Australian Meningococcal Surveillance Programme Annual Report, 2022.

In Australia, both probable and laboratory-confirmed cases of invasive meningococcal disease (IMD) are reported to the National Notifiable Diseases Surveillance System (NNDSS). Compared to 2021, the number of IMD notifications in 2022 increased by 81% to 127, alongside the easing of COVID-19 containment measures. Laboratory confirmation occurred in 95% of these cases, with 51% (62/121) diagnosed by bacterial culture and 49% (59/121) by nucleic acid amplification testing. The serogroup was determined for 97% of laboratory-confirmed cases (117/121): serogroup B (MenB) accounted for 83% of infections (100/121); MenW for 4% (5/121); MenY for 10% (12/121); no infections were attributed to MenC disease. Fine typing was available on 67% of the cases for which the serogroup was determined (78/117). In MenB isolates, 27 porA types were detected, the most prevalent of which were P1.7-2,4 (18%;11/62), P1.22,14 (15%; 9/62), P1.18-1,34 (10%; 6/62) and P1.7,16-26 (10%; 6/62). All five MenW infections identified as porA type P1.5,2 with different MLST sequence types (ST): 11, 574, 1287, 12351, 13135 all belonging to clonal complex 11, the hypervirulent strain reported in outbreaks in Australia and overseas. In MenY, the predominant porA type was P1.5-1,10-1 (73%; 8/11), ST 1655 and from clonal complex 23. Children less than 5 years of age and people aged 15-19 years were overrepresented with IMD notifications, accounting for 22% (27/121) and 23% (28/121) of laboratory-confirmed cases respectively. Fifteen percent of laboratory-confirmed notifications (18/121) were in persons aged 45-64 years. MenB infections were detected in all age groups but predominated in persons aged 15-19 years (93% of IMD in this age group; 26/28) and comprised 89% (24/27) of infections in children aged less than 5 years. MenW infections were markedly reduced in 2022, accounting for two IMD detections in children 1-4 years (2/16) and sporadic detections in other older age groups. MenY infections were largely detected in adults aged 45-64 years, accounting for 28% of IMD in this age group (5/18). All 62 cultured IMD isolates had antimicrobial susceptibility testing performed. Minimum inhibitory concentration (MIC) values were categorised using Clinical Laboratory Standards Institute (CLSI) interpretative criteria: 5% (3/62) were defined as penicillin resistant (MIC value ≥ 0.5 mg/L); 71% (44/62) had intermediate susceptibility to penicillin (MIC values 0.125 and 0.25 mg/L) and 24% (15/62) were susceptible to penicillin. All isolates were susceptible to ceftriaxone, ciprofloxacin and rifampicin.

Australian Meningococcal Surveillance Programme Annual Report, 2021.

Invasive meningococcal disease (IMD) is a notifiable disease in Australia, with both probable and laboratory-confirmed cases of IMD reportable to the National Notifiable Diseases Surveillance System (NNDSS). In 2021, there were 74 notifications of IMD made, the lowest number recorded since 1991 when records began. Ninety-one percent of notified cases (67/74) were laboratory confirmed, with 69% of laboratory-confirmed cases (46/67) diagnosed by bacterial culture and 31% (21/67) by nucleic acid amplification testing. The serogroup was determined for 63/67 laboratory-confirmed cases (94%): serogroup B (MenB) accounted for 52% of infections (35/67); MenW for 22% (15/67); MenY for 19% (13/67); there were no infections attributed to MenC. Fine typing was available on 37/67 (55%) where the serogroup was determined. The greatest variability was in MenB, with nine different porA types represented. All MenW infections belonged to a single porA type (P1.5,2) with five different MLST sequence types represented: 11, 574, 1287, 12351, 13135; all belonged to clonal complex 11, the hypervirulent strain reported in recent outbreaks in Australia and overseas. All MenY were from the same porA antigen type, P1.5-1,10-1: MLST sequence type 1655; clonal complex 23. Peaks occurred in children less than 5 years, reaching 24% (16/67) of reported cases, and in those aged 15-19 years reaching 16% (11/67) of reported cases. It is notable that 15% (10/67) of notifications were in persons aged 45-64 years, and an equivalent proportion (15%; 10/67) in adults aged 65 years and above. MenB infections predominated in persons aged 15-19 years (100%, 11/11), and comprised 56% (9/16) of infections in children aged less than 5 years. By contrast, Men W infections accounted for half (5/10) of IMD detections in infants less than 1 year, and 30% (3/10) of infections in persons aged 45-65 years. MenY infections predominated in adults aged 65 years and greater, resulting in 70% (7/10) of IMD in this age group. All 46 IMD isolates had antimicrobial susceptibility testing performed. Minimum inhibitory concentration (MIC) values were categorised using Clinical Laboratory Standards Institute (CLSI) interpretative criteria: 13% (6/46) were defined as penicillin resistant (MIC value, ≥ 0.5 mg/L); 59% (27/46) had intermediate susceptibility to penicillin (MIC values, 0.125 and 0.25 mg/L) and 28% (13/46) were susceptible to penicillin. All isolates were susceptible to ceftriaxone and rifampicin. A single MenB IMD isolate from New South Wales exhibited ciprofloxacin resistance (MIC value, 0.125 mg/L).

Bacterial Ocular Surveillance System (BOSS) Sydney, Australia 2017-2018.

ABSTRACT: This study investigated antimicrobial resistance (AMR) profiles from a cohort of patients with bacterial keratitis treated at Sydney Eye Hospital, 1 January 2017 - 31 December 2018. These AMR profiles were analysed in the context of the current Australian empiric regimens for topical therapy: ciprofloxacin/ofloxacin monotherapy versus combination therapy of cefalotin/cephazolin plus gentamicin. At our Centre, combinations of (i) chloramphenicol plus gentamicin and (ii) chloramphenicol plus ciprofloxacin are alternatively used, so were also analysed. Three hundred and seventy-four isolates were cultured prospectively: 280/374 (75%) were gram positive, and 94/374 (25%) were gram negative. Coagulase-negative staphylococci comprised 173/374 (46%). Isolates included Staphylococcus aureus (n = 43/374) 11%; Streptococcus pneumoniae (n = 14/374) 3.7%; and Pseudomonas aeruginosa (n = 50/374) 13%. Statistical comparison was performed. There was no significant difference between cover provided either of the current Australian recommendations: ciprofloxacin/ofloxacin vs cefalotin/cephazolin plus gentamicin (5.3% vs 4.8%, respectively; p = 0.655). However, the combination of chloramphenicol plus an anti-pseudomonal agent (ciprofloxacin/ofloxacin or gentamicin) had significantly improved cover. Chloramphenicol plus gentamicin was superior to ciprofloxacin/ofloxacin (1.9% vs 5.3% resistance respectively; p = 0.007), and cefalotin/cephazolin plus gentamicin (1.9% vs 4.8%; p = 0.005). Chloramphenicol plus ciprofloxacin was superior to ciprofloxacin/ofloxacin monotherapy (1.3% vs 5.3%; p ≤ 0.001), and to cefalotin/cephazolin plus gentamicin (1.3% vs 4.8%; p = 0.003). Chloramphenicol plus gentamicin versus chloramphenicol plus ciprofloxacin/ofloxacin were equivalent (p = 0.48). There was no demonstrated in vitro superiority of either the current empiric antibiotic regimens. For our setting, for bacterial keratitis, chloramphenicol in combination offered superior in vitro cover. Broadened surveillance for ocular AMR is urgently needed across jurisdictions.