patients). Combining genomics with high-quality epidemiologic data gives substantial insights into the burden and distribution of critical MDROs in hospitals, including in-hospital transmission. By defining transmission rates by genomics, we hope to enable comparisons over time and between sites, and introduce this as a new outcome measure to assess the efficacy of infection control interventions.
Global spread of three multidrug-resistant lineages of Staphylococcus epidermidis
Publisher: Springer Science and Business Media LLC
Date: 03-09-2018
Mucormycosis in Australia: contemporary epidemiology and outcomes
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.CMI.2016.01.005
Abstract: Mucormycosis is the second most common cause of invasive mould infection and causes disease in erse hosts, including those who are immuno-competent. We conducted a multicentre retrospective study of proven and probable cases of mucormycosis diagnosed between 2004-2012 to determine the epidemiology and outcome determinants in Australia. Seventy-four cases were identified (63 proven, 11 probable). The majority (54.1%) were caused by Rhizopus spp. Patients who sustained trauma were more likely to have non-Rhizopus infections relative to patients without trauma (OR 9.0, p 0.001, 95% CI 2.1-42.8). Haematological malignancy (48.6%), chemotherapy (42.9%), corticosteroids (52.7%), diabetes mellitus (27%) and trauma (22.9%) were the most common co-morbidities or risk factors. Rheumatological/autoimmune disorders occurred in nine (12.1%) instances. Eight (10.8%) cases had no underlying co-morbidity and were more likely to have associated trauma (7/8 87.5% versus 10/66 15.2% p <0.001). Disseminated infection was common (39.2%). Apophysomyces spp. and Saksenaea spp. caused infection in immuno-competent hosts, most frequently associated with trauma and affected sites other than lung and sinuses. The 180-day mortality was 56.7%. The strongest predictors of mortality were rheumatological/autoimmune disorder (OR = 24.0, p 0.038 95% CI 1.2-481.4), haematological malignancy (OR = 7.7, p 0.001, 95% CI 2.3-25.2) and admission to intensive care unit (OR = 4.2, p 0.02, 95% CI 1.3-13.8). Most deaths occurred within one month. Thereafter we observed ergence in survival between the haematological and non-haematological populations (p 0.006). The mortality of mucormycosis remains particularly high in the immuno-compromised host. Underlying rheumatological/autoimmune disorders are a previously under-appreciated risk for infection and poor outcome.
Increased diagnostic yield of routine multiplex PCR compared to clinician requested testing for detection of Trichomonas vaginalis
Publisher: Elsevier BV
Date: 02-2021
Prevalence of HIV indicator conditions in late presenting patients with HIV: A missed opportunity for diagnosis?
Publisher: Oxford University Press (OUP)
Date: 05-10-2019
DOI: 10.1093/QJMED/HCY223
Abstract: To evaluate prior prevalence of HIV indicator conditions in late-presenters with HIV infection. Retrospective cohort study between 2000 and 2014 in a healthcare network in Melbourne, Australia comparing patients presenting with late diagnosis of HIV infection (CD4 < 350 cells/ml) to those patients who had a CD greater than or equal to 350 cells/ml at presentation. The European AIDS Clinical Society guidelines on HIV indicator guided testing were used to assess for any indicator conditions in their prior medical history which may have represented a missed opportunity for earlier diagnosis. Main outcome measures: Descriptive statistics and prevalence of HIV indicator conditions. Of 436 patients with HIV infection, 82 were late presenters. Late presenters were more commonly male (83% vs. 75%, P = 0.11), older (mean age 45 vs. 39 years), born overseas (61% vs. 58%, P = 0.68) and report heterosexual transmission as their exposure risk (51% vs. 31%, P < 0.001). Of 80 patients with late presentation of HIV infection, 54 (55%) had at least one, 29 (36%) at least 2, 12 (15%) at least 3 and 5 (6%) had 4 or more previous HIV indicator conditions which would have triggered HIV testing according to guidelines. The most common indicator conditions were: unexplained loss of weight (31%), herpes zoster (10%), thrombocytopenia or leukopenia (10%), oral or oesophageal candidiasis (10%) and community acquired pneumonia (9%). Twenty patients (25%) had HIV indicator conditions diagnosed at least 12 months before the eventual diagnosis of HIV infection. Patients diagnosed with late-presenting HIV often had an HIV indicator condition prior to presentation, presenting a missed opportunity for earlier diagnosis.
Infectious complications of traditional Samoan tattooing [2]
Publisher: Elsevier BV
Date: 10-2005
Acute hepatitis associated with Campylobacter jejuni bacteraemia
Publisher: Springer Science and Business Media LLC
Date: 09-1997
DOI: 10.1007/BF01708559
Abstract: Herein, we report a new approach to synthesize a series of 1,2,4-[
Unrecognised vitamin D deficiency: low concentrations in African migrants with HIV in Australia
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/SH08048
Increasing tolerance of hospital Enterococcus faecium to hand-wash alcohols
Publisher: Cold Spring Harbor Laboratory
Date: 16-05-2016
DOI: 10.1101/053728
Abstract: Alcohol-based hand rubs are international pillars of hospital infection control, restricting transmission of pathogens such as Staphylococcus aureus . Despite this success, health care infections caused by Enterococcus faecium (Efm) - another multidrug resistant pathogen - are increasing. We tested alcohol tolerance of 139 hospital Efm isolates, obtained between 1997 and 2015 and found Efm post-2010 were 10-fold more tolerant to alcohol killing than older isolates. Using a mouse infection control model, we then showed that alcohol tolerant Efm resisted standard 70% isopropanol surface disinfection and led to gastrointestinal colonization significantly more often than alcohol sensitive Efm. We next looked for bacterial genomic signatures of adaptation. Tolerant Efm have independently accumulated mutations modifying genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed their roles in isopropanol tolerance. These findings suggest bacterial adaptation and complicate infection control recommendations. Additional policies and procedures to prevent Efm spread are required.
Impact of Early Valve Surgery on Outcome of Staphylococcus aureus Prosthetic Valve Infective Endocarditis: Analysis in the International Collaboration of Endocarditis–Prospective Cohort Study
Publisher: Oxford University Press (OUP)
Date: 10-11-2014
DOI: 10.1093/CID/CIU871
Vancomycin-resistant enterococci colonization does not increase mortality in end-stage kidney failure: a case-control study
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.JHIN.2013.09.005
Abstract: Vancomycin-resistant enterococci (VRE) colonization is a frequent occurrence in patients with renal failure. Understanding the impact of VRE colonization on this group of patients has considerable clinical applicability. To understand whether VRE colonization in renal patients has an impact on number of admissions to hospital, length of stay, and mortality. A retrospective case-control study of renal dialysis patients was performed between 2000 and 2010. Cases were 134 VRE-colonized patients requiring renal replacement therapy and matched controls were 137 non-colonized patients with the same baseline characteristics. Matched cases and controls were analysed for differences in number of admissions, length of stay, and mortality. There was no difference in mortality between colonized and non-colonized patients (hazard ratio: 1.14 95% confidence interval: 0.78-1.69 P = 0.49). Length of stay for colonized patients was 7.29 days compared with 4.14 days (P < 0.001). The number of admissions for VRE-colonized patients was not significantly different compared with controls (9.34 vs 8.33, P = 0.78). VRE colonization did not increase mortality in renal patients but did contribute to increased length of stay.
Bacteroides pyogenes causing serious human wound infection from animal bites
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.ANAEROBE.2016.10.008
Abstract: Bacteroides pyogenes is part of the normal oral flora of domestic animals. There is one previous report of human infection, with B. pyogenes bacteremia following a cat bite (Madsen 2011). We report seven severe human infections where B. pyogenes was identified by Bruker matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDTI-TOF MS), but not by VITEK MS and was misidentified by VITEK ANC card.
Favipiravir and the Need for Early Ambulatory Treatment of COVID-19
Publisher: American Society for Microbiology
Date: 17-02-2021
DOI: 10.1128/AAC.02489-20
Fatal Legionella longbeachae infection following heart transplantation
Publisher: Springer Science and Business Media LLC
Date: 1998
DOI: 10.1007/BF01584366
Abstract: Immunotherapy has dramatically influenced and changed therapeutical approach in non-small cell lung cancer (NSCLC) in recent five years. Even though we can reach long-term response to this treatment in approximately 20% of patients with NSCLC, we are still not able to identify this cohort of patients based on predictive biomarkers. In our study we have focused on tumor mutation burden (TMB), one of the potential biomarkers which could predict effectiveness of check-point inhibitors, but has several limitations, especially in multiple approaches to TMB quantification and ununiform threshold. We determined the value of TMB in tumor tissue (tTMB) and blood (bTMB) in 20 patients with early stage NSCLC using original custom gene panel LMB_TMB1. We evaluated various possibilities of TMB calculation and concluded that TMB should be counted from both somatic non-synonymous and synonymous mutations. Considering various factors, we established cut-offs of tTMB in/excluding HLA genes as ≥22 mut/Mb and 12 mut/Mb respectively, and cut-offs of bTMB were defined as ≥21 mut/Mb and ≥5 mut/Mb, respectively. We also observed trend in correlation of somatic mutations in HLA genes with overall survival of patients.
Eggerthella lenta Bacteremia Complicated by Spondylodiscitis, Psoas Abscess, and Meningitis
Publisher: American Society for Microbiology
Date: 04-2014
DOI: 10.1128/JCM.03158-13
Abstract: Eggerthella lenta bacteremia is uncommon and generally associated with abdominal sepsis. The organism and its clinical significance have not been well characterized due to historical difficulties with identification. We report a case of severe infection in a paraplegic man complicated by psoas abscess, osteomyelitis, and meningitis and discuss treatment challenges.
Acute Tubular Necrosis and Thrombocytopenia Associated With Rifampin Use: Case Report and Review
Publisher: Oxford University Press (OUP)
Date: 17-05-2022
DOI: 10.1093/OFID/OFAC258
Abstract: A case of rif in-induced acute tubular necrosis requiring hemodialysis in a patient receiving thrice-weekly rif in with daily dapsone for retreatment of relapsed Hansen’s disease is reported. The patient had positive rif in-dependent antiplatelet antibodies. Case reports of acute renal failure associated with the use of rif in are summarized.
Off-target effects of bacillus Calmette–Guérin vaccination on immune responses to SARS-CoV-2: implications for protection against severe COVID-19
Publisher: Wiley
Date: 2022
DOI: 10.1002/CTI2.1387
Abstract: Because of its beneficial off‐target effects against non‐mycobacterial infectious diseases, bacillus Calmette–Guérin (BCG) vaccination might be an accessible early intervention to boost protection against novel pathogens. Multiple epidemiological studies and randomised controlled trials (RCTs) are investigating the protective effect of BCG against coronavirus disease 2019 (COVID‐19). Using s les from participants in a placebo‐controlled RCT aiming to determine whether BCG vaccination reduces the incidence and severity of COVID‐19, we investigated the immunomodulatory effects of BCG on in vitro immune responses to SARS‐CoV‐2. This study used peripheral blood taken from participants in the multicentre RCT and BCG vaccination to reduce the impact of COVID‐19 on healthcare workers (BRACE trial). The whole blood taken from BRACE trial participants was stimulated with γ‐irradiated SARS‐CoV‐2‐infected or mock‐infected Vero cell supernatant. Cytokine responses were measured by multiplex cytokine analysis, and single‐cell immunophenotyping was made by flow cytometry. BCG vaccination, but not placebo vaccination, reduced SARS‐CoV‐2‐induced secretion of cytokines known to be associated with severe COVID‐19, including IL‐6, TNF‐α and IL‐10. In addition, BCG vaccination promoted an effector memory phenotype in both CD4 + and CD8 + T cells, and an activation of eosinophils in response to SARS‐CoV‐2. The immunomodulatory signature of BCG’s off‐target effects on SARS‐CoV‐2 is consistent with a protective immune response against severe COVID‐19.
Impact of an electronic antibiotic advice and approval system on antibiotic prescribing in an Australian teaching hospital
Publisher: AMPCo
Date: 05-2004
DOI: 10.5694/J.1326-5377.2004.TB06022.X
Abstract: The impact of a computer-based infectious diseases electronic antibiotic advice and approval system ("IDEA(3)S") was assessed as an alternative to a labour-intensive, phone-based approval system. IDEA(3)S-based approvals replaced 48% of all approvals for the most frequently requested antimicrobial agents (ceftriaxone/cefotaxime, vancomycin) and were associated with stable overall rates of antimicrobial use. Antibiotic prescribing for community-acquired pneumonia was 76% concordant with IDEA(3)S recommendations, and clinical acceptance of IDEA(3)S was excellent. Successful implementation required a coordinated, evidence-based approach between clinicians, pharmacists and hospital administration, together with ongoing staff education and feedback of results. IDEA(3)S is a useful new adjunct to routine clinician consultation to support appropriate antibiotic prescribing for a number of common indications in hospitals.
COVID‐19 in Australia: our national response to the first cases of SARS‐CoV‐2 infection during the early biocontainment phase
Publisher: Wiley
Date: 2021
DOI: 10.1111/IMJ.15105
Impact of Kiestra total laboratory automation workflow on job satisfaction, education and quality: a staff survey
Publisher: Elsevier BV
Date: 10-2022
Invasive infections due to filamentous fungi other than Aspergillus: epidemiology and determinants of mortality
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.CMI.2014.12.021
Abstract: The epidemiology of invasive fungal disease (IFD) due to filamentous fungi other than Aspergillus may be changing. We analysed clinical, microbiological and outcome data in Australian patients to determine the predisposing factors and identify determinants of mortality. Proven and probable non-Aspergillus mould infections (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria) from 2004 to 2012 were evaluated in a multicentre study. Variables associated with infection and mortality were determined. Of 162 episodes of non-Aspergillus IFD, 145 (89.5%) were proven infections and 17 (10.5%) were probable infections. The pathogens included 29 fungal species/species complexes mucormycetes (45.7%) and Scedosporium species (33.3%) were most common. The commonest comorbidities were haematological malignancies (HMs) (46.3%) diabetes mellitus (23.5%), and chronic pulmonary disease (16%) antecedent trauma was present in 21% of cases. Twenty-five (15.4%) patients had no immunocompromised status or comorbidity, and were more likely to have acquired infection following major trauma (p <0.01) 61 (37.7%) of cases affected patients without HMs or transplantation. Antifungal therapy was administered to 93.2% of patients (median 68 days, interquartile range 19-275), and adjunctive surgery was performed in 58.6%. The all-cause 90-day mortality was 44.4% HMs and intensive-care admission were the strongest predictors of death (both p <0.001). Survival varied by fungal group, with the risk of death being significantly lower in patients with dematiaceous mould infections than in patients with other non-Aspergillus mould infections. Non-Aspergillus IFD affected erse patient groups, including non-immunocompromised hosts and those outside traditional risk groups therefore, definitions of IFD in these patients are required. Given the high mortality, increased recognition of infections and accurate identification of the causative agent are required.
Trichomoniasis among men presenting to a sexual health clinic in Melbourne, Australia
Publisher: CSIRO Publishing
Date: 04-07-2022
DOI: 10.1071/SH22100
Abstract: In response to the report by Abraham et al., we present our observations of Trichomonas vaginalis (TV) detection in men tested at a public hospital laboratory in Melbourne, Australia, using a multiplex PCR. These studies provide valuable information about TV prevalence in urban communities.
Long-term antibiotic prescribing in the community: 6 years of Australian national data
Publisher: Elsevier BV
Date: 03-2023
Influenza vaccine effectiveness against hospitalisation with influenza in adults in Australia in 2014
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.VACCINE.2015.10.016
Abstract: We provide estimates of the influenza vaccine protection against hospitalisation with laboratory-confirmed influenza in the 2014 Australian season where the A/H1N1 dm09 strain predominated. This was performed using a case-test negative study design as part of a national sentinel surveillance system in Australia. Vaccine effectiveness was estimated as (1-OR)×100% where the odds ratio of vaccination in cases vs test negative participants was estimated from a conditional logistic regression. Between April and November, 1692 adult patients were admitted with laboratory-confirmed influenza. Vaccine effectiveness was estimated from 1283 patients with influenza and 1116 test negative patients where vaccination status was ascertained. Vaccination was associated with a reduction in the risk of hospitalisation with influenza of 51.5% (95% CI: 41.6%, 59.7%) in all patients, and a reduction of 50.7% (95% CI: 40.1%, 59.3%) in the target population for vaccination. We estimate that the influenza vaccine was moderately protective against hospitalisation with laboratory-confirmed influenza during the 2014 influenza season in Australia.
Comparing the identification of Clostridium spp. by two Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) mass spectrometry platforms to 16S rRNA PCR sequencing as a reference sta
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.ANAEROBE.2014.09.007
Abstract: We compared the identification of Clostridium species using mass spectrometry by two different Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) platforms (Bruker MS and Vitek MS) against 16S rRNA sequencing as the reference standard. We then examined the impact of different s le preparations and (on one of those platforms) age of bacterial colonial growth on the performance of the MALDI-TOF MS systems. We identified 10 different species amongst the 52 isolates by 16S rRNA sequencing, with Clostridium perfringens the most prevalent (n=30). Spectrometric analysis using Vitek MS correctly speciated 47/52 (90.4%) isolates and was not affected by the s le preparation used. Performance of the Bruker MS was dependent on s le preparation with correct speciation obtained for 36 of 52 (69.2%) isolates tested using the Direct Transfer [DT] protocol, but all 52 (100%) isolates were correctly speciated using either an Extended Direct Transfer [EDT] or a Full Formic Extraction [EX] protocol. We then examined the effect of bacterial colonial growth age on the performance of Bruker MS and found substantial agreement in speciation using DT (Kappa=0.62, 95% CI: 0.46-0.75), almost perfect agreement for EDT (Kappa=0.94, 95% CI: 0.86-1.00) and exact agreement for EX (Kappa=1.00) between different days.
Comparison of contemporary invasive and non-invasive Streptococcus pneumoniae isolates reveals new insights into circulating anti-microbial resistance determinants
Publisher: American Society for Microbiology
Date: 12-10-2023
DOI: 10.1128/AAC.00785-23
Who really knows their patients' penicillin adverse drug reaction status? A cross-sectional survey
Publisher: Wiley
Date: 2015
DOI: 10.1111/IMJ.12634
Abstract: This cross-sectional survey of patients with adverse drug reactions (ADR) to penicillin and their treating doctor, nurse and pharmacist was undertaken to identify the extent of healthcare workers (HCW) awareness of their patients' ADR, and antibiotic use in hospital. There were 23 (38%) doctors, 53 (87%) nurses and 40 (66%) pharmacists who were aware of their patient's penicillin ADR, despite more than half of their patients receiving antibiotics. Interventions encouraging 'double checking' may improve antibiovigilance.
Editorial
Publisher: Cambridge University Press (CUP)
Date: 09-2017
DOI: 10.1017/JMO.2017.48
MELTING MUSCLES
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2009
Polyclonal emergence of vanA vancomycin-resistant Enterococcus faecium in Australia
Publisher: Oxford University Press (OUP)
Date: 28-12-2017
DOI: 10.1093/JAC/DKW539
Abstract: To investigate the genetic context associated with the emergence of vanA VRE in Australia. The whole genomes of 18 randomly selected vanA -positive Enterococcus faecium patient isolates, collected between 2011 and 2013 from hospitals in four Australian capitals, were sequenced and analysed. In silico typing and transposon lasmid assembly revealed that the sequenced isolates represented (in most cases) different hospital-adapted STs and were associated with a variety of different Tn 1546 variants and plasmid backbone structures. The recent emergence of vanA VRE in Australia was polyclonal and not associated with the dissemination of a single 'dominant' ST or vanA -encoding plasmid. Interestingly, the factors contributing to this epidemiological change are not known and future studies may need to consider investigation of potential community sources.
Low rates of endocarditis in healthcare-associated Staphylococcus aureus bacteremia suggest that echocardiography might not always be required
Publisher: Springer Science and Business Media LLC
Date: 21-10-2016
DOI: 10.1007/S10096-015-2505-8
Abstract: Healthcare-associated Staphylococcus aureus bacteremia (HA-SAB) is an increasingly frequently observed complication of medical treatment. Current guidelines recommend evaluation with echocardiography and preferably transesophageal echocardiography for the exclusion of infectious endocarditis (IE). We performed a retrospective analysis of all patients with HA-SAB between 1 January 2007 and 31 July 2012. Patients were ided into those with a high degree of clinical suspicion of IE (prosthetic intracardiac device, hemodialysis or positive blood cultures for 4 days or more) or those with a low degree of clinical suspicion of IE (absence of high-risk features based on previous literature as strong indicators of endocarditis). Three hundred and fifty-eight patients with HA-SAB were evaluated to determine the prevalence of IE, including 298 (83 %) who had echocardiography. Fourteen patients (4 %) had a final diagnosis of IE after echocardiography. In the group with a high degree of clinical suspicion 11 out of 84 patients (13 %) had IE. In the group with a low degree of clinical suspicion group 3 out 274 patients (1.1 %) had IE. HA-SAB has a low rate of IE, especially in the absence of high-risk features such as prolonged bacteremia, intracardiac prosthetic devices, and hemodialysis. Echocardiographic imaging in this low-risk population of patients is rarely helpful and may generally be avoided, although careful clinical follow-up is warranted. Patients with HA-SAB who have mechanical valves, intracardiac devices, prolonged bacteremia or dialysis dependency have a high incidence of IE and should be evaluated thoroughly using echocardiography.
Mycobacterium haemophilum bone and joint infection in HIV/AIDS: case report and literature review
Publisher: SAGE Publications
Date: 10-01-2015
Abstract: We report a case of disseminated Mycobacterium haemophilum osteomyelitis in a patient with advanced HIV infection, who later developed recurrent immune reconstitution inflammatory syndrome after commencement of antiretroviral therapy. We review previous reports of M. haemophilum bone and joint infection associated with HIV infection and describe the management of M. haemophilum-associated immune reconstitution inflammatory syndrome, including the role of surgery as an adjunctive treatment modality and the potential drug interactions between antiretroviral and antimycobacterial agents.
Repeated Vaccination Does Not Appear to Impact Upon Influenza Vaccine Effectiveness Against Hospitalization With Confirmed Influenza
Publisher: Oxford University Press (OUP)
Date: 17-03-2017
DOI: 10.1093/CID/CIX209
Abstract: Annual influenza vaccine is recommended for those at greatest risk of severe influenza infection. Recent reports of a negative impact of serial influenza vaccination on vaccine effectiveness (VE) raises concerns about the recommendation for annual influenza vaccines, particularly in persons at greatest risk. The Influenza Complications Alert Network (FluCAN) is an Australian hospital-based sentinel surveillance program. In this observational study, cases were defined as subjects aged >9 years admitted with influenza confirmed by polymerase chain reaction. Controls were subjects with acute respiratory illness testing negative for influenza. Propensity scores were used to adjust for the likelihood of being vaccinated. VE was calculated as 1 - adjusted odds ratio of vaccination in cases compared with test-negative controls. Over 2010-2015, 6223 cases and 6505 controls were hospitalized with confirmed influenza and influenza test-negative acute respiratory illness, respectively. Following stratification by quintile of propensity score, site, and year, VE was estimated to be 43% (95% confidence interval [CI], 37%-49%) overall. VE was estimated to be 51% (95% CI, 45%-57%) in those vaccinated in both the current and previous season, compared with 33% (95% CI, 17%-47%) vaccinated in the current season only and 35% (95% CI, 21%-46%) in the previous season only. Similar results were observed for influenza A/H1N1, influenza A/H3N2, and influenza B strains. Vaccination in both the current and previous seasons was associated with a higher VE against hospitalization with influenza than vaccination in either single season. These findings reinforce current recommendations for annual influenza vaccination, particularly those at greatest risk of influenza disease.
Identification and characterisation of fosfomycin resistance in Escherichia coli urinary tract infection isolates from Australia
Publisher: Elsevier BV
Date: 10-2020
Isolation and rapid sharing of the 2019 novel coronavirus (
SARS
‐CoV‐2) from the first patient diagnosed with
COVID
‐19 in Austra
Publisher: AMPCo
Date: 04-2020
DOI: 10.5694/MJA2.50569
Whole genome analysis of cephalosporin-resistant Escherichia coli from bloodstream infections in Australia, New Zealand and Singapore: high prevalence of CMY-2 producers and ST131 carrying blaCTX-M-15
Publisher: Oxford University Press (OUP)
Date: 14-12-2017
DOI: 10.1093/JAC/DKX466
Abstract: To characterize MDR Escherichia coli from bloodstream infections (BSIs) in Australia, New Zealand and Singapore. We collected third-generation cephalosporin-resistant (3GC-R) E. coli from blood cultures in patients enrolled in a randomized controlled trial from February 2014 to August 2015. WGS was used to characterize antibiotic resistance genes, MLST, plasmids and phylogenetic relationships. Antibiotic susceptibility was determined using disc diffusion and Etest. A total of 70 3GC-R E. coli were included, of which the majority were ST131 (61.4%). BSI was most frequently from a urinary source (69.6%), community associated (62.9%) and in older patients (median age 71 years). The median Pitt score was 1 and ICU admission was infrequent (3.1%). ST131 possessed more acquired resistance genes than non-ST131 (P = 0.003). Clade C1/C2 ST131 predominated (30.2% and 53.5% of ST131, respectively) and these were all ciprofloxacin resistant. All clade A ST131 (n = 6) were community associated. The predominant ESBL types were blaCTX-M (80.0%) and were strongly associated with ST131 (95% carried blaCTX-M), with the majority blaCTX-M-15. Clade C1 was associated with blaCTX-M-14 and blaCTX-M-27, whereas blaCTX-M-15 predominated in clade C2. Plasmid-mediated AmpC genes (mainly blaCMY-2) were frequent (17.1%) but were more common in non-ST131 (P < 0.001) isolates from Singapore and Brisbane. Two strains carried both blaCMY-2 and blaCTX-M. The majority of plasmid replicon types were IncF. In a prospective collection of 3GC-R E. coli causing BSI, community-associated Clade C1/C2 ST131 predominate in association with blaCTX-M ESBLs, although a significant proportion of non-ST131 strains carried blaCMY-2.
Clinical illness with viable severe acute respiratory coronavirus virus 2 (SARS-CoV-2) virus presenting 72 days after infection in an immunocompromised patient
Publisher: Cambridge University Press (CUP)
Date: 19-03-2021
DOI: 10.1017/ICE.2021.120
Epidemiology and Mortality of Staphylococcus aureus Bacteremia in Australian and New Zealand Children.
Publisher: American Medical Association (AMA)
Date: 10-2016
DOI: 10.1001/JAMAPEDIATRICS.2016.1477
Abstract: Staphylococcus aureus bacteremia (SAB) in children causes significant morbidity and mortality, but the epidemiology in children is not well characterized. To describe the epidemiology of SAB in children and adolescents younger than 18 years from Australia and New Zealand. A prospective cohort study, using data from the Australian New Zealand Cooperative on Outcomes in Staphylococcal Sepsis cohort for 1153 children with SAB from birth to less than 18 years in pediatric and general hospitals across Australia and New Zealand, collected between January 1, 2007, and December 31, 2012. Multivariate analysis was performed to identify risk factors for mortality. Incidence calculations were calculated separately for Australasian children younger than 15 years using postcode population denominator data from Australian and New Zealand census data. Demographic data, hospital length of stay, principal diagnosis, place of SAB onset (community or hospital), antibiotic susceptibility and principal antibiotic treatment, and 7- and 30-day mortality. Of the 1153 children with SAB, complete outcome data were available for 1073 children (93.1%) of these, males accounted for 684 episodes (63.7%) of SAB. The median age was 57 months (interquartile range, 2 months to 12 years). The annual incidence of SAB for Australian children was 8.3 per 100 000 population and was higher in indigenous children (incident rate ratio, 3.0 [95% CI, 2.4-3.7]), and the incidence for New Zealand children was 14.4 per 100 000 population and was higher in Māori children (incident rate ratio, 5.4 [95% CI, 4.1-7.0]). Community-onset SAB occurred in 761 cases (70.9%), and 142 cases (13.2%) of the infections were methicillin-resistant S aureus (MRSA). Bone or joint infection was most common with 348 cases (32.4%), and endocarditis was uncommon with 30 cases (2.8%). Seven- and 30-day mortality rates were 2.6% (n = 28) and 4.7% (n = 50), respectively. Risk factors for mortality were age younger than 1 year Māori or Pacific ethnicity endocarditis, pneumonia, or sepsis and receiving no treatment or treatment with vancomycin. Mortality was 14.0% (6 of 43) in children with methicillin-susceptible S aureus (MSSA) treated with vancomycin compared with 2.6% (22 of 851) in children treated with alternative agents (OR, 6.1 [95% CI, 1.9-16.7]). MRSA infection was associated with increased length of stay but not mortality. In this large cohort study of the epidemiology of SAB in children, death was uncommon, but the incidence was higher for infants and varied by treatment, ethnicity, and clinical presentation. This study provides important information on the epidemiology of SAB in children and risk factors for mortality.
Increasing rates and clinical consequences of nalidixic acid-resistant isolates causing enteric fever in returned travellers: an 18-year experience
Publisher: Springer Science and Business Media LLC
Date: 09-04-2009
DOI: 10.1007/S10096-009-0732-6
Abstract: The purpose of this study was to examine the rate and clinical consequences of nalidixic acid-resistant (NAR) isolates in travellers with enteric fever presenting to a hospital in a developed country. We retrospectively examined microbiologically confirmed cases of enteric fever in adult returned travellers over an 18-year period presenting to two tertiary referral hospitals in Melbourne, Australia. There were 59 cases of Salmonella typhi infection, 43 cases of S. paratyphi A infection and two cases of S. paratyphi B infection. Most patients reported recent travel to India (36%) or Indonesia (29%). NAR isolates were commonly encountered (41% of all isolates), particularly from India (75%), Pakistan (80%) and Bangladesh (60%). The number of NAR isolates increased progressively after 2003. Patients with NAR isolates had prolonged mean fever clearance time (5.6 vs. 3.3 days, P = 0.03) and prolonged hospital stay (7.9 vs. 5.7 days, P = 0.02) compared to non-resistant isolates. This represents the largest report of NAR enteric fever in returned travellers. NAR isolates predominate in cases of enteric fever from South Asia and result in prolonged fever clearance time and hospital stay. Empiric therapy with alternative antibiotics such as ceftriaxone or azithromycin should be considered in patients with suspected enteric fever from this region.
Peripheral intravenous catheter‐associated Staphylococcus aureus bacteraemia: more than 5 years of prospective data from two tertiary health services
Publisher: AMPCo
Date: 06-2013
DOI: 10.5694/MJA12.11699
Abstract: To determine the incidence, risk factors for and outcomes of Staphylococcus aureus bacteraemia (SAB) associated with peripheral intravenous catheters (PIVCs). A review of prospectively collected data from two tertiary health services on all health care-associated SAB episodes occurring in adults aged > 17 2013s from January 2007 to July 2012. Numbers of health care-associated SAB episodes device type, location of insertion, device dwell time and outcome at 7 and 30 days for all SAB episodes associated with use of a PIVC rates of SAB per 10 000 occupied bed-days (OBDs). Overall, 137 of 583 health care-associated-SAB episodes (23.5%) were deemed to be PIVC associated, with an incidence of 0.26/10 000 OBD. The mean dwell time for PIVCs was 3.5 days (range, 0.25-9 days) and 45.2% of SABs occurred in PIVCs with a dwell time ≥ 4 days. Of the PIVC-associated SAB episodes, 39.6% involved PIVCs inserted in the ED, 39.6% involved PIVCs inserted on wards and 20.8% involved PIVCs inserted by the ambulance service. Of the PIVC-associated SABs occurring within 4 days of insertion, 61% were inserted by ED staff or the ambulance service. PIVC-associated SAB were associated with a 30-day all-cause mortality rate of 26.5%. PIVC-associated SAB is an under-recognised complication. The high incidences of SAB associated with PIVCs inserted in emergency locations and with prolonged dwell times support recommendations in clinical guidelines for routine removal of PIVCs.
Management of dengue in Australian travellers: A retrospective multicentre analysis
Publisher: AMPCo
Date: 04-2017
DOI: 10.5694/MJA16.01056
Abstract: To describe the epidemiology, clinical and laboratory features and outcomes of dengue in returned Australian travellers, applying the revised WHO dengue classification (2009) to this population. Retrospective case series analysis of confirmed dengue cases hospitalised at one of four Australian tertiary hospitals, January 2012 - May 2015. Clinical features, laboratory findings and outcomes of patients with dengue dengue classification according to 2009 WHO guidelines. 208 hospitalised patients (median age, 32 years range, 4-76 years) were included in the study. Dengue was most frequently acquired in Indonesia (94 patients, 45%) and Thailand (40, 19%). The most common clinical features were fever (98% of patients) and headache (76%). 84 patients (40%) met the WHO criteria for dengue with warning signs, and one the criteria for severe dengue the most common warning signs were mucosal bleeding (44 patients, 21%) and abdominal pain (43, 21%). Leukopenia (176 patients, 85%), thrombocytopenia (133, 64%), and elevated liver enzyme levels (154, 76%) were the most common laboratory findings. 46 patients (22%) had serological evidence of previous exposure to dengue virus. WHO guidelines were documented as a management benchmark in ten cases (5%) 46 patients (22%) received non-steroidal anti-inflammatory drugs (NSAIDs). A significant proportion of returning Australian travellers hospitalised for dengue have unrecognised warning signs of severe disease. Many received NSAIDs, which can increase the risk of haemorrhage in dengue. As travel to Asia from Australia continues to increase, it is vital for averting serious outcomes that clinicians can recognise and manage dengue.
Teicoplanin non-susceptible coagulase-negative staphylococci in a large Australian healthcare network: Implications for treatment with vancomycin
Publisher: Sri Lanka Journals Online (JOL)
Date: 04-05-2017
Clostridioides difficile Infection: Clinical Practice and Health Outcomes in 6 Large Tertiary Hospitals in Eastern Australia
Publisher: Oxford University Press (OUP)
Date: 03-05-2023
DOI: 10.1093/OFID/OFAD232
Abstract: Clostridioides difficile infection (CDI) is associated with significant morbidity and mortality in both healthcare and community settings. We aimed to define the predisposing factors, risks for severe disease, and mortality determinants of CDI in eastern Australia over a 1-year period. This is an observational retrospective study of CDI in hospitalized patients aged ≥18 years in 6 tertiary institutions from 1 January 2016 to 31 December 2016. Patients were identified through laboratory databases and medical records of participating institutions. Clinical, imaging, and laboratory data were input into an electronic database hosted at a central site. A total of 578 patients (578 CDI episodes) were included. Median age was 65 (range, 18–99) years and 48.2% were male. Hospital-onset CDI occurred in 64.0%. Recent antimicrobial use (41.9%) and proton pump inhibitor use (35.8%) were common. Significant risk factors for severe CDI were age & years (P & .001), malignancy within the last 5 years (P & .001), and surgery within the previous 30 days (P & .001). Significant risk factors for first recurrence included severe CDI (P = .03) and inflammatory bowel disease (P = .04). Metronidazole was the most common regimen for first episodes of CDI with 65.2% being concordant with Australian treatment guidelines overall. Determinants for death at 60 days included age ≥65 years (P = .01), severe CDI (P & .001), and antibiotic use within the prior 30 days (P = .02). Of those who received metronidazole as first-line therapy, 10.1% died in the 60-day follow-up period, compared to 9.8% of those who received vancomycin (P = .86). Patients who experience CDI are vulnerable and require early diagnosis, clinical surveillance, and effective therapy to prevent complications and improve outcomes.
Effectiveness of H1N1/09 monovalent and trivalent influenza vaccines against hospitalization with laboratory-confirmed H1N1/09 influenza in Australia: A test-negative case control study
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.VACCINE.2011.07.087
Abstract: We aimed to estimate the effectiveness of H1N1/09 containing influenza vaccines against hospitalization from influenza in Australia. We performed a test-negative case control study in patients hospitalized in 15 sentinel Australian hospitals between March and November 2010, comparing influenza vaccination (H1N1/09 monovalent or 2010 seasonal trivalent) in hospitalized patients with PCR-confirmed influenza compared to PCR-negative controls. Between March and November 2010, 1169 hospitalized patients were tested for suspected influenza, of which influenza vaccine status was ascertained in 165/238 patients with H1N1/09 influenza, 40/64 with seasonal influenza and 558/867 test negative controls 24% of H1N1/09 cases, 43% of seasonal influenza cases and 54% of controls were vaccinated. VE against hospitalisation with H1N1/09 influenza after adjusting for age, medical comorbidities and pregnancy status was estimated at 49% (95% CI: 13%, 70%). Influenza vaccination was associated with a reduction in hospitalisation caused by H1N1/09 influenza in the 2010 southern hemisphere winter season.
The microbiology and outcome of sepsis in Victoria, Australia
Publisher: Cambridge University Press (CUP)
Date: 19-08-2005
DOI: 10.1017/S0950268805004796
Abstract: We analysed data from 33741 patients with ICD-10-AM-defined sepsis from an Australian hospital morbidity dataset to investigate the relationships between specific types of organisms, potential risk factors for infection, organ dysfunction, ICU utilization and hospital mortality. A total of 24% of patients received some of their care in an intensive care unit, and the overall hospital mortality rate was 18%. Gram-positive bacteria were isolated in 27% of cases and Gram-negative bacteria in 20%. Sepsis due to Staphylococcus aureus was associated with vascular and joint devices whereas Pseudomonas aeruginosa and Gram-negative rods were more common with genitourinary devices and lymphoproliferative disease. Sepsis-associated organ dysfunction most commonly involved the respiratory system, followed by the renal and circulatory systems. These patterns may provide useful clues to the pathogenesis and therapy of this often fatal syndrome which is a major ongoing problem for hospitalized patients.
Review of HIV testing recommendations in Australian specialty guidelines for HIV indicator conditions: a missed opportunity for recommending testing?
Publisher: Wiley
Date: 03-2020
DOI: 10.1111/IMJ.14641
Abstract: Australian National human immunodeficiency virus (HIV) Testing policy recommends HIV indicator condition-based testing, adapted from the European AIDS Clinical Society (EACS) guidelines. To evaluate the extent that Australian non-HIV specialty guidelines mention and recommend HIV testing in HIV indicator conditions. EACS guidelines were reviewed to produce a list of 24 AIDS-defining conditions (ADC) and 31 indicator conditions (IC) where HIV prevalence >0.1%, and 5 IC where HIV non-diagnosis would have adverse effect on patients' management. Australian guidelines for these conditions were identified from websites of specialty societies, electronic Therapeutic Guidelines, National Health and Medical Research Council (NHMRC), state governments, MEDLINE and Google searches. We identified eight key IC as that were part of the HIDES I study. Overall, 51 ADC and IC had Australian guidelines: 24/51(47%) mention association with HIV and 14/51 (27%) recommend HIV testing. Twenty-five out of 51 (49%) Australian guidelines were for ADC: 18/25(72%) mention association with HIV and 5/25 (20%) recommend testing. Twenty-five out of 51 (49%) were guidelines IC with HIV prevalence of 0.1%: 6/25 (24%) mention HIV association and 8/25 (32%) recommend HIV testing. Two of eight (25%) key IC had no Australian guidelines and 3/8 (38%) do not mention HIV association or recommend HIV testing. Although almost half of HIV non-HIV guidelines for ADC and IC mention HIV association, only 27% specifically recommend HIV testing. This suggests partnership with guideline development and specialist groups may be useful to ensure patients diagnosed with ADC/IC are tested for HIV.
Quadrivalent Human Papillomavirus recombinant vaccine associated lipoatrophy
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.VACCINE.2009.06.026
Abstract: Involutional lipoatrophy, a loss of subcutaneous fat, may be idiopathic, associated with inflammatory skin conditions, or trauma, and has also been reported following injections of medications including insulin, corticosteroids and penicillin. There have also been reports in association with Diptheria Pertussis Tetanus (DPT) vaccine. We report on two cases of lipoatrophy associated with the new Quadrivalent Human Papillomavirus (HPV) recombinant vaccine (Gardasil).
Neurocysticercosis Causing Sudden Death
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2010
Exacerbation phenotyping in chronic obstructive pulmonary disease
Publisher: Wiley
Date: 28-10-2013
DOI: 10.1111/RESP.12197
Abstract: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are crucial events but causes remain poorly defined. A method to clinically 'phenotype' AECOPD have been proposed, and 52 hospitalized chronic obstructive pulmonary disease exacerbations according to underlying aetiology have now been prospectively phenotyped. Multiple exacerbation phenotypes were identified. A subpopulation coinfected with virus and bacteria had a significantly longer length of hospital stay, and this pilot study indicates that exacerbation phenotyping may be advantageous.
Hampered by historical paradigms – echinocandins and the treatment of Candida endocarditis
Publisher: Wiley
Date: 20-11-2013
DOI: 10.1111/MYC.12154
Abstract: Infective endocarditis due to Candida sp. has a high mortality rate. Traditionally, management involves early surgery and prolonged hotericin ± flucytosine. We report a case of Candida parapsilosis bileaflet mitral valve endocarditis cured with anidulafungin and fluconazole, and review the role of echinocandins in the management of Candida endocarditis.
Life-long antimicrobial therapy: where is the evidence?
Publisher: Oxford University Press (OUP)
Date: 04-06-2018
DOI: 10.1093/JAC/DKY174
Abstract: The decision to prescribe long-term or 'life-long' antibiotics in patients requires careful consideration by the treating clinician. While several guidelines exist to help assist in this decision, the long-term consequences are yet to be well studied. In this review, we aim to provide a summary of the available evidence for patient populations where long-term antibiotic therapy is currently recommended in clinical practice. We will also discuss the pitfalls of this approach, including medication adverse effects, economic cost and any possible contribution to the emerging epidemic of microbial resistance.
Corynebacterium macginleyi in the era of MALDI-TOF MS: epidemiology, susceptibility patterns and prevalence of co-infection
Publisher: Elsevier BV
Date: 04-2022
Investigation of an outbreak of Serratia marcescens in a neonatal unit via a case-control study and molecular typing
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.AJIC.2006.12.012
Abstract: In March 2004, infection or colonization with Serratia marcescens affected one third of all neonates in a newborn services unit (NBS). We performed a case-control study and automated ribotyping. Forty-nine cases were compared with 64 controls. The overall mean length of stay (LOS) in the NBS was 67 days for cases and 36 days for controls, P = .005. Cases were of lower mean birth weight than controls (1566 g vs 1968 g, respectively, P = .02). Risk factors that trended toward significance for S marcescens acquisition included the following: premature rupture of membranes (odds ratio [OR], 2.7 95% confidence interval [95% CI]: 1.0-7.1 P = .05), vaginal delivery at our hospital (OR, 2.1 95% CI: 0.9-4.6 P = .06), intubation at delivery (OR, 2.3 95% CI: 0.9-5.2 P = .05), mechanical ventilation (OR, 2.1 95% CI: 0.9-4.4 P = .06), and theophylline treatment (OR, 2.5 95% CI: 1.1-5.4 P = .02). Multiple logistic regression analysis revealed vaginal delivery at our hospital (OR, 3.4 95% CI: 1.4-8.2 P = .007) and LOS >30 days (OR, 4.4 95% CI: 1.8-10.6 P = .001) as independent risk factors for S marcescens acquisition. Ribotyping of specimens revealed 5 restriction patterns. Cases were of lower birth weight than controls, were born by vaginal delivery at our hospital, had longer LOS in NBS, and had greater requirements for respiratory support. Ribotyping of specimens revealed that this outbreak was not clonal.
Rat-bite fever septic arthritis: illustrative case and literature review
Publisher: Springer Science and Business Media LLC
Date: 10-11-2006
DOI: 10.1007/S10096-006-0224-X
Abstract: Rat-bite fever is a rare zoonotic infection caused by Streptobacillus moniliformis or Spirillum minus, which is characterised by fever, rash and arthritis. The arthritis has previously been described as non-suppurative and isolation of the organism from synovial fluid as very uncommon. This article reports a case of septic arthritis diagnosed as rat-bite fever when the organism was cultured from synovial fluid and reviews another 15 cases of S. moniliformis septic arthritis reported in the worldwide literature since 1985. Articles were included in this review if S. moniliformis was cultured from synovial fluid. Of the published cases, 88% presented with polyarthritis, affecting small and large joints although two had monoarticular hip sepsis. Fever was present in 88%, rash in 25% and 56% had extra-articular features. Synovial fluid analysis revealed high cell counts in all cases (mean 51,000 x 10(9)/l) with a predominance of polymorphonuclear leucocytes, and organisms were found on Gram stain in only 50%. Penicillin was used for treatment in 56% of cases and surgery was required in 30%. All patients recovered. Rat-bite fever arthritis can be suppurative and attempts should be made to isolate the organism from synovial fluid. The diagnosis should be considered when there is arthritis and a high synovial fluid cell count but no apparent organism, especially when the patient has had contact with rats.
What's hanging around your neck? Pathogenic bacteria on identity badges and lanyards
Publisher: AMPCo
Date: 2008
DOI: 10.5694/J.1326-5377.2008.TB01494.X
Abstract: To determine whether identity badges and lanyards worn by health care workers (HCWs) are capable of harbouring potentially pathogenic bacteria. Cross-sectional study of 71 HCWs (59 clinical ward staff and 12 infection control staff) at Monash Medical Centre, a university teaching hospital. S les from lanyards, identity badge surfaces and connections (eg, clips, keys, pens) were cultured. The study was conducted from July to August 2006. Presence of pathogenic bacteria on identity badges and lanyards differences in bacterial counts on items carried by nurses and doctors. A total of 27 lanyards were identified with pathogenic bacteria, compared with 18 badges. Analysing lanyards and badges as a combined group, seven had methicillin-resistant Staphylococcus aureus, 29 had methicillin-sensitive S. aureus (MSSA), four had Enterococcus spp and five had aerobic gram-negative bacilli. Lanyards were found to be contaminated with 10 times the median bacterial load per area s led compared with identity badges. There were no significant differences between nurses and doctors in total median bacterial counts on items carried, but doctors had 4.41 times the risk of carrying MSSA on lanyards (95% CI, 1.14-13.75). Identity badges and lanyards worn by HCWs may be contaminated with pathogenic bacteria, which could be transmitted to patients. In view of this finding we suggest appropriate infection control interventions.
Multi-site implementation of whole genome sequencing for hospital infection control: A prospective genomic epidemiological analysis
Publisher: Elsevier BV
Date: 06-2022
Infective Endocarditis in Patients on Chronic Hemodialysis
Publisher: Elsevier BV
Date: 04-2021
Foreign tick smuggling rickettsia evades Australian border control
Publisher: AMPCo
Date: 06-2018
DOI: 10.5694/MJA17.01201
Acquired bloodstream infection in the intensive care unit: Incidence and attributable mortality
Publisher: Springer Science and Business Media LLC
Date: 2011
DOI: 10.1186/CC10114
Diagnosis and Management of Clostridium difficile Infection
Publisher: Georg Thieme Verlag KG
Date: 02-02-2015
Abstract: There have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease, attributed to the emergence of a fluoroquinolone-resistant "hypervirulent" strain, ribotype 027. C. difficile is now the most common pathogen causing hospital-acquired infection in U.S. hospitals, and community-acquired infections are increasing. The diagnosis of CDI is based on a combination of signs and symptoms, confirmed by laboratory tests. Clinical manifestations of CDI can range from asymptomatic colonization to severe pseudomembranous colitis and death. Many aspects of laboratory diagnosis of CDI remain contentious. Toxin enzyme immunoassays are too insensitive to be used alone, while nucleic acid lification tests have emerged as an option, either as a stand-alone test or as part of a multitest algorithm. Oral vancomycin and metronidazole have been the recommended antimicrobial therapy options, and fidaxomicin is an effective new alternative. There is ongoing concern regarding the potential inferiority of metronidazole, in particular for severe CDI. Management of severe CDI and recurrent CDI continue to represent major treatment challenges. Biological therapies for the restoration of the intestinal microbiota (e.g., fecal microbiota transplantation) and monoclonal antibody therapy are promising approaches for CDI management, in particular troublesome recurrent CDI. This review will concentrate on the diagnosis and management of CDI in adults.
Candida Infective Endocarditis: an Observational Cohort Study with a Focus on Therapy
Publisher: American Society for Microbiology
Date: 04-2015
DOI: 10.1128/AAC.04867-14
Abstract: Candida infective endocarditis is a rare disease with a high mortality rate. Our understanding of this infection is derived from case series, case reports, and small prospective cohorts. The purpose of this study was to evaluate the clinical features and use of different antifungal treatment regimens for Candida infective endocarditis. This prospective cohort study was based on 70 cases of Candida infective endocarditis from the International Collaboration on Endocarditis (ICE)-Prospective Cohort Study and ICE-Plus databases collected between 2000 and 2010. The majority of infections were acquired nosocomially (67%). Congestive heart failure (24%), prosthetic heart valve (46%), and previous infective endocarditis (26%) were common comorbidities. Overall mortality was high, with 36% mortality in the hospital and 59% at 1 year. On univariate analysis, older age, heart failure at baseline, persistent candidemia, nosocomial acquisition, heart failure as a complication, and intracardiac abscess were associated with higher mortality. Mortality was not affected by use of surgical therapy or choice of antifungal agent. A subgroup analysis was performed on 33 patients for whom specific antifungal therapy information was available. In this subgroup, 11 patients received hotericin B-based therapy and 14 received echinocandin-based therapy. Despite a higher percentage of older patients and nosocomial infection in the echinocandin group, mortality rates were similar between the two groups. In conclusion, Candida infective endocarditis is associated with a high mortality rate that was not impacted by choice of antifungal therapy or by adjunctive surgical intervention. Additionally, echinocandin therapy was as effective as hotericin B-based therapy in the small subgroup analysis.
Population-based surveillance for scedosporiosis in Australia: Epidemiology, disease manifestations and emergence of Scedosporium aurantiacum infection
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1111/J.1469-0691.2009.02802.X
Abstract: Australia-wide population-based surveillance for scedosporiosis identified 180 cases, with 118 (65.6%) cases of colonization and 62 (34.4%) cases of infection. Predisposing factors for isolation of Scedosporium spp. included chronic lung disease in 37.8% and malignancy in 21.7% of cases. Predictors of invasive disease (n=62) included haematological stem cell transplantation (n=7), leukaemia (n=16) and diabetes mellitus (n=8). Of 183 phenotypically-speciated isolates, 75 (41%) were Scedosporium prolificans (risk factors: haematologic cancer (n=17), neutropaenia (n=14)) and 108 (59%) had Scedosporium apiospermum/Pseudallescheria boydii phenotype [risk factor: diabetes (n=15)]. Scedosporium prolificans (p 0.01) and leukaemia (p 0.03) independently predicted death. Epidemiological and antifungal susceptibility profiles of Scedosporium aurantiacum (prevalence>or=15.8%) and S. apiospermum were similar. No patient with S. aurantiacum infection (n=6) died. This is the first description of clinical features associated with S. aurantiacum.
Viral Genomics to Inform Infection-control Response in Occupational Coronavirus Disease 2019 (COVID-19) Transmission
Publisher: Oxford University Press (OUP)
Date: 14-09-2020
DOI: 10.1093/CID/CIAA1385
Abstract: Healthcare workers are at increased risk of occupational transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report 2 instances of healthcare workers contracting SARS-CoV-2 despite no known breach of personal protective equipment. Additional specific equipment cleaning was initiated. Viral genomic sequencing supported this transmission hypothesis and our subsequent response.
Vancomycin minimum inhibitory concentration, host comorbidities and mortality in staphylococcus aureus bacteraemia
Publisher: Elsevier BV
Date: 12-2013
Candidaemia with uncommon Candida species: Predisposing factors, outcome, antifungal susceptibility, and implications for management
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1111/J.1469-0691.2009.02821.X
Abstract: The risk factors for and clinical features of bloodstream infection with uncommon Candida spp. (species other than C. albicans, C. glabrata, C. parapsilosis, C. tropicals and C. krusei) are incompletely defined. To identify clinical variables associated with these species that might guide management, 57 cases of candidaemia resulting from uncommon Candida spp. were analysed in comparison with 517 episodes of Candida albicans candidaemia (2001-2004). Infection with uncommon Candida spp. (5.3% of candidaemia cases), as compared with C. albicans candidaemia, was significantly more likely to be outpatient-acquired than inpatient-acquired (15 of 57 vs. 65 of 517 episodes, p 0.01). Prior exposure to fluconazole was uncommon (n=1). Candida dubliniensis was the commonest species (n=22, 39%), followed by Candida guilliermondii (n=11, 19%) and Candida lusitaniae (n=7, 12%).C. dubliniensis candidaemia was independently associated with recent intravenous drug use (p 0.01) and chronic liver disease (p 0.03), and infection with species other than C. dubliniensis was independently associated with age<65 years (p 0.02), male sex (p 0.03) and human immunodeficiency virus infection (p 0.05). Presence of sepsis at diagnosis and crude 30-day mortality rates were similar for C. dubliniensis-related, non-C. dubliniensis-related and C. albicans-related candidaemia. Haematological malignancy was the commonest predisposing factor in C. guilliermondii (n=3, 27%) and C. lusitaniae (n=3, 43%) candidaemia. The 30-day mortality rate of C. lusitaniae candidaemia was higher than the overall death rate for all uncommon Candida spp. (42.9% vs. 25%, p not significant). All isolates were susceptible to hotericin B, voriconazole, posaconazole, and caspofungin five strains (9%) had fluconazole MIC values of 16-32 mg/L. Candidaemia due to uncommon Candida spp. is emerging among hospital outpatients certain clinical variables may assist in recognition of this entity.
Under-utilisation of cardioprotective glucose-lowering medication in diabetics living with HIV
Publisher: CSIRO Publishing
Date: 23-08-2022
DOI: 10.1071/SH22070
Abstract: Diabetes is an increasingly common co-morbidity in people living with HIV (PLWH). Given new evidence demonstrating cardiovascular benefits of sodium glucose transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1RA) in diabetic patients, we reviewed medical charts of 262 PLWH at Monash Health through a 1-year retrospective cohort study to determine the rates of their use. Prevalence of diabetes was 13.4% (35) and 60% (21) had microvascular and macrovascular complications. Only 4% (95% CI 0.1%–19.6%) of diabetic patients were receiving SGLT2i and 19% (95% CI 6%–39.4%) were receiving GLP1RA. Prescribers should carefully consider their choice of glucose-lowering medication when treating PLWH.
Streptococcus pyogenes aortic aneurysm infection: forgotten but not gone
Publisher: MDPI AG
Date: 07-11-2013
DOI: 10.4081/IDR.2013.E11
Abstract: Historically, Streptococcus pyogenes was a common cause of endocarditis and infected aortic aneurysm. Today, endovascular infections due to this organism have become exceedingly rare. We report the first case of aortic aneurysm infection due to S. pyogenes treated with initial endoluminal repair, review previous reports and discuss current treatment options.
Identification and diversity of Actinomyces species in a clinical microbiology laboratory in the MALDI-TOF MS era
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.ANAEROBE.2018.09.007
Abstract: Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has emerged as a reliable tool for bacterial identification. This study compared the Bruker MALDI-TOF BioTyper MS (MBT) and 16S rRNA gene sequencing for the identification of Actinomyces and Actinotignum spp. The MBT identified 68/77 (88.3%) of Actinomyces isolates to the genus-level and 44/77 (57.1%) of Actinomyces isolates to the species-level using the manufacturer's identification criteria. The MBT did not yield reliable identification for only 1/77 (1.3%) and generated no identification for 8/77 (10.4%) of the isolates. No misidentifications were found. Discordance at the species level was observed for eight isolates. Overall, the MBT demonstrated good concordance with the 16S rRNA gene sequencing with the exception of the closely related species A. naeslundii, A. viscosus and A. oris. A variety of Actinomyces spp. were isolated from orocervicofacial/dental specimens, but only a limited number of species were isolated from urine or intra-abdominal specimens. This study confirms the utility of MBT in the identification of Actinomyces spp. and describes the ersity and anatomic niche of species in human clinical specimens from various body sites.
A history of infection with varicella is strongly predictive of the presence of varicella-zoster virus antibodies in a heterogenous Australian HIV cohort
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-09-2015
Fatal case of toxic shock-like syndrome due to group C streptococcus associated with superantigen exotoxin
Publisher: American Society for Microbiology
Date: 06-2004
DOI: 10.1128/JCM.42.6.2866-2869.2004
Abstract: Group C streptococci have been reported to cause invasive disease similar to that classically associated with group A streptococcus (GAS). We describe a fatal case of toxic shock-like syndrome due to Streptococcus equi subsp. zooepidemicus . The causative organism did not possess any known GAS superantigen exotoxin genes but did show evidence of superantigen production.
Antibiotic Choice May Not Explain Poorer Outcomes in Patients With Staphylococcus aureus Bacteremia and High Vancomycin Minimum Inhibitory Concentrations
Publisher: Oxford University Press (OUP)
Date: 08-2011
Abstract: There are concerns about reduced efficacy of vancomycin in patients with Staphylococcus aureus bacteremia (SAB), especially when the minimum inhibitory concentration (MIC) nears the upper limit of the susceptible range. We examined the relationship between antibiotic treatment, 30-day mortality, and microbiologic parameters in a large Australasian cohort of patients with SAB. We assessed 532 patients with SAB from 8 hospitals. All patients with methicillin-resistant S. aureus (MRSA) bacteremia were treated with vancomycin, and patients with methicillin-susceptible S. aureus (MSSA) bacteremia received either flucloxacillin or vancomycin. Increasing vancomycin MIC was associated with increased mortality in vancomycin-treated patients. However, even in patients with MSSA bacteremia treated with flucloxacillin, mortality was also higher if the vancomycin Etest MIC of their isolate was >1.5 μg/mL, compared with those with lower MIC isolates (26.8% vs 12.2% P < .001). After adjustment in a multivariate model, age, hospital-onset SAB and vancomycin MIC were independently associated with mortality, but methicillin resistance and antibiotic choice were not. We have confirmed an association between higher vancomycin MIC and increased mortality in patients with SAB, but surprisingly this relationship was not related to the antibiotic treatment received, suggesting that the use of vancomycin per se is not responsible for the poorer outcome.
Molecular characterization and antimicrobial susceptibilities of Clostridium difficile clinical isolates from Victoria, Australia
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.ANAEROBE.2015.05.001
Abstract: Some Australian strain types of Clostridium difficile appear unique, highlighting the global ersity of this bacterium. We examined recent and historic local isolates, finding predominantly toxinotype 0 strains, but also toxinotypes V and VIII. All isolates tested were susceptible to vancomycin and metronidazole, while moxifloxacin resistance was only detected in recent strains.
Duration of in vivo antimicrobial activity of antibiotic-impregnated cerebrospinal fluid catheters
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2006
DOI: 10.1227/01.NEU.0000210155.65102.E7
Abstract: Shunt infection is a major neurosurgical concern even after 50 years of experience with shunt surgery. Staphylococcus species are responsible for the majority of cerebrospinal fluid shunt infections. In vitro, antibiotic-impregnated cerebrospinal fluid shunt catheters (AIC) have demonstrated protection against multiple staphylococcus species and strains for reasonable periods. We aim to study the longevity of antimicrobial activity of AIC in vivo by using explanted catheters. Twenty-five AICs (rif icin [0.054%] and clindamycin [0.15%]) were explanted from 18 patients for noninfectious reasons, from 11 to 700 days postimplantation. The catheters were set up on standardized Staphylococcus aureus culture plates to detect antimicrobial activity. Unused fresh AIC segments were used as control in each culture plates. Fourteen explanted AICs demonstrated persistent antimicrobial activity against staphylococcal species. Antimicrobial activity was detected for a period of implantation up to 127 days. This is longer than that predicted by in vitro models. The persistent antimicrobial activity is likely to translate to ongoing in vivo antimicrobial protection. This period of protection exceeds that during which most shunt infections occur.
Decreased Copper in Alzheimer’s Disease Brain Is Predominantly in the Soluble Extractable Fraction
Publisher: Hindawi Limited
Date: 2013
DOI: 10.1155/2013/623241
Abstract: Alzheimer’s disease (AD) is the leading cause of dementia and represents a significant burden on the global economy and society. The role of transition metals, in particular copper (Cu), in AD has become of significant interest due to the dyshomeostasis of these essential elements, which can impart profound effects on cell viability and neuronal function. We tested the hypothesis that there is a systemic perturbation in Cu compartmentalization in AD, within the brain as well as in the periphery, specifically within erythrocytes. Our results showed that the previously reported decrease in Cu within the human frontal cortex was confined to the soluble ( P 0.05 ) and total homogenate ( P 0.05 ) fractions. No differences were observed in Cu concentration in erythrocytes. Our data indicate that there is a brain specific alteration in Cu levels in AD localized to the soluble extracted material, which is not reflected in erythrocytes. Further studies using metalloproteomics approaches will be able to elucidate the metabolic mechanism(s) that results in the decreased brain Cu levels during the progression of AD.
Surveillance of life-long antibiotics—A cross-sectional cohort study assessing patient attitudes and understanding of long-term antibiotic consumption
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.IDH.2019.05.002
Abstract: Some patients receive long-term or life-long antibiotics for suppression of infections deemed otherwise incurable. Little is known about the consequences of this strategy. We aimed to explore patients' attitudes towards and knowledge concerning prolonged antibiotic therapy. A cross-sectional cohort pilot study of outpatients on long-term antibiotics was performed. Surveys were conducted at our healthcare network in Victoria, Australia between April and December 2015. Microbiological screening for multi-resistant organisms (MRO) was also performed. Heterogeneity was noted in the prescribed antibiotics and documented indications, with rif icin and fusidic acid for suppression of prosthetic joint infection the most common regimen and indication. 41% (12/29) of participants reported side-effects attributed to their antibiotics, but 72% (21/29) still declared complete adherence to their prescribed regimen. 76% (22/29) of participants stated that they would cease their long-term antibiotics based on medical advice. 19/29 (66%) participants consented to microbiological screening and 4 were found to be colonised with MROs. They had spent more days as an inpatient in the preceding 12 months than the screened participants who were not colonised. Participants in this study had a good understanding of their infection and the indications for their long-term antibiotic therapy, and were adherent to this therapy despite many experiencing side-effects attributed to their antibiotics. Patients who are prescribed life-long antibiotics can be carriers of multi-resistant organisms, but both the drivers of this resistance, and the broader impact of colonisation with MRO in this population is unclear.
Long-Term Outcomes in Patients on Life-Long Antibiotics: A Five-Year Cohort Study
Publisher: MDPI AG
Date: 05-01-2022
DOI: 10.3390/ANTIBIOTICS11010062
Abstract: Background: Little is known about the impacts at an in idual level of long-term antibiotic consumption. We explored health outcomes of long-term antibiotic therapy prescribed to a cohort of patients to suppress infections deemed incurable. Methods: We conducted a 5-year longitudinal study of patients on long-term antibiotics at Monash Health, a metropolitan tertiary-level hospital network in Australia. Adults prescribed antibiotics for months to suppress chronic infection or prevent recurrent infection were included. A retrospective review of medical records and a descriptive analysis was conducted. Results: Twenty-seven patients were followed up during the study period, from 29 patients originally identified in Monash Health in 2014. Seven of the 27 patients (26%) died from causes unrelated to the suppressed infection, six (22%) ceased long-term antibiotic therapy and two (7%) required treatment modification. Fifteen (56%) were colonised with multiresistant microorganisms, including vancomycin resistant Enterococci, methicillin resistant Staphylococcus aureus, and carbapenem resistant Enterobacteriaciae. Conclusions: This work highlights the potential pitfalls of long-term antibiotic therapy, and the frailty of this cohort, who are often ineligible for definitive curative therapy.
Underdiagnosis of Chlamydia trachomatis and Chlamydia psittaci revealed by introduction of respiratory multiplex PCR assay with Chlamydiaceae family primers
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.DIAGMICROBIO.2017.11.013
Abstract: We describe unanticipated detection of respiratory infection with Chlamydia trachomatis and Chlamydia psittaci after introduction of respiratory multiplex polymerase chain reaction assay that includes Chlamydiaceae family primers. We detected cases of pediatric C. trachomatis and of adult C. psittaci infection in patients with previously unrecognized risk factors. Directed testing for C. trachomatis and C. psittaci based on clinical features and risk factors alone is likely to miss the majority of infected cases.
One-year outcome following biological or mechanical valve replacement for infective endocarditis
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.IJCARD.2014.10.125
Abstract: Nearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality. Among 5591 patients included in the International Collaboration on Endocarditis Prospective Cohort Study, 1467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement. Patients who received bioprostheses were older (62 vs 54years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%) proportion of health care-associated IE was higher (26% vs 17%) intracardiac abscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p=0.0009) and 25.3% vs 16.6% (p<.0001), respectively. In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60). Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298). Patients with IE who receive a biological valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biological valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction.
Molecular characterization of fosfomycin-resistant Escherichia coli urinary tract infection isolates from Australia
Publisher: Elsevier BV
Date: 09-2021
Curtobacterium flaccumfaciens Septic Arthritis following Puncture with a Coxspur Hawthorn Thorn
Publisher: American Society for Microbiology
Date: 07-2011
DOI: 10.1128/JCM.00340-11
Abstract: Curtobacterium species are recognized plant pathogens. We report the first well-documented case of Curtobacterium human infection, a child with septic arthritis following puncture with a Coxspur Hawthorn plant thorn. The organism isolated from synovial tissue and the plant thorn was identified as Curtobacterium flaccumfaciens by 16S rRNA gene sequence analysis.
Heterogeneous Vancomycin‐Intermediate Susceptibility Phenotype in Bloodstream Methicillin‐ResistantStaphylococcus aureusIsolates from an International Cohort of Patients with Infective Endocard
Publisher: Oxford University Press (OUP)
Date: 11-2009
DOI: 10.1086/606027
Phylogenetic analysis of viridans group streptococci causing endocarditis
Publisher: American Society for Microbiology
Date: 09-2008
DOI: 10.1128/JCM.00920-08
Abstract: Identification of viridans group streptococci (VGS) to the species level is difficult because VGS exchange genetic material. We performed multilocus DNA target sequencing to assess phylogenetic concordance of VGS for a well-defined clinical syndrome. The hierarchy of sequence data was often discordant, underscoring the importance of establishing biological relevance for finer phylogenetic distinctions.
Antiretroviral treatment use, co-morbidities and clinical outcomes among Aboriginal participants in the Australian HIV Observational Database (AHOD)
Publisher: Springer Science and Business Media LLC
Date: 12-08-2015
Different faces of N ocardia infection in renal transplant recipients
Publisher: Wiley
Date: 28-01-2016
DOI: 10.1111/NEP.12585
Abstract: Nocardia infections are an uncommon but important cause of morbidity and mortality in renal transplant recipients. The present study was carried out to determine the spectrum of Nocardia infections in a renal transplant centre in Australia. A retrospective chart analysis of all renal transplants performed from 2008 to 2014 was conducted to identify cases of culture proven Nocardia infection. The clinical course for each patient with nocardiosis was examined. Four of the 543 renal transplants patients developed Nocardia infection within 2 to 13 months post-transplant. All patients were judged at high immunological risk of rejection pre-transplant and had received multiple sessions of plasmaphoeresis and intravenous immunoglobulin before the onset of the infection. Two patients presented with pulmonary nocardiosis and two with cerebral abscesses. One case of pulmonary nocardiosis was complicated by pulmonary aspergillosis and the other by cytomegalovirus pneumonia. All four patients improved with combination antibiotic therapy guided by drug susceptibility testing. At the time of Nocardia infection all four patients were receiving primary prophylaxis with trimethoprim/sulphamethoxazole (TMP/SMX) 160/800 mg, twice weekly. Plasmaphoeresis may be risk factor for Nocardia infection and need further study. Nocardia infection may coexist with other opportunistic infections. Identification of the Nocardia species and drug susceptibility testing is essential in guiding the effective management of patients with Nocardia. Intermittent TMP-SMX (one double strength tablet, twice a week) appears insufficient to prevent Nocardia infection in renal transplant recipients.
Genetic and molecular predictors of high vancomycin MIC in Staphylococcus aureus bacteremia isolates
Publisher: American Society for Microbiology
Date: 09-2014
DOI: 10.1128/JCM.01320-14
Abstract: An elevated vancomycin MIC is associated with poor outcomes in Staphylococcus aureus bacteremia (SAB) and is reported in patients with methicillin-susceptible S. aureus (MSSA) bacteremia in the absence of vancomycin treatment. Here, using DNA microarray and phenotype analysis, we investigated the genetic predictors and accessory gene regulator ( agr ) function and their relationship with elevated vancomycin MIC using blood culture isolates from a multicenter binational cohort of patients with SAB. Specific clonal complexes were associated with elevated (clonal complex 8 [CC8] [ P 0.001]) or low (CC22 [ P 0.001], CC88 [ P 0.001], and CC188 [ P = 0.002]) vancomycin MIC. agr dysfunction ( P = 0.014) or agr genotype II ( P = 0.043) were also associated with an elevated vancomycin MIC. Specific resistance and virulence genes were also linked to an elevated vancomycin MIC, including blaZ ( P = 0.002), sea ( P 0.001), clfA ( P 0.001), splA ( P = 0.001), and the arginine catabolic mobile element (ACME) locus ( P = 0.02). These data suggest that inherent organism characteristics may explain the link between elevated vancomycin MICs and poor outcomes in patients with SAB, regardless of the antibiotic treatment received. A consideration of clonal specificity should be included in future research when attempting to ascertain treatment effects or clinical outcomes.
Contamination of renal patients hospital chart covers with vancomycin resistant enterococci: Handle!with care
Publisher: OMICS Publishing Group
Date: 11-2011
DOI: 10.4066/AMJ.2011.726
Should we routinely test for Mycoplasma genitalium when testing for other sexually transmitted infections?
Publisher: AMPCo
Date: 10-11-2020
DOI: 10.5694/MJA2.50399
Emergence of a Ribotype 244 Strain of Clostridium difficile Associated With Severe Disease and Related to the Epidemic Ribotype 027 Strain
Publisher: Oxford University Press (OUP)
Date: 04-04-2014
DOI: 10.1093/CID/CIU203
Abstract: We identified 12 patients with Clostridium difficile infection between July 2011 and March 2012 from whom an unusual C. difficile strain was isolated. This strain had a single-nucleotide deletion of the tcdC gene at position 117 and binary toxin genes, which are characteristic of the hypervirulent ribotype (RT) 027 strain. A retrospective cohort study of 12 patients infected with C. difficile RT244 and 24 patients infected with non-RT244/non-RT027 strains matched for place of diagnosis and time of collection of specimen was performed. We performed whole-genome sequencing to understand the relationship of the RT244 strain to other C. difficile strains and further understand its virulence potential. Clostridium difficile RT244 was associated with more severe disease and a higher mortality rate. Phylogenomic analysis using core genome single-nucleotide polymorphisms showed that RT244 is in the same genetic clade (clade 2) as RT027 but is distinct from all RT027 strains. The pathogenicity locus of the RT244 strain encodes a variant toxin B, and this was confirmed by demonstration of Clostridium sordellii-like cytopathic effect on Vero cells. Toxin B production in culture supernatants was lower than that seen with a RT027 strain. Our findings demonstrate the pathogenic potential of this RT244 C. difficile strain and emphasize the importance of ongoing surveillance for emergent strains.
Acute pancreatitis caused by tipranavir/ritonavir-induced hypertriglyceridaemia [3]
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-02-2007
Distribution of ESBLs, AmpC β-lactamases and carbapenemases among Enterobacteriaceae isolates causing intra-abdominal and urinary tract infections in the Asia-Pacific region during 2008–14: results fr
Publisher: Oxford University Press (OUP)
Date: 04-10-2016
DOI: 10.1093/JAC/DKW398
Surveillance for antimicrobial resistance in Australian isolates of Clostridium difficile, 2013-14
Publisher: Oxford University Press (OUP)
Date: 28-07-2015
DOI: 10.1093/JAC/DKV220
Abstract: The objective of this study was to determine the activity of fidaxomicin and comparator antimicrobials against Clostridium difficile isolated from patients with C. difficile infection (CDI) in Australian hospitals and in the community. One private and one public laboratory from five states in Australia submitted a total of 474 isolates/PCR-positive stool s les during three collection periods in August-September 2013 (n = 175), February-March 2014 (n = 134) and August-September 2014 (n = 165). Isolate identification was confirmed by selective culture for C. difficile and a proportion of isolates from each state were characterized by PCR for toxin genes and PCR ribotyping. MICs of fidaxomicin and eight comparator antimicrobials were determined for all isolates using agar methodology. Site collection yielded 440 isolates of C. difficile and PCR revealed a heterogeneous strain population comprising 37 different PCR ribotypes (RTs), 95% of which were positive for tcdA and tcdB (A+B+). The most common RTs were 014 (29.8%) and 002 (15.9%). Epidemic RT 027 was not identified however, small numbers of virulent RTs 078 and 244 were found. Resistance to vancomycin, metronidazole and fidaxomicin was not detected and resistance to moxifloxacin was very low (3.4%). Fidaxomicin showed potent in vitro activity against all 440 isolates (MIC50/MIC90 0.03/0.12 mg/L) and was superior to metronidazole (MIC50/MIC90 0.25/0.5 mg/L) and vancomycin (MIC50/MIC90 1/2 mg/L). These data confirm the potent in vitro activity of fidaxomicin against C. difficile. Moreover, this study provides an important baseline for ongoing long-term surveillance of antimicrobial resistance and prospective tracking of prominent and emerging strain types.
Victorian Specialist Immunisation Services (VicSIS) – bolstering adult clinics for COVID-19 vaccines
Publisher: Informa UK Limited
Date: 26-04-2022
Dengue fever in travellers: are we missing warning signs of severe dengue in a non‐endemic setting?
Publisher: AMPCo
Date: 04-2016
DOI: 10.5694/MJA15.01183
C-reactive protein and immature-to-total neutrophil ratio have no utility in guiding lumbar puncture in suspected neonatal sepsis
Publisher: Wiley
Date: 30-03-2018
DOI: 10.1111/JPC.13890
Abstract: Meningitis may complicate neonatal sepsis, but there is scant evidence to inform the decision to perform a lumbar puncture (LP) and considerable variation in practice. We investigated whether inflammatory markers - C-reactive protein (CRP) and immature-to-total neutrophil ratio (ITR) - were predictive of meningitis or significant cerebrospinal fluid (CSF) pleocytosis and useful in guiding the decision to perform a LP. We studied all inpatients in a single tertiary neonatal unit who were <6 months of age who had a LP performed between March 2011 and October 2014. We categorised CSF results as follows: (i) culture-positive meningitis (ii) probable culture-negative meningitis but meeting a priori criteria for significant CSF leucocytosis or (iii) no evidence of meningitis. CRP and ITR obtained within 48 h of LP were analysed. We assessed the test performance of CRP and ITR by area under receiver operating characteristic curves. A total of 757 (male 471, 62.2%) infants were included. The median (interquartile range) gestational age was 38.4 weeks (30-40.3), and birthweight was 2940 g (1330-3560). Ten (1.3%) infants had culture-positive meningitis 71 (9.4%) were classified as probable culture-negative meningitis and 676 (89.3%) as non-meningitis. The area under receiver operating characteristic curve for culture-positive and probable culture-negative meningitis was 0.43 for CRP (95% confidence interval 0.36-0.51) and 0.58 for ITR (0.51-0.65). At a CRP threshold of 30 mg/L, there was a positive likelihood ratio (LR) of 0.77 and a negative LR of 1.44. CRP and ITR perform poorly in identifying infants with confirmed or probable meningitis. The decision to perform an LP should be more focused on clinical grounds and/or a positive blood culture and less on inflammatory or haematological markers in isolation.
Influenza epidemiology in patients admitted to sentinel Australian hospitals in 2017: the Influenza Complications Alert Network (FluCAN)
Publisher: Australian Government Department of Health
Date: 16-09-2019
Abstract: The Influenza Complications Alert Network (FluCAN) is a sentinel-hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2017 influenza season. In this observational surveillance system, cases were defined as patients admitted to any of the 17 sentinel hospitals with influenza confirmed by nucleic acid detection. Data are also collected on a frequency-matched control group of influenza-negative patients admitted with acute respiratory infection. During the period 3 April to 31 October 2017 (the 2017 influenza season), 4,359 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 52% were elderly (≥65 years), 14% were children ( years), 6.5% were Aboriginal and Torres Strait Islander peoples, 1.6% were pregnant and 78% had chronic comorbidities. A significant proportion were due to influenza B (31%). Estimated vaccine coverage was 72% in the elderly (≥65 years), 50% in non-elderly adults with medical comorbidities and 24% in children ( years) with medical comorbidities. The estimated vaccine effectiveness (VE) in the target population was 23% (95% CI: 7%, 36%). There were a large number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2017, with case numbers more than twice that reported in 2016.
SMART‐COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community‐Acquired Pneumonia
Publisher: Oxford University Press (OUP)
Date: 08-2008
DOI: 10.1086/589754
Abstract: Existing severity assessment tools, such as the pneumonia severity index (PSI) and CURB-65 (tool based on confusion, urea level, respiratory rate, blood pressure, and age >or=65 years), predict 30-day mortality in community-acquired pneumonia (CAP) and have limited ability to predict which patients will require intensive respiratory or vasopressor support (IRVS). The Australian CAP Study (ACAPS) was a prospective study of 882 episodes in which each patient had a detailed assessment of severity features, etiology, and treatment outcomes. Multivariate logistic regression was performed to identify features at initial assessment that were associated with receipt of IRVS. These results were converted into a simple points-based severity tool that was validated in 5 external databases, totaling 7464 patients. In ACAPS, 10.3% of patients received IRVS, and the 30-day mortality rate was 5.7%. The features statistically significantly associated with receipt of IRVS were low systolic blood pressure (2 points), multilobar chest radiography involvement (1 point), low albumin level (1 point), high respiratory rate (1 point), tachycardia (1 point), confusion (1 point), poor oxygenation (2 points), and low arterial pH (2 points): SMART-COP. A SMART-COP score of >or=3 points identified 92% of patients who received IRVS, including 84% of patients who did not need immediate admission to the intensive care unit. Accuracy was also high in the 5 validation databases. Sensitivities of PSI and CURB-65 for identifying the need for IRVS were 74% and 39%, respectively. SMART-COP is a simple, practical clinical tool for accurately predicting the need for IRVS that is likely to assist clinicians in determining CAP severity.
The burden of infective endocarditis in an Australian cohort of people who inject drugs
Publisher: Wiley
Date: 10-2019
DOI: 10.1111/IMJ.14717
Abstract: Infective endocarditis (IE) results in substantial morbidity and mortality in people who inject drugs (PWID). To describe the burden of IE and its outcomes in PWID. Retrospective cohort study of adults admitted to a tertiary referral centre in Melbourne, Australia, with IE due to injection drug use from 1997 to 2015. Ninety-seven PWID with 127 episodes of IE were identified with a median acute inpatient stay of 37 days (1-84). Admission to an intensive care unit was required in 67/127 (53%) episodes. Twenty-seven percent (34/127) of episodes occurred in patients with a previous episode of endocarditis. One third (43/127, 34%) of episodes involved left-sided cardiac valves. Antimicrobial treatment was completed in 88 (70%) episodes. Valve surgery was performed in 25/127 (20%) episodes. Predictors of surgery in univariable analysis were left-sided cardiac involvement (risk ratio (RR) 6.0), severe valvular regurgitation (RR 2.6) and cardiac failure (RR 2.2) (all P < 0.005). Twenty (16%) episodes resulted in death. Predictors of mortality on univariable analysis were left-sided cardiac involvement (RR 6.4), and not completing treatment (RR 0.12 both P < 0.001). The average estimated cost per episode was AU$74 168. IE causes a considerable burden of disease in PWID, with significant healthcare utilisation and cost. Surgery and death are not infrequent complications. In addition to ensuring completion of antimicrobial therapy, strategies such as opioid maintenance programmes may be useful in improving health outcomes for PWID.
Cryptococcemia in primary HIV infection
Publisher: SAGE Publications
Date: 11-07-2016
Abstract: Opportunistic infections have been reported infrequently in primary HIV infection. We report a case of cryptococcemia in primary HIV infection. To our knowledge there has not been such a case reported. Our case highlights the need for clinicians to be wary of other opportunistic infections, including cryptococcosis, in primary HIV infection.
Management of Aspergillus osteomyelitis: report of failure of liposomal amphotericin B and response to voriconazole in an immunocompetent host and literature review
Publisher: Springer Science and Business Media LLC
Date: 05-2003
DOI: 10.1007/S10096-003-0909-3
Abstract: Presented here is a case of Aspergillus osteomyelitis in an immunocompetent patient that progressed despite surgery and prolonged treatment with liposomal hotericin B the report is followed by a review of the literature. The review of this case and 41 similar cases found an overall cure rate of 69%. The importance of surgery when hotericin B is used as first-line therapy is indicated by a 14% cure rate when hotericin B is used alone compared to 75% when combined with surgery. When therapy is failing or surgery is contraindicated, dose escalation using a lipid formulation was not effective. On review, the addition of another agent, in particular 5-fluorocytosine, appears to be more beneficial. The patient reported here responded rapidly to voriconazole, a promising new antifungal agent for Aspergillus infections.
Primary psoas muscle abscess in pregnancy
Publisher: Wiley
Date: 12-2008
Risk factors for peritoneal dialysis-related peritonitis: can we reduce the incidence and improve patient selection?
Publisher: Wiley
Date: 06-02-2007
DOI: 10.1111/J.1440-1797.2006.00756.X
Abstract: Peritonitis is a serious complication of peritoneal dialysis (PD) and a major cause of hospitalization, catheter loss, transfer to haemodialysis and death. Thus, it is important to identify risk factors for PD-related peritonitis in order to reduce the incidence and improve patient selection. This study is a prospective cohort review (1992-2003) with data consisting of 12,844 patient months, 506 PD patients and 623 episodes of peritonitis. Comorbidities and patient demographics were provided by the Australian and New Zealand Dialysis and Transplant Registry and these were merged with the hospital combined clinical and microbiology laboratory peritonitis database. Variables identified to be associated with an increased likelihood of peritonitis were: age (every 10 years OR, 1.26 95% CI, 1.07-1.48), gender (female OR, 1.91 95% CI, 1.2-3.01), current smoker at entry to dialysis (OR, 1.71 95% CI, 1.04-2.82) and the pre twin bag connection system (OR, 2.07 95% CI, 1.22-3.52). Increasing age, female gender and smoking increased the risk of peritonitis. Identifying these risk factors will assist in the selection, training and monitoring of our PD population.
Determinants of mortality in non-neutropenic ICU patients with candidaemia
Publisher: Springer Science and Business Media LLC
Date: 2009
DOI: 10.1186/CC7964
Antimicrobial resistance surveillance of Clostridioides difficile in Australia, 2015–18
Publisher: Oxford University Press (OUP)
Date: 25-04-2021
DOI: 10.1093/JAC/DKAB099
Abstract: Clostridioides difficile was listed as an urgent antimicrobial resistance (AMR) threat in a report by the CDC in 2019. AMR drives the evolution of C. difficile and facilitates its emergence and spread. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is nationwide longitudinal surveillance of C. difficile infection (CDI) in Australia. To determine the antimicrobial susceptibility of C. difficile isolated in Australia between 2015 and 2018. A total of 1091 strains of C. difficile were collected over a 3 year period by a network of 10 diagnostic microbiology laboratories in five Australian states. These strains were tested for their susceptibility to nine antimicrobials using the CLSI agar incorporation method. All strains were susceptible to metronidazole, fidaxomicin, rifaximin and amoxicillin/clavulanate and low numbers of resistant strains were observed for meropenem (0.1% 1/1091), moxifloxacin (3.5% 38/1091) and vancomycin (5.7% 62/1091). Resistance to clindamycin was common (85.2% 929/1091), followed by resistance to ceftriaxone (18.8% 205/1091). The in vitro activity of fidaxomicin [geometric mean MIC (GM) = 0.101 mg/L] was superior to that of vancomycin (1.700 mg/L) and metronidazole (0.229 mg/L). The prevalence of MDR C. difficile, as defined by resistance to ≥3 antimicrobial classes, was low (1.7% 19/1091). The majority of C. difficile isolated in Australia did not show reduced susceptibility to antimicrobials recommended for treatment of CDI (vancomycin, metronidazole and fidaxomicin). Resistance to carbapenems and fluoroquinolones was low and MDR was uncommon however, clindamycin resistance was frequent. One fluoroquinolone-resistant ribotype 027 strain was detected.
Integrase-resistant HIV in an antiretroviral-naive patient in Australia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-02-2017
Clinical manifestations of cryptococcus gattii infection: Determinants of neurological sequelae and death
Publisher: Oxford University Press (OUP)
Date: 05-06-2012
DOI: 10.1093/CID/CIS529
Abstract: Longer-term morbidity and outcomes of Cryptococcus gattii infection are not described. We analyzed clinical, microbiological, and outcome data in Australian patients followed for 12 months, to identify prognostic determinants. Culture-confirmed C. gattii cases from 2000 to 2007 were retrospectively evaluated. Clinical, microbiological, radiological, and outcome data were recorded at diagnosis and at 6 weeks, 6 months, and 12 months. Clinical and laboratory variables associated with mortality and with death and/or neurological sequelae were determined. Annual C. gattii infection incidence was 0.61 per 10(6) population. Sixty-two of 86 (72%) patients had no immunocompromise 6 of 24 immunocompromised hosts had idiopathic CD4 lymphopenia, and 1 had human immunodeficiency virus/AIDS. Clinical and microbiological characteristics of infection were similar in immunocompromised and healthy hosts. Isolated lung, combined lung and central nervous system (CNS), and CNS only disease was reported in 12%, 51% and 34% of the cases, respectively. Complications in CNS disease included raised intracranial pressure (42%), hydrocephalus (30%), neurological deficits (27% 6% developed during therapy) and immune reconstitutionlike syndrome (11%). Geometric mean serum cryptococcal antigen (CRAG) titers in CNS disease were 563.9 (vs 149.3 in isolated lung infection). Patient immunocompromise was associated with increased mortality risk. An initial cerebrospinal fluid CRAG titer of ≥256 predicted death and/or neurological sequelae (P = .05). Neurological C. gattii disease predominates in the Australian endemic setting. Lumbar puncture and cerebral imaging, especially if serum CRAG titers are ≥512, are essential. Long-term follow up is required to detect late neurological complications. Immune system evaluation is important because host immunocompromise is associated with reduced survival.
Influenza Epidemiology, Vaccine Coverage and Vaccine Effectiveness in Children Admitted to Sentinel Australian Hospitals in 2017: Results from the PAEDS-FluCAN Collaboration
Publisher: Oxford University Press (OUP)
Date: 21-08-2019
DOI: 10.1093/CID/CIY597
Abstract: In 2017, Australia experienced record influenza notifications. Two surveillance programs combined to summarize the epidemiology of hospitalized influenza in children and report on vaccine effectiveness (VE) in the context of a limited nationally funded vaccination program. Subjects were prospectively recruited (April-October 2017). Case patients were children aged ≤16 years admitted to 11 hospitals with an acute respiratory illness and laboratory-confirmed influenza. Controls were hospitalized with acute respiratory illness and tested negative for influenza. VE estimates were calculated using the test-negative design. A total of 1268 children were hospitalized with influenza: 31.5% were <2 years old, 8.3% were indigenous, and 45.1% had comorbid conditions predisposing to severe influenza. Influenza B was detected in 34.1% with influenza A/H1N1 and A/H3N2 detected in 47.2% and 52.8% of subtyped influenza A specimens. The median length of stay was 3 days (interquartile range, 1-5), 14.5% were admitted to the intensive care unit, and 15.9% received oseltamivir. Four in-hospital deaths occurred (0.3%): one was considered influenza associated. Only 17.1% of test-negative-controls were vaccinated. The VE of inactivated quadrivalent influenza vaccine for preventing hospitalized influenza was estimated at 30.3% (95% confidence interval, 2.6%-50.2%). Significant influenza-associated morbidity was observed in 2017 in Australia. Most hospitalized children had no comorbid conditions. Vaccine coverage and antiviral use was inadequate. Influenza vaccine was protective in 2017, yet VE was lower than previous seasons. Multiple Australian states have introduced funded preschool vaccination programs in 2018. Additional efforts to promote vaccination and monitor effectiveness are required.
Acanthamoeba encephalitis: Isolation of genotype t1 in mycobacterial liquid culture medium
Publisher: American Society for Microbiology
Date: 02-2015
DOI: 10.1128/JCM.02887-14
Abstract: We report a case of Acanthamoeba encephalitis diagnosed from an antemortem brain biopsy specimen, where the organism was first isolated in mycobacterial liquid medium and first identified by using a sequence generated by a commercial panfungal sequencing assay. We correlate susceptibility results with clinical outcome.
Novel use of toxigenic gene analysis for the identification of clostridium species
Publisher: Elsevier BV
Date: 2014
Changing epidemiology of candidaemia in Australia
Publisher: Oxford University Press (OUP)
Date: 08-11-2016
DOI: 10.1093/JAC/DKW422
Abstract: Knowledge of contemporary epidemiology of candidaemia is essential. We aimed to identify changes since 2004 in incidence, species epidemiology and antifungal susceptibilities of Candida spp. causing candidaemia in Australia. These data were collected from nationwide active laboratory-based surveillance for candidaemia over 1 year (within 2014-2015). Isolate identification was by MALDI-TOF MS supplemented by DNA sequencing. Antifungal susceptibility testing was performed using Sensititre YeastOne™. A total of 527 candidaemia episodes (yielding 548 isolates) were evaluable. The mean annual incidence was 2.41/105 population. The median patient age was 63 years (56% of cases occurred in males). Of 498 isolates with confirmed species identity, Candida albicans was the most common (44.4%) followed by Candida glabrata complex (26.7%) and Candida parapsilosis complex (16.5%). Uncommon Candida species comprised 25 (5%) isolates. Overall, C. albicans (>99%) and C. parapsilosis (98.8%) were fluconazole susceptible. However, 16.7% (4 of 24) of Candida tropicalis were fluconazole- and voriconazole-resistant and were non-WT to posaconazole. Of C. glabrata isolates, 6.8% were resistant/non-WT to azoles only one isolate was classed as resistant to caspofungin (MIC of 0.5 mg/L) by CLSI criteria, but was micafungin and anidulafungin susceptible. There was no azole/echinocandin co-resistance. We report an almost 1.7-fold proportional increase in C. glabrata candidaemia (26.7% versus 16% in 2004) in Australia. Antifungal resistance was generally uncommon, but azole resistance (16.7% of isolates) amongst C. tropicalis may be emerging.
A simplified, amplicon-based method for whole genome sequencing of human respiratory syncytial viruses
Publisher: Cold Spring Harbor Laboratory
Date: 25-11-2022
DOI: 10.1101/2022.11.24.516812
Abstract: Human Respiratory Syncytial Virus (RSV) infections pose a significant risk to human health worldwide, especially for young children. Whole genome sequencing (WGS) provides a useful tool for global surveillance to better understand the evolution and epidemiology of RSV and provide essential information that may impact on antibody treatments, antiviral drug sensitivity and vaccine effectiveness. Here we report the development of a rapid and simplified licon-based one-step multiplex reverse-transcription polymerase chain reaction (mRT-PCR) for WGS of both human RSV-A and RSV-B viruses. The method requires only two reactions for each s le, which significantly reduces the cost and time compared to other commonly used RSV WGS methods. In silico analysis and laboratory testing revealed that the primers used in the new method covered most of the currently circulating RSV-A and RSV-B. Amplicons generated were suitable for both Illumina and Oxford Nanopore Technologies (ONT) NGS platforms. This new method was tested on 200 clinical s les collected in Australia in 2020 and 2021 with RSV Ct values between 10 and 32. A success rate of 88% with a full coverage for the genome of 99 RSV-A and 77 RSV-B was achieved. This assay is simple to set up, robust, easily scalable in s le preparation and relatively inexpensive, and as such, provides a valuable addition to existing NGS RSV WGS methods.
Antifungal therapy and management of complications of cryptococcosis due to Cryptococcus gattii
Publisher: Oxford University Press (OUP)
Date: 22-05-2013
DOI: 10.1093/CID/CIT341
Abstract: We describe antifungal therapy and management of complications due to Cryptococcus gattii infection in 86 Australian patients followed for at least 12 months. Patient data from culture-confirmed cases (2000-2007) were recorded at diagnosis, 6 weeks, 6 months, and 12 months. Clinical, laboratory, and treatment variables associated with raised intracranial pressure (ICP) and immune reconstitution inflammatory syndrome (IRIS) were determined. Seven of 10 patients with lung infection received hotericin B (AMB) induction therapy (6 with 5-flucytosine [5-FC] for a median of 2 weeks) median duration of therapy including azole eradication therapy was 41 weeks, with a complete artial clinical response in 78%. For neurologic disease, 88% of patients received AMB, 78% with 5-FC, for a median of 6 weeks. The median total course was 18 months. Nine patients receiving fluconazole induction therapy were reinduced with AMB plus 5-FC for clinical failure. Raised ICP (31 patients) was associated with initial abnormal neurology, and neurologic sequelae and/or death at 12 months (both P = .02) cerebrospinal fluid drains/shunts were placed in 58% of patients and in 64% of 22 patients with hydrocephalus. IRIS developed 2-12 months after starting antifungals in 8 patients, who presented with new/enlarging brain lesions. Risk factors included female sex, brain involvement at presentation, and higher median CD4 counts (all P < .05) corticosteroids reduced cryptococcoma-associated edema. Induction AMB plus 5-FC is indicated for C. gattii neurologic cryptococcosis (6 weeks) and when localized to lung (2 weeks). Shunting was often required to control raised ICP. IRIS presents with cerebral manifestations.
Influenza epidemiology in patients admitted to sentinel Australian hospitals in 2018: the Influenza Complications Alert Network (FluCAN)
Publisher: Australian Government Department of Health
Date: 18-11-2019
Abstract: The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2018 influenza season. In this observational surveillance system, cases were defined as patients admitted to any of the 17 sentinel hospitals with influenza confirmed by nucleic acid detection. Data were also collected on a frequency-matched control group of influenza-negative patients admitted with acute respiratory infection. During the period 3 April to 31 October 2018 (the 2018 influenza season), 769 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 30% were elderly (≥65 years), 28% were children ( years), 6.4% were Aboriginal and Torres Strait Islander peoples, 2.2% were pregnant and 66% had chronic comorbidities. A small proportion of FluCAN admissions were due to influenza B (13%). Estimated vaccine coverage was 77% in the elderly (≥65 years), 45% in non-elderly adults with medical comorbidities and 26% in children ( years) with medical comorbidities. The estimated vaccine effectiveness (VE) in the target population was 52% (95% CI: 37%, 63%). There were a smaller number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2018 than in 2017, with the demographic profile reflecting the change in circulating subtype from A/H3N2 to A/H1N1.
Successful use of eltrombopag without splenectomy in refractory HIV-related immune reconstitution thrombocytopenia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-09-2012
Bacteraemia due to Stenotrophomonas maltophilia
Publisher: Elsevier BV
Date: 07-2002
Abstract: Stenotrophomonas maltophilia is an important nosocomial pathogen and a therapeutic challenge. A ten-year review of episodes of bacteraemia due to S. maltophilia was undertaken in light of reports of an increasing frequency of infection. A retrospective analysis of bloodstream infections due toS. maltophilia at a tertiary care hospital in Melbourne, Australia. Cases were identified via microbiology laboratory reports, and relevant clinical data were collected from the medical record of each patient. Eighty per cent of these 45 episodes were nosocomial. The most common characteristics in cases of bacteraemia were the presence of an indwelling central venous catheter (CVC) (38/45, 84%) and previous antibiotic therapy (33/45, 73%). There were 8 deaths (8/44, 18%) within 7 days of bacteraemia. A significant correlation was found between deaths and a failure to remove the CVC (P = 0.01) or treat with appropriate antimicrobials (P = 0.01). Antibiotic susceptibility testing revealed that isolates were most sensitive to sulphamethoxazole (80%), chlor henicol (75.5%) and ceftazidime (64.5%). S. maltophilia is an important pathogen especially in the highly compromised host. Isolation of this organism from a blood culture should prompt a careful review of the patient with particular emphasis on removal of indwelling CVCs and commencement of appropriate antibiotic therapy.
Novel Use of Tryptose Sulfite Cycloserine Egg Yolk Agar for Isolation of Clostridium perfringens during an Outbreak of Necrotizing Enterocolitis in a Neonatal Unit
Publisher: American Society for Microbiology
Date: 11-2010
DOI: 10.1128/JCM.01724-10
Abstract: Clostridium perfringens has been associated with necrotizing enterocolitis (NEC), which is a serious disease of neonates. Our study describes the novel use of selective tryptose sulfite cycloserine with egg yolk agar (TSC-EYA) during a nursery outbreak. This medium provides a rapid, sensitive, and accurate presumptive identification of C. perfringens .
Association Between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-01-2015
DOI: 10.1161/CIRCULATIONAHA.114.012461
Abstract: Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined. The International Collaboration on Endocarditis–PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non–cardiac device–related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and Staphyloccus aureus etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE. Surgical decision making in IE is largely consistent with established guidelines, although nearly one quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by Society of Thoracic Surgeons IE score provides prognostic information for survival beyond the operative period. S aureus IE was significantly associated with nonsurgical management.
New diagnosis of HIV with Cryptococcus neoformans infection presenting as a pleural syndrome
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2022
Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-04-2016
Abstract: Host factors and complications have been associated with higher mortality in infective endocarditis ( IE ). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in IE . Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ ICE ]–Prospective Cohort Study [ PCS ], 2000–2006, n=4049), a model to predict 6‐month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry ( ICE ‐ PLUS , 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the ICE ‐ PCS cohort and 342 of 1197 (28.6%) in the ICE ‐ PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE , causative organism, left‐sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6‐month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62–0.89). A simplified risk model was developed by weight adjustment of these variables. Six‐month mortality after IE is ≈25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE .
Respiratory virus detection and co‐infection in children and adults in a large Australian hospital in 2009–2015
Publisher: Wiley
Date: 06-06-2018
DOI: 10.1111/JPC.14076
Autoimmune haemolytic anaemia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-07-2010
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