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Article ; Online: Key predictors and burden of meticillin-resistant Staphylococcus aureus infection in comparison with meticillin-susceptible S. aureus infection in an Australian hospital setting.

Miyakis, S / Brentnall, S / Masso, M / Reynolds, G / Byrne, M K / Newton, P / Crawford, S / Fish, J / Nicholas, B / Hill, T / van Oijen, A M

The Journal of hospital infection

2022 Volume 129, Page(s) 41–48

Abstract: ... on the healthcare system. Relatively few reliable estimates are available regarding the impact of meticillin-resistant S ... aureus (MRSA) infection compared with meticillin-susceptible S. aureus (MSSA) infection.: Aims ... length of stay and costs of hospital services, and identify predictors of MRSA as a cause of S. aureus ...

Abstract	Background: Staphylococcus aureus is associated with significant mortality and increased burden on the healthcare system. Relatively few reliable estimates are available regarding the impact of meticillin-resistant S. aureus (MRSA) infection compared with meticillin-susceptible S. aureus (MSSA) infection. Aims: To compare patients with MRSA infection and MSSA infection to identify differences in inpatient mortality, length of stay and costs of hospital services, and identify predictors of MRSA as a cause of S. aureus infection. Methods: An analytical, retrospective, longitudinal study using non-identifiable linked data on adults admitted to hospitals of a health district in Australia with a diagnosis of S. aureus infection over a 10-year period. The main outcome measure was 30-day inpatient mortality. Secondary endpoints included total overnight stays, all-cause inpatient mortality, and hospitalization costs within 1 year of index admission. Findings: Inpatient mortality at 30, 100 and 365 days was estimated to be significantly greater for patients with MRSA infection. The mean additional cost of MRSA infection when controlling for additional factors was $5988 and 4 nights of additional hospital stay per patient within 1 year of index admission. Key predictors of MRSA infection were: date of index admission; higher comorbidity score; greater socio-economic disadvantage; admission to hospital other than via the emergency department; older age; and prior admission to hospital within 28 days of index admission. Conclusions: MRSA infection is associated with increased inpatient mortality, costs and hospital length of stay compared with MSSA infection. Efforts are required to alleviate the additional burden of MRSA infection on patients and healthcare systems.
MeSH term(s)	Adult ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Staphylococcus aureus ; Methicillin/pharmacology ; Methicillin Resistance ; Retrospective Studies ; Longitudinal Studies ; Australia/epidemiology ; Staphylococcal Infections ; Hospitals
Chemical Substances	Methicillin (Q91FH1328A)
Language	English
Publishing date	2022-07-14
Publishing country	England
Document type	Journal Article
ZDB-ID	779366-2
ISSN	1532-2939 ; 0195-6701
ISSN (online)	1532-2939
ISSN	0195-6701
DOI	10.1016/j.jhin.2022.07.004
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Zs.A 1586: Show issues

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Article ; Online: Experience with COVID-19: swab technique shows no association with willingness to retest.

Ruiz, Haley / Westley-Wise, Victoria / Mayne, Darren J / Keighley, Caitlin / Newton, Peter / Miyakis, Spiros / Seale, Holly

Pathology

2023 Volume 56, Issue 3, Page(s) 441–444

MeSH term(s)	Humans ; COVID-19 ; Specimen Handling/methods ; SARS-CoV-2
Language	English
Publishing date	2023-10-12
Publishing country	England
Document type	Letter
ZDB-ID	7085-3
ISSN	1465-3931 ; 0031-3025
ISSN (online)	1465-3931
ISSN	0031-3025
DOI	10.1016/j.pathol.2023.07.017
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Zs.A 723: Show issues

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Article ; Online: Q Fever in Rural Australia: Education Versus Vaccination.

Lindsay, Patrick J / Rohailla, Sagar / Miyakis, Spiros

Vector borne and zoonotic diseases (Larchmont, N.Y.)

2018 Volume 18, Issue 11, Page(s) 632–634

Abstract: Background: Q fever is an infection caused by Coxiella burnetii, a zoonotic disease acquired from both wild and domestic animals. Northern rural New South Wales (NSW) communities in Australia have an increased risk of exposure to this organism. Both the ...

Abstract	Background: Q fever is an infection caused by Coxiella burnetii, a zoonotic disease acquired from both wild and domestic animals. Northern rural New South Wales (NSW) communities in Australia have an increased risk of exposure to this organism. Both the acute and chronic phases of the infection are associated with significant morbidity, which is often increased by delayed recognition and treatment. Recent termination of vaccination programs in Australia may increase the risk of infection in these populations. Materials and methods: This cross-sectional study evaluated the current knowledge base and overall understanding of clinicians on the epidemiology, presentation, and diagnosis of Q fever in the Northern New South Wales Local Health District. Results: Forty-five participants responded to the survey. Among those, 35 participants (78%) were hospital based and 10 (22%) were from doctors working in the community. Thirty-one (72%) clinicians answered bacteria as the cause of Q fever, 34 (79.1%) participants selected animals as the reservoir of Q fever infection, and 22 (51%) identified inhalation as the form of transmission. The majority identified livestock rearing occupations (84%) as a high-risk group; however, only 65-70% identified stock yard and meat workers as groups also at risk. Furthermore, 23 (51%) of the participants considered those living in rural and remote communities as high risk. Conclusions: Our results identified gaps in knowledge of clinicians in the epidemiology and diagnosis of acute Q fever infection. With the termination of vaccination programs, this study highlights the need for education programs that can increase Q fever awareness toward prompt identification and treatment.
MeSH term(s)	Bacterial Vaccines/administration & dosage ; Cross-Sectional Studies ; Data Collection ; Health Knowledge, Attitudes, Practice ; Humans ; Occupational Exposure ; Q Fever/prevention & control ; Risk Factors ; Rural Population ; Surveys and Questionnaires ; Vaccination
Chemical Substances	Bacterial Vaccines
Language	English
Publishing date	2018-08-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2047199-3
ISSN	1557-7759 ; 1530-3667
ISSN (online)	1557-7759
ISSN	1530-3667
DOI	10.1089/vbz.2018.2307
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Zs.A 6137: Show issues

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Article ; Online: Multi-year antimicrobial-resistance trends in urine Escherichia coli isolates from both community-based and hospital-based laboratories of an Australian local health district.

Keighley, Caitlin / van Oijen, Antoine M / Brentnall, Stuart J / Sanderson-Smith, Martina / Newton, Peter / Miyakis, Spiros

Journal of global antimicrobial resistance

2022 Volume 31, Page(s) 386–390

Abstract: Objectives: Efforts to monitor and combat antimicrobial resistance (AMR) are typically focused on the hospital-based laboratory setting. The aim of this study was to longitudinally examine and compare trends in AMR among urine Escherichia coli isolates ... ...

Abstract	Objectives: Efforts to monitor and combat antimicrobial resistance (AMR) are typically focused on the hospital-based laboratory setting. The aim of this study was to longitudinally examine and compare trends in AMR among urine Escherichia coli isolates from a private community-based laboratory and a public hospital-based laboratory in an Australian local health district. Methods: A total of 108 262 urine E. coli isolates from a public hospital-based laboratory (N = 34 103) and a private community-based laboratory (N = 74 159) in a single health district between 2007-2019 were analysed. Linear regression was used to identify significance of change in AMR rates in both laboratories independently and detect any significant interaction of each setting in proportional change over the study period. Results: Similar AMR trends were detected among urinary E. coli isolates in private community-based laboratory and public hospital-based laboratory settings over 12 y. AMR rates were consistently higher in the public hospital-based setting. Ampicillin was the only antibiotic for which the E. coli resistance trend did not significantly change over the time period in either laboratory setting. All other antibiotics showed a significant increase in AMR rates over time in both settings. Conclusions: AMR rates in both the private community-based laboratory and public hospital-based laboratory settings increased over time and were consistently higher in the public hospital-based laboratory setting. Since private laboratories handle the vast majority of pathology volumes in community outpatient settings in Australia, interventions incorporating the community-based laboratory setting are critical to addressing AMR in the community.
Language	English
Publishing date	2022-11-25
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2710046-7
ISSN	2213-7173 ; 2213-7173
ISSN (online)	2213-7173
ISSN	2213-7173
DOI	10.1016/j.jgar.2022.11.008
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Article ; Online: Implementation of an antimicrobial stewardship programme and reduction in carbapenemase-producing Enterobacterales in an Australian local health district.

Cipko, Kimberly / Cuenca, Jose / Wales, Erica / Harris, Joanna / Bond, Stuart / Newton, Peter / Miyakis, Spiros

JAC-antimicrobial resistance

2020 Volume 2, Issue 3, Page(s) dlaa041

Abstract: Background: Carbapenemase-producing Enterobacterales (CPE) are increasingly seen in Australian hospitals. Antimicrobial stewardship (AMS) interventions have been shown to reduce rates of carbapenem-resistant organisms; data on their effect on CPE rates ... ...

Abstract	Background: Carbapenemase-producing Enterobacterales (CPE) are increasingly seen in Australian hospitals. Antimicrobial stewardship (AMS) interventions have been shown to reduce rates of carbapenem-resistant organisms; data on their effect on CPE rates are limited. Objectives: To explore the effect of a multi-site computer-supported AMS programme on the rates of CPE in an Australian local health district. Methods: All laboratory CPE isolates between 2008 and 2018 were identified. Microbiological and demographic data, CPE risk factors and outcomes were collected. Monthly carbapenem use was expressed as DDD per 1000 occupied bed days (OBD). Hand hygiene compliance rates among healthcare workers were analysed. A computer-supported AMS programme was implemented district-wide in 2012. Bivariate relationships were examined using Pearson's Results: We identified 120 isolates from 110 patients. Numbers of CPE isolates and carbapenem use both showed a strong downward trend during the study period; the decreases were strongly correlated ( Conclusions: We demonstrated a reduction of CPE isolates in conjunction with reduced carbapenem use, longitudinally consolidated by a formal AMS programme. Prospective studies are needed to validate the effect of AMS on carbapenem resistance, especially in high-prevalence settings.
Language	English
Publishing date	2020-07-13
Publishing country	England
Document type	Journal Article
ISSN	2632-1823
ISSN (online)	2632-1823
DOI	10.1093/jacamr/dlaa041
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Article ; Online: Impact of an antimicrobial stewardship intervention on appropriateness of prescribing for community-acquired pneumonia in an Australian regional hospital.

Bond, Stuart E / Boutlis, Craig S / Yeo, Wilfred W / Miyakis, Spiros

Internal medicine journal

2017 Volume 47, Issue 5, Page(s) 582–585

Abstract: Community-acquired pneumonia (CAP) is the second commonest indication for antibiotic use in Australian hospitals and is therefore a frequent target for antimicrobial stewardship. A single-centre prospective study was conducted in a regional referral ... ...

Abstract	Community-acquired pneumonia (CAP) is the second commonest indication for antibiotic use in Australian hospitals and is therefore a frequent target for antimicrobial stewardship. A single-centre prospective study was conducted in a regional referral hospital comparing management of adult patients with CAP before and after an educational intervention. We demonstrated a reduction in duration of therapy and reduced inappropriate use of ceftriaxone-based regimens for non-severe CAP.
Language	English
Publishing date	2017-05
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.13401
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Zs.A 792: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 424: Show issues

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Article ; Online: Discontinuation of peri-operative gentamicin use for indwelling urinary catheter manipulation in orthopaedic surgery.

Bond, Stuart E / Boutlis, Craig S / Jansen, Stuart G / Miyakis, Spiros

ANZ journal of surgery

2017 Volume 87, Issue 11, Page(s) E199–E203

Abstract: Background: Gentamicin has historically been used prior to insertion and removal of indwelling urinary catheters (IDCs) around elective joint replacement surgery to prevent infection; however, this indication is not recognized in the Australian ... ...

Abstract	Background: Gentamicin has historically been used prior to insertion and removal of indwelling urinary catheters (IDCs) around elective joint replacement surgery to prevent infection; however, this indication is not recognized in the Australian Therapeutic Guidelines: Antibiotic and the paradigm for safe use of gentamicin has shifted. Methods: The antimicrobial stewardship team of a 500 bed tertiary regional hospital performed a retrospective clinical study of gentamicin IDC prophylaxis around total hip and knee arthroplasties. Results were presented to the orthopaedic surgeons. A literature review identified no guidelines to support gentamicin prophylaxis and only a very low risk of bacteraemia associated with IDC insertion/removal in patients with established bacteriuria. Consensus was reached with the surgeons to discontinue this practice. Subsequent prospective data collection was commenced to determine effectiveness, with weekly feedback to the Department Head of Orthopaedics. Results: Data from 137 operations pre-intervention (6 months) were compared with 205 operations post-intervention (12 months). The median patient age was 72 years in both groups. Following the intervention, reductions in gentamicin use were demonstrated for IDC insertion (59/137 (42%) to 4/205 (2%), P < 0.01) and removal (39/137 (28%) to 6/205 (3%), P < 0.01). No gentamicin use was observed during the final 40 weeks of the post-intervention period. There were no significant differences between the groups for pre-operative bacteriuria, surgical site infections or acute kidney injury. Conclusion: A collaborative approach using quality improvement methodology can lead to an evidence-based reappraisal of established practice. Regular rolling audits and timely feedback were useful in sustaining change.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis/standards ; Arthroplasty/adverse effects ; Australia/epidemiology ; Bacteremia/drug therapy ; Bacteremia/prevention & control ; Bacteriuria/drug therapy ; Bacteriuria/prevention & control ; Catheters, Indwelling/adverse effects ; Catheters, Indwelling/microbiology ; Catheters, Indwelling/standards ; Device Removal/adverse effects ; Device Removal/standards ; Female ; Gentamicins/administration & dosage ; Gentamicins/therapeutic use ; Humans ; Male ; Middle Aged ; New South Wales/epidemiology ; Orthopedic Procedures/adverse effects ; Perioperative Care/standards ; Practice Patterns, Physicians'/standards ; Retrospective Studies ; Surgical Wound Infection/prevention & control ; Urinary Catheters/microbiology
Chemical Substances	Anti-Bacterial Agents ; Gentamicins
Language	English
Publishing date	2017-11
Publishing country	Australia
Document type	Comparative Study ; Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.13642
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Zs.A 180: Show issues

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Article ; Online: Cytophagic histiocytic panniculitis with haemophagocytosis in a patient with familial multiple lipomatosis and review of the literature.

Krilis, Matthew / Miyakis, Spiros

Modern rheumatology

2012 Volume 22, Issue 1, Page(s) 158–162

Abstract: We report a patient with the extremely rare familial multiple lipomatosis syndrome, who developed the uncommon autoimmune disease cytophagic histiocytic panniculitis, manifested as inflammation of preexisting lipomas. Despite his initial critical ... ...

Abstract	We report a patient with the extremely rare familial multiple lipomatosis syndrome, who developed the uncommon autoimmune disease cytophagic histiocytic panniculitis, manifested as inflammation of preexisting lipomas. Despite his initial critical condition and unsuccessful treatment with steroids, he responded to cyclosporin and remains well 15 years after diagnosis. In contrast with most previous reports, our patient stays dependent on cyclosporin; repeated attempts of discontinuing or substituting treatment were quickly followed by relapse. Haemophagocytic panniculitis is considered as a T-cell disorder, but its exact pathophysiological mechanism has not been clarified. Differential diagnosis of cytophagic histiocytic panniculitis mainly includes malignant histiocytosis, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and lupus erythematosus panniculitis (lupus profundus). We discuss the main clinical features, diagnostic challenges and treatment issues of this usually benign, but at times life-threatening autoimmune condition.
MeSH term(s)	Cyclosporine/therapeutic use ; Diagnosis, Differential ; Family Health ; Female ; Genetic Predisposition to Disease ; Histiocytic Sarcoma/diagnosis ; Histiocytosis, Non-Langerhans-Cell/complications ; Histiocytosis, Non-Langerhans-Cell/diagnosis ; Histiocytosis, Non-Langerhans-Cell/drug therapy ; Humans ; Lipomatosis, Multiple Symmetrical/diagnosis ; Lipomatosis, Multiple Symmetrical/drug therapy ; Lipomatosis, Multiple Symmetrical/genetics ; Lymphohistiocytosis, Hemophagocytic/complications ; Lymphohistiocytosis, Hemophagocytic/diagnosis ; Lymphohistiocytosis, Hemophagocytic/drug therapy ; Lymphoma, T-Cell/diagnosis ; Male ; Panniculitis/complications ; Panniculitis/diagnosis ; Panniculitis/drug therapy ; Pedigree ; Treatment Outcome
Chemical Substances	Cyclosporine (83HN0GTJ6D)
Language	English
Publishing date	2012-02
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2078157-X
ISSN	1439-7609 ; 1439-7595
ISSN (online)	1439-7609
ISSN	1439-7595
DOI	10.1007/s10165-011-0487-7
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Zs.B 2982: Show issues

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Article ; Online: Novel antimicrobial agents against multi-drug-resistant gram-positive bacteria: an overview.

Giannakaki, Venetia / Miyakis, Spiros

Recent patents on anti-infective drug discovery

2012 Volume 7, Issue 3, Page(s) 182–188

Abstract: Antimicrobial resistance threatens to compromise the treatment of bacterial infectious diseases. Strains resistant to most (if not all) antibiotics available have emerged. Gram-positive such representatives include strains of Methicillinresistant ... ...

Abstract	Antimicrobial resistance threatens to compromise the treatment of bacterial infectious diseases. Strains resistant to most (if not all) antibiotics available have emerged. Gram-positive such representatives include strains of Methicillinresistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE) and highly-resistant to penicillin Streptococcus pneumoniae. Although the phenomenon of antimicrobial drug resistance is expanding, limited number of new antibiotics has been successfully developed in the last few decades. Several novel antimicrobial agents, however, are currently in diverse phases of development and undergoing clinical trials. This review will summarize the main candidates for novel antibacterial agents active against Gram-positive multi-resistant pathogens along with the discussion of some patents relevant to the topic.
MeSH term(s)	Animals ; Anti-Infective Agents/chemistry ; Anti-Infective Agents/pharmacology ; Anti-Infective Agents/therapeutic use ; Clinical Trials as Topic/methods ; Drug Resistance, Multiple, Bacterial/drug effects ; Drug Resistance, Multiple, Bacterial/physiology ; Gram-Positive Bacteria/drug effects ; Gram-Positive Bacteria/physiology ; Gram-Positive Bacterial Infections/drug therapy ; Gram-Positive Bacterial Infections/physiopathology ; Humans
Chemical Substances	Anti-Infective Agents
Language	English
Publishing date	2012-09-27
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2261296-8
ISSN	2212-4071 ; 1574-891X
ISSN (online)	2212-4071
ISSN	1574-891X
DOI	10.2174/157489112803521959
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Zs.A 6397: Show issues

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Article ; Online: Carbapenem sparing in the management of post-transrectal prostate biopsy bacteraemia.

Trad, Mohamad-Ali / Materne, Mishael / Reynolds, Gemma / Yao, Jinna / Miyakis, Spiros / Skyring, Tim / Newton, Peter

ANZ journal of surgery

2019 Volume 89, Issue 7-8, Page(s) 935–939

Abstract: Background: Sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy is a major complication. With the emergence of multidrug-resistant organisms, empirical use of carbapenem antibiotics has been increasing. This study, conducted in the ... ...

Abstract	Background: Sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy is a major complication. With the emergence of multidrug-resistant organisms, empirical use of carbapenem antibiotics has been increasing. This study, conducted in the Illawarra Shoalhaven Local Health District (ISLHD), Australia, quantifies how much we can spare carbapenem use. Methods: A retrospective audit of patients who underwent TRUS prostate biopsy and were admitted post-operatively with proven bacteraemia between January 2007 and April 2016. Results: Of 2719 TRUS procedures, 50 (1.84%) cases had bacteraemia. The most common isolate was Escherichia coli in 44 of 50 (88%) of which six of 50 (12%) were extended-spectrum beta-lactamase (ESBL)-producing. Sixteen different empirical antimicrobial regimens were used, to which 42 of 50 (84%) of isolates were susceptible. Eight (16%) isolates were resistant to the chosen empiric combination, with five switched over to appropriate treatment once antimicrobial sensitivity results became available. Empirical carbapenem was utilized in 12 of 50 (24%) patients with only two of the ESBL isolates covered. A further 10 of 50 patients received carbapenems during their admission. Carbapenems could have been avoided in 18 of 22 (82%). A total of 86% of organisms (n = 43) were susceptible to the combination of amoxicillin-clavulanate and gentamicin. Conclusion: Although the rates of bacteraemia with ESBL-producing organisms post-TRUS biopsy are increasing, use of carbapenem-free combination antimicrobials as empirical therapy appears to be safe and effective in our setting. Clinicians can utilize local resistance patterns to inform targeted and appropriate therapy for septic patients.
MeSH term(s)	Aged ; Aged, 80 and over ; Bacteremia/drug therapy ; Carbapenems/administration & dosage ; Humans ; Image-Guided Biopsy/methods ; Male ; Middle Aged ; Postoperative Complications/drug therapy ; Prostate/pathology ; Prostatic Neoplasms/pathology ; Rectum ; Retrospective Studies ; Ultrasonography, Interventional
Chemical Substances	Carbapenems
Language	English
Publishing date	2019-07-04
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.15322
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