A Persisting Nontropical Focus of Burkholderia pseudomallei with Limited Genome Evolution over Five Decades.

is the causative agent of the high-mortality disease melioidosis. Although melioidosis is classified as a tropical disease, rare autochthonous cases have been reported from temperate climatic regions, with uncertainty as to whether is persistent in the local environment and whether specific genetic mechanisms facilitate the survival of outside the tropics. Sporadic cases of melioidosis occurred in a valley region (latitude 31.

Whole-genome sequencing of a quarter-century melioidosis outbreak in temperate Australia uncovers a region of low-prevalence endemicity.

Melioidosis, caused by the highly recombinogenic bacterium , is a disease with high mortality. Tracing the origin of melioidosis outbreaks and understanding how the bacterium spreads and persists in the environment are essential to protecting public and veterinary health and reducing mortality associated with outbreaks. We used whole-genome sequencing to compare isolates from a historical quarter-century outbreak that occurred between 1966 and 1991 in the Avon Valley, Western Australia, a region far outside the known range of endemicity.

Bilateral prosthetic hip joint infections associated with a Psoas abscess. A Case Report.

Introduction: Psoas abscess is a recognized but under-diagnosed complication of prosthetic hip joint infections.

Case Report: We report a case of a 68-year-old man with right and left hip arthroplasties performed 22 and 14 years ago, respectively, who presented with non-specific symptoms and was subsequently diagnosed with left psoas abscess on CT scan. Drainage of the psoas abscess was complicated by the formation of a discharging sinus connected to the left hip.

Case report: Eumycetoma and mycotic arthritis of the knee caused by Arthrographis kalrae.

A 33-year-old male presents following a penetrating injury to his right knee. Clinically he demonstrated pain, an effusion and fevers. At diagnostic arthroscopy, no microbiological growth was cultured.

Epidemiology of Clostridium difficile infection in two tertiary-care hospitals in Perth, Western Australia: a cross-sectional study.

The epidemiology of Clostridium difficile infection (CDI) has changed over time and between countries. It is therefore essential to monitor the characteristics of patients at risk of infection and the circulating strains to recognize local and global trends, and improve patient management. From December 2011 to May 2012 we conducted a prospective, observational epidemiological study of patients with laboratory-confirmed CDI at two tertiary teaching hospitals in Perth, Western Australia to determine CDI incidence and risk factors in an Australian setting.

Use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis for rapid confirmation of Burkholderia pseudomallei in septicemic melioidosis.

Burkholderia pseudomallei was quickly identified from blood cultures collected from septicemic patients by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis using an in-house reference library. This procedure reduced the time to definitive identification by more than 24 hours. This analysis is a useful addition to laboratory methods for early recognition of septicemic melioidosis in non-endemic settings.

Refractory Arthrographis kalrae native knee joint infection.

Rare reports of infection with Arthrographis kalrae have often demonstrated a protracted clinical course. We describe refractory infection of the native knee with Arthrographis kalrae after a penetrating injury and Yttrium synovectomy, finally controlled with two stage joint revision and combination antifungal therapy. The paucity of worldwide data about such uncommon invasive fungal infections contributes to the diagnostic and therapeutic challenges of these cases.

First Australian isolation of epidemic Clostridium difficile PCR ribotype 027.

We report the first isolation in Australia of a hypervirulent epidemic strain of Clostridium difficile, PCR ribotype 027. It was isolated from a 43-year-old woman with a permanent ileostomy, who appears to have been infected while travelling in the United States. The isolate was positive for toxin A, toxin B and binary toxin, and resistant to fluoroquinolone antimicrobials, and had characteristic deletions in the tcdC gene.

Outbreak of invasive methicillin-resistant Staphylococcus aureus infection associated with acupuncture and joint injection.

Objective: To describe an outbreak of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection after percutaneous needle procedures (acupuncture and joint injection) performed by a single medical practitioner.

Setting: A medical practitioner's office and 4 hospitals in Perth, Western Australia.

Patients: Eight individuals who developed invasive MRSA infection after acupuncture or joint injection performed by the medical practitioner.

Respiratory infections and lung function in an Australian Aboriginal community.

Background And Objective: To investigate the association between serological evidence of past infections with common respiratory pathogens and lung function in members of an isolated community of Aborigines from tropical coastal north-western Australia.

Methods: FEV(1) and FVC were assessed by dry bellows spirometer. Serum IgG titres to 11 common respiratory pathogens were assayed.

Clostridium difficile-associated diarrhoea.

Clostridium difficile is an important nosocomial pathogen and the most frequently diagnosed cause of infectious hospital-acquired diarrhoea. Toxigenic strains usually produce toxin A and toxin B, which are the primary virulence factors of C. difficile.

Prevention of tunneled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate: a randomized controlled study.

Tunneled catheters are widely used for the provision of hemodialysis. Long-term catheter survival is limited by tunneled catheter-related infections (CRI). This study assesses the efficacy of catheter-restricted filling with gentamicin and citrate in preventing CRI in hemodialysis patients.

Case report: recovery from persistent septicemic melioidosis.

Septicemic melioidosis is often fatal despite treatment with antibiotics such as ceftazidime to which Burkholderia pseudomallei, the causal pathogen, is sensitive in vitro. We report a near-fatal case of septicemic melioidosis with persistent B. pseudomallei bacteremia despite intravenous ceftazidime in which combination therapy with meropenem and ciprofloxacin, splenectomy and correction of metabolic acidosis allowed for hospital discharge.

Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer).

Aims: This was a pilot study of the use of a clinical pharmacist as a therapeutics adviser (academic detailer) to modify antibiotic prescribing by general practitioners.

Methods: Following a visit by the adviser (March-May), 112 general practitioners were recruited and randomised to control or active groups. A panel of experts prepared a best practice chart of recommended drugs for upper and lower respiratory tract infections, otitis media and urinary tract infections.

The spotted traveller.

A 23 year old university student comes to see you with a febrile illness and a rash. She has just returned from a 6 week holiday in South East Asia having visited Thailand, Vietnam, Hong Kong and the Philippines. Prior to going away she went to a travel clinic, was appropriately immunised and given malaria prophylaxis which she has taken assiduously.

Fusidic acid in other infections.

Fusidic acid, both systemic and topical, has been used for a wide variety of less common infections. Efficacy for oral fusidic acid has been demonstrated in the treatment of Clostridium difficile colitis and in staphylococcal infections in patients with cystic fibrosis. Topical fusidic acid gel is also effective in bacterial conjunctivitis and other minor external eye infections, and may be effective in reducing bacterial flora in the conjunctival sac prior to eye surgery.