Laboratory-based surveillance of Clostridium difficile Infection in Australian health care and community settings, 2013 to 2018

In the early 2000s, a binary toxin (CDT)-producing strain of Clostridium difficile, ribotype 027 (RT027), caused extensive outbreaks of diarrheal disease in North America and Europe. This strain has not become established in Australia, and there is a markedly different repertoire of circulating strains there compared to other regions of the world. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is a nationwide longitudinal surveillance study of C. difficile infection (CDI) in Australia. Here, we describe the molecular epidemiology of CDI in Australian health care and community settings over the first 5 years of the study, 2013 to 2018. Between 2013 and 2018, 10 diagnostic microbiology laboratories from five states in Australia participated in the CDARS study. From each of five states, one private (representing community) and one public (representing hospitals) laboratory submitted isolates of C. difficile or PCR-positive stool samples during two collection periods per year, February-March (summer/autumn) and August-September (winter/spring). C. difficile was characterized by toxin gene profiling and ribotyping. A total of 1,523 isolates of C. difficile were studied. PCR ribotyping yielded 203 different RTs, the most prevalent being RT014/020 (n = 449; 29.5%). The epidemic CDT+ RT027 (n = 2) and RT078 (n = 6), and the recently described RT251 (n = 10) and RT244 (n = 6) were not common, while RT126 (n = 17) was the most prevalent CDT+ type. A heterogeneous C. difficile population was identified. C. difficile RT014/020 was the most prevalent type found in humans with CDI. Continued surveillance of CDI in Australia remains critical for the detection of emerging strain lineages

High-resolution record of displacement accumulation on an active normal fault: implications for models of slip accumulation during repeated earthquakes

The spatial and temporal accumulation of slip from multiple earthquake cycles on active faults is poorly understood. Here, we describe a methodology that can determine the time period of observation necessary to reliably constrain fault behaviour, using a high-resolution long-time-scale (the last 17kyr) fault displacement dataset over the Rangitaiki Fault (Whakatane Graben, New Zealand). The fault linked at c. 300 ka BP, and analysis of time periods within the last 17 kyr gives insight into steady-state behaviour for time intervals as short as c. 2 kyr. The maximum displacement rate observed on the Rangitaiki Fault is 3.6 ± 1.1 mm yr-1 measured over 17 kyr. Displacement profiles of the last 9 ka of fault movement are similar to profiles showing the last 300 ka of fault movement. In contrast, profiles determined for short time intervals (2 - 3 kyr) are highly irregular and show points of zero displacement on the larger segments. This indicates temporal and spatial variability in incremental displacement associated with surface-rupturing slip events. There is spatial variability in slip rates along fault segments, with minima at locations of fault interaction or where fault linkage has occurred in the past. This evidence suggests that some earthquakes appear to have been confined to specific segments, whereas larger composite ruptures have involved the entire fault. The short-term variability in fault behaviour suggests that fault activity rates inferred from geodetic surveys or surface ruptures from a single earthquake, may not adequately represent the longer-term activity nor reflect its future behaviour. Different magnitude events may occur along the same fault segment, with asperities preventing whole segment rupture for smaller magnitude events

A Consensus-Based Interpretation of the Benchmark Evidence from South American Trials : Treatment of Intracranial Pressure Trial

Widely-varying published and presented analyses of the Benchmark Evidence From South American Trials: Treatment of Intracranial Pressure (BEST TRIP) randomized controlled trial of intracranial pressure (ICP) monitoring have suggested denying trial generalizability, questioning the need for ICP monitoring in severe traumatic brain injury (sTBI), re-assessing current clinical approaches to monitored ICP, and initiating a general ICP-monitoring moratorium. In response to this dissonance, 23 clinically-active, international opinion leaders in acute-care sTBI management met to draft a consensus statement to interpret this study. A Delphi method-based approach employed iterative pre-meeting polling to codify the group's general opinions, followed by an in-person meeting wherein individual statements were refined. Statements required an agreement threshold of more than 70% by blinded voting for approval. Seven precisely-worded statements resulted, with agreement levels of 83% to 100%. These statements, which should be read in toto to properly reflect the group's consensus positions, conclude that the BEST TRIP trial: 1) studied protocols, not ICP-monitoring per se; 2) applies only to those protocols and specific study groups and should not be generalized to other treatment approaches or patient groups; 3) strongly calls for further research on ICP interpretation and use; 4) should be applied cautiously to regions with much different treatment milieu; 5) did not investigate the utility of treating monitored ICP in the specific patient group with established intracranial hypertension; 6) should not change the practice of those currently monitoring ICP; and 7) provided a protocol, used in non-monitored study patients, that should be considered when treating without ICP monitoring. Consideration of these statements can clarify study interpretation