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Objective: To determine the prevalence of multiresistant organism (MRO) colonisation of reusable venesection tourniquets., Design and Setting: A prospective study in a tertiary hospital to collect and analyse reusable venesection tourniquets for the presence of MROs - methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum β-lactamase and metallo-β-lactamase-producing Enterobacteriaceae - using a sensitive enrichment method. Tourniquets were collected and tested during a 10-week period between September and November 2010., Main Outcome Measure: Prevalence of MRO colonisation of tourniquets., Results: The overall colonisation rate of 100 tourniquets randomly collected from general wards, ambulatory care areas and critical care areas was 78%. MROs were isolated from 25 tourniquets collected from a variety of hospital locations, including general wards, the intensive care unit, burns unit and anaesthetic bay. MRSA was isolated from 14 tourniquets and VRE from 19; both MRSA and VRE were isolated from nine tourniquets. There were no microorganisms isolated from 22 tourniquets., Conclusion: Reusable tourniquets can be colonised with MROs and may be a potential source of transmission of MROs to hospitalised patients.

A national interdisciplinary body is urgently needed to manage the looming antimicrobial resistance crisis.

Three cases of cholera in women aged 71, 72 and 84 years were notified in November 2006 in Sydney, New South Wales. This is the first reported cluster of cholera in Australia for over 30 years, and was an unusual outbreak in patients with no history of recent travel to cholera-endemic areas. A food trace-back investigation found that the only exposure common to all cases was consumption of raw whitebait imported from Indonesia. This outbreak demonstrates that the practice of eating raw whitebait does occur in Australia, albeit in the process of taste-testing uncooked fritter batter. All three patients were undergoing long-term therapy with proton-pump inhibitors, which may have contributed to their susceptibility to the disease. A review of importation practices of food from cholera-endemic regions may be required to prevent future transmission.

Soft tissue infections are common and usually respond rapidly to oral antibiotics; if empirical therapy fails then exposure to unusual organisms should be considered. Septic arthritis requires early recognition, identification of the infecting pathogen and urgent joint washout to prevent irreversible cartilage and bone destruction. Prosthetic joint infection is uncommon but has high morbidity; the best outcomes are achieved with removal of the prosthesis and replacement after at least six weeks of antibiotic therapy. Osteomyelitis often complicates diabetic foot infection with ulceration and is rarely cured by antibiotics alone; early surgical intervention achieves the best outcome.

We present a patient diagnosed as having tuberculous lymphadenitis after lymph node biopsy and referred for tuberculous therapy. On review, because of recent cat exposure, she was tested for cat scratch disease (CSD), but serological tests for Bartonella henselae were negative. However, the diagnosis of CSD was confirmed, and tuberculosis excluded, by polymerase chain reaction techniques. This case serves as a reminder that CSD may mimic tuberculosis histologically and that sensitive molecular diagnostic tests are available.

About one in three patients with advanced immune deficiency will develop disseminated MAC infection. This incidence can be reduced with prophylactic drug therapy, and established infections can be effectively treated, with improved quality of life and lengthened survival.

Objective: To assess the incidence of local and systemic infection caused by central venous catheters in a general hospital population., Setting: Concord Repatriation General Hospital, Sydney, April to August 1991 inclusive., Design: A prospective survey of all patients with in situ central venous catheters. Systemic catheter-related infection was detected by blood and routine catheter tip culture, and local infection by clinical observation of the catheter exit site., Outcome Measures: Local and systemic infection and complications., Results: 479 central venous catheters were surveyed in 311 patients. Local infection developed in association with 54 catheters (11%) and systemic infection with 32 (6.7%). Local infection was predictive of systemic infection, but its absence did not exclude systemic infection. Haemodialysis catheters were responsible for a higher systemic infection rate than other catheter types, the most common organism responsible being methicillin-resistant Staphylococcus aureus. Twenty per cent of all bacteraemias (33/160) detected in the hospital occurred in patients with a central venous catheter and 24 of these (73%) were definitely or probably due to the catheter. Staphylococci were the predominant isolates and 40% of the methicillin-resistant S. aureus bacteraemias detected were due to catheter-related infection. Infection complications were few: three patients developed local abscesses; one endocarditis; and two died., Conclusions: Central venous catheter-related infection is common in general hospital populations. Staphylococcal bacteraemia and local infection in a patient with a central venous catheter are strongly suggestive of catheter-related systemic infection. Empirical antibiotic treatment should include at least antistaphylococcal cover.