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Harwood A, Pearson S, Howard J, Jones N, Greenlees R, Broms C, Gardiner SJ, Dalton SC. Pre-hospital, pre-antibiotic blood cultures for patients with suspected sepsis-a feasibility study. N Z Med J 2024; 137:108-112. [PMID: 38513210 DOI: 10.26635/6965.6382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Aileen Harwood
- Medical Student, Faculty of Health Sciences, University of Otago, Christchurch
| | - Scott Pearson
- Emergency Medicine Physician, Emergency Department, Christchurch Hospital, Te Whatu Ora - Waitaha Canterbury
| | - Julia Howard
- Clinical Microbiologist, Canterbury Health Laboratories, Christchurch, Te Whatu Ora - Waitaha Canterbury
| | - Nicole Jones
- Project Specialist, Hato Hone St John Tāmaki Makaurau Auckland
| | - Rosie Greenlees
- Technical Lead - Bacteriology, Canterbury Health Laboratories, Christchurch, Te Whatu Ora - Waitaha Canterbury
| | - Charlotte Broms
- Area Operations Manager Canterbury, Hato Hone St John Tāmaki Makaurau Auckland
| | - Sharon J Gardiner
- Antimicrobial Stewardship Pharmacist, Infection Management Service, Christchurch Hospital, Te Whatu Ora - Waitaha Canterbury
| | - Simon C Dalton
- Infectious Diseases Physician, Infection Management Service, Christchurch Hospital, Te Whatu Ora - Waitaha Canterbury
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Campbell PO, Gallagher K, Dalton SC, Metcalf SCL, Douglas NM, Chambers ST. Safety and clinical outcomes of outpatient parenteral antibiotic therapy for infective endocarditis in Christchurch, New Zealand: A retrospective cohort study. Int J Infect Dis 2023; 134:172-176. [PMID: 37331565 DOI: 10.1016/j.ijid.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVES We examined the safety and clinical outcomes of outpatient parenteral antibiotic therapy (OPAT) for patients with infective endocarditis (IE) in Christchurch, New Zealand. METHODS Demographic and clinical data were collected from all adult patients treated for IE over 5 years. Outcomes were stratified by receipt of at least partial OPAT vs entirely hospital-based parenteral therapy. RESULTS There were 172 episodes of IE between 2014 and 2018. OPAT was administered in 115 cases (67%) for a median of 27 days after a median of 12 days of inpatient treatment. In the OPAT cohort, viridans group streptococci were the commonest causative pathogens (35%) followed by Staphylococcus aureus (25%) and Enterococcus faecalis (11%). There were six (5%) antibiotic-related adverse events and 26 (23%) readmissions in the OPAT treatment group. Mortality in OPAT patients was 6% (7/115) at 6 months and 10% (11/114) at 1 year and for patients receiving wholly inpatient parenteral therapy was 56% (31/56) and 58% (33/56), respectively. Three patients (3%) in the OPAT group had a relapse of IE during the 1-year follow-up period. CONCLUSION OPAT can be used safely in patients with IE, even in selected cases with complicated or difficult-to-treat infections.
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Affiliation(s)
- Patrick O Campbell
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand.
| | - Kate Gallagher
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand
| | - Simon C Dalton
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand
| | - Sarah C L Metcalf
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand
| | - Nicholas M Douglas
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand; Division of Medicine, University of Otago, Christchurch, New Zealand; Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Stephen T Chambers
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand; Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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Gardiner SJ, Duffy EJ, Chambers ST, Thomas MG, Addidle M, Arnold B, Arroll B, Balm MN, Perales CB, Berger S, Best E, Betty B, Birch M, Blackmore TK, Bloomfield M, Briggs S, Bupha-Intr O, Burns A, Campbell C, Chin PK, Dalton SC, Davies N, Douglas NM, Plessis TD, Elvy J, Everts R, Green J, Grimwade K, Handy R, Hardie MG, Henderson E, Holland DJ, Howard J, Hudson B, Huggan P, Isenman H, Issa M, Kelly MJ, Li C, Lim AG, Lim J, Maze M, Metcalf SC, McCall C, Murdoch D, McRae G, Nisbet M, Pithie A, Raymond N, Read K, Restrepo D, Ritchie S, Robertson B, Ussher JE, Voss L, Walls T, Sen Yew H. Antimicrobial stewardship in human healthcare in Aotearoa New Zealand: urgent call for national leadership and co-ordinated efforts to preserve antimicrobial effectiveness. N Z Med J 2021; 134:113-128. [PMID: 34695098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Sharon J Gardiner
- Antimicrobial Stewardship Pharmacist, Canterbury District Health Board, Christchurch; Co-lead of the New Zealand Antimicrobial Stewardship/Infection Pharmacist Expert Group
| | - Eamon J Duffy
- Lead Antimicrobial Stewardship/Infectious Diseases Pharmacist, Auckland District Health Board, Auckland; Co-lead of the NZ Antimicrobial Stewardship/Infection Pharmacist Expert Group
| | | | - Mark G Thomas
- Infectious Diseases Physician, Auckland District Health Board, Auckland
| | - Michael Addidle
- Clinical Microbiologist, Pathlab, Tauranga, and The Institute of Environmental Science and Research NZ
| | - Brendan Arnold
- Infectious Diseases Physician, Southern District Health Board, Dunedin
| | - Bruce Arroll
- Head of Department, Department of General Practice and Primary Health Care, University of Auckland, Auckland
| | - Michelle Nd Balm
- Infectious Diseases Physician and Clinical Microbiologist, Capital and Coast District Health Board, Wellington
| | | | - Sarah Berger
- Nursing Director, Infection Prevention and Control Service, Canterbury District Health Board, Christchurch
| | - Emma Best
- Senior Lecturer, Department of Paediatrics, University of Auckland; Paediatric Infectious Diseases Physician, Starship Children's Health, Auckland District Health Board, Auckland
| | - Bryan Betty
- Medical Director, Royal New Zealand College of General Practitioners, Wellington
| | - Mark Birch
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Timothy K Blackmore
- Infectious Diseases Physician and Microbiologist, Capital and Coast District Health Board and Wellington Southern Community Laboratories, Wellington
| | - Max Bloomfield
- Infectious Diseases Physician, Capital and Coast District Health Board, Wellington
| | - Simon Briggs
- Infectious Diseases Physician, Auckland District Health Board, Auckland
| | - Olivia Bupha-Intr
- Infectious Diseases Physician, Capital and Coast District Health Board, Wellington
| | - Andrew Burns
- Infectious Diseases Physician, Hawke's Bay District Health Board, Hastings
| | - Chloë Campbell
- Professional Practice Pharmacist, Pharmaceutical Society of New Zealand Incorporated, Wellington
| | - Paul Kl Chin
- Clinical Pharmacologist, Department of Medicine, University of Otago, Christchurch
| | - Simon C Dalton
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Nicola Davies
- Antimicrobial Stewardship Pharmacist, Waitemata District Health Board, Auckland
| | - Nicholas M Douglas
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Tanya du Plessis
- Antimicrobial Stewardship/Infectious Diseases Pharmacist, Counties Manukau District Health Board, Auckland
| | - Juliet Elvy
- Clinical Microbiologist, Wellington Southern Community Laboratories, Wellington and Medlab South, Nelson/Marlborough
| | - Richard Everts
- Infectious Diseases Physician, Nelson Marlborough District Health Board, Nelson
| | - Jared Green
- Infectious Diseases Physician, General and Acute Care Medicine Physician, and Rural Generalist, Waikato District Health Board, Hamilton
| | - Kate Grimwade
- Infectious Diseases Physician, Bay of Plenty District Health Board, Tauranga
| | - Rupert Handy
- Infectious Diseases Physician, Auckland District Health Board, Auckland
| | - Mariam G Hardie
- Antimicrobial Stewardship Pharmacist, Waitemata District Health Board, Auckland
| | - Emma Henderson
- Antimicrobial Pharmacist, Hutt Valley District Health Board, Lower Hutt
| | - David J Holland
- Infectious Diseases Physician, Counties Manukau District Health Board, Auckland
| | - Julia Howard
- Clinical Microbiologist, Waikato District Health Board, Hamilton
| | - Ben Hudson
- Senior Lecturer, Department of General Practice, University of Otago, Christchurch
| | - Paul Huggan
- Infectious Diseases Physician, Waikato District Health Board, Hamilton
| | - Heather Isenman
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Mohammed Issa
- Antimicrobial Stewardship/Infectious Diseases Pharmacist, Waikato District Health Board, Hamilton
| | - Matthew J Kelly
- Infectious Diseases Physician, Hutt Valley District Health Board, Lower Hutt
| | - Cat Li
- Antimicrobial Stewardship Pharmacist, Capital and Coast District Health Board, Wellington
| | - Anecita G Lim
- Senior Lecturer, School of Nursing, University of Auckland, Auckland
| | - Joyce Lim
- Antimicrobial Stewardship Pharmacist, Southern District Health Board, Dunedin
| | - Michael Maze
- Infectious Diseases and Respiratory Medicine Physician, Department of Medicine, University of Otago, Christchurch
| | - Sarah Cl Metcalf
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Cate McCall
- Lecturer, Centre for Post Graduate Nursing Studies, University of Otago, Christchurch
| | - David Murdoch
- Dean and Head of Campus, University of Otago, Christchurch
| | - Grant McRae
- Senior Clinical Pharmacist, MidCentral District Health Board, Palmerston North
| | - Mitzi Nisbet
- Infectious Diseases and Respiratory Physician, Auckland District Health Board, Auckland
| | - Alan Pithie
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
| | - Nigel Raymond
- Infectious Diseases Physician, Capital and Coast District Health Board, Wellington
| | - Kerry Read
- Infectious Diseases Physician, Waitemata District Health Board, Auckland
| | - Dalilah Restrepo
- Infectious Diseases Physician, MidCentral District Health Board, Palmerston North
| | - Stephen Ritchie
- Infectious Diseases Physician, Auckland District Health Board and University of Auckland, Auckland
| | - Ben Robertson
- Antimicrobial Stewardship Pharmacist, Hawke's Bay District Health Board, Hastings
| | - James E Ussher
- Clinical Microbiologist, Southern Community Laboratories, Dunedin, and Associate Professor, Department of Microbiology and Immunology, University of Otago, Dunedin
| | - Lesley Voss
- Paediatric Infectious Diseases Physician, Starship Children's Health, Auckland District Health Board, Auckland
| | - Tony Walls
- Paediatric Infectious Diseases Physician, University of Otago, Christchurch
| | - Haur Sen Yew
- Infectious Diseases Physician, Canterbury District Health Board, Christchurch
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Zhu J, Mahon C, Dalton SC. Mycobacterium mantenii: a rare cause of chronic ulceration in an immunocompetent female in the southern hemisphere. N Z Med J 2021; 134:78-82. [PMID: 34012142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Julia Zhu
- Dermatology Advanced Trainee Registrar, Dermatology Department, Christchurch Public Hospital, Christchurch, New Zealand
| | - Caroline Mahon
- Clinical Lead and Consultant Dermatologist, Dermatology Department, Christchurch Public Hospital, Christchurch, New Zealand
| | - Simon C Dalton
- Consultant Infectious Diseases Physician, Infectious Diseases Department, Christchurch Public Hospital, Christchurch, New Zealand
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Chapman NG, Dalton SC, Hore TA. Hepatobiliary tuberculosis: a notorious mimic to be considered within the differential diagnosis of cholangiocarcinoma. ANZ J Surg 2021; 91:E706-E707. [PMID: 33764616 DOI: 10.1111/ans.16752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Nicholas G Chapman
- Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Simon C Dalton
- Department of Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Todd A Hore
- Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
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6
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Gardiner SJ, Basevi AB, Hamilton NL, Metcalf SC, Chambers ST, Withington SG, Chin PK, Freeman JT, Dalton SC. Point prevalence surveys of antimicrobial use in adult inpatients at Canterbury District Health Board Hospitals. N Z Med J 2020; 133:18-33. [PMID: 33223545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIMS To determine the nature and appropriateness of antimicrobial prescribing in adult inpatients at Canterbury District Health Board (CDHB). METHODS Multidisciplinary teams collected clinical details for all adult inpatients on antimicrobial therapy at three CDHB facilities (~1,100 beds) and made standardised assessments based on the Australian National Antimicrobial Prescribing Survey (http://naps.org.au) against local guidelines and national funding criteria. RESULTS Antimicrobial therapy was prescribed to 42% of inpatients (322/760), usually to treat infections [377/480 prescriptions (79%)], with amoxicillin+clavulanic acid the agent most commonly prescribed [72/480 prescriptions (15%)]. Of assessable prescriptions, 74% (205/278) were guideline compliant, 98% (469/480) were funding criteria compliant, and 83% (375/451) were appropriate clinically. Prescriptions for the most common indications-surgical prophylaxis [66/480 (14%)] and community-acquired pneumonia [56/480 (12%)]-were often non-compliant with guidelines (32% and 41%, respectively) and inappropriate (18% and 21%, respectively). Overall, the indication was documented in 353/480 (74%) prescriptions, the review/stop date documented in 145/480 (30%) prescriptions, and surgical prophylaxis stopped within 24 hours in 53/66 (80%) prescriptions. CONCLUSIONS Most antimicrobial prescriptions were appropriate and complied with guidelines. Compliance with key quality indicators (indication documented, review/stop date documented, and surgical prophylaxis ceased within 24 hours) were well below target (>95%) and needs improvement.
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Affiliation(s)
- Sharon J Gardiner
- Antimicrobial Stewardship Pharmacist, Infectious Diseases, Clinical Pharmacology and Pharmacy Departments, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Ari B Basevi
- Medical Student, Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Niall L Hamilton
- Clinical Pharmacology Registrar, Clinical Pharmacology Department, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Sarah Cl Metcalf
- Infectious Diseases Physician, Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Stephen T Chambers
- Infectious Diseases Physician, Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch; Pathology Department, University of Otago, Christchurch
| | - Stephen G Withington
- Rural Hospital Medicine Physician, Ashburton Hospital, Canterbury District Health Board, Ashburton
| | - Paul K Chin
- Clinical Pharmacologist, Clinical Pharmacology Department, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Joshua T Freeman
- Clinical Microbiologist, Microbiology, Canterbury Health Laboratories, Christchurch
| | - Simon C Dalton
- Infectious Diseases Physician, Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch
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Chambers ST, Long M, Gardiner SJ, Chin PKL, Yi M, Dalton SC, Drennan PG, Metcalf SCL. Determinants of vancomycin nephrotoxicity when administered to outpatients as a continuous 24-hour infusion. Int J Antimicrob Agents 2020; 55:105972. [PMID: 32298746 DOI: 10.1016/j.ijantimicag.2020.105972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022]
Abstract
Vancomycin continuous infusion (VCI) is used to treat serious Gram-positive infections in outpatients. This study was conducted to retrospectively investigate the rate of nephrotoxicity and associated risk factors in out-patients on VCI between May 2013 and November 2018. Vancomycin concentration was monitored twice-weekly to ensure adequate concentrations while avoiding high concentrations linked to nephrotoxicity (a rise in serum creatinine of ≥50% or 44 µmol/L from baseline). The likelihood of developing nephrotoxicity was evaluated using multivariable logistic regression. The 223 patients treated had a mean (standard deviation) age of 61 (16.7) years, baseline serum creatinine of 83.9 (21.2) µmol/L and estimated glomerular filtration rate (eGFR) of 80.6 (20.1) mL/min/1.73m2. Most patients (66%) were treated for bone and joint infections. Eight patients (3.6%) developed nephrotoxicity. In the most parsimonious model, nephrotoxicity was independently associated with an increased median (interquartile range) weighted-average serum vancomycin concentration (28.0 [24.3-32.6] vs. 22.4 [20.2-24.5] mg/L; odds ratio [OR] 1.25; 95% confidence interval [95% CI] 1.09-1.46; P<0.002) and Charlson co-morbidity index (OR 1.62; 95% CI 1.07-2.47; P=0.02). Post-hoc analysis identified 26 patients with a lower nephrotoxicity threshold (rise in serum creatinine of ≥30% or 27 μmol/L). Independent predictors of nephrotoxicity in this group were an increased weighted-average vancomycin concentration, diabetes, con-gestive heart failure and exposure to non-loop diuretics. The nephrotoxicity rate during VCI in this study was lower than previously reported (3.6% vs 15.0-17.0%). Reducing the weighted-average serum vancomycin concentration may reduce nephrotoxicity while maintaining efficacy.
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Affiliation(s)
- Stephen T Chambers
- Department of Pathology, University of Otago, Christchurch, New Zealand; Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand.
| | - Madeleine Long
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Sharon J Gardiner
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand; Pharmacy Services, Christchurch Hospital, Christchurch, New Zealand; Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand.
| | - Paul K L Chin
- Department of Clinical Pharmacology, Christchurch Hospital, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Ma Yi
- Medical and Women's Business Management, Christchurch Hospital, Christchurch, New Zealand
| | - Simon C Dalton
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Philip G Drennan
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sarah C L Metcalf
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
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Howard JC, Chen K, Anderson T, Dalton SC. Elizabethkingia miricola bacteraemia in a haemodialysis patient. Access Microbiol 2020; 2:acmi000098. [PMID: 34568756 PMCID: PMC8459099 DOI: 10.1099/acmi.0.000098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/20/2019] [Indexed: 11/18/2022] Open
Abstract
We report a case of catheter-associated Elizabethkingia miricola bacteraemia in a haemodialysis patient. The patient was a 73-year-old home haemodialysis patient who presented with a history of recurrent falls and fevers. Blood cultures grew Gram-negative bacilli identified by MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry 6903 MSP Library) and 16S rRNA gene sequencing as E. miricola. E. miricola is an emerging human pathogen and is multidrug-resistant, making the choice of antimicrobial therapy challenging. There are only a small number of case reports of human infection worldwide and this is the second reported case of catheter-related bacteraemia. It has also been found in the hospital environment in South Korea and is pathogenic in black-spotted frogs.
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Affiliation(s)
- Julia C Howard
- Microbiology Department, Canterbury Health Laboratories, Christchurch, New Zealand.,Present address: Microbiology Department, Waikato Hospital, Hamilton, New Zealand
| | - Kevin Chen
- Department of Infectious Diseases, Christchurch Hospital, New Zealand.,Present address: Department of Medicine, Tauranga Hospital, Tauranga, New Zealand
| | - Trevor Anderson
- Microbiology Department, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Simon C Dalton
- Department of Infectious Diseases, Christchurch Hospital, New Zealand
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Alfeld KE, Dalton SC. Pharyngoconjunctival fever. N Z Med J 2018; 131:77-80. [PMID: 29771905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Kate E Alfeld
- Medical Registrar, Department of General Medicine, Christchurch Hospital, Christchurch
| | - Simon C Dalton
- Infectious Diseases Physician, Infectious Disease Department, Christchurch Hospital, Christchurch
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Gardiner SJ, Metcalf SC, Chin PK, Doogue MP, Dalton SC, Chambers ST. Metronidazole stewardship initiative at Christchurch hospitals-achievable with immediate benefits. N Z Med J 2018; 131:53-58. [PMID: 29649197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIMS To evaluate an antimicrobial stewardship (AMS) initiative to change hospital prescribing practice for metronidazole. METHODS In October 2015, the Canterbury District Health Board (CDHB) AMS committee changed advice for metronidazole to promote two times daily dosing for most indications, prioritisation of the oral route and avoidance of double anaerobic cover. Adoption of the initiative was facilitated via change in prescribing guidelines, education and ongoing pharmacy support. Usage and expenditure on metronidazole for adult inpatients were compared for the five years pre- and two years post-change. Other district health boards (DHBs) were surveyed to determine their dosing recommendation for metronidazole IV. RESULTS Mean annual metronidazole IV use, as defined daily doses per 1,000 occupied bed days, decreased by 43% post-initiative. Use of non-IV (oral or rectal) formulations increased by 104%. Total savings associated with the initiative were approximately $33,400 in drug costs plus $78,200 per annum in IV giving sets and post-dose flushes. Twelve of 20 (60%) DHBs (including CDHB) endorse twice daily IV dosing. CONCLUSIONS In addition to financial savings, reduction in IV doses has potential benefits, including avoidance of IV catheter-associated complications such as bloodstream infections. Approaches to metronidazole dosing vary across DHBs and could benefit from national coordination.
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Affiliation(s)
- Sharon J Gardiner
- Antimicrobial Stewardship Pharmacist, Departments of Infectious Diseases, Clinical Pharmacology and Pharmacy, Canterbury District Health Board, Christchurch
| | - Sarah Cl Metcalf
- Infectious Diseases Physician, Department of Infectious Diseases, Canterbury District Health Board, Christchurch
| | - Paul Kl Chin
- Clinical Pharmacologist and Senior Lecturer, Department of Clinical Pharmacology, Canterbury District Health Board, Christchurch; Department of Medicine, University of Otago, Christchurch
| | - Matthew P Doogue
- Clinical Pharmacologist and Associate Professor, Department of Clinical Pharmacology, Canterbury District Health Board, Christchurch; Department of Medicine, University of Otago, Christchurch
| | - Simon C Dalton
- Infectious Diseases Physician, Department of Infectious Diseases, Canterbury District Health Board, Christchurch
| | - Stephen T Chambers
- Infectious Diseases Physician and Professor, Department of Infectious Diseases, Canterbury District Health Board, Christchurch; Department of Pathology, Canterbury District Health Board, Christchurch
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Abstract
The challenges as we strive towards universal health coverage are many, but the need for an improved health workforce is chief among them. Unfortunately the global deficit in skilled professionals continues to increase. Nevertheless, there are potential solutions, and success stories are well documented when the approach is on system building and sustainability. As we approach 2015 and the Millennium Development Goals, we must shift our focus to a more distant time point in order to achieve the dramatic gains in global health that are possible. However, we must understand that there can be no health without a workforce.
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Affiliation(s)
- Simon C Dalton
- International Medical Services Ltd, Hamilton 3204, New Zealand
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Dalton SC, Chambers ST. Cutaneous myiasis due to Dermatobia hominis (the human botfly) in a New Zealand traveller returned from South America. N Z Med J 2009; 122:95-99. [PMID: 19834527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
The CT appearance of dilated hepatic lymphatics in liver transplant recipients has been described recently. We have observed similar findings of presumed hepatic lymphatic dilatation and perivascular lymphedema in 20 patients seen over an 8-month period, none of whom had received a liver transplant. Review of these patients' records showed that 18 (90%) of 20 had underlying disease processes that could have caused dilated lymphatics as a result of either increased lymph flow or lymphatic obstruction. We have grouped these processes into three etiologic categories: (1) posttraumatic hepatic lymphatic obstruction, (2) obstruction caused by malignant lymphadenopathy, and (3) congestive hepatomegaly caused by cardiac decompensation. The appearance of hepatic lymphatic dilatation and surrounding lymphedema needs to be recognized so that lymphatic dilatation is not mistaken for dilated intrahepatic bile ducts.
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Affiliation(s)
- D B Koslin
- Department of Radiology, University of Alabama Hospital, Birmingham 35233
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