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Chris Degeling, Jane Johnson, Jon Iredell, Ky-Anh Nguyen, Jacqueline M Norris, John D Turnidge, Angus Dawson, Stacy M Carter, Gwendolyn L Gilbert
OBJECTIVE: To elicit the views of well-informed community members on the acceptability of proposed policy interventions designed to improve community use of antibiotics in Australia. DESIGN: Two community juries held in 2016. SETTING AND PARTICIPANTS: Western Sydney and Dubbo communities in NSW, Australia. Twenty-nine participants of diverse social and cultural backgrounds, mixed genders and ages recruited via public advertising: one jury was drawn from a large metropolitan setting; the other from a regional/rural setting...
June 30, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Justin A Ellem, Andrew N Ginn, Sharon C-A Chen, John Ferguson, Sally R Partridge, Jonathan R Iredell
We identified discrete importation events of the mcr-1 gene on incompatibility group IncI2 plasmids in Escherichia coli isolated from patients in New South Wales, Australia, in 2011 and 2013. mcr-1 is present in a small minority of colistin-resistant Enterobacteriaceae and appears not to be established locally.
July 2017: Emerging Infectious Diseases
Lechelle K Van Breda, Om P Dhungyel, Andrew N Ginn, Jonathan R Iredell, Michael P Ward
Diarrhoeal diseases in piglets caused by Escherichia coli are responsible for substantial losses each year in the Australian pig industry. A cross-sectional survey was conducted (September 2013-May 2014) across 22 commercial pig herds located in southeastern Australia: NSW (n = 9); VIC (n = 10); and SA (n = 3), to estimate the prevalence of E. coli associated diarrhoea in pre- and post-weaned piglets and to identify key risk factors associated with E. coli disease. A questionnaire on management and husbandry practices was included...
2017: PloS One
Paula Bustamante, Jonathan R Iredell
The stable maintenance of certain plasmids in bacterial populations has contributed significantly to the current worldwide antibiotic resistance (AbR) emergency. IncX plasmids, long underestimated in this regard, have achieved recent notoriety for their roles in transmission of resistance to carbapenem and colistin, the last-line antibiotics for Gram-negative infections. Toxin-antitoxin (TA) systems contribute to stable maintenance of many AbR plasmids, and a few TA systems have been previously described in the IncX plasmids...
March 3, 2017: Plasmid
Muhammad Kamruzzaman, Shereen Shoma, Christopher M Thomas, Sally R Partridge, Jonathan R Iredell
Antibiotic resistance increases the likelihood of death from infection by common pathogens such as Escherichia coli and Klebsiella pneumoniae in developed and developing countries alike. Most important modern antibiotic resistance genes spread between such species on self-transmissible (conjugative) plasmids. These plasmids are traditionally grouped on the basis of replicon incompatibility (Inc), which prevents coexistence of related plasmids in the same cell. These plasmids also use post-segregational killing ('addiction') systems, which poison any bacterial cells that lose the addictive plasmid, to guarantee their own survival...
2017: PloS One
Andrew N Ginn, Briony Hazelton, Shereen Shoma, Martin Cullen, Thomas Solano, Jonathan R Iredell
Culture remains the gold standard for diagnosis of blood stream infections (BSI), but its clinical utility is limited by slow turnaround times. Here we describe a method for rapid quantitative detection of bacterial DNA directly extracted from whole blood using a multiplexed tandem real-time PCR (MT-PCR) assay targeting Staphylococcus, Streptococcus, Pseudomonas, Enterococcus and Enterobacteriaceae 16S rDNA genes. Results were available less than 3.5 hours after blood collection with all five bacterial targets having limits of detection between 10(1) and 10(3) CFU/mL...
April 2017: Pathology
James N Fullerton, Kelly Thompson, Amith Shetty, Jonathan R Iredell, Harvey Lander, John A Myburgh, Simon Finfer
OBJECTIVE: To estimate the impact of adopting the proposed new diagnostic criteria for sepsis, based on Sequential Organ Failure Assessment (SOFA) criteria, on the diagnosis and apparent mortality of sepsis in Australian and New Zealand intensive care units. DESIGN, SETTING AND PARTICIPANTS: A two-stage, post hoc analysis of prospectively collected ICU research data from 3780 adult patients in 77 Australian and New Zealand ICUs on 7 study days, between 2009 and 2014...
March 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Robert Eric Beardmore, Rafael Peña-Miller, Fabio Gori, Jonathan Iredell
Can we exploit our burgeoning understanding of molecular evolution to slow the progress of drug resistance? One role of an infection clinician is exactly that: to foresee trajectories to resistance during antibiotic treatment and to hinder that evolutionary course. But can this be done at a hospital-wide scale? Clinicians and theoreticians tried to when they proposed two conflicting behavioral strategies that are expected to curb resistance evolution in the clinic, these are known as "antibiotic cycling" and "antibiotic mixing...
April 1, 2017: Molecular Biology and Evolution
M J Ellington, O Ekelund, F M Aarestrup, R Canton, M Doumith, C Giske, H Grundman, H Hasman, M T G Holden, K L Hopkins, J Iredell, G Kahlmeter, C U Köser, A MacGowan, D Mevius, M Mulvey, T Naas, T Peto, J-M Rolain, Ø Samuelsen, N Woodford
Whole genome sequencing (WGS) offers the potential to predict antimicrobial susceptibility from a single assay. The European Committee on Antimicrobial Susceptibility Testing established a subcommittee to review the current development status of WGS for bacterial antimicrobial susceptibility testing (AST). The published evidence for using WGS as a tool to infer antimicrobial susceptibility accurately is currently either poor or non-existent and the evidence / knowledge base requires significant expansion. The primary comparators for assessing genotypic-phenotypic concordance from WGS data should be changed to epidemiological cut-off values in order to improve differentiation of wild-type from non-wild-type isolates (harbouring an acquired resistance)...
January 2017: Clinical Microbiology and Infection
James Knox, Snehal Jadhav, Danielle Sevior, Alex Agyekum, Margaret Whipp, Lynette Waring, Jonathan Iredell, Enzo Palombo
No abstract text is available yet for this article.
February 2016: Pathology
E Geoffrey Playford, Jeffrey Lipman, Michael Jones, Anna F Lau, Masrura Kabir, Sharon C-A Chen, Deborah J Marriott, Ian Seppelt, Thomas Gottlieb, Winston Cheung, Jonathan R Iredell, Emma S McBryde, Tania C Sorrell
BACKGROUND:  Delayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk. METHODS:  A prospective cohort study of 6685 consecutive nonneutropenic patients admitted to 7 Australian intensive care units (ICUs) for ≥72 hours was performed. Clinical risk factors for IC occurring prior to and following ICU admission, colonization with Candida species on surveillance cultures from 3 sites assessed twice weekly, and the occurrence of IC ≥72 hours following ICU admission or ≤72 hours following ICU discharge were measured...
December 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
K D Nizio, K A Perrault, A N Troobnikoff, M Ueland, S Shoma, J R Iredell, P G Middleton, S L Forbes
Chronic pulmonary infections are the principal cause of morbidity and mortality in individuals with cystic fibrosis (CF). Due to the polymicrobial nature of these infections, the identification of the particular bacterial species responsible is an essential step in diagnosis and treatment. Current diagnostic procedures are time-consuming, and can also be expensive, invasive and unpleasant in the absence of spontaneously expectorated sputum. The development of a rapid, non-invasive methodology capable of diagnosing and monitoring early bacterial infection is desired...
April 27, 2016: Journal of Breath Research
Amith L Shetty, Tristam Brown, Tarra Booth, Kim Linh Van, Daphna E Dor-Shiffer, Milan R Vaghasiya, Cassanne E Eccleston, Jonathan Iredell
OBJECTIVE: Systemic inflammatory response syndrome (SIRS)-based severe sepsis screening algorithms have been utilised in stratification and initiation of early broad spectrum antibiotics for patients presenting to EDs with suspected sepsis. We aimed to investigate the performance of some of these algorithms on a cohort of suspected sepsis patients. METHODS: We conducted a retrospective analysis on an ED-based prospective sepsis registry at a tertiary Sydney hospital, Australia...
June 2016: Emergency Medicine Australasia: EMA
Alex Agyekum, Alicia Fajardo-Lubián, Xiaoman Ai, Andrew N Ginn, Zhiyong Zong, Xuejun Guo, John Turnidge, Sally R Partridge, Jonathan R Iredell
The minimal concentration of antibiotic required to inhibit the growth of different isolates of a given species with no acquired resistance mechanisms has a normal distribution. We have previously shown that the presence or absence of transmissible antibiotic resistance genes has excellent predictive power for phenotype. In this study, we analyzed the distribution of six β-lactam antibiotic susceptibility phenotypes associated with commonly acquired resistance genes in Enterobacteriaceae in Sydney, Australia...
May 2016: Journal of Clinical Microbiology
Jon Iredell, Jeremy Brown, Kaitlin Tagg
Resistance of the Enterobacteriaceae to antibiotics, especially of the β lactam type, is increasingly dominated by the mobilization of continuously expressed single genes that encode efficient drug modifying enzymes. Strong and ubiquitous selection pressure has seemingly been accompanied by a shift from "natural" resistance, such as inducible chromosomal enzymes, membrane impermeability, and drug efflux, to the modern paradigm of mobile gene pools that largely determine the epidemiology of modern antibiotic resistance...
February 8, 2016: BMJ: British Medical Journal
Alex Agyekum, Alicia Fajardo-Lubián, Daniel Ansong, Sally R Partridge, Tsiri Agbenyega, Jonathan R Iredell
Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamases (ESBLs) are among the most multidrug-resistant pathogens in hospitals and are spreading worldwide. Horizontal gene transfer and spread of high-risk clones are involved in ESBL dissemination. Investigation of the resistance phenotypes of 101 consecutive clinical E. coli (n=58) and K. pneumoniae (n=43) isolated at the Komfo Anokye Teaching Hospital in Ghana over 3 months revealed 63 (62%) with an ESBL phenotype. All 63 had a blaCTX-M gene, and sequence analysis showed that 62 of these were blaCTX-M-15...
April 2016: Diagnostic Microbiology and Infectious Disease
Kaitlin A Tagg, Andrew N Ginn, Sally R Partridge, Jonathan R Iredell
Effective surveillance and management of pathogenic Escherichia coli relies on robust and reproducible typing methods such as multilocus sequence typing (MLST). Typing of E. coli by MLST enables tracking of pathogenic clones that are known to carry virulence factors or spread resistance, such as the globally-prevalent ST131 lineage. Standard MLST for E. coli requires sequencing of seven alleles, or a whole genome, and can take several days. Here, we have developed and validated a nucleic-acid-based MALDI-TOF mass spectrometry (MS) method for MLST as a rapid alternative to sequencing that requires minimal operator expertise...
2015: PloS One
M Lindsay Grayson, Nenad Macesic, G Khai Huang, Katherine Bond, Jason Fletcher, Gwendolyn L Gilbert, David L Gordon, Jane F Hellsten, Jonathan Iredell, Caitlin Keighley, Rhonda L Stuart, Charles S Xuereb, Marilyn Cruickshank
INTRODUCTION: Important culture-change initiatives (e.g. improving hand hygiene compliance) are frequently associated with variable uptake among different healthcare worker (HCW) categories. Inherent personality differences between these groups may explain change uptake and help improve future intervention design. MATERIALS AND METHODS: We used an innovative personality-profiling tool (ColourGrid®) to assess personality differences among standard HCW categories at five large Australian hospitals using two data sources (HCW participant surveys [PS] and generic institution-wide human resource [HR] data) to: a) compare the relative accuracy of these two sources; b) identify differences between HCW groups and c) use the observed profiles to guide design strategies to improve uptake of three clinically-important initiatives (improved hand hygiene, antimicrobial stewardship and isolation procedure adherence)...
2015: PloS One
Dale Dominey-Howes, Beata Bajorek, Carolyn A Michael, Brittany Betteridge, Jonathan Iredell, Maurizio Labbate
We advocate that antibiotic resistance be reframed as a disaster risk management problem. Antibiotic-resistant infections represent a risk to life as significant as other commonly occurring natural disasters (e.g., earthquakes). Despite efforts by global health authorities, antibiotic resistance continues to escalate. Therefore, new approaches and expertise are needed to manage the issue. In this perspective we: (1) make a call for the emergency management community to recognize the antibiotic resistance risk and join in addressing this problem; (2) suggest using the risk management process to help tackle antibiotic resistance; (3) show why this approach has value and why it is different to existing approaches; and (4) identify public perception of antibiotic resistance as an important issue that warrants exploration...
2015: Frontiers in Microbiology
Jen Kok, Jimmy Ng, Stephen C Li, John Giannoutsos, Vineet Nayyar, Jonathan R Iredell, Dominic E Dwyer, Sharon C-A Chen
Data on the performance of point-of-care (POC) or near-patient devices in the management of critically unwell patients are limited, meaning that there are demands for confirming POC test results in the routine clinical laboratory and so potentially leading to delay in treatment provision. We evaluated the performance of the i-STAT CHEM 8+ and CG4+, Hemochron Signature Elite, HemoCue Hb 201+ and WBC Diff Systems on whole blood collected from medical and surgical patients admitted to the intensive care unit at an Australian tertiary care hospital...
August 2015: Pathology
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