Grant W Waterer

University of Western Australia | UWA · School of Medicine and Pharmacology

Parapneumonic effusion and empyema are rising in incidence worldwide, particularly in association with comorbidities in an aging population. Also driving this change is the widespread uptake of pneumococcal vaccines, leading to the emergence of nonvaccine-type pneumococci and other bacteria. Early treatment with systemic antibiotics is essential bu...

In this pilot study, we report the novel association of bacterial pneumonia with myocardial fibrosis and new-onset left ventricular dysfunction during convalescence. This is consistent with epidemiological studies associating pneumonia with new-onset chronic heart failure and with animal studies reporting fibrosis following bacterial translocation...

Influenza is a common cause of acute respiratory infection, and is a major cause of morbidity and mortality. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2019 influenza season. The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that opera...

Introduction: Influenza is a common cause of acute respiratory infection, and is a major cause of morbidity and mortality. Coronavirus disease 2019 (COVID-19) is an acute respiratory infection that emerged as a pandemic worldwide before the start of the 2020 Australian influenza season. This report summarises the epidemiology of hospitalisations w...

Rationale: Pleural effusion commonly complicates community-acquired pneumonia (CAP) and is associated with intense pleural inflammation. Whether anti-inflammatory treatment with corticosteroids improves outcomes is unknown. Objectives: To assess the effects of corticosteroids in an adult population with pneumonia-related pleural effusion. Metho...

COVID-19 is a new infectious disease causing severe respiratory failure and death for which optimal treatment is currently unclear. Many therapies have been proven to be ineffective; however, promising findings related to corticosteroid therapy have been published. Analysis of published data including in this issue suggests that therapy with cortic...

Intensive care units (ICUs) are an appropriate focus of antibiotic stewardship program efforts because a large proportion of any hospital's use of parenteral antibiotics, especially broad-spectrum, occurs in the ICU. Given the importance of antibiotic stewardship for critically ill patients and the importance of critical care practitioners as the f...

Purpose of review: The American Thoracic Society and Infectious Diseases Society of America recently released their joint guideline for the diagnosis and treatment of adults with community-acquired pneumonia (CAP). The co-chairs of the guideline committee provide a summary of the guideline process, key recommendations from the new guideline and fu...

The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2018 influenza season. In this observational surveillance system, cases were defined...

Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinic...

Background: Community-acquired pneumonia (CAP) is a major global disease. Parapneumonic effusions often complicate CAP and range from uninfected (simple) to infected (complicated) parapneumonic effusions and empyema (pus). CAP patients who have a pleural effusion at presentation are more likely to require hospitalization, have a longer length of s...

The Influenza Complications Alert Network (FluCAN) is a sentinel-hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2017 influenza season. In this observational surveillance system, cases were defined...

Community-acquired pneumonia (CAP) is one of the most common infectious diseases, as well as a major cause of death both in developed and developing countries, and it remains a challenge for physicians around the world. Several guidelines have been published to guide clinicians in how to diagnose and take care of patients with CAP. However, there a...

Objective Anxiety and depression are common comorbidities in people diagnosed with chronic obstructive pulmonary disease (COPD). Despite concomitant psychological symptomatology being reported in 22–48% of people with COPD, most literature focuses on identifying the risk factors for anxiety or depression separately. Therefore, our objective was to...

Ninety‐five adults enrolled in the Etiology of Pneumonia in the Community study with negative admission influenza polymerase chain reaction (PCR) tests received influenza vaccination during hospitalization. Acute and convalescent influenza serology were performed. After vaccination, seropositive (≥1:40) hemagglutination antibody titers (HAI) were a...

BACKGROUND This study investigated the association between nadir anemia and mortality and length of stay (LOS) in a general population of hospitalized patients. STUDY DESIGN AND METHODS A retrospective cohort study of tertiary hospital admissions in Western Australia between July 2010 and June 2015. Outcome measures were in‐hospital mortality and...

Background: Adult community-acquired pneumonia (CAP) guidelines from the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) include indications for urinary antigen tests (UATs) for Streptococcus pneumoniae (SP) and Legionella pneumophila (LP). These recommendations were based on expert opinion and have not been rigor...

Background and objective Pleural infection is a clinical challenge; its microbiology can be complex. Epidemiological and outcome data of pleural infection in adult Australians are lacking. We describe the bacteriology and clinical outcomes of Australian adults with culture‐positive pleural infection (CPPI) over a 6‐year period. Methods Cases with...

Background/aim: The optimal empiric antibiotic regimen for patients with community-acquired pneumonia (CAP) remains unclear. This study aimed to evaluate the clinical cure rate, mortality, and length of stay among patients hospitalized with community- acquired pneumonia in nonintensive care unit (ICU) wards and treated with a β-lactam, β-lactam a...

Pleural infection/empyema is common and its incidence continues to rise. Streptococcus pneumoniae is the commonest bacterial cause of empyema in children and among the commonest in adults. The mesothelium represents the first line of defense against invading microorganisms, but mesothelial cell responses to common empyema pathogens, including S. pn...

Introduction: Adults hospitalized with community-acquired pneumonia are at high risk for short-term mortality. However, it is unclear whether improvements in in-hospital pneumonia care could substantially lower this risk. We extensively reviewed all in-hospital deaths in a large prospective CAP study to assess the cause of each death and assess th...

Purpose of Review Despite modern healthcare practices and antimicrobial agents, community-acquired pneumonia (CAP) and associated parapneumonic effusion (PPE) are still common, associated with significant morbidity and mortality, and responsible for significant healthcare system costs globally. There is a need for adjunctive therapies to improve th...

During the period 1 April to 30 October 2016 (the 2016 influenza season), 1,952 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 46% were elderly (e65 years), 18% were children (<16 years), 5% were Aboriginal and Torres Strait Islander peoples, 3% were pregnant and 76% had chronic co-morbidities. Thi...

Empyema is defined by the presence of bacteria and/or pus in pleural effusions. However, the biology of bacteria within human pleural fluid has not been studied. Streptococcus pneumoniae is the most common cause of pediatric and frequent cause of adult empyema. We investigated whether S. pneumoniae can proliferate within human pleural fluid and if...

Individual pleural fluid characteristics. (DOC)

Background: The clinical significance of pneumonia visualized on computed tomography (CT) in the setting of a normal chest x-ray (CXR) is uncertain. Methods: In a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia (CAP), we compared the presenting clinical features, pathogens, and outcomes of pati...

Community acquired pneumonia remains a common cause of morbidity and mortality. Usually, the causal organism is not identified and treatment remains empiric. Recent computed tomography and magnetic resonance imaging studies have challenged the accuracy of the clinical diagnosis of pneumonia, and epidemiologic studies are changing our perspective of...

Rationale: Up to one-third of the patients hospitalized with pneumococcal pneumonia experience major adverse cardiac events (MACE) during or after pneumonia. In mice, Streptococcus pneumoniae can invade the myocardium, induce cardiomyocyte death, and disrupt cardiac function following bacteremia, but it is unknown whether the same occurs in humans...

Background Recent trials suggest procalcitonin-based guidelines can reduce antibiotic use for respiratory infections. However, the accuracy of procalcitonin to discriminate between viral and bacterial pneumonia requires further dissection. Methods We evaluated the association between serum procalcitonin concentration at hospital admission with pat...

Background Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patie...

Background: Annual influenza vaccine is recommended for those at greatest risk of severe influenza infection. Recent reports of a negative impact of serial influenza vaccination on vaccine effectiveness raises concerns about the recommendation for annual influenza vaccines, particularly in those at greatest risk. Methods: The Influenza Complicat...

The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all states and territories in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2015 influenza season. In this observational study, cases were defined as p...

Community-acquired pneumonia (CAP) is a global disease responsible for a large proportion of deaths and having significant economic cost. As diagnostic tools have increased in sensitivity, our understanding of the etiology of CAP has begun to change with a significant increase in confirmed viral infections and the recognition that multiple pathogen...

The ‘atypical’ pathogens causing pneumonia have long been problematic for physicians because we have had to rely on serologic tests to make a diagnosis. The introduction of polymerase chain reaction techniques revolutionized the diagnosis of respiratory infections and now a new wave of technologies promising faster, cheaper, and more comprehensive...

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application t...

Abstract Background: Influenza is associated with serious health impacts including mortality, morbidity, and increased health care utilisation. Emergency departments (ED) have increased influenza presentations every year and education has been proven to reduce ED re-attendances and evidence for ED influenza Education Interventions (EI) is unclear....

New viral respiratory pathogens are emerging with increasing frequency and have potentially devastating impacts on the population worldwide. Recent examples of newly emerged threats include severe acute respiratory syndrome coronavirus, the 2009 H1N1 influenza pandemic, and Middle East respiratory syndrome coronavirus. Experiences with these pathog...

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application t...

Background: Prevalence of Staphylococcus aureus community-acquired pneumonia (CAP) and its clinical features remain incompletely understood, complicating empirical selection of antibiotics. Methods: Using a multicenter prospective surveillance study of adults hospitalized with CAP, we calculated the prevalence of methicillin-resistant S. aureus...

Background: Predicting intensive care need among adults with community-acquired pneumonia (CAP) remains challenging. Methods: Using a multicenter prospective cohort study of adults hospitalized with CAP, we evaluated the association of serum procalcitonin concentration at hospital presentation with the need for invasive respiratory and/or vasopr...

The objective of this study was to investigate the discriminant validity of commonly used depression and anxiety screening tools in order to determine the most suitable tool for patients with chronic obstructive pulmonary disease (COPD). COPD patients ( n = 56) completed the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (B...

There is a considerable amount of evidence that supports the possibility of an increased risk of pneumonia associated with prolonged use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD). However, as yet, no statistically significant increase in pneumonia-related 30-day mortality in patients on ICS has b...

Background: Pulmonary embolism (PE) remains a significant cause of hospital admission and healthcare costs. Estimates of PE incidence came from the 1990s, and data are limited to describe trends in hospital admissions for PE over the last decade. Methods: We analyzed Nationwide Inpatient Sample (NIS) data from 1993 to 2012 to identify patients a...

Cytomegalovirus (CMV) establishes lifelong infections with episodes of active replication. We hypothesized that recurrent CMV replication in older individuals may suppress protective immune responses to non-tuberculous mycobacteria (NTM) and so potentiate pulmonary disease. Accordingly, levels of antibodies to three CMV antigen preparations were hi...

Background Hospitalisations for chronic obstructive pulmonary disease (COPD) exacerbation affect patient outcomes and healthcare costs. The long-term impact of an integrated COPD disease-management approach on hospitalisation remains controversial. AimThe aim of this study was to evaluate whether a multidisciplinary community service reduces respir...

Introduction: Anxiety and depression are common comorbidities in COPD patients. The Hospital Anxiety and Depression Scale (HADS) is recommended for routine screening of COPD patients but has only been validated twice for this population with questionable results; once for anxiety (HADS-A) resulting in sensitivity/specificity of 36/90% and once for...

The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all states and territories in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2014 influenza season. In this observational study, cases were defined as p...

BACKGROUND Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radio-graphically and with the use of current laboratory diagnostic tests are needed. METHODS We conducted active population-based surveillance for community-acquired pneumonia requiring ho...

Pneumonia remains a significant cause of morbidity and mortality, whether community acquired (CAP) or hospital acquired. Although many microbial pathogens may cause pneumonia, the most commonly encountered are pneumococcus; atypical organisms, such as Mycoplasma pneumoniae or Legionella; and at times Staphylococcus aureus and certain gram-negative...

Residents in 11 long-term care facilities, and presenting to a single tertiary hospital site, were sampled to estimate prevalence of oropharyngeal colonization with resistant Gram-negative bacteria. From 124 residents, only one isolate (0.8%; 95% confidence interval 0.0%, 4.4) was multi-resistant (an extended-spectrum β-lactamase producing Escheric...

During seasonal influenza epidemics and pandemics, virus transmission causes significant public health concern. Reduction of viral transmission by non-pharmaceutical interventions (NPI) has a significant appeal and is often recommended. However, the efficacy of such interventions is unclear. A systematic literature review was undertaken to identify...

Current guidelines recommend empirical treatment against Pseudomonas aeruginosa in community-acquired pneumonia (CAP) patients with specific risk factors. However, evidence to support these recommendations is limited. We evaluate the risk factors and the impact of antimicrobial therapy in patients hospitalized with CAP due to P. aeruginosa. We perf...

We are entering into a new era of healthcare wherein patient outcomes are increasingly being publicly reported, not just by institution, but by individual clinicians. This review focuses on the issue of quality of care of patients with community-acquired pneumonia (CAP), in particular the choice of outcome, quality of data needed and recommendation...

We review the potential new diagnostic tools for determining the cause of pneumonia in the setting of community-acquired infection after outlining the limitation of currently available tests. A number of new tools are on the horizon with the potential to overcome the problems of existing tests. These tools include new nucleic acid amplification pla...

We report on 19 patients from Western Australia of pleural empyema with Klebsiella oxytoca, an organism never before reported in association with this condition. Median age was 65 years, 14/17 (83%) had been in hospital within 30 days prior to diagnosis, 12/18 (67%) had active cancer, 9/17 (53%) had been in intensive care and 7/17 (41%) had prior s...

The Nationwide Inpatient Sample aggregated data from approximately 20% of US hospital admissions from 1993 to 2011. Prior literature found that pneumonia admissions decreased following the introduction of the pneumococcal vaccine in 2000.¹ The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), codes provide...

It also makes sense that giving antibiotics promptly is part of the optimal care of a patient with pneumonia. However, studies focusing purely on quicker delivery of antibiotics have not resulted in better patient outcomes.⁸ What then explains the apparent disconnect between the observed associations with better patient outcomes and quicker antibio...

RATIONALE: Acute exacerbations of COPD are a major cause of hospitalisations worldwide. Treatment for exacerbations of COPD are not well based in evidence (e.g. steroids, antibiotics) and benchmarks for key outcomes (e.g. mortality, length of hospital stay, 30-day representation rates) are no where near as well defined as they are for community-acq...

Bronchiectasis is a significant chronic health problem with major morbidity, mortality, and economic costs. However, despite the large burden of disease, much of the treatment for bronchiectasis is not guided by high-quality randomized controlled data but extrapolated from studies in patients with cystic fibrosis. Thankfully, in the past few years,...

β2 adrenergic receptor (ADRβ2) polymorphisms including ADRβ2+46G>A have been reported to cause adverse outcomes in mild asthmatics. The extent to which ADRβ2 polymorphisms and in particular their haplotypes contribute to severe asthma is unknown. To determine the association of ADRβ2 polymorphisms and haplotypes with asthma severity. Caucasians (n...

We report a case of significant pulmonary hemorrhage developing shortly after commencing ticagrelor and aspirin therapy and requiring coronary artery bypass grafting to safely cease the antiplatelet therapy. Lung biopsy findings were consistent with drug-induced lung injury. Clinicians should be aware of this significant adverse event with this dru...

Respiratory Infections PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Azithromycin (AZ) is a macrolide that has shown increased survival in patients with community-acquired pneumonia and bacteremic pneumococcal pneumonia. Immunomodulatory properties are claimed to be associated with th...

Community-acquired pneumonia (CAP) remains a leading cause of death worldwide and a major burden on healthcare resources. CAP may vary in severity, from a mild disease managed in the community to a very severe illness requiring hospital or intensive care unit (ICU) admission. Illness severity is not always obvious at presentation and therefore a ra...

Community-acquired pneumonia (CAP) is a common cause of sepsis. Active full-length caspase-12 (CASP12L), confined to the people of African descent, has been associated with increased susceptibility to and mortality from severe sepsis. The objective of this study was to determine whether CASP12L was a marker for susceptibility and/or severity of CAP...

A 67-year-old woman with mild Alzheimer's disease who has a 2-day history of productive cough, fever, and increased confusion is transferred from a nursing home to the emergency department. According to the transfer records, she has had no recent hospitalizations or recent use of antibiotic agents. Her temperature is 38.4°C (101°F), the blood press...

Several studies described a clinical benefit of macrolides due to their immunomodulatory properties in different respiratory diseases. We aim to assess the effect of macrolide therapy on mortality for patients hospitalized due to Pseudomonas aeruginosa Community-acquired pneumonia (CAP). We performed a retrospective population-based study of >150 h...

Medical advances have failed to arrest the growing morbidity and mortality from lung diseases. COPD, lung cancer and pulmonary infections remain leading causes of death. More than any other time in human history, we need high quality, translatable, patient-focussed respiratory research that will improve clinical practice. Close teamwork of scientis...

ICU Infections PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PMPURPOSE: Pneumonia caused by Pseudomonas aeruginosa carries a higher morbidity and mortality. Current guidelines advocate the early use of a combination of empiric antibiotics against P aeruginosa. There is controversy re...