https://ogma.newcastle.edu.au/vital/access/ /manager/Index en-au 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19799 Wed 11 Apr 2018 15:56:13 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41115 Tue 26 Jul 2022 09:16:23 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47674 Tue 24 Jan 2023 16:02:03 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:51428 Tue 05 Sep 2023 17:46:50 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:30743 Thu 24 Mar 2022 11:34:27 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47420 Thu 19 Jan 2023 12:56:37 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:7639 Sat 24 Mar 2018 08:36:02 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:13301 Sat 24 Mar 2018 08:18:05 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:17178 Sat 24 Mar 2018 08:06:32 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:5313 Sat 24 Mar 2018 07:45:59 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:29250 Sat 24 Mar 2018 07:36:46 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:27435 Sat 24 Mar 2018 07:35:01 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:25808 Enterococcus faecium is a major nosocomial pathogen causing significant morbidity and mortality worldwide. Assessment of E. faecium using MLST to understand the spread of this organism is an important component of hospital infection control measures. Recent studies, however, suggest that MLST might be inadequate for E. faecium surveillance. Objectives: To use WGS to characterize recently identified vancomycin-resistant E. faecium (VREfm) isolates non-typeable by MLST that appear to be causing a multi-jurisdictional outbreak in Australia. Methods: Illumina NextSeq and Pacific Biosciences SMRT sequencing platforms were used to determine the genome sequences of 66 non-typeable E. faecium (NTEfm) isolates. Phylogenetic and bioinformatics analyses were subsequently performed using a number of in silico tools. Results: Sixty-six E. faecium isolates were identified by WGS from multiple health jurisdictions in Australia that could not be typed by MLST due to a missing pstS allele. SMRT sequencing and complete genome assembly revealed a large chromosomal rearrangement in representative strain DMG1500801, which likely facilitated the deletion of the pstS region. Phylogenomic analysis of this population suggests that deletion of pstS within E. faecium has arisen independently on at least three occasions. Importantly, the majority of these isolates displayed a vancomycin-resistant genotype. Conclusions: We have identified NTEfm isolates that appear to be causing a multi-jurisdictional outbreak in Australia. Identification of these isolates has important implications for MLST-based typing activities designed to monitor the spread of VREfm and provides further evidence supporting the use of WGS for hospital surveillance of E. faecium.]]> Sat 24 Mar 2018 07:34:38 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:24751 Clostridium difficile rose in prominence in the early 2000s with large-scale outbreaks of a particular binary toxin-positive strain, ribotype 027, in North America and Europe. In Australia outbreaks of the same scale had not and have not been seen. A survey of C. difficile across Australia was performed for 1 month in 2010. A collection of 330 C. difficile isolates from all States and Territories except Victoria and the Northern Territory was amassed. PCR ribotyping revealed a diverse array of strains. Ribotypes 014/020 (30.0%) and 002 (11.8%) were most common, followed by 054 (4.2%), 056 (3.9%), 070 (3.6%) and 005 (3.3%). The collection also contained few binary toxin positive strains, namely 027 (0.9%), 078 (0.3%), 244 (0.3%), 251 (0.3%) and 127 (0.3%). The survey highlights the need for vigilance for emerging strains in Australia, and gives an overview of the molecular epidemiology of C. difficile in Australia prior to an increase in incidence noted from mid-2011.]]> Sat 24 Mar 2018 07:14:09 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32931 Enterobacter spp. possess chromosomal AmpC beta-lactamases that may be expressed at high levels. Previous studies have demonstrated a risk of relapsed bacteraemia following therapy with third generation cephalosporins (3GCs). What additional factors predict microbiological failure in Enterobacter bacteraemia is unclear. We aimed to determine factors associated with microbiological failure in Enterobacter bacteraemia. Methods: We retrospectively identified cases of bacteraemia caused by Enterobacter spp. occurring in four hospitals. Using a case-control design, we determined clinical risk factors for persistence or relapse defined as repeated positive blood cultures collected between 72 hours and up to 28 days post initial positive blood culture. Results: During the study period a total of 922 bacteraemia events caused by Enterobacter spp. in adults were identified. The overall risk of relapsed or persisting bacteraemia at 28 days was low (31 of 922, 3.4%), with only 2 patients experiencing emergent resistance to 3GCs. A total of 159 patients were included in the case-control study. Using multivariate logistic regression, independent predictors for relapse were a line-associated source of infection (OR 3.87; 95% CI 1.56-9.60, p = 0.004) and the presence of immunosuppression (OR 2.70; 95% CI 1.14-6.44, p = 0.02). On univariate analysis definitive therapy with a broad-spectrum beta-lactam-beta-lactamase inhibitor (BLBLI, e.g. piperacillin-tazobactam) was not associated with relapse (OR 1.83; 95% CI 0.64-5.21, p = 0.26) although the proportion of patients receiving a BLBLI as definitive therapy was relatively small (21/159, 13.2%). Conclusions: The risk of relapsed or persistent Enterobacter bacteraemia appears to be low in Australia. A line-associated source of infection and immunocompromise were significant independent predictors for relapse. Larger, preferably randomized, studies are needed to address whether BLBLIs represent an effective carbapenem-sparing option for Enterobacter bacteraemia.]]> Mon 23 Sep 2019 12:28:05 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47481 Mon 23 Jan 2023 11:40:45 AEDT ]]>