Tony Keil

Bacteria which are metabolically active yet unable to be cultured and eradicated by antibiotic treatment are present in the middle ear effusion of children with chronic otitis media with effusion (COME) and recurrent acute otitis media (rAOM). These observations are suggestive of biofilm presence or intracellular sequestration of bacteria and may play a role in OM pathogenesis. The aim of this project is to provide evidence for the presence of otopathogenic bacteria intracellularly or within biofilm in the middle ear mucosa of children with COME or rAOM.

In 2010 there were 214 laboratory-confirmed cases of invasive meningococcal disease analysed by the National Neisseria Network, a nationwide network of reference laboratories. One hundred and twenty-four isolates of Neisseria meningitidis from invasive cases of meningococcal disease were available for which the phenotypes (serogroup, serotype and serosubtype) and/ or genotype and antibiotic susceptibility were determined. An additional 90 cases were confirmed by non-culture based methods (77 by nucleic acid amplification testing and 13 by serology), and where possible, serotyping was determined. Nationally 167 (78%) laboratory-confirmed cases, where a serogroup was determined, were infected with serogroup B, 16 (7.5%) with serogroup C, 9 (4.2%) with serogroup W135 and 7 (3.3%) with serogroupY meningococci. The national total of confirmed cases has decreased since 2004, but the number of cases may vary between jurisdictions each year. New South Wales had the highest number of recorded cases in 2010. Typical primary and secondary disease peaks were observed in those aged 4 years or less and in adolescents and young adults respectively. Serogroup B cases predominated in all age groups and jurisdictions. The common phenotype circulating in Australia continues to be B: 15: P1.7, corresponding to the porA genotype P1.7,16-26. Serogroup C cases were again numerically low, as were serogroups W135 and Y. Eighty per cent of all isolates showed decreased susceptibility to the penicillin group of antibiotics (minimal inhibitory concentration (MIC) 0.06-0.5 mg/L). All isolates remained susceptible to ceftriaxone. One isolate had reduced susceptibility to ciprofloxacin, and none to rifampicin.

Background: Current evidence indicates that probiotic supplementation significantly reduces all-cause mortality and definite necrotising enterocolitis without significant adverse effects in preterm neonates. As the debate about the pros and cons of routine probiotic supplementation continues, many institutions are satisfied with the current evidence and wish to use probiotics routinely. Because of the lack of detail on many practical aspects of probiotic supplementation, clinician-friendly guidelines are urgently needed to optimise use of probiotics in preterm neonates. Aim: To develop evidence-based guidelines for probiotic supplementation in preterm neonates. Methods: To develop core guidelines on use of probiotics, including strain selection, dose and duration of supplementation, we primarily used the data from our recent updated systematic review of randomised controlled trials. For equally important issues including strain identification, monitoring for adverse effects, product format, storage and transport, and regulatory hurdles, a comprehensive literature search, covering the period 1966-2010 without restriction on the study design, was conducted, using the databases PubMed and EMBASE, and the proceedings of scientific conferences; these data were used in our updated systematic review. Results: In this review, we present guidelines, including level of evidence, for the practical aspects (for example, strain selection, dose, duration, clinical and laboratory surveillance) of probiotic supplementation, and for dealing with non-clinical but important issues (for example, regulatory requirements, product format). Evidence was inadequate in some areas, and these should be a target for further research. Conclusion: We hope that these evidence-based guidelines will help to optimise the use of probiotics in preterm neonates. Continued research is essential to provide answers to the current gaps in knowledge about probiotics.

In 2009 there were 233 laboratory-confirmed cases of invasive meningococcal disease (IMD) analysed by the National Neisseria Network, Australia, a nationwide network of reference laboratories. One hundred and thirty-five isolates of Neisseria meningitidis from invasive cases of meningococcal disease were available for which the phenotypes (serogroup, serotype and serosubtype) and/or genotype and antibiotic susceptibility were determined. An additional 98 cases were confirmed by non-culture-based methods (92 by nucleic acid amplification testing (NAAT) and six by serology), and where possible serotyping was determined. Nationally, 194 (83%) laboratory-confirmed cases where a serogroup was determined were infected with serogroup B and 13 (5.6%) serogroup C meningococci. The national total of confirmed cases has remained relatively stable since 2006, but the number of cases may vary between jurisdictions each year. New South Wales had the highest number of recorded cases in 2009. Typical primary and secondary disease peaks were observed in those aged 4 years or less and in adolescents and young adults respectively. Serogroup B cases predominated in all age groups and jurisdictions. The common phenotypes circulating in Australia continue to be B:15:P1.7 and B:4:P1.4. Although serogroup C cases were low, phenotype C:2a:P1.5 again predominated in this group. No evidence of meningococcal capsular 'switching' was detected. Approximately two-thirds of all isolates showed decreased susceptibility to the penicillin group of antibiotics (MIC 0.06 to 0.5 mg/L). All isolates remained susceptible to ceftriaxone. Four isolates had reduced susceptibility to ciprofloxacin, and none to rifampicin.

In 2008, there were 260 laboratory-confirmed cases of invasive meningococcal disease (IMD) analysed by the National Neisseria Network, a nationwide network of reference laboratories. One hundred and forty-nine isolates of Neisseria meningitidis from invasive cases of meningococcal disease were available for which the phenotypes (serogroup, serotype and serosubtype) and antibiotic susceptibility were determined. An additional 111 cases were confirmed by nonculture based methods. Nationally, 223 (85%) laboratory-confirmed cases where a serogroup was determined were infected with serogroup B and 17 (6.5%) infected with serogroup C meningococci. Nationally, the total number of confirmed cases has remained relatively stable since 2006, but the number of cases in each jurisdiction may vary from year to year. Queensland had the highest number of recorded cases in 2008. Typical primary and secondary disease peaks were observed in those aged 4 years or less and in adolescents and young adults respectively. Serogroup B cases predominated in all age groups and jurisdictions. The common phenotypes circulating in Australia were again B: 15: P1.7 and B: 4: P1.4. Although serogroup C cases were numerically low, phenotype C: 2a: P1.5 predominated in this group. No evidence of meningococcal capsular ` switching' was detected. About three-quarters of all isolates showed decreased susceptibility to the penicillin group of antibiotics (MIC 0.06-0.5 mg/L). All isolates remained susceptible to ceftriaxone. One isolate had reduced susceptibility to rifampicin and two to ciprofloxacin.