ASID New Zealand 2020 Annual Meeting

CONFERENCE HANDBOOK

E: [email protected] W: www.asid.net.au/groups/nz-annual-meeting ASID New Zealand 2020 Annual Meeting 0

ASID New Zealand 2020 Annual Meeting

Friday 30 October 2020 9:00 am to 4:30 pm (NZDT)

Convener: Dr Chris Hopkins

ASID Secretariat: Marilena Salvo, Senior Executive Officer Maureen Ryan, Events Manager

This year's event will be held as a virtual meeting with hubs in the following locations: • Auckland (main hub): Parnell Community Centre, Pukekawa & Bledisloe Rooms, Jubilee Building, 545 Parnell Road, Parnell • Auckland: North Shore Hospital Hospice Seminar Room 1, level 3 • Christchurch: Manawa Building Room HP303 - 276 Antigua Street, Christchurch Central, Christchurch • Midlands: Tauranga Hospital, Ako Room, Pathlab Bay of Plenty, Cameron Road, Tauranga • : Wellington Hospital, Level 6, Grace Neill Block

Image: Hub locations

Twitter hashtag: Join the conversation at #asidnz20

The program is current at the time of publishing and is subject to change at short notice.

The Australasian Society for Infectious Diseases is the peak professional body for infectious diseases and microbiology in the region and a key stakeholder for government departments, medical colleges and other societies, including international organisations. ASID New Zealand 2020 Annual Meeting 1

Invited Speakers

Professor/Ahorangi Michael Baker Department of Public Health/Te Tari Hauora Tūmatanui; University of Otago, Wellington/Te Whare Wānanga o Otāgo ki Te Whanga-nui-a-Ta

Michael Baker is a public health physician and Professor in the Department of Public Health at the University of Otago. He is a member of the Ministry of Health’s COVID-19 Technical Advisory Group, has taken a leading role in formulating New Zealand’s elimination strategy against this pandemic and established a programme of research on the epidemiology, prevention and control of COVID-19 with support from the Health Research Council of New Zealand.

Dr Ashley Bloomfield Director-General of Health and Chief Executive

Dr Bloomfield qualified in medicine at the in 1990 and after several years of clinical work specialised in public health medicine. His particular area of professional interest is non-communicable disease prevention and control, and he spent 2011 at the World Health Organization in Geneva working on this topic at a global level. Dr Bloomfield was Chief Executive at Hutt Valley from 2015 to 2018. Prior to that, he held a number of senior leadership roles within the Ministry of Health.

Dr Richard Chen Urgent Care Physician prior to COVID-19. Quarantine Medical Lead since February 2020.

Involved with initial operations at the Whangaparaoa Naval Base for Evacuees out of the Wuhan Epicenter and later Guests from the Cruise Ship Outbreak. Now stationed at Jet Park Quarantine responsible for COVID-19 cases from across the border and community clusters within the Greater Auckland, Waikato and Rotorua Regions.

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Invited Speakers

Professor Allen Cheng

Allen Cheng is Director of the Infection Prevention and Healthcare Epidemiology Unit at Alfred Health, and Professor of Infectious Diseases Epidemiology at the School of Public Health and Preventive Medicine at Monash University. He is the current ASID President, Co-Chair of the Australian Technical Advisory Group on Immunisation and a member of several other government advisory committees.

Dr Gary McAuliffe

Dr McAuliffe is a graduate of Imperial College School of Medicine in the UK. He trained in microbiology in Christchurch, Auckland, and Darwin. Relevant areas of clinical experience include: paediatrics, adult infections and tropical medicine. In addition to being Medical Director of Labtests and Northland Pathology Laboratory, Dr McAuliffe works eight tenths at Labtests as a clinical microbiologist, and two tenths in the microbiology department at LabPLUS, Auckland Hospital. Dr McAuliffe is a Fellow of the Royal College of Pathologists of Australasia.

Dr Mariam Parwaiz Public Health Medicine Specialist

Dr Parwaiz is a public health medicine specialist and, since July 2020, has been the clinical lead for the ARPHS COVID-19 response. Dr Parwaiz completed her medical degree at the University of Otago in 2012 and recently completed public health medicine specialist training. In addition to previous roles at ARPHS, Dr Parwaiz has worked in public health positions at Counties Manukau Health and Te Marae Ora Cook

Islands Ministry of Health, and has served on the Council of the New Zealand College of Public Health Medicine as the Registrar Representative.

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The 2020 ASID NZ Annual Meeting is made possible with the generous support of our sponsors

More information on the sponsors can be found from page 19.

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ASID New Zealand 2020 Annual Meeting Program Friday 30 October, online streaming with regional hubs

TIME SPEAKER SITE TITLE 8:30 REGISTRATION / SOUND CHECK 9:00 Chris Hopkins Auckland hub Welcome 9:05 Tim Cutfield & Amanda Taylor London COVID-19 in London 9:20 Gary McAuliffe Auckland hub Laboratory response to COVID-19 9:40 Michael Baker Christchurch hub The COVID-19 elimination strategy: Implications and opportunities for NZ 10:00 Ashley Bloomfield Auckland hub Ministry of Health response to COVID-19 10:20 Mariam Parwaiz Auckland hub The August Auckland outbreak 10:40 Panel kōrero 11:00 PAKARU KAWHE / COFFEE BREAK 11:20 Allen Cheng Melbourne Victoria's second wave - lessons learned 11:40 Shivani Fox-Lewis Auckland hub A comparison of SARS-CoV-2 antibody assays evaluated in Auckland, New Zealand 12:00 Susan Morpeth Auckland hub COVID-19 clinical trials in NZ 12:20 Richard Chen Auckland hub Being the quarantine doctor SARS-CoV-2 viral load dynamics & real-time RT-PCR cycle threshold interpretation in symptomatic non- 12:35 Andrew Fox-Lewis Auckland hub hospitalised individuals in NZ 12:50 Nadia Mekki Perth Healthcare Workers’ Perceptions on the COVID-19 Pandemic in a Western Australian Hospital 13:05 TINA / LUNCH 13:20 AGM Highly effective prophylaxis with ertapenem for transrectal ultrasound-guided prostate biopsy: effects on 14:15 Max Bloomfield Wellington hub overall antibiotic use and inpatient hospital exposure Ceftazidime-avibactam plus aztreonam susceptibility testing against New Zealand metallo-beta- 14:30 Aaron Keene Tauranga hub lactamase producing Enterobacterales 14:45 Leeyan Gilmour Auckland hub The Alarming Reality: Our New Zealand Congenital Syphilis Epidemic 15:00 PAKARU KAWHE / COFFEE BREAK 15:30 Aaron Keene & Kevin Chen Tauranga hub A cluster of botulism cases in the Bay of Plenty. Clinical presentation, treatment, diagnostics and pitfalls. 15:45 Katie Walland Auckland hub Do patients with sepsis die of sepsis? A narrative review 16:00 Simon Briggs Auckland hub Enterococcal endocarditis treatment with benzylpenicillin plus ceftriaxone A Qualitative Study Investigating Emergency Department Nurse and Doctor Perceptions of Sepsis 16:15 Alice Rogan Wellington hub Management & Factors Impacting on Patient Care 16:30 CLOSE

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Proffered Papers Abstracts

A comparison of SARS-CoV-2 antibody assays evaluated in Auckland, New Zealand

Authors: Fox-Lewis S1, Whitcombe A2,3, McGregor R2,3, Carlton L2, Hwang Y1, Austin P1, Aspin L4, Raill B5, Webb R2,6,7, Taylor S8, Morpeth S8, Roberts S3,9, Moreland NJ2,3, McAuliffe G1,10

1Department of Virology-Immunology, LabPLUS, Auckland City Hospital, Auckland, New Zealand 2Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand 3Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand 4Department of Biochemistry and Immunology, Labtests, Auckland, New Zealand 5Department of Biochemistry, Middlemore Hospital, Auckland, New Zealand 6Starship Children’s Hospital, Auckland, New Zealand 7KidzFirst Children’s Hospital, Middlemore Hospital, Auckland, New Zealand 8Department of Microbiology, Middlemore Hospital, Auckland, New Zealand 9Department of Microbiology, LabPLUS, Auckland City Hospital, Auckland, New Zealand 10 Department of Microbiology, Labtests, Auckland, New Zealand

Introduction: Serological assays for SARS-CoV-2 have a diagnostic role in situations where detection via molecular methods alone is insufficient, due to the timing and quality of sample collection. Serological assays must be assessed in the relevant epidemiological context, to determine locally-applicable sensitivity and specificity data. We present a comparison of nine serological assays conducted in Auckland, New Zealand.

Methods: The nine assays evaluated were the Abbott Architect IgG, Roche Elecsys total antibody, Euroimmun IgA to Spike protein and IgG to Spike and nucleocapsid proteins, EDI IgM and IgG, in-house University of Auckland two-step ELISA and surrogate viral neutralisation assay (cPASS, GenScript).

Pre-pandemic and pandemic (positive and negative RT-PCR) samples were tested on each assay, and sensitivity and specificity calculated. Pandemic samples were from inpatients to Auckland City Hospital and Middlemore Hospital March to May 2020.

Results: With the exception of the IgA and IgM assays, the remaining seven assays demonstrated high specificity (94.2-100%) and reasonable sensitivity (86.7-100%). The in-house ELISA and cPASS assays performed best (100% sensitivity and specificity), but present challenges to implementation in diagnostic laboratories. The high- throughput Abbott and Roche assays are readily implemented, highly specific (100%, 99.2% respectively) but have lower sensitivity (86.7%, 89.5% respectively). ASID New Zealand 2020 Annual Meeting 6

Conclusion: This study presents a comparison of nine serological assays within the epidemiological context of New Zealand. The IgG, the total antibody and surrogate viral neutralisation assays demonstrated high specificity and reasonable sensitivity. The application of these assays needs to incorporate local laboratory workflow and logistics, with respect to anticipated testing volume.

Disclosure of interest statement: The authors have no competing interests to declare.

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SARS-CoV-2 viral load dynamics and real-time RT-PCR cycle threshold interpretation in symptomatic non-hospitalised individuals in New Zealand: a multicentre cross-sectional observational study.

Authors: Fox-Lewis A1, Fox-Lewis S2, Beaumont J3, Drinkovic D4, Harrower J5, Howe K5, Jackson C6, Rahnama F2, Shilton B7, Qiao H3, Smith K4, Morpeth SC3, Taylor S3, Blakiston M1,7, Roberts S1, McAuliffe G2,7

Author affiliations: 1Microbiology Department, LabPLUS, Auckland City Hospital, Auckland DHB, Auckland, New Zealand, 2Virology-Immunology Department, LabPLUS, Auckland City Hospital, Auckland DHB, Auckland, New Zealand, 3Microbiology Department, Middlemore Hospital, Counties Manukau DHB, Auckland, New Zealand, 4Microbiology Department, North Shore Hospital, Waitematā DHB, Auckland, New Zealand, 5Auckland Regional Public Health Service, Auckland DHB, Auckland, New Zealand, 6Public Health Northland, Northland DHB, Whangarei, New Zealand, 7Labtests, Auckland, New Zealand

Corresponding author: Dr Andrew Fox-Lewis Postal address: Microbiology Department, LabPLUS, Building 31, Auckland City Hospital, Gate 4 off Grafton Rd, Grafton, Auckland, New Zealand. Email: [email protected]. Telephone: +64224586511.

Introduction: This study aimed to describe population-level SARS-CoV-2 upper respiratory tract (URT) viral load dynamics by stratifying RT-PCR positivity rates and Ct values of URT samples from COVID-19 cases by days since symptom onset (DSSO), and to explore utility of Ct values in determining potential infectivity.

Methods: Multicentre cross-sectional observational study of laboratory, public health and hospitalisation data for PCR-confirmed COVID-19 cases within the New Zealand Northern Region, 12/02/2020-08/06/2020.

Results: Of 123,124 samples tested for SARS-CoV-2 by PCR, 579 samples from 368 symptomatic non-hospitalised COVID-19 cases were included. Positivity rate was 93.2% (317/340) for samples collected during the symptomatic infectious period (0-10 DSSO) and 36.3% (82/226) for post-infectious period samples. URT viral load peaked shortly after symptom onset, with median Ct values ranging 20.00-29.99 until 15 DSSO and >30.00 after this time. Of positive samples with a Ct <20.00, 96.1% were collected during the symptomatic infectious period. However, of positive samples with a Ct ≥30.00 and ≥35.00, 46.9% and 18.5% respectively were also collected during the symptomatic infectious period.

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Conclusion: At, or soon after symptom onset represents the optimum time to test for SARS-CoV-2 in the URT, with median Ct values suggesting the useful testing window extends until around 15 DSSO. In asymptomatic individuals or those with unknown dates of symptom onset, Ct values <20.00 imply recent onset/potential infectivity, but Ct values ≥30.00/≥35.00 do not exclude recent onset/potential infectivity. Individual sample Ct values should not be used as a marker of time post-infection or to exclude infectivity where date of symptom onset is unavailable.

Disclosure of Interest Statement: The authors declare no conflict of interests and received no specific funding for this work.

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Healthcare Workers’ Perceptions on the COVID-19 Pandemic in a Western Australian Hospital

Authors: Mekki N1, Daniels H1, Tan S1, Friesema K1, Otome O1,2 1St John of God Midland Public and Private Hospitals 2University of Western Australia, Faculty of Health and Medical Sciences

Introduction: Institutional and front- line health-care worker (HCW) preparedness to a global pandemic is often difficult to measure. We sought to assess HCW perceptions on COVID-19 and their confidence at the front-line in dealing with this pandemic.

Methods: We designed a prospective web-based survey consisting of 23 questions using REDcap (v10). The survey was distributed via email to healthcare workers. Most questions required a selection from strongly agree, agree, neither agree nor disagree, disagree and strongly disagree. Responses were collected over 3 weeks in May 2020. Descriptive statistics were used to analyse data.

Results: 10% (176/1700) of HCWs participated. Ages ranged from 18 to 74 and 85.8% were female. 10.2% identified as doctors, 30.7% nursing, 22.2% allied health and 36.9% as other (e.g. cleaners). > 94% were confident on the modes of transmission of COVID-19. 74.4% felt confident in their preparations in caring for patients with suspected or confirmed COVID-19. 29% were not confident on donning and doffing PPE. Of the participants,14.2% identified themselves as having underlying conditions that would put them at increased risk of serious complications from the disease. 10.2% of responders expressed the wish to take time off or resign from their position due to the concerns of acquiring COVID-19 in the work place.

Conclusion: Although our institution’s preparations for this pandemic improved HCW confidence, there remains need to continuously innovate and develop strategies to disseminate knowledge and maintain the acquired skills. We identify HCW physical and mental health as key areas that need special consideration.

Disclosure of Interest Statement: No funding was received in the development of this survey.

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Highly effective prophylaxis with ertapenem for transrectal ultrasound-guided prostate biopsy: effects on overall antibiotic use and inpatient hospital exposure.

Authors: Dr Maxim G. Bloomfield 1,2 [email protected] Aidan D. Wilson 3 [email protected] Mr Rodney C. Studd 4 [email protected] Adjunct Prof Timothy K. Blackmore 1,2 [email protected]

1. Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand 2. Department of Microbiology, Wellington Southern Community Laboratories, Wellington, New Zealand 3. School of Medicine, University of Otago Wellington, Wellington, New Zealand 4. Department of Urology, Wellington Regional Hospital, Wellington, New Zealand

Background: Ertapenem prophylaxis for transrectal ultrasound-guided prostate biopsy (TRUS-PB) has proven highly effective at our institution. A subsequent study showed no selection for carbapenem-resistance, but antimicrobial stewardship (AMS) concerns remained.

Aim: To assess the effects of this prophylaxis on overall antibiotic consumption and exposure to the hospital environment.

Methods: All men undergoing TRUS-PB from November 2006-July 2019 were included. Hospital records of men presenting within 30-days of biopsy were searched to determine if post- biopsy infection (PBI) occurred, antibiotic usage, and duration of hospitalisation. Prophylaxis during the pre-ertapenem period (Period 1: 2006-2012) was oral ciprofloxacin for three-days, with oral amoxicillin-clavulanate added in 2009. During the subsequent period (Period 2: 2012-2019) a single intramuscular dose of ertapenem was used.

Findings: From Periods 1 and 2 1663 and 2357 men, respectively, were included. Median age was 65-years for both groups. Between Periods 1 and 2 PBI incidence decreased from 2.65% to 0.34% (RR 0.13, 95%-CI 0.06-0.27), and PBI-related bacteraemia from 1.14% to 0.04% (RR 0.04, 95% CI-0.01-0.22), with a single bacteraemia during Period 2. PBI- treatment antibiotic consumption decreased from 57.6 to 4.3 Defined Daily Doses (DDDs) per 100-biopsies (difference -53.3, 95%-CI -73.1 to -33.5) and overall consumption (treatment plus prophylaxis) reduced from 580.8 to 104.3 DDDs per 100- biopsies (difference -476.5). PBI-related hospitalised bed-days per 100-biopsies decreased from 9.44 to 0.89 (difference -8.55, 95%-CI -12.31 to -4.79).

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Conclusion: Ertapenem prophylaxis was highly effective and resulted in marked reductions in overall antibiotic consumption and inpatient bed-days. Effective prophylaxis has advantages from an AMS perspective.

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Ceftazidime-avibactam plus aztreonam susceptibility testing against New Zealand metallo-beta-lactamase producing Enterobacterales.

Author: 1, 2Keene, A 1Canterbury Health Laboratories, 2Pathology Associates, BOP

Introduction: Our armamentarium of antibiotics capable of treating carbapenemase producing Enterobacterales is diminishing. As such, novel beta-lactamase inhibitors in combination with existing beta-lactam antibiotics are being used for treatment of MBL producing isolates causing infection. Aztreonam plus ceftazidime-avibactam is one such combination, however no commercial susceptibility testing methods exist. Methods: 30 clinical MBL-producing isolates were tested in duplicate using gradient diffusion superposition. This involves placing a ceftazidime-avibactam gradient diffusion strip onto a lawn of the test organism, allowing it to diffuse for exactly 10 minutes, then removing and placing an aztreonam test strip in the exact same place as the original test strip. Aztreonam MICs were read after 18 hours and MICs compared with broth microdilution.

Results: The superposition method showed 100% reproducibility. The addition of ceftazidime- avibactam to aztreonam achieved a reduction in MIC of 8.7 and 5.6 doubling-dilutions for K.pneumoniae and E.coli respectively. The method showed 96% essential agreement, 82% categorical agreement against broth microdilution with one single minor error. All categorical agreement discrepancies were in E.coli around the CLSI aztreonam breakpoints.

Conclusion: The gradient diffusion superposition method may be a cheap, reproducible method of performing AST of ceftazidime-avibactam plus aztreonam on MBL producing Enterobacterales, however further investigation is required to determine its suitability in E.coli around the CLSI aztreonam breakpoints.

Disclosure of Interest Statement: This study was funded by the Canterbury District Health Board. No conflicts of interest are declared.

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The Alarming Reality: Our New Zealand Congenital Syphilis Epidemic

Authors: Gilmour LS1, Best E2,3, Duncanson M4, Wheeler B4, Sherwood J5, Walls T6,7

1Department of Paediatrics, Middlemore Hospital, Auckland 2Department of Paediatric Infectious Diseases, Starship Hospital, ADHB, Auckland 3Department of Paediatrics, Child and Youth Health, University of Auckland 4New Zealand Paediatric Surveillance Unit, University of Otago, Dunedin 5Institue of Environmental Science and Research Ltd (ESR) 6Department of Paediatrics, University of Otago, Christchurch 7Department of Paediatrics, Christchurch Public Hospital

Introduction: Syphilis, a disease which was once in decline, has made a resurgence worldwide. New Zealand has had increasing syphilis incidence rates since it became a notifiable disease in 2017. This study aimed to collect epidemiologic, descriptive and treatment data on mother to child transmission of syphilis across New Zealand.

Methods: Over a 26 month period from April 2018 to May 2020 (inclusive), paediatricians throughout New Zealand were asked to notify possible, probable and confirmed cases of congenital syphilis to the New Zealand Paediatric Surveillance Unit.

Results: Thirty-two cases were identified during the study period. Almost half (43%) of all cases were identified in the three Auckland DHBs. There were 12 cases of confirmed or probable congenital syphilis. Nine of the infants presented with clinical findings. A significant proportion (34%) of maternal infections were early syphilis and the women who gave birth to affected infants were less likely to have received antenatal care, adequate treatment and follow up monitoring of treatment for syphilis during pregnancy.

Conclusion: This study quantifies the significant burden of disease that congenital syphilis has on our population. Rather than being a rare disease, there is an “outbreak” of congenital syphilis in New Zealand. Case finding and treatment of syphilis in pregnancy are critical to prevent this. Our findings show urgent need for measures such as repeat maternal syphilis screening in early third trimester; whether this is by affected region, risk-factor based or instituted for all in the context of rising cases, is debated.

Disclosure of Interest Statement: This study was undertaken in conjunction with the New Zealand Paediatric Surveillance Unit (University of Otago).

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A cluster of botulism cases in the Bay of Plenty. Clinical presentation, treatment, diagnostics and pitfalls

Authors: Keene, A1 Chen, K2

1Pathlab Bay of Plenty, 2Bay of Plenty District Health Board

Introduction: We present a cluster foodborne botulism cases in the Bay of Plenty in four adults associated with consumption of pickled sea snails. We discuss the clinical presentation and outline the key features that distinguish it from other differential diagnoses. We review the diagnostic methods available locally and abroad, and discuss the difficulties in accessing treatment and testing in New Zealand.

We propose a national resource or guideline to prevent delays in the diagnosis and treatment of future botulism cases in New Zealand.

Disclosure of Interest Statement: No conflicts of interest are declared.

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Do patients with sepsis die of sepsis? A narrative review

Author: Katie Walland

Introduction: The Global Sepsis Alliance report that one in five deaths worldwide is associated with sepsis, but it is not clear how many of these are directly caused by sepsis, and may hence be amenable to specific sepsis interventions. Singer et al raised concerns that much of the reported sepsis mortality may be related to frailty and comorbidity rather than a dysregulated host response to infection. This is particularly important in the context of clinical trials using 90 day mortality as a primary end point, as the available evidence suggests that earlier deaths, within 3- 7 days, are more likely to be directly attributable to the septic event. A narrative review was conducted to answer the question “what are the causes of death in sepsis?”.

Methods: A search of MEDLINE was completed with the MESH major heading “sepsis”, sub- headings “classification”, “complications” and “mortality”, and major heading “cause of death”. Additional articles were identified from manual searches and the references of relevant articles.

Results: Six papers directly addressed the study question. Five had study populations ranging 79-244, the sixth paper described outcomes from a large trial and had 1201 patients. Three were ICU studies, one was mixed ED/ICU study, one mixed ED/ICU/general ward and one was ward based. Five were adult studies and one was a paediatric study. There was significant heterogeneity in the classification systems used to categorise the deaths. One assessed deaths within 28 days, two addressed deaths within 90 days and three considered all deaths within the index hospital admission. The percentage of deaths attributed directly to sepsis ranged from 24.1% - 78.7% in adult studies, and was reported as 90% in the paediatric study.

Conclusion: Understanding the cause of death in sepsis patients is key to assessing the impact of novel treatments and care pathways, as well as improving the care of individual patients. Current evidence is limited and heterogenous. A standardised reporting process would be optimum, and reporting causes of death in sepsis trials may assist in their interpretation.

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The outcomes of adult patients with enterococcal endocarditis receiving treatment from an Outpatient Parenteral Antibiotic Therapy Service with continuous infusion benzyl penicillin plus gentamicin or ceftriaxone.

Authors: Briggs S1, Broom M1, Duffy E1, Everts R2, Everts G3, Chatfield A4, Lowe B4, McBride S5, Bhally H6.

1 Infectious Disease Unit, Auckland City Hospital, 2 Infectious Disease Service, Nelson Bays Primary Health, 3 Department of Medicine, Tauranga Hospital, 4 Cardiology Unit, Auckland City Hospital, 5 Infectious Disease Unit, Middlemore Hospital, 6 Infectious Disease Unit, North Shore and Waitakere Hospitals.

Introduction: Guideline approved Outpatient Parenteral Antibiotic Therapy (OPAT) for enterococcal endocarditis is challenging. Continuous infusion (CI) benzyl penicillin (PEN) and daily gentamicin (GEN) or ceftriaxone (CRO) have been used, however the outcomes of these regimens are uncertain. We aimed to assess the outcomes of adults receiving OPAT CI PEN for enterococcal endocarditis.

Methods: A retrospective review of adults with enterococcal endocarditis receiving at least two weeks of CI PEN between July 2013 and June 2019. Patients were divided into two groups (GEN or CRO) based on the predominant synergy antibiotic they received during the first 14 days of treatment.

Results: Forty-one patients received 43 treatment courses; 20 GEN, 23 CRO. Enterococcus faecalis was the causative organism in 42 patients and E. faecium in one patient. The median duration of intravenous beta-lactam treatment was 42 (GEN) and 43 (CRO) days. The median duration of CI PEN was 28 (GEN) and 29 days (CRO). The median duration of total synergy antibiotic was 34.5 (GEN) and 41 (CRO) days. A significant adverse antibiotic effect occurred in seven (GEN) and zero (CRO) patients (p<0.01). There were two definite relapses (one in each group) and one possible relapse (GEN). The attributable 12 month mortality was nil in both groups.

Conclusion: The regimens of CI PEN with either daily GEN or CRO for the treatment of enterococcal endocarditis appear efficacious. The CRO regimen resulted in a lower number of significant adverse antibiotic effects.

Disclosure of Interest Statement: No funding was received for this study.

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A Qualitative Study Investigating Emergency Department Nurse and Doctor Perceptions of Sepsis Management & Factors Impacting on Patient Care

Author: Alice Rogan

Objective: Early sepsis recognition and treatment are essential in order to reduce the burden of disease. There is a paucity of evidence regarding how sepsis management is perceived by ED nurses and doctors. This descriptive qualitative design study aims to explore the perceptions & perspectives that ED doctors and nurses have with regards to the identification and management of patients presenting with sepsis.

Methods: ED nurses and doctors were invited to attend a peer matched semi structured focus group interview. All participants provided written informed consent. Two study investigators facilitated the interviews with a third present to moderate and standardize the focus groups. Interviews were audio recorded and later transcribed. Thematic analysis was performed with the aid of NVIVO software in order to generate nodes, subthemes and final themes.

Results: Between 30th January 2020 and 27th February 2020, six focus group interviews were conducted involving 40 ED staff members (18 nurses, 19 RMOs and 3 TIs). Interview length ranged from 27 to 38 minutes (Mean 33.5 minutes). Three key themes were identified: Clinical management; challenges and delays & communication. Each theme was broken down into sub-themes for analysis.

Conclusion: ED clinicians report several factors that affect how patients with sepsis are managed in the ED. Some of these factors are out of the control of individual ED departments but those that are modifiable need to be identified and optimised. Future research and sepsis management pathways need to account for the complex ED working environment and challenges that ED clinicians face before implementing change.

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ASID NZ 2020 Annual Meeting Sponsors

Merck Sharp & Dohme (New Zealand) Limited (MSD)

Merck Sharp & Dohme (New Zealand) Limited (MSD) is a subsidiary of Merck & Co. Inc. MSD was established in New Zealand in 1962.

In New Zealand, MSD provides medicines, vaccines and biologic therapies across a broad range of therapeutic areas. These include; oncology, anaesthesia, HIV/AIDS, antibacterials/antifungals and immunisations.

MSD is one of the few pharmaceutical companies still conducting clinical trials in New Zealand and invests approximately $NZ78 million in local clinical research.1 Current research programmes include oncology, infectious diseases, endocrinology, chronic cough and vaccines.1

For more information contact Lynda McCree. Lynda is responsible for the Infectious Diseases portfolio, looking after both the product management and customer responsibilities for MSD.

Lynda McCree, Associate Brand Manager – Infectious Diseases Email: [email protected], Mobile: +64 27 585 7924

Reference: MSD NZ Data on File

Copyright © 2020 Merck Sharp & Dohme (New Zealand) Limited, Level 3, 123 Carlton Gore Rd, Newmarket, Auckland 1023. All rights reserved. NZ-NON-00076 NA 12356 First Issued October 2020

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GSK

WHAT SETS US APART GSK is committed to helping patients regain control of their breathing by understanding their experiences and answering the key scientific questions that affect their lives.

GSK’s scientists constantly seek innovated approaches to ensure Healthcare Professionals can make the most informed decisions about patients’ health and feel empowered in their respiratory treatment choices.

Our global investments in the latest scientific research enable GSK’s dedicated respiratory teams to develop the most innovate new treatments that help people to breathe better.

Contact:

Courtney Walkinshaw – HIV Brand Manager [email protected] Tel: 021 529 795

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Pfizer

About Pfizer New Zealand: Breakthroughs that change patients’ lives™

At Pfizer, we apply science and our global resources to improve health and well-being at every stage of life. We strive to set the standard for quality, safety and value in the discovery, development and manufacturing of medicines and vaccines. Our diversified global health care portfolio includes biologic and small molecule medicines and vaccines. Consistent with our responsibility as one of the world's leading biopharmaceutical companies, we also collaborate with healthcare providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For more than 150 years, Pfizer has worked in countries around the world to make a difference for all who rely on us.

Pfizer Anti-Infectives has undertaken to prioritise research, education and drug development initiatives designed to help address the critical need for novel antimicrobial medicines, a better understanding of bacterial antibiotic resistance and projects to enhance antimicrobial stewardship. Please visit us at www.pfizer.co.nz.

Pfizer Anti-Infectives contacts:

Andy Sutton, Account Manager Pasquale Gargiulo, Associate Medical Director Email: [email protected] Email: [email protected] Mobile: +64 21 482 368 Mobile: +64 21 192 2077

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