Hugh Murray
@Hugh_Murray_
Followers
94
Following
228
Media
3
Statuses
31
Advanced Trainee in Infectious Diseases | Running and hiking in my spare time
Melbourne, Victoria
Joined April 2019
REPRIEVE: Significant decrease in major adverse cardiovascular events with pitavastin. RCT trial enrolled only low-to-moderate CV risk PWH, for whom a statin might not otherwise be prescribed. Important clinical trial with direct relevance to pt care. https://t.co/dVtQgtAGhz
8
72
198
Diagnostic codes for hospital discharges are important for lots of reasons. One being accuracy for burden of disease. Here we found that the rapidity of diagnostic test results (for flu) impacts on the discharge code: https://t.co/nswhFL2E5F Nice work by trainee @Hugh_Murray_
0
2
5
Something of a change of pace from adult ID this week, as #VIDS_JC with @syctong looked at this really interesting article on microbiota-directed food supplements, presented by Dr @Hugh_Murray_. 1/14 https://t.co/mw9Emw0Cwz
nejm.org
More than 30 million children worldwide have moderate acute malnutrition. Current treatments have limited effectiveness, and much remains unknown about the pathogenesis of this condition. Children ...
1
2
1
A good list @Josh_S_Davis! I’ll point out that BRIEF TB used rifapentine rather than rifampicin, though, so we shouldn’t get too excited in Australia just yet. @sanofi when will you register here?
And here is my #top10papers in ID for 2019 in one slide if you can't be bothered reading the whole thread #IDtwitter. Happy new year!
0
1
4
@emilylheil @accpinfdprn thank you @emilylheil for being funny and brilliant and sending me your slides in advance to help create this #tweetorial 🤗 #accpam19 #cap #idtwitter #medtwitter
1
3
31
https://t.co/IH9Qs54cwV.
@padstamundo @davidantibiotic screening for Penicillinase in PSSA. Further proof for enrolling patients in PSSA BSI trials. @Hugh_Murray_ @syctong @Josh_S_Davis
biorxiv.org
Penicillin susceptible Staphylococcus aureus (PSSA) may occasionally be encountered as a cause of complicated S. aureus infection, such as endocarditis or bloodstream infections. Clinicians may...
0
4
18
👩🏻38. HIV since 2013. HAART since 2019. 3 months with fever, weight loss and cough Xpert MTB +. Pancytopenia Blood Smear (image) Diagnosis...
7
20
48
14/ Summary Penicillin may be an effective option in susceptible S. aureus infections as long as appropriate susceptibility testing is performed
0
0
4
13/ - EUCAST now recommends testing disc zone diameter and zone edge appearance on a 1unit disc, which was validated against blaZ PCR testing in this Swedish study - Chromogenic cephalosporin-based beta-lactamase tests are no longer recommended https://t.co/kAib82OPOY
1
0
1
12/ - The sensitivity of disc zone diameter and zone edge alone was 66% and 89% respectively for the 10unit disc, and 100% and 100% respectively for the 1unit disc in a study from an Australian micro lab https://t.co/rkgtjm1eOr
2
0
2
11/ - Disc zone diameter alone does not reliably detect penicillin resistance, however evaluating the zone edge provides more information (see figure) https://t.co/zA2erZsU8j
1
1
2
10/ Potential problems with using penicillin 1. To safely use penicillin, we need to be confident in excluding the presence of B-lactamase, and there are potential problems with phenotypic laboratory detection methods (disc zone of inhibition diameter + zone edge appearance)
1
0
2
9/ 3/3 Potentially less adverse effects than some anti-staphylococcal penicillins such as flucloxacillin or nafcillin
1
0
1
8/ 2/3 Potentially better mortality outcomes when used in susceptible infections, although this is only from retrospective data https://t.co/oIswbDAxdK
https://t.co/o1DeBbBgDO
pubmed.ncbi.nlm.nih.gov
In clinical practice, differing opinions exists regarding the optimal management of patients with penicillin-susceptible Staphylococcus aureus (PSSA) bloodstream infection (BSI). The aim of this...
1
0
1
7/ 1/3 Penicillin spends a greater amount of time above the MIC compared to anti-staphylococcal penicillins due to - a lower MIC break point; typically 0.12mg/L for pen G compared to 2 for oxacillin - being less protein bound https://t.co/aYTbIiEtSR
pubmed.ncbi.nlm.nih.gov
Disk-diffusion is a simple and reliable method to detect penicillin resistance in SA, and susceptibility rates are significant. Penicillin has many theoretical advantages and should be considered in...
1
0
2
5/ What is the mechanism PR in SA? - production of beta-lactamase (encoded by the blaZ gene) that hydrolyzes pen. - There are four types of B-lactamase; A, B, C, D - blaZ has common genetic ancestors in human/bovine SA and coagulase negative staph https://t.co/Cg03xvJ4zq
pubmed.ncbi.nlm.nih.gov
Results indicated a separate evolution for plasmid- and chromosomally-encoded blaZ. Although a common gene pool seems to exist among staphylococci, exchange of blaZ between strains and species is...
1
0
2
4/ 2/2 Surprisingly, there are recent reports of decreasing rates of PR; PSSA made up 25% of all MSSA clinical isolates in one centre in Canada, and PSSA increased from 13% to 32% of MSSA from 2003 to 2012 in another in the US https://t.co/LTwTK2Wmh6
https://t.co/xtvHYa32Jj
1
0
5
3/ Prevalence of PSSA 1/2 Within a few years of the introduction of penicillin for the Rx of S. aureus in 1941, widespread penicillin resistance (PR) was evident. Resistance rates have subsequently rapidly increased over the past 80 years.
1
0
1
2/ Firstly, why are we interested in PSSA bacteraemia? i) Increasing prevalence ii) Potential for penicillin based Rx that may be more efficacious and less harmful
2
0
2