ORCID Profile
0000-0002-5885-2084
Current Organisations
Ballarat Health Services
,
University of Melbourne
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Publisher: Oxford University Press (OUP)
Date: 15-02-2004
DOI: 10.1086/381202
Publisher: Wiley
Date: 11-2005
DOI: 10.1111/J.1445-5994.2005.00947.X
Abstract: Paracetamol is a component of a number of drugs taken in overdose (OD). The influence of alcohol use (acute or chronic) on the presentation and clinical course of paracetamol OD is contentious. This study explores the relationship between paracetamol OD, alcohol consumption and clinical outcomes at a regional Australian hospital. To determine the frequency, circumstances and outcomes of paracetamol OD presentations to a regional Australian general hospital over a 4-year period. Medical records of patients admitted to the Ballarat Health Services (BHS) as a result of paracetamol OD between January 2000 and December 2003 were reviewed. Patient demographics, amount of paracetamol ingested, other drug coingestions, alcohol history, previous medication OD, clinical course and outcomes were recorded. Annual admissions resulting from paracetamol OD almost doubled during the 4 years studied. The risk of a repeat paracetamol OD was highest within 4 weeks of the initial OD. Alcohol, benzodiazepines and antidepressants were commonly coingested. The strongest predictor of severe hepatotoxicity was delayed or no N-acetyl cysteine treatment in patients consuming greater than 10 g of paracetamol or with toxic serum paracetamol levels. A history of alcohol consumption did not appear to worsen outcomes.
Publisher: Cambridge University Press (CUP)
Date: 04-2005
DOI: 10.1086/502555
Abstract: To compare ventilator-associated pneumonia (VAP) rates and patterns of isolates across studies of antibiotic and non-antibiotic methods for preventing VAP. With the use of 42 cohort study groups as the reference standard, the prevalence of VAP was modeled in two linear regressions: one with the control groups and the other with the intervention groups of 96 VAP prevention studies. The proportion of patients admitted with trauma and the VAP diagnostic criteria were used as ecologic correlates. Also, the patterns of pathogenic isolates were available for 117 groups. In the first regression model, the VAP rates for the control groups of antibiotic-based prevention studies were at least 18 (CI 95 , 12 to 24) per 100 patients higher than those in the cohort study groups ( P .001). By contrast, comparisons of cohort study groups with all other control and intervention groups in the first and second regression models yielded differences that were less than 6 per 100 and not significant ( P .05). For control groups with VAP rates greater than 35%, the patterns of VAP isolates, such as the proportion of Staphylococcus aureus, more closely resembled those in the corresponding intervention groups than in the cohort groups. The rates of VAP in the control groups of the antibiotic prevention studies were significantly higher than expected and the patterns of pathogenic isolates were unusual. These observations suggest that inapparent outbreaks of VAP occurred in these studies. The possibility remains that antibiotic-based VAP prevention presents a major cross-infection hazard.
Publisher: Oxford University Press (OUP)
Date: 08-03-2008
DOI: 10.1093/JAC/DKN086
Abstract: The ventilator-associated pneumonia incident proportion (VAP-IP) is highly variable among control groups of studies of methods for its prevention. The objective here is to develop and validate a literature-derived benchmark against which these groups can be profiled. A literature search yielded 95 cohort groups and control and intervention groups of 150 studies of either non-antimicrobial or antimicrobial methods of VAP prevention. The 95 cohort groups comprise a benchmark set (30 groups), from which the reference funnel plot (RFP) was derived, and a search set (65 groups), against which the benchmark was validated. The VAP-IP data of the benchmark set were found in five published systematic reviews, whereas the VAP-IP data of the search set were abstracted directly from the literature. Among the 95 cohort groups, the VAP-IP of groups with size >399 was significantly lower than the VAP-IP of smaller groups. Compared with the RFP, 15 of 51 (29%) control groups from studies of antimicrobial methods of VAP prevention with concurrent design were high outlier versus 2 of 110 (2%) control groups from other types of study design (P < 0.001). There were only 22 (14%) outlier groups, all low outlier, among the 162 intervention groups. Study design factors such as concurrency and study size have potentially greater influence on the VAP-IP than do the VAP prevention methods under study. The outlier status of control groups were inapparent in the in idual studies and the meta-analyses and yet would have confounded the estimates of treatment effect.
Publisher: Elsevier BV
Date: 06-1993
DOI: 10.1016/0962-8479(93)90005-I
Abstract: Segmentation of cardiac fibrosis and scars is essential for clinical diagnosis and can provide invaluable guidance for the treatment of cardiac diseases. Late Gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been successful in guiding the clinical diagnosis and treatment reliably. For LGE CMR, many methods have demonstrated success in accurately segmenting scarring regions. Co-registration with other non-contrast-agent (non-CA) modalities [e.g., balanced steady-state free precession (bSSFP) cine magnetic resonance imaging (MRI)] can further enhance the efficacy of automated segmentation of cardiac anatomies. Many conventional methods have been proposed to provide automated or semi-automated segmentation of scars. With the development of deep learning in recent years, we can also see more advanced methods that are more efficient in providing more accurate segmentations. This paper conducts a state-of-the-art review of conventional and current state-of-the-art approaches utilizing different modalities for accurate cardiac fibrosis and scar segmentation.
Publisher: Oxford University Press (OUP)
Date: 07-2019
DOI: 10.1093/CID/CIZ554
Abstract: Cluster-randomized trials (CRTs) are able to address research questions that randomized controlled trials (RCTs) of in idual patients cannot answer. Of great interest for infectious disease physicians and infection control practitioners are research questions relating to the impact of interventions on infectious disease dynamics at the whole-of-population level. However, there are important conceptual differences between CRTs and RCTs relating to design, analysis, and inference. These differences can be illustrated by the adage “peas in a pod.” Does the question of interest relate to the “peas” (the in idual patients) or the “pods” (the clusters)? Several ex les of recent CRTs of community and intensive care unit infection prevention interventions are used to illustrate these key concepts. Ex les of differences between the results of RCTs and CRTs on the same topic are given.
Publisher: Wiley
Date: 05-2007
Publisher: Oxford University Press (OUP)
Date: 15-11-2005
DOI: 10.1086/497376
Publisher: Informa Healthcare
Date: 03-1995
Publisher: American Society for Microbiology
Date: 12-2009
DOI: 10.1128/JCM.01189-09
Abstract: Endotoxemia is undetectable for up to 60% of cases of bacteremia caused by gram-negative (GN) species, a discordance attributed to the limitations of the Limulus assay for endotoxemia. The lipid A structure of the endotoxin molecule is critical for the sensing of GN bacteria by the host immune system although not so for sensing by the Limulus assay. The lipid A structure of commensal Enterobacteriaceae is hexa-acyl, whereas non- Enterobacteriaceae have a broader range of structures. By using a previously published classification of lipid A structures (R. S. Munford, Infect. Immun. 76:454-465, 2008), the association of endotoxemia with bacteremia caused by GN organisms is reexamined for 580 GN bacteremic patients from 46 studies. Endotoxemia was less commonly detected for cases of bacteremia caused by Salmonella enterica serovar Typhi (four studies 15 of 55 cases of bacteremia [27%]) than for cases of bacteremia caused by Neisseria meningitidis (five studies 69 of 84 cases [82%]) and Pseudomonas pseudomallei (one study 38 of 41 cases [93%]) among studies restricted to those with specified cases of bacteremia caused by GN organisms. Among 23 unrestricted studies, endotoxemia was less commonly detected for cases of bacteremia with a commensal member of the Enterobacteriaceae (104 of 240 cases [43%]) than with non- Enterobacteriaceae (59 of 100 cases [59%]) (summary odds ratio, 0.53 [90% confidence interval, 0.33 to 0.85]). This finding is consistent across all the unrestricted studies, even including studies with seemingly contrary results for endotoxemia diagnosis among cases of bacteremia caused by GN bacteria overall. Surprisingly, with bacteremia caused by commensal Enterobacteriaceae , the diagnosis of endotoxemia appears to be unrelated to the Limulus assay sensitivity. Across these 45 studies, the association of endotoxemia with GN bacteremia is variable but consistent for different types of GN bacteremia.
Publisher: Elsevier BV
Date: 03-2012
Publisher: American Society for Microbiology
Date: 09-2013
DOI: 10.1128/AAC.00424-13
Abstract: Among various methods for preventing ventilator-associated pneumonia (VAP), the evidence base for selective digestive decontamination (SDD) appears most compelling. However, the extent of Staphylococcus aureus emergence with SDD use remains uncertain. Groups from 37 observational studies and component (control and intervention) groups from 58 studies of SDD and other methods of VAP prevention were sourced exclusively from 10 systematic reviews. S. aureus as a proportion of VAP isolates ( S. aureus isolate proportion [ S. aureus IP]) among component groups was calibrated versus that among observational groups (the benchmark). The influence of topical placebo used for blinding purposes and other group-level factors was estimated using generalized estimating equation methods (GEE). The mean S. aureus IP is 22% (95% confidence interval [CI], 19 to 25) for 37 observational groups versus 32% (24 to 41) and 20% (15 to 25) for 22 control groups from the SDD evidence base which did versus did not receive topical placebo, respectively. In GEE models including all 148 observational and component groups, membership of a control ( P = 0.03) or intervention ( P 0.001) group of an SDD study that used topical placebo was associated with higher S. aureus IP, whereas, in contrast, membership of these groups was without effect on Pseudomonas aeruginosa . Topical placebo is implicated as a vehicle for selective cross-infection with S. aureus within the specific context of the SDD evidence base. This effect of topical placebo is perfidious it could contribute to the higher VAP incidence and inflate the apparent “effectiveness” of SDD. The SDD evidence base requires reappraisal.
Publisher: SAGE Publications
Date: 10-2003
DOI: 10.1179/096805103225002511
Abstract: The prognostic value of the detection of endotoxin in plasma of patients with suspected Gram-negative sepsis is unclear despite numerous studies. Sixteen studies have reported endotoxemia detection and blood culture results with outcome data for 1937 patients with suspected Gram-negative sepsis. Comparisons of the fatality rates for the subgroups of patients with, respectively, either endotoxemia (group 3), or Gram-negative bacteremia (group 2), or both detected (group 1), versus the fatality rate for the subgroup of patients with these factors absent (group 4), were made based on summary odds ratios (and 95% CI). Summary odds ratios for the comparison of group 2 versus group 4 and group 3 versus group 4 were non-significant (2.2 0.9-5.8 and 2.0 0.8-4.8, respectively). The summary odds ratio was significant for group 1 versus group 4 (3.6 2.1-6.3), and more so among studies in which non-Enterobacteriaceae were common among the Gram-negative blood culture isolates (4.8 2.1-10.7). Endotoxemia, like Gram-negative bacteremia, is a weak prognostic indicator. Endotoxemia appears to have most prognostic significance when it is detected in the co-presence of Gram-negative bacteremia. The differing interpretations among published studies could be attributed to the variability in types of Gram-negative bacteremia observed.
Publisher: American Society for Microbiology
Date: 04-2015
DOI: 10.1128/JCM.03531-14
Abstract: The clinical significance of endotoxin detection in blood has been evaluated for a broad range of patient groups in over 40 studies published over 4 decades. The influences of Gram-negative (GN) bacteremia species type and patient inclusion criteria on endotoxemia detection rates in published studies remain unclear. Studies were identified after a literature search and manual reviews of article bibliographies, together with a direct approach to authors of potentially eligible studies for data clarifications. The concordance between GN bacteremia and endotoxemia expressed as the summary diagnostic odds ratios (DORs) was derived for three GN bacteremia categories across eligible studies by using a hierarchical summary receiver operating characteristic (HSROC) method. Forty-two studies met broad inclusion criteria, with between 2 and 173 GN bacteremias in each study. Among all 42 studies, the DORs (95% confidence interval) were 3.2 (1.7 to 6.0) and 5.8 (2.4 to 13.7) in association with GN bacteremias with Escherichia coli and those with Pseudomonas aeruginosa , respectively. Among 12 studies of patients with sepsis, the proportion of endotoxemia positivity (95% confidence interval) among patients with P. aeruginosa bacteremia (69% [57 to 79%] P = 0.004) or with Proteus bacteremia (76% [51 to 91%] P = 0.04) was significantly higher than that among patients without GN bacteremia (49% [33 to 64%]), but this was not so for patients bacteremic with E. coli (57% [40 to 73%] P = 0.55). Among studies of the sepsis patient group, the concordance of endotoxemia with GN bacteremia was surprisingly weak, especially for E. coli GN bacteremia.
Publisher: Archives of Pathology and Laboratory Medicine
Date: 12-2011
DOI: 10.5858/ARPA.2011-0016-SO
Abstract: Meta-analytic summaries are needed on clinical studies of diagnostic tests. Meta-analyses on clinical studies of diagnostic tests commonly use the receiver operating characteristic method, which differs conceptually and computationally from the more widely known meta-analytic methods applicable in other contexts, such as in studies of randomized controlled trials. Important conceptual differences for clinical studies of diagnostic tests versus randomized controlled trials are that the study subpopulations are not defined by random allocation and the test threshold typically varies across studies to accommodate “rule in” versus “rule out” testing strategies. The receiver operating characteristic method has evolved substantially in the past decade, and the most recent approaches use multilevel regression methods that require iterative computational solutions to estimate the influence of the study-level variables. Using current methodology, a meta-analysis on clinical studies of diagnostic tests can address questions relevant to the clinical application of a diagnostic test that cannot be answered at the level of the in idual study.
Publisher: MDPI AG
Date: 27-02-2018
Publisher: Springer Science and Business Media LLC
Date: 04-12-2019
Publisher: S. Karger AG
Date: 2013
DOI: 10.1159/000347172
Abstract: The prognostic impact of endotoxemia detection in sepsis is unclear. Endotoxemia is detectable in % of patients with Gram-negative (GN) bacteremias. Mortality proportion data were available from 27 published studies of patients with GN bacteremia in various settings. Among ten studies restricted to specific types of GN bacteremia, endotoxemia was associated with significantly increased mortality risk for i Neisseria meningitidis /i (4 studies 138 bacteremias OR 26.0 95% CI, 1.6-321) but not for i Salmonella enterica /i serovar Typhi (3 studies 36 bacteremias OR 0.89 95% CI, 0.01-74.1). For 17 unrestricted studies (319 GN bacteremic patients), endotoxemia was associated with an increased mortality risk with non- i Escherichia coli /i Enterobacteriaceae such as i Klebsiella /i and i Enterobacter /i species (97 bacteremias OR 3.7 95% CI, 1.3-10.3). By contrast, i E. coli /i (144 bacteremias OR 0.78 95% CI, 0.36-1.7), and non-Enterobacteriaceae species such as i Pseudomonas /i species (78 bacteremias OR 1.7 95% CI, 0.7-4.6) had no increased mortality risk. That endotoxemia detection is predictive of mortality among patients bacteremic with non- i E. coli /i Enterobacteriaceae but not i E. coli /i is surprising given the presumed commonality of the hexa-acyl lipid A structure among Enterobacteriaceae species.
Publisher: Elsevier BV
Date: 08-2010
Publisher: SAGE Publications
Date: 03-2010
Abstract: Influenza is a highly contagious infection with the potential for outbreaks in residential facilities despite seemingly adequate vaccination levels among residents. The management of an influenza A outbreak in a residential facility for cognitively impaired residents of an Australian regional health service is described. Twenty-five of the residents of a 60-bed standalone facility were affected, with one fatality resulting. As virological confirmation of the outbreak was received late on a Friday, the initiation of antiviral treatment and prophylaxis occurred out of hours. The unanticipated consequences of this out-of-hours management are discussed. The management of an influenza outbreak in a dementiaspecific residential facility requires a specific infection control response which anticipates the ethical issues relating to the care of the cognitively impaired.
Publisher: Massachusetts Medical Society
Date: 07-01-2010
DOI: 10.1056/NEJMC0910310
Publisher: Springer Science and Business Media LLC
Date: 2011
DOI: 10.1186/CC9406
Publisher: Springer Science and Business Media LLC
Date: 29-11-2010
DOI: 10.1007/S10096-009-0841-2
Abstract: The limulus assay for endotoxin has been studied as a method for the rapid identification of gram-negative (GN) bacteraemia. The chromogenic (C-limulus) version is 100-fold more sensitive to an internal endotoxin standard than the earlier gelation version (G-limulus). The objective of this analysis is to compare the concordance between GN bacteraemia and endotoxaemia as determined in clinical studies using either version of the limulus assay. The summary results for the diagnostic odds ratio (DOR), sensitivity and specificity were derived using a hierarchical summary receiver operating characteristic (HSROC) method of meta-analysis. Fifty-eight studies (25 G-limulus and 33 C-limulus) were included. Surprisingly, the mean DOR (4.9 3-7.9 versus 10.7 5.2-21.8) was inferior for studies using the C-limulus versus the original G-limulus version of the assay. Moreover, among studies limited to sepsis syndrome patients, the mean DOR remains poor at 4.2 (1.8-9.5). The proportion of GN bacteraemic patients for whom endotoxaemia is not detectable with either version of the limulus assay is >20% among the 58 studies overall, but >30% after the exclusion of studies with 20% among studies of patients with sepsis syndrome. These findings help to reconcile seemingly disparate study results.
Publisher: Oxford University Press (OUP)
Date: 15-09-2003
DOI: 10.1086/377611
Publisher: Wiley
Date: 02-2019
DOI: 10.1111/IMJ.14208
Abstract: A retrospective observational study of 21 patients admitted to the Intensive Care Unit (ICU) of Frankston Hospital with acute asthma between 2011 and 2014 was undertaken. We report the outcomes for three groups of patients those that did (n = 7) or did not (n = 6) receive initial therapy with non-invasive ventilation (NIV) together with those that received invasive ventilation (n = 8). Patients successfully managed with NIV alone experienced a shorter ICU and hospital stay versus those who required invasive ventilation.
Publisher: Elsevier BV
Date: 10-1992
Publisher: Oxford University Press (OUP)
Date: 22-10-2013
DOI: 10.1093/CID/CIS903
Publisher: Oxford University Press (OUP)
Date: 07-02-2019
DOI: 10.1093/JAC/DKY573
Abstract: Multiple in idual studies of selective digestive decontamination/selective oropharyngeal decontamination (SDD/SOD) among ICU patients appear to show potent infection prevention effects. Surprisingly, the event rates for multiple endpoints including ventilator-associated pneumonia, bacteraemia and candidaemia among concurrent control groups within SDD/SOD studies appear unusually high versus other rates in the literature. These paradoxical observations raise concern that the contextual effects of SDD/SOD, as postulated in the original SDD/SOD study, not only exist but also are strong. Until these effects are addressed within an optimally designed study, the safety of SDD/SOD within the 'whole of ICU' remains questionable.
Publisher: Oxford University Press (OUP)
Date: 17-07-2019
DOI: 10.1093/JAC/DKZ300
Abstract: Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) regimens appear protective against ICU-acquired overall bacteraemia. These regimens can be factorized as topical antibiotic prophylaxis (TAP) with (SDD) or without (SOD) protocolized parenteral antibiotic prophylaxis (PPAP) using cephalosporins. Both TAP and cephalosporins are risk factors for enterococcal colonization although their impact on enterococcal bacteraemia within studies of SDD/SOD remains unclear. To benchmark the enterococcal bacteraemia incidence within component (control and intervention) groups of SDD/SOD studies among ICU patients versus studies without intervention (observational groups). The literature was searched for SDD/SOD studies reporting enterococcal bacteraemia incidence data. In addition, component groups of studies of various non-antibiotic interventions served to provide additional points of reference. The mean incidence per 100 patients (and 95% CI) for enterococcal bacteraemia among 19 SDD/SOD studies was equally increased among concurrent control (2.1 1.0%–4.7%) and intervention (2.3 2.0%–2.7%) groups versus the benchmark incidence (0.8 0.6%–1.2%) derived from 16 observational study groups and also versus 9 component groups from non-antibiotic studies. These higher incidences remained apparent (P 0.02) in a meta-regression model adjusting for groupwide factors such as PPAP use, mechanical ventilation proportion, group mean length of stay days and publication year. The incidences of enterococcal bacteraemia within both concurrent control and intervention groups of SDD/SOD studies are unusually high compared with the literature-derived benchmark. The impact of parenteral cephalosporin used as PPAP additional to TAP on enterococcal bacteraemia incidence was indeterminate in this analysis.
Publisher: Massachusetts Medical Society
Date: 04-11-1993
Publisher: Elsevier BV
Date: 05-1993
DOI: 10.1016/0140-6736(93)93139-R
Abstract: There is strong evidence to implicate endotoxin released from gram negative bacteria in the pathogenesis of the sepsis syndrome and related conditions, but equally compelling data bring the role of endotoxin into doubt. Reappraisal of endotoxin and its release from gram negative bacteria suggests that it is not directly responsible for the complications of sepsis syndrome. Rather, release of endotoxin is a marker for the transition of gram negative organisms to cell-wall-deficient forms (L-forms) that may persist undetected despite antibiotic therapy directed against the parental form. This transition has two consequences in compromised patients: L-forms cause organ failure, and they serve as a sanctuary from which cell-wall-intact revertants may arise.
Publisher: Oxford University Press (OUP)
Date: 23-03-2011
DOI: 10.1093/JAC/DKR112
Abstract: The selective digestive decontamination (SDD) component antibiotics have activity against Pseudomonas aeruginosa, an important ventilator-associated pneumonia (VAP) isolate. Evaluating the relationship between the anti-pseudomonal activity of SDD towards its VAP prevention effect is complicated by postulated indirect effects of SDD mediated in the concurrent control groups. The objective here is to address these effects through a benchmarking analysis of the evidence base. Forty-eight observational studies of VAP incidence and 43 interventional studies of SDD and other methods of VAP prevention were sourced from 10 reviews. The P. aeruginosa isolate proportion (P. aeruginosa-IP) data were summarized by meta-analysis using random effects methods. The mode of VAP diagnosis, proportion of trauma admissions and the intervention method under study were examined in meta-regression models as potential group-level predictors of P. aeruginosa-IP. The mean P. aeruginosa-IP derived from the observational studies (the benchmark) is 22.3% [95% confidence interval (CI) 19.8%-25.2%] versus 19.6% (95% CI 15.6%-24.4%) and 20.8% (95% CI 14.6%-28.5%) for concurrent control groups and intervention groups of SDD studies, respectively. In the meta-regression models, the proportion of trauma admissions is negatively correlated with P. aeruginosa-IP, whereas membership of neither a concurrent control nor intervention group of an SDD study is negatively correlated. There is no evidence for either direct or indirect effects of SDD on P. aeruginosa-IP that could account for the profound effects of SDD on VAP incidence.
Publisher: Elsevier BV
Date: 09-2013
Publisher: Springer Science and Business Media LLC
Date: 2012
DOI: 10.1186/CC11462
Publisher: Springer Science and Business Media LLC
Date: 16-03-2010
Publisher: American Society for Microbiology
Date: 08-2018
DOI: 10.1128/AAC.00291-18
Abstract: Regimens containing topical polymyxin appear highly effective at preventing ventilator-associated pneumonia (VAP) overall and, more so, VAP caused by Gram-negative bacteria. However, Stoutenbeek's postulates that VAP incidences within studies of topical antibiotics depend on the context of whether the component (control and intervention) groups of each study were concurrent versus nonconcurrent remain untested. The literature was searched for concurrent control (CC) versus nonconcurrent control (NCC) designed studies of respiratory tract applications of topical polymyxin to mechanically ventilated (MV) patients that reported incidences of Pseudomonas -associated ventilator-associated pneumonia (PsVAP). Studies of various interventions other than topical polymyxin (nonpolymyxin studies) served to provide additional points of reference. The PsVAP incidences within the component groups of all studies were benchmarked against groups from observational studies. This was undertaken by meta-regression using generalized estimating equation methods. Dot plots, caterpillar plots, and funnel plots enable visual benchmarking. The PsVAP benchmark (and 95% confidence interval [CI]) derived from 102 observational groups is 4.6% (4.0 to 5.3%). In contrast, the mean PsVAP within NCC polymyxin intervention groups (1.6% CI, 1.0 to 4.5%) is lower than that of all other component group categories. The mean PsVAP within CC polymyxin control groups (9.9% CI, 7.6 to 12.8%) is higher than that of all other component group categories. The PsVAP incidences of control and intervention groups of studies of respiratory tract applications of polymyxin are dependent on whether the groups were within a concurrent versus nonconcurrent study. Stoutenbeek's concurrency postulates are validated.
Publisher: MDPI AG
Date: 04-01-2018
Publisher: MDPI AG
Date: 18-12-2013
Publisher: Springer Science and Business Media LLC
Date: 18-08-2022
DOI: 10.1186/S12982-022-00116-9
Abstract: Whether Candida interacts with Gram-positive bacteria, such as Staphylococcus aureus, coagulase negative Staphylococci (CNS) and Enterococci, to enhance their invasive potential from the microbiome of ICU patients remains unclear. Several effective anti-septic, antibiotic, anti-fungal, and non-decontamination based interventions studied for prevention of ventilator associated pneumonia (VAP) and other ICU acquired infections among patients receiving prolonged mechanical ventilation (MV) are known to variably impact Candida colonization. The collective observations within control and intervention groups from numerous ICU infection prevention studies enables tests of these postulated microbial interactions in the clinical context. Four candidate generalized structural equation models (GSEM), each with Staphylococcus aureus, CNS and Enterococci colonization, defined as latent variables, were confronted with blood culture and respiratory tract isolate data derived from 460 groups of ICU patients receiving prolonged MV from 283 infection prevention studies. Introducing interaction terms between Candida colonization and each of S aureus (coefficient + 0.40 95% confidence interval + 0.24 to + 0.55), CNS (+ 0.68 + 0.34 to + 1.0) and Enterococcal (+ 0.56 + 0.33 to + 0.79) colonization (all as latent variables) improved the fit for each model. The magnitude and significance level of the interaction terms were similar to the positive associations between exposure to topical antibiotic prophylaxis (TAP) on Enterococcal (+ 0.51 + 0.12 to + 0.89) and Candida colonization (+ 0.98 + 0.35 to + 1.61) versus the negative association of TAP with S aureus (− 0.45 − 0.70 to − 0.20) colonization and the negative association of anti-fungal exposure and Candida colonization (− 1.41 − 1.6 to − 0.72). GSEM modelling of published ICU infection prevention data enables the postulated interactions between Candida and Gram-positive bacteria to be tested using clinically derived data. The optimal model implies interactions occurring in the human microbiome facilitating bacterial invasion and infection. This interaction might also account for the paradoxically high bacteremia incidences among studies of TAP in ICU patients.
Publisher: SAGE Publications
Date: 06-2001
Publisher: American Medical Association (AMA)
Date: 22-09-2010
Publisher: Informa Healthcare
Date: 02-1997
Abstract: Meta-analysis offers an alternative approach to examining specific sub-groups, such as classes of antibiotics, types of bacteria as well as patient groups whose response to the agent under investigation may not be equivalent. In this review, the strengths and pitfalls of meta-analyses of anti-infective therapies will be discussed.
No related grants have been discovered for James Hurley.