Pathology
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The aim of this study was to describe the burden and organism antibiotic resistance patterns of skin and soft tissue infections (SSTI) due to Staphylococcus aureus presenting in a remote Australian Northern Territory community in the Barkly region. We collated reported antibiograms of all skin and superficial soft tissue swab specimens obtained from the town's Indigenous medical clinic from 12 of the 13 months between November 2016 and December 2017. Clinician's notes for the consultation associated with each test request were examined to determine the nature of the clinical problem and to access other relevant data. ⋯ Of the 215 S. aureus, 98 [46%, 95% confidence interval (CI) 31-52] were methicillin resistant S. aureus (MRSA) and 117 (54%, 95% CI 48-61) sensitive (MSSA). Significant numbers were also resistant to other frequently used oral antibiotics, with resistance to erythromycin in 52 (24%), clindamycin in 51 (24%), trimethoprim in 22 (10%) and fusidic acid in eight (4%). In the Barkly region of Australia's NT in 2017, community-acquired staphylococcal SSTI needing professional care is equally likely to be caused by MRSA as by MSSA.
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We and others have previously highlighted the potential problems with testing of lupus anticoagulants (LA) in patients on anticoagulant therapy, including most recently as related to the direct oral anticoagulants (DOACs). Thus, current DOACs in use (e.g., dabigatran, a direct thrombin inhibitor, and apixaban and rivaroxaban, both direct Xa inhibitors), affect a wide variety of coagulation assays, including those used in LA investigation. The Russell viper venom time (RVVT) assay in particular, key to the investigation of LA, is highly sensitive to DOACs. ⋯ LA testing in the presence of DOACs also led to lower intra-patient consistency in LA test results. We conclude that ex-vivo data appears to confirm the potential for false positive (with rivaroxaban) and potential for false negative (with apixaban) identification of LA in patients on DOAC treatment. We also make some recommendations in regards to such testing.