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1.
Intern Med J ; 53(12): 2257-2263, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36917124

RESUMO

BACKGROUND: Antimicrobial resistance and therapy-related adverse effects make Mycobacterium abscessus treatment challenging. Omadacycline is a novel, bioavailable aminomethylcycline with favourable in vitro activity against M. abscessus. AIMS: To describe a case report and review the published literature describing outcomes for M. abscessus infections treated with omadacycline. METHODS: Systematic literature review. RESULTS: We identified three articles that, in addition to our case report, describe 18 patients. Pulmonary infections were most frequent. Minimum inhibitory concentrations were reported for two isolates (0.25 and 0.5 mg/L). Despite half the patients starting omadacycline because of failure of prior therapy, 15 (83%) had a favourable outcome, defined as 'cure', 'improvement' or 'clinical success' as determined by the primary study authors. One patient (6%) discontinued omadacycline because of gastrointestinal intolerance. CONCLUSIONS: Although the limited observational data and in vitro susceptibility results are encouraging, randomised control trials are required to determine the role of omadacycline as part of combination therapy for this most difficult-to-treat pathogen.


Assuntos
Infecções por Mycobacterium não Tuberculosas , Mycobacterium abscessus , Humanos , Antibacterianos , Tetraciclinas/uso terapêutico , Tetraciclinas/farmacologia , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Testes de Sensibilidade Microbiana
2.
Intern Med J ; 49(8): 1016-1022, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30667165

RESUMO

BACKGROUND: Preliminary studies have reported promising results for the utility of gallium-68 (Ga-68) citrate positron emission tomography-computed tomography (PET-CT) for infection imaging. This technique offers reduced radiation dose to patients, shorter time between injection and imaging and reduced time for image acquisition compared to the 'gold standard' nuclear imaging technique: gallium-67 (Ga-67) citrate scintigraphy. AIMS: To compare the two imaging modalities to ascertain whether Ga-68 citrate PET-CT is of equivalent diagnostic efficacy for bone and joint infection or pyrexia of unknown origin (PUO) and to assess image quality and reporter confidence. METHODS: Patients with PUO and suspected bone or joint infection underwent Ga-67 citrate scintigraphy and Ga-68 citrate PET-CT. Participants were followed up for 3 months to record subsequent treatment, investigations and outcome. RESULTS: 60 patients were recruited to this multicentre prospective study: 32 for bone and joint infection, 28 for PUO. The results show a sensitivity of 81% for Ga-67 citrate scintigraphy and 69% for Ga-68 citrate PET-CT, a specificity of 79% for Ga-67 citrate and 67% for Ga-68 citrate and were concordant for 76% of the participants. The reporting physician confidence was significantly lower for Ga-68 citrate (P < 0.05), frequently due to prominent physiologic blood pool activity adjacent to the site of infection. CONCLUSION: The sensitivity and specificity of Ga-68 citrate PET-CT were found to be consistently lower than Ga-67 citrate scintigraphy. Additionally, due to the insufficient level of confidence of the reporting physicians for the Ga-68 citrate PET-CT, this modality could not currently be recommended to replace Ga-67 citrate scintigraphy for routine clinical use.


Assuntos
Febre de Causa Desconhecida/diagnóstico por imagem , Infecções/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos/farmacocinética , Radioisótopos de Gálio , Humanos , Estudos Prospectivos , Sensibilidade e Especificidade
3.
Emerg Infect Dis ; 24(7): 1345-1348, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29912714

RESUMO

Two cases of Legionnaires' disease and 1 of Pontiac fever occurred among the crew of a merchant ship operating off the shores of Australia. PCR assays identified potential sources in the ship's cabins. Modification of maritime regulations for Legionnaires' disease prevention in commercial vessels is needed for nonpassenger merchant ships.


Assuntos
Surtos de Doenças , Legionelose , Doença dos Legionários/epidemiologia , Navios , Doença Relacionada a Viagens , Austrália/epidemiologia , História do Século XXI , Humanos , Oceano Índico , Legionelose/genética , Doença dos Legionários/história , Doença dos Legionários/microbiologia , Doença dos Legionários/transmissão , Pessoa de Meia-Idade , Estações do Ano
4.
J Infect Dis ; 205(12): 1840-8, 2012 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-22492857

RESUMO

BACKGROUND: It is uncertain whether particular clones causing invasive community-onset methicillin-resistant and methicillin-sensitive Staphylococcus aureus (cMRSA/cMSSA) infection differ in virulence. METHODS: Invasive cMRSA and cMSSA cases were prospectively identified. Principal component analysis was used to derive an illness severity score (ISS) from clinical data, including 30-day mortality, requirement for intensive hospital support, the presence of bloodstream infection, and hospital length of stay. The mean ISS for each S. aureus clone (based on MLST) was compared with its DNA microarray-based genotype. RESULTS: Fifty-seven cMRSA and 50 cMSSA infections were analyzed. Ten clones caused 82 (77%) of these infections and had an ISS calculated. The enterotoxin gene cluster (egc) and the collagen adhesin (cna) gene were found in 4 of the 5 highest-ranked clones (ST47-MSSA, ST30-MRSA-IV[2B], ST45-MSSA, and ST22-MRSA-IV[2B]) compared with none and 1 of the lowest 5 ranked clones, respectively. cMSSA clones caused more severe infection than cMRSA clones. The lukF/lukS Panton-Valentine leukocidin (PVL) genes did not directly correlate with the ISS, being present in the second, fourth, and 10th most virulent clones. CONCLUSIONS: The clinical severity of invasive cMRSA and cMSSA infection is likely to be attributable to the isolates' entire genotype rather than a single putative virulence determinant such as PVL.


Assuntos
Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/patologia , Índice de Gravidade de Doença , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Staphylococcus aureus/patogenicidade , Fatores de Virulência/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bacteriemia/patologia , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação
5.
J Med Microbiol ; 56(Pt 10): 1410-1412, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17893183

RESUMO

A case of endophthalmitis caused by Williamsia muralis is described. The infection occurred following a procedure known as intravitreal triamcinolone acetonide injection for the treatment of diabetic maculopathy. This is the first report of W. muralis as a causative agent of endophthalmitis.


Assuntos
Actinomycetales/isolamento & purificação , Endoftalmite/microbiologia , Idoso , Complicações do Diabetes/complicações , Complicações do Diabetes/tratamento farmacológico , Humanos , Masculino
6.
Diagn Microbiol Infect Dis ; 54(4): 289-97, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16466900

RESUMO

We report a direct polymerase chain reaction/sequence (d-PCRS)-based method for the rapid identification of clinically significant fungi from 5 different types of commercial broth enrichment media inoculated with clinical specimens. Media including BacT/ALERT FA (BioMérieux, Marcy l'Etoile, France) (n = 87), BACTEC Plus Aerobic/F (Becton Dickinson, Microbiology Systems, Sparks, MD) (n = 16), BACTEC Peds Plus/F (Becton Dickinson) (n = 15), BACTEC Lytic/10 Anaerobic/F (Becton Dickinson) (n = 11) bottles, and BBL MGIT (Becton Dickinson) (n = 11) were inoculated with specimens from 138 patients. A universal DNA extraction method was used combining a novel pretreatment step to remove PCR inhibitors with a column-based DNA extraction kit. Target sequences in the noncoding internal transcribed spacer regions of the rRNA gene were amplified by PCR and sequenced using a rapid (24 h) automated capillary electrophoresis system. Using sequence alignment software, fungi were identified by sequence similarity with sequences derived from isolates identified by upper-level reference laboratories or isolates defined as ex-type strains. We identified Candida albicans (n = 14), Candida parapsilosis (n = 8), Candida glabrata (n = 7), Candida krusei (n = 2), Scedosporium prolificans (n = 4), and 1 each of Candida orthopsilosis, Candida dubliniensis, Candida kefyr, Candida tropicalis, Candida guilliermondii, Saccharomyces cerevisiae, Cryptococcus neoformans, Aspergillus fumigatus, Histoplasma capsulatum, and Malassezia pachydermatis by d-PCRS analysis. All d-PCRS identifications from positive broths were in agreement with the final species identification of the isolates grown from subculture. Earlier identification of fungi using d-PCRS may facilitate prompt and more appropriate antifungal therapy.


Assuntos
Meios de Cultura , DNA Fúngico/análise , Fungos Mitospóricos/isolamento & purificação , Micoses/diagnóstico , Reação em Cadeia da Polimerase/métodos , Análise de Sequência de DNA , Custos e Análise de Custo , DNA Intergênico/genética , Humanos , Fungos Mitospóricos/genética , Fungos Mitospóricos/crescimento & desenvolvimento , Reação em Cadeia da Polimerase/economia , Transcrição Gênica
7.
Trop Med Infect Dis ; 1(1)2016 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-30270856

RESUMO

We describe the first reported case of spotted fever group rickettsiosis in Western Australia, and two cases of probable Rickettsia honei from a new geographic focus. These findings highlight the need to raise awareness of ricksettsial infection among local clinicians as well as those treating visitors to this region, important for outdoor recreation.

8.
Clin Infect Dis ; 34(6): 849-52, 2002 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-11830799

RESUMO

We describe a patient with multiple cerebral lesions that initially were believed to be tumor metastases but were later found to be caused by Nocardia asteroides, after magnetic resonance spectroscopy (MRS) findings suggested that the lesions were infective in origin. This case report demonstrates the ability of MRS, a noninvasive imaging modality, to aid in the diagnosis of brain infection.


Assuntos
Encefalopatias/diagnóstico , Córtex Cerebral/microbiologia , Nocardiose/diagnóstico , Nocardia asteroides , Idoso , Encefalopatias/microbiologia , Córtex Cerebral/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Nocardiose/microbiologia
10.
Int J Infect Dis ; 8(5): 275-83, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15325596

RESUMO

BACKGROUND: Community-onset infections caused by methicillin-resistant Staphylococcus aureus (COMRSA) are being increasingly reported worldwide. METHODS: A retrospective study was performed of 14 patients with 15 episodes of COMRSA bacteremia (COMRSAB) admitted to the Royal Darwin Hospital, Northern Territory, Australia from 1998 to 2001. Isolates from COMRSAB episodes underwent extended susceptibility testing and molecular typing by pulsed field gel electrophoresis and allotyping of the staphylococcal cassette chromosome mec (SCCmec) region by polymerase chain reaction. RESULTS: The proportion of community-onset S. aureus bacteremia episodes that were due to COMRSA increased from 9% in 1998 to 20% in 2001. The clinical features of COMRSAB were similar to those seen with methicillin-susceptible strains, including sepsis, endocarditis and metastatic infection. Ineffective empiric antimicrobial therapy was administered in the majority (80%) of episodes. All COMRSAB isolates tested contained allotype IV SCCmec, which is commonly found in community isolates of MRSA and rarely found in isolates from healthcare-associated MRSA infection. CONCLUSION: The increasing incidence of COMRSAB in our region has resulted in the addition of vancomycin to standard empiric therapy in certain patients with suspected S. aureus bacteremia acquired in the community.


Assuntos
Bacteriemia/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Resistência a Meticilina , Staphylococcus aureus/efeitos dos fármacos , Antibacterianos/farmacologia , Austrália/epidemiologia , Bacteriemia/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Humanos , Meticilina/farmacologia , Resistência a Meticilina/genética , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/classificação , Staphylococcus aureus/genética
12.
Int J Infect Dis ; 18: 38-40, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24215937

RESUMO

OBJECTIVE: To determine whether there is an association between the species of Streptococcus anginosus group (SAG) bacteria and the clinical outcome. METHODS: Isolates from invasive infections caused by SAG bacteria at our institution between January 2004 and February 2009 were identified phenotypically to the taxonomic level of species. Clinical data from the medical records of the patients from whom these isolates were recovered were obtained retrospectively and analyzed. RESULTS: Patients with invasive Streptococcus intermedius infections had a significantly longer hospital stay than patients infected with S. anginosus (p = 0.024) and a significantly higher 30-day all-cause mortality than patients infected with Streptococcus constellatus (p = 0.049). CONCLUSION: Identification of SAG bacteria to the taxonomic level of species may be of prognostic importance.


Assuntos
Infecções Estreptocócicas/epidemiologia , Streptococcus anginosus/isolamento & purificação , Streptococcus intermedius/isolamento & purificação , Técnicas de Tipagem Bacteriana , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Especificidade da Espécie , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Streptococcus anginosus/classificação , Streptococcus intermedius/classificação
13.
Am J Trop Med Hyg ; 91(3): 451-60, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24957537

RESUMO

Rickettsial infections represent a major cause of non-malarial febrile illnesses among the residents of Southeast Asia and returned travelers from that region. There are several challenges in recognition, diagnosis, and management of rickettsioses endemic to Southeast Asia. This review focuses on the prevalent rickettsial infections, namely, murine typhus (Rickettsia typhi), scrub typhus (Orientia tsutsugamushi), and members of spotted fever group rickettsiae. Information on epidemiology and regional variance in the prevalence of rickettsial infections is analyzed. Clinical characteristics of main groups of rickettsioses, unusual presentations, and common pitfalls in diagnosis are further discussed. In particular, relevant epidemiologic and clinical aspects on emerging spotted fever group rickettsiae in the region, such as Rickettsia honei, R. felis, R. japonica, and R. helvetica, are presented. Furthermore, challenges in laboratory diagnosis and management aspects of rickettsial infections unique to Southeast Asia are discussed, and data on emerging resistance to antimicrobial drugs and treatment/prevention options are also reviewed.


Assuntos
Orientia tsutsugamushi/isolamento & purificação , Infecções por Rickettsia/epidemiologia , Rickettsia/isolamento & purificação , Tifo por Ácaros/epidemiologia , Animais , Anti-Infecciosos/uso terapêutico , Anticorpos Antibacterianos/sangue , Sudeste Asiático/epidemiologia , Farmacorresistência Bacteriana , Febre , Humanos , Orientia tsutsugamushi/imunologia , Orientia tsutsugamushi/patogenicidade , Prevalência , Rickettsia/imunologia , Rickettsia/patogenicidade , Infecções por Rickettsia/diagnóstico , Infecções por Rickettsia/tratamento farmacológico , Infecções por Rickettsia/microbiologia , Rickettsia typhi/imunologia , Rickettsia typhi/isolamento & purificação , Rickettsia typhi/patogenicidade , Tifo por Ácaros/diagnóstico , Tifo por Ácaros/tratamento farmacológico , Tifo por Ácaros/microbiologia , Viagem
14.
J Med Microbiol ; 60(Pt 6): 715-721, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21372181

RESUMO

AmpC ß-lactamases (Bla(AmpC)) are an emerging group of antimicrobial resistance determinants. The lack of an agreed Bla(AmpC) detection method hinders investigation of their epidemiology and understanding of their clinical significance. This study compared the sensitivity and specificity of phenotypic methods of Bla(AmpC) detection in a collection of 246 Enterobacteriaceae with a diverse range of ß-lactam resistance profiles. The Bla(AmpC) screening methods evaluated were based on cephamycin, ceftazidime and cefepime susceptibility. These were compared with Bla(AmpC) screening using conventional ESBL detection methods. The confirmatory methods evaluated were biologically based assays, inhibitor-based assays, an AmpC Etest and a rapid chromogenic assay. A multiplex nucleic acid amplification test and the three-dimensional enzyme extraction assay were used as reference methods. Bla(AmpC) activity was present in 74 isolates. The majority of the enzymes were plasmid-encoded and belonged to the CMY, DHA and EBC families. The screening methods had sensitivities between 47 and 99 % and specificities of 45-95 %. The performance of confirmatory tests varied widely, ranging in sensitivity from 19 % to 97 % and in specificity from 88 % to 100 %. Only the Tris-EDTA and MAST ID D68C disc tests had a sensitivity and a specificity above 90 %. Further investigation is needed to establish the most suitable enzyme substrates, inhibitor types, inhibitor concentrations and interpretative cut-offs in order to refine the inhibitor-based methods. A simple disc-based protocol using cefoxitin non-susceptibility as a screening tool, followed by the Tris-EDTA method for confirmation, detects Bla(AmpC) activity with 95 % sensitivity and 98 % specificity.


Assuntos
Proteínas de Bactérias/análise , Técnicas Bacteriológicas/métodos , Enterobacteriaceae/enzimologia , beta-Lactamases/análise , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/microbiologia , Humanos , Programas de Rastreamento/métodos , Sensibilidade e Especificidade
15.
Commun Dis Intell Q Rep ; 34(3): 342-4, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21090191

RESUMO

A 4-year-old fully immunised male presented to a regional hospital in the West Kimberley with fever and lethargy. Blood cultures yielded serogroup B Neisseria meningitidis, resistant to benzylpenicillin (minimum inhibitory concentration (MIC) 1.0 mg/L). The patient was treated with intravenous ceftriaxone and made a complete recovery. Although invasive N. meningitidis isolates with reduced penicillin susceptibility are not uncommon in Australia, this is the first report of a benzylpenicillin-resistant isolate (MIC > 0.5 mg/L) causing invasive disease. As benzylpenicillin is currently recommended as first line empiric and definitive therapy for invasive meningococcal disease, the emergence of penicillin-resistant N. meningitidis disease is of concern and emphasises the importance of ongoing surveillance for antimicrobial resistance.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Ceftriaxona/uso terapêutico , Infecções Meningocócicas/tratamento farmacológico , Neisseria meningitidis/efeitos dos fármacos , Resistência às Penicilinas , Pré-Escolar , Genótipo , Humanos , Masculino , Infecções Meningocócicas/diagnóstico , Testes de Sensibilidade Microbiana , Neisseria meningitidis/genética , Austrália Ocidental
16.
Commun Dis Intell Q Rep ; 34(3): 339-41, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21090190

RESUMO

Mycobacterium bovis is a zoonotic member of the Mycobacterium tuberculosis complex responsible for a clinical syndrome indistinguishable from that due to M. tuberculosis. In Australia, infection with M. bovis has historically been associated with employment in the livestock industry or immigration from countries in which animal disease is endemic. It currently accounts for 0.2% of all human cases of tuberculosis within Australia. This paper describes a case of pulmonary M. bovis in a butcher and reviews factors responsible for the declining incidence of this disease in Australia.


Assuntos
Indústria de Processamento de Alimentos , Mycobacterium bovis , Exposição Ocupacional , Tuberculose Pulmonar/veterinária , Zoonoses/epidemiologia , Animais , Austrália/epidemiologia , Bovinos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/transmissão , Zoonoses/transmissão
17.
Med J Aust ; 192(7): 417-9, 2010 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-20367593

RESUMO

A 19-year-old Sudanese woman, who had lived for about a decade in Ugandan refugee camps, was referred for investigation of a 12-month history of a generalised rash. Two months later, her condition had deteriorated to include cachexia and drowsiness. Despite initial negative findings on investigation, human African trypanosomiasis (HAT) was suspected, and parasites were found in a double-centrifuged sample of cerebrospinal fluid. Eflornithine, the appropriate drug for treatment of late-stage disease, was obtained through the World Health Organization. This case highlights the diagnostic and therapeutic difficulties in managing late-stage HAT in a non-endemic country.


Assuntos
Refugiados , Tripanossomíase Africana/diagnóstico , Austrália/epidemiologia , Líquido Cefalorraquidiano/parasitologia , Eflornitina/uso terapêutico , Feminino , Humanos , Sudão/etnologia , Tripanossomicidas/uso terapêutico , Trypanosoma brucei brucei/isolamento & purificação , Tripanossomíase Africana/tratamento farmacológico , Adulto Jovem
18.
PLoS One ; 5(1): e8705, 2010 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-20090931

RESUMO

BACKGROUND: Bacterial pneumonia is a well described complication of influenza. In recent years, community-onset methicillin-resistant Staphylococcus aureus (cMRSA) infection has emerged as a contributor to morbidity and mortality in patients with influenza. Since the emergence and rapid dissemination of pandemic A(H1N1)2009 influenzavirus in April 2009, initial descriptions of the clinical features of patients hospitalized with pneumonia have contained few details of patients with bacterial co-infection. METHODOLOGY/PRINCIPAL FINDINGS: Patients with community-acquired pneumonia (CAP) caused by co-infection with pandemic A(H1N1)2009 influenzavirus and cMRSA were prospectively identified at two tertiary hospitals in one Australian city during July to September 2009, the period of intense influenza activity in our region. Detailed characterization of the cMRSA isolates was performed. 252 patients with pandemic A(H1N1)2009 influenzavirus infection were admitted at the two sites during the period of study. Three cases of CAP due to pandemic A(H1N1)2009/cMRSA co-infection were identified. The clinical features of these patients were typical of those with S. aureus co-infection or sequential infection following influenza. The 3 patients received appropriate empiric therapy for influenza, but inappropriate empiric therapy for cMRSA infection; all 3 survived. In addition, 2 fatal cases of CAP caused by pandemic A(H1N1)2009/cMRSA co-infection were identified on post-mortem examination. The cMRSA infections were caused by three different cMRSA clones, only one of which contained genes for Panton-Valentine Leukocidin (PVL). CONCLUSIONS/SIGNIFICANCE: Clinicians managing patients with pandemic A(H1N1)2009 influenzavirus infection should be alert to the possibility of co-infection or sequential infection with virulent, antimicrobial-resistant bacterial pathogens such as cMRSA. PVL toxin is not necessary for the development of cMRSA pneumonia in the setting of pandemic A( H1N1) 2009 influenzavirus co-infection.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Bacteriana/epidemiologia , Infecções Estafilocócicas/epidemiologia , Austrália/epidemiologia , Infecções Comunitárias Adquiridas/complicações , Humanos , Influenza Humana/complicações , Influenza Humana/virologia , Pneumonia Bacteriana/complicações , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/microbiologia
19.
Med J Aust ; 190(8): 421-5, 2009 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-19374613

RESUMO

About 13,000 refugees are currently accepted for migration into Australia each year, many of whom have spent protracted periods living in extremely disadvantaged circumstances. As a result, medical practitioners are increasingly managing recently arrived refugees with acute and chronic infectious diseases. The Australasian Society for Infectious Diseases has formulated guidelines for the diagnosis, management and prevention of infection in newly arrived refugees. This article is an abridged version of the guidelines, which are available in full at . All refugees should be offered a comprehensive health assessment, ideally within 1 month of arrival in Australia, that includes screening for and treatment of tuberculosis, malaria, blood-borne viral infections, schistosomiasis, helminth infection, sexually transmitted infections, and other infections (eg, Helicobacter pylori) as indicated by clinical assessment; and assessment of immunisation status, and catch-up immunisations where appropriate. The assessment can be undertaken by a general practitioner or within a multidisciplinary refugee health clinic, with use of an appropriate interpreter when required. The initial assessment should take place over at least two visits: the first for initial assessment and investigation and the second for review of results and treatment or referral.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/terapia , Refugiados , Austrália , Doenças Transmissíveis/transmissão , Humanos
20.
Med J Aust ; 191(7): 368-73, 2009 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-19807625

RESUMO

OBJECTIVE: To document the types of, and mortality from, Staphylococcus aureus bacteraemia in Australia and New Zealand, and determine factors associated with mortality. DESIGN AND SETTING: Prospective observational study in 27 independent or hospital pathology laboratories in Australia (24) and New Zealand (3), employing a web-based database to prospectively record demographic features, selected risk factors, principal antibiotic treatment and mortality data on all patients with positive blood cultures for S. aureus from June 2007 to May 2008. MAIN OUTCOME MEASURE: 30-day all-cause mortality. RESULTS: 1994 episodes of S. aureus bacteraemia were identified, and complete 30-day follow-up data were available for 1865. Most episodes had their onset in the community (60.8%; 95% CI, 58.7%-63.0%). Methicillin-resistant S. aureus (MRSA) caused 450 episodes (24.1%; 95% CI, 22.2%-25.9%), and 123 of these (27.3%) had a susceptibility profile consistent with community-associated MRSA. All-cause mortality at 30 days was 20.6% (95% CI, 18.8%-22.5%). On univariate analysis, increased mortality was significantly associated with older age, European ethnicity, MRSA infection, infections not originating from a medical device, sepsis syndrome, pneumonia/empyema, and treatment with a glycopeptide or other non-beta-lactam antibiotic. On multivariable analysis, independent predictors of mortality were age, sepsis syndrome, pneumonia/empyema, device-associated infection with a secondary focus, left-sided endocarditis, and treatment with a glycopeptide such as vancomycin, but not MRSA infection. CONCLUSIONS: S. aureus bacteraemia is a common infection in both the community and hospitals in Australia and New Zealand, and is associated with appreciable mortality. Invasive MRSA infection may be more life-threatening, partly because of the inferior efficacy of the standard treatment, vancomycin. National web-based surveillance of S. aureus bacteraemia and its outcomes is not only important but also easily achievable.


Assuntos
Bacteriemia/mortalidade , Infecções Estafilocócicas/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Criança , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Staphylococcus aureus , Adulto Jovem
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