Mary O'Reilly

Sepsis and 'superbugs': should we favour the transperineal over the transrectal approach for prostate biopsy?

To determine the rate of hospital re‐admission for sepsis after transperineal (TP) biopsy using both local data and worldwide literature, as there is growing interest in TP biopsy as an alternative to transrectal ultrasonography (TRUS)‐guided biopsy for patients undergoing repeat prostate biopsy.

Use of empiric antimicrobial therapy in neutropenic fever

Administration of empiric antimicrobial therapy is standard practice in the management of neutropenic fever, but there remains considerable debate about the selection of an optimal regimen. In view of emerging evidence regarding efficacy and toxicity differences between empiric treatment regimens, and strong evidence of heterogeneity in clinical practice, the current guidelines were developed to provide Australian clinicians with comprehensive guidance for selecting an appropriate empiric strategy in the setting of neutropenic fever. Beta‐lactam monotherapy is presented as the treatment of choice for all clinically stable patients while early treatment with combination antibiotic therapy is considered for patients at higher risk. Due consideration is given to the appropriate use of glycopeptides in this setting. Several clinical caveats, accounting for institution‐ and patient‐specific risk factors, are provided to help guide the judicious use of the agents described. Detailed recommendations are also provided regarding time to first dose, timing of blood cultures, selection of a first‐line antibiotic regimen, subsequent modification of antibiotic choice and cessation of therapy.

Use of empiric antimicrobial therapy in neutropenic fever. Australian Consensus Guidelines 2011 Steering Committee.

Administration of empiric antimicrobial therapy is standard practice in the management of neutropenic fever, but there remains considerable debate about the selection of an optimal regimen. In view of emerging evidence regarding efficacy and toxicity differences between empiric treatment regimens, and strong evidence of heterogeneity in clinical practice, the current guidelines were developed to provide Australian clinicians with comprehensive guidance for selecting an appropriate empiric strategy in the setting of neutropenic fever. Beta‐lactam monotherapy is presented as the treatment of choice for all clinically stable patients while early treatment with combination antibiotic therapy is considered for patients at higher risk. Due consideration is given to the appropriate use of glycopeptides in this setting. Several clinical caveats, accounting for institution‐ and patient‐specific risk factors, are provided to help guide the judicious use of the agents described. Detailed recommendations are also provided regarding time to first dose, timing of blood cultures, selection of a first‐line antibiotic regimen, subsequent modification of antibiotic choice and cessation of therapy.

Introduction to the Australian consensus guidelines for the management of neutropenic fever in adult cancer patients, 2010/2011

The current consensus guidelines were developed to standardize the clinical approach to the management of neutropenic fever in adult cancer patients throughout Australian treating centres. The three areas of clinical practice covered by the guidelines, the process for developing consensus opinion, and the system used to grade the evidence and relative strength of recommendations are described. The health economics implications of establishing clinical guidance are also discussed.

Transrectal ultrasound-guided biopsy sepsis and the rise in carbapenem antibiotic use

This study sought to determine the number of hospital admissions for sepsis following transrectal ultrasound‐guided (TRUS) biopsy, and the rate of both prophylactic and therapeutic use of carbapenem antibiotics for TRUS biopsy, at a single institution.

Introduction to the Australian consensus guidelines for the management of neutropenic fever in adult cancer patients, 2010/2011. Australian Consensus Guidelines 2011 Steering Committee.

The current consensus guidelines were developed to standardize the clinical approach to the management of neutropenic fever in adult cancer patients throughout Australian treating centres. The three areas of clinical practice covered by the guidelines, the process for developing consensus opinion, and the system used to grade the evidence and relative strength of recommendations are described. The health economics implications of establishing clinical guidance are also discussed.

CNS listeriosis confused with leptomeningeal carcinomatosis in a patient with a malignant insulinoma.

We describe a case of presumed listeria monocytogenes rhomboencephalitis, which was initially confused with leptomeningeal carcinomatosis in a patient with a malignant carcinoid tumor. Long-term corticosteroid treatment and immunosuppression caused by malignancy predisposed the patient to developing listeriosis. The clinical and radiologic features of this illustrative case are described. Listeriosis is an important treatable differential diagnosis in patients with malignancy presenting with neurologic signs.

Targeting antimicrobial stewardship in hospitalized patients with community‐acquired pneumonia within 24 h of admission

Background: A pilot project promoting optimal antibiotic usage in patients admitted with pneumonia within the first 24 h of their admission was commenced at Angliss Hospital (AH) and Maroondah Hospital (MH). The aim of this project was to support initial management of CAP with goals of (i) identifying the best strategy to identify patients in a timely fashion, (ii) assess appropriateness of initial antibiotic prescribed, (iii) provide feedback and education to prescribers, (iv) monitor uptake of recommendations and (v) determine impact, if any, on patient length of stay. It was planned to incorporate this into usual workflow.

Response to Re: Transrectal ultrasound-guided biopsy sepsis and the rise in carbapenem antibiotic use: Letter to the Editor

1. Hanasono MM, Silva AK, Yu P, Skoracki RJ. A comprehensive algorithm for oncologic maxillary reconstruction. Plast. Reconstr. Surg. 2013; 131: 47–60. 2. Rahpeyma A, Khajehahmadi S, Razmara F. Submental flap in intraoral reconstruction after pathologic resections: indications and limitations. J. Maxillofac. Oral Surg. 2015; 14: 57–62. 3. Elsherbiny M, Mebed A, Mebed H. Microvascular radial forearm fasciocutaneous free flap for palatomaxillary reconstruction following malignant tumor resection. J. Egypt. Natl Canc. Inst. 2008; 20: 90–7.

Response to Re: Transrectal ultrasound‐guided biopsy sepsis and the rise in carbapenem antibiotic use

1. Hanasono MM, Silva AK, Yu P, Skoracki RJ. A comprehensive algorithm for oncologic maxillary reconstruction. Plast. Reconstr. Surg. 2013; 131: 47–60. 2. Rahpeyma A, Khajehahmadi S, Razmara F. Submental flap in intraoral reconstruction after pathologic resections: indications and limitations. J. Maxillofac. Oral Surg. 2015; 14: 57–62. 3. Elsherbiny M, Mebed A, Mebed H. Microvascular radial forearm fasciocutaneous free flap for palatomaxillary reconstruction following malignant tumor resection. J. Egypt. Natl Canc. Inst. 2008; 20: 90–7.