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Collins D.A.,University of Western Australia | Hawkey P.M.,Public Health England | Hawkey P.M.,University of Birmingham | Riley T.V.,University of Western Australia | Riley T.V.,PathWest Laboratory Medicine WA
Antimicrobial Resistance and Infection Control | Year: 2013

While Clostridium difficile infection (CDI) has come to prominence as major epidemics have occurred in North America and Europe over the recent decade, awareness and surveillance of CDI in Asia have remained poor. Limited studies performed throughout Asia indicate that CDI is also a significant nosocomial pathogen in this region, but the true prevalence of CDI remains unknown. A lack of regulated antibiotic use in many Asian countries suggests that the prevalence of CDI may be comparatively high. Molecular studies indicate that ribotypes 027 and 078, which have caused significant outbreaks in other regions of the world, are rare in Asia. However, variant toxin A-negative/toxin B-positive strains of ribotype 017 have caused epidemics across several Asian countries. Ribotype smz/018 has caused widespread disease across Japan over the last decade and more recently emerged in Korea. This review summarises current knowledge on CDI in Asian countries. © 2013 Collins et al.; licensee BioMed Central Ltd.

Slimings C.,University of Western Australia | Riley T.V.,University of Western Australia | Riley T.V.,PathWest Laboratory Medicine WA
Journal of Antimicrobial Chemotherapy | Year: 2014

Objectives: To update the evidence for associations between antibiotic classes and hospital-acquired Clostridium difficile infection (HA-CDI). Methods: Electronic databases of journal articles, scholarly theses and conference proceedings using subject headings and keywords related to CDI and antibiotic exposure were searched. Observational epidemiological studies measuring associations between antibiotic classes and HA-CDI were eligible for inclusion. Pooled ORs and 95% CIs were calculated using a random effects model. Study factors identified a priori were examined as sources of heterogeneity. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Results: Of 569 citations identified, 13 case-control and 1 cohort study (15 938 patients) were included. The strongest associations were found for third-generation cephalosporins (OR = 3.20, 95% CI = 1.80-5.71; n = 6 studies; I2 = 79.2%), clindamycin (2.86, 2.04-4.02; n = 6; I2 = 28.5%), second-generation cephalosporins (2.23, 1.47-3.37; n = 6; I2 = 48.4%), fourth-generation cephalosporins (2.14, 1.30-3.52; n = 2; I2 = 0.0%), carbapenems (1.84, 1.26-2.68; n = 6; I2 = 0.0%), trimethoprim/sulphonamides (1.78, 1.04-3.05; n = 5; I2 = 70%), fluoroquinolones (1.66, 1.17-2.35; n = 10; I2 = 64%) and penicillin combinations (1.45, 1.05-2.02; n = 6; I2 = 54%). The study population and the timing of measurement of antibiotic exposure were the most common sources of heterogeneity. Study quality scored high for seven studies, moderate for six studies and low for one study. Conclusions: The risk of HA-CDI remains greatest for cephalosporins and clindamycin, and their importance as inciting agents should not be minimized. The importance of fluoroquinolones should not be overemphasized, particularly if fluoroquinolone-resistant epidemic strains of C. difficile are absent. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Myhill P.C.,University of Western Australia | Davis W.A.,University of Western Australia | Peters K.E.,University of Western Australia | Chubb S.A.P.,University of Western Australia | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Few prospective intervention studies have examined the effect of continuous positive airway pressure (CPAP) therapy on cardiovascular disease (CVD) risk factors in diabetes. Objective: Our objective was to determine whether CPAP improves CVD risk factors in patients with type 2 diabetes and obstructive sleep apnea (OSA). Design and Setting: This was a randomized parallel group intervention trial in an urban Australian community. Patients: Fifty-nine participants of the Fremantle Diabetes Study Phase II at high risk for OSA consented to confirmatory polysomnography followed by randomization to a 3-month CPAP intervention initiated early (<1 wk) or late (1-2 months). Main Outcome Measures: Patients were assessed before and 1 and 3 months after CPAP started. Tests for repeated measures were used to compare variables of interest over time. Results: Forty-four patients (75%) completed the study. Their mean ± SD age was 66.1 ± 8.8 yr, and 61.4% were male. Completers and noncompleters had similar age, sex, diabetes duration, apneahypopnea index, and Epworth Sleepiness Scale (P ≥ 0.29). There were no differences in outcome between early and late randomization, and the data were pooled. The Epworth Sleepiness Scale decreased between entry and 1 month [-4.8 (-6.5 to -3.1), P < 0.001]. Blood pressure improved between entry and 3 months (from 149 ± 23/80 ± 12 to 140 ± 18/73 ± 13 mm Hg; P ≤ 0.007). Pulse rate declined within the first month [-6 (-10 to -2) beats/min, P = 0.002]. Glycemic control and serum lipids, which were mostly within recommended target ranges at entry, did not change. Conclusions: Three months of CPAP in community-based people with type 2 diabetes significantly decreased blood pressure and pulse rate but did not influence metabolic control. Copyright © 2012 by The Endocrine Society.

Hooper A.J.,PathWest Laboratory Medicine WA | Burnett J.R.,PathWest Laboratory Medicine WA | Burnett J.R.,University of Western States
Expert Opinion on Biological Therapy | Year: 2013

Introduction: Proprotein convertase subtilisin kexin type 9 (PCSK9), a serine protease that binds to the low density lipoprotein (LDL) receptor promoting its degradation, is an important regulator of LDL metabolism. PCSK9 'gain-of-function' mutations are rare and cause high plasma LDL-cholesterol and increase atherosclerotic cardiovascular disease, whereas more common 'loss-of-function' mutations cause low LDL-cholesterol and atheroprotection. PCSK9 is a novel, attractive and viable therapeutic target for the treatment of hypercholesterolemia, with human studies using a variety of anti-PCSK9 therapies underway. Areas covered: This review summarizes the latest findings in clinical trials of PCSK9 inhibitors, including antibodies, gene silencing and small peptides. Expert opinion: PCSK9 inhibition would appear to be an effective strategy for lowering plasma LDL-cholesterol and enhancing the LDL-cholesterol lowering ability of statins in patients with familial hypercholesterolemia, patients with refractory hypercholesterolemia at high risk of cardiovascular disease and patients with severe hypercholesterolemia who are not at target or are intolerant of statins, with a variety of anti-PCSK9 therapies in clinical trials. © 2013 Informa UK, Ltd.

O'Reilly L.C.,PathWest Laboratory Medicine WA
Journal of Microbiological Methods | Year: 2011

The DNA of some bacteria is broken up by Tris-dependent endonuclease activity during the process of sample preparation for pulsed field gel electrophoresis (PFGE). Adding thiourea to the electophoresis buffer for isolates that exhibit DNA degradation has been the method used for many bacterial genera. For a particular group of isolates of Serratia marcescens this method was unsuccessful. A combination of techniques was used to overcome the problem. © 2011 Elsevier B.V.

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