Category Journal paper

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 […]

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 […]

Arboviruses in the news- Chikungunya, Zika et al

This recent NEJM editorial provides a good overview of the worrying global situation concerning four important arboviruses: West Nile, Chikungunya, Zika and Dengue. This presentation, CHIKV ZIKA Ferguson Feb 2015 includes microbiological and clinical overviews and data on recent Pacific nation epidemiology.

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 […]