Category Journal paper

What is the best way to treat skin abscess?

Skin (staphylococcal) abscesses (boils) are often treated with antimicrobials, but are they really needed? The New England Journal of Medicine recently presented a case vignette and asked prescribers to weigh in on whether they thought antibiotics were needed or if incision and drainage alone were enough.

Revised sepsis definitions are a scene changer!

These carefully wrought new definitions potentially revolutionise our approach and will provide greater diagnostic clarity for more rapid recognition and treatment. Highly relevant to all clinicians. Recommendations (JAMA current edition)  Editorial and several other items of note (all free access) Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For […]

Sparing meropenem 101 – treatment of ESCPM species and AmpC betalactamases unpacked

Guest post: Patrick Harris, Staff Specialist in Microbiology, Central Laboratory, Pathology Queensland, Brisbane Infectious disease and microbiology trainees diligently learn about organisms that have a type of broad-spectrum beta-lactamase (i.e. an enzyme that can inactivate betalactam antibiotics) called ‘AmpC’.  These enzymes are encoded by a gene that is usually located on the chromosome of many Gram-negative […]

How to select an antibiotic dose for children

Dosing information for children, unlike adults, is often presented as a mg/kg range. So how do you choose what dose to use?This recent discussion from the BMJ has some important take home messages . Did you know that a child qualifies for an adult antibiotic dose usually by the time they weigh 40 kg?  That […]

Antimicrobials in palliative care- comfort or cure?

Guest post from Dr Hema Varadhan, Staff Specialist Microbiology: The focus of palliative care is to provide comfort for patients in their final stages of life. The use of medication should aim to provide this comfort by controlling troubling symptoms. So what role to antimicrobials have, if the intention is not curative?

Recurrent urinary tract infection in women – are antibiotics the answer?

What is the evidence? This interesting paper from 2010 discusses the natural history of UTI in women and distinguishes two conditions – the ‘urethral’ (or ‘dysuria/frequency’) syndrome’ (US) which affects a proportion of women with recurrent symptoms and many courses of treatment.  It is known that US is a self-limited condition in a majority of patients.  Some women are said to […]

Reducing ESBL Gram negative fluoroquinolone resistance – what is the ecological sweet spot for usage?

This excellent recent paper from Sarma et al brings focus on what the target level of quinolone use should be in order to have an impact on quinolone resistance in Enterobacteriaceae.  It describes the situation across a region of England (9 hospitals and other facilities) where quite stringent control of cephalosporin use was already in place […]

Case report: Community-Acquired Pyelonephritis in Pregnancy Caused by KPC-Producing Klebsiella pneumoniae

In northern NSW, we already face cases similar to that described below – infection with multi-drug resistant carbapenemase-producing Gram negative organisms.  The major global types of these organisms are named with acronyms that refer to the type of carbapenemase gene – KPC, NDM (New Delhi Metallobetalactamase), IMP (imipenemase) and others.  KPC-type organisms are prevalent in Greece, […]

Parental Expectations and Otitis Media Antibiotic Prescription

Parental expectations that antibiotics will be prescribed for self-limiting childhood complaints are difficult to overcome. It becomes more difficult when antibiotic prescribing practice differs between prescribers and doesn’t always follow best practice guidelines.  A recent survey of parents with children in playgroup or childcare in Brisbane showed that knowledge about correct treatment of otitis media was […]

Diagnostic error is a major factor leading to inappropriate antimicrobial use- recent landmark paper

Diagnostic accuracy is a factor neglected by most antimicrobial stewardship programs and should perhaps be subject to regular audit and feedback.  It is heavily dependent upon the context of the clinical contact – for example, time-pressured, after hours hospital ward patient encounters are prone to quick judgements and sloppy diagnoses.  For a persuasive discussion of […]