Category Health Pathology NSW

Micro comments: Clostridium difficile testing

Here are our local Pathology North (NSW) comments together with their rationale: Positive CDI test result comment (no test of clearance required!): The duration of contact precautions following recovery are controversial. Patients will continue to excrete C. difficile for weeks following recovery and can represent a cross infection risk. However continent patients with formed stool who […]

Microlab comment: beta-haemolytic streptococci isolated from blood

Here is another one used for uncomplicated bloodstream infection events: Infections due to these species of streptococci are usually rapidly responsive to appropriate antibiotic therapy which can be of short duration with no minimum IV requirement as endocarditis is not a usual consideration.  Penicillin resistance has not been documented and flucloxacillin is just as active (see […]

Micro comments unpacked: Gram negative bacteraemia

Here is an example comment from Pathology North which is added to positive blood culture reports when a Gram negative coliform species ( Enterobacteriacae eg. E. coli) has been isolated: The comment’s rationale is to promote short course treatment and also to prompt oral antibiotic switching in a timely manner.  It also prompts consideration of source […]

Maximising the value of blood cultures

Blood cultures give a critically important window on bacterial and fungal sepsis, providing direct patient treatment guidance and reliable antimicrobial susceptibility data that are used to construct cumulative antibiograms and empirical treatment guidelines.  They also help to rule out serious bacterial infection, provided that collection occurs prior to antibiotic treatment and an adequate patient sample is taken. Here […]

What are cumulative antibiograms ?

Antibiograms summarise local antimicrobial susceptibility in order to guide appropriate antimicrobial prescribing. Ideally they are updated annually by microbiology services to provide a current  picture of bacterial susceptibility and the local incidence of key sentinel resistant pathogens.

Australian National Antimicrobial Resistance Strategy: Objective Seven, Governance- What does it mean for HNE?

The final objective Seven of the Australian strategy focuses on strengthening AMS governance at local, regional and national levels to ensure leadership, engagement and accountability for actions taken to combat antimicrobial resistance. A coordinated effort from a wide range of participants is required.  Engaging participants at the frontline of antibiotic prescribing will be an important step in meeting these objectives. Priority […]

Australian National Antimicrobial Resistance Strategy: Objective Five, Research- What does it mean for HNE?

Objective Five of the  Australian strategy focuses on developing and promoting research into new products and approaches to prevent, detect and contain antimicrobial resistance.  The Australian NHMRC currently funds several Centres of Research Excellence focusing on antimicrobial resistance and related topics (see below). National priorities include:  Identifying gaps and agreeing to national research priorities Coordinating research and information sharing […]

Australian National Antimicrobial Resistance Strategy: Objective Three, Surveillance- What does it mean for HNE?

Objective Three of the recently released Australian strategy aims to establish surveillance across human and animal health of antimicrobial resistance and usage through national standardisation of data collection, analysis and reporting and the diagnostic systems used. We need to understand the epidemiology and impact of resistant organisms, identify emerging bacterial resistance and identify trends in antimicrobial prescribing.     Priorities include: improving national […]

C-reactive protein or erythrocyte sedimentation rate?

CRP is considered a better marker of the acute phase of the inflammatory process and can be used to assess response to therapy. Repeating the test more frequently than every 2-3 days is not indicated. There is also little rationale for performing both CRP and ESR when looking for indirect evidence of systemic or local site infection. […]

Stewardship: It’s not just for antimicrobials

An important part of using antimicrobials appropriately is ordering the right pathology tests. Increasing workloads have been identified in pathology departments across Australia and pathology is a significant cost to the health system. While there is no Australian data it has been estimated that up to 25% of pathology ordered in the UK is either […]