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Lenglet A, Contigiani O, Ariti C, Evens E, Charles K, Casimir CF, Delva RS, Badjo C, Roggeveen H, Pawulska B, Clezy K, McRae M, Wertheim H, Hopman J. Correction: Early warning for healthcare acquired infections in neonatal care units in a low-resource setting using routinely collected hospital data: The experience from Haiti, 2014-2018. PLoS One 2024; 19:e0298987. [PMID: 38346067 PMCID: PMC10861029 DOI: 10.1371/journal.pone.0298987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0269385.].
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2
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Jain S, Dempsey K, Clezy K, Bradd P. Evaluation of health worker acceptance and tolerance of respirators in clinical practice-An Australian perspective. Am J Infect Control 2024; 52:46-53. [PMID: 37454930 DOI: 10.1016/j.ajic.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND One of the main infection prevention and control measures introduced during the COVID-19 pandemic was the focused application of respiratory protection to ensure health worker safety and the effective use of personal protective equipment. However, user acceptance of these strategies is paramount in sustainable compliance. This study explores various aspects of respirator use and provides recommendations to improve and maximize health worker safety. The aim of this study was to understand the relationship between respirator (P2/N95) comfort and user experience toward respiratory protection. The aim of this study was to understand the relationship between respirator (P2/N95) comfort and user experience toward respiratory protection. METHODS The nonexperimental cross-sectional design study was conducted in New South Wales, Australia between November and December 2022 using an anonymous self-administered online questionnaire in Microsoft Forms. RESULTS Of 2,514 respondents, 65% reported to have used a respirator every working day with only a few using a respirator once weekly or less (9%). Almost all respondents had completed at least one quantitative fit test (96%) prior to the survey. Fifty-nine percent reported to have experienced discomfort from wearing a respirator and the most reported adverse effect was difficulty communicating (64%), followed by skin irritation or acne (62%) and headache (56%). CONCLUSIONS Despite somewhat less favorable ratings on comfort and communication, health workers are in favor of respiratory protection. However, a focus on tolerance of respirators and strategies to address adverse effects from prolonged respirator use must be considered when implementing policies and procedures. Moreover, resources must be allocated to improve the design, breathability, and sustainability of a respirator along with education and training on how to use respiratory protection safely and effectively.
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Affiliation(s)
- Susan Jain
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia.
| | - Kathy Dempsey
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Kate Clezy
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Patricia Bradd
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
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3
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Truppa C, Alonso B, Clezy K, Deglise C, Dromer C, Garelli S, Jimenez C, Kanapathipillai R, Khalife M, Repetto E. Antimicrobial stewardship in primary health care programs in humanitarian settings: the time to act is now. Antimicrob Resist Infect Control 2023; 12:89. [PMID: 37667372 PMCID: PMC10476422 DOI: 10.1186/s13756-023-01301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
Fragile and conflict-affected settings bear a disproportionate burden of antimicrobial resistance, due to the compounding effects of weak health policies, disrupted medical supply chains, and lack of knowledge and awareness about antibiotic stewardship both among health care providers and health service users. Until now, humanitarian organizations intervening in these contexts have confronted the threat of complex multidrug resistant infections mainly in their surgical projects at the secondary and tertiary levels of care, but there has been limited focus on ensuring the implementation of adequate antimicrobial stewardship in primary health care, which is known to be setting where the highest proportion of antibiotics are prescribed. In this paper, we present the experience of two humanitarian organizations, Médecins sans Frontières and the International Committee of the Red Cross, in responding to antimicrobial resistance in their medical interventions, and we draw from their experience to formulate practical recommendations to include antimicrobial stewardship among the standards of primary health care service delivery in conflict settings. We believe that expanding the focus of humanitarian interventions in unstable and fragile contexts to include antimicrobial stewardship in primary care will strengthen the global response to antimicrobial resistance and will decrease its burden where it is posing the highest toll in terms of mortality.
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Affiliation(s)
- Claudia Truppa
- International Committee of the Red Cross, Geneva, Switzerland.
- CRIMEDIM Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, University of Eastern Piedmont, Novara, Italy.
| | | | - Kate Clezy
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | - Carole Dromer
- International Committee of the Red Cross, Geneva, Switzerland
| | - Silvia Garelli
- International Committee of the Red Cross, Geneva, Switzerland
| | | | | | | | - Ernestina Repetto
- Médecins Sans Frontières, Geneva, Switzerland
- Service des Maladies Infectieuses, Clinique Hospitalière Universitaire Saint Pierre, Bruxelles, Belgium
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Olubiyo R, Chukwumeze F, Lawal AM, Oloruntuyi G, Musoka H, Augustine NA, Abdullahi I, Shehu I, Egwuenu A, Clezy K, Oluyide B, Gomez D, Sherlock M, Lenglet A, Repetto E. Retrospective analysis of fungemia among children in Anka General Hospital, Nigeria, from October 2018 to November 2021: a case series. Oxf Med Case Reports 2023; 2023:omad071. [PMID: 37484557 PMCID: PMC10359058 DOI: 10.1093/omcr/omad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/12/2023] [Accepted: 05/21/2023] [Indexed: 07/25/2023] Open
Abstract
Yeast-related bloodstream infections (BSIs) in pediatric patients are associated with severe acute malnutrition (SAM), hematological/oncological malignancies and admission to an intensive care unit. These infections are rarely described from low- and middle-income countries. We describe a case series of pediatric patients diagnosed with severe sepsis and yeast isolated from their blood culture in a conflict-affected area of Nigeria from October 2018 to November 2021. We identified 20 patients with yeast BSIs, among whom 17 were also diagnosed with SAM. We recommend the inclusion of antifungal treatment for empiric treatment guidelines for children with SAM and severe sepsis in similar settings.
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Affiliation(s)
- Ruth Olubiyo
- Correspondence address. No. 11 First Avenue Gwarinpa, Abuja, Nigeria. Tel: +234-8067-6983-97; E-mail:
| | | | | | | | - Honore Musoka
- Medical Department, Médecins Sans Frontières, Anka, Zamfara, Nigeria
| | | | | | - Ismail Shehu
- Microbiology Unit, Noma Children Hospital, Sokoto, Sokoto, Nigeria
| | - Abiodun Egwuenu
- Nigerian Center for Disease Control (NCDC), FCT Abuja, Nigeria
| | - Kate Clezy
- Public Health Department, Médecins Sans Frontières, Operational Centre Amsterdam, The Netherlands
| | - Bukola Oluyide
- Medical Department, Médecins Sans Frontières, Abuja, Nigeria
| | - Diana Gomez
- Public Health Department, Médecins Sans Frontières, Operational Centre Amsterdam, The Netherlands
| | - Mark Sherlock
- Public Health Department, Médecins Sans Frontières, Operational Centre Amsterdam, The Netherlands
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Dempsey K, Jain S, Clezy K, Bradd P. Implementation of a successful infection prevention and control governance structure and capacity building strategies during COVID-19 pandemic - A brief report. Am J Infect Control 2023; 51:238-240. [PMID: 35839961 PMCID: PMC9273515 DOI: 10.1016/j.ajic.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 01/25/2023]
Abstract
An analysis of the Clinical Excellence Commissions response to COVID-19 prevention and protection measures identified the need to build on the existing governance process to achieve a more structured and methodical approach. The infection prevention and control measures and strategies implemented within health and nonhealth care, proved to be effective and sustainable with the ability to build additional clinician capacity even during an ongoing pandemic.
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Affiliation(s)
- Kathy Dempsey
- (Infection Control & Hospital Epidemiology). CICP-E; NSW ICP Infection Prevention and Control Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Susan Jain
- Infection Prevention and Control Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia,Address correspondence to Susan Jain, Infection Prevention and Control Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, NSW, Australia
| | - Kate Clezy
- Infection Prevention and Control Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Patricia Bradd
- Patient Safety Directorate, Clinical Excellence Commission, Sydney, New South Wales, Australia
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Seale H, Carlson SJ, Maley M, Clezy K, Torda A, Konecny P. Lifting the curtains of silence: Patient perceptions towards needs and responsibilities in contributing to the prevention of healthcare-associated infections and antimicrobial resistance. Am J Infect Control 2022:S0196-6553(22)00814-8. [PMID: 36442687 DOI: 10.1016/j.ajic.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Beyond the use of policy and system-focused approaches, it has been established globally that patients can play a role in enhancing the health care landscape. However, efforts to meaningfully translate patient engagement strategies that promote participation by hospitalized patients in relevant infection prevention and antimicrobial stewardship activities have not yet been realized. This study mapped the key factors acting as barriers and facilitators of patient engagement using a theoretical framework to identify potential new approaches to promote engagement. METHODS Semistructured interviews were conducted with 36 patients from 3 major hospitals in Sydney, Australia, in 2019. Transcripts were inductively analyzed, with the resulting themes categorized into the components of the Capability-Opportunity-Motivation-Behavior model. RESULTS The themes regarding barriers to patient engagement with relevant infection prevention and antimicrobial stewardship activities were: (1) Capability: misunderstanding and knowledge gaps about antimicrobial resistance; (2) Opportunity: strong family/patient support networks and good relationships with nursing staff provide an opportunity to support engagement; (3) Motivation: those who have some level of understanding or experience see the benefit and are most likely to engage actively. CONCLUSIONS Assuming patients are inclined to participate in efforts, a logical starting point would be to build awareness amongst patients and providers; however, education will not suffice. There needs to be a system and policy shift to ensure that patient engagement is recognized as a worthy endeavor.
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Affiliation(s)
- Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Samantha J Carlson
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; School of Social Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Maley
- Department of Microbiology and Infectious Diseases, New South Wales Health Pathology, Liverpool, New South Wales, Australia
| | - Kate Clezy
- Department of Infectious Diseases, Clinical Excellence Commission, NSW Health, Prince of Wales Hospital, Sydney New South Wales, Australia
| | - Adrienne Torda
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Pamela Konecny
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Kogarah, New South Wales, Australia
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Curtis SJ, Trewin A, McDermott K, Were K, Clezy K, Dempsey K, Walsh N. Electronic monitoring of doffing using video surveillance to minimise error rate and increase safety at Howard Springs International Quarantine Facility. Antimicrob Resist Infect Control 2022; 11:120. [PMID: 36175981 PMCID: PMC9522442 DOI: 10.1186/s13756-022-01155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Safe donning and doffing of personal protective equipment (PPE) are critical to prevent transmission of infectious diseases. Novel strategies to improve infection prevention and control (IPC) adherence can optimise safety. We describe and quantify video surveillance of doffing at an outdoor hotel quarantine facility led by the Australian Medical Assistance Team in the Northern Territory, Australia.
Methods
Motion-activated video cameras were installed in seven areas where personnel doffed PPE upon exit from an area dedicated to quarantined residents. Video footage was reviewed daily and compliance issues were identified using a standardised checklist and risk graded to initiate feedback. We collated audit data from 1 February to 18 April 2021 to describe trends by month, staff group, doffing component and risk.
Results
In 235 h of video footage, 364 compliance issues were identified, of which none were considered high-risk compromising to PPE integrity. Compliance issues were low risk (55/364, 15%) or moderate risk (309/364, 85%) and the most common issue was missed or inadequate hand hygiene (156/364, 43%). Compliance issues per minute of video footage reviewed decreased following introduction of the activity, from 24 per 1000 in February to 7 per 1000 in March and April.
Conclusion
Video surveillance with feedback supported rapid response to improve IPC adherence in a challenging ambient environment. The activity focused on perfection to identify compliance issues that would go unreported in most healthcare settings and contributed to a suit of activities that prevented any high-risk PPE breaches or compromises to safety.
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Lenglet A, Contigiani O, Ariti C, Evens E, Charles K, Casimir CF, Senat Delva R, Badjo C, Roggeveen H, Pawulska B, Clezy K, McRae M, Wertheim H, Hopman J. Early warning for healthcare acquired infections in neonatal care units in a low-resource setting using routinely collected hospital data: The experience from Haiti, 2014-2018. PLoS One 2022; 17:e0269385. [PMID: 35737713 PMCID: PMC9223318 DOI: 10.1371/journal.pone.0269385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
In low-resource settings, detection of healthcare-acquired outbreaks in neonatal units relies on astute clinical staff to observe unusual morbidity or mortality from sepsis as microbiological diagnostics are often absent. We aimed to generate reliable (and automated) early warnings for potential clusters of neonatal late onset sepsis using retrospective data that could signal the start of an outbreak in an NCU in Port au Prince, Haiti, using routinely collected data on neonatal admissions. We constructed smoothed time series for late onset sepsis cases, late onset sepsis rates, neonatal care unit (NCU) mortality, maternal admissions, neonatal admissions and neonatal antibiotic consumption. An outbreak was defined as a statistical increase in any of these time series indicators. We created three outbreak alarm classes: 1) thresholds: weeks in which the late onset sepsis cases exceeded four, the late onset sepsis rates exceeded 10% of total NCU admissions and the NCU mortality exceeded 15%; 2) differential: late onset sepsis rates and NCU mortality were double the previous week; and 3) aberration: using the improved Farrington model for late onset sepsis rates and NCU mortality. We validated pairs of alarms by calculating the sensitivity and specificity of the weeks in which each alarm was launched and comparing each alarm to the weeks in which a single GNB positive blood culture was reported from a neonate. The threshold and aberration alarms were the strongest predictors for current and future NCU mortality and current LOS rates (p<0.0002). The aberration alarms were also those with the highest sensitivity, specificity, negative predictive value, and positive predictive value. Without microbiological diagnostics in NCUs in low-resource settings, applying these simple algorithms to routinely collected data show great potential to facilitate early warning for possible healthcare-acquired outbreaks of LOS in neonates. The methods used in this study require validation across other low-resource settings.
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Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Department of Medical Microbiology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Omar Contigiani
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Leiden Observatory, Leiden University, Leiden, The Netherlands
- Lorentz Institute for Theoretical Physics, Leiden University, Leiden, The Netherlands
| | - Cono Ariti
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | | | | | | | | | | | | | - Kate Clezy
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Melissa McRae
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Joost Hopman
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Department of Medical Microbiology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
- Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands
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Jain S, Dempsey K, Clezy K. Implementation of a Respiratory Protection Program within Healthcare Facilities during the COVID-19 Pandemic- Lessons Learned. Am J Infect Control 2022; 50:1067-1069. [PMID: 35688230 PMCID: PMC9173819 DOI: 10.1016/j.ajic.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/19/2022]
Abstract
The use of fit tested respirators in the workplace is required to protect health workers against airborne pathogens. The COVID-19 pandemic required rapid upscaling of fit testing which was achieved using the framework of a respiratory protection program. Implementing and sustaining such a program in the midst of a pandemic was challenging and required clear direction from a lead agency combined with stakeholder engagement.
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Affiliation(s)
- Susan Jain
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia.
| | - Kathy Dempsey
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Kate Clezy
- Healthcare Associated Infection Program, Clinical Excellence Commission, Sydney, New South Wales, Australia
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Bhatia DD, Bhatia KS, Saluja T, Saluja AP, Thind A, Bamra A, Singh G, Singh N, Clezy K, Dempsey K, Hudson B, Jain S. Under-mask beard covers achieve an adequate seal with tight-fitting disposable respirators using quantitative fit testing. J Hosp Infect 2022; 128:8-12. [PMID: 35662553 DOI: 10.1016/j.jhin.2022.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tight-fitting respirators are a critical component of respiratory protection against airborne diseases for health workers. However, they are not recommended for health workers with facial hair. Some health workers are unable to shave for religious or medical reasons. Under-mask beard covers have been proposed as a solution to allow health workers with facial hair to wear tight-fitting respirators. However, studies to date have been limited by their predominant reliance on qualitative rather than quantitative fit testing techniques. AIM To assess the efficacy of under-mask beard covers in achieving an adequate seal with tight-fitting disposable P2/N95 respirators using quantitative fit testing. METHODS Bearded adult males underwent quantitative fit testing with an under-mask beard cover using either a TSI PortaCount Respirator Fit Tester 8038™ or AccuFit 9000 PRO™ fit testing device on up to five disposable P2/N95 respirators (3M 1860, 3M 1870+, BYD N95 Helathcare Particulate Respirator, BSN Medical ProShield N-95 Medium and Trident RTCFFP2). The primary outcome was the proportion of subjects that passed or failed quantitative fit testing with an under-mask beard cover. FINDINGS Thirty subjects were assessed, 24 (80%) passed quantitative fit testing with at least one tight-fitting P2/N95 disposable respirator. Among these subjects the median (IQR) best achieved fit factor was 200 (178-200). No subject had an adverse reaction to the under-mask beard cover. CONCLUSION The under-mask beard cover technique may be used to achieve a satisfactory seal with tight-fitting P2/N95 respirators in health workers with facial hair that cannot shave.
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Goldberg J, Clezy K, Jasovský D, Uyen-Cateriano A. Leaving no one behind: the need for a truly global response to antimicrobial resistance. The Lancet Microbe 2022; 3:e2-e3. [DOI: 10.1016/s2666-5247(21)00303-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
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12
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Gulholm T, Overton K, Clezy K, Torda A, Post JJ. Prevalence of antibiotic allergy labels and their consequences in people presenting to a teaching hospital Emergency Department; a retrospective chart review. Asian Pac J Allergy Immunol 2021; 39:124-128. [PMID: 31175715 DOI: 10.12932/ap-111217-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Antibiotic allergy labels have a direct impact on individual patient care and on the consumption of broad-spectrum antibiotics. OBJECTIVE Our aim was to establish the prevalence of antibiotic allergies and to determine whether patients with documented antibiotic allergy labels received guideline concordant antimicrobial therapy. Additionally we wanted to evaluate the quality of allergy documentation in the medical record. METHODS Prospective audit of all patients presenting to the Emergency Department of an adult teaching hospital in Sydney over a 4 month period. Documented allergy labels, diagnoses, antibiotic administration and outcomes were recorded. Appropriateness of antibiotic choice was based on the Australian National Antimicrobial Prescribing Survey. RESULTS 9.9% of presentations had at least one antibiotic allergy recorded. Significantly more women than men had antibiotic allergies documented. One third of patients with documented antibiotic allergies were prescibed inappropriate antibiotic therapy and some had significant adverse events. CONCLUSIONS The documentation of antibiotic allergy labels and choice of antibiotic treatment can be significantly improved. Strategies to safely de-label people with documented allergies who are not truly allergic need to be implemented.
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Affiliation(s)
- Trine Gulholm
- Department of Microbiology, NSW Health Pathology, Randwick, Australia.,Infectious Diseases Department, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Kristen Overton
- Department of Microbiology, NSW Health Pathology, Randwick, Australia.,Infectious Diseases Department, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Kate Clezy
- Infectious Diseases Department, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Adrienne Torda
- Infectious Diseases Department, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Jeffrey John Post
- Infectious Diseases Department, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Browne K, Wood D, Clezy K, Lehm J, Walsh WR. Reduction of bacterial load with the addition of ultraviolet-C disinfection inside the hyperbaric chamber. Diving Hyperb Med 2020; 50:332-337. [PMID: 33325012 DOI: 10.28920/dhm50.4.332-337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/09/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Healthcare acquired infections (HAIs) are associated with increased mortality, morbidity and prolonged hospital stays. Microbiological contamination of the hospital environment directly contributes to HAIs. Optimising environmental cleaning reduces transmission of HAIs. The hyperbaric chamber poses a specific challenge for infection control as certain disinfectants and alcohol-based hand sanitisers are prohibited due to fire risk. Patients often possess multiple risk factors for HAIs. This study compared the bacteria remaining on a surface (bioburden) after a standard clean and after adjunctive disinfection with an ultraviolet-C (UV-C) robot. METHODS Internal hyperbaric chamber surfaces were first manually cleaned with Clinell® universal wipes and the floor was mopped with Whiteley neutral detergent. Allocated surfaces were swabbed using sterile cotton swabs and processed using a standard microbial culture and a bacteria-specific rapid metabolic assay. Bacterial contamination was also measured by direct contact plating on flat surfaces. The plexiglass ports were covered to protect from potential UV-C mediated damage and used as a negative control. A UV-C disinfection robot was then used to disinfect the chamber for 30 min, whereafter surfaces were swabbed again. RESULTS There was a significantly greater mean reduction in bioburden following adjunctive UV-C disinfection than with standard cleaning alone. The surfaces not routinely manually cleaned (e.g., bench, phone) showed greatest reduction in bacterial load following UV-C cleaning. CONCLUSIONS There was a significant reduction in the bacterial load in the chamber following an adjunctive UV-C clean compared with that of a standard clean. Adjunctive cleaning of the hyperbaric chamber environment with a non-touch UV-C device shows promise as a method to reduce HAIs.
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Affiliation(s)
- Katrina Browne
- Surgical and Orthopaedic Research Laboratory, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
| | - Danielle Wood
- Hyperbaric Medicine Unit, Prince of Wales Hospital, Sydney, Australia.,Corresponding author: Dr Danielle Wood, Hyperbaric Medicine Unit, Prince of Wales Hospital, Nurses Dr, Randwick, NSW 2031, Australia,
| | - Kate Clezy
- Infectious Diseases Department, Prince of Wales Hospital, Sydney Australia
| | - Jan Lehm
- Hyperbaric Medicine Unit, Prince of Wales Hospital, Sydney, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratory, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
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14
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Lenglet A, Schuurmans J, Ariti C, Borgundvaag E, Charles K, Badjo C, Clezy K, Evens E, Senat-Delva R, Berthet M, Lekkerkerker M, McRae M, Wertheim H, Hopman J. Rectal screening displays high negative predictive value for bloodstream infection with (ESBL-producing) Gram-negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit. J Glob Antimicrob Resist 2020; 23:102-107. [PMID: 32890840 DOI: 10.1016/j.jgar.2020.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti. METHODS We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis. RESULTS We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4-28.0%] and 20.6% (95% CI 16.0-26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%. CONCLUSIONS The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.
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Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands; Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands.
| | | | - Cono Ariti
- Centre for Medical Education, Cardiff University School of Medicine, Cardiff, UK
| | | | | | | | - Kate Clezy
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | | | | | | | - Melissa McRae
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Heiman Wertheim
- Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Joost Hopman
- Médecins Sans Frontières, Amsterdam, The Netherlands; Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands
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15
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Menon V, Chubaty A, Clezy K, Su Y, Post JJ, Janssen A, Shaw T, Konecny P. Infectious diseases and antimicrobial prescribing: Online spaced education for junior doctors. J Glob Antimicrob Resist 2020; 22:226-230. [PMID: 32087310 DOI: 10.1016/j.jgar.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/01/2020] [Accepted: 02/10/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Inappropriate antimicrobial prescribing may harm patients and drive antimicrobial resistance. Junior doctors' knowledge of infectious diseases and antimicrobial prescribing is inadequate. Online spaced case-based learning can improve knowledge. OBJECTIVE To develop infectious diseases and antimicrobial prescribing course content for online spaced education and assess its effectiveness and feasibility for junior doctors. METHODS Infectious diseases and antimicrobial course content was developed for an online spaced education platform (Qstream Inc., Burlington, MA). Junior doctors (postgraduate years 1-3) at two tertiary teaching hospitals in Sydney participated in the study. Course content was provided with Qstream at one hospital and at the other hospital via two face-to-face (FTF) tutorials from August to October 2017. Knowledge and self-confidence were compared before and after training within and between both cohorts. RESULTS Participation in the course was higher in the Qstream cohort with 48/127 (37.8%) completing the course compared with 44/110 (40%) attending one or both FTF sessions, of whom 22/110 (20%) attended both. Improvement in mean knowledge score from 69.7% to 81.5% in the Qstream cohort was significantly greater than the FTF cohort's minimal improvement from 67.6% to 67.9% (95% CI 2.79-20.33; P=0.01). In the Qstream cohort mean confidence rating (0-10) improvement from 5.14 to 6.55 was greater than the FTF group improvement from 5.37 to 5.85 (95% CI 0.132-1.171; P=0.02). Qstream feedback was very positive. CONCLUSIONS Online spaced education in infectious diseases and antimicrobial prescribing was feasible, acceptable and effective for junior doctors. It has potential to reduce inappropriate antimicrobial prescribing and warrants further investigation.
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Affiliation(s)
- V Menon
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - A Chubaty
- Pharmacy Department, Prince of Wales Hospital, Sydney, Australia
| | - K Clezy
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Y Su
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
| | - J J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - A Janssen
- Research in Implementation Science and eHealth Group, The University of Sydney, Sydney, Australia
| | - T Shaw
- Research in Implementation Science and eHealth Group, The University of Sydney, Sydney, Australia
| | - P Konecny
- Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Sydney, Australia; St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia.
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16
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Wabe N, Li L, Dahm MR, Lindeman R, Yimsung R, Clezy K, Thomas J, Varndell W, Westbrook J, Georgiou A. Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes: a retrospective observational study across six Australian hospitals. BMJ Open 2019; 9:e030104. [PMID: 31399462 PMCID: PMC6701571 DOI: 10.1136/bmjopen-2019-030104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE A rapid molecular diagnostic test (RMDT) offers a fast and accurate detection of respiratory viruses, but its impact on the timeliness of care in the emergency department (ED) may depend on the timing of the test. The aim of the study was to determine if the timing of respiratory virus testing using a RMDT in the ED had an association with patient care outcomes. DESIGN Retrospective observational study. SETTING Linked ED and laboratory data from six EDs in New South Wales, Australia. PARTICIPANTS Adult patients presenting to EDs during the 2017 influenza season and tested for respiratory viruses using a RMDT. The timing of respiratory virus testing was defined as the time from a patient's ED arrival to time of sample receipt at the hospital laboratory. OUTCOME MEASURES ED length of stay (LOS), >4 hour ED LOS and having a pending RMDT result at ED disposition. RESULTS A total of 2168 patients were included. The median timing of respiratory virus testing was 224 min (IQR, 133-349). Every 30 min increase in the timing of respiratory virus testing was associated with a 24.0 min increase in the median ED LOS (95% CI, 21.8-26.1; p<0.001), a 51% increase in the likelihood of staying >4 hours in ED (OR, 1.51; 95% CI, 1.41 to 1.63; p<0.001) and a 4% increase in the likelihood of having a pending RMDT result at ED disposition (OR, 1.04; 95% CI, 1.02 to 1.05; p<0.001) after adjustment for confounders. CONCLUSION The timing of respiratory virus molecular testing in EDs was significantly associated with a range of outcome indicators. Results suggest the potential to maximise the benefits of RMDT by introducing an early diagnostic protocol such as triage-initiated testing.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Robert Lindeman
- Clinical Operations, NSW Health Pathology, Chatswood, New South Wales, Australia
| | - Ruth Yimsung
- Clinical Operations, NSW Health Pathology, Chatswood, New South Wales, Australia
| | - Kate Clezy
- Infectious Diseases Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Wayne Varndell
- Emergency Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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17
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Jain S, Clezy K, McLaws ML. Modified glove use for contact precautions: Health care workers' perceptions and acceptance. Am J Infect Control 2019; 47:938-944. [PMID: 30850247 DOI: 10.1016/j.ajic.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients colonized or infected with methicillin-resistant Staphylococcus aureus and or vancomycin-resistant Enterococcus are placed under contact precautions. Contact precautions require patients to be placed in single rooms and their health care workers (HCWs) to wear gowns, aprons and gloves on entry and doffing on exit. Glove use is widely accepted to be associated with poor hand hygiene compliance. We trailed the removal of gloves for contact precautions for contacts not expected to involve body fluids to improve hand hygiene between multiple contacts of the patient and patient zone. METHODS We have conducted a 5 phase study of the removal of gloves for contacts without body fluids in 250 HCWs using pretrial focus groups (N = 12), hand microbiology (N = 40) (reported elsewhere), development of a modified contact precautions poster, trial of modified poster (n = 100), posttrial focus group discussion (n = 22), and a survey of HCWs postrollout in additional locations (n = 76). RESULTS Pretrial focus groups identified 4 themes, and the leading theme identified as the facilitator for glove use as self-protection. HCWs viewed current contact precaution guidelines as preventing them from making their own judgement regarding the need for gloving for patient contacts, leading continuous glove use without changing gloves between multiple contacts. Participants believed that the trial empowered them to make their own clinical judgment for gloves and to consciously use hand hygiene between dry (no body fluid) contacts. Four themes were discussed during the posttrial focus groups and although self-protection remained the central theme, hand hygiene replaced glove use. Participants spoke of an appreciation of and increased trust in hand hygiene during nonglove use for dry contacts. The survey responses from additional sites were mostly positive for the safety of nonglove use for dry contacts, it improved hand hygiene and that the adoption of the modified guidelines was empowering. CONCLUSIONS The trial of nonglove use for expected dry contact, while caring for patients under contact precautions for methicillin-resistant S aureus and or vancomycin-resistant Enterococcus, was successful in refocusing HCWs reliance on hand hygiene for self-protection. Mandatory glove use for contact precautions was believed to contribute to their failure to change gloves between procedures on the same patient and patient zone, with HCWs now recognizing multiple contacts with the same gloves as a risk for contamination.
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Affiliation(s)
- Susan Jain
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia; Infection Prevention and Control, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Kate Clezy
- Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
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18
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Overton K, Mennon V, Mothobi N, Neild B, Martinez E, Masters J, Grant P, Akhunji Z, Su WY, Torda A, Whyte CM, Lloyd A, Weatherall C, Hofmeyr A, Foo H, Brookes K, Marriott D, Sintchenko V, Clezy K, Konecny P, Post JJ. Cluster of invasive Mycobacteria chimaera infections following cardiac surgery demonstrating novel clinical features and risks of aortic valve replacement. Intern Med J 2019; 48:1514-1520. [PMID: 30517986 DOI: 10.1111/imj.14093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/18/2018] [Accepted: 04/22/2018] [Indexed: 12/01/2022]
Abstract
There is a global outbreak of infections due to Mycobacterium chimaera associated with cardiac surgery. The most serious infections involve prosthetic material implantation, and all have followed surgical procedures involving cardiopulmonary bypass. We describe a cluster of four cases following cardiac surgery at a tertiary referral centre in Sydney, Australia. We report novel clinical findings, including haemolysis and kidney rupture possibly related to immune reconstitution inflammatory syndrome. The positive effect of corticosteroids on haemodynamic function in two cases and the failure of currently recommended antimicrobial therapy to sterilise prosthetic valve material in the absence of surgery despite months of treatment are also critically examined. Positron emission tomography was positive in two cases despite normal transoesophageal echocardiograms. The proportion of cases with M. chimaera infection after aortic valve replacement (4/890, 0.45%; 95% confidence interval 0.18-1.15%) was significantly higher than after all other cardiothoracic surgical procedures (0/2433, 0%; 95% confidence interval 0-0.16%).
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Affiliation(s)
- Kristen Overton
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Vidthyia Mennon
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Nomvuyo Mothobi
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Blake Neild
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Kogarah, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Elena Martinez
- Centre for Infectious Diseases and Microbiology, Public Health, Westmead Hospital, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia.,NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Jeffrey Masters
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Peter Grant
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Zakir Akhunji
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Wei-Yuen Su
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Adrienne Torda
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Claudia M Whyte
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Lloyd
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Chris Weatherall
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Kogarah, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Ann Hofmeyr
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Hong Foo
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Kim Brookes
- Clinical Governance Unit, South Eastern Sydney Local Health District, The Sutherland Hospital, Caringbah, New South Wales, Australia
| | - Debbie Marriott
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Vitali Sintchenko
- Centre for Infectious Diseases and Microbiology, Public Health, Westmead Hospital, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia.,NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Kate Clezy
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Pam Konecny
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Kogarah, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeffrey J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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19
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Wabe N, Li L, Lindeman R, Yimsung R, Dahm MR, Clezy K, McLennan S, Westbrook J, Georgiou A. The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients. Med J Aust 2019; 210:316-320. [PMID: 30838671 PMCID: PMC6617970 DOI: 10.5694/mja2.50049] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/12/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether rapid polymerase chain reaction (PCR) testing for influenza and respiratory syncytial viruses (RSV) in emergency departments (EDs) is associated with better patient and laboratory outcomes than standard multiplex PCR testing. DESIGN, SETTING A before-and-after study in four metropolitan EDs in New South Wales. PARTICIPANTS 1491 consecutive patients tested by standard multiplex PCR during July-December 2016, and 2250 tested by rapid PCR during July-December 2017. MAIN OUTCOME MEASURES Hospital admissions; ED length of stay (LOS); test turnaround time; patient receiving test result before leaving the ED; ordering of other laboratory tests. RESULTS Compared with those tested by standard PCR, fewer patients tested by rapid PCR were admitted to hospital (73.3% v 77.7%; P < 0.001) and more received their test results before leaving the ED (67.4% v 1.3%; P < 0.001); the median test turnaround time was also shorter (2.4 h [IQR, 1.6-3.9 h] v 26.7 h [IQR, 21.2-37.8 h]). The proportion of patients admitted to hospital was also lower in the rapid PCR group for both children under 18 (50.6% v 66.6%; P < 0.001) and patients over 60 years of age (84.3% v 91.8%; P < 0.001). Significantly fewer blood culture, blood gas, sputum culture, and respiratory bacterial and viral serology tests were ordered for patients tested by rapid PCR. ED LOS was similar for the rapid (7.4 h; IQR, 5.0-12.9 h) and standard PCR groups (6.5 h; IQR, 4.2-11.9 h; P = 0.27). CONCLUSION Rapid PCR testing of ED patients for influenza virus and RSV was associated with better outcomes on a range of indicators, suggesting benefits for patients and the health care system. A formal cost-benefit analysis should be undertaken.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | | | | | - Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | | | - Susan McLennan
- NSW Health Pathology, Sydney, NSW.,Sydney Medical School, University of Sydney, Sydney, NSW
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
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20
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Jain S, Clezy K, McLaws ML. Glove: Use for safety or overuse? Am J Infect Control 2017; 45:1407-1410. [PMID: 29046216 DOI: 10.1016/j.ajic.2017.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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21
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Lee BB, Toh SL, Ryan S, Simpson JM, Clezy K, Bossa L, Rice SA, Marial O, Weber G, Kaur J, Boswell-Ruys C, Goodall S, Middleton J, Tudehope M, Kotsiou G. Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a study protocol for a randomised controlled trial. BMC Urol 2016; 16:18. [PMID: 27084704 PMCID: PMC4833921 DOI: 10.1186/s12894-016-0136-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/28/2016] [Indexed: 01/20/2023] Open
Abstract
Background Urinary tract infections [UTIs] are very common in people with Spinal Cord Injury [SCI]. UTIs are increasingly difficult and expensive to treat as the organisms that cause them become more antibiotic resistant. Among the SCI population, there is a high rate of multi-resistant organism [MRO] colonisation. Non-antibiotic prevention strategies are needed to prevent UTI without increasing resistance. Probiotics have been reported to be beneficial in preventing UTIs in post-menopausal women in several in vivo and in vitro studies. The main aim of this study is to determine whether probiotic therapy with combinations of Lactobacillus reuteri RC-14 + Lactobacillus rhamnosus GR-1 [RC14-GR1] and/or Lactobacillus rhamnosus GG + Bifidobacterium BB-12 [LGG-BB12] are effective in preventing UTI in people with SCI compared to placebo. Method This is a multi-site randomised double-blind double-dummy placebo-controlled factorial design study conducted in New South Wales, Australia. All participants have a neurogenic bladder as a result of spinal injury. Recruitment started in April 2011. Participants are randomised to one of four arms, designed for factorial analysis of LGG-BB12 and/or RC14-GR1 v Placebo. This involves 24 weeks of daily oral treatment with RC14-GR1 + LGG-BB12, RC14-GR1 + placebo, LGG-BB12 + placebo or two placebo capsules. Randomisation is stratified by bladder management type and inpatient status. Participants are assessed at baseline, three months and six months for Short Form Health Survey [SF-36], microbiological swabs of rectum, nose and groin; urine culture and urinary catheters for subjects with indwelling catheters. A bowel questionnaire is administered at baseline and three months to assess effect of probiotics on bowel function. The primary outcome is time from randomisation to occurrence of symptomatic UTI. The secondary outcomes are change of MRO status and bowel function, quality of life and cost-effectiveness of probiotics in persons with SCI. The primary outcome will be analysed using survival analysis of factorial groups, with Cox regression modelling to test the effect of each treatment while allowing for the other, assuming no interaction effect. Hazard ratios and Kaplan-Meier survival curves will be used to summarise results. Discussion If these probiotics are shown to be effective in preventing UTI and MRO colonisation, they would be a very attractive alternative for UTI prophylaxis and for combating the increasing rate of antibiotic resistance after SCI. Trial registration Australian New Zealand Clinical Trials Registry [ACTRN 12610000512022]. Date of registration: 21 June 2010. Electronic supplementary material The online version of this article (doi:10.1186/s12894-016-0136-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bonsan Bonne Lee
- Neuroscience Research Australia [NeuRA] and the University of New South Wales, Sydney, Australia.,Department of Spinal and Rehabilitation Medicine, Prince of Wales Hospital, Sydney, Australia
| | - Swee-Ling Toh
- Department of Spinal and Rehabilitation Medicine, Prince of Wales Hospital, Sydney, Australia. .,School of Public Health, University of Sydney, Sydney, Australia.
| | - Suzanne Ryan
- Neuroscience Research Australia [NeuRA] and the University of New South Wales, Sydney, Australia
| | - Judy M Simpson
- School of Public Health, University of Sydney, Sydney, Australia
| | - Kate Clezy
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
| | - Laetitia Bossa
- Neuroscience Research Australia [NeuRA] and the University of New South Wales, Sydney, Australia.,Centre for Marine Bio-Innovation, University of New South Wales, Sydney, Australia
| | - Scott A Rice
- Centre for Marine Bio-Innovation, University of New South Wales, Sydney, Australia.,The Singapore Centre for Life Sciences Engineering and the School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Obaydullah Marial
- Department of Spinal and Rehabilitation Medicine, Prince of Wales Hospital, Sydney, Australia.,Royal Rehabilitation Centre Sydney, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia
| | - Gerard Weber
- Royal Rehabilitation Centre Sydney, Sydney, Australia
| | | | - Claire Boswell-Ruys
- Neuroscience Research Australia [NeuRA] and the University of New South Wales, Sydney, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation [CHERE], University of Technology Sydney, Sydney, Australia
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, Australia
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22
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Jensen TO, Stelzer-Braid S, Willenborg C, Cheung C, Andresen D, Rawlinson W, Clezy K. Outbreak of respiratory syncytial virus (RSV) infection in immunocompromised adults on a hematology ward. J Med Virol 2016; 88:1827-31. [PMID: 26990584 DOI: 10.1002/jmv.24521] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/07/2022]
Abstract
We describe an outbreak of respiratory syncytial virus (RSV) infection on a hematology ward without allogeneic stem cell transplant patients. Twelve patients and one staff member infected with RSV were identified from the laboratory database. Five patients had lower respiratory tract infection, seven had upper respiratory tract infection, one was asymptomatic, and there were two (15.4%) deaths. Most patients had overlapping periods of potential infectiousness on the ward. Sequencing was possible on eight specimens and five of these had identical sequences. Results were consistent with transmission occurring both on the ward and by introduction of RSV from the community. J. Med. Virol. 88:1827-1831, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Tomas Ostergaard Jensen
- Department of Infectious Diseases, St. Vincent's Hospital, Sydney, Australia.,School of Medical Sciences, University of New South Wales, Australia
| | - Sacha Stelzer-Braid
- School of Medical Sciences, University of New South Wales, Australia.,Division of Serology and Virology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, Australia
| | - Christiana Willenborg
- Division of Serology and Virology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, Australia
| | - Carol Cheung
- Department of Haematology, Prince of Wales Hospital, Sydney, Australia
| | - David Andresen
- Department of Infectious Diseases, St. Vincent's Hospital, Sydney, Australia
| | - William Rawlinson
- School of Medical Sciences, University of New South Wales, Australia.,Division of Serology and Virology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, Australia.,School of Biotechnology and Biomolecular Sciences, University of New South Wales, Australia
| | - Kate Clezy
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
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Hunter M, Clezy K, Hajkowicz KM, Hoy JF, Hume S, O'Sullivan MVN, Runnegar N, Sasadeusz J, Post JJ. Late diagnosis of human immunodeficiency virus infection in patients with viral hepatitis. Intern Med J 2014; 43:732-4. [PMID: 23745999 DOI: 10.1111/imj.12160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/16/2013] [Indexed: 11/29/2022]
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Ison MG, Hui DS, Clezy K, O'Neil BJ, Flynt A, Collis PJ, Simon TJ, Alexander WJ. A clinical trial of intravenous peramivir compared with oral oseltamivir for the treatment of seasonal influenza in hospitalized adults. Antivir Ther 2012; 18:651-61. [PMID: 23111657 DOI: 10.3851/imp2442] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Seasonal interpandemic influenza causes >200,000 annual hospitalizations in the United States. Optimal antiviral treatment in hospitalized patients is not established. METHODS During three interpandemic influenza seasons, 137 patients hospitalized with suspected acute influenza were randomized to 5-day treatment with intravenous peramivir 400 mg or 200 mg once daily or oral oseltamivir 75 mg twice daily. Time to clinical stability and quantitative changes in viral titres from nasopharyngeal specimens were primary and key secondary end points, respectively. RESULTS Infection was confirmed in 122 patients with influenza A (H1N1), influenza A (H3N2) or influenza B. Median times (95% CI) to clinical stability were 37.0 h (22.0, 48.7) with peramivir 400 mg, 23.7 h (16.0, 38.9) with peramivir 200 mg and 28.1 h (22.0, 37.0) with oseltamivir (P=0.306). Patients (n=97) who were clinically unstable at enrolment had median times (95% CI) to clinical stability of 24.3 h (21.2, 47.5) with peramivir 400 mg, 31.0 h (17.2, 47.7) with peramivir 200 mg and 35.5 h (23.3, 37.9) with oseltamivir (P=0.541). Titres of influenza A viruses in nasopharyngeal specimens decreased similarly across treatments, but more rapid decreases in titres of influenza B occurred with peramivir treatment. There were no deaths among patients with confirmed influenza and the incidence of adverse events was low and generally similar among treatment groups. CONCLUSIONS Treatment of acute seasonal influenza in hospitalized adults with either peramivir or oseltamivir resulted in generally similar clinical outcomes. Treatment with peramivir was generally safe and well tolerated and could be of benefit in this population.
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Affiliation(s)
- Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Abstract
Long-term outcomes of HIV-infected patients admitted to the intensive care unit (ICU) since the advent of combination antiretroviral therapy (cART) have not been well described. We reviewed the long-term outcomes and clinical follow-up of HIV-infected patients admitted to the Prince of Wales Hospital ICU between 1999 and 2005 by a retrospective medical record review. Mortality was assessed in the ICU, in hospital and in the long-term. Twenty-four HIV-infected male patients underwent 26 ICU admissions. Their ICU and in-hospital mortalities were 33% and 46%, respectively. Higher APACHE (acute physiology and chronic health evaluation) II scores (median 27 versus 12, P < 0.001), lower CD4 cell counts (median 45 versus 335 cells/μL, P = 0.041) and longer hospitalization times prior to ICU admission (median 4 versus 1 day, P = 0.02) were significantly associated with in-hospital mortality. We found 85% of the subjects who survived hospital admission were still alive at a median of 41 months (4 months to 5 years) of follow-up, all of who were functionally independent. HIV-infected patients who survived ICU admission at our institution had good long-term outcomes in the cART era.
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Affiliation(s)
- H Foo
- Department of Infectious Diseases, Prince of Wales Hospital
| | - K Clezy
- Department of Infectious Diseases, Prince of Wales Hospital
| | - J J Post
- Department of Infectious Diseases, Prince of Wales Hospital
- School of Medical Sciences, University of New South Wales, Sydney, Australia
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Gordin FM, Roediger MP, Girard PM, Lundgren JD, Miro JM, Palfreeman A, Rodriguez-Barradas MC, Wolff MJ, Easterbrook PJ, Clezy K, Slater LN. Pneumonia in HIV-infected persons: increased risk with cigarette smoking and treatment interruption. Am J Respir Crit Care Med 2008; 178:630-6. [PMID: 18617640 DOI: 10.1164/rccm.200804-617oc] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population. OBJECTIVES To evaluate the frequency and risk factors for occurrence of bacterial pneumonia in the present era of potent antiretroviral therapy. METHODS We evaluated data from a randomized trial of episodic antiretroviral therapy. The study, Strategies for Management of Antiretroviral Therapy, enrolled 5,472 participants at 318 sites in 33 countries. Study patients had more than 350 CD4 cells at baseline. Diagnosis of bacterial pneumonia was confirmed by a blinded clinical-events committee. MEASUREMENTS AND MAIN RESULTS During a mean follow-up of 16 months, 116 participants (2.2%) developed at least one episode of bacterial pneumonia. Patients randomized to receive episodic antiretroviral therapy were significantly more likely to develop pneumonia than patients randomized to receive continuous antiretroviral therapy (hazard ratio, 1.55; 95% confidence interval, 1.07-2.25; P = 0.02). Cigarette smoking was a major risk factor: Current-smokers had more than an 80% higher risk of pneumonia compared with never-smokers (hazard ratio, 1.82; 95% confidence interval, 1.09-3.04; P = 0.02). Participants who were on continuous HIV treatment and were current smokers were three times more likely to develop bacterial pneumonia than nonsmokers. Current smoking status was significant, but a past history of smoking was not. CONCLUSIONS Bacterial pneumonia is a major source of morbidity, even for persons on potent antiretroviral therapy, including those with high CD4 cells. Efforts to reduce this illness should stress the importance of uninterrupted antiretroviral therapy and attainment and/or maintenance of nonsmoking status.
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Affiliation(s)
- Fred M Gordin
- Infectious Diseases (151B), Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422, USA.
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Abstract
Influenza is an acute febrile illness caused by influenza A or B viruses. It occurs mainly in winter in temperate climates, and throughout the year in tropical Australia. It is highly contagious and of considerable public health concern because of the rapidity with which epidemics evolve and the associated morbidity and mortality. Most influenza illnesses resolve over about 1 week without specific medical intervention. People at particular risk for complicated infection are those > 65 or < 5 years old, those with chronic medical comorbidities, residents of chronic care facilities (including nursing homes), and women in the second or third trimester of pregnancy. Complicated influenza infection most commonly manifests as primary viral pneumonia, combined viral and bacterial pneumonia, and secondary bacterial pneumonia. Rare but serious complications of influenza include central nervous system involvement (eg, encephalitis, transverse myelitis, aseptic meningitis, and Guillain-Barré syndrome). The recent emergence of avian influenza A/H5N1 and confirmation of sporadic cases of human H5N1 infection have heightened concern about an impending human influenza pandemic, either from a human form of H5N1 or a primary new human influenza strain. H5N1 infection in humans has been associated with severe illness and a > 50% mortality rate, with high mortality in people aged 10-39 years.
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Affiliation(s)
- Mark Boyd
- Department of Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, SA, Australia.
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Affiliation(s)
- S J van Hal
- Infectious Diseases Department, Prince of Wales Hospital, Randwick, Sydney, Australia
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Abstract
OBJECTIVES To describe, retrospectively, the Australian experience of multi-centric Castleman's disease (MCD) in the setting of HIV infection, specifically with the advent of HAART, and newer chemotherapeutic agents. PATIENTS AND METHODS HIV-infected patients diagnosed with MCD since 1994, were identified from three major HIV treatment centres in Australia. Demographic and disease characteristic variables were collated by the National Centre in HIV Epidemiology and Clinical Research. RESULTS Eleven patients were identified with MCD. Medial follow up was 46 (18-57) months. All had CD4 cell counts less than 500 cells/microL. All but one patient was receiving HAART at the time of diagnosis. Nine of the 11 patients had Kaposi's sarcoma (KS) and two patients also developed non-Hodgkin's Lymphoma (NHL). All patients received chemotherapy for MCD. The response rate from Chemotherapy was 64%. Only two patients achieved sustained remissions. The median survival was 21.9 (1-52) months. The mortality was 45% from MCD and its related complications. CONCLUSION MCD in HIV infected patients is a rare and life-threatening disorder. There is limited recent information on optimal treatment for MCD. MCD in our series appeared to be a chemo-responsive disease. In our experience, treatment with liposomal anthracycline was associated with good response rates and acceptable toxicity in several patients, and therefore merits further exploration to establish its role. Treatment in the future may concentrate on novel agents such as anti-interleukin 6, anti-CD20 antibodies, thalidomide and viral ablation.
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Affiliation(s)
- S Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Becket Street, East Melbourne, Victoria 8006, Australia.
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Leenders AC, Reiss P, Portegies P, Clezy K, Hop WC, Hoy J, Borleffs JC, Allworth T, Kauffmann RH, Jones P, Kroon FP, Verbrugh HA, de Marie S. Liposomal amphotericin B (AmBisome) compared with amphotericin B both followed by oral fluconazole in the treatment of AIDS-associated cryptococcal meningitis. AIDS 1997; 11:1463-71. [PMID: 9342068 DOI: 10.1097/00002030-199712000-00010] [Citation(s) in RCA: 220] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Amphotericin B deoxycholate initial therapy and fluconazole maintenance therapy is the treatment of choice for AIDS-associated cryptococcal meningitis. However, the administration of amphotericin B is associated with considerable toxicity. A potential strategy for reducing the toxicity and increasing the therapeutic index of amphotericin B is the use of lipid formulations of this drug. DESIGN AND METHODS HIV-infected patients with cryptococcal meningitis were randomized to treatment with either liposomal amphotericin B (AmBisome) 4 mg/kg daily or standard amphotericin B 0.7 mg/kg daily for 3 weeks, each followed by fluconazole 400 mg daily for 7 weeks. During the first 3 weeks, clinical efficacy was assessed daily. Mycological response was primarily evaluated by cerebrospinal fluid (CSF) cultures at days 7, 14, 21 and 70. RESULTS Of the 28 evaluable patients, 15 were assigned to receive AmBisome and 13 to receive amphotericin B. Baseline characteristics were comparable. The time to and the rate of clinical response were the same in both arms. AmBisome therapy resulted in a CSF culture conversion within 7 days in six out of 15 patients versus one out of 12 amphotericin B-treated patients (P = 0.09), within 14 days in 10 out of 15 AmBisome patients versus one out of nine amphotericin B patients (P = 0.01), and within 21 days in 11 out of 15 AmBisome patients versus three out of eight amphotericin B patients (P = 0.19). When Kaplan-Meier estimates were used to compare time to CSF culture conversion, AmBisome was more effective (P < 0.05; median time between 7 and 14 days for AmBisome versus > 21 days for amphotericin B). AmBisome was significantly less nephrotoxic. CONCLUSIONS A 3-week course of 4 mg/kg AmBisome resulted in a significantly earlier CSF culture conversion than 0.7 mg/kg amphotericin B, had equal clinical efficacy and was significantly less nephrotoxic when used for the treatment of primary episodes of AIDS-associated cryptococcal meningitis.
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Thackway SV, Furner V, Mijch A, Cooper DA, Holland D, Martinez P, Shaw D, van Beek I, Wright E, Clezy K, Kaldor JM. Fertility and reproductive choice in women with HIV-1 infection. AIDS 1997; 11:663-7. [PMID: 9108948 DOI: 10.1097/00002030-199705000-00014] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To measure fertility and birth rates and to describe the reproductive histories of women diagnosed with HIV-1 infection in Australia. METHODS The medical records of 294 women with HIV-1 infection in four states of Australia were reviewed. Expected fertility and birth rates were calculated using national statistics. RESULTS In the study population, 152 (52%) women had at least one pregnancy prior or subsequent to HIV-1 diagnosis. At maternal HIV-1 diagnosis, 71 (24%) women had a total of 106 children aged under 15 years. During the study period, 246 women were aged 15, 44 years and 58 (23%) of these became pregnant after HIV-1 diagnosis. Women whose exposure to HIV-1 was injecting drug use were twice as likely to become pregnant and more likely to have multiple pregnancies than women who did not report injecting drug use. The annual general fertility rate was 30 per 10,000 compared with 63 per 10,000 for the Australian female population aged 15-44 years, and the birth rate in women with HIV-1 infection was one-half that of the general female population. Of pregnancies confirmed after HIV-1 diagnosis, 47% were voluntarily terminated, a rate more than double that of the general population. All multiple terminations were among women whose exposure to HIV-1 was injecting drug use. CONCLUSIONS Fertility and birth rates among women with HIV-1 infection are lower than the general population and the rate of termination higher. The results of this study provide a basis for the management of women with HIV-1 infection who are considering pregnancy.
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Affiliation(s)
- S V Thackway
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
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33
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Mijch AM, Clezy K, Furner V. Managing HIV. Part 6: People living with HIV. 6.2 Women with HIV. Med J Aust 1996; 164:669-71. [PMID: 8657031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Gay men with HIV often belong to strong mutually supportive groups, but many women with HIV experience the disease in relative isolation. Informed primary care doctors can make a valuable difference to their management.
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Affiliation(s)
- A M Mijch
- Fairfield Hospital, Melbourne, VIC, NSW
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34
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Affiliation(s)
| | - Kate Clezy
- National Centre in HIV Epidemiology and Clinical ResearchSydneyNSW
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Fulcher D, Clezy K. Managing HIV. Antiretroviral therapy. Med J Aust 1996; 164:607. [PMID: 8637466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Initiating or changing antiretroviral therapy requires specialist knowledge of indications, side effects and drug interactions. This brief guide highlights the key points for monitoring antiretroviral therapy.
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Affiliation(s)
- D Fulcher
- Department of Immunopathology, Westmead Hospital, Sydney, NSW
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36
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Affiliation(s)
- David Fulcher
- Department of ImmunopathologyWestmead HospitalSydneyNSW
| | - Kate Clezy
- National Centre in HIV Epidemiology and Clinical ResearchSt Vincent's HospitalSydneyNSW
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Giles WB, Clezy K. HIV infection in obstetric and gynaecological practice. Med J Aust 1993; 158:263. [PMID: 8426550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The initial impact of HIV infection on the practising obstetrician and gynaecologist was specifically related to the treatment of HIV positive women who were pregnant. The current North American experience suggests that HIV will be an important consideration in gynaecology from now on.
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Affiliation(s)
- W B Giles
- Department of Obstetrics and Gynaecology, John Hunter Hospital, New Lambton Heights, NSW
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38
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Affiliation(s)
- Warwick B Giles
- Department of Obstetrics and GynaecologyJohn Hunter HospitalLookout RoadNew Lambton HeightsNSW2305
| | - Kate Clezy
- Natilonal Centre in HIV Epidemiology and Clinical ResearchSt Vincent's HospitalDarlinghurstNSW2010
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Clezy K, Gold J, Blaze J, Jones P. Paromomycin for the treatment of cryptosporidial diarrhoea in AIDS patients. AIDS 1991; 5:1146-7. [PMID: 1930784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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