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Arlo Upton

Publications and source records attributed to Arlo Upton.

12 recordsLinked to original sources
PubMed2006

Emergence of opportunistic mould infections in the hematopoietic stem cell transplant patient.

Infection due to opportunistic moulds is an emerging problem in hematopoietic stem cell recipients. Through the 1990s, the incidence of invasive aspergillosis in allogenic graft recipients climbed steadily, peaking at 10% to 15%. In this decade, other opportunistic mould infections are emerging, including zygomycosis, fusariosis, and scedosporiosis. These epidemiologic changes are likely due to greater or different types of host immune suppression, medical interventions such as antifungal prophylaxis, and more successful treatment of aspergillosis, keeping immunosuppressed patients alive and at risk. The non-Aspergillus moulds generally exhibit variable susceptibility to antifungal agents, and outcomes continue to be disappointing. Thus, prevention of infection becomes a prominent concern in the care of these patients.

Journal Article↗
PubMed2005

Excess cost associated with Staphylococcus aureus poststernotomy mediastinitis.

AIM: To determine the additional cost attributable to Staphylococcus aureus poststernotomy mediastinitis (PSM) following sternotomy for cardiac surgery at Green Lane Hospital. METHODS: A retrospective case-control study was undertaken. Nine patients with S. aureus PSM (cases) were matched with nine patients without PSM (controls) for gender, age, type of surgical procedure, time of procedure, and presence of diabetes mellitus. Patients' length and cost of hospital stay (for the admission associated with the initial surgery and any subsequent admissions associated with complications of that surgery) were obtained from the hospital's clinical costing system. RESULTS: S. aureus PSM was associated with longer average length of hospital stay, 42.6+/-18.7 vs 10.4+/-4.0 days (p=0.005). The mean cost per patient in New Zealand dollars was 30,527 dollars +/-10,489 dollars for controls and 76,104 dollars +/- 31,460 dollars for cases, and the mean excess cost associated with S. aureus PSM was 45,677 dollars per patient. CONCLUSIONS: This study illustrates the significant cost of deep surgical site infection, both in terms of length of hospital stay and hospital revenue, and highlights the potential cost benefit of successful strategies to reduce surgical site infection such as S. aureus PSM.

Aged↗
PubMed2005

Culture results of heart valves resected because of streptococcal endocarditis: insights into duration of treatment to achieve valve sterilization.

OBJECTIVES: To analyse the culture results of heart valves removed following streptococcal endocarditis in order to gain insight into the duration of treatment required for valve sterilization. PATIENTS AND METHODS: Retrospective review of 131 episodes of streptococcal endocarditis: 94 due to alpha-haemolytic streptococci; 15 due to beta-haemolytic streptococci; 10 due to nutritionally deficient streptococci; eight due to the Streptococcus anginosus group and four due to Streptococcus pneumoniae. Patients had their valves removed during antimicrobial treatment. Culture results were analysed with respect to duration of treatment before surgery. RESULTS: For alpha-haemolytic streptococci, 17 (18%) valves were culture-positive and 77 (82%) culture-negative after a median (range) of 4 (1-20) and 16 (4-58) days of treatment, respectively, P < 0.001. For beta-haemolytic streptococci, two valves (13%) were culture-positive; both patients had received < or = 4 days of treatment. Four patients (40%) with nutritionally deficient streptococci were culture-positive, and had received < or = 8 days of treatment. For the S. anginosus group, two valves (25%) were culture-positive; both patients had received < or = 4 days of treatment before operation. Overall, only one of 131 (0.8%) valves was culture-positive after 14 days of treatment. All valves infected with beta-haemolytic streptococci, nutritionally deficient streptococci and the S. anginosus group, who were treated for more than 8 days before surgery, were culture-negative. CONCLUSIONS: Our findings support current treatment guidelines for endocarditis caused by alpha-haemolytic streptococci. We suggest that the recommended duration of treatment for endocarditis resulting from other streptococci may be excessive and treatment trials evaluating 2 and 4 week regimens are justified.

Adult↗
PubMed2005

Staphylococcal post-sternotomy mediastinitis: five year audit.

BACKGROUND: The reported rate of post-sternotomy mediastinitis is between 0.8 and 2.3%, with up to 79% of cases caused by staphylococci. Mediastinitis is associated with significant morbidity and mortality. Obesity and diabetes are the only risk factors consistently identified. The aims of the present study were to determine the incidence and risk factors for staphylococci post-sternotomy mediastinitis and to audit its management. METHODS: The clinical records of patients with staphylococcal post-sternotomy mediastinitis between 1 January 1998 and 31 May 2003 were retrospectively reviewed. Information collected included patient demographics, comorbidities, operation type, microbiology findings, surgical and medical management, and outcome. Data collected on cases were compared with data collected in a prospective database of all patients undergoing cardiac surgery. RESULTS: The incidence of staphylococcal post-sternotomy mediastinitis was 1.2% (60 cases in 5176 median sternotomies). Staphylococcus aureus was isolated in 49 (82%) cases and coagulase-negative staphylococci in 11 (18%) cases. Eight (16%) S. aureus isolates were methicillin-resistant. Risk factors associated with mediastinitis were ethnicity, diabetes mellitus, emergency surgery, ejection fraction and length of preoperative hospital stay. In-hospital mortality was 15%. Eighteen per cent of cases were not cured by initial therapy. CONCLUSION: Staphylococcal mediastinitis is a serious complication with significant rates of relapse and mortality. This audit has lead to an evaluation of our clinical pathways to ensure that prevention and management of surgical site infection is optimized.

Adult↗
PubMed2005

Reproducibility of low galactomannan enzyme immunoassay index values tested in multiple laboratories.

The Platelia galactomannan enzyme immunoassay is a commercially available nonculture method for diagnosing invasive aspergillosis. Recently, steps have been taken to improve sensitivity; specifically, a low (0.5 to 0.7) galactomannan index (GMI) value to determine positivity has been validated by multiple groups. We evaluated the intra-assay and interassay reproducibility at low index levels using three different kit lots on three different days in three different microbiology laboratories. Clinical and spiked sera were blinded and sent with galactomannan enzyme immunoassay (EIA) kits to the participating laboratories. We also prospectively collected data on all galactomannan EIAs performed between 1 September 2003 and 21 July 2004 at the University of Washington Medical Center microbiology laboratory to assess reproducibility of clinical samples analyzed in "real time." From the multilaboratory study, a total of 836 results were available for evaluation. Reproducibility was excellent between laboratories and on different days. Significant variability was seen between runs/lots, which may in part be associated with different threshold control values in different kits. Among the 1,410 clinical samples that were prospectively analyzed, 168 (90%) were confirmed to be positive on repeat testing (GMI, > or =0.5). Among the 19 (10.2%) initially positive samples not confirmed on repeat testing, the majority had a GMI at the threshold of the assay (between 0.5 and 0.7). Our findings suggest that the Platelia galactomannan immunoassay has good reproducibility. However, changes in GMI levels when different kit lots are used, and single samples with low-positive (GMI of 0.5 to 0.7) indices, should be interpreted with caution.

Antigens, Fungal↗
PubMed2004

Outpatient Parenteral Antimicrobial Therapy (OPAT): a review of experience at Auckland Hospital.

AIM: To review the Auckland Hospital Outpatient Parenteral Antimicrobial Therapy (OPAT) Service. METHODS: Patients (>15 years of age) were referred to the Service and assessed for suitability for outpatient therapy by an infectious diseases physician and a specialist nurse. Patient demographics, referring service, site of infection, and infecting organism, antimicrobial agent/s and outcomes of treatment including complications were recorded. RESULTS: Over a 20-month period 100 patients were treated with 107 courses of outpatient parenteral antibiotic therapy. Bone and joint infections accounted for close to two thirds (60%) of the referrals; discitis/osteomyelitis (36%), septic arthritis (14%) and infected metalware/prosthetic joint infections (10%). Staphylococcus aureus was the most frequently isolated organism (42%), and in 21% of cases no organism was identified. In general, antibiotics prescribed were narrow spectrum and all but six patients self-administered up to four times daily. Eighty-eight percent of treatment courses resulted in a cure. Complications related to therapy occurred in 35% of patients. CONCLUSIONS: We have found that parenteral antibiotic therapy can be administered safely and successfully in an outpatient setting despite relatively frequent dosing intervals. The majority of complications were minor, and 88% of patients were cured.

Adult↗
PubMed2002

Vancomycin-resistant enterococcal colonisation of hospitalised patients in Auckland.

AIM: To assess the prevalence of vancomycin-resistant enterococcal colonisation of hospitalised patients in five selected Auckland hospitals. METHODS: Faeces specimens submitted to the Microbiology Laboratories at Auckland and Middlemore Hospitals for Clostridium difficile toxin assay were screened for the presence of vancomycin-resistant enterococci (VRE). RESULTS: VRE were cultured from two of 686 patients, giving a colonisation rate of 0.3% in those patients who had a faeces sample submitted for C. difficile toxin assay (95% CI 0 to 0.7%). Both isolates were Enterococcus faecalis; susceptible to ampicillin, resistant to vancomycin and of the vanA genotype. CONCLUSIONS: This is the first screening study in New Zealand that has identified patients with VRE colonisation. While VRE are still rarely isolated in this country, rates of colonisation and infection may be increasing. Hospitals need to be aware of the likely emergence of VRE and be prepared to implement strategies to limit their spread.

Adolescent↗
PubMed2002

Could laboratory-based notification improve the control of foodborne illness in New Zealand?

AIMS: To estimate the completeness and timeliness of notifications of seven potentially foodborne diseases in Auckland. METHODS: The diseases audited were shigellosis, salmonellosis, campylobacteriosis, yersiniosis, listeriosis, hepatitis A and verocytotoxigenic (VTEC) E. coli infections. Hospital and community laboratory-confirmed cases for the calendar year 2000 were audited against those notified to the Auckland Regional Public Health Service. Cases were matched on disease, name, date of birth, gender and National Health Index number. RESULTS: There were 3182 laboratory-confirmed cases of the seven diseases identified of which 77% had been notified to the Auckland Regional Public Health Service. The proportion of laboratory-confirmed cases notified ranged from a 65% for hepatitis A to 100% for VTEC infection. The median delay between laboratory confirmation and practitioner notification was two days. Notification of all laboratory-confirmed cases would have resulted in an estimated 145 additional investigations in the year 2000. CONCLUSION: A change to laboratory-based notification could improve public health investigation and control of foodborne disease in New Zealand.

Disease Notification↗