Portable ultrasound machines are frequently used in operating theatres for peripheral single-shot nerve block procedures. This equipment must be decontaminated by reducing the microbial load to a sufficient level to reduce the risk of nosocomial infection. In our institution we use a simple three-step decontamination protocol utilising 70% isopropyl alcohol as chemical disinfectant. We performed a prospective, quality assurance study to assess the efficacy of this protocol, as it is unclear if this is suitable for disinfecting semicritical equipment. The primary endpoint was presence of microbial contamination prior to re-use of equipment. over a four-week period, 120 swabs were taken from multiple sites on our ultrasound machines and linear array transducers for microbial culture. Swabs were taken after decontamination and immediately prior to patient contact. Any pathogenic and environmental bacterial organisms were isolated and identified. no pathogenic organisms were grown from any of the collected swabs. In 85% (n=102) of cultures, no growth was detected. of the remaining 15% (n=18), commensal organisms commonly found on skin, oral and environmental surfaces were isolated. our results suggest that our decontamination protocol may be an effective, rapid and cost-effective method of cleaning ultrasound equipment used for peripheral invasive single-shot nerve blocks. Further guidance from national bodies is required to define appropriate cleaning protocols for these machines.

Background Aerococcus urinae is a bacterium of emerging clinical interest that most commonly causes urinary tract infections (UTI) but can also result in invasive infections. It is a catalase-negative, alpha-haemolytic gram-positive coccus that grows in clusters or tetrads and usually causes urinary tract infections. While rare, infective endocarditis must be considered when A. urinae is isolated in blood culture. The mortality rate of A. urinae infective endocarditis is similar to overall endocarditis mortality. We report a rare case of aortic root abscess caused by A. urinae. Case presentation An 82-year-old Caucasian man presented to hospital with behavioural change and severe malnutrition and was managed for psychotic depression. On day 34 of his inpatient stay, a febrile episode prompted blood cultures, which grew Aerococcus. urinae. Investigations revealed a bicuspid aortic valve, aortic valve endocarditis and aortic root abscess. He also had prostatomegaly. He underwent aortic valve replacement, received 6 weeks of intravenous ceftriaxone and recovered. Conclusion Infective endocarditis should be considered in patients with persistent Aerococcus urinae bacteraemia. Accurate identification with mass spectrometry is recommended to avoid misidentification as staphylococcus, streptococcus or enterococcus, which is a possibility with conventional laboratory methods.

Treatment for cutaneous infection from Mycobacterium abscessus is fraught with poorly established evidence. Given its antibiotic multi-resistance, surgical intervention is often recommended. We report a case of cutaneous M. abscessus infection that was successfully managed with medical therapy alone. A 55-year-old immunocompetent woman from the Bellarine peninsula in Victoria, Australia presented to our hospital with a 2-week history of a non-healing ulcer on her left forearm. The patient had no history of trauma or procedures to the skin. On presentation, the patient had a punch biopsy, which was culture positive for M. abscessus. The isolate was susceptible to clarithromycin and amikacin, had intermediate susceptibility to ciprofloxacin, cefoxitin and linezolid and was resistant to doxycycline, imipenem, cotrimoxazole and moxifloxacin. The tigecycline MIC was 0.25 μg/ml. The patient received a total of 12 weeks of oral clarithromycin 500 mg twice daily, 4 weeks of intravenous amikacin 500 mg daily, 6 weeks of intravenous tigecycline 100 mg over 24 hours via Baxter pump, and 4 weeks of oral clofazimine 100 mg daily. The patient made a good clinical recovery and had her medical therapy ceased after 12 weeks. M. abscessus cutaneous infection in an immunocompetent individual without antecedent trauma or surgery is rare. Our case illustrates the successful treatment of a deep M. abscessus cutaneous ulcer with relatively short duration macrolide-based antibiotic therapy without any surgical intervention.

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