244 results on '"Kotsanas D."'
Search Results
2. Antimicrobial resistance surveillance of Clostridioides difficile in Australia, 2015–18
- Author
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Putsathit, P., Hong, S., George, N., Hemphill, C., Huntington, P.G., Korman, T.M., Kotsanas, D., Lahra, M., McDougall, R., McGlinchey, A., Moore, C.V., Nimmo, G.R., Prendergast, L., Robson, J., Waring, L., Wehrhahn, M.C., Weldhagen, G.F., Wilson, R.M., Riley, T.V., Knight, D.R., Putsathit, P., Hong, S., George, N., Hemphill, C., Huntington, P.G., Korman, T.M., Kotsanas, D., Lahra, M., McDougall, R., McGlinchey, A., Moore, C.V., Nimmo, G.R., Prendergast, L., Robson, J., Waring, L., Wehrhahn, M.C., Weldhagen, G.F., Wilson, R.M., Riley, T.V., and Knight, D.R.
- Abstract
Background Clostridioides difficile was listed as an urgent antimicrobial resistance (AMR) threat in a report by the CDC in 2019. AMR drives the evolution of C. difficile and facilitates its emergence and spread. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is nationwide longitudinal surveillance of C. difficile infection (CDI) in Australia. Objectives To determine the antimicrobial susceptibility of C. difficile isolated in Australia between 2015 and 2018. Methods A total of 1091 strains of C. difficile were collected over a 3 year period by a network of 10 diagnostic microbiology laboratories in five Australian states. These strains were tested for their susceptibility to nine antimicrobials using the CLSI agar incorporation method. Results All strains were susceptible to metronidazole, fidaxomicin, rifaximin and amoxicillin/clavulanate and low numbers of resistant strains were observed for meropenem (0.1%; 1/1091), moxifloxacin (3.5%; 38/1091) and vancomycin (5.7%; 62/1091). Resistance to clindamycin was common (85.2%; 929/1091), followed by resistance to ceftriaxone (18.8%; 205/1091). The in vitro activity of fidaxomicin [geometric mean MIC (GM) = 0.101 mg/L] was superior to that of vancomycin (1.700 mg/L) and metronidazole (0.229 mg/L). The prevalence of MDR C. difficile, as defined by resistance to ≥3 antimicrobial classes, was low (1.7%; 19/1091). Conclusions The majority of C. difficile isolated in Australia did not show reduced susceptibility to antimicrobials recommended for treatment of CDI (vancomycin, metronidazole and fidaxomicin). Resistance to carbapenems and fluoroquinolones was low and MDR was uncommon; however, clindamycin resistance was frequent. One fluoroquinolone-resistant ribotype 027 strain was detected.
- Published
- 2021
3. Antimicrobial resistance surveillance of Clostridioides difficile in Australia, 2015-18.
- Author
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Putsathit P., Hong S., George N., Hemphill C., Huntington P.G., Korman T.M., Kotsanas D., Lahra M., McDougall R., McGlinchey A., Moore C.V., Nimmo G.R., Prendergast L., Robson J., Waring L., Wehrhahn M.C., Weldhagen G.F., Wilson R.M., Riley T.V., Knight D.R., Putsathit P., Hong S., George N., Hemphill C., Huntington P.G., Korman T.M., Kotsanas D., Lahra M., McDougall R., McGlinchey A., Moore C.V., Nimmo G.R., Prendergast L., Robson J., Waring L., Wehrhahn M.C., Weldhagen G.F., Wilson R.M., Riley T.V., and Knight D.R.
- Abstract
Background: Clostridioides difficile was listed as an urgent antimicrobial resistance (AMR) threat in a report by the CDC in 2019. AMR drives the evolution of C. difficile and facilitates its emergence and spread. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is nationwide longitudinal surveillance of C. difficile infection (CDI) in Australia. Objective(s): To determine the antimicrobial susceptibility of C. difficile isolated in Australia between 2015 and 2018. Method(s): A total of 1091 strains of C. difficile were collected over a 3 year period by a network of 10 diagnostic microbiology laboratories in five Australian states. These strains were tested for their susceptibility to nine antimicrobials using the CLSI agar incorporation method. Result(s): All strains were susceptible to metronidazole, fidaxomicin, rifaximin and amoxicillin/clavulanate and low numbers of resistant strains were observed for meropenem (0.1%; 1/1091), moxifloxacin (3.5%; 38/1091) and vancomycin (5.7%; 62/1091). Resistance to clindamycin was common (85.2%; 929/1091), followed by resistance to ceftriaxone (18.8%; 205/1091). The in vitro activity of fidaxomicin [geometric mean MIC (GM)=0.101 mg/L] was superior to that of vancomycin (1.700 mg/L) and metronidazole (0.229 mg/L). The prevalence of MDR C. difficile, as defined by resistance to >=3 antimicrobial classes, was low (1.7%; 19/1091). Conclusion(s): The majority of C. difficile isolated in Australia did not show reduced susceptibility to antimicrobials recommended for treatment of CDI (vancomycin, metronidazole and fidaxomicin). Resistance to carbapenems and fluoroquinolones was low and MDR was uncommon; however, clindamycin resistance was frequent. One fluoroquinolone-resistant ribotype 027 strain was detected. Copyright © 2021 The Author(s). Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
- Published
- 2021
4. Laboratory-based surveillance of clostridium difficile infection in australian health care and community settings, 2013 to 2018.
- Author
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Hong S., Lahra M., McDougall R., Moore C.V., Riley T.V., Knight D.R., Korman T.M., Huntington P.G., Hemphill C., George N., Putsathit P., Nimmo G.R., Kotsanas D., Prendergast L., Robson J., Waring L., Wehrhahn M.C., Weldhagen G.F., Wilson R.M., Hong S., Lahra M., McDougall R., Moore C.V., Riley T.V., Knight D.R., Korman T.M., Huntington P.G., Hemphill C., George N., Putsathit P., Nimmo G.R., Kotsanas D., Prendergast L., Robson J., Waring L., Wehrhahn M.C., Weldhagen G.F., and Wilson R.M.
- Abstract
In the early 2000s, a binary toxin (CDT)-producing strain of Clostridium difficile, ribotype 027 (RT027), caused extensive outbreaks of diarrheal disease in North America and Europe. This strain has not become established in Australia, and there is a markedly different repertoire of circulating strains there compared to other regions of the world. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is a nationwide longitudinal surveillance study of C. difficile infection (CDI) in Australia. Here, we describe the molecular epidemiology of CDI in Australian health care and community settings over the first 5 years of the study, 2013 to 2018. Between 2013 and 2018, 10 diagnostic microbiology laboratories from five states in Australia participated in the CDARS study. From each of five states, one private (representing community) and one public (representing hospitals) laboratory submitted isolates of C. difficile or PCR-positive stool samples during two collection periods per year, February-March (summer/autumn) and August-September (winter/spring). C. difficile was characterized by toxin gene profiling and ribotyping. A total of 1,523 isolates of C. difficile were studied. PCR ribotyping yielded 203 different RTs, the most prevalent being RT014/020 (n = 449; 29.5%). The epidemic CDT+ RT027 (n = 2) and RT078 (n = 6), and the recently described RT251 (n = 10) and RT244 (n = 6) were not common, while RT126 (n = 17) was the most prevalent CDT+ type. A heterogeneous C. difficile population was identified. C. difficile RT014/020 was the most prevalent type found in humans with CDI. Continued surveillance of CDI in Australia remains critical for the detection of emerging strain lineages.Copyright © 2020 American Society for Microbiology. All Rights Reserved.
- Published
- 2021
5. Impact of on-site compared to off-site testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) on duration of isolation and resource utilization.
- Author
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Roberts A.T., Wong G., Kotsanas D., Francis M.J., Stuart R.L., Roberts A.T., Wong G., Kotsanas D., Francis M.J., and Stuart R.L.
- Abstract
Rapid detection and isolation of coronavirus disease 2019 (COVID-19) patients is the only means of reducing hospital transmission. We describe the impact of implementation of on-site severe acute respiratory coronavirus virus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction (RT-PCR) testing on reducing turnaround time, isolation duration, pathology test ordering, and antibiotic use in patients who do not have COVID-19.Copyright © 2021 Cambridge University Press. All rights reserved.
- Published
- 2021
6. Impact of coronavirus disease 2019 (COVID-19) pandemic isolation measures on the rate of non-COVID-19 infections in hematology patients
- Author
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Miller, JH, Opat, SS, Shortt, J, Kotsanas, D, Dendle, C, Graham, M, Miller, JH, Opat, SS, Shortt, J, Kotsanas, D, Dendle, C, and Graham, M
- Published
- 2021
7. Impact of on-site compared to off-site testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) on duration of isolation and resource utilization
- Author
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Roberts, AT, Wong, G, Kotsanas, D, Francis, MJ, Stuart, RL, Graham, M, Rogers, BA, Roberts, AT, Wong, G, Kotsanas, D, Francis, MJ, Stuart, RL, Graham, M, and Rogers, BA
- Abstract
Rapid detection and isolation of coronavirus disease 2019 (COVID-19) patients is the only means of reducing hospital transmission. We describe the impact of implementation of on-site severe acute respiratory coronavirus virus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction (RT-PCR) testing on reducing turnaround time, isolation duration, pathology test ordering, and antibiotic use in patients who do not have COVID-19.
- Published
- 2021
8. Laboratory-based surveillance of Clostridium difficile Infection in Australian health care and community settings, 2013 to 2018
- Author
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Hong, S., Putsathit, P., George, N., Hemphill, C., Huntington, P.G., Korman, T.M., Kotsanas, D., Lahra, M., McDougall, R., Moore, C.V., Nimmo, G.R., Prendergast, L., Robson, J., Waring, L., Wehrhahn, M.C., Weldhagen, G.F., Wilson, R.M., Riley, T.V., Knight, D.R., Diekema, D.J., Hong, S., Putsathit, P., George, N., Hemphill, C., Huntington, P.G., Korman, T.M., Kotsanas, D., Lahra, M., McDougall, R., Moore, C.V., Nimmo, G.R., Prendergast, L., Robson, J., Waring, L., Wehrhahn, M.C., Weldhagen, G.F., Wilson, R.M., Riley, T.V., Knight, D.R., and Diekema, D.J.
- Abstract
In the early 2000s, a binary toxin (CDT)-producing strain of Clostridium difficile, ribotype 027 (RT027), caused extensive outbreaks of diarrheal disease in North America and Europe. This strain has not become established in Australia, and there is a markedly different repertoire of circulating strains there compared to other regions of the world. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is a nationwide longitudinal surveillance study of C. difficile infection (CDI) in Australia. Here, we describe the molecular epidemiology of CDI in Australian health care and community settings over the first 5 years of the study, 2013 to 2018. Between 2013 and 2018, 10 diagnostic microbiology laboratories from five states in Australia participated in the CDARS study. From each of five states, one private (representing community) and one public (representing hospitals) laboratory submitted isolates of C. difficile or PCR-positive stool samples during two collection periods per year, February-March (summer/autumn) and August-September (winter/spring). C. difficile was characterized by toxin gene profiling and ribotyping. A total of 1,523 isolates of C. difficile were studied. PCR ribotyping yielded 203 different RTs, the most prevalent being RT014/020 (n = 449; 29.5%). The epidemic CDT+ RT027 (n = 2) and RT078 (n = 6), and the recently described RT251 (n = 10) and RT244 (n = 6) were not common, while RT126 (n = 17) was the most prevalent CDT+ type. A heterogeneous C. difficile population was identified. C. difficile RT014/020 was the most prevalent type found in humans with CDI. Continued surveillance of CDI in Australia remains critical for the detection of emerging strain lineages.
- Published
- 2020
9. Intermittent negative blood cultures in Staphylococcus aureus bacteremia; a retrospective study of 1071 episodes.
- Author
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Graham M., Stewart J.D., Kotsanas D., Woolley I., Korman T.M., Graham M., Stewart J.D., Kotsanas D., Woolley I., and Korman T.M.
- Abstract
Background. Recommended management of Staphylococcus aureus bacteremia (SAB) includes follow-up blood culture sets (BCs) to determine the duration of bacteremia. Duration of bacteremia is an important prognostic factor in SAB, and follow-up BCs have a critical role in differentiation of uncomplicated and complicated SAB. However, intermittent negative BCs occur in SAB. Clinical guidelines for SAB management do not specify an approach to follow-up BCs' collection or define the number of negative BCs required to demonstrate resolution of bacteremia. This study assessed the frequency of intermittent negative BCs in SAB and used these findings to formulate a recommendation for collection of follow-up BCs. Methods. This retrospective study reviewed 1071 episodes of SAB. Clinical and microbiological data including the duration of bacteremia and the occurrence of intermittent negative BCs (those preceded and followed by positive cultures) were considered. Results. Intermittent bacteremia occurred in 13% (140/1071) of episodes. A single negative BC on days 1-3 had a predictive value of 87%-93% for resolution of bacteremia, although this was improved if all BCs collected within the same day were considered. Conclusions. Intermittent negative BCs are common in SAB. Given this, we would not recommend accepting a single negative BC as demonstrating resolution of the bacteremia. This is particularly important if a patient is to be classified as having uncomplicated SAB.Copyright © The Author(s) 2019.
- Published
- 2020
10. Impact of On-site Compared to Send-away Testing for SARS-CoV-2 on Duration of Isolation and Resource Utilization.
- Author
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Stuart R.L., Kotsanas D., Francis M.J., Graham M., Roberts A., Rogers B.A., Wong G., Stuart R.L., Kotsanas D., Francis M.J., Graham M., Roberts A., Rogers B.A., and Wong G.
- Abstract
Rapid detection and isolation of COVID-19 patients is the only means of reducing hospital transmission. We describe the impact of implementation of on-site SARS-CoV-2 RT-PCR testing on reduction in result turnaround time, isolation duration, pathology test ordering and antibiotic use in patients who do not have COVID-19. Copyright © 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
- Published
- 2020
11. Impact of coronavirus disease 2019 (COVID-19) pandemic isolation measures on the rate of non-COVID-19 infections in hematology patients.
- Author
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Shortt J., Opat S.S., Kotsanas D., Graham M., Dendle C., Miller J.H., Shortt J., Opat S.S., Kotsanas D., Graham M., Dendle C., and Miller J.H.
- Published
- 2020
12. Laboratory Detection and Investigation of Reduced Susceptibility to Vancomycin in Oxacillin-Resistant Staphylococcus aureus
- Author
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Midolo, P. D., Korman, T. M., Kotsanas, D., Russo, P., and Kerr, T. G.
- Published
- 2003
- Full Text
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13. A nonclonal outbreak of vancomycin-sensitive Enterococcus faecalis bacteremia in a neonatal intensive care unit.
- Author
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Howden B.P., Taylor J.E., Kwong J.C., Seemann T., Coombs G.W., Stuart R.L., Kotsanas D., Tan K., Scott C., Baade B., Cheng M.H.L., Tan Z.V., Howden B.P., Taylor J.E., Kwong J.C., Seemann T., Coombs G.W., Stuart R.L., Kotsanas D., Tan K., Scott C., Baade B., Cheng M.H.L., and Tan Z.V.
- Abstract
Objective: To describe an outbreak of bacteremia caused by vancomycin-sensitive Enterococcus faecalis (VSEfe). Design(s): An investigation by retrospective case control and molecular typing by whole-genome sequencing (WGS). Setting(s): A tertiary-care neonatal unit in Melbourne, Australia. Method(s): Risk factors for 30 consecutive neonates with VSEfe bacteremia from June 2011 to December 2014 were analyzed using a case control study. Controls were neonates matched for gestational age, birth weight, and year of birth. Isolates were typed using WGS, and multilocus sequence typing (MLST) was determined. Result(s): Bacteremia for case patients occurred at a median time after delivery of 23.5 days (interquartile range, 14.9-35.8). Previous described risk factors for nosocomial bacteremia did not contribute to excess risk for VSEfe. WGS typing results designated 43% ST179 as well as 14 other sequence types, indicating a polyclonal outbreak. A multimodal intervention that included education, insertion checklists, guidelines on maintenance and access of central lines, adjustments to the late onset sepsis antibiotic treatment, and the introduction of diaper bags for disposal of soiled diapers after being handled inside the bed, led to termination of the outbreak. Conclusion(s): Typing using WGS identified this outbreak as predominately nonclonal and therefore not due to cross transmission. A multimodal approach was then sought to reduce the incidence of VSEfe bacteremia.Copyright © 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
- Published
- 2019
14. A nonclonal outbreak of vancomycin-sensitive Enterococcus faecalis bacteremia in a neonatal intensive care unit
- Author
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Kotsanas, D., Tan, K., Scott, C., Baade, B., Cheng, M.H.L., Tan, Z.V., Taylor, J.E., Kwong, J.C., Seemann, T., Coombs, G.W., Howden, B.P., Stuart, R.L., Kotsanas, D., Tan, K., Scott, C., Baade, B., Cheng, M.H.L., Tan, Z.V., Taylor, J.E., Kwong, J.C., Seemann, T., Coombs, G.W., Howden, B.P., and Stuart, R.L.
- Abstract
Objective: To describe an outbreak of bacteremia caused by vancomycin-sensitive Enterococcus faecalis (VSEfe). Design: An investigation by retrospective case control and molecular typing by whole-genome sequencing (WGS). Setting: A tertiary-care neonatal unit in Melbourne, Australia. Methods: Risk factors for 30 consecutive neonates with VSEfe bacteremia from June 2011 to December 2014 were analyzed using a case control study. Controls were neonates matched for gestational age, birth weight, and year of birth. Isolates were typed using WGS, and multilocus sequence typing (MLST) was determined. Results: Bacteremia for case patients occurred at a median time after delivery of 23.5 days (interquartile range, 14.9–35.8). Previous described risk factors for nosocomial bacteremia did not contribute to excess risk for VSEfe. WGS typing results designated 43% ST179 as well as 14 other sequence types, indicating a polyclonal outbreak. A multimodal intervention that included education, insertion checklists, guidelines on maintenance and access of central lines, adjustments to the late onset sepsis antibiotic treatment, and the introduction of diaper bags for disposal of soiled diapers after being handled inside the bed, led to termination of the outbreak. Conclusions: Typing using WGS identified this outbreak as predominately nonclonal and therefore not due to cross transmission. A multimodal approach was then sought to reduce the incidence of VSEfe bacteremia.
- Published
- 2019
15. Anti-Helicobacter pylori activity of ethoxzolamide.
- Author
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Ferrero R.L., Roujeinikova A., Kotsanas D., Korman T.M., Garcia-Bustos J., Kwok T., Supuran C.T., Modak J.K., Tikhomirova A., Gorrell R.J., Rahman M.M., Ferrero R.L., Roujeinikova A., Kotsanas D., Korman T.M., Garcia-Bustos J., Kwok T., Supuran C.T., Modak J.K., Tikhomirova A., Gorrell R.J., and Rahman M.M.
- Abstract
Ethoxzolamide (EZA), acetazolamide, and methazolamide are clinically used sulphonamide drugs designed to treat non-bacteria-related illnesses (e.g. glaucoma), but they also show antimicrobial activity against the gastric pathogen Helicobacter pylori. EZA showed the highest activity, and was effective against clinical isolates resistant to metronidazole, clarithromycin, and/or amoxicillin, suggesting that EZA kills H. pylori via mechanisms different from that of these antibiotics. The frequency of single-step spontaneous resistance acquisition by H. pylori was less than 5 x 10-9, showing that resistance to EZA does not develop easily. Resistance was associated with mutations in three genes, including the one that encodes undecaprenyl pyrophosphate synthase, a known target of sulphonamides. The data indicate that EZA impacts multiple targets in killing H. pylori. Our findings suggest that developing the approved anti-glaucoma drug EZA into a more effective anti-H. pylori agent may offer a faster and cost-effective route towards new antimicrobials with a novel mechanism of action.Copyright © 2019, & 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
- Published
- 2019
16. Anti-Helicobacter pylori activity of ethoxzolamide
- Author
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Modak, Joyanta Kumer, Tikhomirova, A, Gorrell, RJ, Rahman, MM, Kotsanas, D, Korman, TM, Garcia-Bustos, J, Kwok, T, Ferrero, RL, Supuran, CT, Roujeinikova, A, Modak, Joyanta Kumer, Tikhomirova, A, Gorrell, RJ, Rahman, MM, Kotsanas, D, Korman, TM, Garcia-Bustos, J, Kwok, T, Ferrero, RL, Supuran, CT, and Roujeinikova, A
- Published
- 2019
17. Anti-Helicobacter pylori activity of ethoxzolamide.
- Author
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Modak, JK, Tikhomirova, A, Gorrell, RJ, Rahman, MM, Kotsanas, D, Korman, TM, Garcia-Bustos, J, Kwok, T, Ferrero, RL, Supuran, CT, Roujeinikova, A, Modak, JK, Tikhomirova, A, Gorrell, RJ, Rahman, MM, Kotsanas, D, Korman, TM, Garcia-Bustos, J, Kwok, T, Ferrero, RL, Supuran, CT, and Roujeinikova, A
- Abstract
Ethoxzolamide (EZA), acetazolamide, and methazolamide are clinically used sulphonamide drugs designed to treat non-bacteria-related illnesses (e.g. glaucoma), but they also show antimicrobial activity against the gastric pathogen Helicobacter pylori. EZA showed the highest activity, and was effective against clinical isolates resistant to metronidazole, clarithromycin, and/or amoxicillin, suggesting that EZA kills H. pylori via mechanisms different from that of these antibiotics. The frequency of single-step spontaneous resistance acquisition by H. pylori was less than 5 × 10-9, showing that resistance to EZA does not develop easily. Resistance was associated with mutations in three genes, including the one that encodes undecaprenyl pyrophosphate synthase, a known target of sulphonamides. The data indicate that EZA impacts multiple targets in killing H. pylori. Our findings suggest that developing the approved anti-glaucoma drug EZA into a more effective anti-H. pylori agent may offer a faster and cost-effective route towards new antimicrobials with a novel mechanism of action.
- Published
- 2019
18. Intermittent Negative Blood Cultures in Staphylococcus aureus Bacteremia; a Retrospective Study of 1071 Episodes
- Author
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Stewart, JD, Graham, M, Kotsanas, D, Woolley, I, Korman, TM, Stewart, JD, Graham, M, Kotsanas, D, Woolley, I, and Korman, TM
- Abstract
BACKGROUND: Recommended management of Staphylococcus aureus bacteremia (SAB) includes follow-up blood culture sets (BCs) to determine the duration of bacteremia. Duration of bacteremia is an important prognostic factor in SAB, and follow-up BCs have a critical role in differentiation of uncomplicated and complicated SAB. However, intermittent negative BCs occur in SAB. Clinical guidelines for SAB management do not specify an approach to follow-up BCs' collection or define the number of negative BCs required to demonstrate resolution of bacteremia. This study assessed the frequency of intermittent negative BCs in SAB and used these findings to formulate a recommendation for collection of follow-up BCs. METHODS: This retrospective study reviewed 1071 episodes of SAB. Clinical and microbiological data including the duration of bacteremia and the occurrence of intermittent negative BCs (those preceded and followed by positive cultures) were considered. RESULTS: Intermittent bacteremia occurred in 13% (140/1071) of episodes. A single negative BC on days 1-3 had a predictive value of 87%-93% for resolution of bacteremia, although this was improved if all BCs collected within the same day were considered. CONCLUSIONS: Intermittent negative BCs are common in SAB. Given this, we would not recommend accepting a single negative BC as demonstrating resolution of the bacteremia. This is particularly important if a patient is to be classified as having uncomplicated SAB.
- Published
- 2019
19. Respiratory virus detection and co-infection in children and adults in a large Australian hospital in 2009-2015.
- Author
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Buttery J.P., Ching N.S., Kotsanas D., Easton M.L., Francis M.J., Korman T.M., Buttery J.P., Ching N.S., Kotsanas D., Easton M.L., Francis M.J., and Korman T.M.
- Abstract
Aim: This hospital network-based retrospective observational study aimed to describe the prevalence and seasonality of paediatric and adult viral respiratory pathogens and their rates of co-infections, following the introduction of a rapid multiplex molecular diagnostic assay. Method(s): All nasopharyngeal samples tested in patients presenting to Monash Health, Melbourne, Australia, from August 2009 to July 2015 by means of multiplex tandem polymerase chain reaction using the Respiratory Pathogen 12Plex kit (AusDiagnostics) were included in the analysis. Result(s): There were 28 729 patient samples analysed after duplicate samples were excluded. Positive results were twice as likely in paediatrics, 7573/11 491 (65.9%), compared to adults, 5410/17 238 (31.4%). Co-infection was more frequent in paediatrics, 1642/7573 (21.7% of positives), compared to adults 299/5410 (5.5%). Adenovirus had a high prevalence as a co-infection, 639/990 (64.5%), in paediatrics. Testing frequency increased by 179% in the paediatric group and by 949% for adults over the 6 years of observation. Conclusion(s): This study demonstrated a significant difference in the positive detection rate of pathogens and co-infections between the population groups. Adenovirus had a surprisingly high prevalence as a co-infection, especially in paediatric patients. Over the study period, rapid uptake of the test was observed, especially in adults. This raises concerns about how we can ensure that testing remains rational and is able to be provided in a cost-effective manner in the future.Copyright © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)
- Published
- 2018
20. Increasing tolerance of hospital Enterococcus faecium to handwash alcohols.
- Author
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Johnson P.D.R., Seemann T., Howden B.P., Stinear T.P., Pidot S.J., Gao W., Buultjens A.H., Monk I.R., Guerillot R., Carter G.P., Lee J.Y.H., Lam M.M.C., Grayson M.L., Ballard S.A., Mahony A.A., Grabsch E.A., Kotsanas D., Korman T.M., Coombs G.W., Robinson J.O., Da Silva A.G., Johnson P.D.R., Seemann T., Howden B.P., Stinear T.P., Pidot S.J., Gao W., Buultjens A.H., Monk I.R., Guerillot R., Carter G.P., Lee J.Y.H., Lam M.M.C., Grayson M.L., Ballard S.A., Mahony A.A., Grabsch E.A., Kotsanas D., Korman T.M., Coombs G.W., Robinson J.O., and Da Silva A.G.
- Abstract
Alcohol-based disinfectants and particularly hand rubs are a key way to control hospital infections worldwide. Such disinfectants restrict transmission of pathogens, such as multidrug-resistant Staphylococcus aureus and Enterococcus faecium. Despite this success, health care infections caused by E. faecium are increasing. We tested alcohol tolerance of 139 hospital isolates of E. faecium obtained between 1997 and 2015 and found that E. faecium isolates after 2010 were 10-fold more tolerant to killing by alcohol than were older isolates. Using a mouse gut colonization model of E. faecium transmission, we showed that alcohol-tolerant E. faecium resisted standard 70% isopropanol surface disinfection, resulting in greater mouse gut colonization compared to alcohol-sensitive E. faecium. We next looked for bacterial genomic signatures of adaptation. Alcohol-tolerant E. faecium accumulated mutations in genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed the roles of these genes in the tolerance of E. faecium to isopropanol. These findings suggest that bacterial adaptation is complicating infection control recommendations, necessitating additional procedures to prevent E. faecium from spreading in hospital settings.Copyright © 2018 The Authors, some rights reserved;.
- Published
- 2018
21. C-reactive protein and immature-to-total neutrophil ratio have no utility in guiding lumbar puncture in suspected neonatal sepsis.
- Author
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Tan K., Korman T., Kotsanas D., Burgner D.P., Goldfinch C.D., Tan K., Korman T., Kotsanas D., Burgner D.P., and Goldfinch C.D.
- Abstract
Aim: Meningitis may complicate neonatal sepsis, but there is scant evidence to inform the decision to perform a lumbar puncture (LP) and considerable variation in practice. We investigated whether inflammatory markers - C-reactive protein (CRP) and immature-to-total neutrophil ratio (ITR) - were predictive of meningitis or significant cerebrospinal fluid (CSF) pleocytosis and useful in guiding the decision to perform a LP. Method(s): We studied all inpatients in a single tertiary neonatal unit who were <6 months of age who had a LP performed between March 2011 and October 2014. We categorised CSF results as follows: (i) culture-positive meningitis; (ii) probable culture-negative meningitis but meeting a priori criteria for significant CSF leucocytosis; or (iii) no evidence of meningitis. CRP and ITR obtained within 48 h of LP were analysed. We assessed the test performance of CRP and ITR by area under receiver operating characteristic curves. Result(s): A total of 757 (male 471, 62.2%) infants were included. The median (interquartile range) gestational age was 38.4 weeks (30-40.3), and birthweight was 2940 g (1330-3560). Ten (1.3%) infants had culture-positive meningitis; 71 (9.4%) were classified as probable culture-negative meningitis and 676 (89.3%) as non-meningitis. The area under receiver operating characteristic curve for culture-positive and probable culture-negative meningitis was 0.43 for CRP (95% confidence interval 0.36-0.51) and 0.58 for ITR (0.51-0.65). At a CRP threshold of 30 mg/L, there was a positive likelihood ratio (LR) of 0.77 and a negative LR of 1.44. Conclusion(s): CRP and ITR perform poorly in identifying infants with confirmed or probable meningitis. The decision to perform an LP should be more focused on clinical grounds and/or a positive blood culture and less on inflammatory or haematological markers in isolation.Copyright © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)
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- 2018
22. Underdiagnosis of Chlamydia trachomatis and Chlamydia psittaci revealed by introduction of respiratory multiplex PCR assay with Chlamydiaceae family primers.
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Graham M., Rane V., Khailin K., Williams J., Francis M., Kotsanas D., Korman T.M., Graham M., Rane V., Khailin K., Williams J., Francis M., Kotsanas D., and Korman T.M.
- Abstract
We describe unanticipated detection of respiratory infection with Chlamydia trachomatis and Chlamydia psittaci after introduction of respiratory multiplex polymerase chain reaction assay that includes Chlamydiaceae family primers. We detected cases of pediatric C. trachomatis and of adult C. psittaci infection in patients with previously unrecognized risk factors. Directed testing for C. trachomatis and C. psittaci based on clinical features and risk factors alone is likely to miss the majority of infected cases.Copyright © 2017 Elsevier Inc.
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- 2018
23. Vancomycin-resistant Enterococcus faecium sequence type 796 - rapid international dissemination of a new epidemic clone.
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Stuart R.L., Kotsanas D., Cheng A., Heffernan H., Roberts S.A., Ferguson J.K., Carter G.C., Howden B.P., Stinear T.P., Johnson P.D.R., Mahony A.A., Buultjens A.H., Ballard S.A., Grabsch E.A., Xie S., Seemann T., Coombs G.W., Bak N., Stuart R.L., Kotsanas D., Cheng A., Heffernan H., Roberts S.A., Ferguson J.K., Carter G.C., Howden B.P., Stinear T.P., Johnson P.D.R., Mahony A.A., Buultjens A.H., Ballard S.A., Grabsch E.A., Xie S., Seemann T., Coombs G.W., and Bak N.
- Abstract
Background: Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of hospital-acquired infections. New, presumably better-adapted strains of VRE appear unpredictably; it is uncertain how they spread despite improved infection control. We aimed to investigate the relatedness of a novel sequence type (ST) of vanB E. faecium - ST796 - very near its time of origin from hospitals in three Australian states and New Zealand. Method(s): Following near-simultaneous outbreaks of ST796 in multiple institutions, we gathered then tested colonization and bloodstream infection isolates' antimicrobial resistance (AMR) phenotypes, and phylogenomic relationships using whole genome sequencing (WGS). Patient meta-data was explored to trace the spread of ST796. Result(s): A novel clone of vanB E. faecium (ST796) was first detected at one Australian hospital in late 2011, then in two New Zealand hospitals linked by inter-hospital transfers from separate Melbourne hospitals. ST796 also appeared in hospitals in South Australia and New South Wales and was responsible for at least one major colonization outbreak in a Neonatal Intensive Care Unit without identifiable links between centers. No exceptional AMR was detected in the isolates. While WGS analysis showed very limited diversity at the core genome, consistent with recent emergence of the clone, clustering by institution was observed. Conclusion(s): Evolution of new E. faecium clones, followed by recognized or unrecognized movement of colonized individuals then rapid intra-institutional cross-transmission best explain the multi-center, multistate and international outbreak we observed.Copyright © 2018 The Author(s).
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- 2018
24. Increasing tolerance of hospital Enterococcus faeciumto handwash alcohols
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Pidot, S.J., Gao, W., Buultjens, A.H., Monk, I.R., Guerillot, R., Carter, G.P., Lee, J.Y.H., Lam, M.M.C., Grayson, M.L., Ballard, S.A., Mahony, A.A., Grabsch, E.A., Kotsanas, D., Korman, T.M., Coombs, G.W., Robinson, J.O., Gonçalves da Silva, A., Seemann, T., Howden, B.P., Johnson, P.D.R., Stinear, T.P., Pidot, S.J., Gao, W., Buultjens, A.H., Monk, I.R., Guerillot, R., Carter, G.P., Lee, J.Y.H., Lam, M.M.C., Grayson, M.L., Ballard, S.A., Mahony, A.A., Grabsch, E.A., Kotsanas, D., Korman, T.M., Coombs, G.W., Robinson, J.O., Gonçalves da Silva, A., Seemann, T., Howden, B.P., Johnson, P.D.R., and Stinear, T.P.
- Abstract
Alcohol-based disinfectants and particularly hand rubs are a key way to control hospital infections worldwide. Such disinfectants restrict transmission of pathogens, such as multidrug-resistant Staphylococcus aureus and Enterococcus faecium. Despite this success, health care infections caused by E. faecium are increasing. We tested alcohol tolerance of 139 hospital isolates of E. faecium obtained between 1997 and 2015 and found that E. faecium isolates after 2010 were 10-fold more tolerant to killing by alcohol than were older isolates. Using a mouse gut colonization model of E. faecium transmission, we showed that alcohol-tolerant E. faecium resisted standard 70% isopropanol surface disinfection, resulting in greater mouse gut colonization compared to alcohol-sensitive E. faecium. We next looked for bacterial genomic signatures of adaptation. Alcohol-tolerant E. faecium accumulated mutations in genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed the roles of these genes in the tolerance of E. faecium to isopropanol. These findings suggest that bacterial adaptation is complicating infection control recommendations, necessitating additional procedures to prevent E. faecium from spreading in hospital settings.
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- 2018
25. Vancomycin-resistant Enterococcus faecium sequence type 796 - rapid international dissemination of a new epidemic clone
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Mahony, A.A., Buultjens, A.H., Ballard, S.A., Grabsch, E.A., Xie, S., Seemann, T., Stuart, R.L., Kotsanas, D., Cheng, A., Heffernan, H., Roberts, S.A., Coombs, G.W., Bak, N., Ferguson, J.K., Carter, G.C., Howden, B.P., Stinear, T.P., Johnson, P.D.R., Mahony, A.A., Buultjens, A.H., Ballard, S.A., Grabsch, E.A., Xie, S., Seemann, T., Stuart, R.L., Kotsanas, D., Cheng, A., Heffernan, H., Roberts, S.A., Coombs, G.W., Bak, N., Ferguson, J.K., Carter, G.C., Howden, B.P., Stinear, T.P., and Johnson, P.D.R.
- Abstract
Background: Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of hospital-acquired infections. New, presumably better-adapted strains of VRE appear unpredictably; it is uncertain how they spread despite improved infection control. We aimed to investigate the relatedness of a novel sequence type (ST) of vanB E. faecium - ST796 - very near its time of origin from hospitals in three Australian states and New Zealand. Methods: Following near-simultaneous outbreaks of ST796 in multiple institutions, we gathered then tested colonization and bloodstream infection isolates' antimicrobial resistance (AMR) phenotypes, and phylogenomic relationships using whole genome sequencing (WGS). Patient meta-data was explored to trace the spread of ST796. Results: A novel clone of vanB E. faecium (ST796) was first detected at one Australian hospital in late 2011, then in two New Zealand hospitals linked by inter-hospital transfers from separate Melbourne hospitals. ST796 also appeared in hospitals in South Australia and New South Wales and was responsible for at least one major colonization outbreak in a Neonatal Intensive Care Unit without identifiable links between centers. No exceptional AMR was detected in the isolates. While WGS analysis showed very limited diversity at the core genome, consistent with recent emergence of the clone, clustering by institution was observed. Conclusions: Evolution of new E. faecium clones, followed by recognized or unrecognized movement of colonized individuals then rapid intra-institutional cross-transmission best explain the multi-center, multistate and international outbreak we observed.
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- 2018
26. C-reactive protein and immature-to-total neutrophil ratio have no utility in guiding lumbar puncture in suspected neonatal sepsis
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Goldfinch, CD, Korman, T, Kotsanas, D, Burgner, DP, Tan, K, Goldfinch, CD, Korman, T, Kotsanas, D, Burgner, DP, and Tan, K
- Abstract
AIM: Meningitis may complicate neonatal sepsis, but there is scant evidence to inform the decision to perform a lumbar puncture (LP) and considerable variation in practice. We investigated whether inflammatory markers - C-reactive protein (CRP) and immature-to-total neutrophil ratio (ITR) - were predictive of meningitis or significant cerebrospinal fluid (CSF) pleocytosis and useful in guiding the decision to perform a LP. METHODS: We studied all inpatients in a single tertiary neonatal unit who were <6 months of age who had a LP performed between March 2011 and October 2014. We categorised CSF results as follows: (i) culture-positive meningitis; (ii) probable culture-negative meningitis but meeting a priori criteria for significant CSF leucocytosis; or (iii) no evidence of meningitis. CRP and ITR obtained within 48 h of LP were analysed. We assessed the test performance of CRP and ITR by area under receiver operating characteristic curves. RESULTS: A total of 757 (male 471, 62.2%) infants were included. The median (interquartile range) gestational age was 38.4 weeks (30-40.3), and birthweight was 2940 g (1330-3560). Ten (1.3%) infants had culture-positive meningitis; 71 (9.4%) were classified as probable culture-negative meningitis and 676 (89.3%) as non-meningitis. The area under receiver operating characteristic curve for culture-positive and probable culture-negative meningitis was 0.43 for CRP (95% confidence interval 0.36-0.51) and 0.58 for ITR (0.51-0.65). At a CRP threshold of 30 mg/L, there was a positive likelihood ratio (LR) of 0.77 and a negative LR of 1.44. CONCLUSIONS: CRP and ITR perform poorly in identifying infants with confirmed or probable meningitis. The decision to perform an LP should be more focused on clinical grounds and/or a positive blood culture and less on inflammatory or haematological markers in isolation.
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- 2018
27. Vancomycin-resistant Enterococcus faecium sequence type 796-rapid international dissemination of a new epidemic clone
- Author
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Mahony, AA, Buultjens, AH, Ballard, SA, Grabsch, EA, Xie, S, Seemann, T, Stuart, RL, Kotsanas, D, Cheng, A, Heffernan, H, Roberts, SA, Coombs, GW, Bak, N, Ferguson, JK, Carter, GC, Howden, BP, Stinear, TP, Johnson, PDR, Mahony, AA, Buultjens, AH, Ballard, SA, Grabsch, EA, Xie, S, Seemann, T, Stuart, RL, Kotsanas, D, Cheng, A, Heffernan, H, Roberts, SA, Coombs, GW, Bak, N, Ferguson, JK, Carter, GC, Howden, BP, Stinear, TP, and Johnson, PDR
- Abstract
BACKGROUND: Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of hospital-acquired infections. New, presumably better-adapted strains of VRE appear unpredictably; it is uncertain how they spread despite improved infection control. We aimed to investigate the relatedness of a novel sequence type (ST) of vanB E. faecium - ST796 - very near its time of origin from hospitals in three Australian states and New Zealand. METHODS: Following near-simultaneous outbreaks of ST796 in multiple institutions, we gathered then tested colonization and bloodstream infection isolates' antimicrobial resistance (AMR) phenotypes, and phylogenomic relationships using whole genome sequencing (WGS). Patient meta-data was explored to trace the spread of ST796. RESULTS: A novel clone of vanB E. faecium (ST796) was first detected at one Australian hospital in late 2011, then in two New Zealand hospitals linked by inter-hospital transfers from separate Melbourne hospitals. ST796 also appeared in hospitals in South Australia and New South Wales and was responsible for at least one major colonization outbreak in a Neonatal Intensive Care Unit without identifiable links between centers. No exceptional AMR was detected in the isolates. While WGS analysis showed very limited diversity at the core genome, consistent with recent emergence of the clone, clustering by institution was observed. CONCLUSIONS: Evolution of new E. faecium clones, followed by recognized or unrecognized movement of colonized individuals then rapid intra-institutional cross-transmission best explain the multi-center, multistate and international outbreak we observed.
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- 2018
28. Respiratory virus detection and co-infection in children and adults in a large Australian hospital in 2009-2015
- Author
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Ching, NS, Kotsanas, D, Easton, ML, Francis, MJ, Korman, TM, Buttery, JP, Ching, NS, Kotsanas, D, Easton, ML, Francis, MJ, Korman, TM, and Buttery, JP
- Abstract
AIM: This hospital network-based retrospective observational study aimed to describe the prevalence and seasonality of paediatric and adult viral respiratory pathogens and their rates of co-infections, following the introduction of a rapid multiplex molecular diagnostic assay. METHODS: All nasopharyngeal samples tested in patients presenting to Monash Health, Melbourne, Australia, from August 2009 to July 2015 by means of multiplex tandem polymerase chain reaction using the Respiratory Pathogen 12Plex kit (AusDiagnostics) were included in the analysis. RESULTS: There were 28 729 patient samples analysed after duplicate samples were excluded. Positive results were twice as likely in paediatrics, 7573/11 491 (65.9%), compared to adults, 5410/17 238 (31.4%). Co-infection was more frequent in paediatrics, 1642/7573 (21.7% of positives), compared to adults 299/5410 (5.5%). Adenovirus had a high prevalence as a co-infection, 639/990 (64.5%), in paediatrics. Testing frequency increased by 179% in the paediatric group and by 949% for adults over the 6 years of observation. CONCLUSIONS: This study demonstrated a significant difference in the positive detection rate of pathogens and co-infections between the population groups. Adenovirus had a surprisingly high prevalence as a co-infection, especially in paediatric patients. Over the study period, rapid uptake of the test was observed, especially in adults. This raises concerns about how we can ensure that testing remains rational and is able to be provided in a cost-effective manner in the future.
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- 2018
29. Vancomycin-resistant Enterococcus faecium sequence type 796 - rapid international dissemination of a new epidemic clone
- Author
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Mahony, A., Buultjens, A., Ballard, S., Grabsch, E., Xie, S., Seemann, T., Stuart, R., Kotsanas, D., Cheng, A., Heffernan, H., Roberts, S., Coombs, Geoffrey, Bak, N., Ferguson, J., Carter, G., Howden, B., Stinear, T., Johnson, P., Mahony, A., Buultjens, A., Ballard, S., Grabsch, E., Xie, S., Seemann, T., Stuart, R., Kotsanas, D., Cheng, A., Heffernan, H., Roberts, S., Coombs, Geoffrey, Bak, N., Ferguson, J., Carter, G., Howden, B., Stinear, T., and Johnson, P.
- Abstract
Background: Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of hospital-acquired infections. New, presumably better-adapted strains of VRE appear unpredictably; it is uncertain how they spread despite improved infection control. We aimed to investigate the relatedness of a novel sequence type (ST) of vanB E. faecium - ST796 - very near its time of origin from hospitals in three Australian states and New Zealand. Methods: Following near-simultaneous outbreaks of ST796 in multiple institutions, we gathered then tested colonization and bloodstream infection isolates' antimicrobial resistance (AMR) phenotypes, and phylogenomic relationships using whole genome sequencing (WGS). Patient meta-data was explored to trace the spread of ST796. Results: A novel clone of vanB E. faecium (ST796) was first detected at one Australian hospital in late 2011, then in two New Zealand hospitals linked by inter-hospital transfers from separate Melbourne hospitals. ST796 also appeared in hospitals in South Australia and New South Wales and was responsible for at least one major colonization outbreak in a Neonatal Intensive Care Unit without identifiable links between centers. No exceptional AMR was detected in the isolates. While WGS analysis showed very limited diversity at the core genome, consistent with recent emergence of the clone, clustering by institution was observed. Conclusions: Evolution of new E. faecium clones, followed by recognized or unrecognized movement of colonized individuals then rapid intra-institutional cross-transmission best explain the multi-center, multistate and international outbreak we observed.
- Published
- 2018
30. Influence of Vancomycin Minimum Inhibitory Concentration on the Outcome of Methicillin-Susceptible Staphylococcus aureus Left-Sided Infective Endocarditis Treated with Anti-staphylococcal Beta-Lactam Antibiotics; a Prospective Cohort Study by the International Collaboration on Endocarditis
- Author
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Athan, E., Harris, O., Korman, T. M., Kotsanas, D., Jones, P., Reinbott, P., Ryan, S., Fortes, C. Q., Garcia, P., Jones, S. B., Barsic, B., Bukovski, S., Selton-Suty, C., Aissa, N., Doco-Lecompte, T., Delahaye, F., Vandenesch, F., Tattevin, P., Hoen, B., Plesiat, P., Giamarellou, H., Giannitsioti, E., Tarpatzi, E., Durante-Mangoni, E., Iossa, D., Orlando, S., Ursi, M. P., Pafundi, P. C., D' Amico, F., Bernardo, M., Cuccurullo, S., Dialetto, G., Covino, F. E., Manduca, S., Della Corte, A., De Feo, M., Tripodi, M. F., Baban, T., Kanafani, Z. A., Kanj, S. S., Sfeir, J., Yasmine, M., Morris, A., Murdoch, D. R., Premru, M. M., Lejko-Zupanc, T., Almela, M., Ambrosioni, J., Azqueta, M., Brunet, M., Cervera, C., De Lazzari, E., Falces, C., Fuster, D., Garcia-de-la-Maria, C., Garcia-Gonzalez, J., Gatell, J. M., Marco, F., Miro, J. M., Moreno, A., Ortiz, J., Ninot, S., Pare, J. C., Pericas, J. M., Quintana, E., Ramirez, J., Sandoval, E., Sitges, M., Tolosana, J. M., Vidal, B., Vila, J., Bouza, E., Rodriguez-Creixems, M., Ramallo, V., Bradley, S., Wray, D., Steed, L., Cantey, R., Peterson, G., Stancoven, A., Woods, C., Corey, G. R., Reller, L. B., Fowler, V. G., Chu, V. H., Messina, J. A., Park, L., Sharma-Kuinkel, B. K., Carugati, M., Munoz, P., Baloch, K., Dixon, C. C., Harding, T., Jones-Richmond, M., Pappas, P., Park, L. P., Redick, T., Stafford, J., Anstrom, K., Bayer, A. S., Cabell, C. H., Karchmer, A. W., Sexton, D. J., Wang, A., Chu, V., Durack, D. T., Eykyn, S., Moreillon, P., Olaison, L., Raoult, D., Rubinstein, E., Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Duke University Medical Center, University of Barcelona, Medical University of South Carolina [Charleston] (MUSC), American University of Beirut [Beyrouth] (AUB), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Université de Tsukuba = University of Tsukuba, Pericàs, J M, Messina, J A, Garcia-de-la-Mària, C, Park, L, Sharma-Kuinkel, B K, Marco, F, Wray, D, Kanafani, Z A, Carugati, M, Durante Mangoni, E, Tattevin, P, Chu, V H, Moreno, A, Fowler, V G, Miró, J M, De Feo, Marisa, Athan, E11, Harris, O11, Korman, Tm12, Kotsanas, D13, Jones, P14, Reinbott, P14, Ryan, S14, Fortes, Cq15, Garcia, P16, Jones, Sb16, Barsic, B17, Bukovski, S17, Selton-Suty, C18, Aissa, N18, Doco-Lecompte, T18, Delahaye, F19, Vandenesch, F19, Tattevin, P20, Hoen, B21, Plesiat, P21, Giamarellou, H22, Giannitsioti, E22, Tarpatzi, E22, Durante-Mangoni, E23, Iossa, D23, Orlando, S23, Ursi, Mp23, Pafundi, Pc23, D' Amico, F23, Bernardo, M23, Cuccurullo, S23, Dialetto, G23, Covino, Fe23, Manduca, S23, DELLA CORTE, Alessandro, De Feo, M23, Tripodi, Mf24, Baban, T25, Kanafani, Za25, Kanj, Ss25, Sfeir, J25, Yasmine, M25, Morris, A26, Murdoch, Dr27, Premru, Mm28, Lejko-Zupanc, T28, Almela, M29, Ambrosioni, J29, Azqueta, M29, Brunet, M29, Cervera, C29, De Lazzari, E29, Falces, C29, Fuster, D29, Garcia-de-la-Mària, C29, Garcia-Gonzalez, J29, Gatell, Jm29, Marco, F29, Miró, Jm29, Moreno, A29, Ortiz, J29, Ninot, S29, Paré, Jc29, Pericas, Jm29, Quintana, E29, Ramirez, J29, Sandoval, E29, Sitges, M29, Tolosana, Jm29, Vidal, B29, Vila, J29, Bouza, E30, Muñoz, P, Rodríguez-Créixems, M30, Ramallo, V30, Bradley, S31, Wray, D32, Steed, L32, Cantey, R32, Peterson, G33, Stancoven, A33, Woods, C34, Corey, Gr34, Reller, Lb34, Fowler VG, Jr34, Chu, Vh34, Baloch, K, Chu, Vh, Corey, Gr, Dixon, Cc, Fowler VG, Jr, Harding, T, Jones-Richmond, M, Pappas, P, Park, Lp, Redick, T, Stafford, J, Anstrom, K, Athan, E, Bayer, A, Cabell, Ch, Hoen, B, Karchmer, Aw, Miró, Jm, Murdoch, Dr, Sexton, Dj, Wang, A, Chu, V, Durack, Dt, Eykyn, S, Moreillon, P, Olaison, L, Raoult, D, Rubinstein, E, and Sexton, Dj.
- Subjects
0301 basic medicine ,Male ,medicine.disease_cause ,0302 clinical medicine ,80 and over ,Medicaments antibacterians ,030212 general & internal medicine ,Endocarditi ,Prospective Studies ,Aged, 80 and over ,Endocarditis ,Bacterial ,General Medicine ,Middle Aged ,Staphylococcal Infections ,3. Good health ,Anti-Bacterial Agents ,Fenotip ,Infectious Diseases ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,Treatment Outcome ,Phenotype ,Staphylococcus aureus ,Infective endocarditis ,Staphylococcus aureu ,Vancomycin ,Genotype ,Vancomycin MIC ,Adult ,Aged ,Endocarditis, Bacterial ,Female ,Humans ,Microbial Sensitivity Tests ,Molecular Typing ,Multiplex Polymerase Chain Reaction ,Survival Analysis ,Virulence Factors ,beta-Lactams ,medicine.drug ,Microbiology (medical) ,030106 microbiology ,Biology ,Staphylococcal infections ,Article ,Microbiology ,03 medical and health sciences ,Minimum inhibitory concentration ,medicine ,Etest ,Endocarditis Staphylococcus aureus ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,Antibacterial agents ,Methicillin Susceptible Staphylococcus Aureus - Abstract
Objectives: Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is >= 1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (> 1.5mg/L) phenotype.Methods: All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal beta-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (>= 1.5 mg/L) or low (
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- 2017
- Full Text
- View/download PDF
31. Australian Group on Antimicrobial Resistance Australian Enterococcal Sepsis Outcome Programme annual report, 2014.
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Bell J.M., Pang S., Pearson J.C., Robinson J.O., Johnson P.D., Kotsanas D., Turnidge J.D., Coombs G.W., Daley D.A., Thin Lee Y., Bell J.M., Pang S., Pearson J.C., Robinson J.O., Johnson P.D., Kotsanas D., Turnidge J.D., Coombs G.W., Daley D.A., and Thin Lee Y.
- Abstract
From 1 January to 31 December 2014, 27 institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2014 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the Enterococcus faecium isolates. Of the 952 unique episodes of bacteraemia investigated, 94.4% were caused by either E. faecalis (54.9%) or E. faecium (39.9%). Ampicillin resistance was detected in 0.6% of E. faecalis and in 89.4% of E. faecium. Vancomycin non-susceptibility was reported in 0.2% and 46.1% of E. faecalis and E. faecium respectively. Overall 51.1% of E. faecium harboured vanA or vanB genes. For the vanA/B positive E. faecium isolates, 81.5% harboured vanB genes and 18.5% vanA genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is significantly higher than that seen in most European countries. E. faecium consisted of 113 pulsed-field gel electrophoresis pulsotypes of which 68.9% of isolates were classified into 14 major pulsotypes containing 5 or more isolates. Multilocus sequence typing grouped the 14 major pulsotypes into clonal cluster 17, a major hospital-adapted polyclonal E. faecium cluster. The geographical distribution of the 4 predominant sequence types (ST203, ST796, ST555 and ST17) varied with only ST203 identified across most regions of Australia. Overall 74.7% of isolates belonging to the four predominant STs harboured vanA or vanB genes. In conclusion, the AESOP 2014 has shown enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin resistant vanA or vanB E. faecium, which have limited treatment options.
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- 2017
32. Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal beta-lactam antibiotics: a prospective cohort study by the International Collaboration on Endocarditis.
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Ambrosioni J., Covino F.E., Manduca S., Della Corte A., De Feo M., Tripodi M.F., Baban T., Kanj S.S., Sfeir J., Yasmine M., Morris A., Murdoch D.R., Premru M.M., Lejko-Zupanc T., Almela M., Azqueta M., Brunet M., Cervera C., De Lazzari E., Falces C., Fuster D., Garcia-Gonzalez J., Gatell J.M., Ortiz J., Ninot S., Pare J.C., Quintana E., Ramirez J., Sandoval E., Sitges M., Tolosana J.M., Vidal B., Vila J., Bouza E., Rodriguez-Creixems M., Ramallo V., Bradley S., Steed L., Cantey R., Peterson G., Stancoven A., Woods C., Reller L.B., Pericas J.M., Garcia-de-la-Maria C., Moreno A., Marco F., Sharma-Kuinkel B.K., Carugati M., Messina J.A., Park L., Wray D., Kanafani Z.A., Tattevin P., Munoz P., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Athan E., Chu V.H., Karchmer A.W., Wang A., Bayer A.S., Cabell C.H., Chu V., Corey G.R., Durack D.T., Eykyn S., Fowler V.G., Hoen B., Miro J.M., Sexton D.J., Moreillon P., Olaison L., Raoult D., Rubinstein E., Harris O., Korman T.M., Kotsanas D., Jones P., Reinbott P., Ryan S., Fortes C.Q., Garcia P., Jones S.B., Barsic B., Bukovski S., Selton-Suty C., Aissa N., Doco-Lecompte T., Delahaye F., Vandenesch F., Plesiat P., Giamarellou H., Giannitsioti E., Tarpatzi E., Durante-Mangoni E., Iossa D., Orlando S., Ursi M.P., Pafundi P.C., D' Amico F., Bernardo M., Cuccurullo S., Dialetto G., Ambrosioni J., Covino F.E., Manduca S., Della Corte A., De Feo M., Tripodi M.F., Baban T., Kanj S.S., Sfeir J., Yasmine M., Morris A., Murdoch D.R., Premru M.M., Lejko-Zupanc T., Almela M., Azqueta M., Brunet M., Cervera C., De Lazzari E., Falces C., Fuster D., Garcia-Gonzalez J., Gatell J.M., Ortiz J., Ninot S., Pare J.C., Quintana E., Ramirez J., Sandoval E., Sitges M., Tolosana J.M., Vidal B., Vila J., Bouza E., Rodriguez-Creixems M., Ramallo V., Bradley S., Steed L., Cantey R., Peterson G., Stancoven A., Woods C., Reller L.B., Pericas J.M., Garcia-de-la-Maria C., Moreno A., Marco F., Sharma-Kuinkel B.K., Carugati M., Messina J.A., Park L., Wray D., Kanafani Z.A., Tattevin P., Munoz P., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Athan E., Chu V.H., Karchmer A.W., Wang A., Bayer A.S., Cabell C.H., Chu V., Corey G.R., Durack D.T., Eykyn S., Fowler V.G., Hoen B., Miro J.M., Sexton D.J., Moreillon P., Olaison L., Raoult D., Rubinstein E., Harris O., Korman T.M., Kotsanas D., Jones P., Reinbott P., Ryan S., Fortes C.Q., Garcia P., Jones S.B., Barsic B., Bukovski S., Selton-Suty C., Aissa N., Doco-Lecompte T., Delahaye F., Vandenesch F., Plesiat P., Giamarellou H., Giannitsioti E., Tarpatzi E., Durante-Mangoni E., Iossa D., Orlando S., Ursi M.P., Pafundi P.C., D' Amico F., Bernardo M., Cuccurullo S., and Dialetto G.
- Abstract
Objectives Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is >=1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (>=1.5 mg/L) phenotype. Methods All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal beta-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (>=1.5 mg/L) or low (<1.5 mg/L). Isolates underwent spa typing to infer clonal complexes and multiplex PCR for identifying virulence genes. Univariate analysis was performed to evaluate the association between in-hospital and 1-year mortality, and vancomycin MIC phenotype. Results Sixty-two cases met the inclusion criteria. Vancomycin MIC was low in 28 cases (45%) and high in 34 cases (55%). No significant differences in patient demographic data or characteristics of infection were observed between patients with infective endocarditis due to high and low vancomycin MIC isolates. Isolates with high and low vancomycin MIC had similar distributions of virulence genes and clonal lineages. In-hospital and 1-year mortality did not differ significantly between the two groups (32% (9/28) vs. 27% (9/34), p 0.780; and 43% (12/28) vs. 29% (10/34), p 0.298, for low and high vancomycin MIC respectively). Conclusions In this international cohort of patients with left-sided MSSA endocarditis treated with antistaphylococcal beta-lactams, vancomycin MIC phenotype was not associated with patient demographics, clinical outcome or virulence gene repertoire.Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases
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- 2017
33. Microfiber and steam for a neonatal service: An improved and safe cleaning methodology.
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Tabbara L., Lovegrove A., Scott C., Stuart R.L., Gillespie E., Kotsanas D., Tabbara L., Lovegrove A., Scott C., Stuart R.L., Gillespie E., and Kotsanas D.
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- 2017
34. Increasing tolerance of hospital Enterococcus faecium to hand-wash alcohols
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Romain Guérillot, Johnson Pdr, James O. Robinson, Korman Tm, Glen P. Carter, Andrew A Mahony, Ian R. Monk, Pidot Sj, Geoffrey W. Coombs, Grabsch Ea, Kotsanas D, M.L. Grayson, Benjamin P Howden, Timothy P. Stinear, Wei Gao, Susan A Ballard, Andrew H. Buultjens, Gonçalves da Silva A, Torsten Seemann, Lee Jy, and Lam Mmc
- Subjects
0303 health sciences ,03 medical and health sciences ,Hand wash ,030306 microbiology ,business.industry ,Medicine ,Pulp and paper industry ,business ,030304 developmental biology ,3. Good health - Abstract
Alcohol-based hand rubs are international pillars of hospital infection control, restricting transmission of pathogens such asStaphylococcus aureus. Despite this success, health care infections caused byEnterococcus faecium(Efm) - another multidrug resistant pathogen - are increasing. We tested alcohol tolerance of 139 hospital Efm isolates, obtained between 1997 and 2015 and found Efm post-2010 were 10-fold more tolerant to alcohol killing than older isolates. Using a mouse infection control model, we then showed that alcohol tolerant Efm resisted standard 70% isopropanol surface disinfection and led to gastrointestinal colonization significantly more often than alcohol sensitive Efm. We next looked for bacterial genomic signatures of adaptation. Tolerant Efm have independently accumulated mutations modifying genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed their roles in isopropanol tolerance. These findings suggest bacterial adaptation and complicate infection control recommendations. Additional policies and procedures to prevent Efm spread are required.
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- 2016
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35. Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics: a prospective cohort study by the International Collaboration on Endocarditis
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Pericàs, J.M., primary, Messina, J.A., additional, Garcia-de-la-Mària, C., additional, Park, L., additional, Sharma-Kuinkel, B.K., additional, Marco, F., additional, Wray, D., additional, Kanafani, Z.A., additional, Carugati, M., additional, Durante-Mangoni, E., additional, Tattevin, P., additional, Chu, V.H., additional, Moreno, A., additional, Fowler, V.G., additional, Miró, J.M., additional, Athan, E., additional, Harris, O., additional, Korman, T.M., additional, Kotsanas, D., additional, Jones, P., additional, Reinbott, P., additional, Ryan, S., additional, Fortes, C.Q., additional, Garcia, P., additional, Jones, S.B., additional, Barsic, B., additional, Bukovski, S., additional, Selton-Suty, C., additional, Aissa, N., additional, Doco-Lecompte, T., additional, Delahaye, F., additional, Vandenesch, F., additional, Hoen, B., additional, Plesiat, P., additional, Giamarellou, H., additional, Giannitsioti, E., additional, Tarpatzi, E., additional, Iossa, D., additional, Orlando, S., additional, Ursi, M.P., additional, Pafundi, P.C., additional, D' Amico, F., additional, Bernardo, M., additional, Cuccurullo, S., additional, Dialetto, G., additional, Covino, F.E., additional, Manduca, S., additional, Della Corte, A., additional, De Feo, M., additional, Tripodi, M.F., additional, Baban, T., additional, Kanj, S.S., additional, Sfeir, J., additional, Yasmine, M., additional, Morris, A., additional, Murdoch, D.R., additional, Premru, M.M., additional, Lejko-Zupanc, T., additional, Almela, M., additional, Ambrosioni, J., additional, Azqueta, M., additional, Brunet, M., additional, Cervera, C., additional, De Lazzari, E., additional, Falces, C., additional, Fuster, D., additional, Garcia-Gonzalez, J., additional, Gatell, J.M., additional, Ortiz, J., additional, Ninot, S., additional, Paré, J.C., additional, Pericas, J.M., additional, Quintana, E., additional, Ramirez, J., additional, Sandoval, E., additional, Sitges, M., additional, Tolosana, J.M., additional, Vidal, B., additional, Vila, J., additional, Bouza, E., additional, Muñoz, P., additional, Rodríguez-Créixems, M., additional, Ramallo, V., additional, Bradley, S., additional, Steed, L., additional, Cantey, R., additional, Peterson, G., additional, Stancoven, A., additional, Woods, C., additional, Corey, G.R., additional, Reller, L.B., additional, Baloch, K., additional, Dixon, C.C., additional, Harding, T., additional, Jones-Richmond, M., additional, Pappas, P., additional, Park, L.P., additional, Redick, T., additional, Stafford, J., additional, Anstrom, K., additional, Bayer, A.S., additional, Cabell, C.H., additional, Karchmer, A.W., additional, Sexton, D.J., additional, Wang, A., additional, Chu, V., additional, Durack, D.T., additional, Eykyn, S., additional, Moreillon, P., additional, Olaison, L., additional, Raoult, D., additional, and Rubinstein, E., additional
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- 2017
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36. Teicoplanin non-susceptible coagulase-negative staphylococci in a large Australian healthcare network: Implications for treatment with vancomycin
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Wijesooriya, W. R. P. L. I., primary, Kotsanas, D. N., additional, Korman, T. M., additional, and Graham, M, additional
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- 2017
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37. Disposable antimicrobial and sporicidal privacy curtains: Cost benefit of hanging longer.
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Gillespie E., Kotsanas D., Gillespie E., and Kotsanas D.
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- 2016
38. Does the new low-frequency ultrasonic debridement technology pose an infection control risk for clinicians, patients, and the clinic environment?.
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Bergin S., Haines T., Williams C., Coombes G., Orr E., Kotsanas D., Michailidis L., Bergin S., Haines T., Williams C., Coombes G., Orr E., Kotsanas D., and Michailidis L.
- Abstract
Background Low-frequency ultrasonic debridement (LFUD) is a technology that uses sound waves conducted through saline mist to debride wound tissue. Whilst this technology purportedly reduces wound-healing times, the airborne mist generated is potentially problematic. Theoretically, the saline mist could carry an increased number of microbes into the surrounding environment, posing an infection control risk to the patient, clinician, and clinical environment. This research aimed to establish the degree and extent to which there is microbial spread during the use of, and following the use of, LFUD. The total number of colony forming units was identified for use of LFUD without the suction attachment (control) and with the suction attachment (intervention). Methods This was a prospective, observational study with repeated measures across each treatment (before, during, and after). Quota sampling in a 2x2x2 factorial design was undertaken so that half of the 24 treatments were conducted at each health service (Monash Health vs Peninsula Health), in different treatment environments (inpatient vs outpatient), and half were conducted with and without suction. The use of suction was not randomized but was determined at the treating clinician's discretion. Patients treated in the inpatient environment lay on their beds, whereas patients in the outpatient environment sat in a treatment chair. Results There was higher microbial count during treatment (P<.001) with a higher microbial count associated with lower ultrasound amplitude (P=.028), lower saline flow rate (P=.010), no suction attachment (P=>.001), and a larger wound area (P=.002). All were independently associated with greater microorganism aerosolization. There was no correlation between the type of handpiece selected, the presence of wound infection, and the treatment time or treatment environment. Conclusions This research has assisted in developing guidelines for cleaning of equipment and environments following tre
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- 2016
39. Validated risk score for predicting 6-month mortality in infective endocarditis
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Park, LP, Chu, VH, Peterson, G, Skoutelis, A, Lejko-Zupa, T, Bouza, E, Tattevin, P, Habib, G, Tan, R, Gonzalez, J, Altclas, J, Edathodu, J, Fortes, CQ, Siciliano, RF, Pachirat, O, Kanj, S, Wang, A, Clara, L, LSanchez, M, Casabé, J, Cortes, C, Nacinovich, F, Oses, PF, Ronderos, R, Sucari, A, Thierer, J, Spelman, D, Athan, E, Harris, O, Kennedy, K, Gordon, D, Papanicolas, L, Korman, T, Kotsanas, D, Dever, R, Jones, P, Konecny, P, Lawrence, R, Rees, D, Ryan, S, Feneley, MP, Harkness, J, Post, J, Reinbott, P, Gattringer, R, Wiesbauer, F, Andrade, AR, de Brito, ACP, Guimarães, AC, Tranchesi, RADM, Paiva, MG, Ramos, ADO, Weksler, C, Ferraiuoli, G, Golebiovski, W, Lamas, C, James, AK, Keynan, Y, Morris, AM, Rubinstein, E, Jones, SB, Garcia, P, Cereceda, M, Fica, A, Mella, RM, Fernandez, R, Franco, L, Jaramillo, AN, Barsic, B, Bukovski, S, Krajinovic, V, Pangercic, A, Rudez, I, Vincelj, J, Freiberger, T, Pol, J, Zaloudikova, B, Ashour, Z, Kholy, AE, Mishaal, M, Osama, D, Rizk, H, Aissa, N, Alauzet, C, Alla, F, Campagnac, CC, Doco-Lecompte, T, Selton-Suty, C, Delahaye, F, Delahaye, A, Vandenesch, F, Park, LP, Chu, VH, Peterson, G, Skoutelis, A, Lejko-Zupa, T, Bouza, E, Tattevin, P, Habib, G, Tan, R, Gonzalez, J, Altclas, J, Edathodu, J, Fortes, CQ, Siciliano, RF, Pachirat, O, Kanj, S, Wang, A, Clara, L, LSanchez, M, Casabé, J, Cortes, C, Nacinovich, F, Oses, PF, Ronderos, R, Sucari, A, Thierer, J, Spelman, D, Athan, E, Harris, O, Kennedy, K, Gordon, D, Papanicolas, L, Korman, T, Kotsanas, D, Dever, R, Jones, P, Konecny, P, Lawrence, R, Rees, D, Ryan, S, Feneley, MP, Harkness, J, Post, J, Reinbott, P, Gattringer, R, Wiesbauer, F, Andrade, AR, de Brito, ACP, Guimarães, AC, Tranchesi, RADM, Paiva, MG, Ramos, ADO, Weksler, C, Ferraiuoli, G, Golebiovski, W, Lamas, C, James, AK, Keynan, Y, Morris, AM, Rubinstein, E, Jones, SB, Garcia, P, Cereceda, M, Fica, A, Mella, RM, Fernandez, R, Franco, L, Jaramillo, AN, Barsic, B, Bukovski, S, Krajinovic, V, Pangercic, A, Rudez, I, Vincelj, J, Freiberger, T, Pol, J, Zaloudikova, B, Ashour, Z, Kholy, AE, Mishaal, M, Osama, D, Rizk, H, Aissa, N, Alauzet, C, Alla, F, Campagnac, CC, Doco-Lecompte, T, Selton-Suty, C, Delahaye, F, Delahaye, A, and Vandenesch, F
- Abstract
Background-Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6-month mortality in IE. Methods and Results-Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]-Prospective Cohort Study [PCS], 2000-2006, n=4049), a model to predict 6-month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE-PLUS, 2008-2012, n=1197). The 6-month mortality was 971 of 4049 (24.0%) in the ICE-PCS cohort and 342 of 1197 (28.6%) in the ICE-PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left-sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6-month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62-0.89). A simplified risk model was developed by weight adjustment of these variables. Conclusions-Six-month mortality after IE is 25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE.
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- 2016
40. Australian Group on Antimicrobial Resistance Australian Enterococcal Sepsis Outcome Programme annual report, 2014
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Coombs, G.W., Daley, D.A., Thin Lee, Y., Pang, S., Pearson, J.C., Robinson, J.O., Johnson, P.D.R., Kotsanas, D., Bell, J.M., Turnidge, J.D., Coombs, G.W., Daley, D.A., Thin Lee, Y., Pang, S., Pearson, J.C., Robinson, J.O., Johnson, P.D.R., Kotsanas, D., Bell, J.M., and Turnidge, J.D.
- Abstract
From 1 January to 31 December 2014, 27 institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2014 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the Enterococcus faecium isolates. Of the 952 unique episodes of bacteraemia investigated, 94.4% were caused by either E. faecalis (54.9%) or E. faecium (39.9%). Ampicillin resistance was detected in 0.6% of E. faecalis and in 89.4% of E. faecium. Vancomycin non-susceptibility was reported in 0.2% and 46.1% of E. faecalis and E. faecium respectively. Overall 51.1% of E. faecium harboured vanA or vanB genes. For the vanA/B positive E. faecium isolates, 81.5% harboured vanB genes and 18.5% vanA genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is significantly higher than that seen in most European countries. E. faecium consisted of 113 pulsed-field gel electrophoresis pulsotypes of which 68.9% of isolates were classified into 14 major pulsotypes containing 5 or more isolates. Multilocus sequence typing grouped the 14 major pulsotypes into clonal cluster 17, a major hospital-adapted polyclonal E. faecium cluster. The geographical distribution of the 4 predominant sequence types (ST203, ST796, ST555 and ST17) varied with only ST203 identified across most regions of Australia. Overall 74.7% of isolates belonging to the four predominant STs harboured vanA or vanB genes. In conclusion, the AESOP 2014 has shown enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin resistant vanA or vanB E. faecium, which have limited treatment options.
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- 2016
41. An improved and safe cleaning methodology: Microfibre and steam for a neonatal service.
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Scott C., Tabbara L., Lovegrove A., Stuart R., Kotsanas D., Gillespie E., Scott C., Tabbara L., Lovegrove A., Stuart R., Kotsanas D., and Gillespie E.
- Abstract
Background: In 2013, an outbreak of van B vancomycin resistant enterococcus (VRE) involved the colonisation of 44 babies across the multisite neonatal service. Following that outbreak, we implemented a novel cleaning methodology that did not involve chemical use. However, consideration was required, for very premature babies, at risk of exposure to increased noise levels. Method(s): Over a 2 year period, microfibre-steam technology was implemented. During implementation, noise levels were monitored and VRE screening continued at 6 monthly intervals. Result(s): Noise levels did not exceed limits for babies in isolettes but those in open cots were at risk of exposure to levels above 50 decibels. In 2016 one baby was identified with van A VRE. No other babies became colonised with VRE. Conclusion(s): Application of ear muffs, for babies in open cots, reduced exposure to noise levels during steam cleaning. Cleaning without chemicals is a safe and effective cleaning option for vulnerable populations.
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- 2016
42. Clinical and microbiological characteristics of eggerthella lenta bacteremia.
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Tai A.Y., Kotsanas D., Francis M.J., Roberts S.A., Ballard S.A., Junckerstorff R.K., Kormana T.M., Gardiner B.J., Tai A.Y., Kotsanas D., Francis M.J., Roberts S.A., Ballard S.A., Junckerstorff R.K., Kormana T.M., and Gardiner B.J.
- Abstract
Eggerthella lenta is an emerging pathogen that has been underrecognized due to historical difficulties with phenotypic identification. Until now, its pathogenicity, antimicrobial susceptibility profile, and optimal treatment have been poorly characterized. In this article, we report the largest cohort of patients with E. lenta bacteremia to date and describe in detail their clinical features, microbiologic characteristics, treatment, and outcomes. We identified 33 patients; the median age was 68 years, and there was no gender predominance. Twenty-seven patients (82%) had serious intra-abdominal pathology, often requiring a medical procedure. Of those who received antibiotics (28/33, 85%), the median duration of treatment was 21.5 days. Mortality from all causes was 6% at 7 days, 12% at 30 days, and 33% at 1 year. Of 26 isolates available for further testing, all were identified as E. lenta by both commercially available matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) systems, and none were found to harbor a vanA or vanB gene. Of 23 isolates which underwent susceptibility testing, all were susceptible to amoxicillin-clavulanate, cefoxitin, metronidazole, piperacillin-tazobactam, ertapenem, and meropenem, 91% were susceptible to clindamycin, 74% were susceptible to moxifloxacin, and 39% were susceptible to penicillin.Copyright © 2015, American Society for Microbiology. All Rights Reserved.
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- 2015
43. Surveillance for antimicrobial resistance in Australian isolates of Clostridium difficile, 2013-14.
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Weldhagen G.F., Moore C.V., Paterson D.L., Prendergast L., Huber C.A., Robson J., Waring L., Wehrhahn M.C., Wilson R.M., Riley T.V., Knight D.R., Giglio S., Huntington P.G., Korman T.M., Kotsanas D., Weldhagen G.F., Moore C.V., Paterson D.L., Prendergast L., Huber C.A., Robson J., Waring L., Wehrhahn M.C., Wilson R.M., Riley T.V., Knight D.R., Giglio S., Huntington P.G., Korman T.M., and Kotsanas D.
- Abstract
Objectives: The objective of this study was to determine the activity of fidaxomicin and comparator antimicrobials against Clostridium difficile isolated from patients with C. difficile infection (CDI) in Australian hospitals and in the community. Method(s): One private and one public laboratory from five states in Australia submitted a total of 474 isolates/PCR-positive stool samples during three collection periods in August-September 2013 (n=175), February-March 2014 (n=134) and August-September 2014 (n=165). Isolate identification was confirmed by selective culture for C. difficile and a proportion of isolates from each state were characterized by PCR for toxin genes and PCR ribotyping. MICs of fidaxomicin and eight comparator antimicrobials were determined for all isolates using agar methodology. Result(s): Site collection yielded 440 isolates of C. difficile and PCR revealed a heterogeneous strain population comprising 37 different PCR ribotypes (RTs), 95% of whichwere positive for tcdA and tcdB (A+B+). The most common RTs were 014 (29.8%) and 002 (15.9%). Epidemic RT 027 was not identified; however, small numbers of virulent RTs 078 and 244 were found. Resistance to vancomycin, metronidazole and fidaxomicin was not detected and resistance to moxifloxacin was very low (3.4%). Fidaxomicin showed potent in vitro activity against all 440 isolates (MIC50/MIC90 0.03/0.12 mg/L) and was superior to metronidazole (MIC50/MIC90 0.25/0.5 mg/L) and vancomycin (MIC50/MIC90 1/2 mg/L). Conclusion(s): These data confirm the potent in vitro activity of fidaxomicin against C. difficile. Moreover, this study provides an important baseline for ongoing long-term surveillance of antimicrobial resistance and prospective tracking of prominent and emerging strain types.Copyright © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
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- 2015
44. Impact of early valve surgery on outcome of staphylococcus aureus prosthetic valve infective endocarditis: Analysis in the international collaboration of endocarditis-prospective cohort study.
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Vincelj J., Sexton D.J., Corey G.R., Chu V.H., Wang A., Erpelding M.-L., Durante-Mangoni E., Fernandez-Hidalgo N., Giannitsioti E., Hannan M.M., Lejko-Zupanc T., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Tornos P., De Alarcon A., Parra R., Alestig E., Johansson M., Olaison L., Snygg-Martin U., Pachirat O., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Crowley A.L., Douglas P., Drew L., Holland T., Lalani T., Mudrick D., Samad Z., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., Di Persio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Cabell C.H., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Bayer A.S., Karchmer A.W., Durack D.T., Eykyn S., Moreillon P., Chirouze C., Alla F., Fowler V.G., Miro J.M., Munoz P., Murdoch D.R., Tattevin P., Tribouilloy C., Hoen B., Clara L., Sanchez M., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Casabe J., Cortes C., Altclas J., Kogan S., Spelman D., Athan E., Harris O., Kennedy K., Tan R., Gordon D., Papanicolas L., Eisen D., Grigg L., Street A., Korman T., Kotsanas D., Dever R., Konecny P., Lawrence R., Rees D., Ryan S., Feneley M.P., Harkness J., Jones P., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., De Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., De Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., De Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Barsic B., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Freiberger T., Pol J., Zaloudikova B., Zainab A., El Kholy A., Mishaal M., Rizk H., Aissa N., Alauzet C., Campagnac C., Doco-Lecompte T., Selton-Suty C., Casalta J.-P., Fournier P.-E., Habib G., Raoult D., Thuny F., Delahaye F., Delahaye A., Vandenesch F., Donal E., Donnio P.Y., Michelet C., Revest M., Violette J., Chevalier F., Jeu A., Rusinaru D.M.D., Sorel C., Bernard Y., Leroy J., Plesiat P., Naber C., Neuerburg C., Mazaheri B., Athanasia S., Deliolanis I., Giamarellou H., Tsaganos T., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Sharma G., Francis J., Nair L., Thomas V., Venugopal K., Hurley J., Gilon D., Israel S., Korem M., Strahilevitz J., Casillo R., Cuccurullo S., Dialetto G., Irene M., Ragone E., Tripodi M.F., Utili R., Cecchi E., De Rosa F., Forno D., Imazio M., Trinchero R., Tebini A., Grossi P., Lattanzio M., Toniolo A., Goglio A., Raglio A., Ravasio V., Rizzi M., Suter F., Carosi G., Magri S., Signorini L., Baban T., Kanafani Z., Kanj S.S., Yasmine M., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., Van Der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Lum L.-N., Tan R.-S., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Del Rio A., Falces C., Garcia-De-La-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Moreno A., Ninot S., Vincelj J., Sexton D.J., Corey G.R., Chu V.H., Wang A., Erpelding M.-L., Durante-Mangoni E., Fernandez-Hidalgo N., Giannitsioti E., Hannan M.M., Lejko-Zupanc T., Pare C., Pericas J., Ramirez J., Rovira I., Sitges M., Anguera I., Font B., Guma J.R., Bermejo J., Bouza E., Fernandez M.A.G., Gonzalez-Ramallo V., Marin M., Pedromingo M., Roda J., Rodriguez-Creixems M., Solis J., Almirante B., Tornos P., De Alarcon A., Parra R., Alestig E., Johansson M., Olaison L., Snygg-Martin U., Pachirat O., Pachirat P., Pussadhamma B., Senthong V., Casey A., Elliott T., Lambert P., Watkin R., Eyton C., Klein J.L., Bradley S., Kauffman C., Bedimo R., Crowley A.L., Douglas P., Drew L., Holland T., Lalani T., Mudrick D., Samad Z., Stryjewski M., Woods C.W., Lerakis S., Cantey R., Steed L., Wray D., Dickerman S.A., Bonilla H., Di Persio J., Salstrom S.-J., Baddley J., Patel M., Peterson G., Stancoven A., Afonso L., Kulman T., Levine D., Rybak M., Cabell C.H., Baloch K., Dixon C.C., Harding T., Jones-Richmond M., Pappas P., Park L.P., Redick T., Stafford J., Anstrom K., Bayer A.S., Karchmer A.W., Durack D.T., Eykyn S., Moreillon P., Chirouze C., Alla F., Fowler V.G., Miro J.M., Munoz P., Murdoch D.R., Tattevin P., Tribouilloy C., Hoen B., Clara L., Sanchez M., Nacinovich F., Oses P.F., Ronderos R., Sucari A., Thierer J., Casabe J., Cortes C., Altclas J., Kogan S., Spelman D., Athan E., Harris O., Kennedy K., Tan R., Gordon D., Papanicolas L., Eisen D., Grigg L., Street A., Korman T., Kotsanas D., Dever R., Konecny P., Lawrence R., Rees D., Ryan S., Feneley M.P., Harkness J., Jones P., Post J., Reinbott P., Gattringer R., Wiesbauer F., Andrade A.R., De Brito A.C.P., Guimaraes A.C., Grinberg M., Mansur A.J., Siciliano R.F., Strabelli T.M.V., Vieira M.L.C., De Medeiros Tranchesi R.A., Paiva M.G., Fortes C.Q., De Oliveira Ramos A., Ferraiuoli G., Golebiovski W., Lamas C., Santos M., Weksler C., Karlowsky J.A., Keynan Y., Morris A.M., Rubinstein E., Jones S.B., Garcia P., Cereceda M., Fica A., Mella R.M., Barsic B., Bukovski S., Krajinovic V., Pangercic A., Rudez I., Freiberger T., Pol J., Zaloudikova B., Zainab A., El Kholy A., Mishaal M., Rizk H., Aissa N., Alauzet C., Campagnac C., Doco-Lecompte T., Selton-Suty C., Casalta J.-P., Fournier P.-E., Habib G., Raoult D., Thuny F., Delahaye F., Delahaye A., Vandenesch F., Donal E., Donnio P.Y., Michelet C., Revest M., Violette J., Chevalier F., Jeu A., Rusinaru D.M.D., Sorel C., Bernard Y., Leroy J., Plesiat P., Naber C., Neuerburg C., Mazaheri B., Athanasia S., Deliolanis I., Giamarellou H., Tsaganos T., Mylona E., Paniara O., Papanicolaou K., Pyros J., Skoutelis A., Sharma G., Francis J., Nair L., Thomas V., Venugopal K., Hurley J., Gilon D., Israel S., Korem M., Strahilevitz J., Casillo R., Cuccurullo S., Dialetto G., Irene M., Ragone E., Tripodi M.F., Utili R., Cecchi E., De Rosa F., Forno D., Imazio M., Trinchero R., Tebini A., Grossi P., Lattanzio M., Toniolo A., Goglio A., Raglio A., Ravasio V., Rizzi M., Suter F., Carosi G., Magri S., Signorini L., Baban T., Kanafani Z., Kanj S.S., Yasmine M., Abidin I., Tamin S.S., Martinez E.R., Nieto G.I.S., Van Der Meer J.T.M., Chambers S., Holland D., Morris A., Raymond N., Read K., Dragulescu S., Ionac A., Mornos C., Butkevich O.M., Chipigina N., Kirill O., Vadim K., Vinogradova T., Edathodu J., Halim M., Lum L.-N., Tan R.-S., Logar M., Mueller-Premru M., Commerford P., Commerford A., Deetlefs E., Hansa C., Ntsekhe M., Almela M., Armero Y., Azqueta M., Castaneda X., Cervera C., Del Rio A., Falces C., Garcia-De-La-Maria C., Fita G., Gatell J.M., Marco F., Mestres C.A., Moreno A., and Ninot S.
- Abstract
Background. The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. Methods. Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. Results. EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). Conclusions. In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.Copyright © The Author 2014.
- Published
- 2015
45. Should inflammatory markers inform the decision to perform a lumbar puncture in infants with suspected neonatal sepsis?.
- Author
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Tan K., Goldfinch C., Korman T., Kotsanas D., Burgner D., Tan K., Goldfinch C., Korman T., Kotsanas D., and Burgner D.
- Abstract
Background: Meningitis frequently complicates neonatal sepsis, but there is little consistency to when to perform a lumbar puncture (LP). We investigated whether inflammatory markers; C-reactive protein (CRP) and immature-to-total neutrophil ratio (ITR) were predictive of meningitis or significant CSF pleocytosis and could guide the decision to perform a LP. Method(s): We studied all level 3 NICU inpatients <6 months old with a LP performed between March 2011 and October 2014; categorised on the basis of CSF results as follows: 1) culture-confirmed meningitis, 2) possible meningitis (CSF culture negative plus CSF leukocyte criteria; (i) CSF WCC>100, (ii) WCC > 20 and <500 RBC, (iii) OE ratio > 10), and 3) no evidence of meningitis. CRP and ITR obtained within 48 hours of LP were retrieved. Area under ROC curves were used to determine the test performance of CRP and ITR in predicting meningitis. Result(s): 1193 CSF samples from 801 individual infants yielded 13 cases of culture positive meningitis, 89 possible meningitis, and 837 nonmeningitis. The area under ROC curve for confirmed and possible meningitis: CRP 0.44 (95% CI 0.38-0.51), ITR 0.57 (95% CI 0.51-0.63). At a CRP threshold of 30 mg/L, there was a positive likelihood ratio (LR) of 0.7, and a negative LR of 1.4. Conclusion(s): The test performances of CRP and ITR for differentiating confirmed and possible meningitis were poor, and therefore inflammatory markers should not inform the decision to perform a LP.
- Published
- 2015
46. Molecular characterization and antimicrobial susceptibilities of Clostridium difficile clinical isolates from Victoria, Australia.
- Author
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Elliott B., Korman T.M., Riley T.V., Rood J.I., Jenkin G.A., Lyras D., Carter G.P., Howden B.P., Kotsanas D., Mackin K.E., Elliott B., Korman T.M., Riley T.V., Rood J.I., Jenkin G.A., Lyras D., Carter G.P., Howden B.P., Kotsanas D., and Mackin K.E.
- Abstract
Some Australian strain types of Clostridium difficile appear unique, highlighting the global diversity of this bacterium. We examined recent and historic local isolates, finding predominantly toxinotype 0 strains, but also toxinotypes V and VIII. All isolates tested were susceptible to vancomycin and metronidazole, while moxifloxacin resistance was only detected in recent strains.Copyright © 2015 Elsevier Ltd.
- Published
- 2015
47. Are identity badges and lanyards in pediatrics potentially contaminated with viral pathogens?.
- Author
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Buttery J.P., Bogdanovic-Sakran N., Stuart R.L., Ting C.Y., Cheng D.R., Kotsanas D., Kirkwood C.D., Buttery J.P., Bogdanovic-Sakran N., Stuart R.L., Ting C.Y., Cheng D.R., Kotsanas D., and Kirkwood C.D.
- Abstract
Identity (ID) badges and lanyards worn by pediatric health care workers (HCWs) have been shown to be potential vectors of nosocomial bacterial infections. This cross-sectional study determined the contamination of ID badges and lanyards worn by pediatric HCWs with common respiratory and gastrointestinal viruses. The results showed that ID badges and lanyards are not significantly contaminated with common respiratory or gastrointestinal viruses and are unlikely to be a significant vector for nosocomial infection.Copyright © 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
- Published
- 2015
48. Outbreak of vanB vancomycin-resistant Enterococcus faecium colonization in a neonatal service.
- Author
-
Lister D.M., Gillespie E.E., Scott C., Tan K., Carse E., Howden B.P., Ballard S.A., Kotsanas D., Stuart R.L., Johnson P.D.R., Korman T.M., Doherty R., Mahony A.A., Lister D.M., Gillespie E.E., Scott C., Tan K., Carse E., Howden B.P., Ballard S.A., Kotsanas D., Stuart R.L., Johnson P.D.R., Korman T.M., Doherty R., and Mahony A.A.
- Abstract
Objective To describe successful termination of an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) colonization within a neonatal service. Setting Multisite neonatal intensive care unit and special care nurseries within a single health care service. Participants Forty-four cases of VREfm-colonized neonatal inpatients-including 2 clinical isolates (eye swab and catheter-urine specimen) and 42 screening isolates. Interventions Active surveillance cultures, patient isolation, contact precautions, enhanced environment cleaning, and staff and parent education. Whole genome sequencing and multilocus sequence typing were used to characterize the outbreak and refine infection control procedures. Results Peak prevalence of VREfm colonization across all sites was 31% upon discovery of the outbreak. Subsequent to the intervention, transmission was halted within 8 weeks and no further isolates of the outbreak strain have been detected as of 12 months following outbreak cessation. Environmental swabs revealed VREfm colonization of baby-weighing scales, a baby bath, and a pharmacy refrigerator within the neonatal intensive care unit. All isolates were of a single multilocus sequence type (sequence type 796) and highly clonal at the core genome level. Conclusions Bundled infection control interventions were effective in rapidly terminating a clonal outbreak of sequence type 796 VREfm colonization within a neonatal inpatient service. Strain-typing and active surveillance cultures were critical in guiding the management of this outbreak. The closed environment of a neonatal unit likely facilitated eradication of the patient and environment reservoirs of VREfm colonization.Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
- Published
- 2015
49. Using microfiber and steam technology to improve cleaning outcomes in an intensive care unit.
- Author
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Kotsanas D., Williams N., Stuart R.L., Sloane T., Wright L., Gillespie E., Kotsanas D., Williams N., Stuart R.L., Sloane T., Wright L., and Gillespie E.
- Abstract
The use of microfiber and steam technology may be seen as a novel cleaning method that can improve the outcome of cleaning. We describe its use in an intensive care setting, its impact on vancomycin-resistant enterococci acquisition, and the importance of ensuring adequate education of cleaning staff. Such new methods can have a significant impact on the transmission of multidrug-resistant organisms, provided systems are in place to ensure that the methodology is adhered to and that cleaning hours are adequate.Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc.
- Published
- 2015
50. Health care workers use disposable microfiber cloths for cleaning clinical equipment.
- Author
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Lovegrove A., Kotsanas D., Gillespie E., Lovegrove A., Kotsanas D., and Gillespie E.
- Published
- 2015
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