Changes in alcohol consumption in pregnant Australian women between 2007 and 2011

Abstract

New Delhi metallo-betalactamase-producing Enterobacteriaceae in an Australian child who had not travelled overseas TO THE EDITOR: The editorial by Looke and colleagues in the 18 March 2013 issue of the Journal highlighted the increasing threat of gram-negative resistance. 1 Since its description in 2009, 2 gram-negative bacteria carrying the gene for New Delhi metallo-beta-lactamase-1 (NDM-1) production have been observed globally. To date, a small number of cases have been reported in adults in Australia. 3-5 3-5 In all cases, patients travelled to the Indian subcontinent; many required hospitalisation for their infection. We report the fi rst case of NDM-1producing Enterobacteriaceae in a young infant who had not travelled outside Australia. An Australian-born 3-week-old boy presented to hospital in 2013 with a 4-day history of cough, rhinorrhoea and vomiting. His mother had visited Pakistan and Afghanistan in 2011 and 2012, respectively. The mother had no relevant medical history and had not attended hospitals in either country. She had lived in Australia exclusively during pregnancy. Culture of a clean-catch urine sample grew more than 10 8 colonyforming units (CFU) per litre of Klebsiella pneumoniae (amoxycillin resistant, otherwise susceptible). The child was diagnosed with a urinary tract infection and treated with ceftriaxone and gentamicin followed by oral combined trimethoprim and sulfamethoxazole (co-trimoxazole). The child's symptoms resolved and imaging showed no structural anomaly. The child represented at 5 weeks of age with irritability and vomiting. A urine sample was taken, and the culture grew > 10 8 CFU/L of Enterobacter cloacae. Susceptibility testing was performed using agar dilution, Vitek2 and Etests (bioMérieux). Using Clinical and Laboratory Standards Institute breakpoints, the isolate was resistant to all β-lactam antibiotics, including meropenem, aminoglycosides, quinolones, cotrimoxazole and nitrofurantoin. The minimum inhibitory concentrations to colistin, tigecycline and fosfomycin were < 2 mg/L, < 4 mg/L and < 16 mg/L, respectively. Polymerase chain reaction-based investigation of β-lactamase production provided positive results for bla NDM-1 and bla CTX-M genes. The child was successfully treated with oral fosfomycin (100 mg/kg/day). This case highlights the emerging impact of NDM-1-producing bacteria. Given that the likely source was the mother or another household contact, this is an example of vertical or horizontal transmission in a country with low community prevalence of NDM-1-producing bacteria. In addition to an increased risk for patients previously receiving medical care overseas or returning from countries where there is a high risk of infection with gram-negative bacteria producing NDM-1, their children and household contacts are also at increased risk.

Factors influencing women’s decisions to drink alcohol during pregnancy: findings of a qualitative study with implications for health communication

“…The lack of evidence as to whether low-moderate alcohol intake during pregnancy poses risk to the fetus [ 12 ] maybe part of what is fuelling this cultural double bind. Adding to this, some commentators have voiced concern that the risk of advocating abstinence might pose a risk to the fetus inasmuch as it could provoke anxiety among women who drink while pregnant [ 13 ]. Some argue that imposing a norm of abstinence for pregnant women constitutes an unwarranted form of “coercive control” over women’s bodies [ 14 ].…”

Punishing parents: Child removal in the context of drug use

“…Because a lower limit of safe alcohol exposure has not been established, several countries, including Australia, advise pregnant women to abstain from alcohol completely [7]. Based on the lack of evidence for harm with low levels of alcohol consumption, however, there have been calls to reconsider Australia's guidelines to a more levelled harm reduction approach to alcohol in pregnancy [8]. The debates surrounding illicit drug use in pregnancy are similarly controversial, if not more so.…”

Changes in alcohol consumption in pregnant Australian women between 2007 and 2011

“…To the Editor : Further to the letter by Batagol 1 regarding the National Health and Medical Research Council (NHMRC) guidelines on alcohol consumption during pregnancy, 2 I believe that the guidelines should emphasise the basic principles of embryology and teratology. The first 2 weeks after conception (2–4 weeks after the last prepregnancy menstrual period, when women are unaware that they have conceived) are known as the “all‐or‐none period” — a phase during which teratogens will either cause non‐viability or do no harm at all.…”