Shigella species epidemiology and antimicrobial susceptibility: the implications of emerging azithromycin resistance for guiding treatment, guidelines and breakpoints.

OBJECTIVES: To examine antimicrobial susceptibility patterns and predictors of resistance among Shigella isolates in New South Wales (NSW), Australia during 2013-14 with emphasis on azithromycin. METHODS: Cross-sectional analysis of all shigellosis cases (160) notified to public health authorities in NSW, Australia was performed. RESULTS: Among 160 Shigella isolates tested, 139 (86.9%) were susceptible to azithromycin, 104 (65.0%) to ciprofloxacin and 38 (23.7%) to co-trimoxazole. Ciprofloxacin resistance was 1.9 times more common in infections acquired in Australia compared with those acquired overseas, while azithromycin resistance was 8.5 times more common in males. CONCLUSIONS: We recommend ongoing reconsideration of guidelines for the treatment of shigellosis based on emerging resistance patterns. First-line therapy may need to be reconsidered based on local resistance rates due to common resistance to co-trimoxazole and ciprofloxacin. We recommend culture and susceptibility testing for suspected and proven shigellosis. Azithromycin susceptibility breakpoints for Shigella species may need to be species specific.

What factors do cancer patients believe contribute to the development of their cancer? (New South Wales, Australia).

OBJECTIVE: To analyze Australian cancer patients' beliefs about factors contributing to the development of their cancer. METHODS: As part of a case-control study (The Cancer Council NSW Cancer, Lifestyle and Evaluation of Risk Study), a total of 2,857 cancer patients (open to all types of cancer) were surveyed and via an open-ended question, were asked to specify factors they think contributed to the development of their cancer. Qualitative analysis and categorical techniques were used to analyze the data. RESULTS: About half, 53%, of patients specified at least one contributing factor. The odds of a person specifying a contributing factor increased with time period since diagnosis (p = 0.0006). Patients most frequently specified, respectively: "Stress" (15.4%), "Genetics/hereditary" (10.9%) and "Smoking" (6.2%). Among factors specified the largest proportion (24.1%) was perceived to be "Non-modifiable." CONCLUSION: Cancer patients specified a broad range of factors and agents to which their disease may be attributed. Some of these were poorly correlated with epidemiological rankings of attributable risk factors. The role of psychosocial and genetic factors was overstated. Misconceptions regarding the causes of cancer are a key consideration of health professionals when devising communication strategies around cancer prevention.