David R Murdoch

University of Otago, Taieri, Otago, New Zealand

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Publications (175)920.78 Total impact

  • Namrata Prasad · David R Murdoch · Hugh Reyburn · John A Crump
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    ABSTRACT: With apparent declines in malaria worldwide during the last decade and more widespread use of malaria rapid diagnostic tests, healthcare workers in low-resource areas face a growing proportion of febrile patients without malaria. We sought to describe current knowledge and identify information gaps of the etiology severe febrile illness in low-and middle-income countries. We conducted a systematic review of studies conducted in low-and-middle income countries 1980-2013 that prospectively assessed consecutive febrile patients admitted to hospital using rigorous laboratory-based case definitions. We found 45 eligible studies describing 54,578 patients; 9,771 (17.9%) had a positive result for ≥1 pathogen meeting diagnostic criteria. There were no eligible studies identified from Southern and Middle Africa, Eastern Asia, Oceania, Latin American and Caribbean regions, and the European region. The median (range) number of diagnostic tests meeting our confirmed laboratory case definitions was 2 (1 to 11) per study. Of diagnostic tests, 5,052 (10.3%) of 49,143 had confirmed bacterial or fungal bloodstream infection; 709 (3.8%) of 18,142 had bacterial zoonosis; 3,488 (28.5%) of 12,245 had malaria; and 1,804 (17.4%) of 10,389 had a viral infection. We demonstrate a wide range of pathogens associated with severe febrile illness and highlight the substantial information gaps regarding the geographic distribution and role of common pathogens. High quality severe febrile illness etiology research that is comprehensive with respect to pathogens and geographically representative is needed.
    PLoS ONE 06/2015; 10(6):e0127962. DOI:10.1371/journal.pone.0127962 · 3.23 Impact Factor
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    ABSTRACT: We used Demographic and Health Survey data to describe the 2-week period prevalence of fever, cough, and diarrhea among children aged < 5 years in low-resources areas. We then explored the relationship between prevalence of isolated fever and malaria risk. Fever and isolated fever occurred in 26.7% and 7.0% of children, respectively, and was not fully explained by malaria. © The American Society of Tropical Medicine and Hygiene.
    The American journal of tropical medicine and hygiene 04/2015; 93(1). DOI:10.4269/ajtmh.14-0646 · 2.74 Impact Factor
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    ABSTRACT: Use of pneumococcal conjugate vaccines (PCVs) in resource-poor countries has focused on early infant immunisation with little emphasis on protection in late infancy and beyond. Boosting of the immune response later in infancy might provide improved persistence of immunogenicity into early childhood, however data are scarce. The aim of this study was to investigate if a two-dose prime with booster at age 9 months compared with a three-dose prime-only PCV schedule provided non-inferior immunogenicity in early infancy and superior persistence of antibody responses in early childhood.
    The Lancet Infectious Diseases 02/2015; 15(4). DOI:10.1016/S1473-3099(15)70007-1 · 19.45 Impact Factor
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    ABSTRACT: Use of pneumococcal conjugate vaccines (PCVs) in resource-poor countries has focused on early infant immu nisation with little emphasis on protection in late infancy and beyond. Boosting of the immune response later in infancy might provide improved persistence of immunogenicity into early childhood, however data are scarce. The aim of this study was to investigate if a two-dose prime with booster at age 9 months compared with a three-dose prime-only PCV schedule provided non-inferior immunogenicity in early infancy and superior persistence of antibody responses in early childhood.
    The Lancet Infectious Diseases 02/2015; · 19.45 Impact Factor
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    ABSTRACT: Invasive pneumococcal disease is one of the major causes of death in young children in resource poor countries. Nasopharyngeal carriage studies provide insight into the local prevalence of circulating pneumococcal serotypes. There are very few data on the concurrent carriage of multiple pneumococcal serotypes. This study aimed to identify the prevalence and serotype distribution of pneumococci carried in the nasopharynx of young healthy Nepalese children prior to the introduction of a pneumococcal conjugate vaccine using a microarray-based molecular serotyping method capable of detecting multi-serotype carriage. We conducted a cross-sectional study of healthy children aged 6 weeks to 24 months from the Kathmandu Valley, Nepal between May and October 2012. Nasopharyngeal swabs were frozen and subsequently plated on selective culture media. DNA extracts of plate sweeps of pneumococcal colonies from these cultures were analysed using a molecular serotyping microarray capable of detecting relative abundance of multiple pneumococcal serotypes. 600 children were enrolled into the study: 199 aged 6 weeks to <6 months, 202 aged 6 months to < 12 months, and 199 aged 12 month to 24 months. Typeable pneumococci were identified in 297/600 (49·5%) of samples with more than one serotype being found in 67/297 (20·2%) of these samples. The serotypes covered by the thirteen-valent pneumococcal conjugate vaccine were identified in 44·4% of samples containing typeable pneumococci. Application of a molecular serotyping approach to identification of multiple pneumococcal carriage demonstrates a substantial prevalence of co-colonisation. Continued surveillance utilising this approach following the introduction of routine use of pneumococcal conjugate vaccinates in infants will provide a more accurate understanding of vaccine efficacy against carriage and a better understanding of the dynamics of subsequent serotype and genotype replacement.
    PLoS ONE 02/2015; 10(2):e0114286. DOI:10.1371/journal.pone.0114286 · 3.23 Impact Factor
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    ABSTRACT: Invasive pneumococcal disease is one of the major causes of death in young children in resource poor countries. Nasopharyngeal carriage studies provide insight into the local preva-lence of circulating pneumococcal serotypes. There are very few data on the concurrent car-riage of multiple pneumococcal serotypes. This study aimed to identify the prevalence and serotype distribution of pneumococci carried in the nasopharynx of young healthy Nepalese children prior to the introduction of a pneumococcal conjugate vaccine using a microarray-based molecular serotyping method capable of detecting multi-serotype carriage. We con-ducted a cross-sectional study of healthy children aged 6 weeks to 24 months from the Kathmandu Valley, Nepal between May and October 2012. Nasopharyngeal swabs were fro-zen and subsequently plated on selective culture media. DNA extracts of plate sweeps of pneumococcal colonies from these cultures were analysed using a molecular serotyping mi-croarray capable of detecting relative abundance of multiple pneumococcal serotypes. 600 children were enrolled into the study: 199 aged 6 weeks to <6 months, 202 aged 6 months to < 12 months, and 199 aged 12 month to 24 months. Typeable pneumococci were identified in 297/600 (49Á5%) of samples with more than one serotype being found in 67/297 (20Á2%) of these samples. The serotypes covered by the thirteen-valent pneumococcal conjugate vac-cine were identified in 44Á4% of samples containing typeable pneumococci. Application of a molecular serotyping approach to identification of multiple pneumococcal carriage demon-strates a substantial prevalence of co-colonisation. Continued surveillance utilising this ap-proach following the introduction of routine use of pneumococcal conjugate vaccinates in infants will provide a more accurate understanding of vaccine efficacy against carriage and a better understanding of the dynamics of subsequent serotype and genotype replacement.
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    ABSTRACT: Quantitative lytA PCR is often performed using in-house standards. We hypothesised equivalence when measuring a standard suspension of Streptococcus pneumoniae by colony-forming-units (CFU) or genome-copies. Median (IQR) ratio of CFU/genome-copies was 0.19 (0.1–1.2). Genome-copies were less variable than CFU, but the discrepancy between the methods highlights challenges with absolute quantification.
    12/2014; 2. DOI:10.1016/j.bdq.2014.11.003
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    ABSTRACT: To determine whether supplementation with vitamin D improves resilience to the adverse effects of earthquakes. Opportunistic addition to an established randomised double blind placebo controlled trial. Christchurch, New Zealand, where a prolonged series of catastrophic earthquakes beginning on 4 September 2010 occurred, which caused widespread destruction, fatalities, and extensive psychological damage. 322 healthy adults (241 women; 81 men) aged 18-67 who were already participating in the vitamin D and acute respiratory infections study (VIDARIS) between February 2010 and November 2011. Participants were randomised to receive an oral dose of either 200 000 IU vitamin D3 monthly for two months then 100 000 IU monthly (n=161) or placebo (n=161) for a total of 18 months. This is a post hoc analysis from the previously published VIDARIS trial. The primary endpoint in the current analysis was the self reported effects and overall adverse impact of the Christchurch earthquakes as assessed by questionnaire four months after the most destructive earthquake on 22 February 2011, which was used as the index event. The secondary end point was the number of "psychological" adverse events that participants reported at their usual monthly appointments as part of the original VIDARIS trial. 308 participants completed the earthquake impact questionnaire (n=152 in the vitamin D group and 156 in the placebo group). There was no significant difference in the number of self reported adverse effects between those receiving vitamin D supplementation and those receiving placebo. There was also no difference in the overall adverse impact score between treatment groups (χ(2) P=0.44). The exception was that those in the vitamin D group experienced more adverse effects on family relationships (22% v 13%; χ(2) P=0.03). The number of psychological adverse events-such as fatigue, stress, anxiety, and insomnia-that participants reported at their usual monthly appointments was significantly higher after the earthquake (χ(2) P=0.007) but did not differ between treatment groups. In this trial, vitamin D supplementation did not reduce the adverse impact of earthquakes in healthy adults. Trial registration Australian New Zealand Clinical Trials Registry (anzctr.org.au) ACTRN12609000486224. © Slow et al 2014.
    BMJ Clinical Research 12/2014; 349(dec15 17):g7260. DOI:10.1136/bmj.g7260 · 14.09 Impact Factor
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    ABSTRACT: Background. The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis–Prospective Cohort Study. Methods. Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. Results. EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non–S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39–1.15]; P = .15). Conclusions. In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.
    Clinical Infectious Diseases 11/2014; 60(5). DOI:10.1093/cid/ciu871 · 9.42 Impact Factor
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    ABSTRACT: Several commercial assays are now available to detect the nucleic acid of multiple respiratory pathogens from a single specimen. Head-to-head comparisons of such assays using a single set of standard specimens provide additional information about key assay parameters such as sensitivity, specificity and lower limits of detection, and help to inform the decision regarding which method to use. We evaluated two real-time PCR platforms: the Fast-track Diagnostics® (FTD) multiplex respiratory panel and a TaqMan array card (TAC) for simultaneous uniplex detection of multiple respiratory pathogens. Two sets of samples were used to evaluate the assays. One set was created by spiking pooled nasal wash or phosphate buffered saline with specified volumes of known concentrations of virus and/or bacteria. Clinical nasal wash specimens from children with lower respiratory tract illness comprised the other set. Thirteen pathogen targets were compared between the two platforms. Testing with a validation panel of spiked samples revealed a sensitivity of 96.1% and 92.9% for the FTD and TAC assays, respectively. Specificity could not be reliably calculated due to a suspected contamination of the sample substrate. Inter-assay agreement was high (>95%) for most targets. Previously untested clinical specimens tested by both assays revealed a high percent agreement (>95%) for all except rhinovirus, enterovirus and Streptococcus pneumoniae. Limitations of this evaluation included extraction of the validation samples by two different methods and the evaluation of the assays in different laboratories. However, neither of these factors significantly impacted inter-assay agreement for these sets of samples, and it was demonstrated that both assays could reliably detect clinically relevant concentrations of bacterial and viral pathogens. Copyright © 2014. Published by Elsevier B.V.
    Journal of Microbiological Methods 10/2014; 107C:222-226. DOI:10.1016/j.mimet.2014.10.009 · 2.10 Impact Factor
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    ABSTRACT: AimThis study aims to describe the microbiology of middle ear fluid (MEF) in a cohort of children vaccinated with Streptococcus pneumoniae conjugate vaccine (PCV7) having ventilation tube insertion. Nasopharyngeal (NP) carriage of otopathogens in these children is compared with children without history of otitis media.Methods Between May and November 2011, MEF and NP samples from 325 children aged <3 years were collected in three major centres in New Zealand at the time of ventilation tube insertion. An age-matched non-otitis-prone comparison group of 137 children had NP samples taken. A questionnaire was completed by both groups.ResultsImmunisation coverage with at least one dose of PCV7 was 97%. Haemophilus influenzae was cultured in 19.4% of MEF and was polymerase chain reaction (PCR) positive in 43.4%. S. pneumoniae and Moraxella catarrhalis were cultured in <10% of MEF samples but were PCR positive for 23.1% and 38.7%, respectively. H. influenzae was the most common organism isolated from NP samples (60%) in the grommet group, while M. catarrhalis (56%) was the most common in the non-otitis prone group. S. pneumoniae was more commonly found in the nasopharynx of children with ear disease (41% vs. 29%). 19F was the most prominent S. pneumoniae serotype in NP samples of both groups, but no serotype dominated in MEF. Ninety-five per cent of H. influenzae isolates were confirmed to be non-typeable H. influenzae.Conclusion In this cohort of children with established ear disease requiring surgical intervention, non-typeable H. influenzae is the dominant pathogen in both the nasopharynx and MEF.
    Journal of Paediatrics and Child Health 10/2014; 51(3). DOI:10.1111/jpc.12710 · 1.19 Impact Factor
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    ABSTRACT: Background: Data regarding characteristics of bloodstream infections in Myanmar are limited. Methods: Blood culture results from all outpatients and inpatients were extracted from records of the Clinical Microbiology Laboratory, Yangon General Hospital, for the period 2005 through 2013. Results: Of 3865 blood cultures performed, 449 (11.6%) were positive for a pathogenic organism. Gram-negative bacteria was the most common organism group, accounting for 246 (55.5%) of 449 isolations. Staphylococcus aureus was the most common isolate, detected in 171 (38.1%) of 449 blood cultures. From 2005-2008 to 2009-2013 the proportion of all pathogenic isolates that were Gram-positive declined from 52.8% (167/316) to 20.3% (27/133) (p < 0.001), whereas the proportion of Gram-negative bacteria rose from 45.6% (144/316) to 78.9% (105/133) (p < 0.001), with non-fermentative bacilli accounting for much of this increase. Antimicrobial susceptibility testing demonstrated a high prevalence resistance of S. aureus to first-line antimicrobials such as erythromycin, penicillin and oxacillin. More than half of tested Escherichia coli and Citrobacter species showed resistance to amoxicillin-clavulanic acid, ceftriaxone or gentamicin. Conclusions: Bloodstream infections are common among patients receiving blood culture at a tertiary hospital in Yangon, Myanmar. Our findings suggest that antimicrobial resistance among invasive bacteria is common, similar to patterns described elsewhere in the region, and highlight the need for locally adapted antimicrobial guidelines for sepsis management.
    Transactions of the Royal Society of Tropical Medicine and Hygiene 09/2014; 108(11). DOI:10.1093/trstmh/tru151 · 1.93 Impact Factor
  • Clinical Infectious Diseases 07/2014; 59(10). DOI:10.1093/cid/ciu608 · 9.42 Impact Factor
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    ABSTRACT: Previous randomized controlled trials of vitamin D supplementation and blood pressure (BP) mainly have given vitamin D for short periods (<6 months) or at low doses (400 IU per day). This study aims to determine whether long-term high-dose vitamin D taken for 18 months lowers BP. Adults were recruited from a healthcare organization or university into a double-blind controlled trial and randomized to receive either vitamin D3 200 000 IU for 2 months followed by 100 000 IU monthly up to 18 months (n=161) or placebo (n=161). BP was measured at baseline, 5, and 18 months. Subjects had a mean (SD) age of 47.6 (9.7) years, 75% were women, and 94% were of European ancestry (white). Mean (SD) 25-hydroxyvitamin D3 changed from 73 (22) nmol/L at baseline to 124 (28) nmol/L at 18 months in the vitamin D group, and from 71 (22) nmol/L to 56 (22) nmol/L in the placebo group. Mean BP was similar for the vitamin D and placebo groups at baseline (123.4/76.3 versus 122.6/75.6 mm Hg; respectively). The mean change (95% confidence interval) in BP at 18 months minus baseline in the vitamin D group compared with placebo group was -0.6 (-2.8 to 1.6) mm Hg for systolic (P=0.61) and 0.5 (-1.1, 2.2) mm Hg for diastolic (P=0.53). Long-term vitamin D supplementation, which increased mean 25-hydroxyvitamin D3 concentration >100 nmol/L for 18 months, had no effect on systolic or diastolic BP in predominantly white, healthy adults without severe vitamin D deficiency. Beneficial effects on BP cannot be ruled out for other populations.
    Hypertension 06/2014; 64(4). DOI:10.1161/HYPERTENSIONAHA.114.03466 · 7.63 Impact Factor
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    Alex Binfield · Carolyn Aird · David R Murdoch · Peter Elder · Tony Walls
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    ABSTRACT: AimsVitamin D deficiency is associated with infectious diseases; however, it is not known whether vitamin D levels are affected by acute infection. Our aim was to establish whether 25-hydroxyvitamin D (25OHD) levels taken during an acute bacterial infection are representative of baseline levels. Methods Thirty children between 6 months and 15 years of age with proven bacterial infections presenting to a tertiary paediatric referral centre had 25OHD levels taken during their acute infection and again 1 month later provided that they had recovered from their infection, had no subsequent infections and had not been taking vitamin supplements. 25OHD levels were measured by liquid chromatography mass spectrometry. ResultsMean 25OHD at enrolment was 67.5nmol/L (standard deviation (SD) 22.0), and mean 25OHD at 1 month follow up was 72.7nmol/L (SD 25.8) (paired t-test P = 0.25). C-reactive protein levels were recorded in 29/30 patients at enrolment (mean 85.1mg/L, SD 83.5) and 25/30 patients at follow-up (mean 4.0mg/L, SD 3.3) (paired t-test P = 0.002). The ethnicity of the participants was New Zealand European or European Other, 26; Samoan, 2; Maori, 1; and Chinese, 1. Conclusions In children, 25OHD levels are not affected by acute bacterial infections; 25OHD levels taken during acute bacterial infection are representative of baseline levels. 25OHD levels collected during acute bacterial infection provide reliable information for case-control studies.
    Journal of Paediatrics and Child Health 06/2014; 50(8). DOI:10.1111/jpc.12620 · 1.19 Impact Factor
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    ABSTRACT: Background Pneumococcal disease is a significant cause of morbidity and mortality in young children in Nepal, and currently available pneumococcal conjugate vaccines offer moderate coverage of invasive disease isolates. Methods A prevalence study of children aged 1.5 to 24 months in urban and rural Nepal was conducted. In the urban group, nasopharyngeal swabs (NPS) were transported using silica desiccant packages (SDP) with delayed processing (2 weeks), or skim-milk-tryptone-glucose-glycerin (STGG) with immediate processing (within 8 hours). Pneumococcal nasopharyngeal carriage prevalence, serogroup/type distribution and isolate genotypes (as defined by multilocus sequence typing) were determined. Results 1101 children were enrolled into the study: 574 in the urban group and 527 in the rural group. Overall carriage prevalence based on culture from specimens transported and stored in STGG was 58.7% (337/574), compared to 40.9% (235/574) in SDP. There was concordance of detection of pneumococcus in 67% of samples. Using the SDP method, pneumococcal carriage prevalence was higher in the rural population (69.2%; 364/526) compared to the urban population (40.9%; 235/574). Serogroup/type distribution varied with geographical location. Over half of the genotypes identified in both the urban and rural pneumococcal populations were novel. Conclusion The combination of delayed culture and transport using SDP underestimates the prevalence of pneumococcal carriage; however, in remote areas, this method could still provide a useful estimate of carriage prevalence and serogroup/type distribution. Vaccine impact is unpredictable in a setting with novel genotypes and limited serotype coverage as described here. Consequently, continued surveillance of pneumococcal isolates from carriage and disease in Nepali children following the planned introduction of pneumococcal conjugate vaccines introduction will be essential.
    PLoS ONE 06/2014; 9(6):e98739. DOI:10.1371/journal.pone.0098739 · 3.23 Impact Factor
  • Sophie C.H. Wen · Trevor Anderson · David Murdoch
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    ABSTRACT: Streptococcus pseudopneumoniae is a novel species belonging to the viridans group streptococci (VGS). Accurate species identification is challenging due to significant homology to other VGS. Whole-genome sequencing of S. pseudopneumoniae suggests it most likely originated from Streptococcus pneumoniae, sharing many of its virulence genes. There are several limitations when using traditional phenotypic identification methods to identify this organism. Other identification approaches include genotypic methods, pherotype analysis, and matrix-assisted laser desorption ionization–time of flight mass spectrometry. S. pseudopneumoniae is most commonly isolated from respiratory specimens, and its associations with chronic obstructive pulmonary disease and aspiration pneumonia have been previously described, suggesting that the organism treads the fine line between commensal and pathogen. Recent isolation of S. pseudopneumoniae from blood raises the important question of its clinical relevance. Antimicrobial susceptibility profiles of S. pseudopneumoniae indicate a higher level of resistance than other VGS. However, further information may be required to determine the choice of breakpoints.
    Clinical Microbiology Newsletter 05/2014; 36(9):65–71. DOI:10.1016/j.clinmicnews.2014.04.003
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    ABSTRACT: We retrospectively examined medical records of 87 patients with HACEK bacterbaemia to determine whether endocarditis was present as defined by the Duke criteria. The overall positive predictive value (PPV) of HACEK bacteraemia for endocarditis was 60%. The PPV varied with different HACEK species from 0% (Eikenella corrodens) to 100% (Aggregatibacter actinomycetemcomitans).
    Journal of Medical Microbiology 03/2014; 63(Pt_6). DOI:10.1099/jmm.0.070060-0 · 2.27 Impact Factor
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    ABSTRACT: The practice of an infectious diseases (ID) physician is evolving. A contemporary understanding of the frequency and variety of patients and syndromes seen by ID services has implications for training, service development and setting research priorities. We performed a 2-week prospective survey of formal ID physician activities related to direct inpatient care, encompassing 53 hospitals throughout Australia, New Zealand and Singapore and documented 1722 inpatient interactions. Infections involving the skin and soft tissue, respiratory tract and bone/joints together accounted for 49% of all consultations. Suspected/confirmed pathogens were primarily bacterial (60%), rather than viral (6%), fungal (4%), mycobacterial (2%) or parasitic (1%). Staphylococcus aureus was implicated in 409 (24%) of episodes, approximately four times more frequently than the next most common pathogen. The frequency of health-care related infections (35%), immunosuppression (21%), diabetes mellitus (19%), prosthesis related infections (13%), multi-resistant pathogens (13%) and non-infectious diagnoses (9%) was high, although consult characteristics varied between geographic settings and hospital types. Our study highlights the diversity of inpatient related ID activities and should direct future teaching and research. ID physicians’ ability to offer beneficial consultative advice requires broad understanding of, and ability to interact with, a wide range of referring specialities. This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 02/2014; 20(10). DOI:10.1111/1469-0691.12581 · 5.20 Impact Factor

Publication Stats

4k Citations
920.78 Total Impact Points

Institutions

  • 2003–2015
    • University of Otago
      • • Department of Microbiology and Immunology
      • • Christchurch School of Medicine and Health Sciences
      Taieri, Otago, New Zealand
  • 1995–2013
    • Canterbury District Health Board
      Christchurch, Canterbury Region, New Zealand
  • 2012
    • Mahidol University
      • Department of Tropical Pathology
      Bangkok, Bangkok, Thailand
    • Johns Hopkins Bloomberg School of Public Health
      • International Vaccine Access Center
      Baltimore, MD, United States
  • 2011
    • University of Oxford
      Oxford, England, United Kingdom
    • Oxford University Hospitals NHS Trust
      Oxford, England, United Kingdom
  • 2001–2008
    • Canterbury Health Laboratories
      Christchurch, Canterbury, New Zealand
  • 2001–2007
    • Duke University Medical Center
      • • Department of Pathology
      • • Division of Infectious Diseases
      Durham, North Carolina, United States
  • 2002
    • University of Canterbury
      Christchurch, Canterbury Region, New Zealand
  • 1999–2002
    • Duke University
      Durham, North Carolina, United States