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P J Collignon

Publications and source records attributed to P J Collignon.

At least 19 recordsLinked to original sources
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↗
PubMed1987

Extrapulmonary tuberculosis--a continuing problem in Australia.

Extrapulmonary tuberculosis (TB) remains a major health problem in Australia, with 24.3% of all new tuberculosis notifications in 1984 of extrapulmonary origin. We have reviewed our recent experience to assess the epidemiology and clinical features that may allow the earlier recognition and treatment of patients at risk for this disease. From 1980-1985, 51 cases of extrapulmonary TB were identified at Westmead Hospital. Thirty-eight patients were born outside Australia, mainly in South-East Asia and Europe. The commonest sites of disease were the lymph nodes, genitourinary tract, pleura and bone. Tuberculous lymphadenitis occurred predominantly in South-East Asians, whilst genitourinary tract disease was confined to Caucasians. A history of previous exposure to tuberculosis was obtained in 45% of patients. Fever, sweats and weight loss were noted in less than half of the cases. Changes consistent with old pulmonary disease were found on routine chest X-ray in 34% of cases. Laboratory confirmation of TB was made in 88% of cases, with typical histopathology in 90% and isolation of Mycobacterium tuberculosis in 69% of specimens submitted for analysis. Drug resistance was confined to isolates from South-East Asian patients.

Asia, Southeastern↗
PubMed1986

Propionibacterium acnes infection in neurosurgical patients. Experience with high-dose penicillin therapy.

Propionibacterium acnes is an underestimated but significant cause of cerebrospinal fluid (CSF) infection after neurosurgical procedures and in the presence of prosthetic devices. The most effective therapy for such infections has not been defined. We report here our experience with the use of high-dose penicillin in the treatment of six patients with postoperative infection which was caused by P. acnes. All patients received 3-4 million units of penicillin by the intravenous route every four hours, in combination with surgical drainage and removal of prosthetic devices where appropriate. All but one of the patients recovered from their infection. The remaining patient responded to penicillin but died of a massive intraventricular haemorrhage after 12 days. Isolates of P. acnes had minimal inhibitory concentrations to penicillin that ranged from 0.03-0.12 mg/L. No adverse reactions to penicillin were recorded. We conclude that high-dose intravenous penicillin therapy, in combination with surgical drainage and removal of foreign bodies, constitutes appropriate therapy for CSF infections that are due to P. acnes.

Combined Modality Therapy↗
PubMed1986

Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-associated bacteremia?

Semiquantitative culturing of catheter tips has been used as an index of catheter-related bacteremia. As the sensitivity and predictive values of this test have not been determined, we studied 780 tips from central vein catheters inserted into 440 critically ill patients in an intensive care unit. The results were correlated with clinical data for 30 bacteremic episodes which occurred in these patients, 14 of which were catheter related. When five or more colonies per plate were taken as a positive result, the sensitivity of the method was 92%, and the specificity was 83%. Although the predictive value of a negative result was excellent (99.8%), the predictive value of a positive result was low (8.8%) in our patient population, which had a relatively low incidence of catheter-related bacteremia (2%). We conclude that a semiquantitative culture technique is useful in the diagnosis of bacteremia associated with central vein catheters.

Bacteria↗