The Medical journal of Australia
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To determine the effectiveness of a care bundle, with a novel line maintenance procedure, in reducing the rate of central line-associated bloodstream infection (CLABSI) in the intensive care unit (ICU). ⋯ Our study suggests that this care bundle, using a novel maintenance procedure, can effectively reduce the CLABSI rate and maintain it at zero out to 2 years.
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Multidrug-resistant (MDR) gram-negative bacilli (GNB) are now globally widespread and present a major challenge to modern medical practice. Resistance to common antibiotics such as ceftriaxone is becoming more frequent in Australia, primarily mediated by extended-spectrum β-lactamase enzymes in common organisms such as Escherichia coli, and may occur in both hospital- and community-acquired infections. Carbapenem-resistant Enterobacteriaceae have emerged rapidly in recent years and are well established in many countries in the Asia-Pacific region. ⋯ A key risk factor for infection with MDR GNB is travel to countries with high rates of resistance, especially with health care exposure. With limited prospects for new antibiotics in late-stage development that are active against MDR GNB, our national response to these challenges will require a multifaceted approach, including widespread implementation of antimicrobial stewardship, enhanced surveillance, targeted screening of at-risk patients and improved infection control practices. In the longer term, restriction of agricultural use of antibiotic classes critical to human medicine, removal of barriers to new drug development, and technological advances in rapid microbiological diagnostics will be required.
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To assess the performance and acceptability of the OraQuick Advance Rapid HIV-1/2 Antibody Test (ORT) in Australia. ⋯ ORT sensitivity is reduced in early HIV infection. The test is highly acceptable and less stressful than venous sampling. Participants are keen to be tested with the ORT in future, would recommend it to peers and would have tests more frequently if the ORT were licensed. TGA approval of this test might slow increasing HIV infection rates among MSM and others by facilitating diagnosis and treatment.
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To examine whether there have been recent changes in Australian antiretroviral treatment (ART) prescribers' perceptions and practices relating to early ART initiation, which was defined as commencing ART when a patient's CD4+ T-cell count approaches 500 cells/mm3 or immediately after a patient is diagnosed with HIV. ⋯ Our findings show increasing acceptance of and support for early ART initiation primarily as treatment and not as prevention.