Biological Filtration is Resilient to Wildfire Ash-Associated Organic Carbon Threats to Drinking Water Treatment.

Elevated/altered levels of dissolved organic matter (DOM) in water can be challenging to treat after wildfire. Biologically mediated treatment removes some DOM; here, its ability to remove elevated/altered postfire dissolved organic carbon (DOC) resulting from wildfire ash was investigated for the first time. Treatment of wildfire ash-amended (low, moderate, high) source waters by bench-scale biofilters was evaluated in duplicate. Turbidity and DOC were typically well-removed (effluent turbidity ≤0.3 NTU; average DOC removal ∼20%) in all biofilters during periods of stable source water quality. Daily DOC removal across all biofilters (ash-amended and controls) was generally consistent, suggesting that (i) the biofilter DOC biodegradation capacity was not deleteriously impacted by the ash and (ii) the biofilters buffered the ash-associated increases in water extractable organic matter. DOM fractionation indicates this was because the biodegradable low molecular weight neutral fractions of DOM, which increased with ash addition, were reduced by biofiltration while humic substances were largely recalcitrant. Thus, biological filtration was resilient to wildfire ash-associated DOM threats to drinking water treatment, but operational resilience may be compromised if the balance between readily removed and recalcitrant fractions of DOM change, as was observed during brief periods herein.

Assessment of a rapid diagnostic test to exclude bacteraemia and effect on clinical decision-making for antimicrobial therapy.

Unnecessary antimicrobial treatment promotes the emergence of resistance. Early confirmation that a blood culture is negative could shorten antibiotic courses. The Cognitor Minus test, performed on blood culture samples after 12 hours incubation has a negative predictive value (NPV) of 99.5%. The aim of this study was to determine if earlier confirmation of negative blood culture result would shorten antibiotic treatment. Paired blood cultures were taken in the Critical Care Unit at a teaching hospital. The Cognitor Minus test was performed on one set >12 hours incubation but results kept blind. Clinicians were asked after 24 and 48 hours whether a result excluding bacteraemia or fungaemia would affect decisions to continue or stop antimicrobial treatment. Over 6 months, 125 patients were enrolled. The median time from start of incubation to Cognitor Minus test was 27.1 hours. When compared to 5 day blood culture results from both the control and test samples, Cognitor Minus gave NPVs of 99% and 100% respectively. Test results would have reduced antibiotic treatment in 14% (17/119) of patients at 24 and 48 hours (24% at either time) compared with routine blood culture. The availability of rapid tests to exclude bacteraemia may be of benefit in antimicrobial stewardship.