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Microbiology Australia Microbiology Australia
Issue 1

Hospital-acquired Infections, Susceptibility Testing and Infection Control

Vertical Transmission

Happy New Year and welcome to the first issue of Microbiology Australia for 2014. The focus of this month’s issue is the very important topic of hospital-acquired infections, guest edited by Lyn Gilbert (past ASM President), Jon Iredell (current President-elect) and John Merlino. Looking through the wonderful contributions they have made and also those they have secured from other experts in the field, this issue has the makings of becoming a reference text on the subject – and required reading for all who have an interest...

Healthcare infection prevention and control really is everyone’s business

Healthcare-associated infections (HAIs) are more important than most people realise. They are estimated to affect 7–10% of all patients admitted to hospital and are among the top five causes of death worldwide, including in countries like Australia with sophisticated (and expensive) healthcare systems. In Australia it is estimated that 200,000 HAIs occur each year; they affect 5–10% of hospital patients, contribute to 7,000 deaths and are responsible for A$2–3 billion in excess health costs. In the USA they cause an es...

Hospitals as amplifiers of infectious diseases

Institutions for the care of the sick and relief of the poor date back at least to ancient Egypt and Greece. In Europe they were generally run by religious communities (Fig. 1), until the Reformation, in the 16–17th Century, when many passed from Church, to secular control. ‘Modern’ hospitals, which would become centres of medical innovation, research and training, were first established during the Enlightenment, in the 18th Century, funded by wealthy benefactors, specifically for care of the sick.

Antibiotic susceptibility testing methods and emerging bacterial resistance in hospitals

Clinical microbiology laboratories, whether in hospitals or private institutions, have the important task of performing antimicrobial susceptibility testing on significant bacterial pathogens isolated from a variety of specimens. The aim of all this testing is to detect possible emerging antimicrobial drug resistance in unusual and common pathogens so that infections are treated with the appropriate antibiotics. Microbiologists and clinicians in hospitals are today more dependent on results from in vitro susceptibility testing. This sign...

Active screening for multiresistant Enterobacteriaceae

The control of multiresistant organisms (MROs) is made difficult by a large reservoir of unrecognised, asymptomatic colonised patients. Hence, active screening is generally used as part of a multifaceted infection control intervention. Active screening for multiresistant Gram-negative bacteria (MRGNB) involves collection of screening specimens from patients with relevant risk factors. Positive results may result in institution of contact precautions, cohorting of patients and enhanced cleaning and surveillance. Active decolonisation is used for...

Epidemiology of healthcare-associated infections: uses, pitfalls and the future

This paper provides an overview of the history of epidemiological activities in Australia at state and national levels to monitor healthcare-associated infections (HAIs), an examination of the pitfalls of surveillance as an epidemiological design for causality of HAIs and the attempts at correcting them, the ease of web access for information about statewide programs and reports and a look into the future of HAI epidemiology.

Surfaces and fomites as a source of healthcare-associated infections

Fomites are inanimate objects in the environment that can become contaminated with pathogenic microorganisms, facilitating their transfer from one patient or surface to another. Understanding how pathogens are spread in the environment and terminating the spread is important for controlling nosocomial outbreaks.

Clostridium difficile infection in Australia

Clostridium difficile is the most common cause worldwide of infectious diarrhoea in hospitalised patients. It is also thought to be the number one healthcare-related infection in the USA costing >US$3 billion annually. In a recent report from the Centers for Disease Control and Prevention, C. difficile was described as ‘an immediate public health threat that requires urgent and aggressive action'1. Infection occurs following ingestion of C. difficile, probably as a spo...

VISA and hVISA in hospitals

Staphylococcus aureus is noted for its clinical spectrum of disease ranging from asymptomatic colonisation to overwhelming sepsis and death and for its ability to become resistant to antibiotics. Resistance to beta-lactams, methicillin resistance, was first described 50 years ago, becoming a clinical problem in hospitals in the 1970s and the community in the 1990s. MRSA strains that originated in hospitals are usually also resistant to most of the non-beta-lactams as well, leaving vancomycin as the main parenteral drug to treat serious M...

The CDS Antimicrobial Susceptibility Test Method: fulfilling a need

The need for both the adoption of a uniform method of antimicrobial susceptibility testing by laboratories in Australia and the alliance of the laboratories with a reference laboratory was demonstrated clearly more than 40 years ago. This review outlines how the CDS Antimicrobial Test has fulfilled this need and demonstrates the value of the association of diagnostic laboratories with a readily accessible reference laboratory in reducing errors in antimicrobial susceptibility testing in practice.

Vancomycin-resistant enterococci in hospitals

Control measures for vancomycin-resistant enterococci (VRE) should be determined by the current epidemiology of infection and must be practical and effective. It is essential that emphasis is placed on consistent implementation of enhanced standard precautions (horizontal measures) in healthcare that reduce infections caused by all organisms, not just VRE. Effective antimicrobial stewardship programs are paramount and should target reduction in the use of extended-spectrum cephalosporins, carbapenems and fluoroquinolones. VRE c...

Early warning systems augmented by bacterial genomics

The number of microbial threats – in the form of newly identified pathogens, infections crossing the species barrier to people, diseases adapting to new environments, transmissible drug-resistance genes and microbial agents appearing in more virulent forms – has multiplied to an unprecedented degree. The epidemiology of well-known infectious diseases has also been changing due to the globalisation of trade and in response to immunisation campaigns. This evolving epidemiology presents new challenges to countries' healthcare systems...

Laboratory automation: efficiency and turnaround times

Although automation is widely used in clinical chemistry, hematology and immunology laboratories, the microbiology laboratory has been slow to adopt automation. Some may criticise microbiologists as being overly conservative and this may seem justified when we recognise that many of the fundamental technologies used in today's laboratories have existed for more than 100 years (e.g. petri dishes of culture media, biochemical tests for organism identification, microscope for observing organisms on glass slides). Some testing in microbiology has b...

Microbial strain typing in surveillance and outbreak investigation: past, present and future

It is estimated that 180 000 cases of hospital-acquired infections occur in Australian hospitals each year1. Many of these follow colonisation of patients by nosocomial bacterial pathogens. Identifying these acquisition events is necessary to target infection control interventions and to accurately estimate the burden of hospital-acquired infections on our healthcare system. Strain typing is required to reliably monitor these nosocomial acquisition events, particularly for organisms with h...

Acinetobacter baumannii and hospital infections

Acinetobacter baumannii is now considered a highly important pathogen implicated in hospital infections, especially in critically unwell patients in the intensive care unit. The presence of mechanical ventilator tubing, central venous lines, urinary catheters and exposure to broad-spectrum antibiotics are important risk factors. The combination of intrinsic and acquired antibiotic resistance mechanisms, virulence and survival factors, and the ability to cause widespread hospital outbreaks, make this a truly challenging pathogen in hospit...

Hospital-acquired Pneumocystis pneumonia: a renewed concern?

Pneumocystis pneumonia (PCP), caused by the fungus Pneumocystis jirovecii, is a life-threatening pulmonary infection in immuncompromised hosts. Solid organ transplant (SOT) recipients are among those at increased risk, with infection attributed to reactivation of dormant colonisation1. Prior to the institution of routine antimicrobial prophylaxis, the overall incidence of PCP in SOT recipients was 5–15%, with the lowest incidence in kidney recipients (2–15%) and the hi...

Movement of resistance genes in hospitals

Enterobactericeae resistant to multiple antibiotics are an increasing global health problem that impacts treatment and survival of hospitalised patients. In these organisms much of the antibiotic resistance is due to a wide variety of ‘mobile' resistance genes that have been captured from the chromosomes of different bacterial species and transferred to plasmids by the actions of various mobile genetic elements. These plasmids can then spread between bacterial cells, including different species. The association of resistance genes...

Management of antibiotic resistance in the intensive care unit setting from an international perspective

Infections represent one of the most threatening complications for intensive care unit (ICU) patients. Approximately 50% of all ICU patients are treated for infection or suspected infection during their ICU stay, of which approximately half are acquired during the ICU stay. Multidrug-resistant (MDR) organisms are often the etiologic agents with a dramatic impact in morbidity and mortality rates. The emergence of carbapenemase-producing bacteria, in particular the emerging K. pneumoniae strains harboring the plasmid-encoded KPC-type carba...

ASM Antimicrobial Special Interest Group update

The Antimicrobial Special Interest Group (ASIG) is one of the largest special interest groups within the ASM. In 2012 there were over 923 ASIG members. In 2013 there were over 721 members listed under ASIG. Some of our members have retired but still keep in touch. In 2012–13 ASM ASIG members were actively involved with local and national ASM Branch meetings in various states, usually in the form of communication and newsletters. The committee actively communicates via emails and the website www.asig.org.au on emerging issues, methodology...

Professor David James Kemp OAM FAA: 1945–2013

Dave Kemp was an exceptional and highly respected scientist. An outstanding molecular biologist, Dave Kemp was noted for his technological innovation, which he used to address signal questions in both immunology and parasitology.

Volume 35 Number 1

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