Pneumococcal bacteraemia in adults over a 10-year period (2011-2020): a clinical and serotype analysis.

BACKGROUND: Streptococcus pneumoniae (pneumococcus) is a human nasopharyngeal tract coloniser responsible for invasive pneumococcal disease, which is largely vaccine preventable. Vaccination is recommended from birth for all, and through adulthood for those with risk conditions. AIMS: To describe the clinical and serotype analysis of pneumococcus bacteraemia over a 10-year period. METHODS: A 10-year (February 2011-December 2020) retrospective review was performed on all adult (age ≥18 years) pneumococcus bacteraemia presenting to the four public hospitals in Western Sydney, Australia. Comorbidities and risk factors were recorded. RESULTS: Three hundred unique episodes of S. pneumoniae bloodstream infection (SPBI) were identified during the study period. The median age for SPBI was 63 years with 31.7% aged 70 years or older. A 94.7% had one or more risks factors for SPBI. Pneumonia was reported in 80% of all SPBI, whereas meningitis was reported in 6% and infective endocarditis in <1%. Asplenia was noted in 2.4%. Seven- and 30-day mortality was 6.6% and 11.9%, with a higher 30-day mortality in those aged ≥70 years (24.4%). The serotype distribution showed 7-valent conjugate vaccine covered 11.0% of all isolates, whereas 13-valent conjugate vaccine (13vPCV) and a 23-valent polysaccharide vaccine (23vPPV) covered 41.7% and 69.0% respectively. Immunisation details were available for 110 individuals, of whom, only 7.3% had received pneumococcal vaccination. CONCLUSIONS: Most patients with pneumococcal bacteraemia had age- or comorbidity-related risk factors but were not vaccinated. Two-thirds of cases occurred in people aged <70 years. 13vPCV and 23vPPV covered 41.7% and 69.0% of bacteraemic isolates.

Fulminant Bacillus cereus food poisoning with fatal multi-organ failure.

This case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic.

Perceptions of US and Australian Medical Students and Instructors About Clinical Professional Attire: LAPEL Study.

CONTEXT: White coats have long been the professional uniform of physicians. However, when physicians opt to remove the white coat, their clothing underneath is brought to the forefront and can influence how they are perceived by their patients. OBJECTIVE: To explore the perceptions of medical students and their instructors about appropriate clinical professional attire. METHODS: An anonymous, voluntary 55-question survey was electronically distributed to medical students and their instructors at 2 US and 2 Australian medical schools. The survey incorporated 30 images of sample attire, 9 demographic questions, and 16 questions regarding culture and context of clothing and accessories. RESULTS: In total, 411 students and 73 instructors participated in this study. The data revealed that white coats and neckties are nearly absent in Australian clinical attire. Overall, students were significantly more supportive of full facial coverage due to religious or cultural values compared with instructors (P<.001), and US medical students were significantly more supportive than Australian students (P<.001). All cohorts preferred dress code policies that directed students to avoid but not prohibit the use of perfume or cologne. Nose rings were controversial with significantly more support for use from medical students than instructors (pooled cohorts, P=.002). Medical students in both the United States and Australia indicated that they were most influenced by observing the attire of physicians at work (155 [38%]), compared with courses in medical ethics (19 [5%]), school policy (16 [4%]), or hospital policy (9 [2%]). CONCLUSION: Although regional dress code practices are different in the United States compared with Australia, medical students were overall most influenced by their instructors' attire in clinical settings.