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Chai MG, Tu Q, Cotta MO, Bauer MJ, Balch R, Okafor C, Comans T, Kruger P, Meyer J, Shekar K, Brady K, Fourie C, Sharp N, Vlad L, Whiley D, Ungerer JPJ, Mcwhinney BC, Farkas A, Paterson DL, Clark JE, Hajkowicz K, Raman S, Bialasiewicz S, Lipman J, Forde BM, Harris PNA, Schlapbach LJ, Coin L, Roberts JA, Irwin AD. Correction: Achievement of therapeutic antibiotic exposures using Bayesian dosing software in critically unwell children and adults with sepsis. Intensive Care Med 2024; 50:810. [PMID: 38563901 PMCID: PMC11078779 DOI: 10.1007/s00134-024-07393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Ming G Chai
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Quyen Tu
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Menino O Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
| | - Michelle J Bauer
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ross Balch
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Charles Okafor
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jason Meyer
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kiran Shekar
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Kara Brady
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Cheryl Fourie
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Natalie Sharp
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Luminita Vlad
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - David Whiley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Jacobus P J Ungerer
- Department of Chemical Pathology, Pathology Queensland, Brisbane, QLD, Australia
- Faculty of Biomedical Science, University of Queensland, Brisbane, QLD, Australia
| | - Brett C Mcwhinney
- Department of Chemical Pathology, Pathology Queensland, Brisbane, QLD, Australia
| | - Andras Farkas
- Optimum Dosing Strategies, Bloomingdale, NJ, 07403, USA
- Department of Pharmacy, Saint Clare's Health, Denville, NJ, 07834, USA
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Julia E Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Sainath Raman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Seweryn Bialasiewicz
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- ICU and Jameson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Nimes University Hospital, University of Montpellier, Nimes, France
| | - Brian M Forde
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lachlan Coin
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
| | - Adam D Irwin
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia.
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Peri AM, Harris PNA, Paterson DL. Host response signature trends in bacteraemia - authors' response. Infect Dis (Lond) 2024; 56:418-420. [PMID: 38446497 DOI: 10.1080/23744235.2024.2326591] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Anna Maria Peri
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - Patrick N A Harris
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- Herston Infectious Diseases Institute, Brisbane, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Peri AM, Chatfield MD, Ling W, Furuya-Kanamori L, Harris PNA, Paterson DL. Rapid diagnostic tests and antimicrobial stewardship programs for the management of bloodstream infection: What is their relative contribution to improving clinical outcomes? A systematic review and network meta-analysis. Clin Infect Dis 2024:ciae234. [PMID: 38676943 DOI: 10.1093/cid/ciae234] [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: 01/24/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Evidence about the clinical impact of rapid diagnostic tests (RDT) for the diagnosis of bloodstream infections is limited, and whether RDT are superior to conventional blood cultures (BC) embedded within antimicrobial stewardship programs (ASP) is unknown. METHODS We performed network meta-analyses (NMA) using results from studies of patients with bloodstream infection with the aim of comparing the clinical impact of RDT (applied on positive BC broth or whole blood) to conventional BC, both assessed with and without ASP with respect to mortality, length of stay (LOS) and time to optimal therapy (TOT). RESULTS Eighty-eight papers were selected, including 25,682 patient encounters. There was an appreciable amount of statistical heterogeneity within each meta-analysis. The NMA showed a significant reduction in mortality associated with the use of RDT + ASP vs BC alone (OR 0.72, 95%CI 0.59, 0.87) and with the use of RDT + ASP vs BC + ASP (OR 0.78 95%CI 0.63, 0.96). No benefit in survival was found associated with the use of RDT alone nor with BC + ASP compared to BC alone. A reduction in LOS was associated with RDT + ASP vs BC alone (0.91, 95%CI 0.84, 0.98) while no difference in LOS was shown between any other groups. A reduced TOT was shown when RDT + ASP was compared to BC alone (-29 h, 95%CI -35, -23), BC + ASP (-18 h, 95%CI -27, -10) and to RDT alone (-12 h, 95%CI -20, -3). CONCLUSION The use of RDT + ASP may lead to a survival benefit even when introduced in settings already adopting effective ASP in association with conventional BC.
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Affiliation(s)
- Anna Maria Peri
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, QLD, 4029, Australia
| | - Mark D Chatfield
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, QLD, 4029, Australia
| | - Weiping Ling
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, QLD, 4029, Australia
| | - Luis Furuya-Kanamori
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, QLD, 4029, Australia
| | - Patrick N A Harris
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, QLD, 4029, Australia
- Herston Infectious Diseases Institute, Herston, Brisbane, QLD 4029, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane QLD, 4029, Australia
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, QLD, 4029, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Khatri D, Falconer N, de Camargo Catapan S, Coulter S, Gray LC, Paterson DL, Freeman C. Exploring stakeholders' perspectives on antibiogram use, development, and implementation in residential aged care settings. Res Social Adm Pharm 2024:S1551-7411(24)00125-6. [PMID: 38688774 DOI: 10.1016/j.sapharm.2024.04.011] [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: 11/14/2023] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Knowledge of local antibiotic resistance data provided by antibiograms (cumulative-antimicrobial-susceptibility-tests) can assist prescribers to make appropriate empirical antibiotic choices. OBJECTIVE This study explored the perceptions and knowledge of key stakeholders about the role of antibiograms in residential aged care facilities (RACF), and to understand barriers and enablers of antibiogram development and implementation in this setting. METHOD Semi-structured interviews were conducted with aged-care health professionals ('end-users') and antibiogram content experts. This study was conducted in Queensland, Australia in 2023. Using qualitative techniques, framework thematic analysis was used to identify themes, which were mapped to the 'Integrated Promoting Action on Research Implementation in Health Services' framework constructs. RESULTS Twenty interviews were conducted comprising of five 'content-experts' and fifteen 'end-users'. Five themes were identified which indicated lack of knowledge about how to use antibiograms, and its availability. Potential insufficient data was the primary issue identified by content experts with regards to feasibility of annual antibiograms. Pragmatic solutions were offered, such as pooling pathology data from facilities in the same geographical location, extending antibiogram data to two-or three-yearly, or utilising local hospital antibiograms. Presenting antibiogram data in a mode and format suiting preferences of individual users would encourage uptake and improve usability. Antimicrobial stewardship (AMS) champions and pharmacists were highlighted as drivers of educating and promoting antibiogram use. CONCLUSION Clinicians recognised the potential role of antibiograms in improving empirical antibiotic prescribing choices. Establishing their baseline knowledge provides an essential starting point for the education needs of this group. This study provides practical recommendations regarding the presentation of antibiograms to ensure appropriate use and uptake as an AMS tool in RACFs. Pragmatic solutions suggested to overcome challenges of antibiogram development for RACFs should be applied and evaluated to determine feasibility of RACF-specific antibiograms.
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Affiliation(s)
- Dipti Khatri
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.
| | - Nazanin Falconer
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD, Australia
| | - Soraia de Camargo Catapan
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; UQ Centre for Online Health (COH), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Sonali Coulter
- Pathology Queensland, Microbiology Queensland Public Health and Scientific Services, Herston, QLD, Australia
| | - Leonard C Gray
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Christopher Freeman
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia
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Wise MG, Karlowsky JA, Mohamed N, Hermsen ED, Kamat S, Townsend A, Brink A, Soriano A, Paterson DL, Moore LSP, Sahm DF. Global trends in carbapenem- and difficult-to-treat-resistance among World Health Organization priority bacterial pathogens: ATLAS surveillance program 2018-2022. J Glob Antimicrob Resist 2024; 37:168-175. [PMID: 38608936 DOI: 10.1016/j.jgar.2024.03.020] [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: 02/28/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES To report trends in carbapenem resistance and difficult-to-treat resistance (DTR) among clinical isolates of Gram-negative priority pathogens collected by the ATLAS global surveillance program from 2018 to 2022. METHODS Reference broth microdilution testing was performed in a central laboratory for 79,214 Enterobacterales, 30,504 Pseudomonas aeruginosa, and 13,500 Acinetobacter baumannii-calcoaceticus complex isolates collected by a constant set of 157 medical centres in 49 countries in Asia Pacific (APAC), Europe (EUR), Latin America (LATAM), Middle East-Africa (MEA), and North America (NA) regions. MICs were interpreted by 2023 CLSI M100 breakpoints. β-lactamase genes were identified for meropenem-nonsusceptible (MIC ≥2 mg/L) Enterobacterales isolates. RESULTS Carbapenem-resistant Enterobacterales (CRE) detection increased (P < 0.05) in APAC, EUR, LATAM, and MEA regions and decreased in NA, while annual DTR percentages increased in all five regions. Carbapenem-resistant P. aeruginosa (CRPA; decreased in MEA region) and carbapenem-resistant A. baumannii-calcoaceticus complex (CRAB; decreased in MEA region and increased in EUR) remained relatively stable over time in all regions, although notably, annual percentages of CRAB and DTR A. baumannii-calcoaceticus complex isolates were consistently >25 percentage points lower in NA than in other regions. For all regions except NA, the majority of changes in CRE percentages could be attributed to hospital-acquired infections. Among meropenem-nonsusceptible Enterobacterales, KPC was the most frequent carbapenemase in NA and EUR each year. NDM was the most prevalent carbapenemase detected in 2022 in other global regions. CONCLUSION CRE, CRPA, CRAB, and DTR rates vary among global regions over time highlighting the need for continuing surveillance to inform treatment strategies and antimicrobial stewardship.
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Affiliation(s)
| | - James A Karlowsky
- IHMA, Schaumburg, IL; Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Andy Townsend
- Pfizer Hospital Medical Affairs, Pfizer, Congleton, UK
| | - Adrian Brink
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Luke S P Moore
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK; Imperial College Healthcare NHS Trust, North West London Pathology, London, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, London, UK
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Kain MJW, Reece NL, Parry CM, Rajahram GS, Paterson DL, Woolley SD. The Rapid Emergence of Hypervirulent Klebsiella Species and Burkholderia pseudomallei as Major Health Threats in Southeast Asia: The Urgent Need for Recognition as Neglected Tropical Diseases. Trop Med Infect Dis 2024; 9:80. [PMID: 38668541 PMCID: PMC11054678 DOI: 10.3390/tropicalmed9040080] [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: 01/27/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/29/2024] Open
Abstract
The World Health Organization (WHO)'s list of neglected tropical diseases (NTDs) highlights conditions that are responsible for devastating health, social and economic consequences, and yet, they are overlooked and poorly resourced. The NTD list does not include conditions caused by Gram-negative bacilli (GNB). Infections due to GNB cause significant morbidity and mortality and are prevalent worldwide. Southeast Asia is a WHO region of low- and middle-income countries carrying the largest burden of NTDs. Two significant health threats in Southeast Asia are Burkholderia pseudomallei (causing melioidosis) and hypervirulent Klebsiella pneumoniae (HvKp). Both diseases have high mortality and increasing prevalence, yet both suffer from a lack of awareness, significant under-resourcing, incomplete epidemiological data, limited diagnostics, and a lack of evidence-based treatment. Emerging evidence shows that both melioidosis and HvKp are spreading globally, including in high-income countries, highlighting the potential future global threat they pose. In this article, we review both conditions, identifying current trends and challenges in Southeast Asia and areas for future research. We also argue that melioidosis and HvKp merit inclusion as NTDs, and that mandatory global surveillance and reporting systems should be established, and we make an urgent call for research to better understand, detect, and treat these neglected diseases.
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Affiliation(s)
| | | | - Christopher M. Parry
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Giri Shan Rajahram
- Department of Medicine, Queen Elizabeth II Hospital, Kota Kinabalu 88300, Malaysia
- Infectious Diseases Society, Kota Kinabalu Sabah-Menzies School of Health Research, Clinical Research Unit, Kota Kinabalu 88994, Malaysia
| | - David L. Paterson
- ADVANCE-ID Network, Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119077, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Stephen D. Woolley
- Institute of Naval Medicine, Alverstoke, Hampshire PO12 2DL, UK
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals Foundation NHS Trust, Liverpool L7 8YE, UK
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Aslan AT, Paterson DL. Epidemiology and clinical significance of carbapenemases in Australia: a narrative review. Intern Med J 2024; 54:535-544. [PMID: 38584572 DOI: 10.1111/imj.16374] [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: 12/06/2023] [Accepted: 02/23/2024] [Indexed: 04/09/2024]
Abstract
Carbapenemase-producing gram-negative bacteria (CP-GNB) infections threaten public health with high mortality, morbidity and treatment costs. Although frequencies remain low in Australia (total number of CP-GNB infections reported was 907 in 2022), blaIMP-4 has established low levels of endemicity in many states. Imipenemase metallo-β-lactamase types alone accounted for more than half of all carbapenemases in carbapenemase-producing Enterobacterales isolates in Australia, particularly in Enterobacter cloacae complex. New Delhi metallo-β-lactamase constitutes almost 25% of all carbapenemases in Australia and was identified predominantly in Escherichia coli. The OXA-48-like carbapenemases include almost 10% of all carbapenemases and are mainly seen in Klebsiella pneumoniae and E. coli. Although K. pneumoniae carbapenemase-type carbapenemases are rare in Australia, some local outbreaks have occurred. Most carbapenem-resistant (CR) Pseudomonas aeruginosa strains in Australia do not produce carbapenemases. Finally, OXA-23-like carbapenemases are overwhelmingly positive in CR-Acinetobacter baumannii strains in Australia. Treatment of CR-GNB infections challenges physicians. Of 10 new antibiotics active against at least some CR-GNB infections that are approved by the US Food and Drug Administration, just three are approved for use in Australia. In this context, there is still an unmet need for novel antibacterials that can be used for the treatment of CR-GNB infections in Australia, as well as a pressing requirement for new mechanisms to 'de-link' antibiotic sales from their availability. In this narrative review, we aim to overview the epidemiology and clinical significance of carbapenem resistance in Australia as it pertains to Enterobacterales, P. aeruginosa and A. baumannii.
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Affiliation(s)
- Abdullah Tarik Aslan
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Paterson DL. Antibacterial agents active against Gram Negative Bacilli in phase I, II, or III clinical trials. Expert Opin Investig Drugs 2024; 33:371-387. [PMID: 38445383 DOI: 10.1080/13543784.2024.2326028] [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: 01/07/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Antimicrobial resistance is a major threat to modern healthcare, and it is often regarded that the antibiotic pipeline is 'dry.' AREAS COVERED Antimicrobial agents active against Gram negative bacilli in Phase I, II, or III clinical trials were reviewed. EXPERT OPINION Nearly 50 antimicrobial agents (28 small molecules and 21 non-traditional antimicrobial agents) active against Gram-negative bacilli are currently in clinical trials. These have the potential to provide substantial improvements to the antimicrobial armamentarium, although it is known that 'leakage' from the pipeline occurs due to findings of toxicity during clinical trials. Significantly, a lack of funding for large phase III clinical trials is likely to prevent trials occurring for the indications most relevant to loss of life attributed to antimicrobial resistance such as ventilator-associated pneumonia. Non-traditional antimicrobial agents face issues in clinical development such as a lack of readily available and reliable susceptibility tests, and the potential need for superiority trials rather than non-inferiority trials. Most importantly, concrete plans must be made during clinical development for access of new antimicrobial agents to areas of the world where resistance to Gram negative bacilli is most frequent.
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Affiliation(s)
- David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Peri AM, Rafiei N, O'Callaghan K, Brischetto A, Graves B, Sinclair H, Eustace M, Lim K, Parkes-Smith J, Stewart A, Davidson N, Tabah A, Bergh H, Chatfield MD, Harris PNA, Paterson DL. Host response signature trends in persistent bacteraemia and metastatic infection due to Staphylococcus aureus and Gram-negative bacilli: a prospective multicentre observational study. Infect Dis (Lond) 2024; 56:268-276. [PMID: 38093600 DOI: 10.1080/23744235.2023.2294122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/06/2023] [Indexed: 03/16/2024] Open
Abstract
BACKGROUND A prompt diagnosis of bacteraemia and sepsis is essential. Markers to predict the risk of persistent bacteraemia and metastatic infection are lacking. SeptiCyte RAPID is a host response assay stratifying patients according to the risk of infectious vs sterile inflammation through a scoring system (SeptiScore). In this study we explore the association between SeptiScore and persistent bacteraemia as well as metastatic and persistent infection in the context of a proven bacteraemia episode. METHODS This is a prospective multicentre observational 14-month study on patients with proven bacteraemia caused by Staphylococcus aureus or Gram-negative bacilli. Samples for assessment by SeptiCyte were collected with paired blood cultures for 4 consecutive days after the index blood culture. RESULTS We included 86 patients in the study, 40 with S. aureus and 46 with Gram-negative bacilli bacteraemia. SeptiScores over the follow-up were higher in patients with Gram-negative compared to S. aureus bacteraemia (median 6.4, IQR 5.5-7.4 vs 5.6 IQR 5.1-6.2, p = 0.002). Higher SeptiScores were found to be associated with positive blood cultures at follow-up (AUC = 0.86, 95%CI 0.68-1.00) and with a diagnosis of metastatic infection at day 1 and 2 of follow-up (AUC = 0.79, 95%CI 0.57-1.00 and AUC = 0.82, 95%CI 0.63-1.00 respectively) in the context of Gram-negative bacteraemia while no association between SeptiScore and the outcomes of interest was observed in S. aureus bacteraemia. Mixed models confirmed the association of SeptiScore with positive blood cultures at follow-up (p = 0.04) and metastatic infection (p = 0.03) in the context of Gram-negative bacteraemia but not S. aureus bacteraemia after adjusting for confounders. CONCLUSIONS SeptiScores differ in the follow-up of S. aureus and Gram-negative bacteraemia. In the setting of Gram-negative bacteraemia SeptiScore demonstrated a good negative predictive value for the outcomes of interest and might help rule out the persistence of infection defined as metastatic spread, lack of source control or persistent bacteraemia.
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Affiliation(s)
- Anna Maria Peri
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Nastaran Rafiei
- Infectious Diseases Unit, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Kevin O'Callaghan
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Anna Brischetto
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Bianca Graves
- Herston Infectious Diseases Institute, Herston, Brisbane, Queensland, Australia
| | - Holly Sinclair
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Matthew Eustace
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Karen Lim
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Jill Parkes-Smith
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Adam Stewart
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Natalie Davidson
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Haakon Bergh
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Patrick N A Harris
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Herston, Brisbane, Queensland, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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10
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Chai MG, Tu Q, Cotta MO, Bauer MJ, Balch R, Okafor C, Comans T, Kruger P, Meyer J, Shekar K, Brady K, Fourie C, Sharp N, Vlad L, Whiley D, Ungerer JPJ, Mcwhinney BC, Farkas A, Paterson DL, Clark JE, Hajkowicz K, Raman S, Bialasiewicz S, Lipman J, Forde BM, Harris PNA, Schlapbach LJ, Coin L, Roberts JA, Irwin AD. Achievement of therapeutic antibiotic exposures using Bayesian dosing software in critically unwell children and adults with sepsis. Intensive Care Med 2024; 50:539-547. [PMID: 38478027 PMCID: PMC11018654 DOI: 10.1007/s00134-024-07353-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/11/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Early recognition and effective treatment of sepsis improves outcomes in critically ill patients. However, antibiotic exposures are frequently suboptimal in the intensive care unit (ICU) setting. We describe the feasibility of the Bayesian dosing software Individually Designed Optimum Dosing Strategies (ID-ODS™), to reduce time to effective antibiotic exposure in children and adults with sepsis in ICU. METHODS A multi-centre prospective, non-randomised interventional trial in three adult ICUs and one paediatric ICU. In a pre-intervention Phase 1, we measured the time to target antibiotic exposure in participants. In Phase 2, antibiotic dosing recommendations were made using ID-ODS™, and time to target antibiotic concentrations were compared to patients in Phase 1 (a pre-post-design). RESULTS 175 antibiotic courses (Phase 1 = 123, Phase 2 = 52) were analysed from 156 participants. Across all patients, there was no difference in the time to achieve target exposures (8.7 h vs 14.3 h in Phase 1 and Phase 2, respectively, p = 0.45). Sixty-one courses in 54 participants failed to achieve target exposures within 24 h of antibiotic commencement (n = 36 in Phase 1, n = 18 in Phase 2). In these participants, ID-ODS™ was associated with a reduction in time to target antibiotic exposure (96 vs 36.4 h in Phase 1 and Phase 2, respectively, p < 0.01). These patients were less likely to exhibit subtherapeutic antibiotic exposures at 96 h (hazard ratio (HR) 0.02, 95% confidence interval (CI) 0.01-0.05, p < 0.01). There was no difference observed in in-hospital mortality. CONCLUSIONS Dosing software may reduce the time to achieve target antibiotic exposures. It should be evaluated further in trials to establish its impact on clinical outcomes.
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Affiliation(s)
- Ming G Chai
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Quyen Tu
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Menino O Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
| | - Michelle J Bauer
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ross Balch
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Charles Okafor
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jason Meyer
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kiran Shekar
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Kara Brady
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Cheryl Fourie
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Natalie Sharp
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Luminita Vlad
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - David Whiley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Jacobus P J Ungerer
- Department of Chemical Pathology, Pathology Queensland, Brisbane, QLD, Australia
- Faculty of Biomedical Science, University of Queensland, Brisbane, QLD, Australia
| | - Brett C Mcwhinney
- Department of Chemical Pathology, Pathology Queensland, Brisbane, QLD, Australia
| | - Andras Farkas
- Optimum Dosing Strategies, Bloomingdale, NJ, 07403, USA
- Department of Pharmacy, Saint Clare's Health, Denville, NJ, 07834, USA
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Julia E Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Sainath Raman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Seweryn Bialasiewicz
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- ICU and Jameson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Nimes University Hospital, University of Montpellier, Nimes, France
| | - Brian M Forde
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lachlan Coin
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
| | - Adam D Irwin
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia.
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11
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Chew R, Tozer S, Ulett K, Paterson DL, Whiley D, Sloots T, Fielding D, Zappala C, Bashirzadeh F, Hundloe J, Bletchley C, Woods ML. Comparing Polymerase Chain Reaction Testing of Nasopharyngeal Swab and Lower Respiratory Tract Specimens for the Diagnosis of Pneumocystis jirovecii Pneumonia. Open Forum Infect Dis 2024; 11:ofae071. [PMID: 38444816 PMCID: PMC10913836 DOI: 10.1093/ofid/ofae071] [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: 11/21/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
Using nasopharyngeal (NP) swab samples instead of lower respiratory tract specimens for polymerase chain reaction (PCR) to diagnose Pneumocystis jirovecii pneumonia (PJP) may be better tolerated and improve diagnostic accessibility. In this 2-year Australian retrospective cohort study of patients with clinically suspected PJP, P jirovecii PCR on NP swab samples had perfect specificity but low sensitivity (0.66).
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Affiliation(s)
- Rusheng Chew
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mathematical and Economic Modelling Department, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sarah Tozer
- Central Laboratory, Pathology Queensland, Central Laboratory, Brisbane, Australia
| | - Kimberly Ulett
- Department of Medicine, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - David L Paterson
- Central Laboratory, Pathology Queensland, Central Laboratory, Brisbane, Australia
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David Whiley
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Theo Sloots
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David Fielding
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Christopher Zappala
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Farzad Bashirzadeh
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Justin Hundloe
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Cheryl Bletchley
- Central Laboratory, Pathology Queensland, Central Laboratory, Brisbane, Australia
| | - Marion L Woods
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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12
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Peri AM, O’Callaghan K, Rafiei N, Graves B, Sinclair H, Brischetto A, Lim K, Parkes-Smith J, Eustace M, Davidson N, Tabah A, Stewart A, Chatfield MD, Harris PNA, Paterson DL. Persistence of Detectable Pathogens by Culture-Independent Systems (T2 Magnetic Resonance) in Patients With Bloodstream Infection: Prognostic Role and Possible Clinical Implications. Clin Infect Dis 2024; 78:283-291. [PMID: 37890109 PMCID: PMC10874273 DOI: 10.1093/cid/ciad663] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Persistent Staphylococcus aureus bacteremia is associated with metastatic infection and adverse outcomes, whereas gram-negative bacteremia is normally transient and shorter course therapy is increasingly advocated for affected patients. Whether the prolonged detection of pathogen DNA in blood by culture-independent systems could have prognostic value and guide management decisions is unknown. METHODS We performed a multicenter, prospective, observational study on 102 patients with bloodstream infection (BSI) to compare time to bloodstream clearance according to T2 magnetic resonance and blood cultures over a 4-day follow-up. We also explored the association between duration of detectable pathogens according to T2 magnetic resonance (magnetic resonance-DNAemia [MR-DNAemia]) and clinical outcomes. RESULTS Time to bloodstream clearance according to T2 magnetic resonance was significantly longer than blood culture clearance (HR, .54; 95% CI, .39-.75) and did not differ according to the causative pathogen (P = .5). Each additional day of MR-DNAemia increased the odds of persistent infection (defined as metastatic infection or delayed source control) both in the overall population (OR, 1.98; 95% CI, 1.45-2.70) and in S. aureus (OR, 1.92; 95% CI, 1.12-3.29) and gram-negative bacteremia (OR, 2.21; 95% CI, 1.35-3.60). MR-DNAemia duration was also associated with no improvement in Sequential Organ Failure Assessment score at day 7 from infection onset (OR, 1.76; 95% CI, 1.21-2.56). CONCLUSIONS T2 magnetic resonance may help diagnose BSI in patients on antimicrobials with negative blood cultures as well as to identify patients with metastatic infection, source control failure, or adverse short-term outcome. Future studies may inform its usefulness within the setting of antimicrobial stewardship programs.
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Affiliation(s)
- Anna Maria Peri
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Kevin O’Callaghan
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Nastaran Rafiei
- Infectious Diseases Unit, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Bianca Graves
- Herston Infectious Diseases Institute, Herston, Brisbane, Queensland, Australia
| | - Holly Sinclair
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Anna Brischetto
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Karen Lim
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Jill Parkes-Smith
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Matthew Eustace
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Natalie Davidson
- Infectious Diseases Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Adam Stewart
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Herston, Brisbane, Queensland, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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13
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Wang M, Ge L, Chen L, Komarow L, Hanson B, Reyes J, Cober E, Alenazi T, Zong Z, Xie Q, Liu Z, Li L, Yu Y, Gao H, Kanj SS, Figueroa J, Herc E, Cordova E, Weston G, Ananth Tambyah P, Garcia-Diaz J, Kaye KS, Dhar S, Munita JM, Salata RA, Vilchez S, Stryjewski ME, Villegas Botero MV, Iovleva A, Evans SR, Baum K, Hill C, Kreiswirth BN, Patel R, Paterson DL, Arias CA, Bonomo RA, Chambers HF, Fowler VG, Satlin MJ, van Duin D, Doi Y. Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant Acinetobacter baumannii Among Patients From Different Global Regions. Clin Infect Dis 2024; 78:248-258. [PMID: 37738153 PMCID: PMC10874260 DOI: 10.1093/cid/ciad556] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAb) is 1 of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb. METHODS In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis. RESULTS Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases. CONCLUSIONS CRAb infection types and clinical outcomes differed significantly across regions. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. Clinical Trials Registration. NCT03646227.
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Affiliation(s)
- Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China,Shanghai, China
| | - Lizhao Ge
- The Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Liang Chen
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Lauren Komarow
- The Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Blake Hanson
- Center for Infectious Diseases and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, Texas, USA
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia
| | - Eric Cober
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thamer Alenazi
- College of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Zhiyong Zong
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Qing Xie
- Department of Infectious Disease, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhengyin Liu
- Infectious Disease Section, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hainv Gao
- Department of Infectious Diseases, Shulan Hangzhou Hospital, Hangzhou, China
| | - Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jairo Figueroa
- Department of Infectious Diseases, Hospital Universitario Erasmo Meoz ESE, Cúcuta, Colombia
| | - Erica Herc
- Division of Infectious Diseases, Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ezequiel Cordova
- Infectious Diseases Unit, Hospital Cosme Argerich de Buenos Aires, Buenos Aires, Argentina
| | - Gregory Weston
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paul Ananth Tambyah
- Infectious Diseases Translational Research Programme, National University of Singapore, Singapore, Singapore
| | - Julia Garcia-Diaz
- Division of Infectious Diseases, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Keith S Kaye
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Division of Allergy, Immunology and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sorabh Dhar
- Division of Infectious Disease, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jose M Munita
- Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Samuel Vilchez
- Center for Infectious Disease Research, Department of Microbiology and Parasitology, School of Medicine, National Autonomous University of Nicaragua, Leon, Nicaragua
| | - Martin E Stryjewski
- Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | | | - Alina Iovleva
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Scott R Evans
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China,Shanghai, China
- Department of Biostatics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Keri Baum
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carol Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Barry N Kreiswirth
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David L Paterson
- Department of Infectious Diseases, University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Cesar A Arias
- Division of Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, Texas, USA
- Center for Infectious Diseases Research, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, Texas, USA
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Case Western Reserve University VA Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Henry F Chambers
- Department of Medicine, University of California SanFrancisco, San Francisco, California, USA
| | - Vance G Fowler
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael J Satlin
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Yohei Doi
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Microbiology and Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
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14
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Harris PNA, Bauer MJ, Lüftinger L, Beisken S, Forde BM, Balch R, Cotta M, Schlapbach L, Raman S, Shekar K, Kruger P, Lipman J, Bialasiewicz S, Coin L, Roberts JA, Paterson DL, Irwin AD. Rapid nanopore sequencing and predictive susceptibility testing of positive blood cultures from intensive care patients with sepsis. Microbiol Spectr 2024; 12:e0306523. [PMID: 38193658 PMCID: PMC10846127 DOI: 10.1128/spectrum.03065-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
We aimed to evaluate the performance of Oxford Nanopore Technologies (ONT) sequencing from positive blood culture (BC) broths for bacterial identification and antimicrobial susceptibility prediction. Patients with suspected sepsis in four intensive care units were prospectively enrolled. Human-depleted DNA was extracted from positive BC broths and sequenced using ONT (MinION). Species abundance was estimated using Kraken2, and a cloud-based system (AREScloud) provided in silico predictive antimicrobial susceptibility testing (AST) from assembled contigs. Results were compared to conventional identification and phenotypic AST. Species-level agreement between conventional methods and AST predicted from sequencing was 94.2% (49/52), increasing to 100% in monomicrobial infections. In 262 high-quality AREScloud AST predictions across 24 samples, categorical agreement (CA) was 89.3%, with major error (ME) and very major error (VME) rates of 10.5% and 12.1%, respectively. Over 90% CA was achieved for some taxa (e.g., Staphylococcus aureus) but was suboptimal for Pseudomonas aeruginosa. In 470 AST predictions across 42 samples, with both high quality and exploratory-only predictions, overall CA, ME, and VME rates were 87.7%, 8.3%, and 28.4%. VME rates were inflated by false susceptibility calls in a small number of species/antibiotic combinations with few representative resistant isolates. Time to reporting from sequencing could be achieved within 8-16 h from BC positivity. Direct sequencing from positive BC broths is feasible and can provide accurate predictive AST for some species. ONT-based approaches may be faster but significant improvements in accuracy are required before it can be considered for clinical use.IMPORTANCESepsis and bloodstream infections carry a high risk of morbidity and mortality. Rapid identification and susceptibility prediction of causative pathogens, using Nanopore sequencing direct from blood cultures, may offer clinical benefit. We assessed this approach in comparison to conventional phenotypic methods and determined the accuracy of species identification and susceptibility prediction from genomic data. While this workflow holds promise, and performed well for some common bacterial species, improvements in sequencing accuracy and more robust predictive algorithms across a diverse range of organisms are required before this can be considered for clinical use. However, results could be achieved in timeframes that are faster than conventional phenotypic methods.
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Affiliation(s)
- Patrick N. A. Harris
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Herston Infectious Disease Institute, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia
| | - Michelle J. Bauer
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | | | - Brian M. Forde
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Ross Balch
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Menino Cotta
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Luregn Schlapbach
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sainath Raman
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, South Brisbane, Australia
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Anaesthesiology and Critical Care, The University of Queensland, St Lucia, Queensland, Australia
| | - Jeff Lipman
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Intensive Care Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Seweryn Bialasiewicz
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, Faculty of Science, University of Queensland, Brisbane, Australia
| | - Lachlan Coin
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason A. Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Herston Infectious Disease Institute, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - David L. Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- ADVANCE-ID, Saw Swee School of Public Health, National University of Singapore, Singapore, Singapore
| | - Adam D. Irwin
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Infection Management and Prevention Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
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15
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Hardy M, Harris PNA, Paterson DL, Chatfield MD, Mo Y. Win ratio analyses of piperacillin-tazobactam versus meropenem for ceftriaxone non-susceptible Escherichia coli or Klebsiella pneumoniae bloodstream infections: Post-hoc insights from the MERINO trial. Clin Infect Dis 2024:ciae050. [PMID: 38306577 DOI: 10.1093/cid/ciae050] [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: 11/21/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Clinical trials of treatments for serious infections commonly use the primary endpoint of all-cause mortality. However, many trial participants survive their infection and this endpoint may not truly reflect important benefits and risks of therapy. The win ratio uses a hierarchical composite endpoint that can incorporate and prioritise outcome measures by relative clinical importance. METHODS The win ratio methodology was applied post-hoc to outcomes observed in the MERINO trial, which compared piperacillin-tazobactam with meropenem. We quantified the win ratio with a primary hierarchical composite endpoint, including all-cause mortality, microbiological relapse and secondary infection. A win ratio of one would correspond to no difference between the two antibiotics, while a ratio less than one favors meropenem. Further analyses were performed to calculate the win odds and to introduce a continuous outcome variable in order to reduce ties. RESULTS With the hierarchy of all-cause mortality, microbiological relapse and secondary infection, the win ratio estimate was 0.40 (95% CI: 0.22, 0.71; p=0.002), favoring meropenem over piperacillin-tazobactam. However, 73.4% of the pairs were tied due to the small proportion of events. The win odds, a modification of the win ratio accounting for ties, was 0.79 (95% CI: 0.68, 0.92). The addition of length of stay to the primary composite, greatly minimised the number of ties (4.6%) with a win ratio estimate of 0.77 (95% CI: 0.60-0.99; p=0.04). CONCLUSIONS The application of the win ratio methodology to the MERINO trial data illustrates its utility and feasibility for use in antimicrobial trials.
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Affiliation(s)
- Melissa Hardy
- University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Patrick N A Harris
- University of Queensland Centre for Clinical Research, Brisbane, Australia
- Central Microbiology Laboratory, Pathology Queensland, Brisbane, Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Brisbane, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark D Chatfield
- University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Yin Mo
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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16
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Aslan AT, Ezure Y, Harris PNA, Paterson DL. Scoping review of risk-scoring tools for early prediction of bloodstream infections caused by carbapenem-resistant Enterobacterales: do we really have a reliable risk-scoring tool? JAC Antimicrob Resist 2024; 6:dlae032. [PMID: 38414813 PMCID: PMC10899000 DOI: 10.1093/jacamr/dlae032] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
Background Bloodstream infections (BSIs) caused by carbapenem-resistant Enterobacterales (CRE) are a global health concern. Rapid identification of CRE may improve patient outcomes and reduce inappropriate antibiotic prescription. The use of risk-scoring tools (RSTs) can be valuable for optimizing the decision-making process for empirical antibiotic therapy of suspected CRE bacteraemia. These tools can also be used to triage use of expensive rapid diagnostic methods. Methods We systematically reviewed the relevant literature in PubMed/MEDLINE, CINAHL, Cochrane, Web of Science, Embase and Scopus up to 1 November 2022 to identify RSTs that predict CRE BSIs. The literature review and analysis of the articles were performed by two researchers; any inconsistencies were resolved through discussion. Results We identified 9 RSTs developed for early prediction of CRE BSIs and only logistic regression was used for most studies. These RSTs were quite different from each other in terms of their performance and the variables they included. They also had notable limitations and very few of them were externally validated. Conclusions RSTs for early prediction of CRE BSIs have limitations and lack of external validity outside the local setting in which they were developed. Future studies to identify optimal RSTs in high and low CRE-endemic settings are warranted. Approaches based on rapid diagnostics and RSTs should be compared with a treatment approach using both methods in a randomized controlled trial.
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Affiliation(s)
- Abdullah Tarik Aslan
- Faculty of Medicine, University of Queensland, UQ Centre for Clinical Research (UQCCR), Level 8, Building 71/918 Bowen Bridge Rd Herston, Brisbane, QLD 4029, Australia
| | - Yukiko Ezure
- Faculty of Medicine, University of Queensland, UQ Centre for Clinical Research (UQCCR), Level 8, Building 71/918 Bowen Bridge Rd Herston, Brisbane, QLD 4029, Australia
| | - Patrick N A Harris
- Faculty of Medicine, University of Queensland, UQ Centre for Clinical Research (UQCCR), Level 8, Building 71/918 Bowen Bridge Rd Herston, Brisbane, QLD 4029, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Permana B, Harris PNA, Roberts LW, Cuddihy T, Paterson DL, Beatson SA, Forde BM. HAIviz: an interactive dashboard for visualising and integrating healthcare-associated genomic epidemiological data. Microb Genom 2024; 10:001200. [PMID: 38358326 PMCID: PMC10926687 DOI: 10.1099/mgen.0.001200] [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: 10/25/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Existing tools for phylogeographic and epidemiological visualisation primarily provide a macro-geographic view of epidemic and pandemic transmission events but offer little support for detailed investigation of outbreaks in healthcare settings. Here, we present HAIviz, an interactive web-based application designed for integrating and visualising genomic epidemiological information to improve the tracking of healthcare-associated infections (HAIs). HAIviz displays and links the outbreak timeline, building map, phylogenetic tree, patient bed movements, and transmission network on a single interactive dashboard. HAIviz has been developed for bacterial outbreak investigations but can be utilised for general epidemiological investigations focused on built environments for which visualisation to customised maps is required. This paper describes and demonstrates the application of HAIviz for HAI outbreak investigations.
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Affiliation(s)
- Budi Permana
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Queensland, Australia
| | - Patrick N. A. Harris
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
- Pathology Queensland, Central Laboratory, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - Leah W. Roberts
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Immunology and Infection Control, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Thom Cuddihy
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - David L. Paterson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Scott A. Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
- Australian Infectious Disease Research Centre, The University of Queensland, St Lucia, Queensland, Australia
| | - Brian M. Forde
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
- Australian Infectious Disease Research Centre, The University of Queensland, St Lucia, Queensland, Australia
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18
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Paterson DL, Sulaiman HB. "Real-World" Evidence, Target Trial Emulation, and Randomized Clinical Trials-Which Data Should Clinicians Rely on When Choosing Antibiotics? JAMA Netw Open 2024; 7:e2352250. [PMID: 38261324 DOI: 10.1001/jamanetworkopen.2023.52250] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Affiliation(s)
- David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Helmi Bin Sulaiman
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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19
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Khatri D, Freeman C, Falconer N, de Camargo Catapan S, Gray LC, Paterson DL. Clinical impact of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes-A systematic review. Am J Infect Control 2024; 52:107-122. [PMID: 37604208 DOI: 10.1016/j.ajic.2023.08.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) guidelines advocate for the use of antibiograms (cumulative antimicrobial susceptibility test data) as a tool to guide empirical antibiotic prescribing and inform local treatment guidelines. The objective of this review is to evaluate the effectiveness of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes. METHODS Embase, PubMed, CINAHL, and International Pharmacy Abstracts (IPA) databases were searched from inception until September 2022, to identify studies of antibiogram-related interventions in all health care settings. The National Institutes of Health Quality Assessment Tools were used to assess the methodological quality of the included studies. RESULTS Of the 37 included studies, the majority of studies were conducted in the United States (n = 25) and in hospital settings (n = 27). All interventions were multifaceted and in 26 (70%) studies, facility-specific antibiograms could be considered as an integral component of the interventions. A positive impact on antibiotic consumption trends (17 studies), appropriateness of prescribing (16 studies), and cost of treatment (6 studies) was found, with minimal evidence for improvement in mortality, hospitalization, and resistance profiles. Due to the heterogeneity in study designs and outcomes, a meta-analysis was not performed. CONCLUSIONS AMS interventions including antibiograms may improve antibiotic use, appropriateness, and costs. Multifaceted interventions were often used, which precludes drawing conclusions about the effectiveness of antibiograms alone as an AMS tool.
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Affiliation(s)
- Dipti Khatri
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.
| | - Christopher Freeman
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia.
| | - Nazanin Falconer
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD, Australia
| | - Soraia de Camargo Catapan
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; UQ Centre for Online Health (COH), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Leonard C Gray
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - David L Paterson
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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20
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Ling W, Paterson DL, Harris PNA, Furuya-Kanamori L, Edwards F, Laupland KB. Mortality, hospital length of stay, and recurrent bloodstream infections associated with extended-spectrum beta-lactamase-producing Escherichia coli in a low prevalence region: A 20-year population-based large cohort study. Int J Infect Dis 2024; 138:84-90. [PMID: 37949363 DOI: 10.1016/j.ijid.2023.11.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/16/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES This population-based study aimed to investigate the risk factors and effect of extended-spectrum beta-lactamase (ESBL) production on clinical outcomes in Escherichia coli bloodstream infection (BSI) patients. METHODS The study population was defined as patients aged ≥15 years with E. coli BSI in Queensland, Australia, from 2000 to 2019. Outcomes were defined as 30-day case fatality, hospital length of stay (LOS), and recurrent E. coli BSI. RESULTS A total of 27,796 E. coli BSIs were identified, of which 1112 (4.0%) were ESBL-producers. Patients with ESBL-Ec BSI were more frequently older, male, with comorbidity, recurrent E. coli BSI, and less likely with community-associated community-onset infections as compared to non-ESBL-Ec BSI patients. The standardized mortality rate of ESBL-Ec BSI increased 8-fold from 2000 to 2019 (1 to 8 per million residents) and case fatality was 12.8% (n = 142) at 30 days from positive blood culture. Patients with ESBL-Ec BSI were not at higher risk of 30-day case fatality (adjusted hazard ratio [HR] = 0.98, 95% CI: 0.83-1.17), but had higher risk of recurring episodes (adjusted subdistribution HR = 1.58, 95% CI: 1.29-1.92) and observed 14% longer LOS (adjusted incidence rate ratio = 1.14, 95% CI: 1.10-1.18) than non-ESBL-Ec BSI patients. CONCLUSION In this large patient cohort, ESBL-Ec BSI did not increase case fatality risk but observed higher hospital LOS and recurrent E. coli BSI than non-ESBL-Ec BSI. Clinical resources are warranted to account for the higher morbidity risk associated with ESBL production and incidence.
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Affiliation(s)
- Weiping Ling
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - David L Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia; ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Patrick N A Harris
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia; Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, University of Queensland, Australia
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Kevin B Laupland
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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21
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Peri AM, Edwards F, Henden A, Harris PNA, Chatfield MD, Paterson DL, Laupland KB. Bloodstream infections in neutropenic and non-neutropenic patients with haematological malignancies: epidemiological trends and clinical outcomes in Queensland, Australia over the last 20 years. Clin Exp Med 2023; 23:4563-4573. [PMID: 37815735 PMCID: PMC10725384 DOI: 10.1007/s10238-023-01206-x] [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: 05/08/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
Knowledge of the epidemiology of bloodstream infection (BSI) in haematology patients is essential to guide patient management. We investigated the epidemiology of BSI in patients with haematological malignancies in Queensland over the last 20 years (2000-2019), including all episodes diagnosed by the state-wide microbiology service. We identified 7749 BSI in 5159 patients, 58% associated with neutropenia. Gram-negatives were the main causative pathogens (58.3%), more frequent in neutropenic than non-neutropenic patients (3308/5309, 62.3% vs 1932/3678, 52.5%, p < 0.001). Amongst 8987 isolates the most common were E. coli (15.4%) and Pseudomonas spp. (14.2%). Pseudomonas spp. (16.6% vs 10.7%, p < 0.001), Klebsiella spp. (11.6% vs 6.8%, p < 0.001), viridans-group streptococci (4.4% vs 1.2%, p < 0.001) and E. faecium (2.4% vs 0.9%, p < 0.001) were more common in neutropenic than non-neutropenic patients, while S. aureus was less common (5.9% vs 15.6%, p < 0.001). Several antimicrobial resistance rates increased over time and had higher prevalence in neutropenic than non-neutropenic patients, including ciprofloxacin-resistant E. coli (94/758, 12.4% vs 42/506, 8.3%, p = 0.021), trimethoprim-sulfamethoxazole-resistant E. coli (366/764, 47.9% vs 191/517, 36.9%, p < 0.001), penicillin-resistant streptococci (51/236, 21.6% vs 28/260, 10.8%, p < 0.001) and vancomycin-resistant enterococci (46/250, 18.4% vs 9/144, 6.3%, p < 0.001). Carbapenem-resistant Pseudomonas spp. (OR 7.32, 95%CI 2.78-19.32) and fungi, including yeasts and moulds (OR 3.33, 95%CI 2.02-5.48) were associated to the highest odds of 30-day case-fatality at a multivariable logistic regression analysis. Neutropenia was associated with survival (OR 0.66, 95%CI 0.55-0.78). Differences were observed in the BSI epidemiology according to neutropenic status, with an overall increase of resistance over time associated to adverse outcome.
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Affiliation(s)
- Anna Maria Peri
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia.
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Andrea Henden
- Department of Haematology and Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Patrick N A Harris
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Brisbane City, QLD, 4029, Australia
| | - Mark D Chatfield
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kevin B Laupland
- Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Intensive Care Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
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Morpeth SC, Venkatesh B, Totterdell JA, McPhee GM, Mahar RK, Jones M, Bandara M, Barina LA, Basnet BK, Bowen AC, Burke AJ, Cochrane B, Denholm JT, Dhungana A, Dore GJ, Dotel R, Duffy E, Dummer J, Foo H, Gilbey TL, Hammond NE, Hudson BJ, Jha V, Jevaji PR, John O, Joshi R, Kang G, Kaur B, Kim S, Das SK, Lau JSY, Littleford R, Marsh JA, Marschner IC, Matthews G, Maze MJ, McArthur CJ, McFadyen JD, McMahon JH, McQuilten ZK, Molton J, Mora JM, Mudaliar V, Nguyen V, O'Sullivan MVN, Pant S, Park JE, Paterson DL, Price DJ, Raymond N, Rees MA, Robinson JO, Rogers BA, Ryu WS, Sasadeusz J, Shum O, Snelling TL, Sommerville C, Trask N, Lewin SR, Hills TE, Davis JS, Roberts JA, Tong SYC. A Randomized Trial of Nafamostat for Covid-19. NEJM Evid 2023; 2:EVIDoa2300132. [PMID: 38320527 DOI: 10.1056/evidoa2300132] [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: 02/08/2024]
Abstract
A Randomized Trial of Nafamostat for Covid-19Nafamostat mesylate is a potent in vitro antiviral that inhibits the host transmembrane protease serine 2 enzyme used by SARS-CoV-2 for cell entry. Morpeth et al report the results of an open-label randomized clinical trial of nafamostat for noncritically ill patients with Covid-19.
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Affiliation(s)
- Susan C Morpeth
- Department of Microbiology and Infectious Diseases, Middlemore Hospital, Te Whatu Ora Counties Makukau, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Balasubramanian Venkatesh
- Department of Intensive Care Medicine, The University of Queensland at Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Department of Intensive Care Medicine, The University of Queensland at The Wesley Hospital, Toowong, QLD, Australia
- The George Institute for Global Health, Newtown, NSW, Australia
| | - James A Totterdell
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney
| | - Grace M McPhee
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Robert K Mahar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mark Jones
- Department of Health and Clinical Analytics, The University of Sydney School of Public Health, Sydney
| | - Methma Bandara
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Lauren A Barina
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Bhupendra K Basnet
- Department of Medicine, Bir Hospital, Kathmandu, Nepal
- Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - Andrew J Burke
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Department of Infectious Diseases, Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - Belinda Cochrane
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Campbelltown, NSW, Australia
- Western Sydney University School of Medicine, Campbelltown, NSW, Australia
| | - Justin T Denholm
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ashesh Dhungana
- Department of Medicine, National Academy of Medical Sciences at Bir Hospital, Kathmandu, Nepal
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, University of New South Wales, Kensington, NSW, Australia
- Department of Infectious Diseases, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Ravindra Dotel
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, NSW, Australia
| | - Eamon Duffy
- Department of Infectious Diseases, Te Whatu Ora Health New Zealand at Auckland City Hospital, Auckland, New Zealand
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jack Dummer
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Respiratory Services, Dunedin Hospital, Dunedin, New Zealand
| | - Hong Foo
- Department of Microbiology and Infectious Diseases, NSW Health Pathology Liverpool, Liverpool, NSW, Australia
| | - Timothy L Gilbey
- Department of Medicine and Infectious Diseases, Wagga Wagga Base Hospital, Wagga Wagga, Australia
| | - Naomi E Hammond
- Critical Care Program, The George Institute for Global Health, New Town, NSW, Australia
- Critical Care Program, The University of New South Wales, Sydney
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Bernard J Hudson
- Department of Microbiology and Infectious Diseases, NSW Health Pathology, St. Leonards, St. Leonards, NSW, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Purnima R Jevaji
- Department of Research, The George Institute for Global Health, Pune, Maharashta, India
| | - Oommen John
- Department of Research, The George Institute for Global Health, Vellore, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, India
| | - Rajesh Joshi
- Department of Research, The George Institute for Global Health, Pune, Maharashta, India
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Chartered Accountants Australia and New Zealand, Sydney
| | - Baldeep Kaur
- Critical Care Program, The George Institute for Global Health, New Town, NSW, Australia
| | - Seungtaek Kim
- Zoonotic Virus Laboratory, Institut Pasteur Korea, Bundang-gu, Gyeonggi-do, Republic of Korea
| | - Santa Kumar Das
- Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Jillian S Y Lau
- Department of Infectious Diseases, Eastern Health, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Roberta Littleford
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, QLD, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Centre for Child Health Research, University of Western Australia Medical School, Nedlands, WA, Australia
| | - Ian C Marschner
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney
| | - Gail Matthews
- Department of Infectious Diseases, St. Vincent's Hospital Sydney, Sydney
- Therapeutic and Vaccine Research Program, The Kirby Institute at The University of New South Wales, Kensington, NSW, Australia
| | - Michael J Maze
- Department of Medicine, University of Otago Christchurch, Christchurch, New England
| | - Colin J McArthur
- Department of Critical Care Medicine, Te Whatu Ora - Health New Zealand, Wellington, New Zealand
| | - James D McFadyen
- Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
- Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - James H McMahon
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Zoe K McQuilten
- Department of Haematology, Monash Health, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - James Molton
- Department of Infectious Diseases, Western Health, Footscray, VIC, Australia
| | - Jocelyn M Mora
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Vijaybabu Mudaliar
- Department of Research, The George Institute for Global Health, Pune, Maharashta, India
| | - Vi Nguyen
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew V N O'Sullivan
- Department of Microbiology and Infectious Diseases, NSW Health Pathology Westmead Hospital, Newcastle, NSW, Australia
- Faculty of Medicine and Health, University of Sydney Westmead Clinical School, Sydney
| | - Suman Pant
- Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Jaha E Park
- Business Development Team, Chong Kun Dang Pharmaceutical Corp., Dongbaekjukjeon-daero, Giheung-gu Yongin, Kyeonggi-do, Republic of Korea
| | - David L Paterson
- Saw Swee Hock School of Public Health, National Institute of Singapore, Singapore
| | - David J Price
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nigel Raymond
- Department of Medicine, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
- Department of Medicine, Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Megan A Rees
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - James O Robinson
- Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Benjamin A Rogers
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- Department of Infectious Diseases, Monash Health, Clayton, VIC, Australia
| | - Wang-Shick Ryu
- Virology, Institute Pasteur Korea, Bundang-gu, Gyeonggi-do, Republic of Korea
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Omar Shum
- Department of Infectious Diseases, Wollongong Hospital, Kingoonya, NSW, Australia
- Graduate School of Medicine, University of Wollongong, Wollonngong, NSW, Australia
| | - Thomas L Snelling
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - Christine Sommerville
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Nanette Trask
- Chartered Accountants Australia and New Zealand, Sydney
| | - Sharon R Lewin
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Thomas E Hills
- Department of Clinical Research, Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand
| | - Joshua S Davis
- School of Medicine and Public Health, The University of Newcastle, New Castle, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Jason A Roberts
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
- Metro North Health, Herston Infectious Diseases Institute, Herston, QLD, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Division of Anaesthesiology, Critical Care Emergency and Pain Medicine, Nîmes University Hospital at The University of Montpellier, Nîmes, France
| | - Steven Y C Tong
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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Peel TN, Astbury S, Cheng AC, Paterson DL, Buising KL, Spelman T, Tran-Duy A, Adie S, Boyce G, McDougall C, Molnar R, Mulford J, Rehfisch P, Solomon M, Crawford R, Harris-Brown T, Roney J, Wisniewski J, de Steiger R. Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty. N Engl J Med 2023; 389:1488-1498. [PMID: 37851875 DOI: 10.1056/nejmoa2301401] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND The addition of vancomycin to beta-lactam prophylaxis in arthroplasty may reduce surgical-site infections; however, the efficacy and safety are unclear. METHODS In this multicenter, double-blind, superiority, placebo-controlled trial, we randomly assigned adult patients without known methicillin-resistant Staphylococcus aureus (MRSA) colonization who were undergoing arthroplasty to receive 1.5 g of vancomycin or normal saline placebo, in addition to cefazolin prophylaxis. The primary outcome was surgical-site infection within 90 days after surgery. RESULTS A total of 4239 patients underwent randomization. Among 4113 patients in the modified intention-to-treat population (2233 undergoing knee arthroplasty, 1850 undergoing hip arthroplasty, and 30 undergoing shoulder arthroplasty), surgical-site infections occurred in 91 of 2044 patients (4.5%) in the vancomycin group and in 72 of 2069 patients (3.5%) in the placebo group (relative risk, 1.28; 95% confidence interval [CI], 0.94 to 1.73; P = 0.11). Among patients undergoing knee arthroplasty, surgical-site infections occurred in 63 of 1109 patients (5.7%) in the vancomyin group and in 42 of 1124 patients (3.7%) in the placebo group (relative risk, 1.52; 95% CI, 1.04 to 2.23). Among patients undergoing hip arthroplasty, surgical-site infections occurred in 28 of 920 patients (3.0%) in the vancomyin group and in 29 of 930 patients (3.1%) in the placebo group (relative risk, 0.98; 95% CI, 0.59 to 1.63). Adverse events occurred in 35 of 2010 patients (1.7%) in the vancomycin group and in 35 of 2030 patients (1.7%) in the placebo group, including hypersensitivity reactions in 24 of 2010 patients (1.2%) and 11 of 2030 patients (0.5%), respectively (relative risk, 2.20; 95% CI, 1.08 to 4.49), and acute kidney injury in 42 of 2010 patients (2.1%) and 74 of 2030 patients (3.6%), respectively (relative risk, 0.57; 95% CI, 0.39 to 0.83). CONCLUSIONS The addition of vancomycin to cefazolin prophylaxis was not superior to placebo for the prevention of surgical-site infections in arthroplasty among patients without known MRSA colonization. (Funded by the Australian National Health and Medical Research Council; Australian New Zealand Clinical Trials Registry number, ACTRN12618000642280.).
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Affiliation(s)
- Trisha N Peel
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Sarah Astbury
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Allen C Cheng
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - David L Paterson
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Kirsty L Buising
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Tim Spelman
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - An Tran-Duy
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Sam Adie
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Glenn Boyce
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Catherine McDougall
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Robert Molnar
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Jonathan Mulford
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Peter Rehfisch
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Michael Solomon
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Ross Crawford
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Tiffany Harris-Brown
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Janine Roney
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Jessica Wisniewski
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
| | - Richard de Steiger
- From the Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences (T.N.P., S. Astbury, J.W.), and the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.C.C.), Monash University, the Department of Infectious Diseases, Alfred Health (T.N.P., S. Astbury, A.C.C., J.R., J.W.), the Department of Infectious Diseases, Doherty Institute (K.L.B.), the Department of Surgery, St. Vincent's Hospital (T.S.), the Centre for Health Policy, Melbourne School of Population and Global Health (A.T.-D.), and the Department of Surgery, Epworth HealthCare (R.S.), University of Melbourne, the Victorian Infectious Diseases Service, Royal Melbourne Hospital (K.L.B.), and the Department of Health Services Research, Peter MacCallum Cancer Centre, and Burnet Institute (T.S.), Melbourne, VIC, the St. George and Sutherland Clinical Campuses, School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney (S. Adie, R.M.), Bendigo Health, Bendigo, VIC (G.B.), the Department of Orthopaedics, Prince Charles Hospital, Metro North Hospital and Health Service (C.M., R.C.), the Department of Medicine (C.M.) and the Centre for Clinical Research (T.H.-B.), University of Queensland, and Queensland University of Technology (R.C.), Brisbane, the Department of Orthopaedics, Launceston General Hospital, Tasmanian Health Service, Launceston, TAS (J.M.), Gippsland Orthopaedic Group, Traralgon, VIC (P.R.), and Prince of Wales Hospital and Prince of Wales Private Hospital, Randwick, NSW (M.S.) - all in Australia; Advancing Clinical Evidence in Infectious Diseases, Saw Swee Hock School of Public Health, and the Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (D.L.P.); and the Department of Clinical Neuroscience, Karolinska Institute, Stockholm (T.S.)
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Laupland KB, Edwards F, Harris PNA, Paterson DL. Significant clinical differences but not outcomes between Klebsiella aerogenes and Enterobacter cloacae bloodstream infections: a comparative cohort study. Infection 2023; 51:1445-1451. [PMID: 36881325 PMCID: PMC10545569 DOI: 10.1007/s15010-023-02010-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Although Klebsiella aerogenes (formerly Enterobacter aerogenes) and Enterobacter cloacae share many phenotypic characteristics, controversy exists as to whether they cause clinically distinguishable infections. The objective of this study was to determine the comparative incidence, determinants, and outcomes of K. aerogenes and E. cloacae bloodstream infections (BSI). METHODS Population-based surveillance was conducted among residents aged ≥ 15 years of Queensland, Australia during 2000-2019. RESULTS Overall 695 and 2879 incident K. aerogenes and E. cloacae BSIs were identified for incidence rates of 1.1 and 4.4 per 100,000 population, respectively. There was a marked increase in incidence associated with older age and with males with both species. Patients with K. aerogenes BSIs were older, were more likely male, to have community-associated disease, and to have a genitourinary source of infection. In contrast, E. cloacae were more likely to have co-morbid diagnoses of liver disease and malignancy and be associated with antimicrobial resistance. Enterobacter cloacae were significantly more likely to have repeat episodes of BSI as compared to K. aerogenes. However, no differences in length of stay or all cause 30-day case-fatality were observed. CONCLUSION Although significant demographic and clinical differences exist between K. aerogenes and E. cloacae BSI, they share similar outcomes.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Level 3 Ned Hanlon Building, Butterfield Street, Brisbane, QLD, 4029, Australia.
- Queensland University of Technology (QUT), Brisbane, QLD, Australia.
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Patrick N A Harris
- Faculty of Medicine, University of Queensland, UQ Center for Clinical Research, Brisbane, Australia
- Department of Microbiology, Pathology Queensland, Brisbane, Australia
| | - David L Paterson
- Faculty of Medicine, University of Queensland, UQ Center for Clinical Research, Brisbane, Australia
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Aslan AT, Ezure Y, Horcajada JP, Harris PNA, Paterson DL. In vitro, in vivo and clinical studies comparing the efficacy of ceftazidime-avibactam monotherapy with ceftazidime-avibactam-containing combination regimens against carbapenem-resistant Enterobacterales and multidrug-resistant Pseudomonas aeruginosa isolates or infections: a scoping review. Front Med (Lausanne) 2023; 10:1249030. [PMID: 37727767 PMCID: PMC10506411 DOI: 10.3389/fmed.2023.1249030] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction Carbapenem-resistant Enterobacterales (CRE) and multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infections are associated with a high risk of morbidity, mortality, and treatment costs. We aimed to evaluate in vitro, in vivo and clinical studies comparing the efficacy of ceftazidime-avibactam (CZA) combination regimens with CZA alone against CRE and/or MDR-PA isolates or infections. Methods We systematically reviewed the relevant literature in CINAHL/MEDLINE, Pubmed, Cochrane, Web of Science, Embase, and Scopus until December 1, 2022. Review articles, grey literature, abstracts, comments, editorials, non-peer reviewed articles, non-English articles, and in vitro synergy studies conducted on single isolates were excluded. Results 22 in vitro, 7 in vivo and 20 clinical studies were evaluated. In vitro studies showed reliable synergy between CZA and aztreonam against metallo-β-lactamase (MBL)-producing isolates. Some studies indicated good in vitro synergy between CZA and amikacin, meropenem, fosfomycin and polymyxins against CRE isolates. For MDR-PA isolates, there are comparatively fewer in vitro or in vivo studies. In observational clinical studies, mortality, clinical cure, adverse events, and development of CZA resistance after exposure were generally similar in monotherapy and combination therapy groups. However, antibiotic-related nephrotoxicity and infection relapses were higher in patients receiving CZA combination therapies. Discussion The benefit, if any, of CZA combination regimens in MDR-PA infections is elusive, as very few clinical studies have included these infections. There is no currently documented clinical benefit for the use of CZA combination regimens rather than CZA monotherapy. CZA combined with aztreonam for serious infections due to MBL producers should be evaluated by randomized controlled trials. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278552, CRD42021278552.
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Affiliation(s)
- Abdullah Tarık Aslan
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Yukiko Ezure
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Juan Pablo Horcajada
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
- Infectious Diseases Department, Hospital del Mar, Institut Hospital Del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBERINFEC, ISCIII – CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Patrick N. A. Harris
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - David L. Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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26
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Laupland KB, Edwards F, Furuya-Kanamori L, Paterson DL, Harris PNA. Bloodstream Infection and Colorectal Cancer Risk in Queensland Australia, 2000-2019. Am J Med 2023; 136:896-901. [PMID: 37230400 DOI: 10.1016/j.amjmed.2023.05.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/20/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Bloodstream infections may occur as a complication of colorectal cancer or be a marker for its occult presence. The objectives of this study were to quantify the overall and etiology-specific risks for incident colorectal cancer-associated bloodstream infection. METHODS Population-based surveillance for community-onset bloodstream infection was conducted among adults aged 20 years and older in Queensland, Australia between 2000 and 2019. Statewide databases were used to identify patients with incident colorectal cancer and collect clinical and outcome information. RESULTS After exclusion of 1794 patients with prior colorectal cancer, a cohort of 84,754 patients was assembled, of which 1030 had colorectal cancer-associated bloodstream infection and 83,724 had no colorectal cancer. Bloodstream infection was associated with a 16-fold annualized increased risk for diagnosis of colorectal cancer (incidence rate ratio 16.1; 95% confidence interval [CI], 15.1-17.1) in the adult population. Patients who had colorectal cancer-associated bloodstream infection were more likely to be older and male, have hospital-onset and polymicrobial infections, and have fewer non-cancer-related comorbidities. The organisms associated with highest risk for colorectal cancer included Clostridium species (relative risk [RR] 6.1; 95% CI, 4.7-7.9); especially C. septicum (RR 25.0; 95% CI, 16.9-35.7), Bacteroides species (RR 4.7; 95% CI, 3.8-5.8); especially B. ovatus (RR 11.8; 95% CI, 2.4-34.5), Gemella species (RR 6.5; 95% CI, 3.0-12.5), Streptococcus bovis group (RR 4.4; 95% CI, 2.7-6.8); especially S. infantarius subsp. coli (RR 10.6; 95% CI, 2.9-27.3), Streptococcus anginosus group (RR 1.9; 95% CI, 1.3-2.7), and Enterococcus species (RR 1.4; 95% CI, 1.1-1.8). CONCLUSION Although much attention has been afforded to S. bovis group over the past decades, there are many other isolates associated with higher risk for colorectal cancer-associated bloodstream infections.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Australia.
| | | | - Luis Furuya-Kanamori
- Faculty of Medicine, UQ Center for Clinical Research, University of Queensland, Brisbane, Australia
| | - David L Paterson
- Faculty of Medicine, UQ Center for Clinical Research, University of Queensland, Brisbane, Australia; Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Patrick N A Harris
- Faculty of Medicine, UQ Center for Clinical Research, University of Queensland, Brisbane, Australia; Department of Microbiology, Pathology Queensland, Brisbane, Australia
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Isler B, Vatansever C, Özer B, Çınar G, Aslan AT, Falconer C, Bauer MJ, Forde B, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Saltoğlu N, Azap A, Azap Ö, Akova M, Ergönül Ö, Can F, Paterson DL, Harris PNA. Higher rates of cefiderocol resistance among NDM producing Klebsiella bloodstream isolates applying EUCAST over CLSI breakpoints. Infect Dis (Lond) 2023; 55:607-613. [PMID: 37391868 DOI: 10.1080/23744235.2023.2226709] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Cefiderocol is generally active against carbapenem-resistant Klebsiella spp. (CRK) with higher MICs against metallo-beta-lactamase producers. There is a variation in cefiderocol interpretive criteria determined by EUCAST and CLSI. Our objective was to test CRK isolates against cefiderocol and compare cefiderocol susceptibilities using EUCAST and CLSI interpretive criteria. METHODS A unique collection (n = 254) of mainly OXA-48-like- or NDM-producing CRK bloodstream isolates were tested against cefiderocol with disc diffusion (Mast Diagnostics, UK). Beta-lactam resistance genes and multilocus sequence types were identified using bioinformatics analyses on complete bacterial genomes. RESULTS Median cefiderocol inhibition zone diameter was 24 mm (interquartile range [IQR] 24-26 mm) for all isolates and 18 mm (IQR 15-21 mm) for NDM producers. We observed significant variability between cefiderocol susceptibilities using EUCAST and CLSI breakpoints, such that 26% and 2% of all isolates, and 81% and 12% of the NDM producers were resistant to cefiderocol using EUCAST and CLSI interpretive criteria, respectively. CONCLUSIONS Cefiderocol resistance rates among NDM producers are high using EUCAST criteria. Breakpoint variability may have significant implications on patient outcomes. Until more clinical outcome data are available, we suggest using EUCAST interpretive criteria for cefiderocol susceptibility testing.
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Affiliation(s)
- Burcu Isler
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Cansel Vatansever
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Berna Özer
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Güle Çınar
- Infectious Diseases and Clinical Microbiology, School of Medicine, Ankara University Ankara, Turkey
| | - Abdullah Tarık Aslan
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Caitlin Falconer
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Michelle J Bauer
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Brian Forde
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Funda Şimşek
- Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Necla Tülek
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atilim University, Ankara, Turkey
| | - Hamiyet Demirkaya
- Infectious Diseases and Clinical Microbiology, Ankara Hospital, Başkent University, Ankara, Turkey
| | - Şirin Menekşe
- Infectious Diseases, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Halis Akalin
- Infectious Diseases and Clinical Microbiology, School of Medicine, Uludağ University, Bursa, Turkey
| | - İlker İnanç Balkan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mehtap Aydın
- Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Tükenmez Tigen
- Infectious Diseases and Clinical Microbiology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Safiye Koçulu Demir
- Infectious Diseases and Clinical Microbiology, Demiroglu Bilim University, Istanbul, Turkey
| | - Mahir Kapmaz
- Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Şiran Keske
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- Infectious Diseases, VKV American Hospital, Istanbul, Turkey
| | - Özlem Doğan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Çiğdem Arabacı
- Clinical Microbiology, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serap Yağcı
- Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gülşen Hazırolan
- Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Veli Oğuzalp Bakır
- Graduate School of Sciences and Engineering, Koç University, Istanbul, Turkey
| | - Mehmet Gönen
- Industrial Engineering, College of Engineering, Koç University, Istanbul, Turkey
| | - Neşe Saltoğlu
- Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Alpay Azap
- Infectious Diseases and Clinical Microbiology, School of Medicine, Ankara University Ankara, Turkey
| | - Özlem Azap
- Infectious Diseases and Clinical Microbiology, Ankara Hospital, Başkent University, Ankara, Turkey
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Önder Ergönül
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Füsun Can
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - David L Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Boutzoukas AE, Komarow L, Chen L, Hanson B, Kanj SS, Liu Z, Salcedo Mendoza S, Ordoñez K, Wang M, Paterson DL, Evans S, Ge L, Giri A, Hill C, Baum K, Bonomo RA, Kreiswirth B, Patel R, Arias CA, Chambers HF, Fowler VG, van Duin D. International Epidemiology of Carbapenemase-Producing Escherichia coli. Clin Infect Dis 2023; 77:499-509. [PMID: 37154071 PMCID: PMC10444003 DOI: 10.1093/cid/ciad288] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Carbapenemase-producing (CP) Escherichia coli (CP-Ec) are a global public health threat. We aimed to describe the clinical and molecular epidemiology and outcomes of patients from several countries with CP-Ec isolates obtained from a prospective cohort. METHODS Patients with CP-Ec were enrolled from 26 hospitals in 6 countries. Clinical data were collected, and isolates underwent whole-genome sequencing. Clinical and molecular features and outcomes associated with isolates with or without metallo-β-lactamases (MBLs) were compared. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after the index culture. RESULTS Of the 114 CP-Ec isolates in Consortium on resistance against carbapenems in Klebsiella and other Enterobacterales-2 (CRACKLE-2), 49 harbored an MBL, most commonly blaNDM-5 (38/49, 78%). Strong regional variations were noted with MBL-Ec predominantly found among patients in China (23/49). Clinically, MBL-Ec were more often from urine sources (49% vs 29%), less often met criteria for infection (39% vs 58%, P = .04), and had lower acuity of illness when compared with non-MBL-Ec. Among patients with infection, the probability of a better DOOR outcome for a randomly selected patient with MBL-Ec as compared with non-MBL-Ec was 62% (95% CI: 48.2-74.3%). Among infected patients, non-MBL-Ec had increased 30-day (26% vs 0%; P = .02) and 90-day (39% vs 0%; P = .001) mortality compared with MBL-Ec. CONCLUSIONS Emergence of CP-Ec was observed with important geographic variations. Bacterial characteristics, clinical presentations, and outcomes differed between MBL-Ec and non-MBL-Ec. Mortality was higher among non-MBL isolates, which were more frequently isolated from blood, but these findings may be confounded by regional variations.
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Affiliation(s)
- Angelique E Boutzoukas
- Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Lauren Komarow
- The Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Liang Chen
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Blake Hanson
- Center for Infectious Diseases and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, Texas, USA
| | - Souha S Kanj
- Division of Infectious Diseases, and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zhengyin Liu
- Infectious Disease Section, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Soraya Salcedo Mendoza
- Servicio de Infectología, Organizacion Clinica General del Norte, Barranquilla, Colombia
| | - Karen Ordoñez
- Department of Infectious Diseases, E.S.E. Hospital Universitario, San Jorge de Pereira, Pereira, Colombia
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Scott Evans
- The Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Lizhao Ge
- The Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Abhigya Giri
- The Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Carol Hill
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Keri Baum
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Robert A Bonomo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- VA–Case Center for Antibiotic Resistance and Epidemiology (Case-VA CARES), Cleveland, Ohio, USA
| | - Barry Kreiswirth
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, and Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cesar A Arias
- Division of Infectious Diseases and Center for Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, Texas, USA
| | - Henry F Chambers
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
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29
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Mo Y, Ding Y, Cao Y, Hopkins J, Ashley EA, Waithira N, Wannapinij P, Lee SJ, Ling CL, Hamers RL, Roberts T, Lubell Y, Karkey A, Akech S, Lissauer S, Opintan J, Okeke I, Eremin S, Tornimbene B, Hsu LY, Thwaites L, Lam MY, Pham NT, Pham TK, Teo J, Kwa ALH, Marimuthu K, Ng OT, Vasoo S, Kitsaran S, Anunnatsiri S, Kosalaraksa P, Chotiprasitsakul D, Santanirand P, Plongla R, Chua HH, Tiong XT, Wong KJ, Ponnampalavanar SSLS, Sulaiman HB, Mazlan MZ, Salmuna ZN, Rajahram GS, Zaili MZBM, Francis JR, Sarmento N, Guterres H, Oakley T, Yan J, Tilman A, Khalid MOR, Hashmi M, Mahmood SF, Dhiloo AK, Fatima A, Lubis IND, Wijaya H, Abad CL, Roman AD, Lazarte CCM, Mamun GMS, Asli R, Momin MHFBHA, Nyamdavaa K, Gurjav U, Bory S, Varghese GM, Gupta L, Tantia P, Sinto R, Doi Y, Khanal B, Malijan G, Lazaro J, Gunasekara S, Withanage S, Liu PY, Xiao Y, Wang M, Paterson DL, van Doorn HR, Turner P. ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance. Wellcome Open Res 2023; 8:179. [PMID: 37854055 PMCID: PMC10579854 DOI: 10.12688/wellcomeopenres.19210.2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 10/20/2023] Open
Abstract
Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.
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Affiliation(s)
- Yin Mo
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore, 119074, Singapore
- Department of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Ying Ding
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Yang Cao
- Singapore Clinical Research Institute, Singapore, 139234, Singapore
| | - Jill Hopkins
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 171020, Cambodia
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Naomi Waithira
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Prapass Wannapinij
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Sue J. Lee
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Claire L. Ling
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 171020, Cambodia
| | - Raph L. Hamers
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit (OUCRU) Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tamalee Roberts
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Abhilasha Karkey
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit (OUCRU) Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Samuel Akech
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Samantha Lissauer
- Liverpool School of Tropical Medicine (LSTM), University of Liverpool, Liverpool, England, UK
- Malawi-Liverpool-Wellcome Trust (MLW) Clinical Research Programme, Blantyre, Malawi
| | | | | | | | | | - Li Yang Hsu
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Louise Thwaites
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Minh Yen Lam
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Tieu Kieu Pham
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Jeanette Teo
- Department of laboratory Medicine, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Andrea Lay-Hoon Kwa
- Pharmacy (Research), Singapore General Hospital, Singapore, Singapore
- Emerging Infectious Diseases Programme, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Siriluck Anunnatsiri
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Nai Mueang, Khon Kaen, Thailand
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Nai Mueang, Khon Kaen, Thailand
| | | | | | - Rongpong Plongla
- King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Ke Juin Wong
- Sabah Women and Children's Hospital, Kota Kinabalu, Malaysia
| | | | | | - Mohd Zulfakar Mazlan
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Zeti Norfidiyati Salmuna
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | | | - Joshua R. Francis
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
| | - Nevio Sarmento
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
- Laboratorio Nacional da Saude, Ministerio da Saude, Dili, Timor-Leste
| | | | - Tessa Oakley
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
| | - Ari Tilman
- Laboratorio Nacional da Saude, Ministerio da Saude, Dili, Timor-Leste
| | | | - Madiha Hashmi
- Dr. Ziauddin Hospital Clifton Campus, Karachi, Pakistan
| | | | | | | | - Inke Nadia D. Lubis
- Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia
| | - Hendri Wijaya
- Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia
- General Hospital H. Adam Malik, Medan, Indonesia
| | | | | | - Cecilia C. Maramba Lazarte
- Philippine General Hospital, Manila, Philippines
- University of the Philippines Manila, Manila, Metro Manila, Philippines
| | | | - Rosmonaliza Asli
- Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei-Muara District, Brunei
| | | | | | - Ulziijargal Gurjav
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Lalit Gupta
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Pratik Tantia
- Ananta Institute of Medical Sciences and Research Center, Siyol, India
| | - Robert Sinto
- Cipto Mangunkusumo National Hospital, Faculty of Medicine, Universitas Indonesia, Depok, West Java, Indonesia
| | - Yohei Doi
- Fujita Health University Hospital, Toyoake, Japan
| | - Basudha Khanal
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Greco Malijan
- San Lazaro Hospital, Nagasaki University Collaborative Research Office, Manila, Philippines
| | - Jezreel Lazaro
- Hospital Infection Control Unit, San Lazaro Hospital, Manila, Philippines
| | | | | | - Po Yu Liu
- Taichung Veteran General Hospital, Taichung City, Vietnam
| | - Yonghong Xiao
- The First Affiliated Hospital Of Zhejiang University School Of Medicine, Hangzhou, China
| | - Minggui Wang
- Huashan Hospital, Fudan University, Shanghai, China
| | - David L. Paterson
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
- Department of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - H. Rogier van Doorn
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 171020, Cambodia
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30
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Stewart AG, Heney C, Paterson DL, Harris PNA, Edwards F, Laupland KB. Scedosporium species and Lomentospora prolificans fungaemia is uniformly fatal in patients with haematological malignancy. Intern Med J 2023; 53:1489-1491. [PMID: 37599232 DOI: 10.1111/imj.16198] [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: 01/20/2023] [Accepted: 05/09/2023] [Indexed: 08/22/2023]
Abstract
Scedosporium and Lomentospora species are environmental moulds that are virulent in immunocompromised hosts and rarely cause bloodstream infection (BSI). Patients with Scedosporium and Lomentospora species BSI were identified by the state public laboratory service in Queensland, Australia, over a 20-year period. Twenty-two incident episodes occurred among 21 residents; one patient had a second episode 321 days following the first. Of these, 18 were Lomentospora prolificans, three were Scedosporium apiospermum complex and one was a nonspeciated Scedosporium species. Seventeen (81%) patients died during their index admission, and all-cause mortality at 30, 90 and 365 days was 73%, 82% and 91% respectively. All 20 patients with haematological malignancy died within 365 days of follow-up with a median time to death of 9 days (interquartile range, 6-20 days) following diagnoses of BSI.
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Affiliation(s)
- Adam G Stewart
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Central Microbiology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Claire Heney
- Central Microbiology, Pathology Queensland, Brisbane, Queensland, Australia
| | - David L Paterson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Patrick N A Harris
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
- Central Microbiology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Felicity Edwards
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kevin B Laupland
- Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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31
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Delgarm Shams-Abadi A, Mohammadian-Hafshejani A, Paterson DL, Arash R, Asadi Farsani E, Taji A, Heidari H, Shahini Shams Abadi M. The prevalence of colistin resistance in clinical Stenotrophomonas maltophilia isolates worldwide: a systematic review and meta-analysis. BMC Microbiol 2023; 23:200. [PMID: 37507660 PMCID: PMC10386657 DOI: 10.1186/s12866-023-02950-6] [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: 10/19/2022] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
While trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line therapy of Stenotrophomonas maltophilia infections, colistin is one of the therapeutic options in cases of allergy or resistance to TMP-SMX. However, understanding the global status of resistance to colistin amongst S. maltophilia isolates could be helpful for appropriate antibiotic prescription. This study aimed to conduct a systematic review and meta-analysis to examine the prevalence of colistin resistance in clinical S. maltophilia isolates worldwide. According to eligibility criteria, a total of 61 studies were included in the analysis. The pooled prevalence for colistin resistance was 42% (95% CI: 35-49%), ranging from 0.1 to 97%. Subgroups analysis indicated that, the pooled prevalence of colistin resistance was 44% (95% CI: 29-60%) in 15 studies during 2000-2010, and it was estimated to be 41% (95% CI: 33-50%) in 46 articles from 2011 to 2021. It was 46% (95% CI: 35-58%) in the studies that used broth microdilution method, and 39% (95% CI: 30-49%) in the studies with other used methods. The resistance rate in Asian countries was 45% (95% CI: 31-60%), in European countries was 45% (95% CI: 34-56%) and in the countries of North and South America was 33% (95% CI: 20-46%). Our review showed notable resistance to colistin in clinical S. maltophilia isolates. Given the estimated resistance rates, alternative antibiotics could be preferred to treat serious infections due to S. maltophilia.
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Affiliation(s)
| | | | - David L Paterson
- UQ Center for Clinical Research, University of Queensland, Brisbane, Australia
| | - Rezvan Arash
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Elham Asadi Farsani
- Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Asieh Taji
- International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamid Heidari
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Milad Shahini Shams Abadi
- Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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Permana B, Harris PNA, Runnegar N, Lindsay M, Henderson BC, Playford EG, Paterson DL, Beatson SA, Forde BM. Using Genomics To Investigate an Outbreak of Vancomycin-Resistant Enterococcus faecium ST78 at a Large Tertiary Hospital in Queensland. Microbiol Spectr 2023; 11:e0420422. [PMID: 37191518 PMCID: PMC10269735 DOI: 10.1128/spectrum.04204-22] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
To investigate an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) sequence type 78 (ST78) in a large tertiary Australian hospital. A collection of 63 VREfm ST78 isolates, identified during a routine genomic surveillance program, were subjected to genomic epidemiological analysis based on whole-genome sequencing (WGS) data. The population structure was reconstructed using phylogenetic analysis, and a collection of publicly available VREfm ST78 genomes were used to provide global context. Core genome single nucleotide polymorphism (SNP) distances and available clinical metadata were used to characterize outbreak clusters and reconstruct transmission events. In silico genotyping confirmed that all study isolates were vanB-type VREfm carrying virulence characteristics of the hospital-associated E. faecium. Phylogenetic analysis identified two distinct phylogenetic clades, only one of which was responsible for a hospital outbreak. Four outbreak subtypes could be defined with examples of recent transmissions. Inference on transmission trees suggested complex transmission routes with unknown environmental reservoirs mediating the outbreak. WGS-based cluster analysis with publicly available genomes identified closely related Australian ST78 and ST203 isolates, highlighting the capacity for WGS to resolve complex clonal relationships between the VREfm lineages. Whole genome-based analysis has provided a high-resolution description of an outbreak of vanB-type VREfm ST78 in a Queensland hospital. Combined routine genomic surveillance and epidemiological analysis have facilitated better understanding of the local epidemiology of this endemic strain, providing valuable insight for better targeted control of VREfm. IMPORTANCE Vancomycin-resistant Enterococcus faecium (VREfm) is a leading cause of health care-associated infections (HAIs) globally. In Australia, the spread of hospital-adapted VREfm is largely driven by a single clonal group (clonal complex [CC]), CC17, to which the lineage ST78 belongs. While implementing a genomic surveillance program in Queensland, we observed increased incidence of ST78 colonizations and infections among patients. Here, we demonstrate the use of real-time genomic surveillance as a tool to support and enhance infection control (IC) practices. Our results show that real-time whole-genome sequencing (WGS) can efficiently disrupt outbreaks by identifying transmission routes that in turn can be targeted using resource-limited interventions. Additionally, we demonstrate that by placing local outbreaks in a global context, high-risk clones can be identified and targeted prior to them becoming established within clinical environments. Finally, the persistence of these organism within the hospital highlights the need for routine genomic surveillance as a management tool to control VRE transmission.
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Affiliation(s)
- Budi Permana
- School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, Australia
- Australian Centre for Ecogenomics, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
| | - Patrick N. A. Harris
- Australian Infectious Disease Research Centre, Faculty of Science, The University of Queensland, Brisbane, Australia
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Pathology Queensland, Central Laboratory, Brisbane, Australia
| | - Naomi Runnegar
- Princess Alexandra–Southside Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Margaret Lindsay
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | | | - E. G. Playford
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - David L. Paterson
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Scott A. Beatson
- School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, Australia
- Australian Centre for Ecogenomics, The University of Queensland, Brisbane, Australia
- Australian Infectious Disease Research Centre, Faculty of Science, The University of Queensland, Brisbane, Australia
| | - Brian M. Forde
- Australian Infectious Disease Research Centre, Faculty of Science, The University of Queensland, Brisbane, Australia
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Stewart AG, Chen SCA, Hamilton K, Harris-Brown T, Korman TM, Figtree M, Worth LJ, Kok J, Van der Poorten D, Byth K, Slavin MA, Paterson DL. Clostridioides difficile Infection: Clinical Practice and Health Outcomes in 6 Large Tertiary Hospitals in Eastern Australia. Open Forum Infect Dis 2023; 10:ofad232. [PMID: 37274181 PMCID: PMC10237225 DOI: 10.1093/ofid/ofad232] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/26/2023] [Indexed: 06/06/2023] Open
Abstract
Background Clostridioides difficile infection (CDI) is associated with significant morbidity and mortality in both healthcare and community settings. We aimed to define the predisposing factors, risks for severe disease, and mortality determinants of CDI in eastern Australia over a 1-year period. Methods This is an observational retrospective study of CDI in hospitalized patients aged ≥18 years in 6 tertiary institutions from 1 January 2016 to 31 December 2016. Patients were identified through laboratory databases and medical records of participating institutions. Clinical, imaging, and laboratory data were input into an electronic database hosted at a central site. Results A total of 578 patients (578 CDI episodes) were included. Median age was 65 (range, 18-99) years and 48.2% were male. Hospital-onset CDI occurred in 64.0%. Recent antimicrobial use (41.9%) and proton pump inhibitor use (35.8%) were common. Significant risk factors for severe CDI were age <65 years (P < .001), malignancy within the last 5 years (P < .001), and surgery within the previous 30 days (P < .001). Significant risk factors for first recurrence included severe CDI (P = .03) and inflammatory bowel disease (P = .04). Metronidazole was the most common regimen for first episodes of CDI with 65.2% being concordant with Australian treatment guidelines overall. Determinants for death at 60 days included age ≥65 years (P = .01), severe CDI (P < .001), and antibiotic use within the prior 30 days (P = .02). Of those who received metronidazole as first-line therapy, 10.1% died in the 60-day follow-up period, compared to 9.8% of those who received vancomycin (P = .86). Conclusions Patients who experience CDI are vulnerable and require early diagnosis, clinical surveillance, and effective therapy to prevent complications and improve outcomes.
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Affiliation(s)
- Adam G Stewart
- Correspondence: Adam Stewart, BBiomedSci, MBBS(Hons), MPHTM, Centre for Clinical Research, University of Queensland, Bldg 71/918 RBWH Herston, Brisbane, QLD 4029, Australia (); David Paterson, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549 ()
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
- Department of Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Kate Hamilton
- Department of Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Tiffany Harris-Brown
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University and Monash Health, Melbourne, Australia
| | - Melanie Figtree
- Department of Infectious Diseases, Royal North Shore Hospital, Sydney, Australia
| | - Leon J Worth
- Department of Infectious Diseases, Peter MacCallum Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
| | | | - Karen Byth
- Research and Education Network, Western Sydney Local Health District, Sydney, Australia
- National Health and Medical Research Council Clinical Trials Centre, Sydney University, Sydney, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Centre, Melbourne, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia
| | - David L Paterson
- Correspondence: Adam Stewart, BBiomedSci, MBBS(Hons), MPHTM, Centre for Clinical Research, University of Queensland, Bldg 71/918 RBWH Herston, Brisbane, QLD 4029, Australia (); David Paterson, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549 ()
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Lian ZJ, Phan MD, Hancock SJ, Nhu NTK, Paterson DL, Schembri MA. Genetic basis of I-complex plasmid stability and conjugation. PLoS Genet 2023; 19:e1010773. [PMID: 37347771 DOI: 10.1371/journal.pgen.1010773] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/05/2023] [Indexed: 06/24/2023] Open
Abstract
Plasmids are major drivers of increasing antibiotic resistance, necessitating an urgent need to understand their biology. Here we describe a detailed dissection of the molecular components controlling the genetics of I-complex plasmids, a group of antibiotic resistance plasmids found frequently in pathogenic Escherichia coli and other Enterobacteriaceae that cause significant human disease. We show these plasmids cluster into four distinct subgroups, with the prototype IncI1 plasmid R64 subgroup displaying low nucleotide sequence conservation to other I-complex plasmids. Using pMS7163B, an I-complex plasmid distantly related to R64, we performed a high-resolution transposon-based genetic screen and defined genes involved in replication, stability, and conjugative transfer. We identified the replicon and a partitioning system as essential for replication/stability. Genes required for conjugation included the type IV secretion system, relaxosome, and several uncharacterised genes located in the pMS7163B leading transfer region that exhibited an upstream strand-specific transposon insertion bias. The overexpression of these genes severely impacted host cell growth or reduced fitness during mixed competitive growth, demonstrating that their expression must be controlled to avoid deleterious impacts. These genes were present in >80% of all I-complex plasmids and broadly conserved across multiple plasmid incompatibility groups, implicating an important role in plasmid dissemination.
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Affiliation(s)
- Zheng Jie Lian
- Institute for Molecular Bioscience (IMB), The University of Queensland, Brisbane, Queensland, Australia
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Minh-Duy Phan
- Institute for Molecular Bioscience (IMB), The University of Queensland, Brisbane, Queensland, Australia
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Steven J Hancock
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Nguyen Thi Khanh Nhu
- Institute for Molecular Bioscience (IMB), The University of Queensland, Brisbane, Queensland, Australia
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - David L Paterson
- The University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Mark A Schembri
- Institute for Molecular Bioscience (IMB), The University of Queensland, Brisbane, Queensland, Australia
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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Stewart AG, Bauer MJ, Butkiewicz D, Hinton A, Henderson A, Harris PN, Paterson DL. In vitro activity of oral third-generation cephalosporins plus clavulanate against ESBL-producing Enterobacterales isolates from the MERINO trial. Int J Antimicrob Agents 2023:106858. [PMID: 37211261 DOI: 10.1016/j.ijantimicag.2023.106858] [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: 03/11/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
Extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales as a cause of community-acquired uncomplicated urinary tract infection (UTI) is on the rise. Currently, minimal oral treatment options exist. New combinations of existing oral third generation cephalosporins paired with clavulanate may overcome resistance mechanisms seen in these emerging uropathogens. Ceftriaxone-resistant E. coli and Klebsiella pneumoniae containing CTX-M-type ESBLs or AmpC, in addition to narrow-spectrum OXA and SHV enzymes, were selected from blood culture isolates obtained from the MERINO trial. Minimum inhibitory concentration (MIC) values of third generation cephalosporins (cefpodoxime, ceftibuten, cefixime, cefdinir) both with and without clavulanate were determined. One hundred and one isolates were used with ESBL, AmpC and narrow-spectrum OXA genes (e.g. OXA-1, OXA-10) present in 84, 15 and 35 isolates, respectively. Susceptibility to oral third generation cephalosporins alone was very poor. Addition of 2 mg/L clavulanate lowered the MIC50 values (cefpodoxime MIC50 2 mg/L, ceftibuten MIC50 2 mg/L, cefixime MIC50 2 mg/L, cefdinir MIC50 4 mg/L) and restored susceptibility (33%, 49%, 40%, and 21% susceptible, respectively) in a substantial number of isolates. This finding was less pronounced in isolates co-harbouring AmpC. In vitro activity of these new combinations may be limited in real world Enterobacterales isolates co-harbouring multiple antimicrobial resistance genes. Pharmacokinetic/pharmacodynamic data would be useful in further evaluating their activity.
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Affiliation(s)
- Adam G Stewart
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia; Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Michelle J Bauer
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - Dominika Butkiewicz
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - Alexandra Hinton
- Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Andrew Henderson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia; Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Patrick Na Harris
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia; Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David L Paterson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia; ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Shields RK, Paterson DL, Tamma PD. Navigating Available Treatment Options for Carbapenem-Resistant Acinetobacter baumannii-calcoaceticus Complex Infections. Clin Infect Dis 2023; 76:S179-S193. [PMID: 37125467 PMCID: PMC10150276 DOI: 10.1093/cid/ciad094] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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] [Indexed: 05/02/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex (CRAB) is one of the top-priority pathogens for new antibiotic development. Unlike other antibiotic-resistant threats, none of the available therapies have been shown to consistently reduce mortality or improve patient outcomes in clinical trials. Antibiotic combination therapy is routinely used in clinical practice; however, the preferred combination has not been defined. This narrative review focuses on evidence-based solutions for the treatment of invasive CRAB infections. We dissect the promise and perils of traditional agents used in combination, such as colistin, sulbactam, and the tetracyclines, and offer clinical pearls based on our interpretation of the available data. Next, we investigate the merits of newly developed β-lactam agents like cefiderocol and sulbactam-durlobactam, which have demonstrated contrasting results in recent randomized clinical trials. The review concludes with the authors' perspective on the evolving treatment landscape for CRAB infections, which is complicated by limited clinical data, imperfect treatment options, and a need for future clinical trials. We propose that effective treatment for CRAB infections requires a personalized approach that incorporates host factors, the site of infection, pharmacokinetic-pharmacodynamic principles, local molecular epidemiology of CRAB isolates, and careful interpretation of antibiotic susceptibility testing results. In most clinical scenarios, a dose-optimized, sulbactam-based regimen is recommended with the addition of at least one other in vitro active agent. Should sulbactam-durlobactam receive regulatory approval, recommendations will need to be re-evaluated with the most recent evidence.
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Affiliation(s)
- Ryan K Shields
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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37
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Isler B, Aslan AT, Benli BS, Paterson DL, Daneman N, Fowler R, Akova M. Duration of antibiotic treatment and timing of oral switch for bloodstream infections: a survey on the practices of infectious diseases and intensive care physicians. Int J Antimicrob Agents 2023; 61:106802. [PMID: 37015260 DOI: 10.1016/j.ijantimicag.2023.106802] [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: 02/06/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Abstract
AIM This study was designed to understand current practice in duration of antibiotic treatment and timing of intravenous (iv) to oral switch for common bacteraemic conditions amongst infectious diseases (ID) and intensive care unit (ICU) physicians. METHODS An online survey consisting of 18 questions comprising five common clinical bacteremia scenarios (adapted from the original survey designed by University of Toronto (Toronto, Ontario, Canada)) was conducted amongst Turkish ID and ICU physicians between November 2020 and November 2021. RESULTS A total of 236 physicians (76.5 % ID and 17.5 % ICU) responded. The most commonly recommended duration for bacteremia was 14 days (42%), followed by 10 (27%) and 7 (18%) days. The median (IQR) recommended durations were 10 (10-14) days for central venous catheter associated bloodstream infection, 10 (7-14) days for bacteraemic pneumonia, 14 (10-14) days for bacteraemic urinary tract and intraabdominal infections, and 14 days (7-14) for bacteraemic skin and soft tissue infection. Carbapenem resistance but not pathogen type influenced the recommendations. There was not a significant difference in responses for most scenarios between ID and ICU physicians. A switch to oral antibiotics after a median duration of 7 (IQR 5-7) days of iv treatment was considered by 80% of respondents. CONCLUSION Prolonged treatment was recommended for most clinical scenarios. Extended iv durations were recommended before oral switch. A presumption that resistant bacterial infections require longer therapy may be responsible for prolonged treatment durations.
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Affiliation(s)
- Burcu Isler
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia; Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia.
| | - Abdullah Tarık Aslan
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Burhan Sami Benli
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Nick Daneman
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Robert Fowler
- Department of Medicine and Department of Critical Care Medicine, Sunnybrook Hospital; H. Barrie Fairley Professor, Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
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Walczak A, McCarthy K, Paterson DL. A contemporary case series of Pseudomonas aeruginosa infective endocarditis. Medicine (Baltimore) 2023; 102:e32662. [PMID: 37000062 PMCID: PMC10063303 DOI: 10.1097/md.0000000000032662] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 04/01/2023] Open
Abstract
Pseudomonas aeruginosa infective endocarditis (IE) is a rare disease associated with high mortality and complications. Here, we describe a contemporary set of patients aiming to improve the understanding of risk factors, clinical features, treatments, and outcomes. This retrospective case series reviewed cases from 3 tertiary metropolitan hospitals between January 1999 and January 2019. prespecified data were collected for each case, with a review of risk factors, valve involvement, acquisition, treatment, and complications. Fifteen patients were identified over a 20 years period. All patients presented with fever, 5/15 had preexisting prosthetic valve with valvular heart disease in 7/15 patients making it the most common risk factor. Intravenous drug use (IVDU) was the source in only 6/15 cases with healthcare associated infection and left-sided valvular involvement being more common than previous reports both occurring in 9/15 cases. Complications occurred in 11/15 patients with a 30 days mortality of 13%. Surgery was performed in 7/15 patients and 9/15 patients received antibiotic combination therapy. One year mortality was higher in those with increasing age, comorbidities, left-sided valve involvement, presence of predefined complications, and antibiotic monotherapy. Development of resistance occurred in 2 cases that received monotherapy. P aeruginosa IE remains a rare disease with high mortality and secondary complications.
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Affiliation(s)
- Andrew Walczak
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Kate McCarthy
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Department of Microbiology, Pathology Queensland, Brisbane, Queensland, Australia
| | - David L. Paterson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
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Denny KJ, Lea RA, Lindell-Innes R, Haupt LM, Heffernan AJ, Harvey NR, Hughes O, Cao VT, Stuart J, Paterson DL, McNamara JF, Ungerer JPJ, Pretorius CJ, Griffiths LR, Lipman J. Diagnosing sepsis in the ICU: Comparison of a gene expression signature to pre-existing biomarkers. J Crit Care 2023; 76:154286. [PMID: 36965223 DOI: 10.1016/j.jcrc.2023.154286] [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: 12/02/2022] [Revised: 01/30/2023] [Accepted: 03/02/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE We aimed to identify a gene signature that discriminates between sepsis and aseptic inflammation in patients administered antibiotics in the intensive care unit and compare it to commonly utilised sepsis biomarkers. METHODS 91 patients commenced on antibiotics were retrospectively diagnosed as having: (i) blood culture positive sepsis; (ii) blood culture negative sepsis; or (iii) aseptic inflammation. Bloods were collected after <24 h of antibiotic commencement for both gene expression sequencing analysis and measurement of previously identified biomarkers. RESULTS 53 differentially expressed genes were identified that accurately discriminated between blood culture positive sepsis and aseptic inflammation in a cohort of patients given antibiotics [aROC 0.97 (95% CI, 0.95-0.99)]. This gene signature was validated in a publicly available database. The gene signature outperformed previously identified sepsis biomarkers including C-reactive protein [aROC 0.72 (95% CI, 0.57-0.87)], NT-Pro B-type Natriuretic Peptide [aROC 0.84 (95% CI, 0.73-0.96)], and Septicyte™ LAB [aROC 0.8 (95% CI, 0.68-0.93)], but was comparable to Procalcitonin [aROC 0.96 (95% CI, 0.9-1)]. CONCLUSIONS A gene expression signature was identified that accurately discriminates between sepsis and aseptic inflammation in patients given antibiotics in the intensive care unit.
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Affiliation(s)
- Kerina J Denny
- Department of Intensive Care, Gold Coast University Hospital, Southport, Queensland, Australia; University of Queensland, St Lucia, Queensland, Australia.
| | - Rodney A Lea
- Genomics Research Centre, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
| | - Ross Lindell-Innes
- Department of Haematology, Canberra Hospital, Woden, Canberra, Australia; John Curtin School of Medical Research, Australian National University, Australia
| | - Larisa M Haupt
- Genomics Research Centre, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia; ARC Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology, Australia; Max Planck Queensland Centre for the Materials Sciences of Extracellular Matrices, Queensland, Australia
| | - Aaron J Heffernan
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Nicholas R Harvey
- Genomics Research Centre, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia; Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Oliver Hughes
- Genomics Research Centre, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
| | - Van T Cao
- Genomics Research Centre, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
| | - Janine Stuart
- Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia; ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - John F McNamara
- University of Queensland, St Lucia, Queensland, Australia; Department of Infectious Diseases, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Jacobus P J Ungerer
- Department of Chemical Pathology, Pathology Queensland, Herston, Queensland, Australia; School of Biomedical Science, University of Queensland, Brisbane, Australia
| | - Carel J Pretorius
- Department of Chemical Pathology, Pathology Queensland, Herston, Queensland, Australia; School of Biomedical Science, University of Queensland, Brisbane, Australia
| | - Lyn R Griffiths
- Genomics Research Centre, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
| | - Jeffrey Lipman
- Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Jaimeson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Nimes University Hospital, University of Montpellier, Nimes, France
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Mu A, Klare WP, Baines SL, Ignatius Pang CN, Guérillot R, Harbison-Price N, Keller N, Wilksch J, Nhu NTK, Phan MD, Keller B, Nijagal B, Tull D, Dayalan S, Chua HHC, Skoneczny D, Koval J, Hachani A, Shah AD, Neha N, Jadhav S, Partridge SR, Cork AJ, Peters K, Bertolla O, Brouwer S, Hancock SJ, Álvarez-Fraga L, De Oliveira DMP, Forde B, Dale A, Mujchariyakul W, Walsh CJ, Monk I, Fitzgerald A, Lum M, Correa-Ospina C, Roy Chowdhury P, Parton RG, De Voss J, Beckett J, Monty F, McKinnon J, Song X, Stephen JR, Everest M, Bellgard MI, Tinning M, Leeming M, Hocking D, Jebeli L, Wang N, Ben Zakour N, Yasar SA, Vecchiarelli S, Russell T, Zaw T, Chen T, Teng D, Kassir Z, Lithgow T, Jenney A, Cole JN, Nizet V, Sorrell TC, Peleg AY, Paterson DL, Beatson SA, Wu J, Molloy MP, Syme AE, Goode RJA, Hunter AA, Bowland G, West NP, Wilkins MR, Djordjevic SP, Davies MR, Seemann T, Howden BP, Pascovici D, Tyagi S, Schittenhelm RB, De Souza DP, McConville MJ, Iredell JR, Cordwell SJ, Strugnell RA, Stinear TP, Schembri MA, Walker MJ. Integrative omics identifies conserved and pathogen-specific responses of sepsis-causing bacteria. Nat Commun 2023; 14:1530. [PMID: 36934086 PMCID: PMC10024524 DOI: 10.1038/s41467-023-37200-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
Even in the setting of optimal resuscitation in high-income countries severe sepsis and septic shock have a mortality of 20-40%, with antibiotic resistance dramatically increasing this mortality risk. To develop a reference dataset enabling the identification of common bacterial targets for therapeutic intervention, we applied a standardized genomic, transcriptomic, proteomic and metabolomic technological framework to multiple clinical isolates of four sepsis-causing pathogens: Escherichia coli, Klebsiella pneumoniae species complex, Staphylococcus aureus and Streptococcus pyogenes. Exposure to human serum generated a sepsis molecular signature containing global increases in fatty acid and lipid biosynthesis and metabolism, consistent with cell envelope remodelling and nutrient adaptation for osmoprotection. In addition, acquisition of cholesterol was identified across the bacterial species. This detailed reference dataset has been established as an open resource to support discovery and translational research.
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Affiliation(s)
- Andre Mu
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Wellcome Sanger Institute, Hinxton, UK
| | - William P Klare
- Charles Perkins Centre and School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Sarah L Baines
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - C N Ignatius Pang
- Ramaciotti Centre for Genomics, School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
- Bioinformatics Group, Children's Medical Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Romain Guérillot
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Nichaela Harbison-Price
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Nadia Keller
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Jonathan Wilksch
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Nguyen Thi Khanh Nhu
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Minh-Duy Phan
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Bernhard Keller
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Brunda Nijagal
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Dedreia Tull
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Saravanan Dayalan
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Hwa Huat Charlie Chua
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Dominik Skoneczny
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Jason Koval
- Ramaciotti Centre for Genomics, School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Abderrahman Hachani
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Anup D Shah
- Monash Proteomics and Metabolomics Facility, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Nitika Neha
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Snehal Jadhav
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Sally R Partridge
- Centre for Infectious Diseases and Microbiology, Westmead Hospital/ Westmead Institute, and Sydney ID, University of Sydney, Sydney, NSW, Australia
| | - Amanda J Cork
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Kate Peters
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Olivia Bertolla
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Stephan Brouwer
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Steven J Hancock
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Laura Álvarez-Fraga
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - David M P De Oliveira
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Brian Forde
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Ashleigh Dale
- Charles Perkins Centre and School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Warasinee Mujchariyakul
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Calum J Walsh
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Ian Monk
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | | | - Mabel Lum
- Bioplatforms Australia Ltd., Sydney, NSW, Australia
| | - Carolina Correa-Ospina
- Ramaciotti Centre for Genomics, School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Piklu Roy Chowdhury
- Australian Institute for Microbiology and Infection, University of Technology Sydney, Sydney, NSW, Australia
| | - Robert G Parton
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Centre for Microscopy and Microanalysis, The University of Queensland, Brisbane, QLD, Australia
| | - James De Voss
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - James Beckett
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Francois Monty
- Australian Genome Research Facility Ltd., Melbourne, VIC, Australia
| | - Jessica McKinnon
- Australian Institute for Microbiology and Infection, University of Technology Sydney, Sydney, NSW, Australia
| | - Xiaomin Song
- Australian Proteome Analysis Facility, Macquarie University, Sydney, Australia
| | - John R Stephen
- Australian Genome Research Facility Ltd., Melbourne, VIC, Australia
| | - Marie Everest
- Australian Genome Research Facility Ltd., Melbourne, VIC, Australia
| | - Matt I Bellgard
- Office of eResearch, Queensland University of Technology, Brisbane, QLD, Australia
- Center for Comparative Genomics, Murdoch University, Perth, WA, Australia
| | - Matthew Tinning
- Australian Genome Research Facility Ltd., Melbourne, VIC, Australia
| | - Michael Leeming
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Dianna Hocking
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Leila Jebeli
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Nancy Wang
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Nouri Ben Zakour
- Centre for Infectious Diseases and Microbiology, Westmead Hospital/ Westmead Institute, and Sydney ID, University of Sydney, Sydney, NSW, Australia
| | - Serhat A Yasar
- Ramaciotti Centre for Genomics, School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Stefano Vecchiarelli
- Ramaciotti Centre for Genomics, School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Tonia Russell
- Ramaciotti Centre for Genomics, School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Thiri Zaw
- Australian Proteome Analysis Facility, Macquarie University, Sydney, Australia
| | - Tyrone Chen
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Don Teng
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Zena Kassir
- Ramaciotti Centre for Genomics, School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Trevor Lithgow
- Centre to Impact AMR and Infection Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - Adam Jenney
- Centre to Impact AMR and Infection Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - Jason N Cole
- Department of Pediatrics, School of Medicine, University of California at San Diego, La Jolla, CA, 92093, USA
- Skaggs School of Pharmaceutical Sciences, University of California at San Diego, La Jolla, CA, 92093, USA
| | - Victor Nizet
- Department of Pediatrics, School of Medicine, University of California at San Diego, La Jolla, CA, 92093, USA
- Skaggs School of Pharmaceutical Sciences, University of California at San Diego, La Jolla, CA, 92093, USA
| | - Tania C Sorrell
- Centre for Infectious Diseases and Microbiology, Westmead Hospital/ Westmead Institute, and Sydney ID, University of Sydney, Sydney, NSW, Australia
| | - Anton Y Peleg
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
- Centre to Impact AMR and Infection Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - David L Paterson
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Scott A Beatson
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Jemma Wu
- Australian Proteome Analysis Facility, Macquarie University, Sydney, Australia
| | - Mark P Molloy
- Australian Proteome Analysis Facility, Macquarie University, Sydney, Australia
| | - Anna E Syme
- Melbourne Bioinformatics, The University of Melbourne, Melbourne, VIC, Australia
| | - Robert J A Goode
- Monash Proteomics and Metabolomics Facility, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
- Commonwealth Scientific and Industrial Research Organisation, Clayton, VIC, Australia
| | - Adam A Hunter
- Center for Comparative Genomics, Murdoch University, Perth, WA, Australia
| | - Grahame Bowland
- Center for Comparative Genomics, Murdoch University, Perth, WA, Australia
| | - Nicholas P West
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Marc R Wilkins
- Ramaciotti Centre for Genomics, School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Steven P Djordjevic
- Australian Institute for Microbiology and Infection, University of Technology Sydney, Sydney, NSW, Australia
| | - Mark R Davies
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Torsten Seemann
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Benjamin P Howden
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Dana Pascovici
- Australian Proteome Analysis Facility, Macquarie University, Sydney, Australia
| | - Sonika Tyagi
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Ralf B Schittenhelm
- Monash Proteomics and Metabolomics Facility, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - David P De Souza
- Metabolomics Australia, Bio21 Institute, The University of Melbourne, Melbourne, Australia
| | - Malcolm J McConville
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan R Iredell
- Centre for Infectious Diseases and Microbiology, Westmead Hospital/ Westmead Institute, and Sydney ID, University of Sydney, Sydney, NSW, Australia
| | - Stuart J Cordwell
- Charles Perkins Centre and School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Richard A Strugnell
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Mark A Schembri
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Mark J Walker
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
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Billot L, Lipman J, Brett SJ, De Waele JJ, Cotta MO, Davis JS, Finfer S, Hammond N, Knowles S, McGuinness S, Myburgh J, Paterson DL, Peake S, Rajbhandari D, Rhodes A, Roberts JA, Roger C, Shirwadkar C, Starr T, Taylor C, Dulhunty JM. Corrigendum to "Statistical analysis plan for the BLING III study: a phase 3 multicentre randomised controlled trial of continuous versus intermittent β-lactam antibiotic infusion in critically ill patients with sepsis" [Crit Care Resusc 23(3) (2021) 273-284]. CRIT CARE RESUSC 2023; 25:60. [PMID: 37876993 PMCID: PMC10581252 DOI: 10.1016/j.ccrj.2023.04.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
[This corrects the article DOI: 10.51893/2021.3.oa4.].
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Affiliation(s)
- Laurent Billot
- The George Institute for Global Health, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jeffrey Lipman
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
- Department of Anaesthesiology, Critical Care and Emergency Medicine, CHU Nîmes, University Montpellier, Nîmes, France
| | - Stephen J Brett
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jan J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Menino Osbert Cotta
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Joshua S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT, Australia
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia
| | - Simon Finfer
- The George Institute for Global Health, Sydney, NSW, Australia
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Naomi Hammond
- The George Institute for Global Health, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Serena Knowles
- The George Institute for Global Health, Sydney, NSW, Australia
| | | | - John Myburgh
- The George Institute for Global Health, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David L Paterson
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Sandra Peake
- Queen Elizabeth Hospital, Adelaide, SA, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Andrew Rhodes
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
- St George's University of London, London, United Kingdom
| | - Jason A Roberts
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
- Department of Anaesthesiology, Critical Care and Emergency Medicine, CHU Nîmes, University Montpellier, Nîmes, France
| | - Claire Roger
- Department of Anaesthesiology, Critical Care and Emergency Medicine, CHU Nîmes, University Montpellier, Nîmes, France
| | | | - Therese Starr
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Colman Taylor
- The George Institute for Global Health, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Joel M Dulhunty
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
- Redcliffe Hospital, Brisbane, QLD, Australia
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42
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Reyes J, Komarow L, Chen L, Ge L, Hanson BM, Cober E, Herc E, Alenazi T, Kaye KS, Garcia-Diaz J, Li L, Kanj SS, Liu Z, Oñate JM, Salata RA, Marimuthu K, Gao H, Zong Z, Valderrama-Beltrán SL, Yu Y, Tambyah P, Weston G, Salcedo S, Abbo LM, Xie Q, Ordoñez K, Wang M, Stryjewski ME, Munita JM, Paterson DL, Evans S, Hill C, Baum K, Bonomo RA, Kreiswirth BN, Villegas MV, Patel R, Arias CA, Chambers HF, Fowler VG, Doi Y, van Duin D, Satlin MJ. Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study. Lancet Microbe 2023; 4:e159-e170. [PMID: 36774938 PMCID: PMC10016089 DOI: 10.1016/s2666-5247(22)00329-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a global threat, but the distribution and clinical significance of carbapenemases are unclear. The aim of this study was to define characteristics and outcomes of CRPA infections and the global frequency and clinical impact of carbapenemases harboured by CRPA. METHODS We conducted an observational, prospective cohort study of CRPA isolated from bloodstream, respiratory, urine, or wound cultures of patients at 44 hospitals (10 countries) between Dec 1, 2018, and Nov 30, 2019. Clinical data were abstracted from health records and CRPA isolates were whole-genome sequenced. The primary outcome was 30-day mortality from the day the index culture was collected. We compared outcomes of patients with CRPA infections by infection type and across geographic regions and performed an inverse probability weighted analysis to assess the association between carbapenemase production and 30-day mortality. FINDINGS We enrolled 972 patients (USA n=527, China n=171, south and central America n=127, Middle East n=91, Australia and Singapore n=56), of whom 581 (60%) had CRPA infections. 30-day mortality differed by infection type (bloodstream 21 [30%] of 69, respiratory 69 [19%] of 358, wound nine [14%] of 66, urine six [7%] of 88; p=0·0012) and geographical region (Middle East 15 [29%] of 52, south and central America 20 [27%] of 73, USA 60 [19%] of 308, Australia and Singapore three [11%] of 28, China seven [6%] of 120; p=0·0002). Prevalence of carbapenemase genes among CRPA isolates also varied by region (south and central America 88 [69%] of 127, Australia and Singapore 32 [57%] of 56, China 54 [32%] of 171, Middle East 27 [30%] of 91, USA ten [2%] of 527; p<0·0001). KPC-2 (n=103 [49%]) and VIM-2 (n=75 [36%]) were the most common carbapenemases in 211 carbapenemase-producing isolates. After excluding USA patients, because few US isolates had carbapenemases, patients with carbapenemase-producing CRPA infections had higher 30-day mortality than those with non-carbapenemase-producing CRPA infections in both unadjusted (26 [22%] of 120 vs 19 [12%] of 153; difference 9%, 95% CI 3-16) and adjusted (difference 7%, 95% CI 1-14) analyses. INTERPRETATION The emergence of different carbapenemases among CRPA isolates in different geographical regions and the increased mortality associated with carbapenemase-producing CRPA infections highlight the therapeutic challenges posed by these organisms. FUNDING National Institutes of Health.
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Affiliation(s)
- Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia
| | - Lauren Komarow
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Liang Chen
- Center for Discovery and Innovation and Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Lizhao Ge
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Blake M Hanson
- Center for Infectious Diseases and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, TX, USA
| | - Eric Cober
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Erica Herc
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Thamer Alenazi
- College of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Keith S Kaye
- Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA; Division of Allergy, Immunology, and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Julia Garcia-Diaz
- Division of Infectious Diseases, Ochsner Medical Center, New Orleans, LA, USA
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | - Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zhengyin Liu
- Infectious Disease Section, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Jose M Oñate
- Servicio de Medicina Interna, Centro Medico Imbanaco, Cali, Colombia
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kalisvar Marimuthu
- Department of Infectious Diseases, Tan Tock Seng Hospital, National Centre for Infectious Diseases, Singapore
| | - Hainv Gao
- Department of Infectious Diseases, Shulan Hangzhou Hospital, Hangzhou, China
| | - Zhiyong Zong
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Sandra L Valderrama-Beltrán
- Infectious Diseases Research Group, School of Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Paul Tambyah
- National University of Singapore, Infectious Diseases Translational Research Program, Singapore
| | - Gregory Weston
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Soraya Salcedo
- Servicio de Infectología, Organizacion Clinica General del Norte, Barranquilla, Colombia
| | - Lillian M Abbo
- Division of Infectious Diseases, University of Miami Hospital, Miami, FL, USA
| | - Qing Xie
- Department of Infectious Disease, Ruijin Hospital, Shanghai, China
| | - Karen Ordoñez
- Department of Infectious Diseases, ESE Hospital Universitario, San Jorge de Pereira, Pereira, Colombia
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Martin E Stryjewski
- Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | - Jose M Munita
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - David L Paterson
- Department of Infectious Diseases, University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, QL, Australia
| | - Scott Evans
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Carol Hill
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Keri Baum
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Robert A Bonomo
- Case Western Reserve University-Veteran Affairs Center for Antimicrobial Resistance and Epidemiology, Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Department of Medicine, Pharmacology, Molecular Biology and Microbiology, and Biochemistry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Barry N Kreiswirth
- Center for Discovery and Innovation and Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Maria Virginia Villegas
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology and Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Cesar A Arias
- Division of Infectious Diseases and Center for Infectious Diseases Research, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX, USA
| | - Henry F Chambers
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vance G Fowler
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Departments of Microbiology and Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Michael J Satlin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.
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Ling W, Paterson DL, Harris PNA, Furuya-Kanamori L, Edwards F, Laupland KB. Population-based incidence and characteristics of adult Escherichia coli bloodstream infection in Queensland, Australia from 2000 to 2019. Open Forum Infect Dis 2023; 10:ofad071. [PMID: 36968960 PMCID: PMC10034595 DOI: 10.1093/ofid/ofad071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Abstract
Background
There is increasing morbidity and mortality attributed to escalating incidence of Escherichia coli bloodstream infection (BSI). The epidemiology of E. coli BSI is dynamic and differs across populations, this study aimed to describe this epidemiology in Queensland, Australia.
Methods
Incident E. coli BSI (new or recurring at least 30 days from previous BSI) in adult (≥15 years) Queenslanders were identified from 2000 to 2019 using Queensland Health databases. Incidence rates, crude and standardized by age and gender, were calculated. Negative binomial regressions were performed to determine predictors of E. coli BSI incidence.
Results
From 2000 to 2019, 30,350 E. coli BSI in 27,793 patients were detected, standardized incidence rate almost doubled from 34.1 to 65.9 cases per 100,000 residents. Predictors of higher incidence rate were older age (≥65 years), comorbidity and community-onset infections. Despite holding constant these factors, incidence rate was estimated to increase 4% (aIRR=1.04, 95% CI: 1.03-1.04) annually over the study period. Approximately 4.2% of E. coli isolates produced extended-spectrum beta-lactamase (ESBL-Ec), with most (95%) detected after 2010. The incidence rate of ESBL-Ec increased 25% (IRR=1.25%, 95% CI: 1.2-1.3) annually, significantly faster than that of non-producers. Amikacin and carbapenems remain effective in vitro against ESBL-Ec BSI in Queensland.
Conclusion
The rise in E. coli BSI is driven both by higher infection rate and shifting epidemiology towards community-onset infections. These are likely attributed to an ageing Australian population with increasing chronic comorbidity. The rapid expansion of ESBL-Ec in recent years is concerning and should be acknowledged for its implication in the community.
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Affiliation(s)
- Weiping Ling
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland , Herston, Brisbane , Australia
| | - David L Paterson
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland , Herston, Brisbane , Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore , Singapore
| | - Patrick N A Harris
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland , Herston, Brisbane , Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane & Women’s Hospital , Herston, Brisbane , Australia
| | - Luis Furuya-Kanamori
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland , Herston, Brisbane , Australia
| | - Felicity Edwards
- Queensland University of Technology (QUT) , Brisbane, Queensland , Australia
| | - Kevin B Laupland
- Queensland University of Technology (QUT) , Brisbane, Queensland , Australia
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital , Brisbane, Queensland , Australia
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44
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Forde BM, Bergh H, Cuddihy T, Hajkowicz K, Hurst T, Playford EG, Henderson BC, Runnegar N, Clark J, Jennison AV, Moss S, Hume A, Leroux H, Beatson SA, Paterson DL, Harris PNA. Clinical Implementation of Routine Whole-genome Sequencing for Hospital Infection Control of Multi-drug Resistant Pathogens. Clin Infect Dis 2023; 76:e1277-e1284. [PMID: 36056896 DOI: 10.1093/cid/ciac726] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 05/10/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prospective whole-genome sequencing (WGS)-based surveillance may be the optimal approach to rapidly identify transmission of multi-drug resistant (MDR) bacteria in the healthcare setting. METHODS We prospectively collected methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), carbapenem-resistant Acinetobacter baumannii (CRAB), extended-spectrum beta-lactamase (ESBL-E), and carbapenemase-producing Enterobacterales (CPE) isolated from blood cultures, sterile sites, or screening specimens across three large tertiary referral hospitals (2 adult, 1 paediatric) in Brisbane, Australia. WGS was used to determine in silico multi-locus sequence typing (MLST) and resistance gene profiling via a bespoke genomic analysis pipeline. Putative transmission events were identified by comparison of core genome single nucleotide polymorphisms (SNPs). Relevant clinical meta-data were combined with genomic analyses via customised automation, collated into hospital-specific reports regularly distributed to infection control teams. RESULTS Over 4 years (April 2017 to July 2021) 2660 isolates were sequenced. This included MDR gram-negative bacilli (n = 293 CPE, n = 1309 ESBL), MRSA (n = 620), and VRE (n = 433). A total of 379 clinical reports were issued. Core genome SNP data identified that 33% of isolates formed 76 distinct clusters. Of the 76 clusters, 43 were contained to the 3 target hospitals, suggesting ongoing transmission within the clinical environment. The remaining 33 clusters represented possible inter-hospital transmission events or strains circulating in the community. In 1 hospital, proven negligible transmission of non-multi-resistant MRSA enabled changes to infection control policy. CONCLUSIONS Implementation of routine WGS for MDR pathogens in clinical laboratories is feasible and can enable targeted infection prevention and control interventions.
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Affiliation(s)
- Brian M Forde
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Haakon Bergh
- Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Thom Cuddihy
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Krispin Hajkowicz
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Trish Hurst
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - E Geoffrey Playford
- Infection Management Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Belinda C Henderson
- Infection Management Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia.,Faculty of Medicine, PA-Southside Clinical School, University of Queensland, Brisbane, QLD, Australia
| | - Julia Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, QLD, Australia.,Centre for Children's Health Research, Children's Health Queensland, Brisbane, Australia
| | - Amy V Jennison
- Public Health Microbiology, Forensic and Scientific Services, Queensland Health, Brisbane, QLD, Australia
| | - Susan Moss
- Public Health Microbiology, Forensic and Scientific Services, Queensland Health, Brisbane, QLD, Australia
| | - Anna Hume
- Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Hugo Leroux
- Australian e-Health Research Centre, CSIRO, Brisbane, QLD, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - David L Paterson
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia.,Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Patrick N A Harris
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia.,Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
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45
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McQuilten ZK, Venkatesh B, Jha V, Roberts J, Morpeth SC, Totterdell JA, McPhee GM, Abraham J, Bam N, Bandara M, Bangi AK, Barina LA, Basnet BK, Bhally H, Bhusal KR, Bogati U, Bowen AC, Burke AJ, Christopher DJ, Chunilal SD, Cochrane B, Curnow JL, Das SK, Dhungana A, Di Tanna GL, Dotel R, DSouza H, Dummer J, Dutta S, Foo H, Gilbey TL, Giles ML, Goli K, Gordon A, Gyanwali P, Haksar D, Hudson BJ, Jani MK, Jevaji PR, Jhawar S, Jindal A, John MJ, John M, John FB, John O, Jones M, Joshi RD, Kamath P, Kang G, Karki AR, Karmalkar AM, Kaur B, Koganti KC, Koshy JM, Krishnamurthy MS, Lau JS, Lewin SR, Lim LL, Marschner IC, Marsh JA, Maze MJ, McGree JM, McMahon JH, Medcalf RL, Merriman EG, Misal AP, Mora JM, Mudaliar VK, Nguyen V, O'Sullivan MV, Pant S, Pant P, Paterson DL, Price DJ, Rees MA, Robinson JO, Rogers BA, Samuel S, Sasadeusz J, Sharma D, Sharma PK, Shrestha R, Shrestha SK, Shrestha P, Shukla U, Shum O, Sommerville C, Spelman T, Sullivan RP, Thatavarthi U, Tran HA, Trask N, Whitehead CL, Mahar RK, Hammond NE, McFadyen JD, Snelling TL, Davis JS, Denholm JT, Tong SYC. Anticoagulation Strategies in Non-Critically Ill Patients with Covid-19. NEJM Evid 2023; 2:EVIDoa2200293. [PMID: 38320033 DOI: 10.1056/evidoa2200293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Anticoagulation in Non-Critically Ill Covid-19 PatientsMcQuilten et al. conducted a randomized clinical trial comparing low-dose, intermediate-dose, low-dose plus aspirin, and therapeutic-dose anticoagulation in patients with Covid-19 of diverse ethnicities in high-, low-, and middle-income countries.
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Affiliation(s)
- Zoe K McQuilten
- Monash University, Melbourne, Australia
- Monash Health, Melbourne, Australia
| | - Balasubramanian Venkatesh
- University of Queensland, Brisbane, Australia
- The George Institute for Global Health, Sydney, Australia
- The George Institute for Global Health, Delhi, Delhi, India
- The Wesley Hospital, Brisbane, Queensland, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, Delhi, Delhi, India
- Imperial College, London, England, United Kingdom
| | - Jason Roberts
- University of Queensland, Brisbane, Australia
- Metro North Health, Brisbane, Queensland, Australia
| | | | - James A Totterdell
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Grace M McPhee
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - John Abraham
- Christian Medical College, Ludhiana, Punjab, India
| | - Niraj Bam
- Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Bagmati, Nepal
| | - Methma Bandara
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ashpak K Bangi
- Jivanrekha Multispeciality Hospital, Pune, Maharashtra, India
| | - Lauren A Barina
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Bhupendra K Basnet
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | - Hasan Bhally
- North Shore Hospital, Auckland, North Island, New Zealand
| | - Khema R Bhusal
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | - Umesh Bogati
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Andrew J Burke
- University of Queensland, Brisbane, Australia
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | | | - Sanjeev D Chunilal
- Monash University, Melbourne, Australia
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Belinda Cochrane
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
- Western Sydney University, Sydney, New South Wales, Australia
| | - Jennifer L Curnow
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Santa Kumar Das
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | - Ashesh Dhungana
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | | | | | - Hyjel DSouza
- The George Institute for Global Health, Delhi, Delhi, India
| | - Jack Dummer
- University of Otago, Dunedin, Otago, New Zealand
- Dunedin Hospital, Dunedin, Otago, New Zealand
| | - Sourabh Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Hong Foo
- NSW Health Pathology, Sydney, New South Wales, Australia
| | - Timothy L Gilbey
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
| | - Michelle L Giles
- Monash University, Melbourne, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kasiram Goli
- Aditya Multi-speciality Hospital, Guntur, Andhra Pradesh, India
| | - Adrienne Gordon
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Newborn Care, Melbourne, Victoria, Australia
| | - Pradip Gyanwali
- Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Bagmati, Nepal
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | | | | | | | | | | | - Aikaj Jindal
- Satguru Partap Singh Hospitals, Ludhiana, Punjab, India
| | | | - Mary John
- Christian Medical College, Ludhiana, Punjab, India
| | | | - Oommen John
- The George Institute for Global Health, Delhi, Delhi, India
- Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Mark Jones
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rajesh D Joshi
- The George Institute for Global Health, Delhi, Delhi, India
| | | | | | - Achyut R Karki
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | | | - Baldeep Kaur
- The George Institute for Global Health, Sydney, Australia
| | | | - Jency M Koshy
- Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | | | - Jillian S Lau
- Eastern Health, Melbourne, Victoria, Australia
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - Sharon R Lewin
- Monash Health, Melbourne, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Ian C Marschner
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Julie A Marsh
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - James M McGree
- Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | | | | | - Jocelyn M Mora
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Vi Nguyen
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Matthew V O'Sullivan
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
- NSW Health Pathology, Sydney, New South Wales, Australia
| | - Suman Pant
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | - Pankaj Pant
- Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Bagmati, Nepal
| | - David L Paterson
- National Institute of Singapore, Singapore, Singapore, Singapore
| | - David J Price
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Megan A Rees
- Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James O Robinson
- College of Science, Health, Engineering and Education, Discipline of Health, Murdoch University, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Benjamin A Rogers
- Monash University, Melbourne, Australia
- Monash Health, Melbourne, Australia
| | | | - Joe Sasadeusz
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deepak Sharma
- Maharaja Agrasen Superspeciality Hospital, Delhi, Delhi, India
| | | | - Roshan Shrestha
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati, Nepal
| | - Sailesh K Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | - Prajowl Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Bagmati, Nepal
| | - Urvi Shukla
- Symbiosis University Hospital & Research Centre, Pune, Maharashtra, India
| | - Omar Shum
- The Wollongong Hospital, Wollongong, New South Wales, Australia
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Christine Sommerville
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Tim Spelman
- Karolinska Institute, Solna, Stockholm, Sweden
- Burnet Institute, Melbourne, Victoria, Australia
| | - Richard P Sullivan
- St. George Hospital, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Huyen A Tran
- Monash University, Melbourne, Australia
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nanette Trask
- Chartered Accountants Australia and New Zealand, Perth, Western Australia, Australia
| | - Clare L Whitehead
- The Royal Women's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robert K Mahar
- Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Perth, Western Australia, Australia
| | - Naomi E Hammond
- The George Institute for Global Health, Sydney, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - James D McFadyen
- The Alfred Hospital, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Thomas L Snelling
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Justin T Denholm
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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46
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Atamna A, Margalit I, Ayada G, Babich T, Naucler P, Valik JK, Giske CG, Benito N, Cardona R, Rivera A, Pulcini C, Fattah MA, Haquin J, Macgowan A, Chazan B, Yanovskay A, Ami RB, Landes M, Nesher L, Zaidman-Shimshovitz A, McCarthy K, Paterson DL, Tacconelli E, Buhl M, Mauer S, Rodríguez-Baño J, de Cueto M, Oliver A, de Gopegui ER, Cano A, Machuca I, Gozalo-Marguello M, Martinez-Martinez L, Gonzalez-Barbera EM, Alfaro IG, Salavert M, Beovic B, Saje A, Mueller-Premru M, Pagani L, Vitrat V, Kofteridis D, Zacharioudaki M, Maraki S, Weissman Y, Paul M, Dickstei Y, Yahav D. Outcomes of octogenarians and nonagenarians with Pseudomonas aeruginosa bacteremia: a multicenter retrospective study. Infection 2022:10.1007/s15010-022-01973-x. [PMID: 36571672 DOI: 10.1007/s15010-022-01973-x] [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: 10/05/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND P. aeruginosa bacteremia is a common and severe infection carrying high mortality in older adults. We aimed to evaluate outcomes of P. aeruginosa bacteremia among old adults (≥ 80 years). METHODS We included the 464/2394 (19%) older adults from a retrospective multinational (9 countries, 25 centers) cohort study of individuals hospitalized with P. aeruginosa bacteremia. Bivariate and multivariable logistic regression models were used to evaluate risk factors for 30-day mortality among older adults. RESULTS Among 464 adults aged ≥ 80 years, the mean age was 84.61 (SD 3.98) years, and 274 (59%) were men. Compared to younger patients, ≥ 80 years adults had lower Charlson score; were less likely to have nosocomial acquisition; and more likely to have urinary source. Thirty-day mortality was 30%, versus 27% among patients 65-79 years (n = 894) and 25% among patients < 65 years (n = 1036). Multivariate analysis for predictors of mortality among patients ≥ 80 years, demonstrated higher SOFA score (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.23-1.51, p < 0.001), corticosteroid therapy (OR 3.15, 95% CI: 1.24-8.01, p = 0.016) and hospital acquired P. aeruginosa bacteremia (OR 2.30, 95% CI: 1.33-3.98, p = 0.003) as predictors. Appropriate empirical therapy within 24 h, type of definitive anti-pseudomonal drug, and type of regimen (monotherapy or combination) were not associated with 30-day mortality. CONCLUSIONS In older adults with P. aeruginosa bacteremia, background conditions, place of acquisition, and disease severity are associated with mortality, rather than the antimicrobial regimen. In this regard, preventive efforts and early diagnosis before organ failure develops might be beneficial for improving outcomes.
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Affiliation(s)
- Alaa Atamna
- Infectious Diseases Unit, Rain Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah Tikva, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ili Margalit
- Infectious Diseases Unit, Rain Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah Tikva, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gida Ayada
- Medicine C, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Tanya Babich
- Infectious Diseases Unit, Rain Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah Tikva, Israel.,Research Authority, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Pontus Naucler
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John Karlsson Valik
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruben Cardona
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Rivera
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Celine Pulcini
- Université de Lorraine, APEMAC, 54000, Nancy, France.,Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Manal Abdel Fattah
- Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Justine Haquin
- Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Alasdair Macgowan
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Anna Yanovskay
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ronen Ben Ami
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Landes
- Infectious Diseases Unit, Sourasky Medical Center, Tel-Aviv, Israel
| | - Lior Nesher
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Zaidman-Shimshovitz
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kate McCarthy
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Evelina Tacconelli
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Michael Buhl
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Susanna Mauer
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Jesús Rodríguez-Baño
- Hospital Universitario Virgen Macarena, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS)/CSIC and CIBERINFEC, Instituto de Salud Carlos III ES, Sevilla, Spain
| | - Marina de Cueto
- Hospital Universitario Virgen Macarena, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS)/CSIC and CIBERINFEC, Instituto de Salud Carlos III ES, Sevilla, Spain
| | - Antonio Oliver
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma, Spain
| | - Enrique Ruiz de Gopegui
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma, Spain
| | - Angela Cano
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Isabel Machuca
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | | | - Luis Martinez-Martinez
- Microbiology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | | | - Miguel Salavert
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Bojana Beovic
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andreja Saje
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Manica Mueller-Premru
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Virginie Vitrat
- Infectious Diseases Unit, Annecy-Genevois Hospital Center (CHANGE), Annecy, France
| | - Diamantis Kofteridis
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Maria Zacharioudaki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Maraki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Yulia Weissman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mical Paul
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstei
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
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47
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Isler B, Falconer C, Vatansever C, Özer B, Çınar G, Aslan AT, Forde B, Harris P, Şimşek F, Tülek N, Demirkaya H, Menekşe Ş, Akalin H, Balkan İİ, Aydın M, Tigen ET, Demir SK, Kapmaz M, Keske Ş, Doğan Ö, Arabacı Ç, Yağcı S, Hazırolan G, Bakır VO, Gönen M, Saltoğlu N, Azap A, Azap Ö, Akova M, Ergönül Ö, Can F, Paterson DL. High prevalence of ArmA-16S rRNA methyltransferase among aminoglycoside-resistant Klebsiella pneumoniae bloodstream isolates. J Med Microbiol 2022; 71. [PMID: 36748503 DOI: 10.1099/jmm.0.001629] [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] [Indexed: 12/24/2022] Open
Abstract
Introduction. Aminoglycosides are used for the treatment of carbapenemase-producing Klebsiella pneumoniae (CPK) infections. 16S rRNA methyltransferases (RMTs) confer resistance to all aminoglycosides and are often cocarried with NDM.Hypothesis/Gap Statement. There is a dart of studies looking at the aminoglycoside resistance mechanisms for invasive CPK isolates, particularly in OXA-48 endemic settings.Aim. We aimed to determine the prevalence of RMTs and their association with beta lactamases and MLSTs amongst aminoglycoside-resistant CPK bloodstream isolates in an OXA-48 endemic setting.Methodology. CPK isolates (n=181), collected as part of a multicentre cohort study, were tested for amikacin, gentamicin and tobramycin susceptibility using custom-made sensititre plates (GN2XF, Thermo Fisher Scientific). All isolates were previously subjected to whole-genome sequencing. Carbapenemases, RMTs, MLSTs and plasmid incompatibility groups were detected on the assembled genomes.Results. Of the 181 isolates, 109(60 %) were resistant to all three aminoglycosides, and 96 of 109(88 %) aminoglycoside-resistant isolates carried an RMT (85 ArmA, 10 RmtC, 4 RmtF1; three isolates cocarried ArmA and RmtC). Main clonal types associated with ArmA were ST2096 (49/85, 58 %) and ST14 (24/85, 28 %), harbouring mainly OXA-232 and OXA-48 +NDM, respectively. RmtC was cocarried with NDM (5/10) on ST395, and NDM +OXA-48 or NDM +KPC (4/10) on ST14, ST15 and ST16. All RMT producers also carried CTX-M-15, and the majority cocarried SHV-106, TEM-150 and multiple other antibiotic resistance genes. The majority of the isolates harboured a combination of IncFIB, IncH and IncL/M type plasmids. Non-NDM producing isolates remained susceptible to ceftazidime-avibactam.Conclusion. Aminoglycoside resistance amongst CPK bloodstream isolates is extremely common and mainly driven by clonal spread of ArmA carried on ST2096 and ST14, associated with OXA-232 and OXA48 +NDM carriage, respectively.
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Affiliation(s)
- Burcu Isler
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Caitlin Falconer
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Cansel Vatansever
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Berna Özer
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Güle Çınar
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Abdullah Tarık Aslan
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brian Forde
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Patrick Harris
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - Funda Şimşek
- Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Necla Tülek
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Atilim University, Ankara, Turkey
| | - Hamiyet Demirkaya
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Şirin Menekşe
- Infectious Diseases, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Halis Akalin
- Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Turkey
| | - İlker İnanç Balkan
- Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, School of Medicine, Istanbul, Turkey
| | - Mehtap Aydın
- Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Tükenmez Tigen
- Infectious Diseases and Clinical Microbiology, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Safiye Koçulu Demir
- Infectious Diseases and Clinical Microbiology, Demiroglu Bilim University, Istanbul, Turkey
| | - Mahir Kapmaz
- Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Şiran Keske
- Infectious Diseases, VKV American Hospital, Istanbul, Turkey.,Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Özlem Doğan
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Çiğdem Arabacı
- Clinical Microbiology, University of Health Sciences, Ministry of Health Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Serap Yağcı
- Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gülşen Hazırolan
- Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Veli Oğuzalp Bakır
- Graduate School of Sciences and Engineering, Koç University, Istanbul, Turkey
| | - Mehmet Gönen
- Industrial Engineering, College of Engineering, Koç University, Istanbul, Turkey
| | - Neşe Saltoğlu
- Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, School of Medicine, Istanbul, Turkey
| | - Alpay Azap
- Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Azap
- Infectious Diseases and Clinical Microbiology, Başkent University, Ankara Hospital, Ankara, Turkey
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Önder Ergönül
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey.,Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Füsun Can
- Koç University İş Bank Centre for Infectious Diseases (KUISCID), Istanbul, Turkey.,Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - David L Paterson
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia.,ADVANCE ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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48
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Tong SYC, Mora J, Bowen AC, Cheng MP, Daneman N, Goodman AL, Heriot GS, Lee TC, Lewis RJ, Lye DC, Mahar RK, Marsh J, McGlothlin A, McQuilten Z, Morpeth SC, Paterson DL, Price DJ, Roberts JA, Robinson JO, van Hal SJ, Walls G, Webb SA, Whiteway L, Yahav D, Davis JS. The Staphylococcus aureus Network Adaptive Platform Trial Protocol: New Tools for an Old Foe. Clin Infect Dis 2022; 75:2027-2034. [PMID: 35717634 PMCID: PMC9710697 DOI: 10.1093/cid/ciac476] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 01/17/2023] Open
Abstract
Staphylococcus aureus bloodstream (SAB) infection is a common and severe infectious disease, with a 90-day mortality of 15%-30%. Despite this, <3000 people have been randomized into clinical trials of treatments for SAB infection. The limited evidence base partly results from clinical trials for SAB infections being difficult to complete at scale using traditional clinical trial methods. Here we provide the rationale and framework for an adaptive platform trial applied to SAB infections. We detail the design features of the Staphylococcus aureus Network Adaptive Platform (SNAP) trial that will enable multiple questions to be answered as efficiently as possible. The SNAP trial commenced enrolling patients across multiple countries in 2022 with an estimated target sample size of 7000 participants. This approach may serve as an exemplar to increase efficiency of clinical trials for other infectious disease syndromes.
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Affiliation(s)
- Steven Y C Tong
- Department of Infectious Diseases University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jocelyn Mora
- Department of Infectious Diseases University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Matthew P Cheng
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Anna L Goodman
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom.,Department of Infection, St Thomas Hospital, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - George S Heriot
- Department of Infectious Diseases University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Todd C Lee
- Clinical Practice Assessment Unit and Division of Infectious Diseases, McGill University, Montreal, Canada
| | - Roger J Lewis
- Berry Consultants, LLC, Austin, Texas, USA.,Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.,Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David C Lye
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Robert K Mahar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Australia
| | - Julie Marsh
- Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
| | | | - Zoe McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Haematology, Monash Health, Melbourne, Australia
| | - Susan C Morpeth
- Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - David J Price
- Department of Infectious Diseases University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - J Owen Robinson
- Department of Infectious Diseases, Royal Perth Hospital, Perth, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Australia.,PathWest Laboratory Medicine, Perth, Australia.,College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Sebastiaan J van Hal
- Department of Microbiology and Infectious Diseases Royal Prince Alfred Hospital, Sydney, Australia.,School of Medicine, University of Sydney, Sydney, Australia
| | - Genevieve Walls
- Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand
| | - Steve A Webb
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Lyn Whiteway
- Freelance Health Consumer Advocate, Adealide, South Australia, Australia
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Joshua S Davis
- School of Medicine and Public Health and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
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49
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Kwok M, McGeorge S, Mayer‐Coverdale J, Graves B, Paterson DL, Harris PN, Esler R, Dowling C, Britton S, Roberts MJ. Guideline of guidelines: management of recurrent urinary tract infections in women. BJU Int 2022; 130 Suppl 3:11-22. [PMID: 35579121 PMCID: PMC9790742 DOI: 10.1111/bju.15756] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To compare recurrent urinary tract infection (rUTI) guidelines from major urological and non-urological organisations internationally and identify areas of consensus and discrepancy. METHODS PubMed, Google Scholar and the official webpages of major urological, gynaecological, infectious diseases and general practice organisations were searched for rUTI guidelines in March 2022. Nine guidelines were included for review: European Association of Urology, National Institute for Health and Care Excellence (NICE), Society of Obstetricians and Gynaecologists of Canada, American Academy of Family Physicians, Mexican College of Gynaecology and Obstetrics Specialists, Swiss Society of Gynaecology and Obstetrics, Spanish Society of Infectious Diseases and Clinical Microbiology, German Association of Scientific Medical Societies, and the combined American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. RESULTS The definition and evaluation of rUTIs, and antibiotic prophylaxis strategies, were mostly consistent across guidelines, and emphasised the importance of obtaining urine cultures and limiting cystoscopy and upper tract imaging in women without risk factors. Variable recommendations were noted for symptomatic treatment, self-initiated antibiotics, and antibiotic-sparing preventative strategies such as cranberry, vaginal oestrogen, immunoactive prophylaxis with OM-89, intravesical glycosaminoglycan instillation, and phytotherapeutics. Recent randomised evidence supports the use of methenamine hippurate. Either continuous or post-coital prophylactic antibiotics were supported by all guidelines. None of the guidelines were tailored to the management recurrent complicated UTI. CONCLUSION Multiple rUTI guidelines were identified and mostly limited their recommendations to otherwise healthy non-pregnant women with uncomplicated cystitis. Variation was noted, particularly in antibiotic-sparing preventative strategies. Some conflicting recommendations are due to more recent guidelines including updated evidence. Future guidelines should consider recommendations to assist management of complex patient groups, such as recurrent complicated UTI.
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Affiliation(s)
- Michael Kwok
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQldAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQldAustralia,Department of UrologyRedcliffe HospitalRedcliffeQldAustralia
| | - Stephen McGeorge
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQldAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQldAustralia
| | | | | | - David L. Paterson
- Department of Infectious DiseasesRoyal Brisbane and Women’s HospitalBrisbaneQldAustralia,Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchBrisbaneQldAustralia
| | - Patrick N.A. Harris
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchBrisbaneQldAustralia,Central LaboratoryPathology QueenslandBrisbaneQldAustralia
| | - Rachel Esler
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQldAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQldAustralia
| | | | - Sumudu Britton
- Department of Infectious DiseasesRoyal Brisbane and Women’s HospitalBrisbaneQldAustralia,Infection and Inflammation ProgramQIMR Berghofer Medical Research InstituteHerstonQldAustralia
| | - Matthew J. Roberts
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQldAustralia,Department of UrologyRedcliffe HospitalRedcliffeQldAustralia,Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchBrisbaneQldAustralia
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50
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Isler B, Aslan AT, Akova M, Harris P, Paterson DL. Treatment strategies for OXA-48-like and NDM producing Klebsiella pneumoniae infections. Expert Rev Anti Infect Ther 2022; 20:1389-1400. [PMID: 36150216 DOI: 10.1080/14787210.2022.2128764] [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] [Indexed: 12/15/2022]
Abstract
INTRODUCTION OXA-48 and NDM are amongst the most prevalent carbapenemase types associated with Klebsiella pneumoniae worldwide, with an increase in their prevalence in recent years. Knowledge on the treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP) comes from KPC-producing CRKP with limited data available for OXA-48-like and NDM producers. Our aim is to review the literature on the treatment of OXA-48-like and NDM-producing CRKP with the goal of providing an update on the available antibiotic treatment strategies, particularly in light of changing carbapenemase epidemiology and increasing antimicrobial resistance. AREAS COVERED We reviewed studies looking at the antibiotic treatment and outcome of OXA-48-like and/or NDM-producing CRKP. EXPERT OPINION The best available treatment option for OXA-48 producers is ceftazidime-avibactam, where available and when the price permits its use. Colistin remains as the second-line option if in vitro susceptibility is demonstrated with an appropriate method. There is not enough evidence to support the use of meropenem-containing combination therapies for meropenem-resistant OXA-48 producers. Treatment of NDM producers is an unmet need. Ceftazidime-avibactam and aztreonam combination or cefiderocol can be used for NDM producers, where available. Higher cefiderocol MICs against NDM producers is concerning. Aztreonam-avibactam provides hope for the treatment of NDM producers.
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Affiliation(s)
- Burcu Isler
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Abdullah Tarık Aslan
- Department of Internal Medicine, Golhisar State Hospital, 15100 Golhisar, Turkey
| | - Murat Akova
- Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara
| | - Patrick Harris
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia
| | - David L Paterson
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Australia.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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