CUTI medium improves the detection of mixed cultures, thereby improving the reliability of reporting of significant isolates when compared with CLED agar. When supplemented with simple bench tests it provides an identification system capable of speciating 86.8% of Gram negative isolates and providing a valuable cost effective mechanism for antimicrobial resistance surveillance.

Aims: To compare four media-UTI medium, BBL CHROMagar, CPS ID2, and Harlequin CLED-using a collection of fully characterised organisms and subsequent "field trial". Methods: Seven hundred and eighty seven fully characterised isolates (730 Gram negative bacteria, 47 Gram positive bacteria, and 10 yeasts) were used to test for accuracy of organism identification. To assess isolation rates and ability to detect mixed cultures, 1435 urine samples were cultured in the three best performing chromogenic media (UTI medium, BBL CHROMagar, and CPS ID2) and CLED. Results: The chromogenic agars differed in their accuracy of identification, with BBL CHROMagar performing best and Harlequin CLED performing least well. Similarly, BBL CHROMagar achieved a higher overall isolation rate than UTI medium and CPS ID2. When mixed growth was defined as greater than two organism types, BBL CHROMagar detected more mixed cultures than did UTI medium and CPS ID2, although the differences were not significant. When mixed growth was defined as greater than one organism type the increased number of mixed growths detected by BBL CHROMagar became significant, largely because of differences in enterococcal isolation rates. Conclusion: The use of BBL CHROMagar, UTI medium, or CPS ID2 chromogenic agar as a replacement for CLED agar would improve the detection rate of contaminated urine samples. Enhanced identification helps to distinguish different species, facilitating the monitoring of bacterial resistance in support of the national antibiotic strategy. BBL CHROMagar gave the highest overall organism recovery rates, greatest ability to detect mixed cultures, and the most accurate identification of organisms.

Streptococcus pneumoniae grows well and generally exhibits typical morphology on Columbia blood agar, whereas Haemophilus influenzae requires a more complex medium to meet its growth requirements -usually chocolated blood agar -on which S. pneumoniae is less easily recognisable. Therefore, a single medium that produces typical morphology of S. pneumoniae and facilitates the growth of H. influenzae would have considerable potential advantages. It has been claimed that blood agar supplemented with nicotinamide adenine dinucleotide (NAD) is such a medium. However, despite its routine use in several large diagnostic laboratories its performance has never been properly evaluated. In the present study, 1724 sputum samples were examined in four laboratories. The isolation rates of H. influenzae and S. pneumoniae on NADsupplemented blood agar (SBA) were compared with those on a two-plate combination of plain blood (BA) and chocolated blood agar (CBA). The two-plate combination performed significantly better for both organisms; isolation rates for H. influenzae were increased from 8.16% on SBA to 11.07% on BA plus CBA and for S. pneumoniae from 4.18% to 4.68%. Isolation rates were also compared after incubation for 24 and 48 h. With the two-plate combination, isolation rates for H. influenzae and S. pneumoniae were increased by 0.98% and O.l6%, respectively, and for SBA by 0.57% and 0.32% after 48 h. However, despite this increase, SBA still performed less well than the twoplate combination.

Introduction: Aboriginal and Torres Strait Islander people are at higher risk of developing chronic kidney disease, particularly those in remote areas, when compared with non-Indigenous Australians. While the number of Indigenous Australians requiring kidney replacement therapy has increased over time, rates of kidney transplantation (KTx) in prevalent patients has remained low at 14% compared with 50% in non-indigenous Australians. Methods: The National Indigenous Kidney Transplant Taskforce (NIKTT) was established in 2018 in response to the disproportionately low rates of KTx among Aboriginal and Torres Strait Islander people in Australia. We describe the outcomes of a NIKTT-sponsored initiative developed by the teams at Sir Charles Gairdner Hospital, Royal Perth Hospital and Kimberley Aboriginal Medical Service aimed at identifying and addressing modifiable barriers to accessing KTx for Aboriginal Australians with kidney failure in the Kimberley, Western Australia. This remote area which is over 1000 km from the capital city of Perth and spans a vast area of northwest Western Australia caters to the dialysis needs of over 150 Aboriginal Australians. Results: A multi-pronged approach was used. Culturally appropriate KTx education modules were developed for patients and health professionals in close consultation with Aboriginal liaison officers, Aboriginal health service and the members of the newly established Indigenous Reference Groups (IRG) from the region. These materials were utilised during the small group formal education and informal yarning sessions during the Transplant Outreach Clinics. Work is ongoing to create flip-books and posters. Indigenous Reference Groups were formed across the Kimberley region. Three multi-disciplinary Outreach Clinics were conducted in the region, attended by transplant physicians, surgeons and nurses. This resulted in an increase in the number of Aboriginal patients undergoing assessment from 10 to 71, with 23 being approved for transplant suitability. Several patients were identified to have modifiable barriers to transplant work-up. The number of patients active on the transplant waitlist increased from 4 to 12 within a year of outreach visits. To date, 6 patients from the region have successfully received a transplant. Feedback from patients has been overwhelmingly positive. Conclusion: Improving access to KTx and transplant outcomes for Aboriginal Australians requires a collaborative, holistic and culturally safe approach to the delivery of care. At the core of addressing the inequality in access to kidney transplantation, is the need to effectively communicate, engage and empower the Aboriginal patients and their communities.

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