MIXED NON-ALBICANS CANDIDA FUNGEMIA: AN UNCOMMON BUT EASILY OVERLOOKED CLINICAL ENTITY

The increasing use of invasive medical devices and broad-spectrum antimicrobial agents has resulted in rising candidemia rates throughout the world. A 70-year-old diabetic and schizophrenic woman was admitted initially for staphylococcal sepsis secondary to an infected sacral sore but developed a catheter-related bloodstream infection caused by extended-spectrum β-lactamase-producing Klebsiella sp. which necessitated the administration of meropenem. Unfortunately, after a week on the carbapenem, the bacterial sepsis was followed by candidemia. Parenteral fluconazole therapy was started pending identification of the yeast(s). Two distinct Candida species were isolated from her blood which were identified biochemically using ID 32 C as Candida tropicalis and Candida lipolytica. Both yeasts possessed elevated minimal inhibitory concentrations toward fluconazole and although amphotericin B was eventually administered, the patient succumbed to her illness

Evaluation of rapid antigen detection test for group A Streptococci pharyngitis among children in an out-patient clinic in Malaysia

One of the most common conditions encountered in the out-patient setting is acute pharyngitis. Group A Streptococcus (GAS) accounts for 15%-30% of cases of sore throat particularly in children under 15 years old. Rapid antigen testing (RADT) is an alternative diagnostic method to detect GAS pharyngitis. This study was done to evaluate the agreement between RADT whereby BIONEXIA® Strep A Plus (BioMérieux, France) kit was used and throat culture in the diagnosis of GAS pharyngitis in children presented with a sore throat. One hundred and ten children from a primary health care clinic with sore throat were included in this study. All children were evaluated based on McIsaac scoring and throat swab samples were taken for both throat culture and RADT testing. The prevalence of GAS pharyngitis by RADT in this study was 7.3% over one year. A higher incidence of GAS pharyngitis was noted in the school-aged children than the preschool-age children. There was no correlation between cough, lymph node enlargement, and tonsillar enlargement in predicting GAS pharyngitis. The sensitivity and specificity of RADT were 100% and 98%, respectively, when taking throat culture as a gold standard. A good agreement between RADT and throat culture was achieved (k=0.848). McIsaac scoring was noted to have good predictability for GAS pharyngitis with AUC=0.82. In conclusion, the rapid streptococcal antigen detection test showed excellent sensitivity and specificity and detecting GAS from the throat swab samples. Thus, it can be used to aid in the diagnosis of group A Streptococcal pharyngitis and could reduce the overuse of antibiotics. McIsaac score has also proven to be useful as a screening tool for bacterial pharyngitis

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

Predicting the next pandemic: VACCELERATE ranking of the World Health Organization's Blueprint for Action to Prevent Epidemics

Introduction: The World Health Organization (WHO)'s Research and Development (R&D) Blueprint for Action to Prevent Epidemics, a plan of action, highlighted several infectious diseases as crucial targets for prevention. These infections were selected based on a thorough assessment of factors such as transmissibility, infectivity, severity, and evolutionary potential. In line with this blueprint, the VACCELERATE Site Network approached infectious disease experts to rank the diseases listed in the WHO R&D Blueprint according to their perceived risk of triggering a pandemic. VACCELERATE is an EU-funded collaborative European network of clinical trial sites, established to respond to emerging pandemics and enhance vaccine development capabilities. Methods: Between February and June 2023, a survey was conducted using an online form to collect data from members of the VACCELERATE Site Network and infectious disease experts worldwide. Participants were asked to rank various pathogens based on their perceived risk of causing a pandemic, including those listed in the WHO R&D Blueprint and additional pathogens. Results: A total of 187 responses were obtained from infectious disease experts representing 57 countries, with Germany, Spain, and Italy providing the highest number of replies. Influenza viruses received the highest rankings among the pathogens, with 79 % of participants including them in their top rankings. Disease X, SARS-CoV-2, SARS-CoV, and Ebola virus were also ranked highly. Hantavirus, Lassa virus, Nipah virus, and henipavirus were among the bottom-ranked pathogens in terms of pandemic potential. Conclusion: Influenza, SARS-CoV, SARS-CoV-2, and Ebola virus were found to be the most concerning pathogens with pandemic potential, characterised by transmissibility through respiratory droplets and a reported history of epidemic or pandemic outbreaks