A multicentre evaluation and expert recommendations of use of the newly developed BioFire Joint Infection polymerase chain reaction panel.

Septic arthritis is a serious condition with significant morbidity and mortality, routinely diagnosed using culture. The FDA has recently approved the rapid molecular BioFire® Joint Infection Panel (BJIP) for synovial fluid. We aimed to evaluate the BJIP compared to culture and its potential use in patient management. A multicentre retrospective evaluation of BJIP was conducted in the UK and Ireland. Positive percent agreement (PPA) and negative percent agreement (NPA) were calculated between the BJIP and routine culture. A multidisciplinary team (MDT) discussion addressing the optimal or potential case use of the assay practice was facilitated. Three hundred ninety-nine surplus synovial fluid samples (~ 70% from native joints) from eight centres were processed using BJIP in addition to routine culture. An increased yield of positive results was detected using BJIP compared to routine culture (98 vs 83), giving an overall PPA of 91.6% and overall NPA of 93% for the BJIP compared to culture results. The BJIP detected resistant markers and additional organisms that could influence antibiotic choices including Neisseria gonorrhoeae and Kingella kingae. The MDT agreed that the assay could be used, in addition to standard methods, in adult and children patients with specialist advice use based on local needs. Rapid results from BJIP were assessed as having potential clinical impact on patient management. Organisms not included in the panel may be clinically significant and may limit the value of this test for PJI.

Protocol for the Study of Heart and Renal Protection-Extended Review: Additional 5-Year Follow-up of the Australian, New Zealand, and Malaysian SHARP Cohort.

BACKGROUND: There are limited studies on the effects of statins on outcomes in the moderate chronic kidney disease (CKD) population and their trajectory to end-stage kidney disease. OBJECTIVE: To examine the long-term effects of lipid-lowering therapy on all-cause mortality, cardiovascular morbidity, CKD progression, and socioeconomic well-being in Australian, New Zealand, and Malaysian SHARP (Study of Heart and Renal Protection) trial participants-a randomized controlled trial of a combination of simvastatin and ezetimibe, compared with placebo, for the reduction of cardiovascular events in moderate to severe CKD. DESIGN: Protocol for an extended prospective observational follow-up. SETTING: Australian, New Zealand, and Malaysian participating centers in patients with advanced CKD. PATIENTS: All SHARP trial participants alive at the final study visit. MEASUREMENTS: Primary outcomes were measured by participant self-report and verified by hospital administrative data. In addition, secondary outcomes were measured using a validated study questionnaire of health-related quality of life, a 56-item economic survey. METHODS: Participants were followed up with alternating face-to-face visits and telephone calls on a 6-monthly basis until 5 years following their final SHARP Study visit. In addition, there were 6-monthly follow-up telephone calls in between these visits. Data linkage to health registries in Australia, New Zealand, and Malaysia was also performed. RESULTS: The SHARP-Extended Review (SHARP-ER) cohort comprised 1136 SHARP participants with a median of 4.6 years of follow-up. Compared with all SHARP participants who originally participated in the Australian, New Zealand, and Malaysian regions, the SHARP-ER participants were younger (57.2 [48.3-66.4] vs 60.5 [50.3-70.7] years) with a lower proportion of men (61.5% vs 62.8%). There were a lower proportion of participants with hypertension (83.7% vs 85.0%) and diabetes (20.0% vs 23.5%). LIMITATIONS: As a long-term follow-up study, the surviving cohort of SHARP-ER is a selected group of the original study participants, which may limit the generalizability of the findings. CONCLUSION: The SHARP-ER study will contribute important evidence on the long-term outcomes of cholesterol-lowering therapy in patients with advanced CKD with a total of 10 years of follow-up. Novel analyses of the socioeconomic impact of CKD over time will guide resource allocation. TRIAL REGISTRATION: The SHARP trial was registered at ClinicalTrials.gov NCT00125593 and ISRCTN 54137607.

CONTEXTE: On trouve peu d'études faisant état de l'effet des statines sur les issues des patients atteints d'insuffisance rénale chronique (IRC) modérée et sur leur évolution vers l'insuffisance rénale terminale (IRT). OBJECTIF: Observer les effets à long terme d'un traitement hypolipidémiant sur la mortalité toutes causes, la morbidité cardiovasculaire, la progression de l'IRC et le mieux-être socioéconomique des participants australiens, néo-zélandais et malaisiens, à l'essai SHARP; un essai contrôlé à répartition aléatoire qui portait sur l'effet comparatif d'une combinaison de simvastatine et d'ézétimibe, ou d'un placebo, sur la réduction des événements cardiovasculaires en contexte d'IRC modérée à grave. PLAN DE L'ÉTUDE: Il s'agit d'un protocole pour un suivi prospectif et observationnel prolongé. CADRE: Les centres d'Australie, de Nouvelle-Zélande et de Malaisie traitant des patients atteints d'IRC de stade avancé et participant à l'essai SHARP. SUJETS: Tous les participants à l'essai SHARP encore vivants lors de la dernière visite de l'étude. MESURES: Les principaux résultats ont été mesurés par autodéclaration des participants et vérifiés auprès des données administratives de l'hôpital. Les résultats secondaires ont été mesurés à l'aide d'un questionnaire validé évaluant la qualité de vie liée à l'état de santé, une enquête économique de 56 questions. MÉTHODOLOGIE: Les participants ont été suivis tous les six mois en alternant les visites en clinique et les entretiens téléphoniques, jusqu'à cinq ans après la dernière visite prévue lors de l'essai SHARP. On a procédé au couplage des données avec les registres de santé d'Australie, de Nouvelle-Zélande et de Malaisie. RÉSULTATS: La cohorte SHARP-ER était constituée de 1 136 participants à l'essai SHARP et la durée de suivi médiane était de 4,6 ans. En comparaison de l'ensemble des patients ayant participé à l'essai SHARP en Australie, en Nouvelle-Zélande et en Malaisie, la cohorte SHARP-ER était plus jeune (57,2 [48,3-66,4] contre 60,5 [50,3-70,7] ans), comptait moins d'hommes (61,5 % contre 62,8 %) et présentait une plus faible proportion de patients hypertendus (83,7 % contre 85,0 %) ou diabétiques (20,0 % contre 23,5 %). LIMITES: Puisqu'il s'agit d'une étude de suivi à plus long terme, la cohorte de survivants (SHARP-ER) constitue un groupe choisi à partir de l'ensemble des participants à l'essai initial, ce qui pourrait limiter la généralisabilité des résultats. CONCLUSION: L'étude SHARP-ER, avec un suivi total sur dix ans, apportera des informations importantes sur les effets à long terme d'un traitement hypolipidémiant chez les patients atteints d'IRC de stade avancé. De nouvelles analyses des impacts socioéconomiques de l'IRC au fil du temps éclaireront l'affectation des ressources.

Eating disorders should be considered in the differential diagnosis of patients presenting with acute kidney injury and electrolyte derangement.

We present a case of a 40-year-old woman with a history of ongoing anorexia nervosa and bulimia nervosa who has required multiple admissions to hospital for management of acute kidney injury (AKI) and electrolyte derangement. This case is of interest as recent studies have highlighted the significant prevalence of disordered eating and the major public health implications this may have. We discuss the unusual finding of hypercalcaemia in this case and address the investigation and management of AKI and electrolyte disturbance in a patient with anorexia and bulimia.

High-dose amoxicillin should be included in the empirical treatment of suspected meningitis in patients at risk of HIV infection.

The authors report on a case of Listeria rhomboencepahlitis in a previously undiagnosed HIV positive man. This case is of interest as the incidence of Listeria has increased dramatically in recent years and so may increase in the HIV-infected population. The organism is inherently resistant to cephalosporin antibiotics, empirically employed in the treatment of central nervous system infections and thus highlights the need to include amoxicillin in meningitis treatment regimes in patients at risk of HIV infection as well as the older and those known to be immuno-compromised.