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Amith Shetty, Sebastian Sparenberg, Kristian Adams, Selwyn Selvedran, Benjamin Tang, Kim Hanna, Jonathan Iredell
OBJECTIVE: The arterial to end-tidal carbon dioxide tension difference (CO2 gap) correlates with physiologic dead space. The prognostic value of increased CO2 gap in trauma and respiratory distress patients is documented. Transpulmonary arteriovenous shunting is identified as a predictor of mortality in non-pulmonary sepsis. We set out to investigate the prognostic value of the CO2 gap in a pilot study of patients with suspected sepsis from non-respiratory causes. METHODS: Patients presenting to tertiary Australian ED with suspected sepsis (n = 215) underwent near-simultaneous end-tidal carbon dioxide and partial pressure of carbon dioxide measurements...
May 13, 2018: Emergency Medicine Australasia: EMA
Annie Zhuo, Maurizio Labbate, Jacqueline M Norris, Gwendolyn L Gilbert, Michael P Ward, Beata V Bajorek, Chris Degeling, Samantha J Rowbotham, Angus Dawson, Ky-Anh Nguyen, Grant A Hill-Cawthorne, Tania C Sorrell, Merran Govendir, Alison M Kesson, Jonathan R Iredell, Dale Dominey-Howes
OBJECTIVES: To explore and compare the knowledge, attitudes and experiences of doctors, dentists and veterinarians (as prescribers) in relation to antibiotic use and antibiotic resistance (AbR), and to consider the implications of these for policy-making that support a One Health approach. DESIGN: A cross-sectional survey conducted online. SETTING: Doctors, dentists and veterinarians practising in primary, secondary or tertiary care in Australia...
March 30, 2018: BMJ Open
Alicia Arnott, Qinning Wang, Nathan Bachmann, Rosemarie Sadsad, Chayanika Biswas, Cristina Sotomayor, Peter Howard, Rebecca Rockett, Agnieszka Wiklendt, Jon R Iredell, Vitali Sintchenko
Multidrug- and colistin-resistant Salmonella enterica serotype 4,[5],12:i:- sequence type 34 is present in Europe and Asia. Using genomic surveillance, we determined that this sequence type is also endemic to Australia. Our findings highlight the public health benefits of genome sequencing-guided surveillance for monitoring the spread of multidrug-resistant mobile genes and isolates.
April 2018: Emerging Infectious Diseases
Amith Shetty, Stephen Pj Macdonald, Gerben Keijzers, Julian M Williams, Benjamin Tang, Bas de Groot, Kelly Thompson, John F Fraser, Simon Finfer, Rinaldo Bellomo, Jonathan Iredell
Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplicated infection (i.e. without organ dysfunction) and/ or risk stratification. Appropriate sample collection for microbiological testing remains key for subsequent confirmation of diagnosis and rationalisation of antimicrobials...
February 2018: Emergency Medicine Australasia: EMA
Amith L Shetty, Kelly Thompson, Karen Byth, Petra Macaskill, Malcolm Green, Mary Fullick, Harvey Lander, Jonathan Iredell
OBJECTIVES: We investigated specific lactate thresholds for adverse outcomes in patients presenting to emergency departments (EDs) with suspected sepsis identified based on the performance of a sepsis screening algorithm. DESIGN AND SETTING: A standardised sepsis bundle was implemented across public hospitals in New South Wales, Australia, as a quality improvement initiative. A register of all adult ED presentations (≥18 years) meeting predefined criteria for sepsis was created, using a combination of data linkage and direct reporting from 97 participating sites...
January 5, 2018: BMJ Open
Amith Shetty, Stephen Pj MacDonald, Julian M Williams, John van Bockxmeer, Bas de Groot, Laura M Esteve Cuevas, Annemieke Ansems, Malcolm Green, Kelly Thompson, Harvey Lander, Jaimi Greenslade, Simon Finfer, Jonathan Iredell
OBJECTIVE: The Sepsis-3 task force recommends the use of the quick Sequential Organ Failure Assessment (qSOFA) score to identify risk for adverse outcomes in patients presenting with suspected infection. Lactate has been shown to predict adverse outcomes in patients with suspected infection. The aim of the study is to investigate the utility of a post hoc lactate threshold (≥2 mmol/L) added qSOFA score (LqSOFA(2) score) to predict primary composite adverse outcomes (mortality and/or ICU stay ≥72 h) in patients presenting to ED with suspected sepsis...
December 2017: Emergency Medicine Australasia: EMA
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...
February 2018: 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...
May 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
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