Publications by authors named "Andrew J Daley"

74 Publications

Deterministic Fast Scrambling with Neutral Atom Arrays.

Phys Rev Lett 2021 May;126(20):200603

Department of Physics and SUPA, University of Strathclyde, Glasgow G4 0NG, United Kingdom.

Fast scramblers are dynamical quantum systems that produce many-body entanglement on a timescale that grows logarithmically with the system size N. We propose and investigate a family of deterministic, fast scrambling quantum circuits realizable in near-term experiments with arrays of neutral atoms. We show that three experimental tools-nearest-neighbor Rydberg interactions, global single-qubit rotations, and shuffling operations facilitated by an auxiliary tweezer array-are sufficient to generate nonlocal interaction graphs capable of scrambling quantum information using only O(logN) parallel applications of nearest-neighbor gates. These tools enable direct experimental access to fast scrambling dynamics in a highly controlled and programmable way and can be harnessed to produce highly entangled states with varied applications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1103/PhysRevLett.126.200603DOI Listing
May 2021

COVID-19 public health measures and respiratory viruses in children in Melbourne.

J Paediatr Child Health 2021 Jun 3. Epub 2021 Jun 3.

Department of Microbiology, Royal Children's Hospital, Melbourne, Victoria, Australia.

Aim: To describe the epidemiology of respiratory viruses in children before and during the 2020 SARS-CoV-2 pandemic and the relationship to public health measures instituted by the Victorian government.

Methods: Retrospective audit of respiratory viruses at a tertiary paediatric hospital in Melbourne from January 2015 up to week 47, 2020 in children under 18 years of age. The proportion of positive cases in weeks 1-47 in 2015-2019 (period 1) were compared to weeks 1-47, 2020 (period 2), and reviewed in the context of public health restrictions in Victoria.

Results: An annual average of 4636 tests were performed in period 1 compared to 3659 tests in period 2. Proportions of positive influenza A virus, influenza B virus, respiratory syncytial virus (RSV) and human parainfluenza virus were significantly reduced in period 2 compared to period 1: 77.3, 89.4, 68.6 and 66.9% reductions, respectively (all P < 0.001). From week 12-47, 2020, 28 893 SARS-CoV-2 tests were performed with a 0.64% positivity rate. Influenza viruses were not detected after week 17, RSV was not detected after week 35.

Conclusions: Strict public health measures and border closures were successful in eliminating community transmission of SARS-CoV-2 in Melbourne. This was associated with a significant reduction in other respiratory virus infections in children. Identifying sustainable and effective ongoing public health interventions to reduce transmission of RSV and influenza could result in reduced morbidity and mortality in children and requires further research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jpc.15601DOI Listing
June 2021

Rapid detection of human respiratory syncytial virus A and B by duplex real-time RT-PCR.

J Virol Methods 2021 May 10;294:114171. Epub 2021 May 10.

WHO Collaborating Centre for Reference and Research on Influenza, Victoria Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Elizabeth Street, Melbourne, VIC, Australia. Electronic address:

Respiratory syncytial virus (RSV) is a common cause of acute respiratory disease worldwide, especially in young children. The World Health Organization (WHO) has initiated an RSV Surveillance Pilot program that aims to perform worldwide RSV surveillance, requiring the development of reliable and rapid molecular methods to detect and identify RSV. A duplex real-time RT-PCR assay developed for simultaneous detection of both A and B subtypes of RSV was included as part of this program. This duplex assay targeted a conserved region of the RSV polymerase gene and was validated for analytical sensitivity, specificity, reproducibility and clinical performance with a wide range of respiratory specimens. The assay was highly specific for RSV and did not react with non-RSV respiratory pathogens, including the SARS-CoV-2 virus.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jviromet.2021.114171DOI Listing
May 2021

Refractory thoracic conidiobolomycosis treated with mepolizumab immunotherapy.

J Allergy Clin Immunol Pract 2021 Jun 16;9(6):2527-2530.e6. Epub 2021 Feb 16.

Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaip.2021.01.044DOI Listing
June 2021

Candidemia in Children: A 16-year Longitudinal Epidemiologic Study.

Pediatr Infect Dis J 2021 Jun;40(6):537-543

From the Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia.

Background: Candida species are the most common cause of systemic fungal infections in children. Risk factors for candidemia vary in different patient populations, posing challenges for clinical prediction of infection. We describe the epidemiology and clinical disease of candidemia in children admitted to a tertiary pediatric hospital.

Methods: Retrospective audit of children ≤18 years of age with candidemia at a tertiary pediatric hospital over a 16-year period.

Results: There were 139 episodes of candidemia in 124 children. A central venous catheter was present in 94% of episodes, prior antibiotic exposure in 86% and parenteral nutrition in 43%. During the study period, the proportion of candidemia due to non-albicans Candida spp. increased primarily due to a rise in C. krusei. Colonization with Candida spp. in the 30 days before developing candidemia was identified in 40% of episodes and the species was concordant in 60%. Infection at other sites was rare, including pulmonary dissemination (9/38, 24%), renal fungal disease (9/114, 8%), fungal endophthalmitis (8/102, 8%) and hepatosplenic nodules (5/92, 5%). Overall, 8/127 (6%) isolates were fluconazole-resistant (7 C. krusei and 1 C. glabrata) and 7/127 (6%) had intermediate susceptibility to fluconazole. The overall 30-day mortality was 12% and significant risk factors for mortality on multivariate analysis were male sex, liver disease and mucositis.

Conclusions: Our study outlines low rates of disseminated candidiasis and low mortality associated with candidemia at our institution. Additionally, it suggests that prior colonization may be an important risk factor, however, this should be validated in large prospective controlled studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/INF.0000000000003082DOI Listing
June 2021

Collisionally Inhomogeneous Bose-Einstein Condensates with a Linear Interaction Gradient.

Phys Rev Lett 2020 Oct;125(18):183602

Department of Physics and SUPA, University of Strathclyde, Glasgow G4 0NG, United Kingdom.

We study the evolution of a collisionally inhomogeneous matter wave in a spatial gradient of the interaction strength. Starting with a Bose-Einstein condensate with weak repulsive interactions in quasi-one-dimensional geometry, we monitor the evolution of a matter wave that simultaneously extends into spatial regions with attractive and repulsive interactions. We observe the formation and the decay of solitonlike density peaks, counterpropagating self-interfering wave packets, and the creation of cascades of solitons. The matter-wave dynamics is well reproduced in numerical simulations based on the nonpolynomial Schrödinger equation with three-body loss, allowing us to better understand the underlying behavior based on a wavelet transformation. Our analysis provides new understanding of collapse processes for solitons, and opens interesting connections to other nonlinear instabilities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1103/PhysRevLett.125.183602DOI Listing
October 2020

COVID-19 in health-care workers: Testing and outcomes at a Victorian tertiary children's hospital.

J Paediatr Child Health 2020 10 1;56(10):1642-1644. Epub 2020 Sep 1.

Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jpc.15143DOI Listing
October 2020

Effect of Surgical Skin Antisepsis on Surgical Site Infections in Patients Undergoing Gynecological Laparoscopic Surgery: A Double-Blind Randomized Clinical Trial.

JAMA Surg 2020 09;155(9):807-815

Gynaecology Division, The Royal Women's Hospital, Parkville, Victoria, Australia.

Importance: Gynecological laparoscopies are one of the most common surgical procedures worldwide. Limited evidence exists on rates of surgical site infections in patients undergoing gynecological laparoscopies and strategies to prevent these infections.

Objective: To compare rates of port-site infections, organ or space infections, and any type of surgical site infections among patients who underwent gynecological laparoscopies and received 1 of 3 types of skin preparation solutions.

Design, Setting, And Participants: A double-blind randomized clinical trial was conducted between February 28, 2017, and November 26, 2018, at a tertiary university-affiliated referral center. A total of 661 patients 18 years or older who underwent an elective operative laparoscopy for treatment of nonmalignant gynecological disorders were randomly assigned in a 1:1:1 ratio to have their skin cleaned before surgery with alcohol-based chlorhexidine, alcohol-based povidone-iodine, or water-based povidone-iodine. Statistical analysis was performed from February 28, 2017, to November 26, 2018. Analyses were performed on a modified intention-to-treat basis.

Interventions: A total of 221 patients were randomized to have their skin prepared preoperatively with water-based povidone-iodine, 220 were randomized to alcohol-based povidone-iodine, and 220 were randomized to alcohol-based chlorhexidine. The patients were blinded to the solution used to clean their skin. Patients were followed up 1 and 4 weeks after surgery by a physician who was blinded to the skin preparation solution used at surgery. Evidence of infection according to Centers for Disease Control and Prevention criteria were documented.

Main Outcomes And Measures: The primary outcome of this study was port-site infection 30 days after surgery. Secondary outcomes were organ or space infections and any type of surgical site infections; the study also aimed to prospectively describe rates of surgical site infections in gynecological laparoscopies.

Results: Of the 661 patients, 640 (96.8%; mean [SD] age, 36.2 [10.6] years) were examined after surgery by a physician at the study site and were included in the modified intention-to-treat analysis. The overall rate of port-site infection was 10.2% (65 of 640), rate of organ or space infection was 6.6% (42 of 640), and rate of any surgical site infection was 16.3% (104 of 640). The odds ratio for port-site infection for alcohol-based chlorhexidine vs water-based povidone-iodine was 1.13 (95% CI, 0.61-2.08), for alcohol-based chlorhexidine vs alcohol-based povidone-iodine was 1.34 (95% CI, 0.71-2.52), and for water-based povidone-iodine vs alcohol-based povidone-iodine was 1.19 (95% 0.62-2.27).

Conclusions And Relevance: Surgical site infections were more common than expected among patients who underwent gynecological laparoscopies. No skin preparation solution provided an advantage compared with the other solutions in reducing infection rates.

Trial Registration: http://anzctr.org.au Identifier: ACTRN12617000475347.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamasurg.2020.1953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344832PMC
September 2020

Multifaceted interventions for healthcare-associated infections and rational use of antibiotics in a low-to-middle-income country: Can they be sustained?

PLoS One 2020 16;15(6):e0234233. Epub 2020 Jun 16.

Department of Pediatrics, DR. Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Background: Transmission of infection between patients by health workers, and the irrational use of antibiotics are preventable causes for healthcare-associated infections (HAI) and multi-resistant organisms. A previous study implementing a hand hygiene campaign and antibiotic stewardship program significantly reduced these infections. Sustaining such interventions can be challenging.

Aims: To evaluate whether there was a sustained effect of a multifaceted infection control and antibiotic stewardship program on HAI and antibiotic use 5 years after it began.

Methods: A prospective evaluation study was conducted over 26 months (from February 2016 to April 2018) in a teaching hospital in Indonesia, 5 years after the implementation of an antibiotic stewardship and infection control program, which was successful when initially evaluated. All children admitted to the pediatric ICU and pediatric wards were observed daily. Assessment of HAI was made based on the criteria from the Centers for Disease Control and Prevention. Assessment of rational antibiotic use was based on the WHO Pocket Book of Hospital Care for Children. Multivariable logistic regression analysis was used to quantify the relationship between the HAI and the multifaceted intervention.

Results: We observed an increase in HAIs, from 8.6% (123/1419 patients) in the initial post-intervention period in 2011-2013 to 16.9% (314/1855) in the evaluation study (relative risk (RR) (95% CI) 1.95 (1.60 to 2.37)). After adjusting for potential confounders, we found that an increase in HAI in the evaluation period with adjusted OR 1.94 (95% CI 1.53 to 2.45). Inappropriate antibiotic use also increased, from 20.6% (182 of 882 patients who were prescribed antibiotics) to 48.6% (545/1855) (RR 2.35 (2.04 to 2.71)). Hand hygiene compliance also declined from 62.9% (1125/1789) observed moments requiring hand hygiene to 51% (1526/2993) (RR 3.33 (2.99 to 3.70)).

Conclusions: Healthcare-associated infections and irrational use of antibiotics remain significant even after the implementation of a multifaceted infection control intervention and antibiotic stewardship program. There is a need for continuous input, ongoing surveillance and long-term monitoring of these interventions to sustain compliance and effectiveness and address problems as they emerge.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234233PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297356PMC
August 2020

SARS-CoV-2 testing and outcomes in the first 30 days after the first case of COVID-19 at an Australian children's hospital.

Emerg Med Australas 2020 10 23;32(5):801-808. Epub 2020 Jun 23.

Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.

Objective: International studies describing COVID-19 in children have shown low proportions of paediatric cases and generally a mild clinical course. We aimed to present early data on children tested for SARS-CoV-2 at a large Australian tertiary children's hospital according to the state health department guidelines, which varied over time.

Methods: We conducted a retrospective cohort study at The Royal Children's Hospital, Melbourne, Australia. It included all paediatric patients (aged 0-18 years) who presented to the ED or the Respiratory Infection Clinic (RIC) and were tested for SARS-CoV-2. The 30-day study period commenced after the first confirmed positive case was detected at the hospital on 21 March 2020, until 19 April 2020. We recorded epidemiological and clinical data.

Results: There were 433 patients in whom SARS-CoV-2 testing was performed in ED (331 [76%]) or RIC (102 [24%]). There were four (0.9%) who had positive SARS-CoV-2 detected, none of whom were admitted to hospital or developed severe disease. Of these SARS-CoV-2 positive patients, 1/4 (25%) had a comorbidity, which was asthma. Of the SARS-CoV-2 negative patients, 196/429 (46%) had comorbidities. Risk factors for COVID-19 were identified in 4/4 SARS-CoV-2 positive patients and 47/429 (11%) SARS-CoV-2 negative patients.

Conclusion: Our study identified a very low rate of SARS-CoV-2 positive cases in children presenting to a tertiary ED or RIC, none of whom were admitted to hospital. A high proportion of patients who were SARS-CoV-2 negative had comorbidities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1742-6723.13550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273066PMC
October 2020

Changing Epidemiology and Predisposing Factors for Invasive Pneumococcal Disease at Two Australian Tertiary Hospitals.

Pediatr Infect Dis J 2020 01;39(1):1-6

Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.

Background: Invasive pneumococcal disease (IPD) is associated with significant morbidity and mortality in children. Universal pneumococcal conjugate vaccination has changed the epidemiology of IPD. In vaccinated children, IPD can be a marker of an underlying immunodeficiency.

Methods: This is a retrospective audit of children younger than 18 years with IPD admitted to 2 tertiary pediatric hospitals in Australia between 2011 and 2017. Data on predisposing conditions, immunologic evaluation, pneumococcal serotype, antibiotic susceptibility and treatment were collected.

Results: During the 7-year period, there were 131 presentations with IPD in 127 children; 3 children had recurrent IPD. Patients presented with sepsis (41%), empyema (29%), meningitis (18%), mastoiditis (12%), pneumonia (10%) and septic arthritis (4%). In 19 (15%) presentations, risk factors for IPD were present, including malignancy, hematologic disorder, chronic liver disease, chronic kidney disease and cochlear implant. Pneumococcal serotypes were determined in 78/131 (60%) of presentations: the most frequent serotypes were 19A (19%), 3 (13%), 7F (10%) and 19F (8%) and non-vaccine serotypes 22F (8%), 35B (6%), 15A (4%) and 38 (4%). Overall, 11% of isolates were non-susceptible to ceftriaxone. Only 36 patients (32%) had an immunologic evaluation, and 4 patients had proven or probable immunodeficiency.

Conclusion: Although pneumococcal conjugate vaccine serotypes 19A, 3, 19F and 7F remain frequent causes of IPD, non-vaccine serotypes are emerging. Our data support vancomycin treatment for children with pneumococcal meningitis given 11% of our isolates were not susceptible to ceftriaxone. It is important to consider underlying conditions predisposing to IPD in a population with high rates of pneumococcal vaccination.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/INF.0000000000002489DOI Listing
January 2020

Controlling Quantum Transport via Dissipation Engineering.

Phys Rev Lett 2019 Nov;123(18):180402

Department of Physics and SUPA, University of Strathclyde, Glasgow G4 0NG, United Kingdom.

Inspired by the microscopic control over dissipative processes in quantum optics and cold atoms, we develop an open-system framework to study dissipative control of transport in strongly interacting fermionic systems, relevant for both solid-state and cold-atom experiments. We show how subgap currents exhibiting multiple Andreev reflections-the stimulated transport of electrons in the presence of Cooper pairs-can be controlled via engineering of superconducting leads or superfluid atomic gases. Our approach incorporates dissipation within the channel, which is naturally occurring and can be engineered in cold gas experiments. This opens opportunities for engineering many phenomena with transport in strongly interacting systems. As examples, we consider particle loss and dephasing, and note different behavior for currents with different microscopic origin. We also show how to induce nonreciprocal electron and Cooper-pair currents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1103/PhysRevLett.123.180402DOI Listing
November 2019

Treelike Interactions and Fast Scrambling with Cold Atoms.

Phys Rev Lett 2019 Sep;123(13):130601

Department of Physics, Stanford University, Stanford, California 94305, USA.

We propose an experimentally realizable quantum spin model that exhibits fast scrambling, based on nonlocal interactions that couple sites whose separation is a power of 2. By controlling the relative strengths of deterministic, nonrandom couplings, we can continuously tune from the linear geometry of a nearest-neighbor spin chain to an ultrametric geometry in which the effective distance between spins is governed by their positions on a tree graph. The transition in geometry can be observed in quench dynamics, and is furthermore manifest in calculations of the entanglement entropy. Between the linear and treelike regimes, we find a peak in entanglement and exponentially fast spreading of quantum information across the system. Our proposed implementation, harnessing photon-mediated interactions among cold atoms in an optical cavity, offers a test case for experimentally observing the emergent geometry of a quantum many-body system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1103/PhysRevLett.123.130601DOI Listing
September 2019

Excitation Modes of Bright Matter-Wave Solitons.

Phys Rev Lett 2019 Sep;123(12):123602

Department of Physics and SUPA, University of Strathclyde, Glasgow G4 0NG, United Kingdom.

We experimentally study the excitation modes of bright matter-wave solitons in a quasi-one-dimensional geometry. The solitons are created by quenching the interactions of a Bose-Einstein condensate of cesium atoms from repulsive to attractive in combination with a rapid reduction of the longitudinal confinement. A deliberate mismatch of quench parameters allows for the excitation of breathing modes of the emerging soliton and for the determination of its breathing frequency as a function of atom number and confinement. In addition, we observe signatures of higher-order solitons and the splitting of the wave packet after the quench. Our experimental results are compared to analytical predictions and to numerical simulations of the one-dimensional Gross-Pitaevskii equation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1103/PhysRevLett.123.123602DOI Listing
September 2019

Spin Models, Dynamics, and Criticality with Atoms in Tilted Optical Superlattices.

Phys Rev Lett 2019 Aug;123(9):090401

Department of Physics and SUPA, University of Strathclyde, Glasgow G4 0NG, United Kingdom.

We show that atoms in tilted optical superlattices provide a platform for exploring coupled spin chains of forms that are not present in other systems. In particular, using a period-2 superlattice in one dimension, we show that coupled Ising spin chains with XZ and ZZ spin coupling terms can be engineered. We use optimized tensor network techniques to explore the criticality and nonequilibrium dynamics in these models, finding a tricritical Ising point in regimes that are accessible in current experiments. These setups are ideal for studying low-entropy physics, as initial entropy is "frozen-out" in realizing the spin models, and provide an example of the complex critical behavior that can arise from interaction-projected models.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1103/PhysRevLett.123.090401DOI Listing
August 2019

The hepatitis B birth-dose immunisation: Exploring parental refusal.

Aust N Z J Obstet Gynaecol 2020 02 1;60(1):93-100. Epub 2019 Jul 1.

The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Melbourne, Victoria, Australia.

Background: Hepatitis B virus (HBV) immunisation is the first vaccine of infant life and one of the most commonly refused immunisations on the Australian Immunisation Schedule.

Aims: To quantify the frequency of declined HBV immunisation birth-doses, investigate reasons for refusal, and determine information sources used by parents.

Materials And Methods: A cross-sectional study using a questionnaire was conducted on postnatal women who declined their newborn's HBV birth-dose immunisation during December 2016-July 2017 at an Australian tertiary referral hospital. Mothers who were non-English-speaking, unwell or medically unstable, or otherwise unavailable were excluded.

Results: One hundred and thirty-seven of the 1574 (8.7%) eligible reviewed infants had HBV immunisation birth-doses documented as declined; 113 mothers consented to complete the questionnaire. The most common reasons for declining the dose were: 'baby too young' (55.8%); preference for two, four and six-month HBV immunisations only (56.6%); perceived low risk of contracting HBV (45.1%); and a fear of 'overloading' their baby's immune system (42.5%). General practitioners or nurses/midwives (43.3%) and the internet/media (33.6%) were the predominant information sources consulted, and 58.4% felt satisfied with the information they received antenatally. Eighty-eight of 113 mothers (77.9%) would still consider future immunisations for their infant.

Conclusions: The majority of postnatal women decline HBV birth-dose immunisation for their newborns citing age-related safety concerns and vaccine misconceptions. Informal information sources such as the internet and media are often consulted. Addressing the need for antenatal and health professional education toward the birth-dose may be instrumental in improving uptake.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajo.13008DOI Listing
February 2020

Larva Eruption: A Furuncle in a Returned Traveller.

J Pediatr 2019 10 14;213:247. Epub 2019 Jun 14.

Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2019.05.037DOI Listing
October 2019

Compliance with screening for and recommended management of maternal group B streptococcus carriage in pregnancy.

Aust N Z J Obstet Gynaecol 2019 12 25;59(6):837-842. Epub 2019 Apr 25.

Department of Microbiology and Infectious Disease, Royal Women's Hospital, Melbourne, Australia.

Background: Universal screening of pregnant women at 35-37 weeks gestation is recommended for detection of anogenital group B streptococcus carriage. Intrapartum chemoprophylaxis is prescribed to carriers to prevent transmission to babies, reducing early-onset neonatal group B streptococcal sepsis.

Aims: To review compliance with, and the effects of education on group B streptococcus screening and intrapartum chemoprophylaxis practices at The Royal Women's Hospital, Melbourne, Australia.

Materials And Methods: A retrospective audit of women delivering in February 2016 and February-March 2017 was conducted. In February 2017, updated early-onset group B streptococcal disease prevention guidelines were released and promoted with targeted education of clinical staff. Compliance was considered appropriate if practices followed up-to-date local protocols.

Results: Screening rate for group B streptococcus was 84.4% (599/710) and carriage rate 19.5% (109/558), while intrapartum antibiotic prophylaxis was optimal in 83% of those labouring greater than four hours (39/47). There was no significant difference in compliance between 2016 and 2017. Of 113 women with unknown group B streptococcal status at delivery, only five of 33 (15%) with clinical risk factors for early-onset neonatal disease received intrapartum prophylaxis.

Conclusions: Compliance remained stable, with no change during or after implementation of new protocols. Compliance with protocols was low for cases with unknown group B streptococcal status at delivery but with the presence of one or more clinical risk factors for early-onset group B streptococcal sepsis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajo.12977DOI Listing
December 2019

Efficacy and safety of intravenous ceftriaxone at home versus intravenous flucloxacillin in hospital for children with cellulitis (CHOICE): a single-centre, open-label, randomised, controlled, non-inferiority trial.

Lancet Infect Dis 2019 05 7;19(5):477-486. Epub 2019 Mar 7.

Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia; Hospital-In-The-Home Department, The Royal Children's Hospital, Melbourne, VIC, Australia. Electronic address:

Background: Outpatient parenteral antimicrobial therapy in children is common despite no evidence of its efficacy or safety from clinical trials. We aimed to compare the efficacy and safety of intravenous antibiotic therapy at home with that of standard treatment in hospital for children with moderate to severe cellulitis.

Methods: The Cellulitis at Home or Inpatient in Children from the Emergency Department (CHOICE) trial was a randomised, controlled, non-inferiority trial in children aged 6 months to 18 years who presented to the emergency department at The Royal Children's Hospital (Melbourne, VIC, Australia) with uncomplicated moderate to severe cellulitis. Participants were randomly assigned to receive either intravenous ceftriaxone (50 mg/kg once daily) at home or intravenous flucloxacillin (50 mg/kg every 6 h) in hospital with web-based randomisation, stratified by age and periorbital cellulitis. The primary outcome was treatment failure, which was defined as no clinical improvement or occurrence of an adverse event, resulting in a change in empiric antibiotics within 48 h of the first dose. Secondary outcomes included adverse events and acquisition of antibiotic-resistant bacteria. Outcomes were assessed in all randomised participants with outcome data (intention-to-treat population) and in all individuals who received treatment as allocated and did not have any major protocol violations (per-protocol population). For home treatment to be non-inferior to hospital treatment, the difference between groups in the proportion of children with treatment failure in the intention-to-treat population had to be less than 15%. This trial is registered with ClinicalTrials.gov, number NCT02334124.

Findings: Between Jan 9, 2015, and June 15, 2017, we screened 1135 children for eligibility, of whom 190 were randomly assigned to receive ceftriaxone at home (n=95) or flucloxacillin in hospital (n=95). The intention-to-treat analysis comprised 188 children (93 in the home group and 95 in the hospital group) because two children in the home group were found to be ineligible after randomisation and were excluded. Treatment failure occurred in two (2%) children in the home group and in seven (7%) children in the hospital group (risk difference -5·2%, 95% CI -11·3 to 0·8, p=0·088). In the per-protocol analysis, treatment failure occurred in one (1%) of 89 children in the home group and in seven (8%) of 91 children in the hospital group (-6·5%, -12·4 to -0·7). Fewer children treated at home than in hospital had an adverse event (two [2%] vs ten [11%]; p=0·048). There was no difference between groups in rates of nasal acquisition of meticillin-resistant Staphylococcus aureus or gastrointestinal acquisition of extended-spectrum β-lactamase-producing bacteria or Clostridium difficile after 3 months.

Interpretation: Home treatment with intravenous ceftriaxone is not inferior to treatment in hospital with intravenous flucloxacillin for children with cellulitis. The standard of care for the intravenous treatment of uncomplicated cellulitis in children should be home or outpatient care when feasible.

Funding: The Royal Children's Hospital Foundation and Murdoch Children's Research Institute.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1473-3099(18)30729-1DOI Listing
May 2019

Persistent Folliculitis in An Immunocompetent Child.

J Paediatr Child Health 2018 11;54(11):1281-1282

Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jpc.14200DOI Listing
November 2018

Predictors of mortality in children with nosocomial bloodstream infection.

Paediatr Int Child Health 2019 05 17;39(2):119-123. Epub 2018 Oct 17.

a Department of Paediatrics, Dr Sardjito Hospital/Faculty of Medicine , Universitas Gadjah Mada , Yogyakarta , Indonesia.

: Nosocomial bloodstream infection (BSI) is associated with high mortality rates. Evaluating factors to predict mortality is important for prevention and improving clinical outcomes. : To evaluate the clinical predictors of mortality in paediatric nosocomial bloodstream infection. : A prospective cohort study was conducted from 1 December 2010 until 28 February 2013 in a teaching hospital in Yogyakarta, Indonesia. All patients admitted consecutively to the paediatric ICU (PICU) and paediatric wards after > 48 h of hospitalisation were eligible. Patients were observed daily to identify the presence of nosocomial BSI based on Centers for Disease Control and Prevention (CDC) criteria. Patients were followed up until they were discharged or died, and predictors of mortality were identified. Logistic regression was used to identify independent predictors. : A total of 2646 patients were recruited, 170 developed nosocomial BSI (6.4%) and 70 of these children died (case fatality rate 41%). Nosocomial BSI was associated with increased mortality with an adjusted OR of 8.5 (95% CI 6.0-12.1). In multivariate analysis, malnutrition, admission to the PICU and use of a central line catheter were independently associated with an increased risk of death with adjusted ORs (95% CI), respectively, of 6.0 (1.6-22.6), 3.2 (1.6-6.7) and 3.1 (1.1-8.7). : The study demonstrates that significant mortality is attributable to nosocomial bloodstream infection. An increased risk of death in children with nosocomial BSI can be identified by simple clinical predictors including malnutrition, admission to the PICU and use of a central line catheter.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20469047.2018.1529459DOI Listing
May 2019

Can colony-forming unit testing be used to extend the shelf life of BCG vaccines?

Tuberculosis (Edinb) 2018 07 6;111:188-192. Epub 2018 Jun 6.

Infectious Diseases & Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia.

A recent shortage in supply of Bacille Calmette-Guérin (BCG), the live attenuated vaccine given to protect against tuberculosis (TB) caused major disruption to global vaccination programs. In this study, we assessed whether quantification of viable bacteria, could be used to inform the use of the BCG vaccine beyond its manufacturer-assigned expiration date. The viability of a single batch of BCG-Denmark was tested in three independent laboratories. There was high inter-vial and inter-laboratory variability in viability counts, however all three laboratories detected a decrease in BCG viability over time. Despite this, there was no difference in the rate of BCG scar formation in infants who were vaccinated with this batch of BCG before and after its manufacturer-assigned expiration date. This study demonstrates the potential for using BCG viability counts to guide the use of BCG vaccine beyond the manufacturer-assigned expiration date.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tube.2018.06.001DOI Listing
July 2018

Adequate or Inadequate? The Volume of Blood Submitted for Blood Culture at a Tertiary Children's Hospital.

Clin Pediatr (Phila) 2018 10 29;57(11):1310-1317. Epub 2018 May 29.

1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.

The volume of blood sampled for culture critically influences the results. This study aimed to determine (1) the volume of blood submitted for culture, (2) the proportion of blood cultures with adequate volume, (3) whether measured improvement from a previous educational intervention had been sustained, and (4) the impact of blood volume on culture result. The volume of blood submitted for cultures was determined over a 13-month period by weighing bottles before and after collection and before and after an educational intervention. The volume of blood submitted in 5127 culture bottles were measured. Fewer than 50% of all cultures were deemed adequate. A significant pathogen was isolated in 4.7% of blood cultures, and low-volume cultures were more likely to yield contaminant isolates (47/2422 [1.9%] vs 22/2705 [0.8%], P = .0005). Subsequently, the higher rate of contaminant isolates from low-volume cultures may affect selection and rationalization of antibiotic therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0009922818778042DOI Listing
October 2018

True Pathogen or Contamination: Validation of Blood Cultures for the Diagnosis of Nosocomial Infections in a Developing Country.

J Trop Pediatr 2018 10;64(5):389-394

Department of Paediatrics, DR. Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Background: Blood culture results are frequently used to guide antibiotic decision-making, but culture contaminants need to be distinguished from true pathogens.

Aims: To assess the contamination rate of blood cultures and validate a method to distinguish between true bacteraemia and contamination.

Methods: We analysed blood culture results from children who were admitted to the paediatric ICU and paediatric wards at the Sardjito Hospital, Yogyakarta, Indonesia between December 2010 and February 2013. For each positive culture result, the type of isolated organism, time to positivity, and the number of positive culture sites were considered to classify the isolate as representing a true bacteraemia or contaminant.

Results: There were 1293 cultures obtained from blood and 308 (23.8%) were positive for bacterial growth. Fifty-three (4.1%) of the total cultures drawn fulfilled criteria for contaminants. The most common blood culture contaminants were coagulase-negative staphylococci.

Conclusion: Using standardized criteria, it is possible to implement a working method to identify true nosocomial infection from blood culture contaminant, and thus limit the effect of contaminated blood culture on irrational antibiotic use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/tropej/fmx081DOI Listing
October 2018

Evaluating an admission avoidance pathway for children in the emergency department: outpatient intravenous antibiotics for moderate/severe cellulitis.

Emerg Med J 2017 Dec 4;34(12):780-785. Epub 2017 Oct 4.

Murdoch Childrens Research Institute, Parkville, Victoria, Australia.

Objective: Children with moderate/severe cellulitis requiring intravenous antibiotics are usually admitted to hospital. Admission avoidance is attractive but there are few data in children. We implemented a new pathway for children to be treated with intravenous antibiotics at home and aimed to describe the characteristics of patients treated on this pathway and in hospital and to evaluate the outcomes.

Methods: This is a prospective, observational cohort study of children aged 6 months-18 years attending the ED with uncomplicated moderate/severe cellulitis in March 2014-January 2015. Patients received either intravenous ceftriaxone at home or intravenous flucloxacillin in hospital based on physician discretion. Primary outcome was treatment failure defined as antibiotic change within 48 hours due to inadequate clinical improvement or serious adverse events. Secondary outcomes include duration of intravenous antibiotics and complications.

Results: 115 children were included: 47 (41%) in the home group and 68 (59%) in the hospital group (59 hospital-only, 9 transferred home during treatment). The groups had similar clinical features. 2/47 (4%) of the children in the home group compared with 8/59 (14%) in the hospital group had treatment failure (P=0.10). Duration of intravenous antibiotics (median 1.9 vs 1.8 days, P=0.31) and complications (6% vs 10%, P=0.49) were no different between groups. Home treatment costs less, averaging $A1166 (£705) per episode compared with $A2594 (£1570) in hospital.

Conclusions: Children with uncomplicated cellulitis may be able to avoid hospital admission via a home intravenous pathway. This approach has the potential to provide cost and other benefits of home treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/emermed-2017-206829DOI Listing
December 2017

Andreev molecules in semiconductor nanowire double quantum dots.

Nat Commun 2017 09 19;8(1):585. Epub 2017 Sep 19.

Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, PA, 15260, USA.

Chains of quantum dots coupled to superconductors are promising for the realization of the Kitaev model of a topological superconductor. While individual superconducting quantum dots have been explored, control of longer chains requires understanding of interdot coupling. Here, double quantum dots are defined by gate voltages in indium antimonide nanowires. High transparency superconducting niobium titanium nitride contacts are made to each of the dots in order to induce superconductivity, as well as probe electron transport. Andreev bound states induced on each of dots hybridize to define Andreev molecular states. The evolution of these states is studied as a function of charge parity on the dots, and in magnetic field. The experiments are found in agreement with a numerical model.Quantum dots in a nanowire are one possible approach to creating a solid-state quantum simulator. Here, the authors demonstrate the coupling of electronic states in a double quantum dot to form Andreev molecule states; a potential building block for longer chains suitable for quantum simulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-017-00665-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605684PMC
September 2017

Is there more to a normal cerebrospinal fluid cell count?

J Paediatr Child Health 2017 04;53(4):429

Laboratory Services, The Royal Children's Hospital, Department of Infectious Diseases and Microbiology, The Royal Women's Hospital, Melbourne, Victoria, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jpc.13424DOI Listing
April 2017

Manipulating the baby biome: What are the issues?

Aust N Z J Obstet Gynaecol 2017 Apr 22;57(2):232-234. Epub 2017 Mar 22.

Department of Infectious Diseases and Microbiology, The Royal Women's Hospital, Melbourne, Victoria, Australia.

Establishing a baby biome through the controversial practice of 'vaginal seeding' has generated interest among the general public and healthcare providers alike. We discuss the potential risks of this practice and offer a harm minimisation approach to managing women requesting vaginal microbiome transfer after delivery by caesarean section.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajo.12599DOI Listing
April 2017

ANTIBIOTIC RESISTANCE AND MORTALITY IN CHILDREN WITH NOSOCOMIAL BLOODSTREAM INFECTION IN A TEACHING HOSPITAL IN INDONESIA.

Southeast Asian J Trop Med Public Health 2016 Sep;47(5):983-93

Nosocomial infection is a major problem in hospitals worldwide. Understanding patterns of bacterial etiology and antibiotic susceptibility are important factors to combating nosocomial infection. Among children with nosocomial bloodstream infection (BSI), we identified pathogens and determined antibiotics resistance patterns and mortality rates for antibiotic-susceptible and multidrugresistant (MDR) infection in patients with nosocomial BSI in pediatric wards and PICU at Dr Sardjito Hospital, Indonesia during December 2010 to February 2013. Of 174 isolates from 170 patients, 168 pathogens were bacteria, of which 148 were gram-negative. Pseudomonas aeruginosa, Klebsiella spp, Enterobacteriaceae, Acinetobacter baumanii, and Escherichia coli was found in 55%, 6%, 4%, 1%, and <1%, respectively of the isolates. Imipenem, amikacin, ciprofloxacin, and ceftazadime had the highest sensitivity to nosocomial pathogens at 86%, 84%, 84%, and 75%, respectively. Eleven patients had MDR-infections, 7 of whom died. Among 153 patients infected with bacteria resistant to <3 classes of antibiotics (non-MDR), mortality was 40%, and among 4 patients with fully drug-susceptible sepsis only one died. Thus, substantial mortality was observed in children with nosocomial-BSI, particularly with MDR pathogens. Given the further high risk of resistance with wider use of carbapenems, third generation cephalosporins and flouroquinolones, prevention should be given highest priority in combating hospital-acquired infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2016