NEWS(spring '05). - Douglass Hanly Moir Pathology

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Disorders of Skeletal Supporting Structures (Part 1)Long axis colour Doppler ultrasound image ofchronic Achilles tendinosis. Note abnormal fusiformswelling of proximal tendon segment with multipleintrasubstance echogenic foci (calcifications) castingacoustic shadows. Areas of colour within the tendondenote accompanying hyperaemia and usuallyindicate a symptomatic (painful) tendon.Treatment ModalitiesLoad reduction/relative restBiomechanical correction- braces/supports- orthotic devices- technique correction- strengthening (eccentric regimens)Massage- ultrasound- laser- heat- extracorporeal shock wave therapy? fibroblaststimulationCryotherapy -decreased metabolic rate/metabolites/extravasated redblood cellsDrugs- NSAIDs - ? increased collagen synthesis- steroids - (tenonecrosis)- protease inhibitors- low dose heparin affect fibrin depositionMRI of Achilles tendinosis. Image shows fusiformthickening of the proximal Achilles tendon segmentwith an underlying zone of poorly-marginatedlow-grade degenerative intrasubstance signalhyperintensity.SurgeryMolecular biology/gene manipulation (in the future)If you have any enquiries, please do not hesitateto contact Dr Fiona Bonar on (02) 98 555 15410
Trends in Antibiotic Sensitivities of Common PathogensDr Ian ChambersDirector of MicrobiologyUrinary Tract PathogensE.coli continues to be the commonest uropathogen in bothoutpatient and inpatient settings, and the great majority remainsensitive to cephalexin, amoxycillin-clavulanate combinations,nitrofurantoin and norfloxacin. An increasing number of isolates(mostly causing infection in hospitalised patients or those withcomplicated urinary tracts) produce an extended-spectrumbeta-lactamase (ESBL). ESBL-producers are resistant to latergenerationcephalosporins such as cefotaxime and ceftazidime,and they are often resistant to other classes of antibiotics suchas aminoglycosides and quinolones. E.coli is the commonestESBL-producer isolated in this laboratory, but Enterobacterspecies and Klebsiella species also have this potential.URINARY TRACT PATHOGENS (% SENSITIVE)ORGANISM Ampicillin Cephalexin Amox/Clav Acid Norfloxacin Trimethoprim NitrofurantoinE.coli 49 95 95 97 81 96S.saprophyticus 100 100 100 100 96 99Proteus species 88 88 92 96 84 0K.pneumoniae 0 93 93 96 86 82Enterococcus species 99 – 99 – – 99Respiratory Tract PathogensStreptococcus pyogenes (Group A Strep) remains exquisitely sensitive to penicillin, but 10 days treatment is recommendedin order to achieve clearance of the organism from the pharynx and prevent relapse. Reduced penicillin-sensitivity inS.pneumoniae continues to be observed, but is not usually of clinical significance when isolated from respiratory specimens.Increased oral dosage, or parenteral administration for more severe infection, effectively treats most cases.In view of the ongoing pertussis outbreak, a reminder may be useful that Australian recommendations (for both treatment andprophylaxis) are clarithromycin or erythromycin for 7 days. The alternative antibiotic for patients who cannot be given theseagents is cotrimoxazole.RESPIRATORY PATHOGENS (% SENSITIVE)ORGANISM Pen/Amp/Amox Amox/Clav Acid Tetracycline ErythromycinH.influenzae 62 100 87 –S.pneumoniae 91 91 75 82M.catarrhalis 44 100 100 92Soft Tissue PathogensApproximately 20% of our Staphylococcus aureus isolates, overall, are methicillin-resistant (and therefore resistant toflucloxacillin, dicloxacillin, cephalosporins, etc). The majority of these are non-multi-resistant S.aureus (also referred to ascommunity acquired MRSA, or cMRSA). Orally-administered antibiotic options for infection caused by these organisms includecotrimoxazole, clindamycin and doxycycline. Importantly, many of these strains of S.aureus produce a toxin known as PantonValentine Leucocidin (PVL) which is associated with tissue necrosis, abscess formation and severe pneumonia. Promptrecognition and appropriate treatment of such infections is vital.The prevalence of penicillin and ciprofloxacin resistance in NSW isolates of Neisseria gonorrhoeae (46% and 47% respectively)should preclude their selection as empiric treatment. Isolates with reduced ceftriaxone susceptibility have been detected inNSW but have not been associated with treatment failure. (Data from Gonococcal Surveillance Unit, Prince of Wales Hospital.)SOFT TISSUE PATHOGENS (% SENSITIVE)ORGANISM Penicillin Erythromycin Tetracycline CiprofloxacinS.pyogenes 100 97 94 –S.aureus (methicillin-sensitive) 18 89 92 –Ciprofloxacin Rifampicin Fusidic Acid Vancomycin Clindamycin CotrimoxazoleCommunity-Acquired MRSA 90 100 97 100 75 99Multi-resistant MRSA 12 99 99 100 0 12Penicillin Ciprofloxacin Spectinomycin CeftriaxoneN.gonorrhoeae 54 53 100 10011
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NEWS(spring '05). - Douglass Hanly Moir Pathology

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