1
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Lahra MM, Latham NH, Templeton DJ, Read P, Carmody C, Ryder N, Ellis SE, Madden EF, Parasuraman A, Wells J, Sheppeard V, Armstrong BH, Holland J, Pendle S, Sherry N, Leong L, Papanicolas L, Selvey CE, Van Hal SJ. Investigation and response to an outbreak of Neisseria meningitidis serogroup Y ST-1466 urogenital infections, Australia. Commun Dis Intell (2018) 2024; 48. [PMID: 38594793 DOI: 10.33321/cdi.2024.48.20] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Abstract In 2023, an increased number of urogenital and anorectal infections with Neisseria meningitis serogroup Y (MenY) were reported in New South Wales (NSW). Whole genome sequencing (WGS) found a common sequence type (ST-1466), with limited sequence diversity. Confirmed outbreak cases were NSW residents with a N. meningitidis isolate matching the cluster sequence type; probable cases were NSW residents with MenY isolated from a urogenital or anorectal site from 1 July 2023 without WGS testing. Of the 41 cases, most were men (n = 27), of whom six reported recent contact with a female sex worker. Five cases were men who have sex with men and two were female sex workers. Laboratory alerts regarding the outbreak were sent to all Australian jurisdictions through the laboratories in the National Neisseria Network. Two additional states identified urogenital MenY ST-1466 infections detected in late 2023. Genomic analysis showed all MenY ST-1466 sequences were interspersed, suggestive of an Australia-wide outbreak. The incidence of these infections remains unknown, due to varied testing and reporting practices both within and across jurisdictions. Isolates causing invasive meningococcal disease (IMD) in Australia are typed, and there has been no MenY ST-1466 IMD recorded in Australia to end of March 2024. Concerns remain regarding the risk of IMD, given the similarity of these sequences with a MenY ST-1466 IMD strain causing a concurrent outbreak in the United States of America.
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Affiliation(s)
- M M Lahra
- World Health Organization Collaborating Centre for STI and AMR, New South Wales Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - N H Latham
- Health Protection NSW, St Leonards, New South Wales, Australia
- New South Wales Public Health Training Program, New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | - D J Templeton
- Sexual Health Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - P Read
- South Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - C Carmody
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - N Ryder
- Centre for Population Health NSW Health, St Leonards, New South Wales, Australia
| | - S E Ellis
- Health Protection NSW, St Leonards, New South Wales, Australia
| | - E F Madden
- Health Protection NSW, St Leonards, New South Wales, Australia
| | - A Parasuraman
- Health Protection NSW, St Leonards, New South Wales, Australia
| | - J Wells
- Health Protection NSW, St Leonards, New South Wales, Australia
| | - V Sheppeard
- South Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - B H Armstrong
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Douglass Hanly Moir Pathology, New South Wales, Australia
| | - J Holland
- Laverty Pathology, New South Wales, Australia
| | - S Pendle
- Australian Clinical Laboratories, New South Wales, Australia
| | - N Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - L Leong
- Department of Infectious Diseases & Immunology, Austin Health, Heidelberg, Victoria, Australia
| | | | - C E Selvey
- Health Protection NSW, St Leonards, New South Wales, Australia
| | - S J Van Hal
- New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Nang SC, Lu J, Yu HH, Wickremasinghe H, Azad MAK, Han M, Zhao J, Rao G, Bergen PJ, Velkov T, Sherry N, McCarthy DT, Aslam S, Schooley RT, Howden BP, Barr JJ, Zhu Y, Li J. Phage resistance in Klebsiella pneumoniae and bidirectional effects impacting antibiotic susceptibility. Clin Microbiol Infect 2024:S1198-743X(24)00145-9. [PMID: 38522841 DOI: 10.1016/j.cmi.2024.03.015] [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: 01/17/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES Bacteriophage (phage) therapy is a promising anti-infective option to combat antimicrobial resistance. However, the clinical utilization of phage therapy has been severely compromised by the potential emergence of phage resistance. Although certain phage resistance mechanisms can restore bacterial susceptibility to certain antibiotics, a lack of knowledge of phage resistance mechanisms hinders optimal use of phages and their combination with antibiotics. METHODS Genome-wide transposon screening was performed with a mutant library of Klebsiella pneumoniae MKP103 to identify phage pKMKP103_1-resistant mutants. Phage-resistant phenotypes were evaluated by time-kill kinetics and efficiency of plating assays. Phage resistance mechanisms were investigated with adsorption, one-step growth, and mutation frequency assays. Antibiotic susceptibility was determined with broth microdilution and population analysis profiles. RESULTS We observed a repertoire of phage resistance mechanisms in K pneumoniae, such as disruption of phage binding (fhuA::Tn and tonB::Tn), extension of the phage latent period (mnmE::Tn and rpoN::Tn), and increased mutation frequency (mutS::Tn and mutL::Tn). Notably, in contrast to the prevailing view that phage resistance re-sensitizes antibiotic-resistant bacteria, we observed a bidirectional steering effect on bacterial antibiotic susceptibility. Specifically, rpoN::Tn increased susceptibility to colistin while mutS::Tn and mutL::Tn increased resistance to rifampicin and colistin. DISCUSSION Our findings demonstrate that K pneumoniae employs multiple strategies to overcome phage infection, which may result in enhanced or reduced antibiotic susceptibility. Mechanism-guided phage steering should be incorporated into phage therapy to better inform clinical decisions on phage-antibiotic combinations.
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Affiliation(s)
- Sue C Nang
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Jing Lu
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Heidi H Yu
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Hasini Wickremasinghe
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Mohammad A K Azad
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Meiling Han
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Jinxin Zhao
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Gauri Rao
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Phillip J Bergen
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Tony Velkov
- Biomedicine Discovery Institute, Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Norelle Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - David T McCarthy
- Department of Civil Engineering, Monash University, Clayton, Victoria, Australia
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Robert T Schooley
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jeremy J Barr
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Yan Zhu
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia; Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, China
| | - Jian Li
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.
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3
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Liu A, Chan E, Madigan V, Leung V, Dosvaldo L, Sherry N, Howden B, Bond K, Marshall C. Using whole genome sequencing to characterize Clostridioides difficile isolates at a tertiary center in Melbourne, Australia. Antimicrob Steward Healthc Epidemiol 2024; 4:e7. [PMID: 38234420 PMCID: PMC10789990 DOI: 10.1017/ash.2023.529] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
Objective Clostridioides difficile infection (CDI) is the commonest cause of healthcare-associated diarrhea and undergoes standardized surveillance and mandatory reporting in most Australian states and territories. Historically attributed to nosocomial spread, local and international whole genome sequencing (WGS) data suggest varied sources of acquisition. This study describes C. difficile genotypes isolated at a tertiary center in Melbourne, Australia, their likely source of acquisition, and common risk factors. Design Retrospective observational study. Setting The Royal Melbourne Hospital (RMH), a 570-bed tertiary center in Victoria, Australia. Methods Short-read whole genome sequencing was performed on 75 out of 137 C. difficile isolates obtained from 1/5/2021 to 28/2/2022 and compared to previous data from 8/11/2015 to 1/11/2016. Existing data from infection control surveillance and electronic medical records were used for epidemiological and risk factor analysis. Results Eighty-five (62.1%) of the 137 cases were defined as healthcare-associated from epidemiological data. On genome sequencing, 33 different multi-locus sequence type (MLST) subtypes were identified, with changes in population structure compared to the 2015-16 period. Risk factors for CDI were present in 130 (94.9%) cases, including 108 (78.8%) on antibiotics, 86 (62.8%) on acid suppression therapy, and 25 (18.2) on chemotherapy. Conclusion In both study periods, most C. difficile isolates were not closely related, suggesting varied sources of acquisition and that spread of C. difficile within the hospital was unlikely. Current infection control precautions may therefore warrant review. Underlying risk factors for CDI were common and may contribute to the proportion of healthcare-associated infections in the absence of proven hospital transmission.
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Affiliation(s)
- Alice Liu
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Microbiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Eddie Chan
- Microbiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Victoria Madigan
- Infectious Diseases Department, The Northern Hospital, Melbourne, Victoria, Australia
| | - Vivian Leung
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Lucille Dosvaldo
- Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Norelle Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Benjamin Howden
- Microbiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia
| | - Katherine Bond
- Microbiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Caroline Marshall
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Nang S, Lu J, Yu H, Wickremasinghe H, Azad M, Han M, Rao G, Bergen P, Velkov T, Sherry N, Aslam S, Schooley R, Howden B, Barr J, Zhu Y, Li J. SY4.1: COMBINATION OF BACTERIOPHAGE AND ANTIBIOTIC: IS IT AN ULTIMATE SOLUTION TO MULTIDRUG RESISTANCE? J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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5
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Dale K, Globan M, Horan K, Sherry N, Ballard S, Tay EL, Bittmann S, Meagher N, Price DJ, Howden BP, Williamson DA, Denholm J. Whole genome sequencing for tuberculosis in Victoria, Australia: A genomic implementation study from 2017 to 2020. Lancet Reg Health West Pac 2022; 28:100556. [PMID: 36034164 PMCID: PMC9405109 DOI: 10.1016/j.lanwpc.2022.100556] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Whole genome sequencing (WGS) is increasingly used by tuberculosis (TB) programs to monitor Mycobacterium tuberculosis (Mtb) transmission. We aimed to characterise the molecular epidemiology of TB and Mtb transmission in the low-incidence setting of Victoria, Australia, and assess the utility of WGS. METHODS WGS was performed on all first Mtb isolates from TB cases from 2017 to 2020. Potential clusters (≤12 single nucleotide polymorphisms [SNPs]) were investigated for epidemiological links. Transmission events in highly-related (≤5 SNPs) clusters were classified as likely or possible, based on the presence or absence of an epidemiological link, respectively. Case characteristics and transmission settings (as defined by case relationship) were summarised. Poisson regression was used to examine associations with secondary case number. FINDINGS Of 1844 TB cases, 1276 (69.2%) had sequenced isolates, with 182 (14.2%) in 54 highly-related clusters, 2-40 cases in size. Following investigation, 140 cases (11.0% of sequenced) were classified as resulting from likely/possible local-transmission, including 82 (6.4%) for which transmission was likely. Common identified transmission settings were social/religious (26.4%), household (22.9%) and family living in different households (7.1%), but many were uncertain (41.4%). While household transmission featured in many clusters (n = 24), clusters were generally smaller (median = 3 cases) than the fewer that included transmission in social/religious settings (n = 12, median = 7.5 cases). Sputum-smear-positivity was associated with higher secondary case numbers. INTERPRETATION WGS results suggest Mtb transmission commonly occurs outside the household in our low-incidence setting. Further work is required to optimise the use of WGS in public health management of TB. FUNDING The Victorian Tuberculosis Program receives block funding for activities including case management and contact tracing from the Victorian Department of Health. No specific funding for this report was received by manuscript authors or the Victorian Tuberculosis Program, and the funders had no role in the study design, data collection, data analysis, interpretation or report writing.
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Affiliation(s)
- Katie Dale
- Victorian Tuberculosis Program, Melbourne Health, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Maria Globan
- Victorian Infectious Diseases Reference Laboratory (VIDRL), at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Norelle Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Susan Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ee Laine Tay
- Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Public Health Division, Department of Health, Victoria, Australia
| | - Simone Bittmann
- Victorian Tuberculosis Program, Melbourne Health, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Niamh Meagher
- Department of Infectious Diseases at the Doherty Institute for Infection & Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David J. Price
- Department of Infectious Diseases at the Doherty Institute for Infection & Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin P. Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deborah A. Williamson
- Victorian Infectious Diseases Reference Laboratory (VIDRL), at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Porter AF, Sherry N, Andersson P, Johnson SA, Duchene S, Howden BP. New rules for genomics-informed COVID-19 responses-Lessons learned from the first waves of the Omicron variant in Australia. PLoS Genet 2022; 18:e1010415. [PMID: 36227810 PMCID: PMC9560517 DOI: 10.1371/journal.pgen.1010415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ashleigh F. Porter
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Norelle Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Patiyan Andersson
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sandra A. Johnson
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sebastian Duchene
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Benjamin P. Howden
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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7
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Audsley JM, Holmes NE, Mordant FL, Douros C, Zufan SE, Nguyen THO, Kedzierski L, Rowntree LC, Hensen L, Subbarao K, Kedzierska K, Nicholson S, Sherry N, Thevarajan I, Tran T, Druce J. Temporal differences in culturable severe acute respiratory coronavirus virus 2 (SARS-CoV-2) from the respiratory and gastrointestinal tracts in a patient with moderate coronavirus disease 2019 (COVID-19). Infect Control Hosp Epidemiol 2022; 43:1286-1288. [PMID: 33966675 PMCID: PMC8144808 DOI: 10.1017/ice.2021.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Jennifer M. Audsley
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Natasha E. Holmes
- Department of Infectious Diseases, Austin Hospital, Heidelberg, Australia
- Department of Medicine and Radiology, The University of Melbourne, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Health and The University of Melbourne, Heidelberg, Australia
| | - Francesca L. Mordant
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Celia Douros
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sara E. Zufan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Thi H. O. Nguyen
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Lukasz Kedzierski
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Louise C. Rowntree
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Luca Hensen
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Kanta Subbarao
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- World Health Organisation (WHO) Collaborating Centre for Reference and Research on Influenza, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Norelle Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Irani Thevarajan
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Services, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Thomas Tran
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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8
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Hogarth F, Coffey P, Goddard L, Lewis S, Labib S, Wilmot M, Andersson P, Sherry N, Seemann T, Howden BP, Freeman K, Baird R, Hosegood I, McDermott K, Walsh N, Polkinghorne B, Marshall C, Davies J, Krause V, Meumann EM. Genomic Evidence of In-Flight SARS-CoV-2 Transmission, India to Australia, April 2021. Emerg Infect Dis 2022; 28:1527-1530. [PMID: 35483111 PMCID: PMC9239893 DOI: 10.3201/eid2807.212466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Epidemiologic and genomic investigation of SARS-CoV-2 infections associated with 2 repatriation flights from India to Australia in April 2021 indicated that 4 passengers transmitted SARS-CoV-2 to >11 other passengers. Results suggest transmission despite mandatory mask use and predeparture testing. For subsequent flights, predeparture quarantine and expanded predeparture testing were implemented.
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Palou T, Wilmot M, Duchene S, Porter A, Kemoi MJ, Suarkia D, Andersson P, Watt A, Sherry N, Seemann T, Sait M, Turharus C, Nguyen S, Schlebusch S, Thompson C, McMahon J, Vaccher S, Lin C, Daoni E, Howden BP, Susapu M. Genomic Characterisation Reveals a Dominant Lineage of SARS-CoV-2 in Papua New Guinea. Virus Evol 2022; 8:veac033. [PMID: 35875697 PMCID: PMC9278129 DOI: 10.1093/ve/veac033] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/22/2022] [Accepted: 04/01/2022] [Indexed: 11/14/2022] Open
Abstract
The coronavirus disease pandemic has highlighted the utility of pathogen genomics as a
key part of comprehensive public health response to emerging infectious diseases threats,
however, the ability to generate, analyse, and respond to pathogen genomic data varies
around the world. Papua New Guinea (PNG), which has limited in-country capacity for
genomics, has experienced significant outbreaks of severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) with initial genomics data indicating a large proportion of
cases were from lineages that are not well defined within the current nomenclature.
Through a partnership between in-country public health agencies and academic
organisations, industry, and a public health genomics reference laboratory in Australia a
system for routine SARS-CoV-2 genomics from PNG was established. Here we aim to
characterise and describe the genomics of PNG’s second wave and examine the sudden
expansion of a lineage that is not well defined but very prevalent in the Western Pacific
region. We generated 1797 sequences from cases in PNG and performed phylogenetic and
phylodynamic analyses to examine the outbreak and characterise the circulating lineages
and clusters present. Our results reveal the rapid expansion of the B.1.466.2 and related
lineages within PNG, from multiple introductions into the country. We also highlight the
difficulties that unstable lineage assignment causes when using genomics to assist with
rapid cluster definitions.
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Affiliation(s)
- Theresa Palou
- National Control Centre, Ministry of Health, Papua New Guinea
| | - Mathilda Wilmot
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sebastian Duchene
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Ashleigh Porter
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Ms Janlyn Kemoi
- Central Public Health Laboratory, Port Moresby, Papua New Guinea
| | | | - Patiyan Andersson
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Anne Watt
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Norelle Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Torsten Seemann
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Michelle Sait
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | | | - Son Nguyen
- Forensic and Scientific Services, Queensland Health, Brisbane, Australia
| | | | - Craig Thompson
- Forensic and Scientific Services, Queensland Health, Brisbane, Australia
| | - Jamie McMahon
- Forensic and Scientific Services, Queensland Health, Brisbane, Australia
| | | | - Chantel Lin
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Esorom Daoni
- National Control Centre, Ministry of Health, Papua New Guinea
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Melinda Susapu
- National Control Centre, Ministry of Health, Papua New Guinea
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Graham M, Ballard SA, Pasricha S, Lin B, Hoang T, Stinear T, Druce J, Catton M, Sherry N, Williamson D, Howden BP. Use of emerging testing technologies and approaches for SARS-CoV-2: review of literature and global experience in an Australian context. Pathology 2021; 53:689-699. [PMID: 34425991 PMCID: PMC8352662 DOI: 10.1016/j.pathol.2021.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/12/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Abstract
Emerging testing technologies for detection of SARS-CoV-2 include those that are rapid and can be used at point-of-care (POC), and those facilitating high throughput laboratory-based testing. Tests designed to be performed at POC (such as antigen tests and molecular assays) have the potential to expedite isolation of infectious patients and their contacts, but most are less sensitive than standard-of-care reverse transcription polymerase chain reaction (RT-PCR). Data on clinical performance of the majority of emerging assays are limited with most evaluations performed on contrived or stored laboratory samples. Further evaluations of these assays are required, particularly when performed at POC on symptomatic and asymptomatic patients and at various time-points after symptom onset. A few studies have so far shown several of these assays have high specificity. However, large prospective evaluations are needed to confirm specificity, particularly before the assays are implemented in low prevalence settings or asymptomatic populations. High throughput laboratory-based testing includes the use of new sample types (e.g., saliva to increase acceptability) or innovative uses of existing technology (e.g., sample pooling). Information detailing population-wide testing strategies for SARS-COV-2 is largely missing from peer-reviewed literature. Logistics and supply chains are key considerations in any plan to 'scale up' testing in the Australian context. The strategic use of novel assays will help strike the balance between achieving adequate test numbers without overwhelming laboratory capacity. To protect testing of high-risk populations, the aims of testing with respect to the phase of the pandemic must be considered.
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Affiliation(s)
- Maryza Graham
- Microbiological Diagnostic Unit, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Infectious Diseases, Monash Health, Clayton, Vic, Australia.
| | - Susan A Ballard
- Microbiological Diagnostic Unit, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Shivani Pasricha
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Belinda Lin
- Microbiological Diagnostic Unit, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Tuyet Hoang
- Microbiological Diagnostic Unit, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Timothy Stinear
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Melbourne Health at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Mike Catton
- Victorian Infectious Diseases Reference Laboratory, Melbourne Health at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Norelle Sherry
- Microbiological Diagnostic Unit, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology, Royal Melbourne Hospital, Parkville, Vic, Australia
| | - Deborah Williamson
- Microbiological Diagnostic Unit, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology, Royal Melbourne Hospital, Parkville, Vic, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
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Zhang W, Chua B, Selva K, Kedzierski L, Ashhurst T, Haycroft E, Shoffner S, Hensen L, Boyd D, James F, Mouhtouris E, Kwong J, Chua K, Drewett G, Copaescu A, Dobson J, Rowntree L, Habel J, Allen L, Koay HF, Neil J, Gartner M, Lee C, Andersson P, Seemann T, Sherry N, Amanat F, Krammer F, Londrigan S, Wakim L, King N, Godfrey D, Mackay L, Thomas P, Nicholson S, Arnold K, Chung A, Holmes N, Smibert O, Trubiano J, Gordon C, Nguyen T, Kedzierska K. Immune responses in COVID-19 respiratory tract and blood reveal mechanisms of disease severity. Res Sq 2021:rs.3.rs-802084. [PMID: 34462740 PMCID: PMC8404907 DOI: 10.21203/rs.3.rs-802084/v1] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although the respiratory tract is the primary site of SARS-CoV-2 infection and the ensuing immunopathology, respiratory immune responses are understudied and urgently needed to understand mechanisms underlying COVID-19 disease pathogenesis. We collected paired longitudinal blood and respiratory tract samples (endotracheal aspirate, sputum or pleural fluid) from hospitalized COVID-19 patients and non-COVID-19 controls. Cellular, humoral and cytokine responses were analysed and correlated with clinical data. SARS-CoV-2-specific IgM, IgG and IgA antibodies were detected using ELISA and multiplex assay in both the respiratory tract and blood of COVID-19 patients, although a higher receptor binding domain (RBD)-specific IgM and IgG seroconversion level was found in respiratory specimens. SARS-CoV-2 neutralization activity in respiratory samples was detected only when high levels of RBD-specific antibodies were present. Strikingly, cytokine/chemokine levels and profiles greatly differed between respiratory samples and plasma, indicating that inflammation needs to be assessed in respiratory specimens for the accurate assessment of SARS-CoV-2 immunopathology. Diverse immune cell subsets were detected in respiratory samples, albeit dominated by neutrophils. Importantly, we also showed that dexamethasone and/or remdesivir treatment did not affect humoral responses in blood of COVID-19 patients. Overall, our study unveils stark differences in innate and adaptive immune responses between respiratory samples and blood and provides important insights into effect of drug therapy on immune responses in COVID-19 patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Luca Hensen
- Peter Doherty Institute for Infection and Immunity
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- University of Melbourne at the Peter Doherty Institute for Infection and Immunity
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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12
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Sherry N, Ernst N, French J, Kontos AP, Collins MW. A-40 Predictors of Failed Effort Testing at Initial Clinic Visit for Concussion Rehabilitation and Outcomes. Arch Clin Neuropsychol 2020. [DOI: 10.1093/arclin/acaa036.40] [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: 11/15/2022] Open
Abstract
Abstract
Objective
Neuropsychological evaluation of concussion typically includes performance validity testing to assess effort. The aim of this study was to explore the usefulness of effort testing as part of initial screening for concussion rehabilitation, including determining the factors that predict effort testing and evaluate outcomes between “good effort” and “failed effort” groups.
Method
Records of 76 patients aged 16–66 years old (M = 40.58 years, SD = 14.18) seen for rehabilitation of non-sport concussion from 2018–2019 were reviewed. Patients completed clinical interview, neurocognitive screening (ImPACT), effort testing (Word Memory Test), vestibular/oculomotor screening (VOMS), and the post-concussion symptom scale (PCSS). A logistic regression (LR) was conducted to predict effort, with predictors including mental health history, secondary gain, work injury, days post-injury, and PCSS. A series of one-way ANOVAs evaluated outcomes from concussion rehabilitation between the good and failed effort groups.
Results
Failed effort occurred in 42% of cases. The LR accurately classified 81.8% of individuals, with mental health history (p = .01) and PCSS (p = .02) as the only significant predictors of effort. There were no differences in recovery time (p = .56) between effort groups, but the failed effort group took longer to return to work (p = .03). Half of individuals who failed effort were seen until discharge, and 69% of them reported no symptoms/mild symptoms at discharge.
Conclusions
Failure of effort testing was predicted by a history of mental health and high symptom burden. Individuals who fail effort testing at initial visit for concussion rehabilitation take longer to return to functional activity but are capable of achieving recovery with compliance and appropriate rehabilitation.
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13
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Sherry N, Howden B. Emerging Gram negative resistance to last-line antimicrobial agents fosfomycin, colistin and ceftazidime-avibactam – epidemiology, laboratory detection and treatment implications. Expert Rev Anti Infect Ther 2018. [DOI: 10.1080/14787210.2018.1453807] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Norelle Sherry
- Antimicrobial Reference and Research Unit, Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, Austin Health, Melbourne, Australia
| | - Benjamin Howden
- Antimicrobial Reference and Research Unit, Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, Austin Health, Melbourne, Australia
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Parbat N, Sherry N, Bellomo R, Schneider AG, Glassford NJ, Johnson PDR, Bailey M. The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters. Crit Care 2013; 17:R184. [PMID: 24004883 PMCID: PMC4057507 DOI: 10.1186/cc12867] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/25/2013] [Accepted: 09/03/2013] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION The management of suspected central venous catheter (CVC)-related sepsis by guide wire exchange (GWX) is not recommended. However, GWX for new antimicrobial surface treated (AST) triple lumen CVCs has never been studied. We aimed to compare the microbiological outcome of triple lumen AST CVCs inserted by GWX (GWX-CVCs) with newly inserted triple lumen AST CVCs (NI-CVCs). METHODS We studied a cohort of 145 consecutive patients with GWX-CVCs and contemporaneous site-matched control cohort of 163 patients with NI-CVCs in a tertiary intensive care unit (ICU). RESULTS GWX-CVC and NI-CVC patients were similar for mean age (58.7 vs. 62.2 years), gender (88 (60.7%) vs. 98 (60.5%) male) and illness severity on admission (mean Acute Physiology and Chronic Health Evaluation (APACHE) III: 71.3 vs. 72.2). However, GWX patients had longer median ICU lengths of stay (12.2 vs. 4.4 days; P < 0.001) and median hospital lengths of stay (30.7 vs. 18.0 days; P < 0.001). There was no significant difference with regard to the number of CVC tips with bacterial or fungal pathogen colonization among GWX-CVCs vs. NI-CVCs (5 (2.5%) vs. 6 (7.4%); P = 0.90). Catheter-associated blood stream infection (CA-BSI) occurred in 2 (1.4%) GWX patients compared with 3 (1.8%) NI-CVC patients (P = 0.75). There was no significant difference in hospital mortality (35 (24.1%) vs. 48 (29.4%); P = 0.29). CONCLUSIONS GWX-CVCs and NI-CVCs had similar rates of tip colonization at removal, CA-BSI and mortality. If the CVC removed by GWX is colonized, a new CVC must then be inserted at another site. In selected ICU patients at higher central vein puncture risk receiving AST CVCs GWX may be an acceptable initial approach to line insertion.
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Affiliation(s)
- Nisha Parbat
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Norelle Sherry
- Departments of Microbiology and Infectious Diseases, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
- ANZIC Research Centre, School of Public Health & Preventive Medicine, Monash University and Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Antoine G Schneider
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Neil J Glassford
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
- ANZIC Research Centre, School of Public Health & Preventive Medicine, Monash University and Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul DR Johnson
- Departments of Microbiology and Infectious Diseases, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Michael Bailey
- ANZIC Research Centre, School of Public Health & Preventive Medicine, Monash University and Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
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Sherry N, Qin J, Fuller MS, Xie Y, Mola O, Bauer M, McIntyre NS, Maxwell D, Liu D, Matias E, Armstrong C. Remote Internet access to advanced analytical facilities: a new approach with Web-based services. Anal Chem 2012; 84:7283-91. [PMID: 22894172 DOI: 10.1021/ac301513b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over the past decade, the increasing availability of the World Wide Web has held out the possibility that the efficiency of scientific measurements could be enhanced in cases where experiments were being conducted at distant facilities. Examples of early successes have included X-ray diffraction (XRD) experimental measurements of protein crystal structures at synchrotrons and access to scanning electron microscopy (SEM) and NMR facilities by users from institutions that do not possess such advanced capabilities. Experimental control, visual contact, and receipt of results has used some form of X forwarding and/or VNC (virtual network computing) software that transfers the screen image of a server at the experimental site to that of the users' home site. A more recent development is a web services platform called Science Studio that provides teams of scientists with secure links to experiments at one or more advanced research facilities. The software provides a widely distributed team with a set of controls and screens to operate, observe, and record essential parts of the experiment. As well, Science Studio provides high speed network access to computing resources to process the large data sets that are often involved in complex experiments. The simple web browser and the rapid transfer of experimental data to a processing site allow efficient use of the facility and assist decision making during the acquisition of the experimental results. The software provides users with a comprehensive overview and record of all parts of the experimental process. A prototype network is described involving X-ray beamlines at two different synchrotrons and an SEM facility. An online parallel processing facility has been developed that analyzes the data in near-real time using stream processing. Science Studio and can be expanded to include many other analytical applications, providing teams of users with rapid access to processed results along with the means for detailed discussion of their significance.
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Affiliation(s)
- N Sherry
- Faculty of Science, The University of Western Ontario, London, ON, Canada
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Prowle JR, Echeverri JE, Ligabo EV, Sherry N, Taori GC, Crozier TM, Hart GK, Korman TM, Mayall BC, Johnson PDR, Bellomo R. Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality. Crit Care 2011; 15:R100. [PMID: 21418635 PMCID: PMC3219371 DOI: 10.1186/cc10114] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/25/2011] [Accepted: 03/21/2011] [Indexed: 12/21/2022]
Abstract
INTRODUCTION To estimate the incidence of intensive care unit (ICU)-acquired bloodstream infection (BSI) and its independent effect on hospital mortality. METHODS We retrospectively studied acquisition of BSI during admissions of >72 hours to adult ICUs from two university-affiliated hospitals. We obtained demographics, illness severity and co-morbidity data from ICU databases and microbiological diagnoses from departmental electronic records. We assessed survival at hospital discharge or at 90 days if still hospitalized. RESULTS We identified 6339 ICU admissions, 330 of which were complicated by BSI (5.2%). Median time to first positive culture was 7 days (IQR 5-12). Overall mortality was 23.5%, 41.2% in patients with BSI and 22.5% in those without. Patients who developed BSI had higher illness severity at ICU admission (median APACHE III score: 79 vs. 68, P < 0.001). After controlling for illness severity and baseline demographics by Cox proportional-hazard model, BSI remained independently associated with risk of death (hazard ratio from diagnosis 2.89; 95% confidence interval 2.41-3.46; P < 0.001). However, only 5% of the deaths in this model could be attributed to acquired-BSI, equivalent to an absolute decrease in survival of 1% of the total population. When analyzed by microbiological classification, Candida, Staphylococcus aureus and gram-negative bacilli infections were independently associated with increased risk of death. In a sub-group analysis intravascular catheter associated BSI remained associated with significant risk of death (hazard ratio 2.64; 95% confidence interval 1.44-4.83; P = 0.002). CONCLUSIONS ICU-acquired BSI is associated with greater in-hospital mortality, but complicates only 5% of ICU admissions and its absolute effect on population mortality is limited. These findings have implications for the design and interpretation of clinical trials.
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Affiliation(s)
- John R Prowle
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia
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Bolivar J, Hultquist K, Raszynski A, Torbati D, Sherry N, Sussmane JB, Wolfsdorf J. Intratracheal pulmonary ventilation versus conventional mechanical ventilation: continuous carinal pressure monitoring at low and high flows and frequencies. ASAIO J 2001; 47:215-9. [PMID: 11374760 DOI: 10.1097/00002480-200105000-00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 02/03/2023] Open
Abstract
We continuously measured proximal and carinal pressures at low and high flow rates and frequencies during conventional mechanical ventilation (CMV) and intratracheal pulmonary ventilation (ITPV), using an artificial lung. The proximal peak inspiratory pressure (PIP), carinal PIP, proximal positive end expiratory pressure (PEEP), and carinal PEEP, or negative end expiratory pressure (NEEP), were measured during simulated CMV and ITPV. Two levels of frequency (30 and 90 per min) and two gas flow rates (3 and 6 L/min) were examined, in both dry and humid states (four combinations of gas flow and frequency at each state). The gas flow and inspiratory time were held constant throughout the CMV and ITPV trials. Humidification of the ventilatory circuit during ITPV prevented the accurate measurement of carinal pressures. This problem was solved by introducing a continuous "bias flow" of 11 ml/min into the pressure monitoring line. A combination of low gas flow and low frequency with CMV showed no significant differences between the proximal and carinal PIP, as well as the proximal and carinal PEEP. The same combination with ITPV, however, resulted in a significantly lower carinal PIP and PEEP, compared to proximal PIP and PEEP. Carinal PIP and PEEP during ITPV were also significantly lower than those observed during CMV with a low flow and low frequency rates. During both CMV and ITPV, using a combination of a high flow rate with a high breathing frequency, carinal PIPs were significantly lower than proximal PIPs. ITPV, however, generated much larger differences between proximal and carinal PIPs than the CMV. A significant NEEP was generated at the carinal level during ITPV with high flow rates, both with high and low frequencies. The NEEP did not occur with a low gas flow, in combination with either a low frequency or a high frequency. The "bias flow" had no significant effect on carinal pressures. In conclusion, ITPV, compared with CMV, generates a significantly lower carinal PIP, but it may also generate carinal NEEP. For safety reasons, therefore, it is essential to monitor carinal pressures continuously in patients treated with ITPV.
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Affiliation(s)
- J Bolivar
- Division of Critical Care Medicine, Miami Children's Hospital, Florida 33155-3009, USA
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Macleod KF, Sherry N, Hannon G, Beach D, Tokino T, Kinzler K, Vogelstein B, Jacks T. p53-dependent and independent expression of p21 during cell growth, differentiation, and DNA damage. Genes Dev 1995; 9:935-44. [PMID: 7774811 DOI: 10.1101/gad.9.8.935] [Citation(s) in RCA: 841] [Impact Index Per Article: 29.0] [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: 01/27/2023]
Abstract
Expression of p21 has been shown to be up-regulated by the p53 tumor suppressor gene in vitro in response to DNA-damaging agents. However, p21 expression can be regulated independently of p53, and here we show that expression of p21 in various tissues during development and in the adult mouse occurs in the absence of p53 function. However, most tissues tested did require p53 for p21 induction following exposure of the whole animal to gamma irradiation. These results show that normal tissue expression of p21 to high levels is not dependent on p53 and confirm that induction of p21 by DNA-damaging agents does require p53. p21 is expressed upon differentiation of p53-deficient murine erythroleukemia (MEL) cells, and the kinetics of induction of p21 in this system suggest that it may be involved in the growth arrest that precedes terminal differentiation. The gene is up-regulated in mouse fibroblasts in response to serum restimulation but the kinetics and levels of induction differ between wild-type and mutant cells. Expression of p21 message following serum restimulation is superinducible by cycloheximide in wild-type but not in p53-deficient cells. The increases in p21 mRNA are reflected in changes in p21 protein levels. p21 expression also appears to be regulated at the post-transcriptional level because moderate increases in mRNA expression, during differentiation of MEL cells and upon serum restimulation of fibroblasts, are followed by large increases in protein levels. Regulation of the mouse p21 promoter by p53 depends on two critical p53-binding sites located 1.95 and 2.85 kb upstream from the transcriptional initiation site. The sequences mediating serum responsiveness of the promoter map to a region containing the proximal p53 site. p53 appears to play a critical role in p21 induction following DNA damage. Moreover, p21 can be regulated independently of p53 in several situations including during normal tissue development, following serum stimulation, and during cellular differentiation.
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Affiliation(s)
- K F Macleod
- Howard Hughes Medical Institute, Massachusetts Institute of Technology, Cambridge 02139, USA
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Livingstone JB, Portnoi T, Sherry N, Rosenheim E, Onesti S. Comprehensive child psychiatry through a team approach. Children 1969; 16:181-6. [PMID: 5822509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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