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1. Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients

Author: Davis, J.S., Metcalf, S., Clark, B., Robinson, J.O., Huggan, P., Luey, C., McBride, S., Aboltins, C., Nelson, R., Campbell, D., Solomon, L.B., Schneider, K., Loewenthal, M.R., Yates, P., Athan, E., Cooper, D., Rad, B., Allworth, T., Reid, A., Read, K., Leung, P., Sud, A., Nagendra, V., Chean, R., Lemoh, C., Mutalima, N., Tran, T., Grimwade, K., Sehu, M., Looke, D., Torda, A., Aung, T., Graves, S., Paterson, D.L., Manning, L., Davis, J.S., Metcalf, S., Clark, B., Robinson, J.O., Huggan, P., Luey, C., McBride, S., Aboltins, C., Nelson, R., Campbell, D., Solomon, L.B., Schneider, K., Loewenthal, M.R., Yates, P., Athan, E., Cooper, D., Rad, B., Allworth, T., Reid, A., Read, K., Leung, P., Sud, A., Nagendra, V., Chean, R., Lemoh, C., Mutalima, N., Tran, T., Grimwade, K., Sehu, M., Looke, D., Torda, A., Aung, T., Graves, S., Paterson, D.L., and Manning, L.
Abstract: Background Periprosthetic joint infection (PJI) is a devastating condition and there is a lack of evidence to guide its management. We hypothesized that treatment success is independently associated with modifiable variables in surgical and antibiotic management. Methods The is a prospective, observational study at 27 hospitals across Australia and New Zealand. Newly diagnosed large joint PJIs were eligible. Data were collected at baseline and at 3, 12, and 24 months. The main outcome measures at 24 months were clinical cure (defined as all of the following: alive, absence of clinical or microbiological evidence of infection, and not requiring ongoing antibiotic therapy) and treatment success (clinical cure plus index prosthesis still in place). Results Twenty-four-month outcome data were available for 653 patients. Overall, 449 patients (69%) experienced clinical cure and 350 (54%) had treatment success. The most common treatment strategy was debridement and implant retention (DAIR), with success rates highest in early postimplant infections (119 of 160, 74%) and lower in late acute (132 of 267, 49%) and chronic (63 of 142, 44%) infections. Selected comorbidities, knee joint, and Staphylococcus aureus infections were independently associated with treatment failure, but antibiotic choice and duration (including rifampicin use) and extent of debridement were not. Conclusions Treatment success in PJI is associated with (1) selecting the appropriate treatment strategy and (2) nonmodifiable patient and infection factors. Interdisciplinary decision making that matches an individual patient to an appropriate management strategy is a critical step for PJI management. Randomized controlled trials are needed to determine the role of rifampicin in patients managed with DAIR and the optimal surgical strategy for late-acute PJI.
Published: 2022

2. Predictors of treatment success following peri-prosthetic joint infection: 24-month follow up from a multi-center prospective observational cohort study of 653 patients

Author: Davis, JS, Metcalf, S, Clark, B, Robinson, JO, Huggan, P, Luey, C, McBride, S, Aboltins, C, Nelson, R, Campbell, D, Solomon, LB, Schneider, K, Loewenthal, MR, Yates, P, Athan, Eugene, Cooper, Darcie, Rad, B, Allworth, T, Reid, A, Read, K, Leung, P, Sud, A, Nagendra, V, Chean, R, Lemoh, C, Mutalima, N, Tran, T, Grimwade, K, Sehu, M, Looke, D, Torda, A, Aung, T, Graves, S, Paterson, DL, Manning, L, Davis, JS, Metcalf, S, Clark, B, Robinson, JO, Huggan, P, Luey, C, McBride, S, Aboltins, C, Nelson, R, Campbell, D, Solomon, LB, Schneider, K, Loewenthal, MR, Yates, P, Athan, Eugene, Cooper, Darcie, Rad, B, Allworth, T, Reid, A, Read, K, Leung, P, Sud, A, Nagendra, V, Chean, R, Lemoh, C, Mutalima, N, Tran, T, Grimwade, K, Sehu, M, Looke, D, Torda, A, Aung, T, Graves, S, Paterson, DL, and Manning, L
Abstract: Abstract Background Peri-prosthetic joint infection (PJI) is a devastating condition and there is a lack of evidence to guide its management. We hypothesised that treatment success is independently associated with modifiable variables in surgical and antibiotic management. Methods Prospective, observational study at 27 hospitals across Australia and New Zealand. Newly diagnosed large joint PJIs were eligible. Data were collected at baseline and at 3, 12 and 24 months. The main outcome measures at 24 months were clinical cure (defined as all of: alive, absence of clinical or microbiological evidence of infection and not requiring ongoing antibiotic therapy) and treatment success (clinical cure plus index prosthesis still in place). Findings 24-month outcome data were available for 653 patients. Overall, 449 (69%) experienced clinical cure and 350 (54%) treatment success. The most common treatment strategy was debridement and implant retention, with success rates highest in early post-implant infections (119/160; 74%) and lower in late acute (132/267, 49%) and chronic (63/142, 44%) infections. Selected comorbidities, knee joint and S.aureus infections were independently associated with treatment failure, but antibiotic choice and duration (including rifampicin use) and extent of debridement were not. Interpretation Treatment success in PJI is associated with selecting the appropriate treatment strategy, and with non-modifiable patient and infection factors. Interdisciplinary decision-making which matches an individual patient to an appropriate management strategy is a critical step for PJI management. Randomised controlled trials are needed to determine the role of rifampicin in patients managed with DAIR and
Published: 2022

3. Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients

Author: Davis, JS, Metcalf, S, Clark, B, Robinson, JO, Huggan, P, Luey, C, McBride, S, Aboltins, C, Nelson, R, Campbell, D, Solomon, LB, Schneider, K, Loewenthal, MR, Yates, P, Athan, E, Cooper, D, Rad, B, Allworth, T, Reid, A, Read, K, Leung, P, Sud, A, Nagendra, V, Chean, R, Lemoh, C, Mutalima, N, Tran, T, Grimwade, K, Sehu, M, Looke, D, Torda, A, Aung, T, Graves, S, Paterson, DL, Manning, L, Davis, JS, Metcalf, S, Clark, B, Robinson, JO, Huggan, P, Luey, C, McBride, S, Aboltins, C, Nelson, R, Campbell, D, Solomon, LB, Schneider, K, Loewenthal, MR, Yates, P, Athan, E, Cooper, D, Rad, B, Allworth, T, Reid, A, Read, K, Leung, P, Sud, A, Nagendra, V, Chean, R, Lemoh, C, Mutalima, N, Tran, T, Grimwade, K, Sehu, M, Looke, D, Torda, A, Aung, T, Graves, S, Paterson, DL, and Manning, L
Abstract: BACKGROUND: Periprosthetic joint infection (PJI) is a devastating condition and there is a lack of evidence to guide its management. We hypothesized that treatment success is independently associated with modifiable variables in surgical and antibiotic management. METHODS: The is a prospective, observational study at 27 hospitals across Australia and New Zealand. Newly diagnosed large joint PJIs were eligible. Data were collected at baseline and at 3, 12, and 24 months. The main outcome measures at 24 months were clinical cure (defined as all of the following: alive, absence of clinical or microbiological evidence of infection, and not requiring ongoing antibiotic therapy) and treatment success (clinical cure plus index prosthesis still in place). RESULTS: Twenty-four-month outcome data were available for 653 patients. Overall, 449 patients (69%) experienced clinical cure and 350 (54%) had treatment success. The most common treatment strategy was debridement and implant retention (DAIR), with success rates highest in early postimplant infections (119 of 160, 74%) and lower in late acute (132 of 267, 49%) and chronic (63 of 142, 44%) infections. Selected comorbidities, knee joint, and Staphylococcus aureus infections were independently associated with treatment failure, but antibiotic choice and duration (including rifampicin use) and extent of debridement were not. CONCLUSIONS: Treatment success in PJI is associated with (1) selecting the appropriate treatment strategy and (2) nonmodifiable patient and infection factors. Interdisciplinary decision making that matches an individual patient to an appropriate management strategy is a critical step for PJI management. Randomized controlled trials are needed to determine the role of rifampicin in patients managed with DAIR and the optimal surgical strategy for late-acute PJI.
Published: 2022

4. Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients

Author: Davis, J.S., Metcalf, S., Clark, B., Robinson, J.O., Huggan, P., Luey, C., McBride, S., Aboltins, C., Nelson, R., Campbell, D., Solomon, L.B., Schneider, K., Loewenthal, M.R., Yates, P., Athan, E., Cooper, D., Rad, B., Allworth, T., Reid, A., Read, K., Leung, P., Sud, A., Nagendra, V., Chean, R., Lemoh, C., Mutalima, N., Tran, T., Grimwade, K., Sehu, M., Looke, D., Torda, A., Aung, T., Graves, S., Paterson, D.L., Manning, L., Davis, J.S., Metcalf, S., Clark, B., Robinson, J.O., Huggan, P., Luey, C., McBride, S., Aboltins, C., Nelson, R., Campbell, D., Solomon, L.B., Schneider, K., Loewenthal, M.R., Yates, P., Athan, E., Cooper, D., Rad, B., Allworth, T., Reid, A., Read, K., Leung, P., Sud, A., Nagendra, V., Chean, R., Lemoh, C., Mutalima, N., Tran, T., Grimwade, K., Sehu, M., Looke, D., Torda, A., Aung, T., Graves, S., Paterson, D.L., and Manning, L.
Abstract: Background Periprosthetic joint infection (PJI) is a devastating condition and there is a lack of evidence to guide its management. We hypothesized that treatment success is independently associated with modifiable variables in surgical and antibiotic management. Methods The is a prospective, observational study at 27 hospitals across Australia and New Zealand. Newly diagnosed large joint PJIs were eligible. Data were collected at baseline and at 3, 12, and 24 months. The main outcome measures at 24 months were clinical cure (defined as all of the following: alive, absence of clinical or microbiological evidence of infection, and not requiring ongoing antibiotic therapy) and treatment success (clinical cure plus index prosthesis still in place). Results Twenty-four-month outcome data were available for 653 patients. Overall, 449 patients (69%) experienced clinical cure and 350 (54%) had treatment success. The most common treatment strategy was debridement and implant retention (DAIR), with success rates highest in early postimplant infections (119 of 160, 74%) and lower in late acute (132 of 267, 49%) and chronic (63 of 142, 44%) infections. Selected comorbidities, knee joint, and Staphylococcus aureus infections were independently associated with treatment failure, but antibiotic choice and duration (including rifampicin use) and extent of debridement were not. Conclusions Treatment success in PJI is associated with (1) selecting the appropriate treatment strategy and (2) nonmodifiable patient and infection factors. Interdisciplinary decision making that matches an individual patient to an appropriate management strategy is a critical step for PJI management. Randomized controlled trials are needed to determine the role of rifampicin in patients managed with DAIR and the optimal surgical strategy for late-acute PJI.
Published: 2022

5. World alliance against antibiotic resistance: The WAAAR declaration against antibiotic resistance

Author: Carlet, J, Aaron, L, Abassi, M, Abbo, L, Aboderin, O, Abraham, E, Abroug, F, Acar, J, Achour, W, Adachi, J, Al-Abri, S, Al-Mousa, H, Albaya-Moreno, A, Alberti, C, Alfandari, S, Alnimr, A, Aranda, C, de Lerma, F, Amer, F, Andremont, A, Angoulvant, F, Anguill, M, Antonelli, M, Antoniadou, E, Arlet, G, Armaganidis, A, Arnera, A, Artigas, A, Attali, C, Auber, F, Aubert, J, Augereau, B, Aupee, M, Bahri, O, Ballereau, F, Bapt, G, Baquero, F, Barkhan, T, Barouti, O, Barthelemy, M, Barton, G, Bastoni, D, Baussier, M, Bavestrello, L, Beger, B, Benenson, S, Bensalem, F, Beraud, G, Bergheau, F, Bernard, G, Berthelot, P, Bertrand, X, Beuhorry-Sassus, F, Beuret, P, Billington, J, Birge, J, Biscardi, S, Blanch, L, Blanchard, H, Bleck, T, Blondeau, J, Blot, F, Borgey, F, Bousquet-Melou, A, Brami, J, Brard, C, Bretagne, S, Bretonniere, C, Brink, A, Brown, S, Bruant-Rodier, C, Brun-Buisson, C, Bruneel, F, de Carvalho, F, Buhot, C, Bukharie, H, Cabie, A, Calandra, T, Caniaux, I, Canica, M, Canton, R, Carenco, P, Carlet, C, Carlet, F, Carlet, R, Cars, O, Cassiano-Neves, M, Castan, B, Castellan, V, Cazenave-Roblot, F, Ceretti, A, Chakarian, J, Chalumeau-Lemoine, L, Chandy, J, Chanfreau, B, Chastre, J, Chausset, R, Chavanet, P, Cheadle, W, Chiche, J, Chidiac, C, Chosidow, O, Chueca, N, Cohen, J, Cohen, R, Collignon, P, Collot, F, Coloby, P, Conly, J, Cordero, C, Cordonnier, C, Corso, A, Cosgrove, S, Courcol, R, Crane, S, Craven, D, Crespin, A, Cyrillo, M, Danin, P, Waele, J, Dellamonica, P, Patchen Dellinger, E, Dellinger, P, Delmont, J, Denes, E, Dimopoulos, G, Drekonja, D, Mansilla, A, Druais, P, Dufour-Pierrat, S, Dumartin, C, Dunser, M, Dupont, M, Durlach, R, Dyar, O, Echaniz, G, Edelstein, P, Eggimann, P, Elghonemi, M, Elmdaghri, N, Elsaid, R, Elsokari, R, Engelhard, D, Fabry, J, Farmer, C, Fernandez, J, Finfer, S, Finn, P, Fjeldsted, K, Floret, D, Flozaro, F, Foegle, J, Forceville, X, Fournier, S, Frachon, I, Friedrich, A, Funuel, P, Gaillard, D, Gaillat, J, Galperine, T, Gambarotto, K, Garo, B, Garrouste-Orgeas, M, Gastemeier, P, Gauchot, J, Gauzit, R, Gavazzi, G, Gazagne, L, Gerberding, J, Ghafur, A, Giamarellos-Bourboulis, E, Giamarellou, E, Giard, M, Gilchrist, M, Gilquin, J, Gilsanz, F, Gniadkowski, M, Gogos, C, Goldman, D, Gordon, F, Gottlieb, T, Gould, I, Gouveia, J, Grant, J, Grason, L, Greder, A, Grundman, H, Guaguere, E, Gueroult-Locher, G, Guery, B, Guidet, B, Guignabert, C, Gupta, P, Gupta, S, Gurjar, M, Guzman, M, Hajjar, J, Hammad, N, Hammerum, A, Hanberger, H, Hanke, R, Harbarth, S, Harel, A, Heisbourg, E, Hermes, I, Hermet, J, Hirschel, B, Hoen, B, Hollis, A, Honghong, X, Hooper, D, Horcajada, J, Housset, B, Hryniewicz, W, Hsu, L, Huang, S, Hughes, J, Hunault, J, Jakobsen, L, Jalil, N, Jansens, H, Jarlier, V, Jarvis, W, Jean, D, Jereb, M, Johnson, J, Joly-Guillou, M, Jonquet, O, Kac, G, Kaddu-Mulindwa, D, Kaku, M, Kilani, B, Kim, E, Gazard, D, Klugman, K, Klutts, S, Kluytmans, J, Kollef, M, Koulenti, D, Kresken, M, Lacoin, F, Lajonchere, J, Landgraf, N, Larroussinie, G, Laterre, P, Lavenaire, A, Lavigne, T, Laxminarayan, R, Le, T, Leblanc-Jouffre, F, Lee, N, Lehiani, O, Lelouet, H, Lemanach-Kergueris, F, Lepape, A, Leroy, J, Lescure, X, Levy, M, Levy-Hara, G, Lin, L, Lipman, J, Livartowski, J, Looke, D, Cardozo, F, Medrano, F, Lotthe, A, Lucet, J, Lupande, D, Madec, J, Mainardi, J, Maiylagan, S, Mancebo, J, Mansour-Adeoti, F, Maravi, E, Marchou, B, Marciniuk, D, Marshall, J, Martin, C, Martin, D, Martinez-Martinez, L, Martinot, A, Maseda, E, Matamis, D, Matheron, S, Matos, R, Matthews, M, May, T, Mayet, T, Mcgowan, J, Mehtar, S, Teles, J, Mendelson, M, Michelet, C, Mifsud, A, Mikaszewska-Sokolewicz, M, Minion, J, Miquel, C, Mira, J, Miro, J, Misset, B, Monot, J, Montravers, P, Mootien, J, Moreno, R, Morris, A, Moulin, G, Mourlan, C, Mouthon, G, Mowafy, W, Muhl, E, Muruganathan, A, Mushira, E, N'Doye, B, Nana, A, Niederman, M, Nitenberg, G, Nordman, P, Novira, A, Nowak, C, Okeke, I, Olaechea, P, Omar, A, Opal, S, Leyba, C, Oudega, B, Oziol, E, Page, B, Paiva, J, Palmer, L, Palomar-Martinez, M, Parneix, P, de la Garanderie, D, Perencevich, E, Perl, T, Perronne, C, Peters, G, Peters, M, Peyramond, D, Philippart, F, Pittet, D, Pittet, J, Plesiat, P, Pletz, M, Ploy, M, Pospisil, F, Pouedras, P, Poulakou, G, Poursinoff, A, Pronovost, P, Pulcini, C, Puoti, M, Puvanendiram, S, Quintel, M, Rabaud, C, Rambaud, C, Ramos, H, Rassla, O, Raymond, J, Regnier, B, Reinhart, K, Condomines, J, Revil, J, Riche, A, Richman, P, Richmann, R, Rodriguez, V, Rodriguez-Bano, J, Romain, O, Romand, K, Rossines, E, Rothan-Tondeur, M, Rousselot, J, Rubinstein, E, Rudnov, V, Saini, N, Salmon, D, Salomao, R, Garcia, M, Santos-Bouza, A, Saux, M, Savey, A, Saxinger, L, Schlemmer, B, Schmit, J, Schneider, D, Schoemaker, J, Singh, S, Sole-Violan, J, Soto, S, Stahl, J, Stoclin, A, Tabah, A, Tabut, J, Tambyah, P, Tamion, F, Tarr, P, Tattevin, P, Tenover, F, Terzi, N, Lecompte, M, Theodore, J, Thevenin, D, Thevenot, P, Thiriet, L, Thompson, C, Thurn, J, Tillotson, G, Tiouiri, H, Torres, A, Tremolieres, F, Troadec, M, Umar, R, Upham, G, Urban, C, Vaarten, J, Valla, D, Van Der Mee-Marquet, N, Van der Meer, J, Van Der Poll, T, Vancel, J, Vanhems, P, Varin, R, Varon, E, Vaughan, D, Veilly, M, Vijayakumar, K, Villanueva, A, Vincent, J, Vitrat, V, Voss, A, Wachter, R, Walsh, T, Wark, P, Waterer, G, Wegener, H, Weinbreck, P, Weinstein, R, Weissman, S, Wiener-Kronish, J, Wilmer, A, Wyplosz, B, Yacoub-Agha, I, Young, M, Yusuf, I, Zein, E, Zhanel, G, Zinner, S, Zoungrana, J, Zubareva, N, Carlet J., Aaron L., Abassi M. S., Abbo L., Aboderin O., Abraham E., Abroug F., Acar J., Achour W., Adachi J., Al-Abri S., Al-Mousa H., Albaya-Moreno A., Alberti C., Alfandari S., Alnimr A., Aranda C. A., de Lerma F. A., Amer F., Andremont A., Angoulvant F., Anguill M., Antonelli M., Antoniadou E., Arlet G., Armaganidis A., Arnera A., Artigas A., Attali C., Auber F., Aubert J. -P., Augereau B., Aupee M., Bahri O., Ballereau F., Bapt G., Baquero F., Barkhan T., Barouti O., Barthelemy M. -A., Barton G., Bastoni D., Baussier M., Bavestrello L., Beger B., Benenson S., Bensalem F., Beraud G., Bergheau F., Bernard G., Berthelot P., Bertrand X., Beuhorry-Sassus F., Beuret P., Billington J., Birge J., Biscardi S., Blanch L., Blanchard H., Bleck T., Blondeau J., Blot F., Borgey F., Bousquet-Melou A., Brami J., Brard C., Bretagne S., Bretonniere C., Brink A., Brown S., Bruant-Rodier C., Brun-Buisson C., Bruneel F., de Carvalho F. B., Buhot C., Bukharie H., Cabie A., Calandra T., Caniaux I., Canica M., Canton R., Carenco P., Carlet C., Carlet F., Carlet R., Cars O., Cassiano-Neves M., Castan B., Castellan V., Cazenave-Roblot F., Ceretti A. -M., Chakarian J. -C., Chalumeau-Lemoine L., Chandy J., Chanfreau B., Chastre J., Chausset R., Chavanet P., Cheadle W., Chiche J. -D., Chidiac C., Chosidow O., Chueca N., Cohen J., Cohen R., Collignon P., Collot F., Coloby P., Conly J., Cordero C., Cordonnier C., Corso A., Cosgrove S., Courcol R., Crane S., Craven D., Crespin A., Cyrillo M., Danin P. -E., Waele J. D., Dellamonica P., Patchen Dellinger E., Dellinger P., Delmont J., Denes E., Dimopoulos G., Drekonja D., Mansilla A. D., Druais P. -L., Dufour-Pierrat S., Dumartin C., Dunser M., Dupont M., Durlach R., Dyar O., Echaniz G., Edelstein P., Eggimann P., Elghonemi M., Elmdaghri N., Elsaid R., Elsokari R., Engelhard D., Fabry J., Farmer C., Fernandez J., Finfer S., Finn P., Fjeldsted K., Floret D., Flozaro F., Foegle J., Forceville X., Fournier S., Frachon I., Friedrich A., Funuel P., Gaillard D., Gaillat J., Galperine T., Gambarotto K., Garo B., Garrouste-Orgeas M., Gastemeier P., Gauchot J. -Y., Gauzit R., Gavazzi G., Gazagne L., Gerberding J., Ghafur A., Giamarellos-Bourboulis E., Giamarellou E., Giard M., Gilchrist M., Gilquin J., Gilsanz F., Gniadkowski M., Gogos C., Goldman D., Gordon F., Gottlieb T., Gould I., Gouveia J., Grant J., Grason L., Greder A., Grundman H., Guaguere E., Gueroult-Locher G., Guery B., Guidet B., Guignabert C., Gupta P., Gupta S., Gurjar M., Guzman M., Hajjar J., Hammad N., Hammerum A., Hanberger H., Hanke R., Harbarth S., Harel A., Heisbourg E., Hermes I., Hermet J. -P., Hirschel B., Hoen B., Hollis A., Honghong X., Hooper D., Horcajada J. P., Housset B., Hryniewicz W., Hsu L. Y., Huang S., Hughes J., Hunault J. -L., Jakobsen L., Jalil N., Jansens H., Jarlier V., Jarvis W., Jean D., Jereb M., Johnson J., Joly-Guillou M. -L., Jonquet O., Kac G., Kaddu-Mulindwa D., Kaku M., Kilani B., Kim E. -C., Gazard D. K., Klugman K., Klutts S., Kluytmans J., Kollef M., Koulenti D., Kresken M., Lacoin F., Lajonchere J. -P., Landgraf N., Larroussinie G., Laterre P. -F., Lavenaire A. -M., Lavigne T., Laxminarayan R., Le T. A. T., Leblanc-Jouffre F., Lee N. Y., Lehiani O., Lelouet H., Lemanach-Kergueris F., Lepape A., Leroy J., Lescure X., Levy M., Levy-Hara G., Lin L. M., Lipman J., Livartowski J., Looke D., Cardozo F. L. L., Medrano F. L., Lotthe A., Lucet J. C., Lupande D., Madec J. -Y., Mainardi J. -L., Maiylagan S., Mancebo J., Mansour-Adeoti F., Maravi E., Marchou B., Marciniuk D., Marshall J., Martin C., Martin D., Martinez-Martinez L., Martinot A., Maseda E., Matamis D., Matheron S., Matos R., Matthews M., May T., Mayet T., McGowan J., Mehtar S., Teles J. M. M., Mendelson M., Michelet C., Mifsud A., Mikaszewska-Sokolewicz M., Minion J., Miquel C., Mira J. -P., Miro J., Misset B., Monot J. -J., Montravers P., Mootien J., Moreno R., Morris A., Moulin G., Mourlan C., Mouthon G., Mowafy W., Muhl E., Muruganathan A., Mushira E., N'Doye B., Nana A., Niederman M., Nitenberg G., Nordman P., Novira A., Nowak C., Okeke I., Olaechea P. M., Omar A., Opal S., Leyba C. O., Oudega B., Oziol E., Page B., Paiva J. A., Palmer L., Palomar-Martinez M., Parneix P., de la Garanderie D. P., Perencevich E., Perl T., Perronne C., Peters G., Peters M., Peyramond D., Philippart F., Pittet D., Pittet J. -F., Plesiat P., Pletz M., Ploy M. -C., Pospisil F., Pouedras P., Poulakou G., Poursinoff A., Pronovost P., Pulcini C., Puoti M., Puvanendiram S., Quintel M., Rabaud C., Rambaud C., Ramos H., Rassla O., Raymond J., Regnier B., Reinhart K., Condomines J. R., Revil J. -C., Riche A., Richman P., Richmann R., Rodriguez V., Rodriguez-Bano J., Romain O., Romand K., Rossines E., Rothan-Tondeur M. I., Rousselot J. -F., Rubinstein E., Rudnov V., Saini N., Salmon D., Salomao R., Garcia M. S., Santos-Bouza A., Saux M. -C., Savey A., Saxinger L., Schlemmer B., Schmit J. -L., Schneider D., Schoemaker J., Singh S., Sole-Violan J., Soto S., Stahl J. -P., Stoclin A., Tabah A., Tabut J. -P., Tambyah P. A., Tamion F., Tarr P., Tattevin P., Tenover F., Terzi N., Lecompte M. T., Theodore J., Thevenin D., Thevenot P., Thiriet L., Thompson C., Thurn J., Tillotson G., Tiouiri H., Torres A., Tremolieres F., Troadec M., Umar R., Upham G., Urban C., Vaarten J., Valla D., Van Der Mee-Marquet N., Van der Meer J., Van Der Poll T., Vancel J., Vanhems P., Varin R., Varon E., Vaughan D., Veilly M., Vijayakumar K., Villanueva A., Vincent J. -L., Vitrat V., Voss A., Wachter R., Walsh T., Wark P., Waterer G., Wegener H. C., Weinbreck P., Weinstein R., Weissman S., Wiener-Kronish J., Wilmer A., Wyplosz B., Yacoub-Agha I., Young M., Yusuf I., Zein E., Zhanel G., Zinner S., Zoungrana J., Zubareva N., Carlet, J, Aaron, L, Abassi, M, Abbo, L, Aboderin, O, Abraham, E, Abroug, F, Acar, J, Achour, W, Adachi, J, Al-Abri, S, Al-Mousa, H, Albaya-Moreno, A, Alberti, C, Alfandari, S, Alnimr, A, Aranda, C, de Lerma, F, Amer, F, Andremont, A, Angoulvant, F, Anguill, M, Antonelli, M, Antoniadou, E, Arlet, G, Armaganidis, A, Arnera, A, Artigas, A, Attali, C, Auber, F, Aubert, J, Augereau, B, Aupee, M, Bahri, O, Ballereau, F, Bapt, G, Baquero, F, Barkhan, T, Barouti, O, Barthelemy, M, Barton, G, Bastoni, D, Baussier, M, Bavestrello, L, Beger, B, Benenson, S, Bensalem, F, Beraud, G, Bergheau, F, Bernard, G, Berthelot, P, Bertrand, X, Beuhorry-Sassus, F, Beuret, P, Billington, J, Birge, J, Biscardi, S, Blanch, L, Blanchard, H, Bleck, T, Blondeau, J, Blot, F, Borgey, F, Bousquet-Melou, A, Brami, J, Brard, C, Bretagne, S, Bretonniere, C, Brink, A, Brown, S, Bruant-Rodier, C, Brun-Buisson, C, Bruneel, F, de Carvalho, F, Buhot, C, Bukharie, H, Cabie, A, Calandra, T, Caniaux, I, Canica, M, Canton, R, Carenco, P, Carlet, C, Carlet, F, Carlet, R, Cars, O, Cassiano-Neves, M, Castan, B, Castellan, V, Cazenave-Roblot, F, Ceretti, A, Chakarian, J, Chalumeau-Lemoine, L, Chandy, J, Chanfreau, B, Chastre, J, Chausset, R, Chavanet, P, Cheadle, W, Chiche, J, Chidiac, C, Chosidow, O, Chueca, N, Cohen, J, Cohen, R, Collignon, P, Collot, F, Coloby, P, Conly, J, Cordero, C, Cordonnier, C, Corso, A, Cosgrove, S, Courcol, R, Crane, S, Craven, D, Crespin, A, Cyrillo, M, Danin, P, Waele, J, Dellamonica, P, Patchen Dellinger, E, Dellinger, P, Delmont, J, Denes, E, Dimopoulos, G, Drekonja, D, Mansilla, A, Druais, P, Dufour-Pierrat, S, Dumartin, C, Dunser, M, Dupont, M, Durlach, R, Dyar, O, Echaniz, G, Edelstein, P, Eggimann, P, Elghonemi, M, Elmdaghri, N, Elsaid, R, Elsokari, R, Engelhard, D, Fabry, J, Farmer, C, Fernandez, J, Finfer, S, Finn, P, Fjeldsted, K, Floret, D, Flozaro, F, Foegle, J, Forceville, X, Fournier, S, Frachon, I, Friedrich, A, Funuel, P, Gaillard, D, Gaillat, J, Galperine, T, Gambarotto, K, Garo, B, Garrouste-Orgeas, M, Gastemeier, P, Gauchot, J, Gauzit, R, Gavazzi, G, Gazagne, L, Gerberding, J, Ghafur, A, Giamarellos-Bourboulis, E, Giamarellou, E, Giard, M, Gilchrist, M, Gilquin, J, Gilsanz, F, Gniadkowski, M, Gogos, C, Goldman, D, Gordon, F, Gottlieb, T, Gould, I, Gouveia, J, Grant, J, Grason, L, Greder, A, Grundman, H, Guaguere, E, Gueroult-Locher, G, Guery, B, Guidet, B, Guignabert, C, Gupta, P, Gupta, S, Gurjar, M, Guzman, M, Hajjar, J, Hammad, N, Hammerum, A, Hanberger, H, Hanke, R, Harbarth, S, Harel, A, Heisbourg, E, Hermes, I, Hermet, J, Hirschel, B, Hoen, B, Hollis, A, Honghong, X, Hooper, D, Horcajada, J, Housset, B, Hryniewicz, W, Hsu, L, Huang, S, Hughes, J, Hunault, J, Jakobsen, L, Jalil, N, Jansens, H, Jarlier, V, Jarvis, W, Jean, D, Jereb, M, Johnson, J, Joly-Guillou, M, Jonquet, O, Kac, G, Kaddu-Mulindwa, D, Kaku, M, Kilani, B, Kim, E, Gazard, D, Klugman, K, Klutts, S, Kluytmans, J, Kollef, M, Koulenti, D, Kresken, M, Lacoin, F, Lajonchere, J, Landgraf, N, Larroussinie, G, Laterre, P, Lavenaire, A, Lavigne, T, Laxminarayan, R, Le, T, Leblanc-Jouffre, F, Lee, N, Lehiani, O, Lelouet, H, Lemanach-Kergueris, F, Lepape, A, Leroy, J, Lescure, X, Levy, M, Levy-Hara, G, Lin, L, Lipman, J, Livartowski, J, Looke, D, Cardozo, F, Medrano, F, Lotthe, A, Lucet, J, Lupande, D, Madec, J, Mainardi, J, Maiylagan, S, Mancebo, J, Mansour-Adeoti, F, Maravi, E, Marchou, B, Marciniuk, D, Marshall, J, Martin, C, Martin, D, Martinez-Martinez, L, Martinot, A, Maseda, E, Matamis, D, Matheron, S, Matos, R, Matthews, M, May, T, Mayet, T, Mcgowan, J, Mehtar, S, Teles, J, Mendelson, M, Michelet, C, Mifsud, A, Mikaszewska-Sokolewicz, M, Minion, J, Miquel, C, Mira, J, Miro, J, Misset, B, Monot, J, Montravers, P, Mootien, J, Moreno, R, Morris, A, Moulin, G, Mourlan, C, Mouthon, G, Mowafy, W, Muhl, E, Muruganathan, A, Mushira, E, N'Doye, B, Nana, A, Niederman, M, Nitenberg, G, Nordman, P, Novira, A, Nowak, C, Okeke, I, Olaechea, P, Omar, A, Opal, S, Leyba, C, Oudega, B, Oziol, E, Page, B, Paiva, J, Palmer, L, Palomar-Martinez, M, Parneix, P, de la Garanderie, D, Perencevich, E, Perl, T, Perronne, C, Peters, G, Peters, M, Peyramond, D, Philippart, F, Pittet, D, Pittet, J, Plesiat, P, Pletz, M, Ploy, M, Pospisil, F, Pouedras, P, Poulakou, G, Poursinoff, A, Pronovost, P, Pulcini, C, Puoti, M, Puvanendiram, S, Quintel, M, Rabaud, C, Rambaud, C, Ramos, H, Rassla, O, Raymond, J, Regnier, B, Reinhart, K, Condomines, J, Revil, J, Riche, A, Richman, P, Richmann, R, Rodriguez, V, Rodriguez-Bano, J, Romain, O, Romand, K, Rossines, E, Rothan-Tondeur, M, Rousselot, J, Rubinstein, E, Rudnov, V, Saini, N, Salmon, D, Salomao, R, Garcia, M, Santos-Bouza, A, Saux, M, Savey, A, Saxinger, L, Schlemmer, B, Schmit, J, Schneider, D, Schoemaker, J, Singh, S, Sole-Violan, J, Soto, S, Stahl, J, Stoclin, A, Tabah, A, Tabut, J, Tambyah, P, Tamion, F, Tarr, P, Tattevin, P, Tenover, F, Terzi, N, Lecompte, M, Theodore, J, Thevenin, D, Thevenot, P, Thiriet, L, Thompson, C, Thurn, J, Tillotson, G, Tiouiri, H, Torres, A, Tremolieres, F, Troadec, M, Umar, R, Upham, G, Urban, C, Vaarten, J, Valla, D, Van Der Mee-Marquet, N, Van der Meer, J, Van Der Poll, T, Vancel, J, Vanhems, P, Varin, R, Varon, E, Vaughan, D, Veilly, M, Vijayakumar, K, Villanueva, A, Vincent, J, Vitrat, V, Voss, A, Wachter, R, Walsh, T, Wark, P, Waterer, G, Wegener, H, Weinbreck, P, Weinstein, R, Weissman, S, Wiener-Kronish, J, Wilmer, A, Wyplosz, B, Yacoub-Agha, I, Young, M, Yusuf, I, Zein, E, Zhanel, G, Zinner, S, Zoungrana, J, Zubareva, N, Carlet J., Aaron L., Abassi M. S., Abbo L., Aboderin O., Abraham E., Abroug F., Acar J., Achour W., Adachi J., Al-Abri S., Al-Mousa H., Albaya-Moreno A., Alberti C., Alfandari S., Alnimr A., Aranda C. A., de Lerma F. A., Amer F., Andremont A., Angoulvant F., Anguill M., Antonelli M., Antoniadou E., Arlet G., Armaganidis A., Arnera A., Artigas A., Attali C., Auber F., Aubert J. -P., Augereau B., Aupee M., Bahri O., Ballereau F., Bapt G., Baquero F., Barkhan T., Barouti O., Barthelemy M. -A., Barton G., Bastoni D., Baussier M., Bavestrello L., Beger B., Benenson S., Bensalem F., Beraud G., Bergheau F., Bernard G., Berthelot P., Bertrand X., Beuhorry-Sassus F., Beuret P., Billington J., Birge J., Biscardi S., Blanch L., Blanchard H., Bleck T., Blondeau J., Blot F., Borgey F., Bousquet-Melou A., Brami J., Brard C., Bretagne S., Bretonniere C., Brink A., Brown S., Bruant-Rodier C., Brun-Buisson C., Bruneel F., de Carvalho F. B., Buhot C., Bukharie H., Cabie A., Calandra T., Caniaux I., Canica M., Canton R., Carenco P., Carlet C., Carlet F., Carlet R., Cars O., Cassiano-Neves M., Castan B., Castellan V., Cazenave-Roblot F., Ceretti A. -M., Chakarian J. -C., Chalumeau-Lemoine L., Chandy J., Chanfreau B., Chastre J., Chausset R., Chavanet P., Cheadle W., Chiche J. -D., Chidiac C., Chosidow O., Chueca N., Cohen J., Cohen R., Collignon P., Collot F., Coloby P., Conly J., Cordero C., Cordonnier C., Corso A., Cosgrove S., Courcol R., Crane S., Craven D., Crespin A., Cyrillo M., Danin P. -E., Waele J. D., Dellamonica P., Patchen Dellinger E., Dellinger P., Delmont J., Denes E., Dimopoulos G., Drekonja D., Mansilla A. D., Druais P. -L., Dufour-Pierrat S., Dumartin C., Dunser M., Dupont M., Durlach R., Dyar O., Echaniz G., Edelstein P., Eggimann P., Elghonemi M., Elmdaghri N., Elsaid R., Elsokari R., Engelhard D., Fabry J., Farmer C., Fernandez J., Finfer S., Finn P., Fjeldsted K., Floret D., Flozaro F., Foegle J., Forceville X., Fournier S., Frachon I., Friedrich A., Funuel P., Gaillard D., Gaillat J., Galperine T., Gambarotto K., Garo B., Garrouste-Orgeas M., Gastemeier P., Gauchot J. -Y., Gauzit R., Gavazzi G., Gazagne L., Gerberding J., Ghafur A., Giamarellos-Bourboulis E., Giamarellou E., Giard M., Gilchrist M., Gilquin J., Gilsanz F., Gniadkowski M., Gogos C., Goldman D., Gordon F., Gottlieb T., Gould I., Gouveia J., Grant J., Grason L., Greder A., Grundman H., Guaguere E., Gueroult-Locher G., Guery B., Guidet B., Guignabert C., Gupta P., Gupta S., Gurjar M., Guzman M., Hajjar J., Hammad N., Hammerum A., Hanberger H., Hanke R., Harbarth S., Harel A., Heisbourg E., Hermes I., Hermet J. -P., Hirschel B., Hoen B., Hollis A., Honghong X., Hooper D., Horcajada J. P., Housset B., Hryniewicz W., Hsu L. Y., Huang S., Hughes J., Hunault J. -L., Jakobsen L., Jalil N., Jansens H., Jarlier V., Jarvis W., Jean D., Jereb M., Johnson J., Joly-Guillou M. -L., Jonquet O., Kac G., Kaddu-Mulindwa D., Kaku M., Kilani B., Kim E. -C., Gazard D. K., Klugman K., Klutts S., Kluytmans J., Kollef M., Koulenti D., Kresken M., Lacoin F., Lajonchere J. -P., Landgraf N., Larroussinie G., Laterre P. -F., Lavenaire A. -M., Lavigne T., Laxminarayan R., Le T. A. T., Leblanc-Jouffre F., Lee N. Y., Lehiani O., Lelouet H., Lemanach-Kergueris F., Lepape A., Leroy J., Lescure X., Levy M., Levy-Hara G., Lin L. M., Lipman J., Livartowski J., Looke D., Cardozo F. L. L., Medrano F. L., Lotthe A., Lucet J. C., Lupande D., Madec J. -Y., Mainardi J. -L., Maiylagan S., Mancebo J., Mansour-Adeoti F., Maravi E., Marchou B., Marciniuk D., Marshall J., Martin C., Martin D., Martinez-Martinez L., Martinot A., Maseda E., Matamis D., Matheron S., Matos R., Matthews M., May T., Mayet T., McGowan J., Mehtar S., Teles J. M. M., Mendelson M., Michelet C., Mifsud A., Mikaszewska-Sokolewicz M., Minion J., Miquel C., Mira J. -P., Miro J., Misset B., Monot J. -J., Montravers P., Mootien J., Moreno R., Morris A., Moulin G., Mourlan C., Mouthon G., Mowafy W., Muhl E., Muruganathan A., Mushira E., N'Doye B., Nana A., Niederman M., Nitenberg G., Nordman P., Novira A., Nowak C., Okeke I., Olaechea P. M., Omar A., Opal S., Leyba C. O., Oudega B., Oziol E., Page B., Paiva J. A., Palmer L., Palomar-Martinez M., Parneix P., de la Garanderie D. P., Perencevich E., Perl T., Perronne C., Peters G., Peters M., Peyramond D., Philippart F., Pittet D., Pittet J. -F., Plesiat P., Pletz M., Ploy M. -C., Pospisil F., Pouedras P., Poulakou G., Poursinoff A., Pronovost P., Pulcini C., Puoti M., Puvanendiram S., Quintel M., Rabaud C., Rambaud C., Ramos H., Rassla O., Raymond J., Regnier B., Reinhart K., Condomines J. R., Revil J. -C., Riche A., Richman P., Richmann R., Rodriguez V., Rodriguez-Bano J., Romain O., Romand K., Rossines E., Rothan-Tondeur M. I., Rousselot J. -F., Rubinstein E., Rudnov V., Saini N., Salmon D., Salomao R., Garcia M. S., Santos-Bouza A., Saux M. -C., Savey A., Saxinger L., Schlemmer B., Schmit J. -L., Schneider D., Schoemaker J., Singh S., Sole-Violan J., Soto S., Stahl J. -P., Stoclin A., Tabah A., Tabut J. -P., Tambyah P. A., Tamion F., Tarr P., Tattevin P., Tenover F., Terzi N., Lecompte M. T., Theodore J., Thevenin D., Thevenot P., Thiriet L., Thompson C., Thurn J., Tillotson G., Tiouiri H., Torres A., Tremolieres F., Troadec M., Umar R., Upham G., Urban C., Vaarten J., Valla D., Van Der Mee-Marquet N., Van der Meer J., Van Der Poll T., Vancel J., Vanhems P., Varin R., Varon E., Vaughan D., Veilly M., Vijayakumar K., Villanueva A., Vincent J. -L., Vitrat V., Voss A., Wachter R., Walsh T., Wark P., Waterer G., Wegener H. C., Weinbreck P., Weinstein R., Weissman S., Wiener-Kronish J., Wilmer A., Wyplosz B., Yacoub-Agha I., Young M., Yusuf I., Zein E., Zhanel G., Zinner S., Zoungrana J., and Zubareva N.
Abstract: We must change how antibiotics are used and adopt proactive strategies, similar to those used to save endangered species. Preservation of the efficacy of antibiotics and to stabilization of antibiotic-susceptible bacterial ecosystems should be global goals. (C) 2014 Elsevier Espana, S.L.U. and SEMICYUC. All rights reserved.
Published: 2015

6. Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance

Author: Harris, P.N.A., Tambyah, P.A., Lye, D.C., Mo, Y., Lee, T.H., Yilmaz, M., Alenazi, T.H., Arabi, Y., Falcone, M., Bassetti, M., Righi, E., Rogers, B.A., Kanj, S., Bhally, H., Iredell, J., Mendelson, M., Boyles, T.H., Looke, D., Miyakis, S., Walls, G., Al Khamis, M., Zikri, A., Crowe, A., Ingram, P., Daneman, N., Griffin, P., Athan, E., Lorenc, P., Baker, P., Roberts, L., Beatson, S.A., Peleg, A.Y., Harris-Brown, T., Paterson, D.L., Robinson, J.O., Harris, P.N.A., Tambyah, P.A., Lye, D.C., Mo, Y., Lee, T.H., Yilmaz, M., Alenazi, T.H., Arabi, Y., Falcone, M., Bassetti, M., Righi, E., Rogers, B.A., Kanj, S., Bhally, H., Iredell, J., Mendelson, M., Boyles, T.H., Looke, D., Miyakis, S., Walls, G., Al Khamis, M., Zikri, A., Crowe, A., Ingram, P., Daneman, N., Griffin, P., Athan, E., Lorenc, P., Baker, P., Roberts, L., Beatson, S.A., Peleg, A.Y., Harris-Brown, T., Paterson, D.L., and Robinson, J.O.
Abstract: Importance: Extended-spectrum β-lactamases mediate resistance to third-generation cephalosporins (eg, ceftriaxone) in Escherichia coli and Klebsiella pneumoniae. Significant infections caused by these strains are usually treated with carbapenems, potentially selecting for carbapenem resistance. Piperacillin-tazobactam may be an effective “carbapenem-sparing” option to treat extended-spectrum β-lactamase producers. Objectives: To determine whether definitive therapy with piperacillin-tazobactam is noninferior to meropenem (a carbapenem) in patients with bloodstream infection caused by ceftriaxone-nonsusceptible E coli or K pneumoniae. Design, Setting, and Participants: Noninferiority, parallel group, randomized clinical trial included hospitalized patients enrolled from 26 sites in 9 countries from February 2014 to July 2017. Adult patients were eligible if they had at least 1 positive blood culture with E coli or Klebsiella spp testing nonsusceptible to ceftriaxone but susceptible to piperacillin-tazobactam. Of 1646 patients screened, 391 were included in the study. Interventions: Patients were randomly assigned 1:1 to intravenous piperacillin-tazobactam, 4.5 g, every 6 hours (n = 188 participants) or meropenem, 1 g, every 8 hours (n = 191 participants) for a minimum of 4 days, up to a maximum of 14 days, with the total duration determined by the treating clinician. Main Outcomes and Measures: The primary outcome was all-cause mortality at 30 days after randomization. A noninferiority margin of 5% was used. Results: Among 379 patients (mean age, 66.5 years; 47.8% women) who were randomized appropriately, received at least 1 dose of study drug, and were included in the primary analysis population, 378 (99.7%) completed the trial and were assessed for the primary outcome. A total of 23 of 187 patients (12.3%) randomized to piperacillin-tazobactam met the primary outcome of mortality at 30 days compared with 7 of 191 (3.7%) randomized to meropenem (risk difference, 8.6
Published: 2018

7. 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 and blaCTX-M-27.

Author: Henderson A., Chiang D., Hwa S.S., Kang Y., Pei O.S., Ying D., Holland U., Korman T., Harris P.N.A., Ben Zakour N.L., Roberts L.W., Wailan A.M., Zowawi H.M., Tambyah P.A., Lye D.C., Jureen R., Lee T.H., Yin M., Izharuddin E., Looke D., Runnegar N., Rogers B., Bhally H., Crowe A., Schembri M.A., Beatson S.A., Paterson D.L., Harris-Brown T., Lorenc P., McNamara J., Underwood N., Eisenmann J., Stewart J., Ali J., Henderson A., Chiang D., Hwa S.S., Kang Y., Pei O.S., Ying D., Holland U., Korman T., Harris P.N.A., Ben Zakour N.L., Roberts L.W., Wailan A.M., Zowawi H.M., Tambyah P.A., Lye D.C., Jureen R., Lee T.H., Yin M., Izharuddin E., Looke D., Runnegar N., Rogers B., Bhally H., Crowe A., Schembri M.A., Beatson S.A., Paterson D.L., Harris-Brown T., Lorenc P., McNamara J., Underwood N., Eisenmann J., Stewart J., and Ali J.
Abstract: Objectives: To characterize MDR Escherichia coli from bloodstream infections (BSIs) in Australia, New Zealand and Singapore. Method(s): We collected third-generation cephalosporin-resistant (3GC-R) E. coli from blood cultures in patients enrolled in a randomized controlled trial fromFebruary 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. Result(s): 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. Conclusion(s): In a prospective collection of 3GC-R E. coli causing BSI, community-associated Clade C1/C2 ST131 predominate in associationwith blaCTX-M ESBLs, although a significant proportion of non-ST131 strains carried blaCMY-2.Copyright © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Published: 2018

8. Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with e coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance.

Author: Pollard J., Arabi Y., Athan E., Lorenc P., Baker P., Roberts L., Beatson S.A., Peleg A.Y., Harris-Brown T., Paterson D.L., McNamara J., Sieler R., Garlick J., Costa J., Roney J., Pratt N., Tabaja H., Kmeid J., Tayyar R., El Zein S., Jones S., Cowan R., Lin B., Rad B., MacMorran E., Dinleyici R., Istanbullu A., Ceylan B., Mert A., Hashhoush M., Dalwi T., Korman T., Azzam R., Birrell M., Hughes C., Khan S., Lau J., Lee L., Lim K., Lin Y.D., Lister D., New D., Rafiei N., Stewart J., Tai A., Trad M.A., Aye Yeung V., McBride S., Holland D., Hopkins C., Luey C., Taylor S., Morpeth S., Finney M., Martin M., Holland U., Ali J., Jureen R., Underwood N., Henderson A., Runnegar N., Slavin M., Robinson O., Rishu A., Shawkat S., Fish J., Chin Liew K., Newton P., Merelli M., Carnelutti A., Ussai S., Pecori D., Izharuddin E., Young B., Ding Y., Ram R., Kelly J., Joshi N., Richards G., Smith O., Alli A., Vermeulen I., Wright B., Grey C., Stewart A., Reddy D., Wasserman S., Richi H., Sultana K., Alanazi N., Bin Awad E., Franzetti F., Stolz A., De Kock E., Magongoa T., Dutoit M., Russo A., Dentone C., Eisen D., Heyer L., Harris P.N.A., Tambyah P.A., Lye D.C., Mo Y., Lee T.H., Yilmaz M., Alenazi T.H., Falcone M., Bassetti M., Righi E., Rogers B.A., Kanj S., Bhally H., Iredell J., Mendelson M., Boyles T.H., Looke D., Miyakis S., Walls G., Al Khamis M., Zikri A., Crowe A., Ingram P., Daneman N., Griffin P., Pollard J., Arabi Y., Athan E., Lorenc P., Baker P., Roberts L., Beatson S.A., Peleg A.Y., Harris-Brown T., Paterson D.L., McNamara J., Sieler R., Garlick J., Costa J., Roney J., Pratt N., Tabaja H., Kmeid J., Tayyar R., El Zein S., Jones S., Cowan R., Lin B., Rad B., MacMorran E., Dinleyici R., Istanbullu A., Ceylan B., Mert A., Hashhoush M., Dalwi T., Korman T., Azzam R., Birrell M., Hughes C., Khan S., Lau J., Lee L., Lim K., Lin Y.D., Lister D., New D., Rafiei N., Stewart J., Tai A., Trad M.A., Aye Yeung V., McBride S., Holland D., Hopkins C., Luey C., Taylor S., Morpeth S., Finney M., Martin M., Holland U., Ali J., Jureen R., Underwood N., Henderson A., Runnegar N., Slavin M., Robinson O., Rishu A., Shawkat S., Fish J., Chin Liew K., Newton P., Merelli M., Carnelutti A., Ussai S., Pecori D., Izharuddin E., Young B., Ding Y., Ram R., Kelly J., Joshi N., Richards G., Smith O., Alli A., Vermeulen I., Wright B., Grey C., Stewart A., Reddy D., Wasserman S., Richi H., Sultana K., Alanazi N., Bin Awad E., Franzetti F., Stolz A., De Kock E., Magongoa T., Dutoit M., Russo A., Dentone C., Eisen D., Heyer L., Harris P.N.A., Tambyah P.A., Lye D.C., Mo Y., Lee T.H., Yilmaz M., Alenazi T.H., Falcone M., Bassetti M., Righi E., Rogers B.A., Kanj S., Bhally H., Iredell J., Mendelson M., Boyles T.H., Looke D., Miyakis S., Walls G., Al Khamis M., Zikri A., Crowe A., Ingram P., Daneman N., and Griffin P.
Abstract: IMPORTANCE Extended-spectrum beta-lactamases mediate resistance to third-generation cephalosporins (eg, ceftriaxone) in Escherichia coli and Klebsiella pneumoniae. Significant infections caused by these strains are usually treated with carbapenems, potentially selecting for carbapenem resistance. Piperacillin-tazobactam may be an effective "carbapenem-sparing" option to treat extended-spectrum beta-lactamase producers. OBJECTIVES To determine whether definitive therapy with piperacillin-tazobactam is noninferior to meropenem (a carbapenem) in patients with bloodstream infection caused by ceftriaxone-nonsusceptible E coli or K pneumoniae. DESIGN, SETTING, AND PARTICIPANTS Noninferiority, parallel group, randomized clinical trial included hospitalized patients enrolled from 26 sites in 9 countries from February 2014 to July 2017. Adult patients were eligible if they had at least 1 positive blood culture with E coli or Klebsiella spp testing nonsusceptible to ceftriaxone but susceptible to piperacillin-tazobactam. Of 1646 patients screened, 391 were included in the study. INTERVENTIONS Patients were randomly assigned 1:1 to intravenous piperacillin-tazobactam, 4.5 g, every 6 hours (n = 188 participants) or meropenem, 1 g, every 8 hours (n = 191 participants) for a minimum of 4 days, up to a maximum of 14 days, with the total duration determined by the treating clinician. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 30 days after randomization. A noninferiority margin of 5% was used. RESULTS Among 379 patients (mean age, 66.5 years; 47.8% women) who were randomized appropriately, received at least 1 dose of study drug, and were included in the primary analysis population, 378 (99.7%) completed the trial and were assessed for the primary outcome. A total of 23 of 187 patients (12.3%) randomized to piperacillin-tazobactam met the primary outcome of mortality at 30 days compared with 7 of 191 (3.7%) randomized to meropenem (risk difference, 8.6
Published: 2018

9. 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 and blaCTX-M-27.

Author: Henderson A., Chiang D., Hwa S.S., Kang Y., Pei O.S., Ying D., Holland U., Korman T., Harris P.N.A., Ben Zakour N.L., Roberts L.W., Wailan A.M., Zowawi H.M., Tambyah P.A., Lye D.C., Jureen R., Lee T.H., Yin M., Izharuddin E., Looke D., Runnegar N., Rogers B., Bhally H., Crowe A., Schembri M.A., Beatson S.A., Paterson D.L., Harris-Brown T., Lorenc P., McNamara J., Underwood N., Eisenmann J., Stewart J., Ali J., Henderson A., Chiang D., Hwa S.S., Kang Y., Pei O.S., Ying D., Holland U., Korman T., Harris P.N.A., Ben Zakour N.L., Roberts L.W., Wailan A.M., Zowawi H.M., Tambyah P.A., Lye D.C., Jureen R., Lee T.H., Yin M., Izharuddin E., Looke D., Runnegar N., Rogers B., Bhally H., Crowe A., Schembri M.A., Beatson S.A., Paterson D.L., Harris-Brown T., Lorenc P., McNamara J., Underwood N., Eisenmann J., Stewart J., and Ali J.
Abstract: Objectives: To characterize MDR Escherichia coli from bloodstream infections (BSIs) in Australia, New Zealand and Singapore. Method(s): We collected third-generation cephalosporin-resistant (3GC-R) E. coli from blood cultures in patients enrolled in a randomized controlled trial fromFebruary 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. Result(s): 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. Conclusion(s): In a prospective collection of 3GC-R E. coli causing BSI, community-associated Clade C1/C2 ST131 predominate in associationwith blaCTX-M ESBLs, although a significant proportion of non-ST131 strains carried blaCMY-2.Copyright © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Published: 2018

10. Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with e coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance.

Author: Pollard J., Arabi Y., Athan E., Lorenc P., Baker P., Roberts L., Beatson S.A., Peleg A.Y., Harris-Brown T., Paterson D.L., McNamara J., Sieler R., Garlick J., Costa J., Roney J., Pratt N., Tabaja H., Kmeid J., Tayyar R., El Zein S., Jones S., Cowan R., Lin B., Rad B., MacMorran E., Dinleyici R., Istanbullu A., Ceylan B., Mert A., Hashhoush M., Dalwi T., Korman T., Azzam R., Birrell M., Hughes C., Khan S., Lau J., Lee L., Lim K., Lin Y.D., Lister D., New D., Rafiei N., Stewart J., Tai A., Trad M.A., Aye Yeung V., McBride S., Holland D., Hopkins C., Luey C., Taylor S., Morpeth S., Finney M., Martin M., Holland U., Ali J., Jureen R., Underwood N., Henderson A., Runnegar N., Slavin M., Robinson O., Rishu A., Shawkat S., Fish J., Chin Liew K., Newton P., Merelli M., Carnelutti A., Ussai S., Pecori D., Izharuddin E., Young B., Ding Y., Ram R., Kelly J., Joshi N., Richards G., Smith O., Alli A., Vermeulen I., Wright B., Grey C., Stewart A., Reddy D., Wasserman S., Richi H., Sultana K., Alanazi N., Bin Awad E., Franzetti F., Stolz A., De Kock E., Magongoa T., Dutoit M., Russo A., Dentone C., Eisen D., Heyer L., Harris P.N.A., Tambyah P.A., Lye D.C., Mo Y., Lee T.H., Yilmaz M., Alenazi T.H., Falcone M., Bassetti M., Righi E., Rogers B.A., Kanj S., Bhally H., Iredell J., Mendelson M., Boyles T.H., Looke D., Miyakis S., Walls G., Al Khamis M., Zikri A., Crowe A., Ingram P., Daneman N., Griffin P., Pollard J., Arabi Y., Athan E., Lorenc P., Baker P., Roberts L., Beatson S.A., Peleg A.Y., Harris-Brown T., Paterson D.L., McNamara J., Sieler R., Garlick J., Costa J., Roney J., Pratt N., Tabaja H., Kmeid J., Tayyar R., El Zein S., Jones S., Cowan R., Lin B., Rad B., MacMorran E., Dinleyici R., Istanbullu A., Ceylan B., Mert A., Hashhoush M., Dalwi T., Korman T., Azzam R., Birrell M., Hughes C., Khan S., Lau J., Lee L., Lim K., Lin Y.D., Lister D., New D., Rafiei N., Stewart J., Tai A., Trad M.A., Aye Yeung V., McBride S., Holland D., Hopkins C., Luey C., Taylor S., Morpeth S., Finney M., Martin M., Holland U., Ali J., Jureen R., Underwood N., Henderson A., Runnegar N., Slavin M., Robinson O., Rishu A., Shawkat S., Fish J., Chin Liew K., Newton P., Merelli M., Carnelutti A., Ussai S., Pecori D., Izharuddin E., Young B., Ding Y., Ram R., Kelly J., Joshi N., Richards G., Smith O., Alli A., Vermeulen I., Wright B., Grey C., Stewart A., Reddy D., Wasserman S., Richi H., Sultana K., Alanazi N., Bin Awad E., Franzetti F., Stolz A., De Kock E., Magongoa T., Dutoit M., Russo A., Dentone C., Eisen D., Heyer L., Harris P.N.A., Tambyah P.A., Lye D.C., Mo Y., Lee T.H., Yilmaz M., Alenazi T.H., Falcone M., Bassetti M., Righi E., Rogers B.A., Kanj S., Bhally H., Iredell J., Mendelson M., Boyles T.H., Looke D., Miyakis S., Walls G., Al Khamis M., Zikri A., Crowe A., Ingram P., Daneman N., and Griffin P.
Abstract: IMPORTANCE Extended-spectrum beta-lactamases mediate resistance to third-generation cephalosporins (eg, ceftriaxone) in Escherichia coli and Klebsiella pneumoniae. Significant infections caused by these strains are usually treated with carbapenems, potentially selecting for carbapenem resistance. Piperacillin-tazobactam may be an effective "carbapenem-sparing" option to treat extended-spectrum beta-lactamase producers. OBJECTIVES To determine whether definitive therapy with piperacillin-tazobactam is noninferior to meropenem (a carbapenem) in patients with bloodstream infection caused by ceftriaxone-nonsusceptible E coli or K pneumoniae. DESIGN, SETTING, AND PARTICIPANTS Noninferiority, parallel group, randomized clinical trial included hospitalized patients enrolled from 26 sites in 9 countries from February 2014 to July 2017. Adult patients were eligible if they had at least 1 positive blood culture with E coli or Klebsiella spp testing nonsusceptible to ceftriaxone but susceptible to piperacillin-tazobactam. Of 1646 patients screened, 391 were included in the study. INTERVENTIONS Patients were randomly assigned 1:1 to intravenous piperacillin-tazobactam, 4.5 g, every 6 hours (n = 188 participants) or meropenem, 1 g, every 8 hours (n = 191 participants) for a minimum of 4 days, up to a maximum of 14 days, with the total duration determined by the treating clinician. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 30 days after randomization. A noninferiority margin of 5% was used. RESULTS Among 379 patients (mean age, 66.5 years; 47.8% women) who were randomized appropriately, received at least 1 dose of study drug, and were included in the primary analysis population, 378 (99.7%) completed the trial and were assessed for the primary outcome. A total of 23 of 187 patients (12.3%) randomized to piperacillin-tazobactam met the primary outcome of mortality at 30 days compared with 7 of 191 (3.7%) randomized to meropenem (risk difference, 8.6
Published: 2018

11. Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance: A Randomized Clinical Trial

Author: Harris, PNA, Tambyah, PA, Lye, DC, Mo, Y, Lee, TH, Yilmaz, M, Alenazi, TH, Arabi, Y, Falcone, M, Bassetti, M, Righi, E, Rogers, BA, Kanj, S, Bhally, H, Iredell, J, Mendelson, M, Boyles, TH, Looke, D, Miyakis, S, Walls, G, Athan, Eugene, MERINO Trial Investigators and the Australasian Society for Infectious Disease Clinical Research Network (ASID-CRN), Harris, PNA, Tambyah, PA, Lye, DC, Mo, Y, Lee, TH, Yilmaz, M, Alenazi, TH, Arabi, Y, Falcone, M, Bassetti, M, Righi, E, Rogers, BA, Kanj, S, Bhally, H, Iredell, J, Mendelson, M, Boyles, TH, Looke, D, Miyakis, S, Walls, G, Athan, Eugene, and MERINO Trial Investigators and the Australasian Society for Infectious Disease Clinical Research Network (ASID-CRN)
Published: 2018

12. Mucormycosis in Australia: Contemporary epidemiology and outcomes

Author: Kennedy, K.J., Daveson, K., Slavin, M.A., van Hal, S.J., Sorrell, T.C., Lee, A., Marriott, D.J., Chapman, B., Halliday, C.L., Hajkowicz, K., Athan, E., Bak, N., Cheong, E., Heath, C.H., Morrissey, C.O., Kidd, S., Beresford, R., Blyth, C., Korman, T.M., Robinson, J.O., Meyer, W., Chen, S.C.-A., Clark, J., McCormack, J., Looke, D., Playford, E.G., Chen, S., Gottlieb, T., Halliday, C., Marriott, D., McMullan, B., Sorrell, T., van Hal, S., Ananda-Rajah, M., Slavin, M., Arthur, I., Heath, C., Kennedy, K., Morris, A., Chambers, S., Kennedy, K.J., Daveson, K., Slavin, M.A., van Hal, S.J., Sorrell, T.C., Lee, A., Marriott, D.J., Chapman, B., Halliday, C.L., Hajkowicz, K., Athan, E., Bak, N., Cheong, E., Heath, C.H., Morrissey, C.O., Kidd, S., Beresford, R., Blyth, C., Korman, T.M., Robinson, J.O., Meyer, W., Chen, S.C.-A., Clark, J., McCormack, J., Looke, D., Playford, E.G., Chen, S., Gottlieb, T., Halliday, C., Marriott, D., McMullan, B., Sorrell, T., van Hal, S., Ananda-Rajah, M., Slavin, M., Arthur, I., Heath, C., Kennedy, K., Morris, A., and Chambers, S.
Abstract: Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse 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 divergence 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.
Published: 2016

13. Mucormycosis in Australia: Contemporary epidemiology and outcomes

Author: Kennedy, K.J., Daveson, K., Slavin, M.A., van Hal, S.J., Sorrell, T.C., Lee, A., Marriott, D.J., Chapman, B., Halliday, C.L., Hajkowicz, K., Athan, E., Bak, N., Cheong, E., Heath, C.H., Morrissey, C.O., Kidd, S., Beresford, R., Blyth, C., Korman, T.M., Robinson, J.O., Meyer, W., Chen, S.C.-A., Clark, J., McCormack, J., Looke, D., Playford, E.G., Chen, S., Gottlieb, T., Halliday, C., Marriott, D., McMullan, B., Sorrell, T., van Hal, S., Ananda-Rajah, M., Slavin, M., Arthur, I., Heath, C., Kennedy, K., Morris, A., Chambers, S., Kennedy, K.J., Daveson, K., Slavin, M.A., van Hal, S.J., Sorrell, T.C., Lee, A., Marriott, D.J., Chapman, B., Halliday, C.L., Hajkowicz, K., Athan, E., Bak, N., Cheong, E., Heath, C.H., Morrissey, C.O., Kidd, S., Beresford, R., Blyth, C., Korman, T.M., Robinson, J.O., Meyer, W., Chen, S.C.-A., Clark, J., McCormack, J., Looke, D., Playford, E.G., Chen, S., Gottlieb, T., Halliday, C., Marriott, D., McMullan, B., Sorrell, T., van Hal, S., Ananda-Rajah, M., Slavin, M., Arthur, I., Heath, C., Kennedy, K., Morris, A., and Chambers, S.
Abstract: Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse 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 divergence 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.
Published: 2016

14. Candidaemia with uncommon Candida species: Predisposing factors, outcome, antifungal susceptibility, and implications for management.

Author: McBride J., Chen S.C.A., Marriott D., Playford E.G., Nguyen Q., Ellis D., Meyer W., Sorrell T.C., Slavin M., McCormack J., Walmsley K., Looke D., Johnson B., Nimmo G., Playford G., Drummond D., Forgan Smith R., Preston E., Allworth A., Faoagali J., Gerns N., Botes J., Cherian S., Robson J., Vohra R., Norton R., Coulter C., O'Kane G., Robb D., Gottlieb T., Chambers I., DeWit D., Carroll M., Dobson P., Ferguson J., Tierney L., Jozwiak F., Munro R., Tomasotos V., Pickles R., Holland J., Groenwad F., Hale K., Watson M., Vaz R., Hardiman R., Baleriola C., Ryan S., Pritchard R., Weeks K., Benn R., Lawrence R., Taylor P., Lindstrom S., Harkness J., Palasanthrian P., Grant R., McPetrie R., Johnson R., Halliday C., Maszewska K., Dennis N., Newton P., Franklin C., Morrisey O., Spelman D., Wesselingh S., Speed B., Hellsten J., Mayall B., Russell J., Broughton S., Woolley I., Coloe S., Sherman A., Korman T., Graves S., Huysmans M., Gordon D., Rowlands K., Shaw D., Ritchie B., Handkle R., Beaman M., Chiam A., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., Collignon P., Roberts J., Watson A., McBride J., Chen S.C.A., Marriott D., Playford E.G., Nguyen Q., Ellis D., Meyer W., Sorrell T.C., Slavin M., McCormack J., Walmsley K., Looke D., Johnson B., Nimmo G., Playford G., Drummond D., Forgan Smith R., Preston E., Allworth A., Faoagali J., Gerns N., Botes J., Cherian S., Robson J., Vohra R., Norton R., Coulter C., O'Kane G., Robb D., Gottlieb T., Chambers I., DeWit D., Carroll M., Dobson P., Ferguson J., Tierney L., Jozwiak F., Munro R., Tomasotos V., Pickles R., Holland J., Groenwad F., Hale K., Watson M., Vaz R., Hardiman R., Baleriola C., Ryan S., Pritchard R., Weeks K., Benn R., Lawrence R., Taylor P., Lindstrom S., Harkness J., Palasanthrian P., Grant R., McPetrie R., Johnson R., Halliday C., Maszewska K., Dennis N., Newton P., Franklin C., Morrisey O., Spelman D., Wesselingh S., Speed B., Hellsten J., Mayall B., Russell J., Broughton S., Woolley I., Coloe S., Sherman A., Korman T., Graves S., Huysmans M., Gordon D., Rowlands K., Shaw D., Ritchie B., Handkle R., Beaman M., Chiam A., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., Collignon P., Roberts J., and Watson A.
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, p0.01). 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 (p0.01) and chronic liver disease (p0.03), and infection with species other than C. dubliniensis was independently associated with age <65 years (p0.02), male sex (p0.03) and human immunodeficiency virus infection (p0.05). 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%, not significant). All isolates were susceptible to amphotericin.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. © 2009 The Authors Journal c
Published: 2012

15. Population-based surveillance for scedosporiosis in Australia: Epidemiology, disease manifestations and emergence of Scedosporium aurantiacum infection.

Author: McGregor A., Cooley L., Cox E., Franklin C., Korman T., Morrissey O., Spelman D., Speed B., Boan P., Dyer J., Gardam D., McLennan D., Murray R., Pryce T., Heath C.H., Slavin M.A., Sorrell T.C., Handke R., Harun A., Phillips M., Nguyen Q., Delhaes L., Ellis D., Meyer W., Chen S.C.A., Collignon P., Benn R., Chambers I., Dennis N., DeWit D., Ferguson J., Gosbell I., Gottlieb T., Halliday C., Holland J., Kesson A., Lawrence R., Marriott D., Newton P., Palasanthrian P., Pickles R., Pritchard B., Tierney L., Tomasotos V., Vaz R., Weeks K., Currie B., Allworth A., Coulter C., Faoagali J., Johnson B., Looke D., McCormack J., Nimmo G., O'Kane G., Playford E.G., Robson J., Rowlands K., Shaw D., McGregor A., Cooley L., Cox E., Franklin C., Korman T., Morrissey O., Spelman D., Speed B., Boan P., Dyer J., Gardam D., McLennan D., Murray R., Pryce T., Heath C.H., Slavin M.A., Sorrell T.C., Handke R., Harun A., Phillips M., Nguyen Q., Delhaes L., Ellis D., Meyer W., Chen S.C.A., Collignon P., Benn R., Chambers I., Dennis N., DeWit D., Ferguson J., Gosbell I., Gottlieb T., Halliday C., Holland J., Kesson A., Lawrence R., Marriott D., Newton P., Palasanthrian P., Pickles R., Pritchard B., Tierney L., Tomasotos V., Vaz R., Weeks K., Currie B., Allworth A., Coulter C., Faoagali J., Johnson B., Looke D., McCormack J., Nimmo G., O'Kane G., Playford E.G., Robson J., Rowlands K., and Shaw D.
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 >=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. © 2009 The Authors Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases.
Published: 2012

16. Active surveillance for candidemia, Australia.

Author: Watson M., Walmsley K., Looke D., Johnson B., Nimmo G., Drummond D., Forgan-Smith R., Preston E., Allworth A., Faoagali J., Gerns N., Botes J., Cherian S., Robson J., Vohra R., Norton R., O'Kane G., Robb D., Gottlieb T., Chambers I., DeWit D., Carroll M., Dobson P., Ferguson J., Tierney L., Jozwiak F., Munro R., Tomasotos V., Pickles R., Holland J., Groenwald F., Hale K., Vaz R., Hardiman R., Baleriola C., Ryan S., Pritchard R., Weeks K., Benn R., Adams N., Lawrence R., Taylor P., Lindstrom S., Harkness J., Palasanthrian P., Grant R., McPetrie R., Johnson R., Halliday C., Maszewska K., Lee O.C., Meyer W., Dennis N., Newton P., Franklin C., Morrisey O., Spelman D., Wesselingh S., Speed B., Hellsten J., Mayall B., Russell J., Broughton S., Woolley I., Coloe S., Korman T., Graves S., Huysmans M., Sherman A., Gordon D., Rowlands K., Shaw D., Ferguson W., Ritchie B., Handke R., Beaman M., Chiam A., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., McBride J., Chen S., Slavin M., Nguyen Q., Marriott D., Playford E.G., Ellis D., Sorrell T., Coulter C., McCormack J., Watson M., Walmsley K., Looke D., Johnson B., Nimmo G., Drummond D., Forgan-Smith R., Preston E., Allworth A., Faoagali J., Gerns N., Botes J., Cherian S., Robson J., Vohra R., Norton R., O'Kane G., Robb D., Gottlieb T., Chambers I., DeWit D., Carroll M., Dobson P., Ferguson J., Tierney L., Jozwiak F., Munro R., Tomasotos V., Pickles R., Holland J., Groenwald F., Hale K., Vaz R., Hardiman R., Baleriola C., Ryan S., Pritchard R., Weeks K., Benn R., Adams N., Lawrence R., Taylor P., Lindstrom S., Harkness J., Palasanthrian P., Grant R., McPetrie R., Johnson R., Halliday C., Maszewska K., Lee O.C., Meyer W., Dennis N., Newton P., Franklin C., Morrisey O., Spelman D., Wesselingh S., Speed B., Hellsten J., Mayall B., Russell J., Broughton S., Woolley I., Coloe S., Korman T., Graves S., Huysmans M., Sherman A., Gordon D., Rowlands K., Shaw D., Ferguson W., Ritchie B., Handke R., Beaman M., Chiam A., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., McBride J., Chen S., Slavin M., Nguyen Q., Marriott D., Playford E.G., Ellis D., Sorrell T., Coulter C., and McCormack J.
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<0.001). Non-Candida albicans species (52.7%) caused 60.5% of cases acquired outside hospitals and 49.9% of IHCA candidemia (p = 0.02). The 30-day death rate was 27.7% in those >=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.
Published: 2012

17. Candidaemia with uncommon Candida species: Predisposing factors, outcome, antifungal susceptibility, and implications for management.

Author: McBride J., Chen S.C.A., Marriott D., Playford E.G., Nguyen Q., Ellis D., Meyer W., Sorrell T.C., Slavin M., McCormack J., Walmsley K., Looke D., Johnson B., Nimmo G., Playford G., Drummond D., Forgan Smith R., Preston E., Allworth A., Faoagali J., Gerns N., Botes J., Cherian S., Robson J., Vohra R., Norton R., Coulter C., O'Kane G., Robb D., Gottlieb T., Chambers I., DeWit D., Carroll M., Dobson P., Ferguson J., Tierney L., Jozwiak F., Munro R., Tomasotos V., Pickles R., Holland J., Groenwad F., Hale K., Watson M., Vaz R., Hardiman R., Baleriola C., Ryan S., Pritchard R., Weeks K., Benn R., Lawrence R., Taylor P., Lindstrom S., Harkness J., Palasanthrian P., Grant R., McPetrie R., Johnson R., Halliday C., Maszewska K., Dennis N., Newton P., Franklin C., Morrisey O., Spelman D., Wesselingh S., Speed B., Hellsten J., Mayall B., Russell J., Broughton S., Woolley I., Coloe S., Sherman A., Korman T., Graves S., Huysmans M., Gordon D., Rowlands K., Shaw D., Ritchie B., Handkle R., Beaman M., Chiam A., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., Collignon P., Roberts J., Watson A., McBride J., Chen S.C.A., Marriott D., Playford E.G., Nguyen Q., Ellis D., Meyer W., Sorrell T.C., Slavin M., McCormack J., Walmsley K., Looke D., Johnson B., Nimmo G., Playford G., Drummond D., Forgan Smith R., Preston E., Allworth A., Faoagali J., Gerns N., Botes J., Cherian S., Robson J., Vohra R., Norton R., Coulter C., O'Kane G., Robb D., Gottlieb T., Chambers I., DeWit D., Carroll M., Dobson P., Ferguson J., Tierney L., Jozwiak F., Munro R., Tomasotos V., Pickles R., Holland J., Groenwad F., Hale K., Watson M., Vaz R., Hardiman R., Baleriola C., Ryan S., Pritchard R., Weeks K., Benn R., Lawrence R., Taylor P., Lindstrom S., Harkness J., Palasanthrian P., Grant R., McPetrie R., Johnson R., Halliday C., Maszewska K., Dennis N., Newton P., Franklin C., Morrisey O., Spelman D., Wesselingh S., Speed B., Hellsten J., Mayall B., Russell J., Broughton S., Woolley I., Coloe S., Sherman A., Korman T., Graves S., Huysmans M., Gordon D., Rowlands K., Shaw D., Ritchie B., Handkle R., Beaman M., Chiam A., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., Collignon P., Roberts J., and Watson A.
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, p0.01). 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 (p0.01) and chronic liver disease (p0.03), and infection with species other than C. dubliniensis was independently associated with age <65 years (p0.02), male sex (p0.03) and human immunodeficiency virus infection (p0.05). 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%, not significant). All isolates were susceptible to amphotericin.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. © 2009 The Authors Journal c
Published: 2012

18. Population-based surveillance for scedosporiosis in Australia: Epidemiology, disease manifestations and emergence of Scedosporium aurantiacum infection.

Author: McGregor A., Cooley L., Cox E., Franklin C., Korman T., Morrissey O., Spelman D., Speed B., Boan P., Dyer J., Gardam D., McLennan D., Murray R., Pryce T., Heath C.H., Slavin M.A., Sorrell T.C., Handke R., Harun A., Phillips M., Nguyen Q., Delhaes L., Ellis D., Meyer W., Chen S.C.A., Collignon P., Benn R., Chambers I., Dennis N., DeWit D., Ferguson J., Gosbell I., Gottlieb T., Halliday C., Holland J., Kesson A., Lawrence R., Marriott D., Newton P., Palasanthrian P., Pickles R., Pritchard B., Tierney L., Tomasotos V., Vaz R., Weeks K., Currie B., Allworth A., Coulter C., Faoagali J., Johnson B., Looke D., McCormack J., Nimmo G., O'Kane G., Playford E.G., Robson J., Rowlands K., Shaw D., McGregor A., Cooley L., Cox E., Franklin C., Korman T., Morrissey O., Spelman D., Speed B., Boan P., Dyer J., Gardam D., McLennan D., Murray R., Pryce T., Heath C.H., Slavin M.A., Sorrell T.C., Handke R., Harun A., Phillips M., Nguyen Q., Delhaes L., Ellis D., Meyer W., Chen S.C.A., Collignon P., Benn R., Chambers I., Dennis N., DeWit D., Ferguson J., Gosbell I., Gottlieb T., Halliday C., Holland J., Kesson A., Lawrence R., Marriott D., Newton P., Palasanthrian P., Pickles R., Pritchard B., Tierney L., Tomasotos V., Vaz R., Weeks K., Currie B., Allworth A., Coulter C., Faoagali J., Johnson B., Looke D., McCormack J., Nimmo G., O'Kane G., Playford E.G., Robson J., Rowlands K., and Shaw D.
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 >=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. © 2009 The Authors Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases.
Published: 2012

19. Active surveillance for candidemia, Australia.

Author: Watson M., Walmsley K., Looke D., Johnson B., Nimmo G., Drummond D., Forgan-Smith R., Preston E., Allworth A., Faoagali J., Gerns N., Botes J., Cherian S., Robson J., Vohra R., Norton R., O'Kane G., Robb D., Gottlieb T., Chambers I., DeWit D., Carroll M., Dobson P., Ferguson J., Tierney L., Jozwiak F., Munro R., Tomasotos V., Pickles R., Holland J., Groenwald F., Hale K., Vaz R., Hardiman R., Baleriola C., Ryan S., Pritchard R., Weeks K., Benn R., Adams N., Lawrence R., Taylor P., Lindstrom S., Harkness J., Palasanthrian P., Grant R., McPetrie R., Johnson R., Halliday C., Maszewska K., Lee O.C., Meyer W., Dennis N., Newton P., Franklin C., Morrisey O., Spelman D., Wesselingh S., Speed B., Hellsten J., Mayall B., Russell J., Broughton S., Woolley I., Coloe S., Korman T., Graves S., Huysmans M., Sherman A., Gordon D., Rowlands K., Shaw D., Ferguson W., Ritchie B., Handke R., Beaman M., Chiam A., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., McBride J., Chen S., Slavin M., Nguyen Q., Marriott D., Playford E.G., Ellis D., Sorrell T., Coulter C., McCormack J., Watson M., Walmsley K., Looke D., Johnson B., Nimmo G., Drummond D., Forgan-Smith R., Preston E., Allworth A., Faoagali J., Gerns N., Botes J., Cherian S., Robson J., Vohra R., Norton R., O'Kane G., Robb D., Gottlieb T., Chambers I., DeWit D., Carroll M., Dobson P., Ferguson J., Tierney L., Jozwiak F., Munro R., Tomasotos V., Pickles R., Holland J., Groenwald F., Hale K., Vaz R., Hardiman R., Baleriola C., Ryan S., Pritchard R., Weeks K., Benn R., Adams N., Lawrence R., Taylor P., Lindstrom S., Harkness J., Palasanthrian P., Grant R., McPetrie R., Johnson R., Halliday C., Maszewska K., Lee O.C., Meyer W., Dennis N., Newton P., Franklin C., Morrisey O., Spelman D., Wesselingh S., Speed B., Hellsten J., Mayall B., Russell J., Broughton S., Woolley I., Coloe S., Korman T., Graves S., Huysmans M., Sherman A., Gordon D., Rowlands K., Shaw D., Ferguson W., Ritchie B., Handke R., Beaman M., Chiam A., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., McBride J., Chen S., Slavin M., Nguyen Q., Marriott D., Playford E.G., Ellis D., Sorrell T., Coulter C., and McCormack J.
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<0.001). Non-Candida albicans species (52.7%) caused 60.5% of cases acquired outside hospitals and 49.9% of IHCA candidemia (p = 0.02). The 30-day death rate was 27.7% in those >=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.
Published: 2012

20. Control of Fluoroquinolone Resistance through Successful Regulation, Australia

Author: Cheng, AC, Turnidge, J, Collignon, P, Looke, D, Barton, M, Gottlieb, T, Cheng, AC, Turnidge, J, Collignon, P, Looke, D, Barton, M, and Gottlieb, T
Abstract: Fluoroquinolone antimicrobial drugs are highly bioavailable, broad-spectrum agents with activity against gram-negative pathogens, especially those resistant to other classes of antimicrobial drugs. Australia has restricted the use of quinolones in humans through its national pharmaceutical subsidy scheme; and, through regulation, has not permitted the use of quinolones in food-producing animals. As a consequence, resistance to fluoroquinolones in the community has been slow to emerge and has remained at low levels in key pathogens, such as Escherichia coli. In contrast to policies in most other countries, this policy has successfully preserved the utility of this class of antimicrobial drugs for treatment of most infections.
Published: 2012

21. Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study

Author: Townell, N, Looke, D, McDougall, D, McCarthy, JS, Townell, N, Looke, D, McDougall, D, and McCarthy, JS
Abstract: BACKGROUND: Relapsing Plasmodium vivax infection results in significant morbidity for the individual and is a key factor in transmission. Primaquine remains the only licensed drug for prevention of relapse. To minimize relapse rates, treatment guidelines have recently been revised to recommend an increased primaquine dose, aiming to achieve a cumulative dose of ≥6 mg/kg, i.e. ≥420 mg in a 70 kg patient. The aims of this study were to characterize the epidemiology of P. vivax infection imported into Queensland Australia, to determine the rates of relapse, to investigate the use of primaquine therapy, and its efficacy in the prevention of relapse. METHODS: A retrospective study was undertaken of laboratory confirmed P. vivax infection presenting to the two major tertiary hospitals in Queensland, Australia between January 1999 and January 2011.Primaquine dosing was classified as no dose, low dose (<420 mg), high dose (≥420 mg), or unknown. The dose of primaquine prescribed to patients who subsequently relapsed that prescribed to patients who did not relapse. RESULTS: Twenty relapses occurred following 151 primary episodes of P. vivax infection (13.2%). Relapses were confirmed among 3/21 (14.2%), 9/50 (18.0%), 1/54 (1.9%) and 7/18 (38.9%) of patients administered no dose, low dose, high dose and unknown primaquine dose respectively. High dose primaquine therapy was associated with a significantly lower rate of relapse compared to patients who were prescribed low dose therapy (OR 11.6, 95% CI 1.5-519, p = 0.005). CONCLUSIONS: Relapse of P. vivax infection is more likely in patients who received low dose primaquine therapy. This study supports the recommendations that high dose primaquine therapy is necessary to minimize relapse of P. vivax malaria.
Published: 2012

22. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: A prospective cohort study

Author: Mollee, P, Jones, M, Stackelroth, Jenny, van Kuilenburg, R, Joubert, W, Faoagali, J, Looke, D, Harper, J, Clements, Archie, Mollee, P, Jones, M, Stackelroth, Jenny, van Kuilenburg, R, Joubert, W, Faoagali, J, Looke, D, Harper, J, and Clements, Archie
Abstract: Central venous catheter-associated bloodstream infections (CABSIs) cause considerable morbidity in patients with cancer. We determined the incidence and risk factors for CABSI by performing a prospective observational cohort study of all adult patients requiring a central venous access device (CVAD) in a haematology-oncology unit. All CVADs were inserted under ultrasound guidance by trained operators in a dedicated interventional radiology facility. A total of 1127 CVADs were assessed in 727 patients over 51 514 line-days. The rate of CABSI per 1000 line-days was 2.50. Factors associated with CABSI included: type of CVAD, greatest for non-tunnelled lines [hazard ratio (HR): 3.50; P< 0.0001] and tunnelled lines (HR: 1.77; P= 0.011) compared to peripherally inserted central venous catheter (PICC) lines; patient diagnosis, greatest for aggressive haematological malignancies (HR: 3.17; P= 0.0007) and least for oesophageal, colon and rectal cancers (HR: 0.29; P= 0.019) compared to other solid tumours; side of insertion, greatest for right-sided lines (HR: 1.60; P= 0.027); and number of prior line insertions (HR: 1.20; P= 0.022). In patients with aggressive haematological malignancies there was significantly more CABSI with non-tunnelled lines (HR: 3.9; P< 0.001) and a trend to more CABSI with tunnelled lines (HR: 1.43; P= 0.12) compared to patients with PICC lines, as well as increased CABSI for right-sided insertions (HR: 1.62; P= 0.047). This study highlights the utility of a standardised CABSI surveillance strategy in adult patients with cancer, provides further data to support the use of PICC lines in such patient populations, and suggests that the side of line insertion may influence risk of CABSI.
Published: 2011

23. Management of mammalian bites.

Author: Dendle C., Looke D., Dendle C., and Looke D.
Abstract: Background: Mammalian bites are a significant public health problem in Australia, with the majority of bites coming from dogs. Complications include tissue damage from the bite itself, infection and post-traumatic stress disorder. Objective(s): This article describes the assessment and management of mammalian bites in the Australian general practice setting based on a PubMed search of the English language literature from the years 1966 to present. Discussion(s): General practitioners need to be familiar with the treatment of animal bites, pitfalls in management, and the need to educate patients on ways to avoid future bite injuries. Meticulous wound cleaning, irrigation, exploration and debridement is essential to bite wound healing. Recognition of complicating fractures with imaging is important. Risk of infection differs among animal species, although most infected bite wounds are polymicrobial.
Published: 2010

24. Management of mammalian bites.

Author: Dendle C., Looke D., Dendle C., and Looke D.
Abstract: Background: Mammalian bites are a significant public health problem in Australia, with the majority of bites coming from dogs. Complications include tissue damage from the bite itself, infection and post-traumatic stress disorder. Objective(s): This article describes the assessment and management of mammalian bites in the Australian general practice setting based on a PubMed search of the English language literature from the years 1966 to present. Discussion(s): General practitioners need to be familiar with the treatment of animal bites, pitfalls in management, and the need to educate patients on ways to avoid future bite injuries. Meticulous wound cleaning, irrigation, exploration and debridement is essential to bite wound healing. Recognition of complicating fractures with imaging is important. Risk of infection differs among animal species, although most infected bite wounds are polymicrobial.
Published: 2010

25. Determinants of mortality in non-neutropenic ICU patients with candidaemia.

Author: Pritchard R., Marriott D.J.E., Geoffrey E.G., Chen S., Slavin M., Nguyen Q., Ellis D., Sorrell T.C., Coulter C., McCormack J., Walmsley K., Looke D., Johnson B., Nimmo G., Playford G., Drummond D., Preston E., Allworth A., Faoagali J., Botes J., Robson J., Norton R., Robb D., Gottlieb T., Chambers I., DeWit D., Ferguson J., Tierney L., Jozwiak F., Munro R., Pickles R., Holland J., Groenwald F., Hale K., Vaz R., Hardiman R., Baleriola C., Weeks K., Benn R., Adams N., Lawrence R., Taylor P., Harkness J., Marriott J., Palasanthrian P., Grant R., Halliday C., Lee O.C., Sorrell T., Newton P., Dennis N., Franklin C., Morrisey O., Spelman D., Speed B., Russell H.J., Coloe S., Sherman A., Korman T., Graves S., Huysmans M., Gordon D., Rowlands K., Shaw D., Ferguson W., Handke R., Davis S., Beaman M., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., Collignon P., Watson A., McBride J., Pritchard R., Marriott D.J.E., Geoffrey E.G., Chen S., Slavin M., Nguyen Q., Ellis D., Sorrell T.C., Coulter C., McCormack J., Walmsley K., Looke D., Johnson B., Nimmo G., Playford G., Drummond D., Preston E., Allworth A., Faoagali J., Botes J., Robson J., Norton R., Robb D., Gottlieb T., Chambers I., DeWit D., Ferguson J., Tierney L., Jozwiak F., Munro R., Pickles R., Holland J., Groenwald F., Hale K., Vaz R., Hardiman R., Baleriola C., Weeks K., Benn R., Adams N., Lawrence R., Taylor P., Harkness J., Marriott J., Palasanthrian P., Grant R., Halliday C., Lee O.C., Sorrell T., Newton P., Dennis N., Franklin C., Morrisey O., Spelman D., Speed B., Russell H.J., Coloe S., Sherman A., Korman T., Graves S., Huysmans M., Gordon D., Rowlands K., Shaw D., Ferguson W., Handke R., Davis S., Beaman M., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., Collignon P., Watson A., and McBride J.
Abstract: Introduction: Candidaemia in critically-ill intensive care unit (ICU) patients is associated with high crude mortality. Determinants of mortality - particularly those amenable to potential modification - are incompletely defined. Method(s): A nationwide prospective clinical and microbiological cohort study of all episodes of ICU-acquired candidaemia occurring in non-neutropenic adults was undertaken in Australian ICUs between 2001 and 2004. Multivariate Cox regression analyses were performed to determine independently significant variables associated with mortality. Result(s): 183 episodes of ICU-acquired candidaemia occurred in 183 patients during the study period. Of the 179 with microbiological data, Candida albicans accounted for 111 (62%) episodes and Candida glabrata, 32 (18%). Outcome data were available for 173: crude hospital mortality at 30 days was 56%. Host factors (older age, ICU admission diagnosis, mechanical ventilation and ICU admission diagnosis) and failure to receive systemic antifungal therapy were significantly associated with mortality on multivariate analysis. Among the subset who received initial fluconazole therapy (n = 93), the crude mortality was 52%. Host factors (increasing age and haemodialysis receipt), but not organism- (Candida species, fluconazole MIC), pharmacokinetic- (fluconazole dose, time to initiation), or pharmacodynamic-related parameters (fluconazole dose:MIC ratio) were associated with mortality. Process of care measures advocated in recent guidelines were implemented inconsistently: follow-up blood cultures were obtained in 68% of patients, central venous catheters removed within five days in 80% and ophthalmological examination performed in 36%. Conclusion(s): Crude mortality remains highin Australian ICU patients with candidaemia and is overwhelmingly related to host factors but not treatment variables (the time to initiation of antifungals or fluconazole pharmacokinetic and pharmacodynamic factors). The role and timin
Published: 2009

26. Determinants of mortality in non-neutropenic ICU patients with candidaemia.

Author: Pritchard R., Marriott D.J.E., Geoffrey E.G., Chen S., Slavin M., Nguyen Q., Ellis D., Sorrell T.C., Coulter C., McCormack J., Walmsley K., Looke D., Johnson B., Nimmo G., Playford G., Drummond D., Preston E., Allworth A., Faoagali J., Botes J., Robson J., Norton R., Robb D., Gottlieb T., Chambers I., DeWit D., Ferguson J., Tierney L., Jozwiak F., Munro R., Pickles R., Holland J., Groenwald F., Hale K., Vaz R., Hardiman R., Baleriola C., Weeks K., Benn R., Adams N., Lawrence R., Taylor P., Harkness J., Marriott J., Palasanthrian P., Grant R., Halliday C., Lee O.C., Sorrell T., Newton P., Dennis N., Franklin C., Morrisey O., Spelman D., Speed B., Russell H.J., Coloe S., Sherman A., Korman T., Graves S., Huysmans M., Gordon D., Rowlands K., Shaw D., Ferguson W., Handke R., Davis S., Beaman M., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., Collignon P., Watson A., McBride J., Pritchard R., Marriott D.J.E., Geoffrey E.G., Chen S., Slavin M., Nguyen Q., Ellis D., Sorrell T.C., Coulter C., McCormack J., Walmsley K., Looke D., Johnson B., Nimmo G., Playford G., Drummond D., Preston E., Allworth A., Faoagali J., Botes J., Robson J., Norton R., Robb D., Gottlieb T., Chambers I., DeWit D., Ferguson J., Tierney L., Jozwiak F., Munro R., Pickles R., Holland J., Groenwald F., Hale K., Vaz R., Hardiman R., Baleriola C., Weeks K., Benn R., Adams N., Lawrence R., Taylor P., Harkness J., Marriott J., Palasanthrian P., Grant R., Halliday C., Lee O.C., Sorrell T., Newton P., Dennis N., Franklin C., Morrisey O., Spelman D., Speed B., Russell H.J., Coloe S., Sherman A., Korman T., Graves S., Huysmans M., Gordon D., Rowlands K., Shaw D., Ferguson W., Handke R., Davis S., Beaman M., McCarthy J., Heath C., Altmann S., Arthur I., Speers D., Cox E., Cooley L., McGregor A., Currie B., Lum G., Fisher D., Collignon P., Watson A., and McBride J.
Abstract: Introduction: Candidaemia in critically-ill intensive care unit (ICU) patients is associated with high crude mortality. Determinants of mortality - particularly those amenable to potential modification - are incompletely defined. Method(s): A nationwide prospective clinical and microbiological cohort study of all episodes of ICU-acquired candidaemia occurring in non-neutropenic adults was undertaken in Australian ICUs between 2001 and 2004. Multivariate Cox regression analyses were performed to determine independently significant variables associated with mortality. Result(s): 183 episodes of ICU-acquired candidaemia occurred in 183 patients during the study period. Of the 179 with microbiological data, Candida albicans accounted for 111 (62%) episodes and Candida glabrata, 32 (18%). Outcome data were available for 173: crude hospital mortality at 30 days was 56%. Host factors (older age, ICU admission diagnosis, mechanical ventilation and ICU admission diagnosis) and failure to receive systemic antifungal therapy were significantly associated with mortality on multivariate analysis. Among the subset who received initial fluconazole therapy (n = 93), the crude mortality was 52%. Host factors (increasing age and haemodialysis receipt), but not organism- (Candida species, fluconazole MIC), pharmacokinetic- (fluconazole dose, time to initiation), or pharmacodynamic-related parameters (fluconazole dose:MIC ratio) were associated with mortality. Process of care measures advocated in recent guidelines were implemented inconsistently: follow-up blood cultures were obtained in 68% of patients, central venous catheters removed within five days in 80% and ophthalmological examination performed in 36%. Conclusion(s): Crude mortality remains highin Australian ICU patients with candidaemia and is overwhelmingly related to host factors but not treatment variables (the time to initiation of antifungals or fluconazole pharmacokinetic and pharmacodynamic factors). The role and timin
Published: 2009

27. Molecular typing of Australian Scedosporium isolates showing genetic variability and numerous S. aurantiacum.

Author: McGregor A., Korman T., Morrissey O., Spelman D., Speed B., Sheorey H., Boan P., Dyer J., Gardam D., McLennan D., Murray R., Pryce T., Delhaes L., Harun A., Chen S.C.A., Nguyen Q., Slavin M., Heath C.H., Maszewska K., Halliday C., Robert V., Sorrell T.C., Meyer W., Collignon P., Benn R., Chambers I., Dennis N., Dewit D., Ferguson J., Gosbell I., Gottlieb T., Holland J., Kesson A., Lawrence R., Marriott D., Newton P., Palasanthrian P., Pickles R., Pritchard R., Tierney L., Tomasotos V., Vaz R., Weeks K., Allworth A., Coulter C., Faoagali J., Johnson B., Looke D., McCormack J., Nimmo G., O'Kane G., Playford E.G., Robson J., Ellis D., Handke R., Rowlands K., Shaw D., Cooley L., Cox E., Franklin C., Joseph C., McGregor A., Korman T., Morrissey O., Spelman D., Speed B., Sheorey H., Boan P., Dyer J., Gardam D., McLennan D., Murray R., Pryce T., Delhaes L., Harun A., Chen S.C.A., Nguyen Q., Slavin M., Heath C.H., Maszewska K., Halliday C., Robert V., Sorrell T.C., Meyer W., Collignon P., Benn R., Chambers I., Dennis N., Dewit D., Ferguson J., Gosbell I., Gottlieb T., Holland J., Kesson A., Lawrence R., Marriott D., Newton P., Palasanthrian P., Pickles R., Pritchard R., Tierney L., Tomasotos V., Vaz R., Weeks K., Allworth A., Coulter C., Faoagali J., Johnson B., Looke D., McCormack J., Nimmo G., O'Kane G., Playford E.G., Robson J., Ellis D., Handke R., Rowlands K., Shaw D., Cooley L., Cox E., Franklin C., and Joseph C.
Abstract: One hundred clinical isolates from a prospective nationwide study of scedosporiosis in Australia (2003-2005) and 46 additional isolates were genotyped by internal transcribed spacer-restriction fragment length polymorphism (ITS-RFLP) analysis, ITS sequencing, and M13 PCR fingerprinting. ITS-RFLP and PCR fingerprinting identified 3 distinct genetic groups. The first group corresponded to Scedosporium prolificans (n = 83), and the other 2 comprised isolates previously identified as S. apiospermum: one of these corresponded to S. apiospermum (n = 33) and the other to the newly described species S. aurantiacum (n = 30). Intraspecies variation was highest for S. apiospermum (58%), followed by S. prolificans (45%) and S. aurantiacum (28%) as determined by PCR fingerprinting. ITS sequence variation of 2.2% was observed among S. apiospermum isolates. No correlation was found between genotype of strains and their geographic origin, body site from which they were cultured, or colonization versus invasive disease. Twelve S. prolificans isolates from 2 suspected case clusters were examined by amplified fragment length polymorphism analysis. No specific clusters were confirmed.
Published: 2008

28. The etiology of community-acquired pneumonia in Australia: Why penicillin plus doxycycline or a macrolide is the most appropriate therapy.

Author: Birch C., Druce J., Bardin P., Hart D., Irving L., Ryan N., Charles P.G.P., Whitby M., Fuller A.J., Stirling R., Wright A.A., Korman T.M., Holmes P.W., Christiansen K.J., Waterer G.W., Pierce R.J.P., Mayall B.C., Armstrong J.G., Catton M.G., Nimmo G.R., Johnson B., Hooy M., Grayson M.L., Grayson L., Johnson P., Munckhof W., Looke D., Garske L., Playford G., Spelman D., Kotsimbos T., Holmes P., Heath C., Birch C., Druce J., Bardin P., Hart D., Irving L., Ryan N., Charles P.G.P., Whitby M., Fuller A.J., Stirling R., Wright A.A., Korman T.M., Holmes P.W., Christiansen K.J., Waterer G.W., Pierce R.J.P., Mayall B.C., Armstrong J.G., Catton M.G., Nimmo G.R., Johnson B., Hooy M., Grayson M.L., Grayson L., Johnson P., Munckhof W., Looke D., Garske L., Playford G., Spelman D., Kotsimbos T., Holmes P., and Heath C.
Abstract: Background. 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. Methods. 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. Results. 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 narrowerspectrum beta-lactams, and they did not differ on the basis of whether a pathogen was identified. Conclusions. 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. Members of the study group are listed at the end of the text. © 2008 by the Infectious Diseases S
Published: 2008

29. Molecular typing of Australian Scedosporium isolates showing genetic variability and numerous S. aurantiacum.

Author: McGregor A., Korman T., Morrissey O., Spelman D., Speed B., Sheorey H., Boan P., Dyer J., Gardam D., McLennan D., Murray R., Pryce T., Delhaes L., Harun A., Chen S.C.A., Nguyen Q., Slavin M., Heath C.H., Maszewska K., Halliday C., Robert V., Sorrell T.C., Meyer W., Collignon P., Benn R., Chambers I., Dennis N., Dewit D., Ferguson J., Gosbell I., Gottlieb T., Holland J., Kesson A., Lawrence R., Marriott D., Newton P., Palasanthrian P., Pickles R., Pritchard R., Tierney L., Tomasotos V., Vaz R., Weeks K., Allworth A., Coulter C., Faoagali J., Johnson B., Looke D., McCormack J., Nimmo G., O'Kane G., Playford E.G., Robson J., Ellis D., Handke R., Rowlands K., Shaw D., Cooley L., Cox E., Franklin C., Joseph C., McGregor A., Korman T., Morrissey O., Spelman D., Speed B., Sheorey H., Boan P., Dyer J., Gardam D., McLennan D., Murray R., Pryce T., Delhaes L., Harun A., Chen S.C.A., Nguyen Q., Slavin M., Heath C.H., Maszewska K., Halliday C., Robert V., Sorrell T.C., Meyer W., Collignon P., Benn R., Chambers I., Dennis N., Dewit D., Ferguson J., Gosbell I., Gottlieb T., Holland J., Kesson A., Lawrence R., Marriott D., Newton P., Palasanthrian P., Pickles R., Pritchard R., Tierney L., Tomasotos V., Vaz R., Weeks K., Allworth A., Coulter C., Faoagali J., Johnson B., Looke D., McCormack J., Nimmo G., O'Kane G., Playford E.G., Robson J., Ellis D., Handke R., Rowlands K., Shaw D., Cooley L., Cox E., Franklin C., and Joseph C.
Abstract: One hundred clinical isolates from a prospective nationwide study of scedosporiosis in Australia (2003-2005) and 46 additional isolates were genotyped by internal transcribed spacer-restriction fragment length polymorphism (ITS-RFLP) analysis, ITS sequencing, and M13 PCR fingerprinting. ITS-RFLP and PCR fingerprinting identified 3 distinct genetic groups. The first group corresponded to Scedosporium prolificans (n = 83), and the other 2 comprised isolates previously identified as S. apiospermum: one of these corresponded to S. apiospermum (n = 33) and the other to the newly described species S. aurantiacum (n = 30). Intraspecies variation was highest for S. apiospermum (58%), followed by S. prolificans (45%) and S. aurantiacum (28%) as determined by PCR fingerprinting. ITS sequence variation of 2.2% was observed among S. apiospermum isolates. No correlation was found between genotype of strains and their geographic origin, body site from which they were cultured, or colonization versus invasive disease. Twelve S. prolificans isolates from 2 suspected case clusters were examined by amplified fragment length polymorphism analysis. No specific clusters were confirmed.
Published: 2008

30. SMART-COP: A tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia.

Author: Ramirez J.A., Looke D., Garske L., Playford G., Spelman D., Kotsimbos T., Heath C., Catton M., Birch C., Druce J., Ryan N., Irving L., Hart D., Bardin P., Charles P., Wolfe R., Whitby M., Fine M.J., Fuller A., Stirling R., Wright A., Christiansen K., Waterer G., Pierce R., Armstrong J., Korman T.M., Holmes P., Obrosky D.S., Peyrani P., Johnson P., Hooy M., Grayson L., Mayall B., Nimmo G., Munckhof W., Ramirez J.A., Looke D., Garske L., Playford G., Spelman D., Kotsimbos T., Heath C., Catton M., Birch C., Druce J., Ryan N., Irving L., Hart D., Bardin P., Charles P., Wolfe R., Whitby M., Fine M.J., Fuller A., Stirling R., Wright A., Christiansen K., Waterer G., Pierce R., Armstrong J., Korman T.M., Holmes P., Obrosky D.S., Peyrani P., Johnson P., Hooy M., Grayson L., Mayall B., Nimmo G., and Munckhof W.
Abstract: Background. 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 >=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). Methods. 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. Results. 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 >=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. Conclusions. 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. © 2008 by the Infectious Diseases Society of America. All rights reserved.
Published: 2008

31. The etiology of community-acquired pneumonia in Australia: Why penicillin plus doxycycline or a macrolide is the most appropriate therapy.

Author: Birch C., Druce J., Bardin P., Hart D., Irving L., Ryan N., Charles P.G.P., Whitby M., Fuller A.J., Stirling R., Wright A.A., Korman T.M., Holmes P.W., Christiansen K.J., Waterer G.W., Pierce R.J.P., Mayall B.C., Armstrong J.G., Catton M.G., Nimmo G.R., Johnson B., Hooy M., Grayson M.L., Grayson L., Johnson P., Munckhof W., Looke D., Garske L., Playford G., Spelman D., Kotsimbos T., Holmes P., Heath C., Birch C., Druce J., Bardin P., Hart D., Irving L., Ryan N., Charles P.G.P., Whitby M., Fuller A.J., Stirling R., Wright A.A., Korman T.M., Holmes P.W., Christiansen K.J., Waterer G.W., Pierce R.J.P., Mayall B.C., Armstrong J.G., Catton M.G., Nimmo G.R., Johnson B., Hooy M., Grayson M.L., Grayson L., Johnson P., Munckhof W., Looke D., Garske L., Playford G., Spelman D., Kotsimbos T., Holmes P., and Heath C.
Abstract: Background. 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. Methods. 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. Results. 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 narrowerspectrum beta-lactams, and they did not differ on the basis of whether a pathogen was identified. Conclusions. 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. Members of the study group are listed at the end of the text. © 2008 by the Infectious Diseases S
Published: 2008

32. Overcrowding and understaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission

Author: Halton, Kate, Graves, Nicholas, Pettitt, Anthony, Morton, Anthony, Looke, D, Whitby, M, Clements, Archie, Halton, Kate, Graves, Nicholas, Pettitt, Anthony, Morton, Anthony, Looke, D, Whitby, M, and Clements, Archie
Abstract: Recent decades have seen the global emergence of meticillin-resistant Staphylococcus aureus (MRSA), causing substantial health and economic burdens on patients and health-care systems. This epidemic has occurred at the same time that policies promoting higher patient throughput in hospitals have led to many services operating at, or near, full capacity. A result has been limited ability to scale services according to fluctuations in patient admissions and available staff, and hospital overcrowding and understaffing. Overcrowding and understaffing lead to failure of MRSA control programmes via decreased health-care worker hand-hygiene compliance, increased movement of patients and staff between hospital wards, decreased levels of cohorting, and overburdening of screening and isolation facilities. In turn, a high MRSA incidence leads to increased inpatient length of stay and bed blocking, exacerbating overcrowding and leading to a vicious cycle characterised by further infection control failure. Future decision making should use epidemiological and economic evidence to evaluate the effect of systems changes on the incidence of MRSA infection and other adverse events.
Published: 2008

33. Malaria

Author: Christiansen, K., Currie, Bart J., Ferguson, J., Franks, G., Garland, S., Grayson, L., Hellsten, J., Isaacs, D., Johnstone, J., Korman, T., Looke, D., Primrose, J., Roughhead, L., Spicer, W. J., Street, A., Christiansen, K., Currie, Bart J., Ferguson, J., Franks, G., Garland, S., Grayson, L., Hellsten, J., Isaacs, D., Johnstone, J., Korman, T., Looke, D., Primrose, J., Roughhead, L., Spicer, W. J., and Street, A.
Published: 2003

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33 results on '"Looke, D"'

1. Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients

2. Predictors of treatment success following peri-prosthetic joint infection: 24-month follow up from a multi-center prospective observational cohort study of 653 patients

3. Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients

4. Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients

5. World alliance against antibiotic resistance: The WAAAR declaration against antibiotic resistance

6. Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance

7. 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 and blaCTX-M-27.

8. Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with e coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance.

9. 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 and blaCTX-M-27.

10. Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with e coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance.

11. Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance: A Randomized Clinical Trial

12. Mucormycosis in Australia: Contemporary epidemiology and outcomes

13. Mucormycosis in Australia: Contemporary epidemiology and outcomes

14. Candidaemia with uncommon Candida species: Predisposing factors, outcome, antifungal susceptibility, and implications for management.

15. Population-based surveillance for scedosporiosis in Australia: Epidemiology, disease manifestations and emergence of Scedosporium aurantiacum infection.

16. Active surveillance for candidemia, Australia.

17. Candidaemia with uncommon Candida species: Predisposing factors, outcome, antifungal susceptibility, and implications for management.

18. Population-based surveillance for scedosporiosis in Australia: Epidemiology, disease manifestations and emergence of Scedosporium aurantiacum infection.

19. Active surveillance for candidemia, Australia.

20. Control of Fluoroquinolone Resistance through Successful Regulation, Australia

21. Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study

22. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: A prospective cohort study

23. Management of mammalian bites.

24. Management of mammalian bites.

25. Determinants of mortality in non-neutropenic ICU patients with candidaemia.

26. Determinants of mortality in non-neutropenic ICU patients with candidaemia.

27. Molecular typing of Australian Scedosporium isolates showing genetic variability and numerous S. aurantiacum.

28. The etiology of community-acquired pneumonia in Australia: Why penicillin plus doxycycline or a macrolide is the most appropriate therapy.

29. Molecular typing of Australian Scedosporium isolates showing genetic variability and numerous S. aurantiacum.

30. SMART-COP: A tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia.

31. The etiology of community-acquired pneumonia in Australia: Why penicillin plus doxycycline or a macrolide is the most appropriate therapy.

32. Overcrowding and understaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission

33. Malaria

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33 results on '"Looke, D"'

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