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Daly CG, Currie BJ, Jeyasingham MS, Moulds RFW, Smith JA, Strathmore NF, Street AC, Goss AN. A change of heart: the new infective endocarditis prophylaxis guidelines. Aust Dent J 2008; 53:196-200; quiz 297. [DOI: 10.1111/j.1834-7819.2008.00049.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Buising KL, Thursky KA, Robertson MB, Black JF, Street AC, Richards MJ, Brown GV. Electronic antibiotic stewardship--reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting. J Antimicrob Chemother 2008; 62:608-16. [PMID: 18550680 DOI: 10.1093/jac/dkn218] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Antibiotic stewardship is important, but the ideal strategy for providing stewardship in a hospital setting is unknown. A practical, sustainable and transferable strategy is needed. This study evaluates the impact of a novel computerized antimicrobial approval system on antibiotic-prescribing behaviour in a hospital. Effects on drug consumption, antibiotic resistance patterns of local bacteria and patient outcomes were monitored. METHODS The study was conducted at a tertiary referral teaching hospital in Melbourne, Australia. The system was deployed in January 2005 and guided the use of 28 restricted antimicrobials. Data were collected over 7 years: 5 years before and 2 years after deployment. Uptake of the system was evaluated using an in-built audit trail. Drug utilization was prospectively monitored using pharmacy data (as defined daily doses per 1000 bed-days) and analysed via time-series analysis with segmental linear regression. Antibiograms of local bacteria were prospectively evaluated. In-hospital mortality and length of stay for patients with Gram-negative bacteraemia were also reported. RESULTS Between 250 and 300 approvals were registered per month during 2006. The gradients in the use of third- and fourth-generation cephalosporins (+0.52, -0.05, -0.39; P < 0.01), glycopeptides (+0.27, -0.53; P = 0.09), carbapenems (+0.12, -0.24; P = 0.21), aminoglycosides (+0.15, -0.27; P < 0.01) and quinolones (+0.76, +0.11; P = 0.08) all fell after deployment, while extended-spectrum penicillin use increased. Trends in increased susceptibility of Staphylococcus aureus to methicillin and improved susceptibility of Pseudomonas spp. to many antibiotics were observed. No increase in adverse outcomes for patients with Gram-negative bacteraemia was observed. CONCLUSIONS The system was successfully adopted and significant changes in antimicrobial usage were demonstrated.
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Affiliation(s)
- K L Buising
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Vic. 3050, Australia.
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Tuxen AJ, Yong MK, Street AC, Dolianitis C. Disseminated cryptococcal infection in a patient with severe psoriasis treated with efalizumab, methotrexate and ciclosporin. Br J Dermatol 2007; 157:1067-8. [PMID: 17854358 DOI: 10.1111/j.1365-2133.2007.08171.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Buising KL, Thursky KA, Black JF, MacGregor L, Street AC, Kennedy MP, Brown GV. Empiric antibiotic prescribing for patients with community-acquired pneumonia: where can we improve? Intern Med J 2007; 38:174-7. [DOI: 10.1111/j.1445-5994.2007.01455.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Buising KL, Thursky KA, Black JF, MacGregor L, Street AC, Kennedy MP, Brown GV. A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax 2006; 61:419-24. [PMID: 16449258 PMCID: PMC2111174 DOI: 10.1136/thx.2005.051326] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Several severity scores have been proposed to predict patient outcome and to guide initial management of patients with community acquired pneumonia (CAP). Most have been derived as predictors of mortality. A study was undertaken to compare the predictive value of these tools using different clinically meaningful outcomes as constructs for "severe pneumonia". METHODS A prospective cohort study was performed of all patients presenting to the emergency department with an admission diagnosis of CAP from March 2003 to March 2004. Clinical and laboratory features at presentation were used to calculate severity scores using the pneumonia severity index (PSI), the revised American Thoracic Society score (rATS), and the British Thoracic Society (BTS) severity scores CURB, modified BTS severity score, and CURB-65. The sensitivity, specificity, positive and negative predictive values were compared for four different outcomes (death, need for ICU admission, and combined outcomes of death and/or need for ventilatory or inotropic support). RESULTS 392 patients were included in the analysis; 37 (9.4%) died and 26 (6.6%) required ventilatory and/or inotropic support. The modified BTS severity score performed best for all four outcomes. The PSI (classes IV+V) and CURB had a very similar performance as predictive tools for each outcome. The rATS identified the need for ICU admission well but not mortality. The CURB-65 score predicted mortality well but performed less well when requirement for ICU was included in the outcome of interest. When the combined outcome was evaluated (excluding patients aged >90 years and those from nursing homes), the best predictors were the modified BTS severity score (sensitivity 94.3%) and the PSI and CURB score (sensitivity 83.3% for both). CONCLUSIONS Different severity scores have different strengths and weaknesses as prediction tools. Validation should be done in the most relevant clinical setting, using more appropriate constructs of "severe pneumonia" to ensure that these potentially useful tools truly deliver what clinicians expect of them.
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Affiliation(s)
- K L Buising
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
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Street AC, Lewin SR. Pneumocystis carinii pneumonia after cessation of secondary prophylaxis in a patient on highly active antiretroviral therapy with a CD4 cell count greater than 200/mm3. AIDS 2001; 15:1912-3. [PMID: 11579267 DOI: 10.1097/00002030-200109280-00034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Skull SA, Andrews RM, Gorrie GJ, Riddell MA, Street AC. Healthcare workers continue to be at risk of measles: a case for better vaccination coverage. Med J Aust 2001; 174:662-3. [PMID: 11480693 DOI: 10.5694/j.1326-5377.2001.tb143486.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hellard ME, Street AC, Johnson PD, Popovic EA, Brown GV. Detection of an aberrant motile larval form in the brain of a patient with neurocysticercosis. Clin Infect Dis 1998; 27:391-3. [PMID: 9709894 DOI: 10.1086/514665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Neurocysticercosis is the most common parasitic infection of the central nervous system in humans. The adult pork tape worm, Taenia solium, resides in the lumen of the intestine, and the only structural element of an adult worm usually found within a tissue cyst in the brain or in muscle is a single invaginated scolex. We report a highly unusual, and perhaps unique, occurrence of neurocysticercosis in which an aberrant worm-like larval form, 12.5 cm in length, was found within a cyst in brain parenchyma.
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Affiliation(s)
- M E Hellard
- Victorian Infectious Diseases Service, Parkville, Australia
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Veitch MG, Johnson PD, Flood PE, Leslie DE, Street AC, Hayman JA. A large localized outbreak of Mycobacterium ulcerans infection on a temperate southern Australian island. Epidemiol Infect 1997; 119:313-8. [PMID: 9440434 PMCID: PMC2809003 DOI: 10.1017/s0950268897008273] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Mycobacterium ulcerans, the organism which causes Buruli or Bairnsdale ulcer, has never been isolated in culture from an environmental sample. Most foci of infection are in tropical regions. The authors describe the first 29 cases of M. ulcerans infection from a new focus on an island in temperate southern Australia, 1992-5. Cases were mostly elderly, had predominantly distal limb lesions and were clustered in a small region in the eastern half of the main town on the island. The authors suspected that an irrigation system which lay in the midst of the cluster was a source of infection. Limitation of irrigation was associated with a dramatic reduction in the number of new cases. These findings support the hypothesis that M. ulcerans has an aquatic reservoir and that persons may be infected directly or indirectly by mycobacteria disseminated locally by spray irrigation.
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Affiliation(s)
- M G Veitch
- National Centre for Epidemiology and Population Health, Australian National University, Canberra
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Tee W, Street AC, Spelman D, Munckhof W, Mijch A. Helicobacter cinaedi bacteraemia: varied clinical manifestations in three homosexual males. Scand J Infect Dis 1996; 28:199-203. [PMID: 8792493 DOI: 10.3109/00365549609049078] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report 3 cases of Helicobacter cinaedi bacteraemia in different hosts representing a spectrum of clinical illness associated with this infection. The first was an AIDS patient with relapsing H. cinaedi bacteraemia despite antibiotic treatment. The second was an HIV seronegative homosexual man with end-stage renal failure, receiving haemodialysis and a previous history of chronic lymphoedema of his legs. He developed H. cinaedi bacteraemia with cellulitis of his left leg. Patient 3, an HIV seronegative homosexual man, had transient H. cinaedi bacteraemia 2 days after the completion of a course of chemotherapy for bilateral testicular carcinoma. The clinical spectrum of disease associated with H. cinaedi is broad, with few specific clinical features. Successful recovery of this fastidious organism from blood aids in the diagnosis of this unusual infection.
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Affiliation(s)
- W Tee
- Victorian Infectious Diseases Reference Laboratory, Fairfield Hospital, Australia
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Abstract
Patients undergoing chronic haemodialysis are at increased risk for infection with hepatitis B virus (HBV), but response to currently available vaccines is suboptimal. We undertook a 4-year prospective study of the efficacy of hepatitis B vaccine in patients with renal insufficiency, who were not yet dialysis-dependent. A booster dose of Recombivax HB was given at 3 or 4 years to those whose antibody levels fell below a predetermined point. Progression to dialysis was associated with poorer initial response to vaccination compared with those remaining dialysis-independent, but response to booster immunization was favourable in both groups. It is concluded that immunization of predialysis patients and subsequent booster vaccine results in a more favourable antibody response than has been seen historically in haemodialysis patients. Local endemicity and cost of vaccine should be considered when determining the best strategy for HBV immunization of patients with chronic renal failure.
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Affiliation(s)
- C S Dukes
- Department of Medicine, Duke University Medical Center, Durham, NC 27710
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Webster M, Street AC, Evans J, Alexiev VD. Structure of (μ-acetato-1κO:2κO')-nonacarbonyl-1κ3C,2κ3C,3κ3C-μ-hydrido-(triphenylphosphine-3κP)-triangulo-triosmium(3 Os–Os) cyclohexane solvate. Acta Crystallogr C 1990. [DOI: 10.1107/s0108270190002207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Street AC, Weddle TZ, Thomann WR, Lundberg EW, Jackson GW, Hamilton JD. Persistence of antibody in healthcare workers vaccinated against hepatitis B. Infect Control Hosp Epidemiol 1990; 11:525-30. [PMID: 2146315 DOI: 10.1086/646086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A cross-sectional serological survey was undertaken in 82 randomly selected high-risk healthcare workers previously vaccinated with the hepatitis B vaccine. The study design allowed for the identification and testing for hepatitis B surface antibody in equal numbers of employees in six-month intervals up to five years after vaccination. The results showed a consistent decline in antibody level with time, and an increasing proportion of participants with antibody levels below the commonly accepted protective level of greater than or equal to 10 S/N (sample counts/negative control counts) radioimmunoassay units. The percent of vaccinees whose S/N ratio was greater than 10 fell from 10% at one year, to 25% at two years, to over 50% at four years. Based on these figures, as well as the financial costs of hepatitis B in employees and the predictability of booster immunization, it was possible to assess the cost benefit of a hospital policy for reimmunization. At our institution, a strategy of revaccination at fixed intervals could save up to $200,000 over a ten-year period if revaccination was not offered and vaccine efficacy declined. The information obtained should help determine the need for revaccination and the advantages and disadvantages of alternative revaccination strategies.
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Affiliation(s)
- A C Street
- Department of Medicine, Durham VA Medical Center, NC
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Street AC. Viral hepatitis. An important sexually transmitted disease. N C Med J 1989; 50:161-3. [PMID: 2710226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hepatitis B is an important sexually transmitted disease. The availability of a safe and effective vaccine has unfortunately had little impact on controlling this disease nationwide or in North Carolina, chiefly because target groups have proven difficult to reach. Both HAV and NANB can be transmitted sexually, but are much less important than HBV.
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Abstract
The published experience with trimethoprim-sulfamethoxazole (TMP-SMZ) for treatment of infective endocarditis was reviewed. Among 62 cases, a high proportion had unusual causative organisms: 60% of cases were due to Coxiella burnetii or Pseudomonas species. Only 17% of patients had previously normal cardiac valves. Patients often had complicated courses in which TMP-SMZ was tried only after other treatment regimens had failed, yet a successful outcome was achieved in 61% of cases. Thirty-five patients were treated with antibiotics alone, while the other 27 patients required combined medical and surgical management. TMP-SMZ has a limited role in the management of infective endocarditis; specific guidelines for its use, including proper laboratory control, have been delineated.
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Affiliation(s)
- A C Street
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710
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Alexiev VD, Evans J, Street AC, Webster M. Structure of 1,2-μ-acetato-(O,O')-1,1,1,2,2,2,3,3,3,3-decacarbonyl-μ-hydrido-triangulo-triosmium: a redetermination and normal probability plot analysis. Acta Crystallogr C 1988. [DOI: 10.1107/s0108270188002604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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