Category Journal paper

Small joint septic arthritis: a different management paradigm

Guest posting: Dr Jonathan Ash, Infectious Diseases Registrar, John Hunter Hospital, Newcastle, NSW.  A recent single centre retrospective case series from Switzerland examined the clinical characteristics, microbiology and treatment of 97 patients with small native joint septic arthritis. The paper highlights significant differences in the pathogenesis of small joint septic arthritis compared to large joints, […]

“UTI” – Requiem for a Heavyweight – a landmark paper

A recent paper, “Urinary Tract Infection”-Requiem for a Heavyweight  by Dr Thomas Finucaine skillfully unpacks many key issues, coupling this with a consideration of the emerging knowledge of the urinary microbiome and virome, suggesting that the term “UTI” might better be referred to as a “urinary dysbiosis”.  The paper is worth a detailed read – here […]

The safe use of intraventricular colistin

Guest posting : Dr Jonathan Ash, Advanced training registrar, John Hunter Hospital. Ventriculitis is a rare but potentially disastrous complication of external ventricular drain placement, and with increasing rates of multi-drug resistant organisms, effective parenteral antibiotic choices are limited. Colistin has an established role in the treatment of infections caused by MDR Gram negatives, particularly […]

Antibiotic gel for acute otitis media – quo vadis?

Chemical engineers at Boston’s Laboratory for Biomaterials have created a single-application bioengineered gel that could deliver a full course of antibiotic therapy for paediatric middle ear infections. While current Australian guidelines state that the vast majority of children do not need antibiotics for otitis media, the gel is claimed to offer hard-to-treat cases a “safer […]

Treatment of boils – Oz GPs reluctant to rely on scalpelmycin rather than antibiotics

Are you following best practice in the management of boils or recurrent skin infection?  We’ve previously addressed this matter detailing a NEJM study that indicated that a majority of US doctors surveyed use incision and drainage only. This recent Australian study investigated treatment of community staphylococcal skin abscesses by GPs and showed that a majority do not follow […]

Acute sinusitis and sore throat in primary care – what evidence?

An excellent paper by Professor Chris Del Mar in Australian Prescriber unpacks the Cochrane reviews on the (quite minimal) value of antimicrobial treatment of these conditions.  The evidence level is quite robust.  For a summary, see below. It couples nicely with a recent pragmatic randomized controlled trial that examined the  effectiveness of steam inhalation and nasal irrigation […]

Why do rates of antimicrobial resistant UTI differ across the world?

It’s well known that rates of antibiotic resistance differ between countries and that previous exposure to antibiotics increases resistance. A recent study in the BMJ looked at rates of resistance in paediatric UTI’s across the globe.

Meningitis: An unexpected adverse effect of antibiotics

Another recent case-control study examining the effects of antimicrobial prescribing on the microbiome and how it affects human health has recently been published. This study aimed to determine if antibiotic prescriptions in the previous year resulted in an increased risk of meningitis.

The post-antibiotic era: A case study

Published in the latest issue of the MJA is a case study of a Victorian patient diagnosed with a carbapenem-resistant Klebsiella pneumoniae. The patient, from rural Victoria, had no history or recent overseas travel and no hospital contact for the last 15 years. He was transferred to a metropolitan hospital for intensive care for severe […]

What does Gram negative rod resistance mean for us clinically?

Enterobacteriacae (gram negative rods) include E. coli, Salmonella and Klebsiella sp. which are important human pathogens. Resistance of the Enterobacteriacae to antibiotics, particularly beta-lactams, is a growing clinical problem. Over use of antibiotics has changed the natural evolution of bacteria creating mobile genes that rapidly spread resistance through populations. Even in countries with controlled antibiotic use have […]