Search

Background: Bacterial meningitis is a medical emergency and timely management has been shown to improve outcomes. The aim of this study was to compare the early assessment and management of adults with suspected community‐onset meningitis between hospitals and identify opportunities for clinical practice improvement. Methods: This retrospective cohort study was conducted at three principal referral hospitals in Sydney, Australia. Adult patients with suspected meningitis undergoing cerebrospinal fluid sampling between 1 July 2018 and 31 June 2019 were included. Relevant clinical and laboratory data were extracted from the medical record. Differences between sites were analysed and factors associated with time to antimicrobial therapy were assessed by Cox regression. Results: In 260 patients, the median time from triage to antibiotic administration was 332 min with a difference of up to 147 min between hospitals. Median time from triage to lumbar puncture (LP) was 366 min with an inter‐hospital difference of up to 198 min. Seventy per cent of patients had neuroimaging prior to LP, and this group had a significantly longer median time to antibiotic administration (367 vs 231 min; P = 0.001). Guideline concordant antibiotics were administered in 84% of patients, with only 39% of those administered adjunctive corticosteroids. Seven (3%) patients had confirmed bacterial meningitis. Modifiable factors associated with earlier antimicrobial administration included infectious diseases involvement (adjusted hazard ratio [aHR], 1.50 [95% confidence interval (CI), 1.01–2.24]) and computed tomography (CT) scanning (aHR, 0.67 [95% CI, 0.46–0.98]). Conclusion: Opportunities for improvement include reducing the time to LP and antibiotic administration, improving coadministration of corticosteroids and avoiding potentially unnecessary CT scanning. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the role of viral polymerase chain reaction (PCR) testing in patients with aseptic meningitis and identify opportunities for improvement in clinical management. All cerebrospinal fluid samples collected in 1 year from four teaching hospitals in Sydney, Australia, were reviewed. Patients with aseptic meningitis were selected, and clinical and diagnostic features, hospital length of stay (LOS), and treatment were analyzed. Identifying a cause by viral PCR did not reduce hospital LOS (median 3 days) or antibiotic use (median 2 days), but the turnaround time of the PCR test correlated with LOS (Rs = 0.3822, p = 0.0003). Forty‐one percent of patients received intravenous acyclovir treatment, which was more frequent in patients admitted under neurologists than infectious diseases physicians (56% vs. 24%; p = 0.013). The majority of patients did not have investigations for alternative causes of aseptic meningitis such as human immunodeficiency virus and syphilis if the viral PCR panel was negative. The benefit of PCR testing in aseptic meningitis in adults in reducing LOS and antibiotic use is unclear. The reasons for unnecessary aciclovir use in meningitis syndromes require further assessment. [ABSTRACT FROM AUTHOR]

Background and Aims: Significant barriers exist with hepatitis B (HBV) case detection and effective linkage to care (LTC). The emergency department (ED) is a unique healthcare interaction where hepatitis screening and LTC could be achieved. We examined the efficacy and utility of automated ED HBV screening for Overseas Born (OB) patients. Methods: A novel‐automated hepatitis screening service "SEARCH" (Screening Emergency Admissions at Risk of Chronic Hepatitis) was piloted at a metropolitan hospital. A retrospective and comparative analysis of hepatitis testing during the SEARCH pilot compared to a period of routine testing was conducted. Results: During the SEARCH pilot, 4778 OB patients were tested for HBV (86% of eligible patient presentations), compared with 1.9% of eligible patients during a control period of clinician‐initiated testing. SEARCH detected 108 (2.3%) hepatitis B surface antigen positive patients including 20 (19%) in whom the diagnosis was new. Among 88 patients with known HBV, 57% were receiving medical care, 33% had become lost to follow‐up and 10% had never received HBV care. Overall, 30/88 (34%) patients with known HBV were receiving complete guideline‐based care prior to re‐engagement via SEARCH. Following SEARCH, LTC was successful achieved in 48/58 (83%) unlinked patients and 19 patients were commenced on anti‐viral therapy. New diagnoses of cirrhosis and hepatocellular carcinoma were made in five and one patient(s) respectively. Conclusions: Automated ED screening of OB patients is effective in HBV diagnosis, re‐diagnosis and LTC. Prior to SEARCH, the majority of patients were not receiving guideline‐based care. [ABSTRACT FROM AUTHOR]

Background and Aims: Achieving Hepatitis B e antigen seroconversion (HBeAg SC) at an earlier age confers a better prognosis. We examined baseline and post‐partum factors associated with HBeAg SC after pregnancy. We developed a tool, the SydPregScore, to estimate the likelihood of HBeAg SC in the years after pregnancy. Methods: A retrospective analysis of an HBeAg‐positive pregnant cohort was conducted. Variables including baseline age, parity, alanine aminotransferase level, HBV viral load, quantitative HBsAg, use of antiviral therapy and post‐partum flare were collected. Univariate and multivariate Cox regression analyses to determine predictors of HBeAg SC and develop a predictor score were performed. Results: We analysed HBeAg SC rates in 220 pregnancies to 149 HBeAg‐positive women from 2006 to 2019. At baseline, their median age was 33 (IQR 29–37), ALT 23 U/L (IQR 17–33) and viral load 8 log10IU/mL (IQR 6.3–8.2 log10IU/mL). The majority (133/198, 67.2%) received short‐course antiviral therapy to prevent mother‐to‐child transmission, and 109/192 (56.8%) had a post‐partum flare. HBeAg SC occurred in 74/220 (33.6%) after pregnancy (median follow‐up 814 days, IQR 405–1531). Multivariate analysis identified baseline viral load <8 log10IU/mL (HR 2.426 [1.224–4.809], p =.011), baseline ALT ≥2 ULN (HR 2.726 [1.299–5.721], p =.008) and age <35 (HR 2.859 [1.255–6.513], p =.012) to be positive predictors of HBeAg SC. The 'SydPreg Score' estimated the probability of HBeAg SC at 2000 days as 10%, 30%, 70% and 80% for 0, 1, 2, and 3 predictors respectively. Conclusion: The SydPreg Score allows the prediction of HBeAg SC in the years after pregnancy. Even in those without elevated ALT, age <35 and viral load <8 log10IU/mL can identify women with a good chance of subsequent HBeAg SC. Those without a chance may benefit from viral suppression. [ABSTRACT FROM AUTHOR]

Objectives: In 2016, The Royal College of Pathologists of Australasia (RCPA) initiated the formation of a working group comprising medical microbiologists to establish guidelines to assist Australian laboratories to implement selective and cascade reporting of antimicrobials-the first guidelines of this type in the world.Methods: A 2017 audit of antimicrobial reporting in Australian and New Zealand laboratories identified significant opportunities for improvement and standardization of selective reporting.Results: The first draft of the RCPA Selective Reporting Guidelines was circulated to all RCPA Microbiology fellows for feedback in August 2018 and the first version was published in February 2019. Subsequently, version two of the guidelines has recently been published in Australia, and New Zealand adapted these guidelines for formulation of their own national guidelines to accommodate local needs.Conclusions: Here we describe the processes, acceptance and challenges associated with the establishment of these guidelines and measurement of their impact. [ABSTRACT FROM AUTHOR]

The document titled "Author Index" is a list of authors and their corresponding page numbers in the Journal of Gastroenterology & Hepatology. It includes a diverse range of authors from various backgrounds and countries. This index can be helpful for library patrons conducting research to quickly locate articles written by specific authors in the journal. However, without further investigation, the significance or context of the list is not clear. [Extracted from the article]