ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest

Melioidosis in Brunei Darussalam

Melioidosis continues to be a major health care problem in Brunei Darussalam. The age of patients, gender distribution, risk factors, and clinical presentations are similar to those reported from other countries in the region. The incidence of melioidosis was high during the wet months and in the Temburong district, which has the highest annual rainfall. In spite of adequate facilities for diagnosis and treatment, the mortality remains high (27%). Women and those presenting with septic shock had higher mortality. There is a case for making melioidosis a notifiable disease in Brunei Darussalam. Coordinated efforts between policy-makers and various stakeholders are required to effectively combat the disease

Haemophagocytic lympohistiocytosis: a rare manifestation of dengue fever

ABSTRACT Haemophagocytic lymphohistiocytosis (HLH) or haemophagocytic syndrome is a rare disorder that is associated with high mortality. Manifestations are often non-specific, mimicking many common conditions that include infections, autoimmune disease and even neoplasms. It is characterised by cytopenia, hepato-splenomegaly, hyperferritinemia, hypertriglyceridemia, and haemophagocytosis. The underlying pathogenesis is not completely known but is believed to be due to activated but ineffective host immune responses in susceptible patients after external trigger such as virus infections. Associations with other micro-organisms have also been reported. We report a case of HLH that was associated with dengue fever, an infection that is still endemic in many parts of the world

An inactivated enterovirus 71 vaccine is safe and immunogenic in healthy adults: A phase I, double blind, randomized, placebo-controlled, study of two dosages

10.1016/j.vaccine.2019.06.023VACCINE37314344-435