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Background COVID‐19 vaccination represents a key preventative part of the Australian public health approach to the SARS‐CoV‐2 pandemic. Hospital inpatients are frequently high‐risk for severe COVID‐19 and death. Anecdotes of high‐risk inpatients being unvaccinated and a lack of EMR visibility of COVID‐19 vaccination status prompted this study as these patients could represent a risk to themselves, staff, other patients and service provision. Aims To determine the uptake of COVID‐19 vaccine among inpatients at an adult Australian tertiary public hospital and identify reasons for non‐vaccination. Methods A point‐prevalence study of patient‐reported COVID‐19 vaccine status was conducted on 26 th October 2021 via an in‐person interview with collection of demographic factors and reasons for non‐vaccination. Results Of 368 (68% of inpatients) participants, 280 (76%) reported receiving at least 1 COVID‐19 vaccine dose. Vaccination status was associated with older age, having received the flu vaccine, being born in Australia and not requiring an English‐language interpreter. The majority (88%) of participants had at least 1 co‐morbid risk factor for severe COVID‐19. Of the unvaccinated (n=88), 67% were willing to be vaccinated with 54% of those indicating vaccination in hospital would be helpful and 42% requesting approval from their doctor. Conclusions Vaccine uptake in our cohort is sub‐optimal. Existing public health programs have failed to reach this high‐risk, vulnerable population. Changes to the national vaccination strategy to include a parallel in‐hospital program for all hospital encounters and target culturally and linguistically diverse individuals may improve uptake among this high‐risk, hard to reach group of patients. This article is protected by copyright. All rights reserved.

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Necrotizing soft tissue infections (NSTI) are associated with high morbidity and mortality. We retrospectively examined the impact of empiric antimicrobials coupled with early surgery (ES) on mortality in NSTI. ES independently reduced 30-day mortality (OR 0.16 [95% CI: 0.05-0.51]; p<0.001) that was not further augmented by empiric antimicrobial choice.

A 46-year-old man presented with a rash over his trunk, neck and limbs. A viral exanthem was suspected and an initial diagnosis of acute cytomegalovirus (CMV) infection was made on the basis of serology results (positive IgM, no quantitation indicated, and negative IgG). Additional laboratory tests showed an elevated C-reactive protein level (26 mg/L; reference interval [RI], 0e10 mg/L) and erythrocyte sedimentation rate (26 mm/h; RI, < 20 mm/h), and normal routine haematology and biochemistry results, apart from a slight elevation of the globulin level (45 g/L; RI, 20e40 g/L). However, the rash persisted, the patient noticed hair loss and he developed worsening visual impairment, which prompted an urgent ophthalmology referral 4 months after initial presentation. On ophthalmological review, the patient was noted to have decreased visual acuity bilaterally (right eye, 6/15; left eye, 6/24) and right optic disc swelling. Syphilis serology was subsequently performed and the results (Treponema pallidum particle agglutination [TPPA] positive and rapid plasma reagin [RPR] reactive [1 : 32]) prompted referral to the infectious diseases unit.Clinical examination at presentation to the infectious diseases unit revealed widespread symmetrical erythematous papulosquamous plaques over his trunk, neck and limbs (Box 1), with several small plaques on the plantar aspect of his left hand and left foot. He also had patchy alopecia (Box 2) and bilateral inguinal lymphadenopathy. At this time, the patient also reported unprotected intercourse with casual male partners. His HIV test result was negative and he had not been tested for syphilis previously. Retrospective testing of the earlier serum positive for CMV IgM revealed positive TPPA and reactive RPR (1 : 64). A punch biopsy of the rash showed a plasma cell-rich granulomatous process spanning the dermis, which supported the diagnosis of syphilis, likely consistent with tertiary syphilis. He was treated with a 15-day course of intravenous benzylpenicillin with concomitant prednisolone in the first 36 hours (given the optic involvement) to reduce the likelihood of a JarischeHerxheimer reaction. Over the treatment course, the patient remained well and his rash started to settle. On follow-up 3 months after treatment, his alopecia had completely resolved and his rash had significantly improved. u 1 Erythematous papulo-squamous plaques over the trunk and arms of the patient 2 Patchy alopecia: note the irregular thinned ("moth-eaten") patches of hair loss characteristic of syphilis T his case exemplifies the consequences of diagnosis based on the performance of a test, which may not have been indicated from the clinical presentation, compounded by a false-positive laboratory result. First, the presentation was not typical of CMV infection. In immunocompetent adults, the most common clinical presentation of CMV infection is a self-limiting mononucleosis-like syndrome 1 characterised by fevers and malaise. Predominant skin manifestations are rare in CMV infection in immunocompetent pa...

Background Antimicrobial resistance (AMR) represents a profound global health threat. Reducing AMR spread requires the identification of transmission pathways. The extent to which hospital wards represent a venue for substantial AMR transmission in low- and middle-income countries settings is poorly understood. Methods Rectal swabs were obtained from adult male inpatients in a “Nightingale” model general medicine ward in Yangon, Myanmar. Resistome characteristics were characterised by metagenomic sequencing. AMR gene carriage was related to inter-patient distance (representing inter-patient interaction) using distance-based linear models. Clinical predictors of AMR patterns were identified through univariate and multivariate regression. Results Resistome similarity showed a weak but significant positive correlation with inter-patient distance (r = 0.12, p = 0.04). Nineteen AMR determinants contributed significantly to this relationship, including those encoding β-lactamase activity (OXA-1, NDM-7; adjusted p < 0.003), trimethoprim resistance (dfrA14, adjusted p = 0.0495), and chloramphenicol resistance (catB3, adjusted p = 0.002). Clinical traits of co-located patients carrying specific AMR genes were not random. Specifically, AMR genes that contributed to distance-resistome relationships (OXA-1, catB3, dfrA14) mapped to tuberculosis patients, who were placed together according to ward policy. In contrast, patients with sepsis were not placed together, and carried AMR genes that were not spatially significant or consistent with shared antibiotic exposure. Conclusions AMR dispersion patterns primarily reflect the placement of particular patients by their condition, rather than AMR transmission. The proportion of AMR determinants that varied with inter-patient distance was limited, suggesting that nosocomial transmission is a relatively minor contributor to population-level carriage.

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