Referral Centre In Australia Research Articles

The changing epidemiology of klebsiella pneumoniae Carbapenemase (KPC) Resistance in Australia

Aims The aims of this study were to firstly describe the epidemiology, risk factors and outcomes of patients with KPC producing organisms at our institution, and secondly, to describe an outbreak involving seven patients admitted to a geriatric evaluation and management (GEM) ward. Methods A retrospective review was conducted to assess 29 patients with KPC producing organisms in a tertiary referral centre in Australia from 2012 to 2014. In addition, a prospective assessment of an outbreak was conducted including a molecular evaluation of the isolates and patient outcomes. Results Of the 29 patients, 55% were male with a median age of 69 years. The greatest risk factors for acquiring a KPC producing organism were length of hospital stay and recent exposure to broad spectrum antibiotics. The 30 day mortality rate was 17.2%, which increased to 37.9% at 60 days. The seven patients identified in the outbreak were exposed to an index case where a KPC was isolated from urine. The whole genome sequence analysis revealed all seven isolates were highly clonally related. Two of the patients died of causes not directly attributable to KPC colonisation. Discussion This study highlights the increasing threat of KPC producing organisms in Australia.

PM425 A retrospective analysis investigating the yield of Transthoracic Echocardiogram in patients presenting with falls to a regional tertiary referral center in Australia

PM425 A retrospective analysis investigating the yield of Transthoracic Echocardiogram in patients presenting with falls to a regional tertiary referral center in Australia

Comparison of the Composite International Diagnostic Interview (CIDI-Auto) with Clinical Diagnosis in a Suicidal Population

The objective was to examine agreement between routine clinician diagnoses of DSM-IV Anxiety, Depressive, Substance-Use disorders with diagnoses generated by CIDI-Auto Version 2.1, administered by trained interviewers. Subjects were 329 deliberate self poisoning patients at a tertiary referral center in Australia. Tests of agreement were: percentage agreement, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and Cohen's kappa coefficients, for 1 month and 12 month CIDI diagnoses. Agreement was poor (kappa <0.40) for Anxiety, Depressive and Substance-Use disorders. Since diagnosis largely determines subsequent treatment, these findings did not support the use of the less expensive CIDI-Auto procedure to replace clinical diagnosis by experienced clinicians for this group of patients exhibiting suicidal behavior.

Pancreatic trauma in children

To document the demographics, mechanisms and outcome of traumatic pancreatitis in children at a single large tertiary referral centre in Australia. We undertook a 10-year retrospective audit of children admitted to the Royal Children's Hospital, Melbourne, Australia with a hospital coded diagnosis which included pancreatic injury between 1993 and 2002. Data included patient demographics, source of admission, mechanism of injury, pancreatic complications, associated injuries, intensive care unit admission, results of any operative findings, results of any acute computed tomography and/or ultrasound imaging of pancreas, selected laboratory findings and length of stay. We identified two distinct groups of patients in the 91 documented cases of pancreatic trauma (median age 8.0 years, range 0.6-15.8 years; M:F 2.5:1.0): 59 had a history of abdominal trauma and elevated serum lipase but no CT or ultrasound evidence of pancreatic injury (Group A); 32 had a history of abdominal trauma, elevated serum lipase but also had CT scan and/or ultrasound evidence of pancreatic injury (Group B). Patients with "less severe" injury based on normal imaging had a lower initial lipase level [Group A, median 651 U/L (interquartile range 520-1,324) vs. Group B, 1,608 U/L (interquartile range 680-3,526); p = 0.005] and shorter admission time [Group A, 9.0 days (interquartile range 5.5-15.5) vs. Group B, 13.4 days (interquartile range 6.8-23.8); p = 0.04]. There were no differences with respect to mortality (Group A, 13.5% vs. Group B, 12.5%), but patients with evidence of injury on imaging were more likely to have surgical intervention (p = 0.0001). The single most important overall cause of pancreatic trauma was involvement in a motor vehicle accident as a passenger or pedestrian. However, in children with high-grade ductal injury, bicycle handlebar injuries were most common. Associated injuries were common in both groups. Significant pancreatic injury can occur in the absence of abnormality on medical imaging. Pancreatic trauma commonly occurs in the context of multiple injuries after motor vehicle accidents in children and bicycle handlebar injuries, especially in boys. Most children can be treated conservatively, with surgical intervention being limited to high-grade ductal injury.

Use of inferior vena cava filters in a tertiary referral centre in Australia

To investigate the use of inferior vena cava (IVC) filters in a tertiary referral centre, looking at indication, types of filters and, with temporary/optional filters, removal rates. Data was collected from a prospective database of all IVC filters inserted from January 2003 to January 2007. Patients' records and radiological imaging were all reviewed. 66 patients (40 males) had IVC filters inserted during the study period. The median age of the male patients was 57.5 (21-79) years, and females 56 (24-81). There were 49 (74.2%) temporary/optional filters and 17 (25.8%) permanent filters. The most common indication for filter was a contraindication to anticoagulation for both permanent (64.7%) and temporary/optional filters (77.6%). In the temporary/optional filter group, 38 of 49 (77.6%) patients had documented venous thromboembolism, while in the permanent filter group, this was 14 of 17 (82.4%). Of the optional filters, 22 of 49 (45.8%) have been removed. More than half (54.2%) of temporary/optional filters were not removed and with potential for long-term complications. A protocol has now being instituted for vascular surgeons to authorize the insertion of filters and to then be responsible for ensuring their removal.

Changing incidence of acute pancreatitis: 10‐year experience at the Royal Children's Hospital, Melbourne

The aim of this study was to assess the incidence and etiology of acute pancreatitis at a major pediatric referral center in Australia. A 10-year retrospective audit was conducted at The Royal Children's Hospital, Melbourne, Australia. All patients from 1993 and 2002 with a serum lipase level greater than three times the upper reference range and a history consistent with acute pancreatitis were included. During the 10-year period, 279 confirmed cases of acute pancreatitis were identified. The median age at presentation was 10 years (range, 0.2-15.9). In 209 (74.9%) patients, a likely cause of acute pancreatitis was found, including trauma (36.3%), systemic disease (22.2%), metabolic (5.8%), biliary (5.4%), drugs (3.2%), or viral illness (2.2%). In the remaining 70 (25.1%) cases, the pancreatitis was deemed idiopathic. Comparing data from 1993 to 1997 with data from 1998-2002, there was a significant increase in the annual incidence of pancreatitis (24.6 +/- 2.3 vs 31.2 +/- 6 cases per year; P = 0.04). A linear regression analysis showed a strong association between the incidence and the year of diagnosis (r(2) = 0.5775, P = 0.01). This increase was mainly due to a significant rise in idiopathic disease (r(2) = 0.83, P = 0.0002) and systemic disease (r(2) = 0.41, P = 0.048), whereas the incidence of other causes of acute pancreatitis remained unchanged. The incidence of acute pancreatitis in children has increased significantly over the past decade. The increase was greatest in children with idiopathic pancreatitis. It remains unclear whether this reflects a true incidence increase or improved clinical awareness.