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1. Atezolizumab and chemotherapy for advanced or recurrent endometrial cancer (AtTEnd): a randomised, double-blind, placebo-controlled, phase 3 trial

Author

Colombo, N, Biagioli, E, Harano, K, Galli, F, Hudson, E, Antill, Y, Choi, C, Rabaglio, M, Marmé, F, Marth, C, Parma, G, Fariñas-Madrid, L, Nishio, S, Allan, K, Lee, Y, Piovano, E, Pardo, B, Nakagawa, S, Mcqueen, J, Zamagni, C, Manso, L, Takehara, K, Tasca, G, Ferrero, A, Tognon, G, Lissoni, A, Petrella, M, Laudani, M, Rulli, E, Uggeri, S, Barretina Ginesta, M, Zola, P, Casanova, C, Arcangeli, V, Antonuzzo, L, Gadducci, A, Cosio, S, Clamp, A, Persic, M, Mcneish, I, Tookman, L, Redondo Sanchez, A, Baldini, E, Palaia, I, Benedetti Panici, P, Takahashi, N, Lombard, J, Ardizzoia, A, Bologna, A, Herrero Ibáñez, A, Musolino, A, Márquez Vázquez, R, Pietzner, K, Braicu, E, Heinzelmann-Schwarz, V, Powell, M, Yokoyama, Y, Baron-Hay, S, Abeni, C, Martin Lorente, C, Cueva, J, Trillsch, F, Heitz, F, Ataseven, B, Petru, E, Heubner, M, Sadozye, A, Dubey, S, Tazbirkova, A, Tiley, S, Chrystal, K, Kim, S, Fehr, M, Scatchard, K, Anand, A, Taylor, A, Watary, H, Enomoto, T, Yoshihara, K, Selva-Nayagam, S, Karki, B, Harrison, M, Wilkinson, K, Goh, J, Glasgow, A, Chantrill, L, Lee, C, Bertolini, A, Narducci, F, Bellotti, G, Fusco, V, Aebi, S, Del Grande, M, Colombo, I, Tokunaga, H, Shigeta, S, Goss, G, Siow, Z, Steer, C, Lin, H, Colombo N., Biagioli E., Harano K., Galli F., Hudson E., Antill Y., Choi C. H., Rabaglio M., Marmé F., Marth C., Parma G., Fariñas-Madrid L., Nishio S., Allan K., Lee Y. C., Piovano E., Pardo B., Nakagawa S., McQueen J., Zamagni C., Manso L., Takehara K., Tasca G., Ferrero A., Tognon G., Lissoni A. A., Petrella M., Laudani M. E., Rulli E., Uggeri S., Barretina Ginesta M. P., Zola P., Casanova C., Arcangeli V., Antonuzzo L., Gadducci A., Cosio S., Clamp A., Persic M., McNeish I., Tookman L., Redondo Sanchez A., Baldini E., Palaia I., Benedetti Panici P., Takahashi N., Lombard J., Ardizzoia A., Bologna A., Herrero Ibáñez A. M., Musolino A., Márquez Vázquez R., Pietzner K., Braicu E., Heinzelmann-Schwarz V. A., Powell M., Yokoyama Y., Baron-Hay S., Abeni C., Martin Lorente C., Cueva J. F., Trillsch F., Heitz F., Ataseven B., Petru E., Heubner M. L., Sadozye A. H., Dubey S., Tazbirkova A., Tiley S., Chrystal K., Kim S. W., Fehr M., Scatchard K., Anand A., Taylor A., Watary H., Enomoto T., Yoshihara K., Selva-Nayagam S., Karki B., Harrison M., Wilkinson K., Goh J., Glasgow A., Chantrill L., Lee C., Bertolini A., Narducci F., Bellotti G., Fusco V., Aebi S., Del Grande M., Colombo I., Tokunaga H., Shigeta S., Goss G., Siow Z. R., Steer C., Lin H., Colombo, N, Biagioli, E, Harano, K, Galli, F, Hudson, E, Antill, Y, Choi, C, Rabaglio, M, Marmé, F, Marth, C, Parma, G, Fariñas-Madrid, L, Nishio, S, Allan, K, Lee, Y, Piovano, E, Pardo, B, Nakagawa, S, Mcqueen, J, Zamagni, C, Manso, L, Takehara, K, Tasca, G, Ferrero, A, Tognon, G, Lissoni, A, Petrella, M, Laudani, M, Rulli, E, Uggeri, S, Barretina Ginesta, M, Zola, P, Casanova, C, Arcangeli, V, Antonuzzo, L, Gadducci, A, Cosio, S, Clamp, A, Persic, M, Mcneish, I, Tookman, L, Redondo Sanchez, A, Baldini, E, Palaia, I, Benedetti Panici, P, Takahashi, N, Lombard, J, Ardizzoia, A, Bologna, A, Herrero Ibáñez, A, Musolino, A, Márquez Vázquez, R, Pietzner, K, Braicu, E, Heinzelmann-Schwarz, V, Powell, M, Yokoyama, Y, Baron-Hay, S, Abeni, C, Martin Lorente, C, Cueva, J, Trillsch, F, Heitz, F, Ataseven, B, Petru, E, Heubner, M, Sadozye, A, Dubey, S, Tazbirkova, A, Tiley, S, Chrystal, K, Kim, S, Fehr, M, Scatchard, K, Anand, A, Taylor, A, Watary, H, Enomoto, T, Yoshihara, K, Selva-Nayagam, S, Karki, B, Harrison, M, Wilkinson, K, Goh, J, Glasgow, A, Chantrill, L, Lee, C, Bertolini, A, Narducci, F, Bellotti, G, Fusco, V, Aebi, S, Del Grande, M, Colombo, I, Tokunaga, H, Shigeta, S, Goss, G, Siow, Z, Steer, C, Lin, H, Colombo N., Biagioli E., Harano K., Galli F., Hudson E., Antill Y., Choi C. H., Rabaglio M., Marmé F., Marth C., Parma G., Fariñas-Madrid L., Nishio S., Allan K., Lee Y. C., Piovano E., Pardo B., Nakagawa S., McQueen J., Zamagni C., Manso L., Takehara K., Tasca G., Ferrero A., Tognon G., Lissoni A. A., Petrella M., Laudani M. E., Rulli E., Uggeri S., Barretina Ginesta M. P., Zola P., Casanova C., Arcangeli V., Antonuzzo L., Gadducci A., Cosio S., Clamp A., Persic M., McNeish I., Tookman L., Redondo Sanchez A., Baldini E., Palaia I., Benedetti Panici P., Takahashi N., Lombard J., Ardizzoia A., Bologna A., Herrero Ibáñez A. M., Musolino A., Márquez Vázquez R., Pietzner K., Braicu E., Heinzelmann-Schwarz V. A., Powell M., Yokoyama Y., Baron-Hay S., Abeni C., Martin Lorente C., Cueva J. F., Trillsch F., Heitz F., Ataseven B., Petru E., Heubner M. L., Sadozye A. H., Dubey S., Tazbirkova A., Tiley S., Chrystal K., Kim S. W., Fehr M., Scatchard K., Anand A., Taylor A., Watary H., Enomoto T., Yoshihara K., Selva-Nayagam S., Karki B., Harrison M., Wilkinson K., Goh J., Glasgow A., Chantrill L., Lee C., Bertolini A., Narducci F., Bellotti G., Fusco V., Aebi S., Del Grande M., Colombo I., Tokunaga H., Shigeta S., Goss G., Siow Z. R., Steer C., and Lin H.

Abstract

Background: At the time of AtTEnd trial design, standard treatment for advanced or recurrent endometrial cancer included carboplatin and paclitaxel chemotherapy. This trial assessed whether combining atezolizumab with chemotherapy might improve outcomes in this population. Methods: AtTEnd was a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial done in 89 hospitals in 11 countries across Europe, Australia, New Zealand, and Asia. Enrolled patients were aged 18 years or older, and had advanced or recurrent endometrial carcinoma or carcinosarcoma, an Eastern Cooperative Oncology Group performance status of 0–2, and received no previous systemic chemotherapy for recurrence. Patients were randomly assigned (2:1) using an interactive web response system (block size of six) to either atezolizumab 1200 mg or placebo given intravenously with chemotherapy (carboplatin at area under the curve of 5 or 6 and paclitaxel 175 mg/m2 intravenously on day 1 every 21 days) for 6–8 cycles, then continued until progression. Stratification factors were country, histological subtype, advanced or recurrent status, and mismatch repair (MMR) status. Participants and treating clinicians were masked to group allocation. The hierarchically tested co-primary endpoints were progression-free survival (in patients with MMR-deficient [dMMR] tumours, and in the overall population) and overall survival (in the overall population). Primary analyses were done in the intention-to-treat population, defined as all randomly assigned patients who gave their full consent to participation in the study and data processing. Safety was assessed in all patients included in the intention-to-treat population who received at least one dose of study treatment. Here, we report the primary progression-free survival and the interim overall survival results. This study is ongoing and is registered with ClinicalTrials.gov, NCT03603184. Findings: Between Oct 3, 2018, and Jan 7, 2022, 551 patients were r

Published
2024

2. COVID-19: Rapid antigen detection for SARS-CoV-2 by lateral flow assay: A national systematic evaluation of sensitivity and specificity for mass-testing

Author

Peto, T., Affron, D., Afrough, B., Agasu, A., Ainsworth, M., Allanson, A., Allen, K., Allen, C., Archer, L., Ashbridge, N., Aurfan, I., Avery, M., Badenoch, E., Bagga, P., Balaji, R., Baldwin, E., Barraclough, S., Beane, C., Bell, J., Benford, T., Bird, S., Bishop, M., Bloss, A., Body, R., Boulton, R., Bown, A., Bratten, C., Bridgeman, C., Britton, D., Brooks, T., Broughton-Smith, M., Brown, P., Buck, B., Butcher, E., Byrne, W., Calderon, G., Campbell, S., Carr, O., Carter, P., Carter, D., Cathrall, M., Catton, M., Chadwick, J., Chapman, D., Chau, K.K., Chaudary, T., Chidavaenzi, S., Chilcott, S., Choi, B., Claasen, H., Clark, S., Clarke, R., Clarke, D., Clayton, R., Collins, K., Colston, R., Connolly, J., Cook, E., Corcoran, M., Corley, B., Costello, L., Coulson, C., Crook, A., Crook, D.W., D'Arcangelo, S., Darby, M-A, Davis, J., de Koning, R., Derbyshire, P., Devall, P., Dolman, M., Draper, N., Driver, M., Dyas, S., Eaton, E., Edwards, J., Elderfield, R., Ellis, K., Ellis, G., Elwell, S., Evans, R., Evans, B., Evans, M., Eyre, D., Fahey, C., Fenech, V., Field, J., Field, A., Foord, T., Fowler, T., French, M., Fuchs, H., Gan, J., Gernon, J., Ghadiali, G., Ghuman, N., Gibbons, K., Gill, G., Gilmour, K., Goel, A., Gordon, S., Graham, T., Grassam-Rowe, A., Green, D., Gronert, A., Gumsley-Read, T., Hall, C., Hallis, B., Hammond, S., Hammond, P., Hanney, B., Hardy, V., Harker, G., Harris, A., Havinden-Williams, M., Hazell, E., Henry, J., Hicklin, K., Hollier, K., Holloway, B., Hoosdally, S.J., Hopkins, S., Hughes, L., Hurdowar, S., Hurford, S-A, Jackman, J., Jackson, H., Johns, R., Johnston, S., Jones, J., Kanyowa, T., Keating-Fedders, K., Kempson, S., Khan, I., Khulusi, B., Knight, T., Krishna, A., Lahert, P., Lampshire, Z., Lasserson, D., Lee, K., Lee, L.Y.W., Legard, A., Leggio, C., Liu, J., Lockett, T., Logue, C., Lucas, V., Lumley, S.F., Maripuri, V., Markham, D., Marshall, E., Matthews, P.C., Mckee, S., McKee, D.F., McLeod, N., McNulty, A., Mellor, F., Michel, R., Mighiu, A., Miller, J., Mirza, Z., Mistry, H., Mitchell, J., Moeser, M.E., Moore, S., Muthuswamy, A., Myers, D., Nanson, G., Newbury, M., Nicol, S., Nuttall, H., Nwanaforo, J.J., Oliver, L., Osbourne, W., Osbourne, J., Otter, A., Owen, J., Panchalingam, S., Papoulidis, D., Pavon, J.D., Peace, A., Pearson, K., Peck, L., Pegg, A., Pegler, S., Permain, H., Perumal, P., Peto, L., Peto, T.E.A., Pham, T., Pickford, H.L., Pinkerton, M., Platton, M., Price, A., Protheroe, E., Purnell, H., Rawden, L., Read, S., Reynard, C., Ridge, S., Ritter, T.G., Robinson, J., Robinson, P., Rodger, G., Rowe, C., Rowell, B., Rowlands, A., Sampson, S., Saunders, K., Sayers, R., Sears, J., Sedgewick, R., Seeney, L., Selassie, A., Shail, L., Shallcross, J., Sheppard, L., Sherkat, A., Siddiqui, S., Sienkiewicz, A., Sinha, L., Smith, J., Smith, E., Stanton, E., Starkey, T., Stawiarski, A., Sterry, A., Stevens, J., Stockbridge, M., Stoesser, N., Sukumaran, A., Sweed, A., Tatar, S., Thomas, H., Tibbins, C., Tiley, S., Timmins, J., Tomas-Smith, C., Topping, O., Turek, E., Neibler, T., Trigg-Hogarth, K., Truelove, E., Turnbull, C., Tyrrell, D., Vaughan, A., Vertannes, J., Vipond, R., Wagstaff, L., Waldron, J., Walker, P., Walker, A.S., Walters, M., Wang, J.Y., Watson, E., Webberley, K., Webster, K., Westland, G., Wickens, I., Willcocks, J., Willis, H., Wilson, S., Wilson, B., Woodhead, L., Wright, D., Xavier, B., Yelnoorkar, F., Zeidan, L., Zinyama, R., Peto, T., Affron, D., Afrough, B., Agasu, A., Ainsworth, M., Allanson, A., Allen, K., Allen, C., Archer, L., Ashbridge, N., Aurfan, I., Avery, M., Badenoch, E., Bagga, P., Balaji, R., Baldwin, E., Barraclough, S., Beane, C., Bell, J., Benford, T., Bird, S., Bishop, M., Bloss, A., Body, R., Boulton, R., Bown, A., Bratten, C., Bridgeman, C., Britton, D., Brooks, T., Broughton-Smith, M., Brown, P., Buck, B., Butcher, E., Byrne, W., Calderon, G., Campbell, S., Carr, O., Carter, P., Carter, D., Cathrall, M., Catton, M., Chadwick, J., Chapman, D., Chau, K.K., Chaudary, T., Chidavaenzi, S., Chilcott, S., Choi, B., Claasen, H., Clark, S., Clarke, R., Clarke, D., Clayton, R., Collins, K., Colston, R., Connolly, J., Cook, E., Corcoran, M., Corley, B., Costello, L., Coulson, C., Crook, A., Crook, D.W., D'Arcangelo, S., Darby, M-A, Davis, J., de Koning, R., Derbyshire, P., Devall, P., Dolman, M., Draper, N., Driver, M., Dyas, S., Eaton, E., Edwards, J., Elderfield, R., Ellis, K., Ellis, G., Elwell, S., Evans, R., Evans, B., Evans, M., Eyre, D., Fahey, C., Fenech, V., Field, J., Field, A., Foord, T., Fowler, T., French, M., Fuchs, H., Gan, J., Gernon, J., Ghadiali, G., Ghuman, N., Gibbons, K., Gill, G., Gilmour, K., Goel, A., Gordon, S., Graham, T., Grassam-Rowe, A., Green, D., Gronert, A., Gumsley-Read, T., Hall, C., Hallis, B., Hammond, S., Hammond, P., Hanney, B., Hardy, V., Harker, G., Harris, A., Havinden-Williams, M., Hazell, E., Henry, J., Hicklin, K., Hollier, K., Holloway, B., Hoosdally, S.J., Hopkins, S., Hughes, L., Hurdowar, S., Hurford, S-A, Jackman, J., Jackson, H., Johns, R., Johnston, S., Jones, J., Kanyowa, T., Keating-Fedders, K., Kempson, S., Khan, I., Khulusi, B., Knight, T., Krishna, A., Lahert, P., Lampshire, Z., Lasserson, D., Lee, K., Lee, L.Y.W., Legard, A., Leggio, C., Liu, J., Lockett, T., Logue, C., Lucas, V., Lumley, S.F., Maripuri, V., Markham, D., Marshall, E., Matthews, P.C., Mckee, S., McKee, D.F., McLeod, N., McNulty, A., Mellor, F., Michel, R., Mighiu, A., Miller, J., Mirza, Z., Mistry, H., Mitchell, J., Moeser, M.E., Moore, S., Muthuswamy, A., Myers, D., Nanson, G., Newbury, M., Nicol, S., Nuttall, H., Nwanaforo, J.J., Oliver, L., Osbourne, W., Osbourne, J., Otter, A., Owen, J., Panchalingam, S., Papoulidis, D., Pavon, J.D., Peace, A., Pearson, K., Peck, L., Pegg, A., Pegler, S., Permain, H., Perumal, P., Peto, L., Peto, T.E.A., Pham, T., Pickford, H.L., Pinkerton, M., Platton, M., Price, A., Protheroe, E., Purnell, H., Rawden, L., Read, S., Reynard, C., Ridge, S., Ritter, T.G., Robinson, J., Robinson, P., Rodger, G., Rowe, C., Rowell, B., Rowlands, A., Sampson, S., Saunders, K., Sayers, R., Sears, J., Sedgewick, R., Seeney, L., Selassie, A., Shail, L., Shallcross, J., Sheppard, L., Sherkat, A., Siddiqui, S., Sienkiewicz, A., Sinha, L., Smith, J., Smith, E., Stanton, E., Starkey, T., Stawiarski, A., Sterry, A., Stevens, J., Stockbridge, M., Stoesser, N., Sukumaran, A., Sweed, A., Tatar, S., Thomas, H., Tibbins, C., Tiley, S., Timmins, J., Tomas-Smith, C., Topping, O., Turek, E., Neibler, T., Trigg-Hogarth, K., Truelove, E., Turnbull, C., Tyrrell, D., Vaughan, A., Vertannes, J., Vipond, R., Wagstaff, L., Waldron, J., Walker, P., Walker, A.S., Walters, M., Wang, J.Y., Watson, E., Webberley, K., Webster, K., Westland, G., Wickens, I., Willcocks, J., Willis, H., Wilson, S., Wilson, B., Woodhead, L., Wright, D., Xavier, B., Yelnoorkar, F., Zeidan, L., and Zinyama, R.

Abstract

Background Lateral flow device (LFD) viral antigen immunoassays have been developed around the world as diagnostic tests for SARS-CoV-2 infection. They have been proposed to deliver an infrastructure-light, cost-economical solution giving results within half an hour. Methods LFDs were initially reviewed by a Department of Health and Social Care team, part of the UK government, from which 64 were selected for further evaluation from 1st August to 15th December 2020. Standardised laboratory evaluations, and for those that met the published criteria, field testing in the Falcon-C19 research study and UK pilots were performed (UK COVID-19 testing centres, hospital, schools, armed forces). Findings 4/64 LFDs so far have desirable performance characteristics (orient Gene, Deepblue, Abbott and Innova SARS-CoV-2 Antigen Rapid Qualitative Test). All these LFDs have a viral antigen detection of >90% at 100,000 RNA copies/ml. 8951 Innova LFD tests were performed with a kit failure rate of 5.6% (502/8951, 95% CI: 5.1–6.1), false positive rate of 0.32% (22/6954, 95% CI: 0.20–0.48). Viral antigen detection/sensitivity across the sampling cohort when performed by laboratory scientists was 78.8% (156/198, 95% CI 72.4–84.3). Interpretation Our results suggest LFDs have promising performance characteristics for mass population testing and can be used to identify infectious positive individuals. The Innova LFD shows good viral antigen detection/sensitivity with excellent specificity, although kit failure rates and the impact of training are potential issues. These results support the expanded evaluation of LFDs, and assessment of greater access to testing on COVID-19 transmission. Funding Department of Health and Social Care. University of Oxford. Public Health England Porton Down, Manchester University NHS Foundation Trust, National Institute of Health Research.

Published
2021

11. Methicillin-resistant Staphylococcus aureus in the Australian community: An evolving epidemic

Author

Nimmo, G. R., Coombs, G. W., Pearson, J. C., O Brien, F. G., Christiansen, K. J., Turnidge, J. D., Gosbell, I. B., Peter Collignon, Mclaws, M. -L, Faoagali, J., George, N., Harper, J., Schooneveldt, J., Bradbury, S., Tiley, S., Gottlieb, T., Funnell, G., Fernandes, C., Benn, R., Yan, B., Ziochos, H., Vickery, A., Mitchell, D., Ryder, S., Branley, J., Spelman, D., Franklin, C., Garland, S., Gonis, G., Waters, M. J., Joyce, L., Ward, P., Andrew, J., Mcgregor, A., Peterson, R., Bell, J., Lim, I., Pratt, R., Pruul, H., Mulgrave, L., Mcgechie, D., Francis, G., Lurn, G., Paul, M., Robson, J., Lee, P. C., and Benson, S.

12. The spirit of you.

Author

Tiley, S, Walters, Joanne, and Payton, Michelle

Published
2017

13. Not All Body Surface Area Formulas Are the Same, but Does It Matter?

Author

Faisal W, Tang HM, Tiley S, and Kukard C

Abstract

Competing Interests: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. Wasek FaisalNo relationship to discloseHoi-Mun TangNo relationship to discloseSusan TileyNo relationship to discloseCraig KukardTravel, Accommodations, Expenses: Astellas Pharma, Novartis, Pfizer, Roche

Published
2016
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14. Clofarabine in the treatment of acute myeloid leukemia in older adults.

Author

Tiley S and Claxton D

Abstract

Objective: To review the literature evaluating the efficacy and tolerability of clofarabine as a single agent and in combination therapy for older patients with acute myeloid leukemia (AML)., Method: A literature search of the PubMed database (1996-April 2012) using the search terms clofarabine and acute myeloid leukemia was performed. All relevant English language articles were reviewed. Clinical trials with patients aged 50 years or older diagnosed with AML were included., Results: Two studies evaluating clofarabine as monotherapy and five studies evaluating clofarabine in combination with cytarabine were reviewed. Clofarabine demonstrated activity in older adults with AML. Response rates and median overall survival (OS) for patients receiving clofarabine were similar to those for patients receiving conventional induction chemotherapy. The induction mortality rate with clofarabine was lower than that seen with intensive chemotherapy. However, clofarabine was associated with a significant risk of severe complications including myelosuppression and sepsis., Conclusion: Clofarabine is an active agent for the treatment of older patients with AML as a single agent or in combination therapy. Based on published data and side-effect profiles, clofarabine may be an appropriate alternative to intensive chemotherapy for older patients with AML, offering similar response rates to traditional 7+3 chemotherapy with potentially decreased induction mortality. The use of clofarabine in combination with newer agents including DNA methyltransferase inhibitors like decitabine is a promising approach for older patients who are not eligible for intensive chemotherapy. Additional randomized controlled trials are needed to directly compare the efficacy of clofarabine as a single agent and in combination therapy compared with intensive chemotherapy regimens.

Published
2013
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15. Pneumococcal vaccination: an important strategy to prevent pneumonia in Aboriginal and Torres Strait Island adults.

Author

Hanna JN, Gratten M, Tiley SM, Brookes DL, and Bapty G

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pneumococcal Vaccines, Pneumonia, Pneumococcal ethnology, Pneumonia, Pneumococcal mortality, Population Surveillance, Queensland epidemiology, Risk Factors, Bacterial Vaccines, Native Hawaiian or Other Pacific Islander, Pneumonia, Pneumococcal prevention & control, Practice Guidelines as Topic, Vaccination standards
Abstract

The objective of the study was to examine the appropriateness of the National Health and Medical Research Council (NHMRC) recommendations concerning pneumococcal vaccination for Aboriginal and Torres Strait Island adults. Laboratory surveillance of invasive pneumococcal disease identified 95 cases acquired by adults 15 years of age and over in Far North Queensland from 1992 to 1995. The most common diagnosis was pneumonia (77 per cent). Sixty-one cases (64 per cent) occurred in Aboriginal and Torres Strait Island adults, who acquired the disease at a younger age (mean 40 years) than did other adults (mean 50 years). Most (93 per cent) of the Aboriginal and Torres Strait Island adults had at least one of the pre-existing medical conditions in the NHMRC criteria for pneumococcal vaccination. The most common was 'alcohol abuse' (62 per cent). Fifty-three (93 per cent) of the pneumococcal isolates from the Aboriginal and Torres Strait Island adults who had pre-existing conditions were serotyped. Fifty (94 per cent) belonged to types included in the currently available pneumococcal vaccine. We conclude that the NHMRC recommendations for pneumococcal vaccination are appropriate, considering the pattern of invasive pneumococcal disease that occurs in Aboriginal and Torres Strait Island adults in Far North Queensland. Because pneumococcal vaccination can reduce the pneumonia-associated morbidity and premature mortality experienced by Aboriginal and Torres Strait Island adults, the vaccine should be offered routinely to those considered to be at risk, particularly young men who have recently begun to consume hazardous amounts of alcohol, and recently diagnosed diabetics.

Published
1997
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16. Emergence of further serotypes of multiple drug-resistant Streptococcus pneumoniae in Queensland.

Author

Gratten M, Nimmo G, Carlisle J, Schooneveldt J, Seneviratne E, Kelly R, Norton R, Ashhurst-Smith C, Love K, Tiley S, Wood G, and Fenton J

Subjects
Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Drug Resistance, Microbial, Humans, Infant, Middle Aged, Pneumococcal Infections drug therapy, Pneumococcal Infections microbiology, Queensland epidemiology, Serotyping, Streptococcus pneumoniae drug effects, Drug Resistance, Multiple, Pneumococcal Infections epidemiology, Streptococcus pneumoniae classification
Abstract

We describe 27 cases of multiple drug-resistant pneumococcal infection in Queensland children (7 cases) and adults (20 cases), between February 1995 and October 1996. Seven patients had invasive disease. Serotypes were those commonly associated with paediatric infections and included types 19F (15 strains), 14 (6), 23F (4), 6A (1) and 19A (1). No rifampicin or vancomycin resistance was encountered. However, pneumococci fully resistant to cotrimoxazole, erythromycin and tetracycline were isolated from 25 of 27 cases (93%). Strains with high level resistance to penicillin and chloramphenicol were also recovered from 16 (59%) and 19 (70%) patients respectively. Twelve of 16 penicillin-resistant isolates showed intermediate resistance to ceftriaxone and two strains were fully resistant to this antibiotic. Clones of types 19F and 14 pneumococci, each with two distinctive resistance patterns, appear to be established in south-east Queensland.

Published
1997

17. An evaluation of four methods for the detection of Pneumocystis carinii in clinical specimens.

Author

Tiley SM, Marriott DJ, and Harkness JL

Subjects
Evaluation Studies as Topic, Fluorescent Antibody Technique, Humans, Prospective Studies, Sensitivity and Specificity, Staining and Labeling methods, Microbiological Techniques, Pneumocystis isolation & purification, Pneumocystis Infections diagnosis
Abstract

We undertook a prospective evaluation of 4 methods for the detection of Pneumocystis carinii in clinical specimens and compared an indirect immunofluorescence assay (IFA) (Diagnostics Pasteur), and a fluorescent whitening agent (FWA) (Blankophor BA 267%, Bayer, Australia) with our standard methenamine silver (MeAg) and toluidine blue O (TB) stains. Two hundred and two specimens were received from 162 patients (133 HIV infected, 19 heart or heart-lung transplant recipients, and 10 "miscellaneous"). The specimens consisted of 132 induced sputa, 56 bronchoalveolar lavage specimens, 10 fine needle aspiration lung biopsies, and 4 pleural fluid specimens. P. carinii was detected in 44 (22%) of the specimens. The sensitivities for the detection of P. carinii pneumonia were IFA: 92% (95% CI, 83-100%), FWA: 57% (95% CI, 41-73%), MeAg: 54% (95% CI, 38-70%), and TB: 49% (95% CI, 33-65%). Discordant results were greatest in specimens from patients who were receiving specific anti-P. carinii prophylaxis, or who had received treatment for several days prior to sampling. IFA was the most sensitive test and relatively easy to perform. IFA was also the most expensive test. We found the FWA method a useful screening test as it is cheap and quick to perform. However, it is less sensitive than IFA, which should be performed on the negative specimens. With the increasing use of specific anti-P. carinii prophylaxis in HIV-infected patients, methods more specific and sensitive than MeAg and TB stains are required. We have found IFA to improve significantly the rate of detection of P. carinii in this patient group.

Published
1994
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