A small percentage of blood cultures performed to diagnose infections are contaminated, due to skin fragments containing bacteria that are dislodged during the blood draw.

This contamination can lead to false positive results that can mislead clinicians into thinking a patient has a potentially serious bloodstream infection. This can lead to the unnecessary prescription of antibiotics and subsequently contributes to the growing risk of antibiotic resistance.

The ISDD is a sterile blood collection system that diverts and sequesters the first 1.5 to 2 milliliters of blood – which often carries contaminating skin cells and microbes. This part of the blood is discarded before testing.

The UNMC study involved comparing 1800 blood cultures – one using standard procedures and one using the ISDD for each of the 900 participating patients. The results showed an 88% decrease in false positives with the ISDD compared to standard procedures – from a rate of 1.78% to 0.2%.

Mark Rupp MD, professor and chief of the UNMC Division of Infectious Diseases was the lead author of the study and noted;

“A lot of people think this is a minor problem. However, contaminated blood cultures are a big deal. Physicians can be led astray and patients may be harmed by additional tests and unnecessary antimicrobial therapy.

What is important about this device is it can greatly limit the blood culture from being contaminated, so physicians are rarely fooled by false-positive results. It gives clinicians confidence that results are accurate.”

The accuracy of Australian pathology is extremely high and every mechanism is used by pathologists to minimise the risk of false positives and negatives. However, even when operating at the highest level of quality these issues can occasionally arise. Those working in pathology are constantly seeking ways to minimise the chance of errors and this new research and device may assist them.

The results are published online in the journal Clinical Infectious Diseases.

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Australian infectious disease researchers at the Illawarra Health and Medical Research Institute have found that people with the blood type O (the most common blood type among Australian patients) could be at higher risk of developing streptococcal infections than those with other blood types.

There are various types of Streptococcal infection, ranging from mild sore throats to deadly infections of the blood or organs. Repeated infections can lead to chronic conditions, such as rheumatic heart disease.

Post-Doctoral Researcher Dr David De Oliveira studied Group A Streptococcus (GAS) and found that the sugar molecules on type O blood may create a ‘bridge’ for colonisation – leaving type O carriers more susceptible to a particularly virulent clone of GAS (M1T1 GAS) present in many invasive infections.

Senior Research Fellow Dr Martina Sanderson-Smith, who co-published the study with Dr De Oliveria, said;

 “We know that some people are more susceptible to streptococcal infections. We wanted to see if there are other biological reasons that increase the risks, and understand why some people suffer repeated infections.”

The next step for the researchers will be a new project studying saliva samples taken from people colonised with GAS, in collaboration with researchers at the Murdoch Children’s Research Institute.

Their hope is that one day they will be able to develop a non-antibiotic treatment for children with sore throats;

“A sore throat is one of the most common reasons children are prescribed antibiotics, but we are becoming more aware that antibiotic overuse can be a problem, so developing non-antibiotic treatments for bacterial infections is important”, said Dr Sanderson-Smith.

Read more about the research here.

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Western Australian scientists have mapped the 3-dimensional molecular structure of a protein called EptA which bacteria use to hide from the human immune system and antibiotics. The Scientists believe the discovery will enable the development of new drugs that are more effective at targeting and killing dangerous bacteria.

Superbugs are a global health problem with around 700,000 deaths per year attributed to them. The World Health Organisation predicts this could rise to 10 million by 2050.

Pathology is key to reducing incorrect use of antibiotics in humans. Microbiology departments are integral to providing fast, detailed reports to doctors about infections. These include results of tests that reveal which antibiotics are effective against a certain bacteria and which won’t work.

Every time a bacteria is exposed to a drug that doesn’t kill it, the bacteria ‘learns’ about the drug and adapts to it. When the bacteria divides into offspring, they carry the ability to resist the drug in their genes. By reducing the administration of ineffective antibiotics, pathology helps the patient get better fast and reduces the growth of resistant bacteria.

Read the full report about the breakthrough here.

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Angus is the world’s only canine hospital employee trained to sniff out the superbug Clostridium difficile. C. difficile is a commonly found bacteria posing little threat to healthy adults but it can kill people with low immune systems. Hospitals are fertile grounds for it to spread among patients – hence visitors are strongly encouraged to wash their hands prior to entering wards.

C. difficile is a prominent superbug because the bacteria have developed immunity to many standard antibiotics. Infected patients must be treated quickly with an effective antibiotic for the sake of their own health and to prevent spread to other patients.

Pathology is integral to ensuring this happens. Microbiology staff test samples from patients for presence of the bug. Once this is confirmed, they test the bacteria against a variety of antibiotics to establish which of these are most effective. This information is provided to the ward doctors who can then prescribe the best antibiotic.

Angus’ ground-breaking career move came three years ago after his owner, Vancouver woman Teresa Zurberg, had a C. difficile infection that almost killed her. Teresa trains dogs in explosive and drug detection whilst her husband Markus is a nurse. He stumbled across a journal article about a Beagle in the Netherlands that had shown the ability to sniff C. difficile out in patients.

Training their new puppy to do this was a no-brainer for the couple. It took 10 months to train him to detect the bug in the environment (bedding, floors, equipment). But despite Angus’ success, he’s not in a position to replace pathology staff. Angus isn’t used directly on patients as he may cause allergies in already unwell people.

At four days a week, it’s nearly a full-time workload for the young pup.

Angus wasn’t directly interviewed for this story, but if he had been, he would probably say that while the long days can be ruff, ultimately his job is paw-some.

Photos and story adapted from https://www.theguardian.com/world/2017/jan/12/clostridium-difficile-infection-canada-dog-detective?CMP=Share_iOSApp_Other

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The World Health Organization has prioritised the fight against antibiotic resistance due to it’s potential to undermine years of successful drug development. As a result, many diseases now only seen in developing nations may return, such as tuberculosis.

Development of the small device has been funded by the US Defense Department and the Gates Foundation, the charitable foundation of Bill and Melinda Gates. It consists of 16 chambers which contain genetic material from bacteria often resistant to antibiotics. When a ‘match’ is made in the DNA, the chamber lights up to alert the doctor. They can then decide to go the extra mile to obtain the best drug for that infection or quarantine the patient to prevent it from being spread.

It is still early days for the device. The American researchers have created a company to raise more funds to improve the technology so that it may be commercially distributed in the future.

There are a number of causes of antibiotic resistance, but all are related to the inappropriate use of antibiotics.

When a patient presents with a likely bacterial infection doctors will ask pathology staff to identify the bacteria and test it for resistance to antibiotics. This ensures they prescribe a drug that will work well against that specific infection.

In remote areas or regions without adequate healthcare infrastructure this is not always possible, so doctors will prescribe a ‘broad spectrum’ antibiotic. These are antibiotics that can kill a lot of different types of bacteria, but often with results that are adequate without being excellent. Strong bacteria will not be killed by the drug and when they multiply, their offspring will also be able to survive exposure to the medication.

Other causes include the overuse of antibiotics in the farming industry to prevent costly outbreaks in herds or flocks. In a major win for those advocating for action against the problem, the American Food and Drug Administration banned the use of certain antibiotics in domestic hand soaps and detergents in 2016.

A simple cause that you can do something about is following doctor’s orders with regards to taking antibiotics. Always finish the full course of antibiotics as directed by your doctor, even when if you start to feel better partway through.

Here is Know Pathology Know Healthcare Ambassador Professor Peter Collignon discussing the problem of antibiotic resistance. Credit to the Milken Institute School of Public Health at the George Washington University for this video.

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It was only the fourth time the general assembly has had a high-level meeting for a health issue. Meanwhile, on the other side of the word, one PhD student is taking matters into her own hands.

Shu Lam is a Malaysian-born PhD student at the University of Melbourne and she’s researching an innovative microbiology approach to attacking drug-resistant infections.

For the past three years Lam has been researching her own method of killing bacteria using tiny star-shaped molecules, built with chains of protein units called peptide polymers.

Lam, who is leading a team of six researchers, has said the 4am starts and weekends of working are worthwhile. She believes her discovery could one day be a ground-breaking alternative to fight antibiotic-resistant infections;

“We’ve discovered that the polymers actually target the bacteria and kill it in multiple ways. One method is by physically disrupting or breaking apart the cell wall of the bacteria. This creates a lot of stress on the bacteria and causes it to start killing itself.”

A significant benefit is that the polymers attack the bacteria directly, unlike antibiotics, which create a toxic swamp that also destroys nearby healthy cells.

Pathology is vital in combatting the overuse and incorrect use of antibiotics which has already rendered some strains of bacteria untreatable, allowing “superbugs” to mutate.

Currently superbugs kill an estimated 700,000 people a year, including 230,000 newborns, but this is set to rise to 10 million a year by 2050 if drastic action is not taken.

It’s very early days but Lam’s research has already been published in Nature Microbiology and is being hailed by scientists as a “breakthrough that could change the face of modern medicine”.

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