561 Metastasectomy for Stage IV Melanoma in the Effective Systemic Treatment Era

Aim Historically, a diagnosis of Stage IV melanoma was a dire one, with low survival rates and ineffective treatment. The only beneficial treatment option was metastasectomy in very selected cases. The recent introduction of the effective systemic therapy agents (EST) (immunotherapy and BRAF inhibitors) dramatically changed this. This research’s aim is to determine if EST + Metastectomy significantly improves OS. And if so, should be considered as the main therapeutic approach to stage IV melanoma patients. Method Single-centre retrospective cohort study from the Melanoma Unit at Calvary Mater Hospital in Australia was conducted, approved by the ethics committee. Inclusion criteria was Stage IV Melanoma patients who received EST from 2009-2019. OS of those who received EST alone are compared to EST + Metastasectomy. The 2 groups were compared retrospectively based on their disease characteristics, using probability score weighting analysis and survival curve. Results This is a preliminary analysis for the first 200 patients, data collection is ongoing. Mean OS is 2 years. Several combinations of immunotherapy treatments were identified. Of the 200 patients, 35% underwent metastasectomy. Mean survival for those who had surgery is 3 years, as oppose to 2 years for those who had EST alone. OS in the Metastasectomy group was higher than those who had EST alone, of 47.1% and 42.3% respectively. The Kaplan Meier curve also shows increase survival in the metastasectomy group, up to year 6 post diagnosis. Conclusions Metastasectomy for stage iv melanoma in the EST era appears to offer a survival benefit in selected patients

Prevalence and antimicrobial susceptibility pattern of Staphylococcus Aureus isolated from clinical specimens at the Mater Hospital Nairobi, Kenya.

Staphylococcus aureus (S. aureus) is a leading cause of hospital and community acquired infections globally. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence has been reported to be high in various settings and is associated with increased morbidity, mortality and risk of nosocomial outbreaks. Surveillance of prevalence and antibiotic susceptibility patterns is important to ensure appropriate antibiotic prescription. The objective of our study was to establish the prevalence of S. aureus, to identify patterns of susceptibility to commonly used antibiotics and quantify contemporary penicillin resistance among S. aureus. A retrospective study was conducted at the Mater Misericordiae Hospital, Nairobi. The study involved a review of non-duplicate records of specimens analyzed between January 2014 and December 2018.A specimen was categorized as Penicillin susceptible (PSSA) if susceptible to Penicillin and Oxacillin, MSSA if resistant to Penicillin but susceptible to Oxacillin, and MRSA if resistant to Oxacillin. We present proportions of S. aureus that was PSSA, MSSA and MRSA. Multivariate logistic regression was used to determine the association between the presence of S. aureus isolates and the source of the clinical specimen (in vs. outpatient), age and gender. A total of 659 specimens of S. aureus were analyzed in the 5-year period. ​​PSSA was the most prevalent organism seen (60.85%) while MRSA was the least prevalent (0.61 %). Most S. aureus was isolated in pus from wound swabs-644 (73. 3%). A significant increase in susceptibility of S. aureus to Penicillin and Amoxicillin-clavulanic acid was observed during the study period however, sensitivity to Amoxicillin declined. This study demonstrated a high prevalence of Penicillin Sensitive S. aureus and a low prevalence of MRSA.

Prevalence and antimicrobial susceptibility pattern of Staphylococcus Aureus isolated from clinical specimens at the Mater Hospital Nairobi, Kenya.

Staphylococcus aureus is a leading cause of hospital and community acquired infections globally. Surveillance of prevalence and antibiotic susceptibility patterns is important to ensure appropriate antibiotic prescription. The aim of this study was to determine the prevalence and susceptibility patterns of Staphylococcus aureus isolated from clinical specimens in a tertiary referral and training hospital.A retrospective study was conducted at the Mater Misericordiae Hospital, Nairobi.It involved analyzing records of specimens analyzed between January 2014 and December 2018. Strains phenotypically resistant to <3 non β-lactam antimicrobial categories were defined as non-multidrug-resistant MRSA (nmMRSA) and strains that were resistant to ≥3 non-β-lactam antimicrobial groups were defined as multidrug-resistant MRSA (mMRSA). A specimen was categorized as Penicillin susceptible (PSSA) if susceptible to Penicillin and Oxacillin, MSSA if resistant to Penicillin and susceptible to Oxacillin, and MRSA if resistant to Oxacillin and Penicillin.ResultsPSSA accounted for 60.85%, (401/659)of S.aureus cultured.The prevalence of MSSA was 38.54%(254/659).MRSA was the least prevalent.(0.61%,4/659).No multi-drug Methicillin resistant S. aureus were isolated in the five-year period.PSSA accounted for 60.85%(401/659)of all S.aureus isolates.100% of MRSA isolated was sensitive to Vancomycin, Linezolid, Tigecycline, Tetracycline and Rifampicin. MRSA was resistant to Clindamycin and Erythromycin.Conclusion;The prevalence of MRSA was low compared to previous studies.All strains isolated were non-multidrug resistant.There was no resistance to Vancomycin detected.Penicillins are still a viable option in the treatment of majority of S.aureus infections in our setting.

Prevalence and antimicrobial susceptibility pattern of Staphylococcus Aureus isolated from clinical specimens at the Mater Hospital Nairobi, Kenya.

Background Staphylococcus aureus is a leading cause of hospital and community acquired infections globally. Surveillance of prevalence and antibiotic susceptibility patterns is important to ensure appropriate antibiotic prescription. The aim of this study was to determine the prevalence and susceptibility patterns of Staphylococcus aureus isolated from clinical specimens in a tertiary hospital with diverse and empirical prescribing habits. Methods A retrospective study was conducted at the Mater Misericordiae Hospital, Nairobi. The study involved records of specimens analyzed between January 2014 and December 2018. S aureus was identified using catalase and coagulase tests. Strains phenotypically resistant to <3 non β-lactam antimicrobial categories were defined as non-multidrug-resistant MRSA (nmMRSA) and strains that were resistant to ≥3 non-β-lactam antimicrobial groups were defined as multidrug-resistant MRSA (mMRSA). A specimen was categorized as Penicillin susceptible (PSSA) if susceptible to penicillin and oxacillin, MSSA if resistant to penicillin and susceptible to oxacillin, and MRSA if resistant to oxacillin and penicillin. Isolates were screened for MRSA using 6μg/ml of oxacillin disc in Mueller-Hinton agar supplemented with 4%NaCl.Data was analyzed using Statistical Package for Social Sciences(SPSS) version 20 software. Pearson’s chi square and Logistic regression were used to assess association between dependent and independent variables. Results A total of 890 specimens of S. aureus were analyzed in the 5-year period. ​​PSSA was the most prevalent organism seen (45%) while MRSA was the least prevalent (0.45% ). There was a fluctuation in the annual prevalence of MRSA between 0-1% over the five years. Most S. aureus was isolated in pus-644(73. 3%). A significant increase in susceptibility of S. aureus to Penicillin and Amoxicillin-clavulanic acid was observed during the study period however, sensitivity to Amoxicillin declined. No mMrsa was detected. Resistance of MRSA to Ampicillin, Penicillin, Tazopiperacillin, Cephalosporins, Erythromycin, Clindamycin, Ciprofloxacin and Meropenem was 100% with both Trimethoprim/sulfamethoxazole and Levofloxacin recording 50% and amoxicillin/clavulanic acid 75% resistance. Conclusion This study demonstrated a steady decline in average annual resistance of S. aureus to commonly used antibiotics. Furthermore, there was a low prevalence of MRSA. No multi-drug Methicillin resistant S. aureus have been isolated in the last five years in this hospital.

A FBN1 variant manifesting as non-syndromic ectopia lentis with retinal detachment: clinical and genetic characteristics

Background/objectives Fibrillin-1 (FBN1) mutations cause connective tissue dysgenesis the main ocular manifestation being ectopia lentis (EL), which may be syndromic or non-syndromic. We describe a pedigree with a FBN1 mutation causing non-syndromic EL with retinal detachment (RRD) and their management. Subjects/methods Patients with familial EL with RRD were invited to participate (vitreoretinopathy branch of Target 5000, the Irish inherited retinal degeneration study). All patients signed full informed consent. The study was approved by the Institutional Review Board of the Mater Hospital, Dublin and abided by the Declaration of Helsinki. Results Seven adults were affected with bilateral EL. All subjects had RRD with bilateral non-synchronous RRD in 57%. Conclusions The FBN1 variant described herein confers an increased risk of both EL and RRD and can now be upgraded to ‘pathogenic’ ACMG status.