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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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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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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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Watson AL, Woodford J, Britton S, Gupta R, Whiley D, McCarthy K. Determining Pneumocystis jirovecii Colonisation from Infection Using PCR-Based Diagnostics in HIV-Negative Individuals. Diagnostics (Basel) 2024; 14:114. [PMID: 38201422 PMCID: PMC10802892 DOI: 10.3390/diagnostics14010114] [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: 11/30/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Pneumocystis jirovecii pneumonia is increasingly diagnosed with highly sensitive PCR diagnostics in immunocompromised, HIV-negative individuals. We assessed the performance of our in-house quantitative PCR with the aim to optimise interpretation. METHODS Retrospective audit of all positive P. jirovecii qPCRs on induced sputum or BAL fluid at a single centre from 2012 to 2023. Medical and laboratory records were analysed and people with HIV were excluded. Cases were categorised as colonisation, high-probability PCP or uncertain PCP infection against a clinical gold standard incorporating clinico-radiological data. Quantitative PCR assay targeting the 5s gene was utilised throughout the time period. RESULTS Of the 82 positive qPCRs, 28 were categorised as high-probability PCP infection, 30 as uncertain PCP and 24 as colonisation. There was a significant difference in qPCR values stratified by clinical category but not respiratory sample type. Current assay performance with a cutoff of 2.5 × 105 copies/mL had a sensitivity of 50% (95% CI, 30.65-69.35%) and specificity of 83.33% (95% CI, 62.62-95.26%). Youden Index calculated at 6.5 × 104 copies/mL had a sensitivity of 75% (56.64-87.32%, 95% CI) and specificity of 66.67% (46.71-82.03%, 95% CI). High and low cutoffs were explored. Significant variables associated with infection were age > 70 years old, the presence of fever, hypoxia or ground glass changes. CONCLUSIONS A single qPCR cutoff cannot reliably determine P. jirovecii infection from colonisation. Low and high cutoffs are useful, however, a large "possible infection" cohort will remain where interpretation of clinic-radiological factors remains essential. Standardisation of assays with prospective validation in specific immunocompromised groups will allow greater generalisability and allow large-scale prospective assay validation to be performed.
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Affiliation(s)
- Anna Louise Watson
- Infectious Diseases, Royal Brisbane & Women’s Hospital, Metro North Health, Herston, QLD 4006, Australia
- Herston Infectious Diseases Institute, Herston, QLD 4006, Australia
| | - John Woodford
- Infectious Diseases, Ipswich Hospital, Ipswich, QLD 4305, Australia
| | - Sumudu Britton
- Infectious Diseases, Royal Brisbane & Women’s Hospital, Metro North Health, Herston, QLD 4006, Australia
| | - Rita Gupta
- Pathology Queensland, Herston, QLD 4006, Australia
| | - David Whiley
- Pathology Queensland, Herston, QLD 4006, Australia
- The University of Queensland, Herston, QLD 4006, Australia
| | - Kate McCarthy
- Infectious Diseases, Royal Brisbane & Women’s Hospital, Metro North Health, Herston, QLD 4006, Australia
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Lowry K, Bauer MJ, Buckley C, Wang C, Bordin A, Badman S, Harris PNA, Mackay I, Whiley D. Evaluation of Illumina® COVIDSeq™ as a tool for Omicron SARS-CoV-2 characterisation. J Virol Methods 2023; 322:114827. [PMID: 37778540 DOI: 10.1016/j.jviromet.2023.114827] [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: 06/01/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/03/2023]
Abstract
The continued emergence and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants requires ongoing genetic surveillance to support public health responses. The expansion of reliable next generation sequence (NGS) platforms has enabled the rapid characterisation of the constant emergence of new SARS-CoV-2 variants using nasopharyngeal swab specimens. Several studies have assessed the ability of COVIDSeq to type earlier SARS-CoV-2 strains (pre-Delta) rapidly and successfully, however, there is limited data showing suitability against Omicron variants. In the present study, we evaluated the performance of the Illumina COVIDSeq Assay as a streamlined amplicon-based NGS platform for detection and typing of Omicron variants. Our results demonstrate the high performance of SARS-CoV-2 sequencing using the COVIDSeq approach, with good repeatability, reproducibility and sensitivity for samples approaching CT 31. The COVIDSeq approach was 100% concordant with samples previously characterized by sequencing methods. The quick library preparation process and high throughput kit made it ideal for reflex testing, with a total time required for sequencing and analysis of approximately two days. This study demonstrates the effectiveness and versatility of the amplicon-based NGS characterisation method for SARS-CoV-2, providing a foundation for further research and development of custom-designed amplicon panels targeting different microorganisms.
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Affiliation(s)
- Kym Lowry
- The Queensland Paediatric Infectious Diseases (QPID) Sakzewski Laboratory, Queensland Children's Hospital, Brisbane, Queensland, Australia; The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Michelle J Bauer
- The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Cameron Buckley
- Infectious Diseases Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Claire Wang
- The Queensland Paediatric Infectious Diseases (QPID) Sakzewski Laboratory, Queensland Children's Hospital, Brisbane, Queensland, Australia; Infectious Diseases Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Amanda Bordin
- The Queensland Paediatric Infectious Diseases (QPID) Sakzewski Laboratory, Queensland Children's Hospital, Brisbane, Queensland, Australia; The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Infectious Diseases Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Steven Badman
- Kirby Institute for Infection and Immunity in Society, University of New South Wales (UNSW) Medicine, UNSW Sydney, Kensington, NSW, Australia
| | - Patrick N A Harris
- The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Infectious Diseases Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Ian Mackay
- The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Infectious Diseases Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - David Whiley
- The Queensland Paediatric Infectious Diseases (QPID) Sakzewski Laboratory, Queensland Children's Hospital, Brisbane, Queensland, Australia; The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Infectious Diseases Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
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Salmerón P, Buckley C, Arando M, Alcoceba E, Romero B, Clavo P, Whiley D, Serra-Pladevall J. Genome-based epidemiology and antimicrobial resistance of Neisseria gonorrhoeae in Spain: A prospective multicentre study. J Eur Acad Dermatol Venereol 2023; 37:2575-2582. [PMID: 37620291 DOI: 10.1111/jdv.19458] [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] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Whole-genome sequencing (WGS) of Neisseria gonorrhoeae isolates combined with epidemiological and phenotypic data provides better understanding of population dynamics. AIM The objective of this study was to investigate the molecular epidemiology of N. gonorrhoeae isolates from three centres in Spain and determine associations of antimicrobial resistance. METHODS Genetic characterization was performed in 170 N. gonorrhoeae isolates. WGS was carried out with the HiSeq platform (Illumina). Genome assemblies were submitted to the PubMLST Neisseria database website to determine NG-MAST, MLST and NG-STAR. Antimicrobial resistance genes and point mutations were identified with PubMLST. Phylogenomic comparison was based on whole-genome single nucleotide polymorphism analysis. RESULTS Twenty-six MLST, 49 NG-MAST and 41 NG-STAR sequence types were detected, the most prevalent being MLST-ST9363 (27.1%), NG-MAST ST569 (12.4%) and NG-STAR ST193 (14.7%). Phylogenetic analysis identified 13 clusters comprising 69% of the isolates, with two of note: one involved cefixime-resistant isolates from Barcelona presenting a mosaic penA X and belonging to MLST-ST7363 and the other involved azithromycin-resistant isolates from Mallorca that possessed the C2611T mutation in the four 23S rRNA alleles belonging to MLST-ST1901. CONCLUSION The population of N. gonorrhoeae is quite heterogeneous in Spain. Our results agree with previous data published in Europe, albeit with some differences in distribution between regions. This study describes the circulation of two gonococcal populations with a specific resistance profile and sequence type in a specific geographic area. WGS is an effective tool for epidemiological surveillance of gonococcal infection and detection of resistance genes.
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Affiliation(s)
- P Salmerón
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Sexually Transmitted Infections Study Group (GEITS), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - C Buckley
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - M Arando
- Sexually Transmitted Infections Study Group (GEITS), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - E Alcoceba
- Microbiology Department, Son Espases Hospital Universitari, Mallorca, Spain
| | - B Romero
- Microbiology Department, Ramón y Cajal Hospital Universitario, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - P Clavo
- Sandoval Health Centre, San Carlos Hospital Clínico, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - D Whiley
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - J Serra-Pladevall
- Sexually Transmitted Infections Study Group (GEITS), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Clinical Laboratory, Hospital Universitari de Vic, Catalonia, Spain
- Faculty of Health Sciences, Universitat de Vic - Universitat Central de Catalunya (UVIC -UCC), Vic, Spain
- Multidisciplinary Inflammation Research Group (MIRG), Fundació Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central, Vic, Spain
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7
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McHugh L, Dyda A, Guglielmino C, Buckley C, Lau CL, Jennison AV, Regan DG, Wood J, Whiley D, Trembizki E. The changing epidemiology of Neisseria gonorrhoeae genogroups and antimicrobial resistance in Queensland, Australia, 2010-15: a case series analysis of unique Neisseria gonorrhoeae isolates. Sex Health 2023; 20:296-302. [PMID: 36972581 DOI: 10.1071/sh22118] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Neisseria gonorrhoeae (NG) can lead to serious reproductive and sexual health outcomes, and the annual number of NG notifications in Australia increased steadily from 10329 in 2010 to 29549 by 2020. Australian populations most affected are urban men who have sex with men and First Nations peoples living in remote areas, and a resurgence in urban heterosexuals has been observed since 2012. METHODS A case series analysis of Queensland NG isolates (2010-15) exploring temporal trends and antimicrobial resistance by demographic and geographic distribution and genotype was performed. Proportions describe age, sex, strain, genogroup (NG multi-antigen sequence typing), region, swab site, antimicrobial sensitivity and isolate rates per 100000 population. Dominant genogroups were identified. RESULTS Among 3953 isolates, the median age was 25years (IQR 20-34years) and most (n =2871/3915, 73%) were men. Brisbane city (68.8) and Far North Queensland (54.1) excluding Cairns showed the highest rates. Forty-six genogroups were documented, seven (G2992, G6876, G1415, G4186, G5, G1407 and G6937) comprised half of all isolates. The predominant male genogroup was G2992 (16%), and G6876 (20%) for females; G5 was predominantly male from 2010 to 2011, but equal in both sexes from 2012 to 2015. CONCLUSION Considerable temporal, geographical and demographical diversity was observed in Queensland NG isolates, which has public health implications. Certain genogroups are more transient than others, and evidence suggests bridging from male-dominant networks to heterosexual networks. Molecular surveillance can enhance tracking the epidemiology and movement of NG in Australia, highlighting the necessity of genotyping to expose potentially prevalent strains circulating in undetected or underrepresented networks by current screening methods.
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Affiliation(s)
- Lisa McHugh
- University of Queensland, School of Public Health, Division of Medicine, Herston, Brisbane, Qld, Australia
| | - Amalie Dyda
- University of Queensland, School of Public Health, Division of Medicine, Herston, Brisbane, Qld, Australia
| | - Christine Guglielmino
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Brisbane, Qld, Australia
| | - Cameron Buckley
- The University of Queensland Centre for Clinical Health Research and Faculty of Medicine, Royal Brisbane and Women's Hospital Campus, Brisbane, Qld, Australia
| | - Colleen L Lau
- University of Queensland, School of Public Health, Division of Medicine, Herston, Brisbane, Qld, Australia; and Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Amy V Jennison
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Brisbane, Qld, Australia
| | - David G Regan
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - James Wood
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - David Whiley
- The University of Queensland Centre for Clinical Health Research and Faculty of Medicine, Royal Brisbane and Women's Hospital Campus, Brisbane, Qld, Australia; and Pathology Queensland, Herston, Brisbane, Qld, Australia
| | - Ella Trembizki
- The University of Queensland Centre for Clinical Health Research and Faculty of Medicine, Royal Brisbane and Women's Hospital Campus, Brisbane, Qld, Australia
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8
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Divithotewala C, Sweeney EL, Burke A, Graves B, Stewart A, Whiley D, Heney C, Hopkins PM, Chambers DC. Mycoplasma hominis and Ureaplasma urealyticum infections in the immediate post-lung transplant period: A case series and literature review. Transpl Infect Dis 2023:e14058. [PMID: 36974436 DOI: 10.1111/tid.14058] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/19/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
Mycoplasma hominis and Ureaplasma species infections in the post-transplant setting are believed to be donor-derived and can be associated with poor outcomes. Difficulty in culturing and identifying these organisms is a significant barrier to diagnosis and early intervention. Tetracyclines, macrolides and fluoroquinolones are the mainstay treatments to cure these infections; however, there are increasing reports of antibiotic resistance. In this case series, we report our single-centre experience with M. hominis and U. urealyticum infection after lung transplantation (9 recipients, all men, mean age 56 years). Delayed diagnosis was common. Young donor age (mean age 23 yrs) and high-risk donor social history (67%) were repeatedly noted in these cases, and all infections were associated with significant morbidity (anastomosis and sternal wound infection, empyema, mediastinitis, pericarditis). Two patients died; with one directly related to Ureaplasma urealyticum infection. In conclusion post lung transplant M. hominis, and U. urealyticum infections are challenging and carry high morbidity. More prospective studies are required to assess the true prevalence, full spectrum of complications and utility of molecular diagnostics to aid early diagnosis and identify antibiotic susceptibility of Mycoplasma and Ureaplasma infections in the post-lung transplant setting.
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Affiliation(s)
| | - Emma L Sweeney
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Andrew Burke
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia
| | - Bianca Graves
- Central Microbiology Laboratory, Pathology Queensland, Brisbane, Australia
| | - Adam Stewart
- Central Microbiology Laboratory, Pathology Queensland, Brisbane, Australia
| | - David Whiley
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Claire Heney
- Central Microbiology Laboratory, Pathology Queensland, Brisbane, Australia
| | - Peter M Hopkins
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Daniel C Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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9
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Biggs SL, Jennison AV, Bergh H, Graham R, Nimmo G, Whiley D. Limited evidence of patient-to-patient transmission of Staphylococcus aureus strains between children with cystic fibrosis, Queensland, Australia. PLoS One 2022; 17:e0275256. [PMID: 36206247 PMCID: PMC9543978 DOI: 10.1371/journal.pone.0275256] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Here we used whole genome sequencing (WGS) to understand strain diversity and potential for patient-to-patient transmission of Staphylococcus aureus among children with cystic fibrosis (CF) in Queensland, Australia. METHODS S. aureus isolates (n = 401) collected between January 2018 and April 2019 from 184 patients with CF (n = 318 isolates) and 76 patients without CF (n = 83 isolates) were subjected to WGS and subsequent multilocus sequence typing (MLST), and a phylogeny was constructed from core genome single nucleotide polymorphism (SNP) analysis. The subsequent data was compared with available patient information. RESULTS WGS revealed that patients with CF were essentially colonised by the same genotypes as those seen in patients without CF. Sequence types (ST) for our patients with CF were predominantly ST5 (20.1%), ST30 (7.3%), ST15 (6.3%) and ST8 (5.3%). Two Australian clones, ST93 and ST239, typically seen in skin infections and health-care settings, respectively, were notably absent from our patients with CF. Based on a SNP distance threshold of 14 SNPs, 20 cluster types involving 50/260 patients were evident; of these, 6 clusters contained only patients found to be siblings or otherwise living in the same household. Epidemiological relationships could not be determined for a remaining 14 cluster types involving 38 patients, comprising 2-7 (median 2) patients each. Multiple S. aureus genotypes were observed in 19/73 CF patients who provided more than one sample. CONCLUSION These results show that WGS is a useful tool for surveillance of S. aureus strains in children with CF and that the strains in our CF cohort were largely consistent with those circulating in patients without CF. Overall, this confirms previous findings and indicates that S. aureus acquisition in children with CF is similar to that of other patient groups, with limited evidence of potential patient-to-patient transmission within this patient group.
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Affiliation(s)
- Sharon L. Biggs
- School of Medicine, The University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - Amy V. Jennison
- Public and Environmental Health, Forensic and Scientific Services, Coopers Plains, Queensland, Australia
| | - Haakon Bergh
- Pathology Queensland Central Laboratory, Herston, Queensland, Australia
| | - Rikki Graham
- Public and Environmental Health, Forensic and Scientific Services, Coopers Plains, Queensland, Australia
| | - Graeme Nimmo
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - David Whiley
- School of Medicine, The University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
- Pathology Queensland Central Laboratory, Herston, Queensland, Australia
- * E-mail:
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10
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Alharbi B, Cozzolino D, Sikulu-Lord M, Whiley D, Trembizki E. Near-infrared spectroscopy as a feasible method for the differentiation of Neisseria gonorrhoeae from Neisseria commensals and antimicrobial resistant from susceptible gonococcal strains. J Microbiol Methods 2022; 201:106576. [PMID: 36096277 DOI: 10.1016/j.mimet.2022.106576] [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: 07/11/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 12/27/2022]
Abstract
Rapid and cost-effective diagnosis of Neisseria gonorrhoeae (NG) are important measures for the control and management of gonococcal infection. Current diagnostic tools such as nucleic acid amplification tests and bacterial culture are not feasible in many resource-poor settings, and so syndromic patient management is commonplace. Alternative cost-effective diagnostic tools are therefore needed. Here, we sought to explore the utility and feasibility of Near Infrared Spectroscopy (NIRS) to (1) identify and differentiate NG from Neisseria commensals and (2) to differentiate fully susceptible NG from resistant NG. NIRS correctly classified NG from Neisseria commensals (R2= 0.89; SECV 0.164) and to a lesser capacity, susceptible NG from resistant (R2 = 0.60; SECV 0.32). To the best our knowledge, this is the first proof of concept study in the field. Further evaluations are now warranted to enhance capacity and accuracy of this diagnostic approach.
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Affiliation(s)
- Bushra Alharbi
- University of Queensland Clinical Research Centre, The University of Queensland, Brisbane, QLD, Australia; Faculty of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Daniel Cozzolino
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation (QAAFI), The University of Queensland, Brisbane, QLD, Australia
| | - Maggy Sikulu-Lord
- School of Biological Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - David Whiley
- University of Queensland Clinical Research Centre, The University of Queensland, Brisbane, QLD, Australia; Pathology Queensland Central Laboratory, Brisbane, QLD, Australia
| | - Ella Trembizki
- University of Queensland Clinical Research Centre, The University of Queensland, Brisbane, QLD, Australia.
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11
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Lowry K, Wang C, Bordin A, Buckley C, Badman S, Harris P, Mackay I, Whiley D. SARS-CoV-2 RT-PCR to Screen for B.1.617.2 (Delta) Variant of Concern. Diagnostics (Basel) 2022; 12:diagnostics12092056. [PMID: 36140458 PMCID: PMC9497716 DOI: 10.3390/diagnostics12092056] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
The continuous transmission and evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has required that diagnostic capabilities be constantly monitored and updated as new variants emerge and prior variants disappear. Although whole genome sequencing provides full characterisation of SARS-CoV-2 directly from patient samples, this has limited throughput and requires sufficient resources. To enhance screening for circulating variants, we designed a rapid in-house RT-PCR assay to target a spike mutation (D950N) in Delta variants, which is not detected in the remaining variants of concern (VOCs). Assay sensitivity for detecting Delta variants was 93% and specificity was 100% using a sequenced sample bank of several lineages. As the D950N mutation is prevalent in >95% of the global Delta variant sequences deposited in GISAID, this assay has the potential to provide rapid results to determine if the samples are presumptively Delta variants and can support clinicians in timely clinical decision-making for effective treatments and surveillance.
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Affiliation(s)
- Kym Lowry
- The Queensland Paediatric Infectious Diseases (QPID) Research Group, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Correspondence:
| | - Claire Wang
- The Queensland Paediatric Infectious Diseases (QPID) Research Group, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Infectious Diseases Laboratory, Prevention Division, Pathology Queensland, Brisbane, QLD 4006, Australia
| | - Amanda Bordin
- The Queensland Paediatric Infectious Diseases (QPID) Research Group, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Infectious Diseases Laboratory, Prevention Division, Pathology Queensland, Brisbane, QLD 4006, Australia
| | - Cameron Buckley
- Infectious Diseases Laboratory, Prevention Division, Pathology Queensland, Brisbane, QLD 4006, Australia
| | - Steven Badman
- Kirby Institute for Infection and Immunity in Society, University of New South Wales (UNSW) Medicine, UNSW Sydney, Kensington, Sydney, NSW 2052, Australia
| | - Patrick Harris
- The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Prevention Division, Pathology Queensland, Brisbane, QLD 4006, Australia
| | - Ian Mackay
- Infectious Diseases Laboratory, Prevention Division, Pathology Queensland, Brisbane, QLD 4006, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD 4029, Australia
| | - David Whiley
- The Queensland Paediatric Infectious Diseases (QPID) Research Group, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- The University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Infectious Diseases Laboratory, Prevention Division, Pathology Queensland, Brisbane, QLD 4006, Australia
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12
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Vodstrcil LA, Plummer EL, Doyle M, Murray GL, Bodiyabadu K, Jensen JS, Whiley D, Sweeney E, Williamson DA, Chow EPF, Fairley CK, Bradshaw CS. Combination therapy for Mycoplasma genitalium, and new insights into the utility of parC mutant detection to improve cure. Clin Infect Dis 2022; 75:813-823. [PMID: 34984438 DOI: 10.1093/cid/ciab1058] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) infection is challenging to cure due to rising antimicrobial resistance and limited treatment options. METHODS This was a prospective evaluation of the efficacy and tolerability of resistance-guided combination antimicrobial therapy for MG-treatment at Melbourne Sexual Health Centre (August 2019-December 2020). All patients received 7-days doxycycline prior to combination therapy based on the macrolide-resistant profile. Macrolide-susceptible infections received combination doxycycline+azithromycin (1g day-1, 500mg days-2-4) and macrolide-resistant infections combination doxycycline+moxifloxacin (400mg daily 7-days). Adherence and adverse effects were recorded at test-of-cure, recommended 14-28-days after antimicrobial completion. Sequencing was performed to determine the prevalence of single nucleotide polymorphisms (SNPs) in the parC gene and their association with moxifloxacin-treatment outcomes in macrolide-resistant infections. RESULTS Of 100 patients with macrolide-susceptible MG treated with doxycycline+azithromycin, 93 were cured (93.0%; 95%CI:86.1%-97.1%). Of 247 patients with macrolide-resistant MG receiving doxycycline+moxifloxacin, 210 were cured (85.0%; 95%CI:80.0%-89.2%). parC sequencing was available for 164 (66%) macrolide-resistant infections; 29% had SNPs at parC S83 or D87 (23% S83I). The absence of SNPs at parC S83/D87 was associated with 98.3% cure (95%CI:93.9-99.8%) following doxycycline+moxifloxacin. The presence of the parC S83I-SNP was associated with failure in 62.5% (95%CI:45.8-77.3%). Side-effects were common (40-46%) and predominantly mild and gastrointestinal. CONCLUSION Combination doxycycline+azithromycin achieved high cure for macrolide-susceptible infections. However, in the context of a high prevalence of the parC S83I mutation (23%) in macrolide-resistant infections, doxycycline+moxifloxacin cured only 85%Infections that were wildtype for S83/D87 experienced high cure following doxycycline+moxifloxacin, supporting the use of a parC-resistance/susceptibility testing strategy in clinical care.
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Affiliation(s)
- Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Gerald L Murray
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Kaveesha Bodiyabadu
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Jorgen S Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - David Whiley
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia.,Pathology Queensland Central Laboratory, Queensland, Australia
| | - Emma Sweeney
- The University of Queensland Centre for Clinical Research (UQ-CCR), Queensland, Australia
| | - Deborah A Williamson
- Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia.,Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Buckley C, Wang CY, Chatfield MD, Bletchly C, Harris P, Whiley D. The impact of COVID-19 epidemic phase and changes in mean viral loads: implications for SARS-CoV-2 testing strategies. Diagn Microbiol Infect Dis 2021; 102:115598. [PMID: 34883385 PMCID: PMC8603442 DOI: 10.1016/j.diagmicrobio.2021.115598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/07/2021] [Accepted: 11/14/2021] [Indexed: 12/11/2022]
Abstract
The sensitivity of SARS-CoV-2 diagnostic tests is inherently linked to viral load. We explored whether average viral loads changed at a population level in Queensland, Australia during the early phase of the pandemic. RT-PCR threshold cycle (CT) values, a crude marker for viral load, were compared for samples collected in February/March-2020 to those collected in April/May-2020, noting that the major public health interventions began in late-March 2020. Positive detections peaked mid-March, which coincided with the highest detection numbers and lowest CT values. However, this changed from April where the later CT samples (CT > 30) predominated. Overall, in February/March 29% (267/922) of samples had CT values >30 cycles compared to 88% (559/636) in April/May. Our study shows that SARS-CoV-2 viral loads in patients may vary at a population level over time. This needs considering when assessing suitability of diagnostic methods, particularly when methods in question are known to have reduced sensitivity.
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Affiliation(s)
- Cameron Buckley
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
| | - Claire Yt Wang
- Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia; Centre for Children's Health Research, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Cheryl Bletchly
- Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
| | - Patrick Harris
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
| | - David Whiley
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia; Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia.
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14
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Lafferty L, Smith K, Causer L, Andrewartha K, Whiley D, Badman SG, Donovan B, Anderson L, Tangey A, Mak D, Maher L, Shephard M, Guy R. Scaling up sexually transmissible infections point-of-care testing in remote Aboriginal and Torres Strait Islander communities: healthcare workers' perceptions of the barriers and facilitators. Implement Sci Commun 2021; 2:127. [PMID: 34743760 PMCID: PMC8572571 DOI: 10.1186/s43058-021-00232-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sexually transmissible infections (STIs), such as gonorrhoea and chlamydia, are highly prevalent, particularly in remote Aboriginal and Torres Strait Islander communities in Australia. In these settings, due to distance to centralised laboratories, the return of laboratory test results can take a week or longer, and many young people do not receive treatment, or it is considerably delayed. Point-of-care testing (POCT) provides an opportunity for same day diagnosis and treatment. Molecular POC testing for STIs was available at 31 regional or remote primary health care clinic sites through the Test-Treat-And-GO (TANGO2) program. This qualitative study sought to identify barriers and facilitators to further scaling up STI POCT in remote Aboriginal communities within Australia. Methods A total of 15 healthcare workers (including nurses and Aboriginal health practitioners) and five managers (including clinic coordinators and practice managers) were recruited from remote health services involved in the TTANGO2 program to participate in semi-structured in-depth interviews. Health services’ clinics were purposively selected to include those with high or low STI POCT uptake. Personnel participants were selected via a hybrid approach including nomination by clinic managers and purposive sampling to include those in roles relevant to STI testing and treatment and those who had received TTANGO2 training for POCT technology. Milat’s scaling up guide informed the coding framework and analysis. Results Acceptability of STI POCT technology among healthcare workers and managers was predominantly influenced by self-efficacy and perceived effectiveness of POCT technology as well as perceptions of additional workload burden associated with POCT. Barriers to integration of STI POCT included retention of trained staff to conduct POCT. Patient reach (including strategies for patient engagement) was broadly considered an enabler for STI testing scale up using POCT technology. Conclusions Remote healthcare clinics should be supported by both program and clinic management throughout scaling up efforts to ensure broad acceptability of STI POCT as well as addressing local health systems’ issues and identifying and enhancing opportunities for patient engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00232-8.
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Affiliation(s)
- Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia. .,Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Kirsty Smith
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Louise Causer
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kelly Andrewartha
- Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, SA, 5042, Australia
| | - David Whiley
- University of Queensland, Brisbane, QLD 4006, Australia
| | - Steven G Badman
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Annie Tangey
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.,Ngaanyatjarra Health Service, Alice Springs, NT, 0870, Australia
| | - Donna Mak
- Department of Health, Western Australia, East Perth, WA, 6004, Australia.,School of Medicine, University of Notre Dame Australia, Fremantle, WA, 6160, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.,Burnet Institute, Melbourne, VIC, 3004, Australia
| | - Mark Shephard
- Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, SA, 5042, Australia
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
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15
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Lu J, Yang Z, Karawita AC, Bunte M, Chew KY, Pegg C, Mackay I, Whiley D, Short KR. Limited evidence for the role of environmental factors in the unusual peak of influenza in Brisbane during the 2018-2019 Australian summer. Sci Total Environ 2021; 776:145967. [PMID: 33640553 DOI: 10.1016/j.scitotenv.2021.145967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/31/2021] [Accepted: 02/13/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To explore the contribution of environmental factors in the unusual pattern of influenza activity observed in Brisbane, Australia during the summer of 2018-2019. METHODS Distributed lag nonlinear models (DLNMs) were used to estimate the effect of environmental factors on weekly influenza incidence in Brisbane. Next generation sequencing was then employed to analyze minor and majority variants in influenza strains isolated from Brisbane children during this period. RESULTS There were limited marked differences in the environmental factors observed in Brisbane between the 2018-2019 summer period and the same period of the proceeding years, with the exception of significant reduction in rainfall. DLNM showed that reduced rainfall in Brisbane (at levels consistent with the 2018-2019 period) correlated with a dramatic increase in the relative risk of influenza. Sulfur dioxide (SO2) levels were also increased in the 2018-2019 period, although these levels did not correlate with an increased risk of influenza. Sequencing of a limited number of pediatric influenza virus strains isolated during the 2018-2019 showed numerous mutations within the viral HA. CONCLUSIONS Taken together, these data suggest a limited role for key environmental factors in the influenza activity observed in Brisbane, Australia during the summer of 2018-2019. One alternative explanation may that viral factors, in addition to other factors not studied herein, contributed to the unusual influenza season. Our findings provide fundamental information that may be beneficial to a better understanding of the seasonal trends of influenza virus.
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Affiliation(s)
- Jianyun Lu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province 510440, China; School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province 510440, China
| | - Anjana C Karawita
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Myrna Bunte
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Keng Yih Chew
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Cassandra Pegg
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Ian Mackay
- Public Health Virology Laboratory, Forensic and Scientific Services, Coopers Plains, Queensland, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - David Whiley
- The University of Queensland Centre for Clinical Research, Australia and Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
| | - Kirsty R Short
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD 4072, Australia; Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, QLD 4072, Australia.
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16
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Trembizki E, Jennison AV, Buckley C, Bright A, Holds J, Ward A, Pitt J, Pendle S, Baird R, Freeman K, Robson J, Mhango L, Lowry K, Lahra M, Whiley D. Enhanced molecular surveillance in response to the detection of extensively resistant gonorrhoea in Australia. J Antimicrob Chemother 2021; 76:270-271. [PMID: 33020835 DOI: 10.1093/jac/dkaa402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ella Trembizki
- The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Amy V Jennison
- Public Health Microbiology, Forensic and Scientific Services, Health Support Queensland, Brisbane, Queensland, Australia
| | - Cameron Buckley
- The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Amy Bright
- Office of Health Protection, Australian Government Department of Health, ACT, Australia
| | - Judith Holds
- South Australia Pathology, Adelaide, South Australia, Australia
| | - Alison Ward
- Adelaide Sexual Health Centre, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John Pitt
- Adelaide City General Practice, South Australia, Australia
| | - Stella Pendle
- Australian Clinical Labs, Bella Vista, New South Wales, Australia
| | - Rob Baird
- Royal Darwin Hospital, Darwin, Territory Pathology, Northern Territory, Australia
| | - Kevin Freeman
- Royal Darwin Hospital, Darwin, Territory Pathology, Northern Territory, Australia
| | - Jenny Robson
- Sullivan Nicolaides Pathology, Queensland, Australia
| | - Lebogang Mhango
- The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Kym Lowry
- The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Monica Lahra
- World Health Organization Collaborating Centre for STI and AMR, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, Australia
| | - David Whiley
- The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia.,Pathology Queensland Central Laboratory, Brisbane, Australia
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17
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Hadad R, Cole MJ, Ebeyan S, Jacobsson S, Tan LY, Golparian D, Erskine S, Day M, Whiley D, Unemo M. Evaluation of the SpeeDx ResistancePlus® GC and SpeeDx GC 23S 2611 (beta) molecular assays for prediction of antimicrobial resistance/susceptibility to ciprofloxacin and azithromycin in Neisseria gonorrhoeae. J Antimicrob Chemother 2021; 76:84-90. [PMID: 32929456 DOI: 10.1093/jac/dkaa381] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Accurate molecular assays for prediction of antimicrobial resistance (AMR)/susceptibility in Neisseria gonorrhoeae (Ng) can offer individualized treatment of gonorrhoea and enhanced AMR surveillance. OBJECTIVES We evaluated the new ResistancePlus® GC assay and the GC 23S 2611 (beta) assay (SpeeDx), for prediction of resistance/susceptibility to ciprofloxacin and azithromycin, respectively. METHODS Nine hundred and sixty-seven whole-genome-sequenced Ng isolates from 20 European countries, 143 Ng-positive (37 with paired Ng isolates) and 167 Ng-negative clinical Aptima Combo 2 (AC2) samples, and 143 non-gonococcal Neisseria isolates and closely related species were examined with both SpeeDx assays. RESULTS The sensitivity and specificity of the ResistancePlus® GC assay to detect Ng in AC2 samples were 98.6% and 100%, respectively. ResistancePlus® GC showed 100% sensitivity and specificity for GyrA S91 WT/S91F detection and 99.8% sensitivity and specificity in predicting phenotypic ciprofloxacin resistance. The sensitivity and specificity of the GC 23S 2611 (beta) assay for Ng detection in AC2 samples were 95.8% and 100%, respectively. GC 23S 2611 (beta) showed 100% sensitivity and 99.9% specificity for 23S rRNA C2611 WT/C2611T detection and 64.3% sensitivity and 99.9% specificity for predicting phenotypic azithromycin resistance. Cross-reactions with non-gonococcal Neisseria species were observed with both assays, but the analysis software solved most cross-reactions. CONCLUSIONS The new SpeeDx ResistancePlus® GC assay performed well in the detection of Ng and AMR determinants, especially in urogenital samples. The GC 23S 2611 (beta) assay performed relatively well, but its sensitivity, especially for predicting phenotypic azithromycin resistance, was suboptimal and further optimizations are required, including detection of additional macrolide resistance determinant(s).
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Affiliation(s)
- Ronza Hadad
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | - Susanne Jacobsson
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lit Yeen Tan
- SpeeDx Pty Ltd, Sydney, New South Wales, Australia
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Michaela Day
- National Infection Service, Public Health England, London, UK
| | - David Whiley
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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18
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Irwin AD, Coin LJM, Harris PNA, Cotta MO, Bauer MJ, Buckley C, Balch R, Kruger P, Meyer J, Shekar K, Brady K, Fourie C, Sharp N, Vlad L, Whiley D, Beatson SA, Forde BM, Paterson D, Clark J, Hajkowicz K, Raman S, Bialasiewicz S, Lipman J, Schlapbach LJ, Roberts JA. Optimising Treatment Outcomes for Children and Adults Through Rapid Genome Sequencing of Sepsis Pathogens. A Study Protocol for a Prospective, Multi-Centre Trial (DIRECT). Front Cell Infect Microbiol 2021; 11:667680. [PMID: 34249774 PMCID: PMC8261237 DOI: 10.3389/fcimb.2021.667680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Sepsis contributes significantly to morbidity and mortality globally. In Australia, 20,000 develop sepsis every year, resulting in 5,000 deaths, and more than AUD$846 million in expenditure. Prompt, appropriate antibiotic therapy is effective in improving outcomes in sepsis. Conventional culture-based methods to identify appropriate therapy have limited yield and take days to complete. Recently, nanopore technology has enabled rapid sequencing with real-time analysis of pathogen DNA. We set out to demonstrate the feasibility and diagnostic accuracy of pathogen sequencing direct from clinical samples, and estimate the impact of this approach on time to effective therapy when integrated with personalised software-guided antimicrobial dosing in children and adults on ICU with sepsis. Methods The DIRECT study is a pilot prospective, non-randomized multicentre trial of an integrated diagnostic and therapeutic algorithm combining rapid direct pathogen sequencing and software-guided, personalised antibiotic dosing in children and adults with sepsis on ICU. Participants and interventions DIRECT will collect microbiological and pharmacokinetic samples from approximately 200 children and adults with sepsis admitted to one of four ICUs in Brisbane. In Phase 1, we will evaluate Oxford Nanopore Technologies MinION sequencing direct from blood in 50 blood culture-proven sepsis patients recruited from consecutive patients with suspected sepsis. In Phase 2, a further 50 consecutive patients with suspected sepsis will be recruited in whom MinION sequencing will be combined with Bayesian software-guided (ID-ODS) personalised antimicrobial dosing. Outcome measures The primary outcome is time to effective antimicrobial therapy, defined as trough drug concentrations above the MIC of the pathogen. Secondary outcomes are diagnostic accuracy of MinION sequencing from whole blood, time to pathogen identification and susceptibility testing using sequencing direct from whole blood and from positive blood culture broth. Discussion Rapid pathogen sequencing coupled with antimicrobial dosing software has great potential to overcome the limitations of conventional diagnostics which often result in prolonged inappropriate antimicrobial therapy. Reduced time to optimal antimicrobial therapy may reduce sepsis mortality and ICU length of stay. This pilot study will yield key feasibility data to inform further, urgently needed sepsis studies. Phase 2 of the trial protocol is registered with the ANZCTR (ACTRN12620001122943). Trial registration Registered with the Australia New Zealand Clinical Trials Registry Number ACTRN12620001122943
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Affiliation(s)
- 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, QLD, Australia
| | - Lachlan J M 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
| | - Patrick N A Harris
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Menino Osbert Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Michelle J Bauer
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Cameron Buckley
- 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
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jason Meyer
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kiran Shekar
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,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, Brisbane, QLD, Australia
| | - Natalie Sharp
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, 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
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Brian M Forde
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - David Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Julia Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Brisbane, QLD, Australia
| | - Sainath Raman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health 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
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.,Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
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19
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Wang CYT, Ballard EL, Pava Z, Marquart L, Gaydon J, Murphy SC, Whiley D, O'Rourke P, McCarthy JS. Analytical validation of a real-time hydrolysis probe PCR assay for quantifying Plasmodium falciparum parasites in experimentally infected human adults. Malar J 2021; 20:181. [PMID: 33838672 PMCID: PMC8035755 DOI: 10.1186/s12936-021-03717-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Volunteer infection studies have become a standard model for evaluating drug efficacy against Plasmodium infections. Molecular techniques such as qPCR are used in these studies due to their ability to provide robust and accurate estimates of parasitaemia at increased sensitivity compared to microscopy. The validity and reliability of assays need to be ensured when used to evaluate the efficacy of candidate drugs in clinical trials. Methods A previously described 18S rRNA gene qPCR assay for quantifying Plasmodium falciparum in blood samples was evaluated. Assay performance characteristics including analytical sensitivity, reportable range, precision, accuracy and specificity were assessed using experimental data and data compiled from phase 1 volunteer infection studies conducted between 2013 and 2019. Guidelines for validation of laboratory-developed molecular assays were followed. Results The reportable range was 1.50 to 6.50 log10 parasites/mL with a limit of detection of 2.045 log10 parasites/mL of whole blood based on a parasite diluted standard series over this range. The assay was highly reproducible with minimal intra-assay (SD = 0.456 quantification cycle (Cq) units [0.137 log10 parasites/mL] over 21 replicates) and inter-assay (SD = 0.604 Cq units [0.182 log10 parasites/mL] over 786 qPCR runs) variability. Through an external quality assurance program, the QIMR assay was shown to generate accurate results (quantitative bias + 0.019 log10 parasites/mL against nominal values). Specificity was 100% after assessing 164 parasite-free human blood samples. Conclusions The 18S rRNA gene qPCR assay is specific and highly reproducible and can provide reliable and accurate parasite quantification. The assay is considered fit for use in evaluating drug efficacy in malaria clinical trials. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03717-y.
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Affiliation(s)
- Claire Y T Wang
- Centre for Children's Health Research, Children's Health Queensland, Brisbane, Australia. .,Child Health Research Centre, The University of Queensland, Brisbane, Australia.
| | - Emma L Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Zuleima Pava
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Louise Marquart
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jane Gaydon
- Centre for Children's Health Research, Children's Health Queensland, Brisbane, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Sean C Murphy
- Departments of Laboratory Medicine and Microbiology, University of Washington, Seattle, WA, USA.,Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA
| | - David Whiley
- Centre for Children's Health Research, Children's Health Queensland, Brisbane, Australia.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter O'Rourke
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
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20
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Badman SG, Vallely AJ, Pardo C, Mhango LP, Cornall AM, Kaldor JK, Whiley D. A comparison of ThinPrep against four non-volatile transport media for HPV testing at or near the point of care. Pathology 2020; 53:264-266. [PMID: 33358758 DOI: 10.1016/j.pathol.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
The Xpert HPV Test is used at point of care for cervical screening in a number of low and middle income countries (LMIC). It is validated for use with ThinPrep-PreservCyt transport medium which has a high methanol content and is therefore classified as a dangerous good for shipping, making cost, transportation and use challenging within LMIC. We compared the performance of ThinPrep against four non-volatile commercially available media for human papillomavirus (HPV) point of care testing. Ten-fold serial dilutions were prepared using three HPV cell lines each positive for 16, 18 or 31 and with each suspended in five different media types. The media types consisted of Phosphate Buffered Saline (ThermoFisher Scientific, USA), Sigma Virocult (Medical Wire and Equipment, UK), MSwab (Copan, Italy) Xpert Transport Media (Cepheid, USA) and ThinPrep-PreservCyt (Hologic, USA). A total of 105 Xpert HPV tests were conducted in a laboratory setting, with seven 10-fold dilutions of each of the three HPV genotypes tested in all five media types. The lowest HPV 10-fold dilution detected for any media, or cell line was the fifth dilution. MSwab was the only medium to detect HPV to the fifth dilution across all three cell types. MSwab transport media may be a suitable alternative to ThinPrep for Xpert HPV point of care testing. A field based, head to head comparison of both media types using the Xpert HPV assay is warranted to confirm these laboratory based findings.
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Affiliation(s)
- S G Badman
- Kirby Institute, UNSW Sydney, NSW, Australia.
| | - A J Vallely
- Kirby Institute, UNSW Sydney, NSW, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - C Pardo
- Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
| | - L P Mhango
- Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
| | - A M Cornall
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Vic, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
| | - J K Kaldor
- Kirby Institute, UNSW Sydney, NSW, Australia
| | - D Whiley
- Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
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21
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van Bockel D, Munier CML, Turville S, Badman SG, Walker G, Stella AO, Aggarwal A, Yeang M, Condylios A, Kelleher AD, Applegate TL, Vallely A, Whiley D, Rawlinson W, Cunningham P, Kaldor J, Guy R. Evaluation of Commercially Available Viral Transport Medium (VTM) for SARS-CoV-2 Inactivation and Use in Point-of-Care (POC) Testing. Viruses 2020; 12:E1208. [PMID: 33114233 PMCID: PMC7690900 DOI: 10.3390/v12111208] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 01/14/2023] Open
Abstract
Critical to facilitating SARS-CoV-2 point-of-care (POC) testing is assurance that viruses present in specimens are inactivated onsite prior to processing. Here, we conducted experiments to determine the virucidal activity of commercially available Viral Transport Mediums (VTMs) to inactivate SARS-CoV-2. Independent testing methods for viral inactivation testing were applied, including a previously described World Health Organization (WHO) protocol, in addition to a buffer exchange method where the virus is physically separated from the VTM post exposure. The latter method enables sensitive detection of viral viability at higher viral titre when incubated with VTM. We demonstrate that VTM formulations, Primestore® Molecular Transport Medium (MTM) and COPAN eNAT™ completely inactivate high-titre SARS-CoV-2 virus (>1 × 107 copies/mL) and are compatible with POC processing. Furthermore, full viral inactivation was rapidly achieved in as little as 2 min of VTM exposure. We conclude that adding certain VTM formulations as a first step post specimen collection will render SARS-CoV-2 non-infectious for transport, or for further in-field POC molecular testing using rapid turnaround GeneXpert platforms or equivalent.
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Affiliation(s)
- David van Bockel
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - C. Mee Ling Munier
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Stuart Turville
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Steven G. Badman
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Gregory Walker
- NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2052, Australia; (G.W.); (M.Y.); (A.C.); (W.R.)
| | - Alberto Ospina Stella
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Anupriya Aggarwal
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Malinna Yeang
- NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2052, Australia; (G.W.); (M.Y.); (A.C.); (W.R.)
| | - Anna Condylios
- NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2052, Australia; (G.W.); (M.Y.); (A.C.); (W.R.)
| | - Anthony D. Kelleher
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Tanya L. Applegate
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Andrew Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - David Whiley
- NSW State Reference Laboratory for HIV-AIDS/St Vincent’s Hospital Sydney, St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital Sydney Limited, Darlinghurst, NSW 2010, Australia;
- Australia Pathology Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia
| | - William Rawlinson
- NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2052, Australia; (G.W.); (M.Y.); (A.C.); (W.R.)
| | - Phillip Cunningham
- Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women’s Hospital Campus, Herston, QLD 4006, Australia;
| | - John Kaldor
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Rebecca Guy
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
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22
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Ferreyra C, Osborn J, Moussy F, Alirol E, Lahra M, Whiley D, Shafer W, Unemo M, Klausner J, Kelly Cirino C, Wi T. Developing target product profiles for Neisseria gonorrhoeae diagnostics in the context of antimicrobial resistance: An expert consensus. PLoS One 2020; 15:e0237424. [PMID: 32870912 PMCID: PMC7462286 DOI: 10.1371/journal.pone.0237424] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/17/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is a need for a rapid diagnostic point of care test to detect Neisseria gonorrhoeae (NG) infection to prevent incorrect, lack or excess of treatment resulting from current syndromic management in low-resource settings. An assay to identify NG antimicrobial resistance (AMR) is also highly desirable to facilitate antibiotic stewardship. Here we describe the development of two target product profiles (TPPs): one for a test for etiological diagnosis of NG and Chlamydia trachomatis (CT) (TPP1) and one for the detection of NG AMR/susceptibility (TPP2). METHODS Draft TPPs were initially developed based on a landscape analysis of existing diagnostics and expert input. TPPs were refined via an online Delphi survey with two rounds of input from 68 respondents. TPP characteristics on which <75% of non-industry respondents agreed were further discussed and revised by an expert working group. RESULTS The need for a test to identify NG in patients with urethral or vaginal discharge was identified as a minimal requirement of TPP1, with a test that can diagnose NG in asymptomatic patients as the optimal requirement. A sensitivity of 80% was considered acceptable, either in context of syndromic management or screening high-risk populations. For TPP2, the agreed minimal requirement was for a test to be used at level 2 healthcare facilities and above, with an optimal requirement of level 1 or above. A lateral flow format was preferred for TPP1, while it was considered likely that TPP2 would require a molecular format. A total of 31 test characteristics were included in TPP1 and 27 in TPP2. CONCLUSIONS Following the working group revisions, TPPs were posted online for public feedback for two months, and are now finalized. The final TPPs are currently guiding the development of new diagnostics that meet the defined characteristics to reach the market within two years.
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Affiliation(s)
- Cecilia Ferreyra
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Jennifer Osborn
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | | | - Emilie Alirol
- Global Antibiotic R&D Partnership (GARDP), Geneva, Switzerland
| | - Monica Lahra
- WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - David Whiley
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - William Shafer
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA and Veterans Affairs Medical Center, Decatur, Georgia, United States of America
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Örebro University Hospital, Örebro, Sweden
| | - Jeffrey Klausner
- Division of Infectious Diseases, University of California and David Geffen School of Medicine Los Angeles, Los Angeles, CA, United States of America
| | | | - Teodora Wi
- World Health Organization (WHO), Geneva, Switzerland
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23
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Wang CYT, Buckley C, Bletchly C, Harris P, Whiley D. Contamination of SARS-CoV-2 RT-PCR probes at the oligonucleotide manufacturer. Pathology 2020; 52:814-816. [PMID: 32888705 PMCID: PMC7437487 DOI: 10.1016/j.pathol.2020.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Claire Y T Wang
- Centre for Children's Health Research, Children's Health Queensland, Brisbane, Qld, Australia.
| | - Cameron Buckley
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
| | - Cheryl Bletchly
- Pathology Queensland Central Laboratory, Brisbane, Qld, Australia
| | - Patrick Harris
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia; Pathology Queensland Central Laboratory, Brisbane, Qld, Australia
| | - David Whiley
- The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia; Pathology Queensland Central Laboratory, Brisbane, Qld, Australia
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24
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Ebeyan S, Windsor M, Bordin A, Mhango L, Erskine S, Trembizki E, Mokany E, Tan LY, Whiley D. Evaluation of the ResistancePlus GC (beta) assay: a commercial diagnostic test for the direct detection of ciprofloxacin susceptibility or resistance in Neisseria gonorrhoeae. J Antimicrob Chemother 2020; 74:1820-1824. [PMID: 30897201 DOI: 10.1093/jac/dkz108] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/04/2019] [Accepted: 02/22/2019] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To evaluate the performance of the ResistancePlus GC (beta) assay for the simultaneous detection of Neisseria gonorrhoeae and gyrA S91 markers of resistance (S91F) and susceptibility (WT) to ciprofloxacin, from both clinical specimens and isolates. METHODS Performance was assessed on several sample banks, including N. gonorrhoeae isolates (n = 822), non-gonococcal isolates (n = 110), N. gonorrhoeae-positive clinical specimens (n = 402) and N. gonorrhoeae-negative specimens (n = 290). Results were compared with previous testing data, including S91 genotyping and phenotypic resistance profiles. RESULTS Overall, the assay demonstrated 100% sensitivity for N. gonorrhoeae detection in clinical isolates. For gyrA S91 mutation detection in clinical isolates, the assay showed 100% sensitivity/specificity compared with the genotype, and >99%/>97% sensitivity/specificity when compared with phenotype. For positive clinical specimens, the assay demonstrated >96% sensitivity for N. gonorrhoeae detection and 100% sensitivity/specificity for gyrA S91 mutation detection. The assay demonstrated >99% specificity for N. gonorrhoeae detection against non-gonococcal isolates and 100% specificity for negative clinical specimens. CONCLUSIONS The ResistancePlus GC (beta) assay is suitable for the detection of N. gonorrhoeae and gyrA markers associated with resistance/susceptibility to ciprofloxacin directly in clinical samples. This assay could be implemented for the individualized treatment of gonorrhoea infections as well as to enhance current antimicrobial resistance surveillance methods.
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Affiliation(s)
| | | | - Amanda Bordin
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
| | - Lebogang Mhango
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
| | | | - Ella Trembizki
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
| | - Elisa Mokany
- SpeeDx Pty Ltd, Sydney, New South Wales, Australia
| | - Lit Yeen Tan
- SpeeDx Pty Ltd, Sydney, New South Wales, Australia
| | - David Whiley
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia.,Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia
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25
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Jennison AV, Whiley D, Lahra MM, Graham RM, Cole MJ, Hughes G, Fifer H, Andersson M, Edwards A, Eyre D. Genetic relatedness of ceftriaxone-resistant and high-level azithromycin resistant Neisseria gonorrhoeae cases, United Kingdom and Australia, February to April 2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 30808445 PMCID: PMC6446956 DOI: 10.2807/1560-7917.es.2019.24.8.1900118] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [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: 11/20/2022]
Abstract
Between February and April 2018, three ceftriaxone-resistant and high-level azithromycin-resistant Neisseria gonorrhoeae cases were identified; one in the United Kingdom and two in Australia. Whole genome sequencing was used to show that the isolates from these cases belong to a single gonococcal clone, which we name the A2543 clone.
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Affiliation(s)
- Amy V Jennison
- Forensic and Scientific Services, Queensland Department of Health, Brisbane, Queensland, Australia
| | - David Whiley
- Pathology Queensland Central Laboratory, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Monica M Lahra
- The University of New South Wales, Sydney, Australia.,New South Wales Health Pathology, Microbiology Randwick, The Prince of Wales Hospital, New South Wales, Australia
| | - Rikki M Graham
- Forensic and Scientific Services, Queensland Department of Health, Brisbane, Queensland, Australia
| | - Michelle J Cole
- National Infection Service, Public Health England, London, United Kingdom
| | - Gwenda Hughes
- Institute of Tropical Medicine, University of São Paulo, Brazil.,National Infection Service, Public Health England, London, United Kingdom
| | - Helen Fifer
- National Infection Service, Public Health England, London, United Kingdom
| | - Monique Andersson
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Anne Edwards
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - David Eyre
- Big Data Institute, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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26
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Fifer H, Hughes G, Whiley D, Lahra MM. Lessons learnt from ceftriaxone-resistant gonorrhoea in the UK and Australia. Lancet Infect Dis 2020; 20:276-278. [PMID: 32112753 DOI: 10.1016/s1473-3099(20)30055-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Helen Fifer
- National Infection Service, Public Health England, London NW9 5EQ, UK.
| | - Gwenda Hughes
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - David Whiley
- Pathology Queensland, Microbiology Department, Herston, QLD, Australia; Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Monica M Lahra
- WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Department of Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia; Faculty of Medicine, School of Medical Sciences, University of New South Wales, NSW, Australia
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27
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Bell S, Aggleton P, Ward J, Murray W, Silver B, Lockyer A, Ferguson T, Fairley CK, Whiley D, Ryder N, Donovan B, Guy R, Kaldor J, Maher L. Young Aboriginal people's engagement with STI testing in the Northern Territory, Australia. BMC Public Health 2020; 20:459. [PMID: 32252712 PMCID: PMC7137447 DOI: 10.1186/s12889-020-08565-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Australian surveillance data document higher rates of sexually transmissible infections (STIs) among young Aboriginal people (15–29 years) in remote settings than non-Aboriginal young people. Epidemiological data indicate a substantial number of young Aboriginal people do not test for STIs. Rigorous qualitative research can enhance understanding of these findings. This paper documents socio-ecological factors influencing young Aboriginal people’s engagement with clinic-based STI testing in two remote settings in the Northern Territory, Australia. Methods In-depth interviews with 35 young Aboriginal men and women aged 16–21 years; thematic analysis examining their perceptions and personal experiences of access to clinic-based STI testing. Results Findings reveal individual, social and health service level influences on willingness to undertake clinic-based STI testing. Individual level barriers included limited knowledge about asymptomatic STIs, attitudinal barriers against testing for symptomatic STIs, and lack of skills to communicate about STIs with health service staff. Social influences both promoted and inhibited STI testing. In setting 1, local social networks enabled intergenerational learning about sexual health and facilitated accompanied visits to health clinics for young women. In setting 2, however, social connectedness inhibited access to STI testing services. Being seen at clinics was perceived to lead to stigmatisation among peers and fear of reputational damage due to STI-related rumours. Modalities of health service provision both enhanced and inhibited STI testing. In setting 1, outreach strategies by male health workers provided young Aboriginal men with opportunities to learn about sexual health, initiate trusting relationships with clinic staff, and gain access to clinics. In setting 2, barriers were created by the location and visibility of the clinic, appointment procedures, waiting rooms and waiting times. Where inhibitive factors at the individual, social and health service levels exist, young Aboriginal people reported more limited access to STI testing. Conclusions This is the first socio-ecological analysis of factors influencing young Aboriginal people’s willingness to undertake testing for STIs within clinics in Australia. Strategies to improve uptake of STI testing must tackle the overlapping social and health service factors that discourage young people from seeking sexual health support. Much can be learned from young people’s lived sexual health experiences and family- and community-based health promotion practices.
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Affiliation(s)
- Stephen Bell
- Kirby Institute for infection and immunity in society, Level 6, Wallace Wurth Building, UNSW Sydney, Sydney, NSW, 2052, Australia. .,Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.,College of Arts and Social Sciences, The Australian National University, Canberra, Australia
| | - James Ward
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Walbira Murray
- Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs, Australia
| | - Bronwyn Silver
- Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs, Australia
| | - Andrew Lockyer
- Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs, Australia
| | - Tellisa Ferguson
- Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | | | - Nathan Ryder
- Kirby Institute for infection and immunity in society, Level 6, Wallace Wurth Building, UNSW Sydney, Sydney, NSW, 2052, Australia.,Pacific Clinic Newcastle, Hunter New England Sexual Health, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Basil Donovan
- Kirby Institute for infection and immunity in society, Level 6, Wallace Wurth Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Rebecca Guy
- Kirby Institute for infection and immunity in society, Level 6, Wallace Wurth Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - John Kaldor
- Kirby Institute for infection and immunity in society, Level 6, Wallace Wurth Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Lisa Maher
- Kirby Institute for infection and immunity in society, Level 6, Wallace Wurth Building, UNSW Sydney, Sydney, NSW, 2052, Australia.,Burnet Institute, Melbourne, Australia
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Ayfan A, Ertl N, Whiley D, Paterson D, Heney C, Harris P, Macdonald J, Irwin A, Zowawi H. Rapid and sensitive molecular detection of antimicrobial resistance (AMR); towards point-of-care testing in low resource settings. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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29
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Bell S, Ward J, Aggleton P, Murray W, Silver B, Lockyer A, Ferguson T, Fairley CK, Whiley D, Ryder N, Donovan B, Guy R, Kaldor J, Maher L. Young Aboriginal people's sexual health risk reduction strategies: a qualitative study in remote Australia. Sex Health 2020; 17:303-310. [DOI: 10.1071/sh19204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/17/2020] [Indexed: 11/23/2022]
Abstract
Background
Surveillance data indicate that Aboriginal and Torres Strait Islander young people are more likely than their non-Indigenous counterparts to experience sexually transmissible infections (STIs) and teenage pregnancy. Despite increasing emphasis on the need for strengths-based approaches to Aboriginal sexual health, limited published data document how young Aboriginal people reduce sexual health risks encountered in their everyday lives. Methods: In-depth interviews with 35 young Aboriginal women and men aged 16–21 years in two remote Australian settings were conducted; inductive thematic analysis examining sexual health risk reduction practices was also conducted. Results: Participants reported individual and collective STI and pregnancy risk reduction strategies. Individual practices included accessing and carrying condoms; having a regular casual sexual partner; being in a long-term trusting relationship; using long-acting reversible contraception; having fewer sexual partners; abstaining from sex; accessing STI testing. More collective strategies included: refusing sex without a condom; accompanied health clinic visits with a trusted individual; encouraging friends to use condoms and go for STI testing; providing friends with condoms. Conclusion: Findings broaden understanding of young Aboriginal people’s sexual health risk reduction strategies in remote Aboriginal communities. Findings signal the need for multisectoral STI prevention and sexual health programs driven by young people’s existing harm minimisation strategies and cultural models of collective support. Specific strategies to enhance young people’s sexual health include: peer condom distribution; accompanied health service visits; peer-led health promotion; continued community-based condom distribution; enhanced access to a fuller range of available contraception in primary care settings; engaging health service-experienced young people as ‘youth health workers’.
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30
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Guy RJ, Ward J, Causer LM, Natoli L, Badman SG, Tangey A, Hengel B, Wand H, Whiley D, Tabrizi SN, Shephard M, Fairley CK, Donovan B, Anderson DA, Regan DG, Maher L, Kaldor JM. Molecular point-of-care testing for chlamydia and gonorrhoea in Indigenous Australians attending remote primary health services (TTANGO): a cluster-randomised, controlled, crossover trial. Lancet Infect Dis 2019; 18:1117-1126. [PMID: 30303108 DOI: 10.1016/s1473-3099(18)30429-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/13/2018] [Accepted: 07/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Timely diagnosis and treatment of sexually transmissible infections will prevent morbidity and onward transmission. We aimed to assess the efficacy of a point-of-care molecular test for Chlamydia trachomatis and Neisseria gonorrhoeae infections at the cluster level to improve infection management among Indigenous Australian communities with high prevalence of sexually transmissible infections. METHODS In this cluster-randomised crossover study, we recruited primary health services in Western Australia, Far North Queensland, and South Australia that provide care to Indigenous people in regional or remote locations. The services were eligible if they did 150 or more tests for C trachomatis or N gonorrhoeae infection per year among individuals aged 16-29 years, and if C trachomatis or N gonorrhoeae positivity was 10% or higher. Services were randomly assigned (1:1) by use of a random-number generator, stratified by geographical region, to either standard care conditions with routine laboratory-based sexually transmissible infection testing for 12 months followed by 12 months of intervention with molecular point-of-care testing, or the reverse sequence. The primary outcome was the proportion of people (aged 16-29 years) found to have C trachomatis or N gonorrhoeae who had a positive result at retesting 3 weeks to 3 months after treatment, and a secondary outcome was treatment within 7 days, both in those aged 16-29 years and at the cluster level. We did these analyses using data from all participants who had a positive result at testing, by point-of-care of laboratory testing (ie, the intention-to-treat population). The trial is registered with Australian and New Zealand Clinical Trials Registry (ACTRN12613000808741). FINDINGS Between June 1, 2013, and Feb 29, 2016, 12 health services were enrolled and randomly assigned to standard care followed by intervention (six) and the reverse sequence (six). After randomisation, one health service that was initially assigned to standard care was excluded because it no longer met the inclusion criteria. 455 individuals tested positive for C trachomatis or N gonorrhoeae infection in the intervention group, and 405 tested positive in the standard care group. In the intervention group, 12 (19%) of 63 individuals retested had a positive test result, compared with nine (13%) of 67 with positive retests in the standard care group (relative ratio [RR] 1·42, 95% CI 0·64-3·13; p=0·405), and 347 (76%) were treated within 7 days in the intervention group, compared with 191 (47%) in the standard care group (RR 1·66, 1·41-1·93; p<0·0001). INTERPRETATION Retesting rates were too low to draw conclusions on the effect of the intervention on repeat infections. Further research will be needed to determine whether point-of-care tests have an effect on reinfection rates, and the sustainability of using this technology. However, our findings show that time to treatment of C trachomatis or N gonorrhoeae infections in primary care clinics in remote areas in Australia with a high prevalence of sexually transmissible infections could be substantially reduced by the use of molecular point-of-care tests. FUNDING The National Health and Medical Research Council, Australia.
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Affiliation(s)
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | | | | | - Annie Tangey
- The Kirby Institute, UNSW Sydney, NSW, Australia; Ngaanyatjarra Health Service, Alice Springs, NT, Australia
| | - Belinda Hengel
- Apunipima Cape York Health Council, Westcourt, QLD, Australia
| | - Handan Wand
- The Kirby Institute, UNSW Sydney, NSW, Australia
| | - David Whiley
- Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology, The Royal Women's Hospital and Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia
| | - Mark Shephard
- International Centre for Point-of-Care Testing, Flinders University, Sturt Campus, Bedford Park, SA, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Carlton, VIC, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | | | | | - Lisa Maher
- The Kirby Institute, UNSW Sydney, NSW, Australia
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31
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Chen MY, McNulty A, Avery A, Whiley D, Tabrizi SN, Hardy D, Das AF, Nenninger A, Fairley CK, Hocking JS, Bradshaw CS, Donovan B, Howden BP, Oldach D. Solithromycin versus ceftriaxone plus azithromycin for the treatment of uncomplicated genital gonorrhoea (SOLITAIRE-U): a randomised phase 3 non-inferiority trial. Lancet Infect Dis 2019; 19:833-842. [PMID: 31196813 DOI: 10.1016/s1473-3099(19)30116-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Antibiotic-resistant gonorrhoea represents a global public health threat, and new therapies are needed. We aimed to compare the efficacy and safety of solithromycin, a fourth generation macrolide, with ceftriaxone plus azithromycin for the treatment of gonorrhoea. METHODS We did an open-label, multicentre, non-inferiority trial of patients aged 15 years or older with uncomplicated untreated genital gonorrhoea at two sites in Australia and one site in the USA. Patients were randomly assigned (1:1) to receive single dose oral solithromycin 1000 mg or intramuscular ceftriaxone 500 mg plus oral azithromycin 1000 mg. Neisseria gonorrhoeae cultures were obtained at baseline and test of cure (day 7 ± 2). The primary outcome was the proportion of patients with eradication of genital N gonorrhoeae based on culture at test of cure, assessed in the microbiological intention-to-treat (mITT) population, which included all randomly assigned patients who received any dose of study drug and had a positive genital culture for N gonorrhoeae at baseline. Non-inferiority of solithromycin was to be concluded if the lower limit of the 95% CI for the between-group differences was greater than -10%. Safety was analysed in all patients who received any dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT02210325. FINDINGS Between Sept 3, 2014, and Aug 27, 2015, 262 patients were randomly assigned and 261 received treatment (130 in the solithromycin group and 131 in the ceftriaxone plus azithromycin group). In the mITT population, 99 (80%) of 123 patients in the solithromycin group and 109 (84%) of 129 patients in the ceftriaxone plus azithromycin group had N gonorrhoeae eradication at test of cure (difference -4·0%, 95% CI -13·6 to 5·5), thus solithromycin did not meet the criterion for non-inferiority at the prespecified -10% margin. The frequency of adverse events was higher in the solithromycin group than the ceftriaxone plus azithromycin group (69 [53%] of 130 patients vs 45 [34%] of 131 patients), the most common of which were diarrhoea (31 [24%] of 130 patients vs 20 [15%] of 131 patients), and nausea (27 [21%] of 130 patients vs 15 [11%] of 131 patients). INTERPRETATION Solithromycin as a single 1000 mg dose is not a suitable alternative to ceftriaxone plus azithromycin as first-line treatment for gonorrhoea. If insufficient duration of solithromycin exposure at the infection site in a subset of individuals was the reason for treatment failures, this might be adequately addressed with dose adjustment. However, any further trials with longer dosing need to consider the potential risk of gastrointestinal effects and liver enzyme elevations. FUNDING Cempra Pharmaceuticals.
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Affiliation(s)
- Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ann Avery
- MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David Whiley
- Queensland Children's Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | - Dwight Hardy
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Basil Donovan
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia; Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
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32
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Badman SG, Willie B, Narokobi R, Gabuzzi J, Pekon S, Amos-Kuma A, Hakim AJ, Weikum D, Gare J, Silim S, Guy RJ, Donovan B, Cunningham P, Kaldor JM, Vallely AJ, Whiley D, Kelly-Hanku A. A diagnostic evaluation of a molecular assay used for testing and treating anorectal chlamydia and gonorrhoea infections at the point-of-care in Papua New Guinea. Clin Microbiol Infect 2019; 25:623-627. [PMID: 30107282 PMCID: PMC11005091 DOI: 10.1016/j.cmi.2018.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/14/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Papua New Guinea has among the highest prevalences of sexually transmissible infections (STIs) globally with no services able to accurately test for anorectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections. Here we prospectively evaluated the diagnostic performance of a molecular CT/NG assay used at the point-of-care (POC) with the aim of enhancing anorectal STI screening and same-day treatment. METHODS Men who have sex with men, transgender women and female sex workers taking part in Papua New Guinea's first large-scale biobehavioural study were enrolled and asked to provide a self-collected anorectal swab for POC GeneXpert CT/NG testing. Same-day treatment was offered if positive. A convenience sample of 396 unique and randomly selected samples were transported to Australia for comparison using the Cobas 4800 CT/NG test (Roche Molecular Diagnostics, Pleasanton, CA, USA). RESULTS A total of 326 samples provided valid results by Cobas whereas 70 samples provided invalid results suggesting inhibition. The positive, negative and overall percentage agreements of GeneXpert CT/NG for the detection of C. trachomatis were 96.7% (95% CI 92.3%-98.9%), 95.5% (95% CI 91.3%-98.0%) and 96.0% (95% CI 93.3%-97.8%), and for N. gonorrhoeae were 93.0% (95% CI 86.1%-97.1%), 100.0% (95% CI 98.3%-100.0%) and 97.8% (95% CI 95.6%-99.1%), respectively. CONCLUSIONS The overall rate of agreement between the GeneXpert and Cobas CT/NG assays was high with 96.0% for C. trachomatis and 97.8% for N. gonorrhoeae. Results from this study data suggest that the GeneXpert CT/NG assay is suitable for testing self-collected anorectal specimens at the POC and that same-day treatment was feasible.
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Affiliation(s)
- S G Badman
- Kirby Institute, UNSW Sydney, NSW, Australia.
| | - B Willie
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - R Narokobi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - J Gabuzzi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - S Pekon
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - A Amos-Kuma
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - A J Hakim
- The Division of Global HIV/TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Weikum
- The Division of Global HIV/TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Gare
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - S Silim
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - R J Guy
- Kirby Institute, UNSW Sydney, NSW, Australia
| | - B Donovan
- Kirby Institute, UNSW Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - P Cunningham
- Kirby Institute, UNSW Sydney, NSW, Australia; St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | - J M Kaldor
- Kirby Institute, UNSW Sydney, NSW, Australia
| | - A J Vallely
- Kirby Institute, UNSW Sydney, NSW, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - D Whiley
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - A Kelly-Hanku
- Kirby Institute, UNSW Sydney, NSW, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
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33
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Huang B, Jennison A, Whiley D, McMahon J, Hewitson G, Graham R, De Jong A, Warrilow D. Illumina sequencing of clinical samples for virus detection in a public health laboratory. Sci Rep 2019; 9:5409. [PMID: 30931974 PMCID: PMC6443674 DOI: 10.1038/s41598-019-41830-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/31/2019] [Indexed: 11/29/2022] Open
Abstract
High-throughput sequencing (HTS) provides the opportunity, once a diagnostic result is obtained, to extract additional information from a virus-containing sample. Hence, it offers advantages over established quantitative amplification technology, such as quantitative PCR, particularly in a public health environment. At this early stage of its clinical application, there have been limited studies comparing HTS performance to that of the more established quantitative PCR technology for direct detection of viruses. In this pilot-scale study, we tested HTS with a range of viruses and sample types routinely encountered in a public health virology laboratory. In comparison with quantitative PCR, our HTS method was able to sensitively (92%) detect all viruses in any sample type with the exception of certain tissues. Moreover, sufficient nucleotide sequence information was obtained to enable genotyping of strains detected, thus providing additional useful epidemiological information. While HTS sensitivity may not yet match that of PCR, the added value through enhanced epidemiological data has considerable potential to enable real-time surveillance of circulating strains so as to facilitate rapid and appropriate response to outbreaks and virus zoonotic spillover events.
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Affiliation(s)
- Bixing Huang
- Public Health Virology Laboratory, Queensland Health Forensic and Scientific Services, PO Box 594, Archerfield, Queensland, 4108, Australia
| | - Amy Jennison
- Public Health Microbiology Laboratory, Queensland Health Forensic and Scientific Services, PO Box 594, Archerfield, Queensland, 4108, Australia
| | - David Whiley
- Microbiology Division, Pathology Queensland Central Laboratory, Brisbane, Queensland, 4029, Australia.,Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, 4029, Australia
| | - Jamie McMahon
- Public Health Virology Laboratory, Queensland Health Forensic and Scientific Services, PO Box 594, Archerfield, Queensland, 4108, Australia
| | - Glen Hewitson
- Public Health Virology Laboratory, Queensland Health Forensic and Scientific Services, PO Box 594, Archerfield, Queensland, 4108, Australia
| | - Rikki Graham
- Public Health Microbiology Laboratory, Queensland Health Forensic and Scientific Services, PO Box 594, Archerfield, Queensland, 4108, Australia
| | - Amanda De Jong
- Public Health Virology Laboratory, Queensland Health Forensic and Scientific Services, PO Box 594, Archerfield, Queensland, 4108, Australia
| | - David Warrilow
- Public Health Virology Laboratory, Queensland Health Forensic and Scientific Services, PO Box 594, Archerfield, Queensland, 4108, Australia.
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Lahra MM, Martin I, Demczuk W, Jennison AV, Lee KI, Nakayama SI, Lefebvre B, Longtin J, Ward A, Mulvey MR, Wi T, Ohnishi M, Whiley D. Cooperative Recognition of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain. Emerg Infect Dis 2019; 24. [PMID: 29553335 PMCID: PMC5875269 DOI: 10.3201/eid2404.171873] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ceftriaxone remains a first-line treatment for patients infected by Neisseria gonorrhoeae in most settings. We investigated the possible spread of a ceftriaxone-resistant FC428 N. gonorrhoeae clone in Japan after recent isolation of similar strains in Denmark (GK124) and Canada (47707). We report 2 instances of the FC428 clone in Australia in heterosexual men traveling from Asia. Our bioinformatic analyses included core single-nucleotide variation phylogeny and in silico molecular typing; phylogenetic analysis showed close genetic relatedness among all 5 isolates. Results showed multilocus sequence type 1903; N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR) 233; and harboring of mosaic penA allele encoding alterations A311V and T483S (penA-60.001), associated with ceftriaxone resistance. Our results provide further evidence of international transmission of ceftriaxone-resistant N. gonorrhoeae. We recommend increasing awareness of international spread of this drug-resistant strain, strengthening surveillance to include identifying treatment failures and contacts, and strengthening international sharing of data.
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Sherrard L, Duplancic C, Wee B, Ramsay K, Webster S, Kidd T, Whiley D, Beatson S, Bell S. P040 Carbapenem-resistant shared Pseudomonas aeruginosa strains with oprD mutations in cystic fibrosis. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Badman SG, Causer LM, Guy R, Wand H, Donovan B, Tabrizi SN, Speers D, Shephard MD, Vallely A, Whiley D. A reliable and easy to transport quality control method for chlamydia and gonorrhoea molecular point of care testing. Pathology 2018; 50:317-321. [PMID: 29336823 DOI: 10.1016/j.pathol.2017.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/04/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 12/29/2022]
Abstract
Quality control (QC) is an essential component of point-of-care testing programs. In the context of a randomised-controlled trial (TTANGO) using GeneXpert (Xpert) Chlamydia trachomatis and Neisseria gonorrhoeae (CT/NG) point-of-care testing in remote areas of Australia, we aimed to develop and utilise a stable positive control material. Bacterial cultures of CT and NG were resuspended together to provide cycle threshold (Ct) values of approximately 25 cycles for both CT and NG when tested on the Xpert CT/NG assay. These positive control suspensions were dried in aliquots, heat inactivated, and then provided to 12 participating health services as research-only QC samples in kit form. At each service, a QC sample was resuspended and tested each month on the Xpert. QC results, including Xpert Ct values, were analysed from each site over 30 months and we calculated costs per QC sample. Overall, at 12 health services there were 89 QC samples tested (average of 8 tests per site per year). Mean Ct values for the 89 controls samples were 25.25 cycles (SD = 1.15) for CT, 24.04 cycles (SD = 1.400) for one NG target and 23.35 cycles (SD = 1.55) for the other NG target. No significant differences in Ct value for CT or NG controls were observed over a trial period of 30 months. Positive QC samples for research use in a trial of a molecular point-of-care assay were inexpensive to produce and stable when stored at 2-8°C. For routine use, additional requirements such as meeting National Association of Testing Authority (NATA) regulations and Therapeutic Goods Administration (TGA) approval will need to be achieved.
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Affiliation(s)
- S G Badman
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
| | - L M Causer
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - R Guy
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - H Wand
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - B Donovan
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - S N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - D Speers
- Pathwest Laboratory Medicine WA, Nedlands, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
| | - M D Shephard
- International Centre for Point-of-Care Testing, Flinders University, SA, Australia
| | - A Vallely
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - D Whiley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia; Pathology Queensland Central Laboratory, Brisbane, Qld, Australia
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- members are listed in the Acknowledgements
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O'Grady KAF, Grimwood K, Toombs M, Sloots TP, Otim M, Whiley D, Anderson J, Rablin S, Torzillo PJ, Buntain H, Connor A, Adsett D, Meng kar O, Chang AB. Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial. BMJ Open 2017; 7:e013796. [PMID: 28259853 PMCID: PMC5353349 DOI: 10.1136/bmjopen-2016-013796] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Acute respiratory infections (ARIs) are leading causes of hospitalisation in Australian children and, if recurrent, are associated with increased risk of chronic pulmonary disorders later in life. Chronic (>4 weeks) cough in children following ARI is associated with decreased quality-of-life scores and increased health and societal economic costs. We will determine whether a validated evidence-based cough algorithm, initiated when chronic cough is first diagnosed after presentation with ARI, improves clinical outcomes in children compared with usual care. METHODS AND ANALYSIS A multicentre, parallel group, open-label, randomised controlled trial, nested within a prospective cohort study in Southeast Queensland, Australia, is underway. 750 children aged <15 years will be enrolled and followed weekly for 8 weeks after presenting with an ARI with cough. 214 children from this cohort with persistent cough at day 28 will be randomised to either early initiation of a cough management algorithm or usual care (107 per group). Randomisation is stratified by reason for presentation, site and total cough duration at day 28 (<6 and ≥6 weeks). Demographic details, risk factors, clinical histories, examination findings, cost-of-illness data, an anterior nasal swab and parent and child exhaled carbon monoxide levels (when age appropriate) are collected at enrolment. Weekly contacts will collect cough status and cost-of-illness data. Additional nasal swabs are collected at days 28 and 56. The primary outcome is time-to-cough resolution. Secondary outcomes include direct and indirect costs of illness and the predictors of chronic cough postpresentation. ETHICS AND DISSEMINATION The Children's Health Queensland (HREC/15/QRCH/15) and the Queensland University of Technology University (1500000132) Research Ethics Committees have approved the study. The study will inform best-practice management of cough in children. TRIAL REGISTRATION NUMBER ACTRN12615000132549.
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Affiliation(s)
- Kerry-Ann F O'Grady
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Southport, Queensland, Australia
| | - Maree Toombs
- The University of Queensland Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
- Carbal Health Services, Toowoomba, Queensland, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Theo P Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Children's Health Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Michael Otim
- School of Public Health, Australian Catholic University, Sydney, New South Wales, Australia
| | - David Whiley
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Jennie Anderson
- Caboolture Community Medical, Caboolture, Queensland, Australia
| | - Sheree Rablin
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Paul J Torzillo
- School of Medicine, The University of Sydney, Newtown, New South Wales, Australia
| | - Helen Buntain
- Wesley Medical Centre, Brisbane, Queensland, Australia
| | - Anne Connor
- Ferny Grove Chambers Medical Practice, Brisbane, Queensland, Australia
| | - Don Adsett
- Department of Paediatrics, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Oon Meng kar
- Department of Paediatrics, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Anne B Chang
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Queensland Children's Respiratory Centre, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
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Henderson A, Whiley D, Francis F, Engler C, Glover M, Nimmo G, Norton R. Beta-lactamase detection in penicillin susceptible Staphylococcus aureus by phenotypic and genotypic methods. Pathology 2017. [DOI: 10.1016/j.pathol.2016.12.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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39
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Badman SG, Vallely LM, Toliman P, Kariwiga G, Lote B, Pomat W, Holmer C, Guy R, Luchters S, Morgan C, Garland SM, Tabrizi S, Whiley D, Rogerson SJ, Mola G, Wand H, Donovan B, Causer L, Kaldor J, Vallely A. A novel point-of-care testing strategy for sexually transmitted infections among pregnant women in high-burden settings: results of a feasibility study in Papua New Guinea. BMC Infect Dis 2016; 16:250. [PMID: 27268218 PMCID: PMC4895793 DOI: 10.1186/s12879-016-1573-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/17/2016] [Indexed: 11/28/2022] Open
Abstract
Background Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is feasible in the high-burden, low-income setting of Papua New Guinea. Methods Women attending their first antenatal clinic visit were invited to participate. CT/NG and TV were tested using the GeneXpert platform (Cepheid, USA), and BV tested using BVBlue (Gryphus Diagnostics, USA). Participants received same-day test results and antibiotic treatment as indicated. Routine antenatal care including HIV and syphilis screening were provided. Results Point-of-care testing was provided to 125/222 (56 %) of women attending routine antenatal care during the three-month study period. Among the 125 women enrolled, the prevalence of CT was 20.0 %; NG, 11.2 %; TV, 37.6 %; and BV, 17.6 %. Over half (67/125, 53.6 %) of women had one or more of these infections. Most women were asymptomatic (71.6 %; 47/67). Women aged 24 years and under were more likely to have one or more STI compared with older women (odds ratio 2.38; 95 % CI: 1.09, 5.21). Most women with an STI received treatment on the same day (83.6 %; 56/67). HIV prevalence was 1.6 % and active syphilis 4.0 %. Conclusion Point-of-care STI testing and treatment using a combination of novel, newly-available assays was feasible during routine antenatal care in this setting. This strategy has not previously been evaluated in any setting and offers the potential to transform STI management in pregnancy and to prevent their associated adverse health outcomes.
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Affiliation(s)
- Steven G Badman
- The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Lisa M Vallely
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Pamela Toliman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Grace Kariwiga
- Department of Obstetrics & Gynaecology, Alotau General Hospital, Milne Bay Province, Alotau, Papua New Guinea
| | - Bomesina Lote
- Alotau Urban Clinic, Alotau, Milne Bay Province, Papua New Guinea
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | | | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Stanley Luchters
- The Burnet Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Sepehr Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
| | - David Whiley
- University of Queensland, Herston, QLD, Australia
| | | | - Glen Mola
- Department of Obstetrics & Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, Australia.,Sydney Sexual Health Centre, Sydney, Australia
| | - Louise Causer
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew Vallely
- The Kirby Institute, University of New South Wales, Sydney, Australia
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40
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Badman SG, Causer LM, Guy R, Tabrizi SN, Francis F, Donovan B, Whiley D. A preliminary evaluation of a new GeneXpert (Gx) molecular point-of-care test for the detection of Trichomonas vaginalis. Sex Transm Infect 2015; 92:350-2. [PMID: 26702132 DOI: 10.1136/sextrans-2015-052384] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/28/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Global concerns regarding the prevalence, asymptomatic nature and burden of disease associated with Trichomonas vaginalis (TV) continue. The lack of a portable molecular point-of-care assay to detect this infectious disease has meant that many remote or low-resource settings still need to rely on delayed results from central laboratories and/or syndromic management as treatment strategies. We evaluated the new GeneXpert (Gx) TV nucleic acid amplification test (NAAT) compared with an in-house laboratory NAAT to determine whether it would be suitable for use at the point of care. METHODS In a state-based laboratory and using their in-house NAAT, we selected the first 60 urine samples that were positive and the first 60 that were negative (n=120) in the study period for Gx TV testing in order to reduce collection delays and avoid the freezing of samples. RESULTS Positive percentage agreement between the Gx TV and NAAT was 95.0% (95% CI 86.1% to 99.0%), negative percentage agreement was 100.0% (95% CI 93.5% to 100.0%) and overall percentage agreement was 97.4% (95% CI 92.5% to 99.5%). Three discordant results were detected with each being close to the cycle threshold of detection using the in-house NAAT assay. CONCLUSIONS Findings suggest the Gx TV assay is easy to use and has suitable overall agreement for sexually transmissible infection (STI) testing at the point of care. It may be used in combination with the Gx CT/NG assay to test for all three STIs simultaneously using this portable and modular-based NAAT platform.
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Affiliation(s)
- S G Badman
- Kirby Institute, UNSW Australia, Sydney, Australia
| | - L M Causer
- Kirby Institute, UNSW Australia, Sydney, Australia
| | - R Guy
- Kirby Institute, UNSW Australia, Sydney, Australia
| | - S N Tabrizi
- University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - F Francis
- Queensland Health Pathology, Townsville, Australia
| | - B Donovan
- Kirby Institute, UNSW Australia, Sydney, Australia Sydney Sexual Health Centre, Sydney, Australia
| | - D Whiley
- University of Queensland-Centre for Clinical Research, Brisbane, Australia
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Chang AB, Smith-Vaughan H, Sloots TP, Valery PC, Whiley D, Beissbarth J, Torzillo PJ. Upper airway viruses and bacteria detection in clinical pneumonia in a population with high nasal colonisation do not relate to clinical signs. Pneumonia (Nathan) 2015; 6:48-56. [PMID: 31641578 PMCID: PMC5922338 DOI: 10.15172/pneu.2015.6/636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/23/2015] [Indexed: 12/27/2022] Open
Abstract
Indigenous Australian children have high (up to 90%) rates of nasopharyngeal microbial colonisation and of hospitalisation for pneumonia. In Indigenous children hospitalised with pneumonia in Central Australia, we describe the nasopharyngeal detection of viruses and bacteria and assessed whether their presence related to signs of pneumonia (tachypnoea and/or chest in-drawing) on hospital admission and during subsequent days. Nasopharyngeal swabs (NPS) and data were prospectively collected from 145 children (median age = 23.5 months, interquartile range [IQR] 8.7–50) hospitalised with pneumonia at Alice Springs Hospital, Australia, between April 2001 and July 2002. The cohort was enrolled in a randomised controlled study using zinc and/or vitamin A supplementation. NPS were taken within 24 hours of hospitalisation and kept frozen at-80°C until analysed in 2014. Polymerase chain reaction (PCR) was used to detect Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and 16 respiratory viruses. Uni- and multi-variate analyses were used to examine the relationships. One or more organisms were present in 137 (94.5%) NPS; 133 (91.7%) detected ≥ 1 bacterium, 34 (37.2%) for ≥ 1 virus and 50 (34.5%) were positive for both viruses and bacteria. C. pneumoniae (n = 3) and M. pneumoniae (n = 2) were rare. In multi-variate analyses, age < 12 months (odds ratio [OR] 6.6 [95% confidence interval {CI} 1.7–25.4]) and fever (OR 4.1 [95% CI 1.7–10.4]) were associated with tachypnoea and chest in-drawing. However the presence of bacteria and/or virus type was not associated with tachypnoea and/or chest in-drawing on admission or during recovery. In children with high nasopharyngeal microbial colonisation rates, the utility of NPS in determining the diagnosis of clinical pneumonia or duration of tachypnoea or in-drawing is likely limited. Larger cohort and case-control studies are required to confirm our findings.
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Affiliation(s)
- Anne B Chang
- 17Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,27Department of Respiratory and Sleep Medicine, Queensland Children's Health Services and Queensland Children's Medical Research Institute, Queensland University of Technology, Herston, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital and Health Service, South Brisbane, Queensland 4101 Australia
| | - Heidi Smith-Vaughan
- 17Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,37School of Medicine, Griffith University, Australia
| | - Theo P Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewksi Virus Research Centre, Queensland Children's Health Services, Herston, Australia
| | - Patricia C Valery
- 17Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - David Whiley
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewksi Virus Research Centre, Queensland Children's Health Services, Herston, Australia
| | - Jemima Beissbarth
- 17Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Paul J Torzillo
- 47Sydney Medical School, University of Sydney, Sydney, Australia.,57Royal Prince Alfred Hospital, Sydney, Australia
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Causer LM, Tangey A, Badman SG, Hengel B, Natoli L, Speers D, Tabrizi SN, Whiley D, Anderson DA, Ward J, Kaldor JM, Guy RJ. 002.2 Operational performance of a new molecular-based point-of-care test for diagnosis of chlamydia trachomatisand neisseria gonorrhoeaeinfection: concordance with conventional laboratory testing. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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43
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Badman SG, Vallely LM, Toliman P, Kariwiga G, Tabrizi S, Pomat W, Guy R, Homer C, Luchters S, Morgan C, Garland SM, Rogerson S, Whiley D, Mola GDL, Wand H, Donovan B, Causer L, Siba P, Kaldor JM, Vallely A. 002.1 Point-of-care testing and immediate treatment of curable sexually transmitted and genital infections among antenatal women in papua new guinea. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Trembizki E, Regan DG, Donovan B, Chen MY, Guy RJ, Lahra MM, Whiley D. 001.5 An australia-wide molecular study of neisseria gonorrhoeaeidentifies frequent occurrence of a key cephalosporin resistance mechanism. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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45
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Hui B, Ryder N, Su JY, Ward J, Chen M, Donovan B, Fairley C, Guy R, Lahra M, Law M, Whiley D, Regan D. 001.6 Exploring the benefits of molecular testing for gonorrhoea antibiotic resistance surveillance in remote settings. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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46
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Hui B, Whiley D, Donovan B, Regan D. P09.09 Exploring the relationship between importation frequency and the persistence of gonorrhoea strains in an msm population: a modelling study. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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47
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Whiley D. S11.1 Real-time pcr detection of n. gonorrhoeaeresistance: where are we now? Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Syrmis MW, Pandey S, Tolson C, Carter R, Congdon J, Sloots T, Coulter C, Whiley D. Identification of Mycobacterium abscessus complex and M. abscessus subsp. massiliense culture isolates by real-time assays. J Med Microbiol 2015; 64:790-794. [PMID: 25976000 DOI: 10.1099/jmm.0.000085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Melanie W Syrmis
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Queensland, Australia.,Queensland Children's Medical Research Institute, Queensland, Australia.,University of Queensland, Queensland, Australia
| | - Sushil Pandey
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Queensland, Australia
| | - Carla Tolson
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Queensland, Australia
| | - Robyn Carter
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Queensland, Australia
| | - Jake Congdon
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Queensland, Australia
| | - Theo Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Queensland, Australia.,Queensland Children's Medical Research Institute, Queensland, Australia.,University of Queensland, Queensland, Australia
| | - Christopher Coulter
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Queensland, Australia
| | - David Whiley
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Health Services, Queensland, Australia.,Queensland Children's Medical Research Institute, Queensland, Australia.,University of Queensland, Queensland, Australia
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49
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Natoli L, Guy RJ, Shephard M, Whiley D, Tabrizi SN, Ward J, Regan DG, Badman SG, Anderson DA, Kaldor J, Maher L. Public health implications of molecular point-of-care testing for chlamydia and gonorrhoea in remote primary care services in Australia: a qualitative study. BMJ Open 2015; 5:e006922. [PMID: 25922100 PMCID: PMC4420950 DOI: 10.1136/bmjopen-2014-006922] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES With accurate molecular tests now available for diagnosis of chlamydia and gonorrhoea (Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG)) at the point-of-care (POC), we aimed to explore the public health implications (benefits and barriers) of their integration into remote primary care in Australia. METHODS Qualitative interviews were conducted with a purposively selected group of 18 key informants reflecting sexual health, primary care, remote Aboriginal health and laboratory expertise. RESULTS Participants believed that POC testing may decrease community prevalence of sexually transmitted infections (STIs), and associated morbidity by reducing the time to treatment and infectious period and expediting partner notification. Also, POC testing could improve acceptability of STI testing, increase testing coverage and result in more targeted prescribing, thereby minimising the risk of antibiotic resistance. Conversely, some felt the immediacy of diagnosis could deter certain young people from being tested. Participants also noted that POC testing may reduce the completeness of communicable disease surveillance data given the current dependence on reporting from pathology laboratories. Others expressed concern about the need to maintain and improve the flow of NG antibiotic sensitivity data, already compromised by the shift to nucleic acid-based testing. This is particularly relevant to remote areas where culture viability is problematic. CONCLUSIONS Results indicate a high level of support from clinicians and public health practitioners for wider access to CT/NG POC tests citing potential benefits, including earlier, more accurate treatment decisions and reductions in ongoing transmission. However, the data also highlight the need for new systems to avoid adverse impact on disease surveillance. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry: ACTRN12613000808741.
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Affiliation(s)
- L Natoli
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - R J Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - M Shephard
- Flinders University International Centre for Point of-Care Testing, Flinders University, Adelaide, South Australia, Australia
| | - D Whiley
- Queensland Paediatric Infectious Diseases (QPID) Laboratory, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - S N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - J Ward
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - D G Regan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - S G Badman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - D A Anderson
- Burnet Institute, Melbourne, Victoria, Australia
| | - J Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - L Maher
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Causer LM, Hengel B, Natoli L, Tangey A, Badman SG, Tabrizi SN, Whiley D, Ward J, Kaldor JM, Guy RJ. A field evaluation of a new molecular-based point-of-care test for chlamydia and gonorrhoea in remote Aboriginal health services in Australia. Sex Health 2015; 12:27-33. [PMID: 25426655 DOI: 10.1071/sh14158] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/21/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Point-of-care (POC) tests could be important public health tools in settings with treatment delays and high rates of sexually transmissible infections (STIs). Use is limited due to suboptimal performance. The performance and ease-of-use of a new molecular-based POC test for simultaneous detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was assessed, alongside two single-organism immunochromatographic tests (ICT). METHODS The evaluation occurred between May 2012 and March 2013 during community STI screens in two remote Aboriginal health services. Urine was tested with the GeneXpert(®)CT/NG and if sufficient volume, also with Diaquick CT and Gonorrhoea Card. The gold standard comparison was laboratory nucleic acid amplification testing (NAAT). Operational characteristics were also assessed. RESULTS Among 198 samples, GeneXpert CT sensitivity and specificity was 100% [95% confidence intervals (CI): 75.9-100] and 99.5% (95% CI: 96.5-100), and NG was 100% (95% CI: 96.5-100) and 100% (95% CI: 97.5-100), respectively. Among a sample subset, Diaquick CT (n=104) sensitivity and specificity was 27.3% (95% CI: 7.3-60.7) and 66.7% (95% CI: 12.5-98.2), and Gonorrhoea Card (n=29), was 66.7% (95% CI: 12.5-98.2) and 76.9% (95% CI: 56.0-90.2), respectively. GeneXpert required 1mL of urine, four steps, 1min specimen preparation and 90min to result. ICTs required 15mL of urine, eight steps, 18min preparation and 10-15min to result. CONCLUSION The accuracy and operational benefits of GeneXpert CT/NG make it very suitable in these settings where delays to treatment are encountered.
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Affiliation(s)
- Louise M Causer
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Belinda Hengel
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Lisa Natoli
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Annie Tangey
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Steven G Badman
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology, Division of Laboratory Services, The Royal Children's Hospital, 50 Flemington Road, Parkville, Vic 3052, Australia
| | - David Whiley
- Queensland Paediatric Infectious Diseases (QPID) Laboratory, Queensland Children's Medical Research Institute, The University of Queensland, Herston, Qld 4029, Australia
| | - James Ward
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - John M Kaldor
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Rebecca J Guy
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
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