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Wellington SCL Newsletter -
23rd February 2017

Please forward this email to all clinical staff 

Please find the latest updates from your laboratory provider Wellington SCL.  In this newsletter we cover:

 
  • Medtech Inbox Mapping Utility 
  • Wellington Community Bacterial Resistance/Susceptibility to Antibiotics, 2016
  • Increasing rates of Gonorrhoea and syphilis testing
  • Streamling of Testosterone testing
  • Microsoft Windows 10 - eLab Printing Issue

Wellington Medtech Inbox Mapping Utility

Wellington Community Bacterial Resistance/Susceptibility to Antibiotics, 2016   

 
We are pleased to release the antibiotic susceptibility profiles of pathogens most frequently isolated from specimens you have submitted for microbiological investigations at Wellington Southern Community Laboratories (WSCL). The agents reported are those which you would commonly use for treatment.
 
There are some general comments to make, and then some specific observations that you should take into account when considering the choice of empiric treatments for the common community-acquired infections you see in your clinical practises.
 
Firstly, the era of complete antibiotic resistance has not yet arrived! This is fortunate but we are not recommending that you relax your guard when it comes to antibiotic prescribing. On the contrary, we are seeking compliance with antibiotic guidelines and we believe that good antibiotic stewardship now will be rewarded with continuing low resistance rates in the future.
 
The antibiotic susceptibility tables that follow provide the evidence on which we base treatments and develop “best practice” guidelines.

We outline the salient features of our findings in bullet-point format.

Table 1: Gram negative and urine isolates (% susceptible)
Click here to view
 
Table 2: Non-urinary isolates (% susceptible)
Click here to view 

On the basis of “you are what you eat” may we conclude that the Community resistance rates, above, largely reflect what and how much you are prescribing for your patients.
We thank you for your role in keeping these resistance rates down to a very respectable level. We are delighted to work cooperatively with you in the future to maintain this and we look forward to publishing the susceptibility data next year.
 
Finally – a plea! You will have noted how important it is for us to distinguish clinically significant infection from colonisation. Please help us interpret the significance of our findings by providing clinical details on the laboratory request form… it does make a difference for antibiotic reporting.  We will be preparing an antibiogram for the elderly. There is a lot of testing in the frail elderly, and a lot of inappropriate antibiotic prescribing… stay tuned!

Dr Michelle Balm, Dr Tim Blackmore, Dr Juliet Elvy, Dr Mark Jones
Wellington SCL

Interesting rates of gonorrhoea and syphillis in the Wellington Region

We thought it important to bring to requestors’ attention the high rates of gonorrhoea being diagnosed at Wellington SCL in January.
 
We perform almost 47,000 gonorrhoea/chlamydia tests annually, and we normally see <1% of persons tested positive (i.e. duplicate samples not counted) for gonococcal tests, and 6.7% for chlamydia. Whilst chlamydia rates are stable, there has been a dramatic increase in gonorrhoea cases to 2.2% of persons testing positive in January 2017. This equates to 72 people compared with 20 to 30 normally per month. 82% of gonorrhoea and 34% of chlamydia cases are men.
 
Infectious syphilis rates are also on the rise, with 6 cases diagnosed by serology in January (normally 2-3 per month). This is line with what’s being seen nationally.
 
What does all of this mean?

  • There is plenty of unsafe sex occurring.
  • The higher rates of men being diagnosed is to be expected because women are less likely to be symptomatic and STI are more common in men who have sex with men.
  • Think of gonorrhoea in men with dysuria, not just a penile discharge
  • Best sample to send for a male is a first pass urine (transfer into the Aptima urine tubes asap). Best sample to send for a female is a low vaginal swab in Aptima tube.
  • Don’t forget about testing other sites when indicated (rectal and pharyngeal) – see STIGMA guidelines http://stipu.nsw.gov.au/wp-content/uploads/STIGMA_Testing_Guidelines_Final_v5.pdf  

 Wellington Sexual Health is there to help with testing, treatment, advice and help with contact tracing and management – 080018881.

Dr Tim Blackmore
Infectious Diseases Specialist

Streamling of Testosterone testing  

 
Our laboratory has used a protocol of testing testosterone by a second method, radioimmunoassay, for high levels in females and low levels in males owing to concerns regarding the accuracy of measuring low concentrations in automated immunoassays which could overestimate in this range.  In recent years, there have been improvements to the automated immunoassays for testosterone. The current assay in our laboratory, Roche Cobas Testosterone II immunoassay, is traceable to the reference method, isotope-dilution gas chromatography-mass spectrometry. It has been shown to have better accuracy at low levels as well as reduced cross reactivity and reduced susceptibility to matrix effects. This assay has also been validated in a study for evaluation of male hypogonadism. In addition, radioimmunoassay is a cumbersome manual test being done in batches so this inevitably lengthens the turnaround time for these samples. Furthermore, enhancement on accuracy for low levels of testosterone requires using another technology, liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Because of these factors, we will be modifying the protocol of testosterone testing. All testosterone results from both female and male samples will be reported by the automated immunoassay. For female samples with borderline high levels of 2-5 nmol/L, a comment will be included in the report recommending confirmatory testing by the LC-MS/MS-based method.  A follow-up request for the confirmatory testing needs to be made as it requires a blood sample in non-gel tube (red-top) and a request for “Testosterone-LCMS”.  This test will also be orderable and searchable as Testosterone-LCMS via electronic ordering, after 25 February and the move to the new laboratory computer system.

This approach will achieve a faster turnaround time for testosterone requests. Meanwhile, confirmatory testing is provided with the most reliable method.  By and large, recognising the inherent limitations of immunoassays is important. We encourage referrers to discuss with us the results if they are not consistent with the clinical picture.

Dr Carol Siu
Chemical Pathologist
Wellington SCL

Microsoft Windows 10 - eLab Printing Issue

The Fault as described:

Can’t print eLabs (or other PDF files) from within Medtech (or direct from the desktop).

The Cause:

Windows has lost the association that says .PDF files need to be opened with Adobe Reader – substituted with opening in MS Word (which doesn’t understand the command to “open and print”).

Workaround:

Open Control Panel, choose “Default Programs” > “Set your default Programs” select “Adobe Acrobat Reader DC” and choose “Set this program as default”  This example is with Windows 10, also works with other versions, but dialogue boxes are slightly different.

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Wellington SCL 
Level 5, CSB 
Riddiford Street 
Newtown
Wellington






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