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P J Collignon

Publications and source records attributed to P J Collignon.

At least 37 records · Page 2Linked to original sources
PubMed1994

Intravascular catheter associated sepsis: a common problem. The Australian Study on Intravascular Catheter Associated Sepsis.

OBJECTIVE: To estimate the number of episodes of intravascular catheter associated sepsis that occur in Australia per year. DESIGN AND SETTING: Data were collected from 15 Australian hospitals (mainly tertiary referral hospitals). All positive results of blood cultures were followed up and the primary sepsis site identified and recorded. The average study period was 1.2 years. RESULTS: Eight hundred and nine episodes of systemic sepsis associated with intravascular catheters were identified from 4957 separate episodes of bacteraemia or fungaemia. Of those in which the catheter site was known, there were 491 episodes of sepsis associated with central vein catheters and 233 with peripheral vein catheters. Systemic sepsis with peripheral vein catheters occurred with 0.36 of every 1000 catheters purchased, but with central vein catheters it was 23 episodes per 1000 catheters (relative risk, 64; 95% confidence interval, 54-76). In these hospitals, 8.2 episodes of intravascular catheter associated sepsis occurred annually per 100 beds and 1.5 episodes per 1000 admissions. From these figures, at least 3000 cases of intravascular sepsis may occur per year in Australia. CONCLUSIONS: Intravascular catheter sepsis is common. Central vein catheters cause more sepsis than peripheral vein catheters. With the greater use of catheters this problem is likely to increase.

Australia↗
PubMed1994

Hospital practices influence the pattern of infective endocarditis.

OBJECTIVE: To identify factors contributing to infective endocarditis at a major teaching hospital. METHODS: Retrospective review of clinical records of patients diagnosed with endocarditis by standard case definitions with respect to causative organisms, clinical features and outcome. RESULTS: One hundred and ninety-three episodes of endocarditis seen between 1979 and 1992 at Westmead Hospital, Sydney, were reviewed. In the 174 cases where the causative organism was isolated, 75 (43%) were Staphylococcus aureus and 50 (29%) were viridans streptococci. Nosocomial acquisition and/or inter-hospital transfer accounted for 83 episodes; 48 (58%) S. aureus (P < 0.001) and nine (11%) viridans streptococci (P < 0.001). In cases from the local community, viridans streptococci were more common than S. aureus (37% versus 25%); these included 18 episodes (14 S. aureus) in intravenous drug users. CONCLUSION: We conclude that, compared with community-acquired infections, the aetiology of endocarditis in a large teaching hospital is influenced strongly by the prevalence of nosocomial endocarditis and the need for interhospital transfer of complicated cases.

Community-Acquired Infections↗
PubMed1993

Bacteraemia and fungaemia in an Australian general hospital--associations and outcomes.

OBJECTIVE: To obtain a comprehensive overview of bacteraemia and fungaemia in a general hospital and thus to determine the incidence, primary sites of sepsis, organisms involved and associated mortality. DESIGN: A prospective laboratory and clinical evaluation of all episodes where microorganisms were cultured from blood over one year. SETTING: The two major hospitals in the Australian Capital Territory which have both community and referral functions. These hospitals provide obstetric and paediatric services along with adult medicine and surgery. PATIENTS: All those who acquired bacteraemia in hospital or presented with a blood-stream infection documented by a positive blood culture. RESULTS: During 1990, 474 clinical episodes of bacteraemia or fungaemia were detected in 446 patients. Significant isolates were identified in 317 of these episodes. The incidence of significant sepsis was 8.1 episodes per 1000 admissions. The most common organisms isolated were Staphylococcus aureus (75 episodes) and Escherichia coli (70 episodes). One hundred and twenty-eight episodes were hospital acquired. Intravenous catheters were the primary sites of sepsis in 68 episodes. Fifty patients died. Higher mortality rates were associated with patients over 60 years of age, respiratory tract sepsis, endocarditis and the presence of an underlying malignancy. CONCLUSION: Bacteraemia and fungaemia are common problems. Nosocomial bacteraemia accounted for 40% of episodes. Half of these nosocomial infections were iatrogenic. Many of the episodes of intravenous catheter sepsis were potentially preventable. Ongoing programs of surveillance of bacteraemia, with the evaluation of primary site, associated features and mortality, are essential to monitor the dimensions of this problem and aid in implementing effective preventive strategies.

Bacteremia↗
PubMed1992

Invasive Haemophilus influenzae infection in the Australian Capital Territory region.

OBJECTIVE: To investigate the pattern of invasive Haemophilus influenzae disease in the Australian Capital Territory (ACT) region with a view to assessing the possible benefits of vaccination in this community. SETTING AND DESIGN: The microbiology department of Royal Canberra Hospital processes all specimens from the three public hospitals in the ACT. Together these hospitals provide all paediatric medical and approximately 80% of adult inpatient beds available in the ACT. We identified all laboratory isolates of H. influenzae obtained from normally sterile sites from 1984 to 1990, and reviewed the clinical records of these patients. Also included in this analysis were all cases of acute epiglottitis identified in hospital discharge summaries, intensive care and coroners' records. Epidemiological, clinical and microbiological data were gathered and assessed. RESULTS: We identified 138 cases of infection. Forty per cent (36 of 66 cases of meningitis, 5 of 44 cases of epiglottitis, 10 of 12 cases of cellulitis) occurred in children aged less than 18 months. Meningitis (48%), epiglottitis (32%), cellulitis (9%) and primary bacteraemia (4%) were the most common syndromes seen. The annual incidence of invasive H. influenzae disease in Canberra was 63.2 per 100,000 children aged under five years. Approximately 1 in 225 children under five years of age and resident in Canberra developed invasive H. influenzae disease. Ninety-eight per cent of isolates serotyped were type b. CONCLUSION: A vaccination program effective in preventing H. influenzae type b infection, completed in infants before 6 months of age, could prevent upwards of 80% of invasive H. influenzae disease in our population. Such a program should be cost effective although precise assessment is hampered by the lack of accurate data on the acceptance rate, costs and efficacy of the current childhood vaccination schedule in our region.

Bacteremia↗
PubMed1992

A national collaborative study of resistance to antimicrobial agents in Haemophilus influenzae in Australian hospitals. The Australian Group for Antimicrobial Resistance (AGAR).

An Australia-wide survey of the prevalence of resistance to antimicrobial agents among Haemophilus influenzae was conducted on clinically significant isolates collected between July 1988 and September 1990. Laboratories from the capital cities of each Australian state and territory participated. Nine hundred and seventy clinical isolates were examined for beta-lactamase production and the MICs of ampicillin, coamoxiclav, chloramphenicol, cefaclor, ceftriaxone, cefotaxime, tetracycline, rifampicin, trimethoprim, sulphamethoxazole and co-trimoxazole were determined using the NCCLS agar dilution method with Haemophilus Test Medium. A smaller number of isolates were tested against penicillin V, penicillin G, ciprofloxacin, piperacillin and erythromycin in addition. The proportion of beta-lactamase producing strains was higher among invasive strains (21.6%) than non-invasive strains (14.2%) and varies considerably between states. The highest prevalence of ampicillin resistance was found in invasive strains from Canberra (40.8%), the lowest in non-invasive strains from Adelaide (5.1%). Paradoxically, in non-invasive strains, although beta-lactamase production was less common, resistance to other antimicrobials was commoner than in invasive strains and also varied between states.

Anti-Bacterial Agents↗
PubMed1992

Streptococcus pneumoniae: how common is penicillin resistance in Australia?

Streptococcus pneumoniae in the past were uniformly susceptible to penicillin. Increasing levels of resistance are now seen worldwide. To define the prevalence of this resistance in Australia, a collaborative study was carried out on all pneumococcal isolates at 15 large metropolitan teaching hospitals. During 1989 details of results of penicillin testing using routine methods were recorded. Isolates found resistant to penicillin were forwarded to Woden Valley Hospital for determination of penicillin minimum inhibitory concentration (MIC). All invasive isolates from five of these hospitals were also forwarded during 1989 and 1990 for MIC testing. Of the 1822 isolates tested, 31 (1.7%) were recorded as penicillin resistant. However, only 16 of 22 resistant isolates forwarded for MIC testing had MICs of > or = 0.1 mg/L confirmed. After adjustment to account for discrepancies with different laboratory testing methods we calculated the likely penicillin resistance to be 1% of isolates. Two of 105 invasive strains tested were found to be penicillin resistant. We conclude that penicillin-resistant S. pneumoniae isolates, including isolates from invasive sites, are found in Australia. All of these isolates had an MIC between 0.1 and 1 mg/L and are thus regarded as 'intermediately' penicillin resistant isolates. No high level resistance (MIC > or = 2 mg/L) was observed. Ongoing surveillance is essential to detect changes in resistance patterns and prevalence, as this will have implications for the empiric treatment of serious disease caused by S. pneumoniae.

Australia↗
PubMed1991

Cleaning and disinfection of endoscopes: have there been recent improvements?

OBJECTIVE: to determine if there have been improvements in the manner in which endoscopes are being cleaned and disinfected since our previous study in 1987. In that study of 123 hospitals, in only 45% of institutions did cleaning and disinfection appear to be satisfactory. DESIGN: One hundred and twenty-two questionnaires were sent to the endoscopy charge nurse of the hospitals identifiable from our previous study. To ensure the collection of complete information from these hospitals, in those from whom a written reply was not received, the information was obtained by persistent telephone contact. The criteria used to assess adequate cleaning and disinfection were the same as in our previous study. These were based on recommendations of learned bodies and the literature. SETTING: A complete cross section of hospitals from all States and Territories in Australia was surveyed. These were both public and private, primary care to tertiary referral, teaching and non-teaching, city and country. MAIN OUTCOME: One hundred and twenty-three replies were obtained from the 122 hospitals surveyed. In 75% cleaning and disinfection of endoscopes appeared to be satisfactory. Adequate cleaning procedures were noted in 77% compared with 60% in the 1987 survey. The use of appropriate disinfection increased to 94% from 62% previously. CONCLUSION: We found that since 1987 there had been a considerable improvement in the cleaning and disinfection of endoscopes in the hospitals surveyed.

Australia↗
PubMed1990

An Australia-wide epidemic of Pseudomonas pickettii bacteraemia due to contaminated "sterile" water for injection.

Nineteen cases of Pseudomonas pickettii bacteraemia and one case of Pseudomonas cepacia bacteraemia were identified in an Australia-wide outbreak of nosocomial sepsis associated with contaminated water for injection. The contamination was limited to one batch of commercially produced water for injection. Four different organisms were identified (three biotypes of P. pickettii and one of P. cepacia). However, P. pickettii biotype 1 appeared to be relatively more virulent than the other biotypes as it was the only identified organism in blood cultures in nearly all cases of sepsis. The ampoules of "sterile" water were each contaminated with approximately 10(3) organisms per millilitre. The lack of an Australian central reporting system for bacteraemia delayed the recognition of this outbreak.

Adult↗
PubMed1990

Endocarditis associated with prosthetic cardiac valves.

Clinical features, microbiology, therapy and outcome of 26 episodes of prosthetic valve endocarditis occurring at Westmead Hospital from 1979 to 1989 were examined retrospectively. Presentation with a new or changed cardiac murmur was associated with early onset infection (within 12 months of prosthetic valve insertion; P = 0.0033). Corynebacteria were the commonest cause of early onset endocarditis (4 of 11 episodes) and Streptococcus viridans of late onset endocarditis (4 of 15 episodes). Nine of 11 episodes responded to antimicrobial therapy and 12 of 15 to medical-surgical therapy. There was a trend towards increased mortality in patients with early onset endocarditis presenting with a new or changed cardiac murmur (4 of 9 v. 1 of 17, P = 0.068), suggesting early surgery should be considered in this group. Analysis of antibiograms and published reports indicated that vancomycin and an aminoglycoside should be recommended as empirical therapy for endocarditis occurring 12 to 18 months after prosthetic valve insertion.

Aminoglycosides↗
PubMed1990

Neurocysticercosis: an under-recognized cause of neurological problems.

Neurocysticercosis is an uncommon, and under-recognized condition in Australia. Changes in immigration patterns may lead to a rising prevalence in this country. Epilepsy is the most common presentation, but it has many other variable forms of neurological manifestations. Eight cases are described, all in immigrants from Eastern Europe, Asia or Central America; the disease was presumably acquired before arrival in Australia. Six patients had symptoms for two to 30 years before the diagnosis was made and, in some cases, the first neurological manifestations appeared decades after initial infection. In patients with active disease a successful outcome followed therapy with praziquantel and corticosteroids. We advise that all patients requiring treatment be admitted to hospital for corticosteroid and anticonvulsant therapy to minimize the clinical deterioration which may result from therapeutic destruction of larvae.

Adolescent↗
PubMed1989

Laboratory diagnosis of intravascular catheter associated sepsis.

Many different methods have been employed to aid in the laboratory diagnosis of intravascular catheter associated infection. However, because of differences in patient populations, the definition of catheter sepsis and types of catheters, comparison of these studies is difficult. Of even more fundamental importance, the question of the pathogenesis of intravascular catheter associated sepsis (i.e. whether the microorganisms migrate to the intravascular space via the internal or external surface of the catheter) has not been resolved and is the subject of ongoing controversy. Semiquantitative culture of catheter tips would appear the easiest and most labour-efficient method available at present to diagnose catheter related infection. With central vein catheter tips, however, a cut-off level below 15 CFU per plate should be adopted as indicating a positive test result, particularly in patient populations with a high prevalence of catheter associated infection. Methods for non-quantitative broth culture of catheter tips are likely to be more sensitive than the semiquantitative method, but are less specific. Quantitative broth methods improve the specificity, but because of the labour costs involved appear not to offer much advantage over the semiquantitative method in the routine clinical laboratory. Many studies have shown that organisms are more frequently seen on staining than recovered by culture of intravascular catheters. Further studies of intravascular cathether sepsis should include a catheter staining method in addition to culture. Aspiration and culture of blood through an intravascular catheter appears to be reasonably specific in diagnosing the presence of infection on the catheter tip, but is only of low sensitivity (20-40%) in the absence of associated bacteremia.

Catheterization, Central Venous↗
PubMed1988

Susceptibility of anaerobic bacteria to antimicrobial agents.

The antimicrobial susceptibility of 1,117 clinical isolates of anaerobic bacteria was determined by the agar dilution technique. Metronidazole was the most active agent; only Propionibacterium acnes and Actinomyces sp. isolates were resistant. Clindamycin and chloramphenical were the next most effective agents. Beta-lactam antibiotics, with the exception of penicillin, were active against most anaerobes other than the Bacteroides fragilis group. At a breakpoint of 8 mg/l, 25% of Fusobacterium spp. and 30% of the non-fragilis Bacteroides spp. were resistant to penicillin. The highest resistance to beta-lactams was seen in the B. fragilis group. Within the indole-positive members of the group, resistance rates of 71% were seen for cefoxitin, 49% for moxalactam, 79% for cefotaxime, 22% for piperacillin and 89% for penicillin. We conclude that metronidazole has the most predictable in vitro activity against common clinical anaerobic isolates and that resistance to beta-lactams was frequent and of potential clinical importance as these latter agents are frequently used in the prophylaxis and therapy of mixed anaerobic infections.

Anti-Bacterial Agents↗