David Andresen

Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines

Few studies are available to inform duration of intravenous antibiotics for children and when it is safe and appropriate to switch to oral antibiotics. We have systematically reviewed antibiotic duration and timing of intravenous to oral switch for 36 paediatric infectious diseases and developed evidence-graded recommendations on the basis of the review, guidelines, and expert consensus. We searched databases and obtained information from references identified and relevant guidelines. All eligible studies were assessed for quality. 4090 articles were identified and 170 studies were included. Evidence relating antibiotic duration to outcomes in children for some infections was supported by meta-analyses or randomised controlled trials; in other infections data were from retrospective series only. Criteria for intravenous to oral switch commonly included defervescence and clinical improvement with or without improvement in laboratory markers. Evidence suggests that intravenous to oral switch can occur earlier than previously recommended for some infections. We have synthesised recommendations for antibiotic duration and intravenous to oral switch to support clinical decision making and prospective research.

Epidemiology and Geographical Distribution of Enteric Protozoan Infections in Sydney, Australia

Background Enteric protozoa are associated with diarrhoeal illnesses in humans; however there are no recent studies on their epidemiology and geographical distribution in Australia. This study describes the epidemiology of enteric protozoa in the state of New South Wales and incorporates spatial analysis to describe their distribution. Design and methods Laboratory and clinical records from four public hospitals in Sydney for 910 patients, who tested positive for enteric protozoa over the period January 2007 - December 2010, were identified, examined and analysed. We selected 580 cases which had residence post code data available, enabling us to examine the geographic distribution of patients, and reviewed the clinical data of 252 patients to examine possible links between protozoa, demographic and clinical features. Results Frequently detected protozoa were Blastocystis spp. (57%), Giardia intestinalis (27%) and Dientamoeba fragilis (12%). The age distribution showed that the prevalence of protozoa decreased with age up to 24 years but increasing with age from 25 years onwards. The geographic provenance of the patients indicates that the majority of cases of Blastocystis (53.1%) are clustered in and around the Sydney City Business District, while pockets of giardiasis were identified in regional/rural areas. The distribution of cases suggests higher risk of protozoan infection may exist for some communities. Conclusions These findings provide useful information for policy makers to design and tailor interventions to target high risk communities. Follow-up investigation into the risk factors for giardiasis in regional/rural areas is needed. Significance for public health This research is significant since it provides the most recent epidemiological update on the common enteric protozoa affecting Australians. It reveals that enteric protozoa cause considerable disease burden in high risk city dwellers, and provides the evidence base for development of targeted interventions for their prevention and control in high risk populations. The prevalence of enteric protozoa in this metropolitan setting underscores that microorganisms do not respect borders and that a collaborative approach is needed to contain the global spread of infectious diseases. Incorporating spatial analysis is valuable in providing a compelling picture of the geographical distribution of these often neglected diseases. Local and State Public Health departments can use this information to support further inves-

High Sensitivity of a Rapid Immunochromatographic Test for Detection of Influenza A Virus 2009 H1N1 in Nasopharyngeal Aspirates from Young Children

Recent reports have suggested that immunochromatographic tests (ICTs) have poor sensitivity for influenza A virus 2009 H1N1 (H1N1 09) infection on swabs ([2][1]) and nasopharyngeal washes ([1][2]), but they do have advantages, including short turnaround time, lack of hardware, and minimal validation

Incidence of sterile cerebrospinal fluid pleocytosis in infants with urinary tract infection

Aim:  To determine the incidence of sterile cerebrospinal fluid (CSF) pleocytosis in infants ≤6 months old with urinary tract infection (UTI).

Comparison of human metapneumovirus and respiratory syncytial virus in children admitted to a paediatric intensive care unit

Aim:  To describe the clinical presentation and course of children admitted to the paediatric intensive care unit (PICU) with human metapneumovirus (hMPV) infection, and compare them with children admitted to the PICU with respiratory syncytial virus (RSV) infection.

Paediatric community-associated Staphylococcus aureus: A retrospective cohort study

We aimed to characterise the demographic and clinical features of paediatric community‐associated Staphylococcus aureus (CA‐SA) infection. We aimed to identify factors associated with methicillin‐resistant S. aureus (MRSA) infection evident at the point of care with the potential to guide antibiotic choice.

Gastrointestinal pathogen distribution in symptomatic children in Sydney, Australia

There is limited information on the causes of paediatric diarrhoea in Sydney. This cross-sectional study used clinical and microbiological data to describe the clinical features and pathogens associated with gastrointestinal illnesses for children presenting to two major public hospitals in Sydney with diarrhoea, for the period January 2007–December 2010. Of 825 children who tested positive for an enteric pathogen, 430 medical records were reviewed. Adenovirus, norovirus and rotavirus were identified in 20.8%, 20.3% and 21.6% of reviewed cases, respectively. Younger children were more likely to have adenovirus and norovirus compared with rotavirus (P = 0.001). More viruses were detected in winter than in the other three seasons (P = 0.001). Rotavirus presented a distinct seasonal pattern with the lowest rates occurring in the warm months and peaking in the cooler months. Adenovirus showed a less consistent monthly trend, and norovirus detection increased in the cooler months (P = 0.008). A decline in the number of rotavirus cases was observed after mid-2008. The majority of childhood diarrhoeal illnesses leading to hospital presentations in Sydney are caused by enteric viruses with most infections following clear seasonal patterns. However, a sustained decrease in the incidence of rotavirus infections has been observed over the study period.

Infections following lawnmower and farm machinery-related injuries in children.

Aims:  Because of the paucity of previous data, we report the organisms causing infection in children with injuries from lawnmowers and farm machinery.

Descriptive epidemiology of infectious gastrointestinal illnesses in Sydney, Australia, 2007 2010

OBJECTIVE There is a lack of information about the prevalence of gastrointestinal illnesses in Australia. Current disease surveillance systems capture only a few pathogens. The aim of this study is to describe the epidemiology of infectious gastrointestinal illnesses in Sydney, Australia. METHODS A retrospective cross-sectional study of patients with gastrointestinal symptoms who visited tertiary public hospitals in Sydney was conducted between 2007 and 2010. Patients with diarrhoea or loose stools with an enteric pathogen detected were identified. Demographic, clinical and potential risk factor data were collected from their medical records. Measures of association, descriptive and inferential statistics were analysed. RESULTS In total, 1722 patients were included in this study. Campylobacter (22.0%) and Clostridium difficile (19.2%) were the most frequently detected pathogens. Stratified analysis showed that rotavirus (22.4%), norovirus (20.7%) and adenovirus (18.1%) mainly affected children under 5 years; older children (5-12 years) were frequently infected with Campylobacter spp. (29.8%) and non-typhoid Salmonella spp. (24.4%); infections with C. difficile increased with age.Campylobacter and non-typhoid Salmonella spp. showed increased incidence in summer months (December to February), while rotavirus infections peaked in the cooler months (June to November). DISCUSSION This study revealed that gastrointestinal illness remains a major public health issue in Sydney. Improvement of current disease surveillance and prevention and control measures are required. This study emphasizes the importance of laboratory diagnosis of enteric infections and the need for better clinical data collection to improve management of disease risk factors in the community.

Non-susceptibility to ceftaroline in healthcare-associated multiresistant MRSA in Eastern Australia

Department of Microbiology, St Vincent’s Hospital, Darlinghurst, Sydney, Australia; School of Biological Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Infectious Diseases and Microbiology, Institute for Clinical Pathology and Medical Research, Westmead, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia; Department of HIV, Immunology and Infectious Diseases, St Vincent’s Hospital, Darlinghurst, Sydney, Australia; Sydney Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia