Internal Medicine Journal最新文献

{"title":"Barriers to exercise prescription among Australian general practitioners and endocrinologists: a cross-sectional survey.","authors":"Isobelle Smith, Lucy Ding, Gimhani Abeygunaselkara, Adrian Bauman","doi":"10.1111/imj.70634","DOIUrl":"https://doi.org/10.1111/imj.70634","url":null,"abstract":"<p><strong>Background: </strong>Physical inactivity is a leading preventable cause of chronic disease in Australia. Exercise prescription by physicians increases patients' physical activity, but implementation is inconsistent, and barriers among Australian physicians are not well characterised.</p><p><strong>Aims: </strong>To investigate barriers and facilitators to exercise prescription among Australian general practitioners (GPs) and endocrinologists and to identify physician characteristics associated with prescription frequency.</p><p><strong>Methods: </strong>Cross-sectional survey of 118 Australian GPs (n = 59) and endocrinologists (n = 59) recruited via purposive and snowball sampling (December 2021-December 2022). Chi-squared tests examined associations with prescription frequency; logistic regression adjusted key associations for specialty, age and physicians' own activity levels.</p><p><strong>Results: </strong>Of 118 physicians, 59% prescribed physical activity to ≥61% of eligible patients (high prescribers). The strongest correlate was systematic assessment of patients' physical activity (81% vs 43% high prescribers; adjusted odds ratio (OR) 5.50, 95% confidence interval (CI): 2.04-14.80). Physicians doubting guideline feasibility were less likely to prescribe (46% vs 76%; adjusted OR 3.20, 95% CI: 1.17-8.75), and feasibility scepticism was associated with physicians' own activity: 74% of those meeting guidelines believed them feasible versus 27% of those who did not (P < 0.001). Written prescriptions and perceived patient disinterest remained associated with prescription frequency after adjustment; associations for training and time barriers attenuated. Knowledge of guidelines was not associated with prescription frequency.</p><p><strong>Conclusions: </strong>Systematic assessment practices and physicians' feasibility beliefs may be more important to exercise prescription than guideline knowledge. Physicians' own exercise habits are associated with their beliefs about what is feasible for patients, with implications for the design of medical education.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ANZTCT cytomegalovirus practice survey for allogeneic haemopoietic stem cell transplant and cellular therapy recipients in Australia and New Zealand.","authors":"Andrea Henden, Lynette Chee, Julia Clark, Rachel Conyers, Julian Cooney, Richard Doocey, David Gottlieb, Tim Prestidge, Madeleine Powys, Philip Selby, Gaurav Sutrave, Eric Wong, Michelle K Yong, Nada Hamad","doi":"10.1111/imj.70627","DOIUrl":"https://doi.org/10.1111/imj.70627","url":null,"abstract":"<p><strong>Background: </strong>Despite pre-emptive treatment (PeT), cytomegalovirus (CMV) disease and reactivation remain a clinical concern. In Australia and New Zealand (ANZ), variability exists in the management of CMV for haematopoietic stem cell transplantation (HSCT) recipients.</p><p><strong>Aims and methods: </strong>To understand the state of practice in Australia, a survey captured insights on detection, monitoring, prophylaxis and treatment from 21 sites, including 11 chimeric antigen receptor T-cell (CAR-T) therapy sites.</p><p><strong>Results: </strong>Respondents reported 26 cases of CMV disease after HSCT and four cases after CAR-T in 2024. All HSCT sites and four CAR-T sites had CMV protocols. Commonly, CMV nucleic acid viral load (VL) testing was employed weekly. Sites utilised plasma (66%) or whole blood (33%). VL was reported as IU/mL (66%), copies/mL (29%) or not specified (5%). One third of respondents tested CMV DNAemia before HSCT. All recipients were monitored regardless of CMV serostatus. Half the sites employed post-HSCT CMV prophylaxis using letermovir (nine sites), (val)aciclovir (eight) and (val)ganciclovir (three). VL thresholds for PeT ranged from 100 to 5000 IU/mL. Most sites used (val)ganciclovir for PeT, with foscarnet second line. At 76% of HSCT sites, PeT continued until two consecutive negative results. Frontline therapy for CMV disease is ganciclovir; 86% of ANZ sites used (val)ganciclovir while three paediatric sites used foscarnet. For resistant or refractory CMV, guidelines recommend foscarnet or maribavir, although maribavir was not funded or used during the survey period. CMV-specific immunotherapy can be considered.</p><p><strong>Conclusions: </strong>Institutional preferences and medicine funding drives variability in ANZ practice. This leaves potential for healthcare inequity since newer antiviral agents are inconsistently used, contrasting with international guidelines.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectory of macrotroponin in a community cohort.","authors":"Duncan J Campbell, Fei Fei Gong, Michele McGrady, David L Prior, Christopher M Reid, Christina M Trambas","doi":"10.1111/imj.70618","DOIUrl":"10.1111/imj.70618","url":null,"abstract":"<p><strong>Background: </strong>Cardiac troponin I (cTnI) is a biomarker for myocardial injury. However, macrotroponin, a complex of cTnI and endogenous cardiac troponin autoantibodies, may artefactually elevate cTnI levels with potential to mislead clinicians, leading to inappropriate investigation and management.</p><p><strong>Aim: </strong>To examine the prevalence and trajectory of macrotroponin in participants of the prospective community-based SCreening Evaluation of the Evolution of New Heart Failure (SCREEN-HF) study cohort.</p><p><strong>Methods: </strong>Inclusion criteria were age ≥ 60 years with one or more self-reported ischaemic or other heart diseases, irregular or rapid heart rhythm, cerebrovascular disease, renal impairment or treatment for hypertension or diabetes for ≥2 years. Exclusion criteria were known heart failure or cardiac abnormality on echocardiography or other imaging. A cutoff residual cTnI activity ≤20% after polyethylene glycol precipitation was used to detect macrotroponin in plasma samples with cTnI levels above the sex-specific 99th percentile reference limits.</p><p><strong>Results: </strong>Of 3156 SCREEN-HF participants with one or more cTnI measurements, 64 (2%) had macrotroponin. Among 2243 participants with two or more cTnI measurements, cTnI levels with macrotroponin were dynamic, although most elevated cTnI levels with macrotroponin at baseline remained elevated (14 of 16 men, 9 of 11 women) for several years during follow-up.</p><p><strong>Conclusions: </strong>Elevated cTnI levels with macrotroponin remained elevated for several years in asymptomatic individuals in this community-based cohort. While interpreting elevated cTnI levels in the clinical context, recording macrotroponin as a diagnosis could alert clinicians to possible artefactual elevation of cTnI levels during subsequent clinical presentation and avoid inappropriate investigation and management.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extremely low diagnostic yield of routine hepatitis B and human immunodeficiency virus screening among incarcerated adults treated for hepatitis C in Western Australia.","authors":"Ali Galalah Mostafa Ismail, Loveinder Madahar, Adam Gregson, Adam Doyle","doi":"10.1111/imj.70629","DOIUrl":"https://doi.org/10.1111/imj.70629","url":null,"abstract":"<p><p>Routine testing for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is recommended prior to initiating direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) in Australian prisons. We evaluated the diagnostic yield of HBV and HIV screening among 713 incarcerated adults commencing DAA therapy across multiple Western Australian prisons between 2017 and 2025. The cohort had a mean age of 34.8 years and was predominantly male (81%). HBV and HIV screening outcomes were available for all participants. Only one (0.14%) participant tested positive for hepatitis B surface antigen and none for HIV. A further 12% had serological evidence of past HBV exposure. These findings confirm an extremely low yield of universal pre-treatment HBV/HIV screening in this setting. While screening remains clinically important, treatment should not be delayed while awaiting results. Parallel testing strategies may streamline care and support hepatitis C elimination efforts in custodial settings. This study represents one of the largest contemporary evaluations of HBV and HIV screening outcomes among incarcerated individuals receiving DAA therapy in Australia.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound in general medicine: establishing a new service.","authors":"Patrick Elliott, Nicole Evans, Richard Coates, Noor Lammoza, Harry Gibbs","doi":"10.1111/imj.70624","DOIUrl":"https://doi.org/10.1111/imj.70624","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) is increasingly used in general medicine to support focussed bedside diagnosis and management. However, many implementation models depend on individual clinicians scanning their own patients. This limits equity of access, slows accumulation of provider experience and makes rapid departmental scale-up challenging. To describe the development and early implementation of a hybrid general medicine consultative POCUS service designed to improve access and scalability at a quaternary teaching hospital in Australia. In February 2025, the Alfred Health General Medicine Department implemented a consultative POCUS model delivered by credentialled specialists and a POCUS fellow. The model combined clinician-performed scans for patients under credentialled providers with an intradepartmental referral service for other general medicine patients. Scans were performed predominantly during business hours and documented using a structured template. Critical findings were verbally communicated. Key implementation elements included formal departmental credentialling, device access, a departmental logbook and active case-finding during the initial implementation phase. Major challenges included limited credentialled provider availability, variable clinician familiarity with POCUS, image storage limitations and dependence on a dedicated fellow. Over 12 months, 683 scans were performed, representing approximately one out of five admissions to the Alfred General Medicine wards. Most studies involved cardiac, pulmonary or combined cardiopulmonary assessment. Our experience suggests a hybrid consultative model may be a feasible approach to improving access to POCUS and accelerating departmental adoption during early implementation.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical ruxolitinib for resistant dupilumab-associated facial dermatitis.","authors":"Gary Xu, Nicolás Urriola","doi":"10.1111/imj.70625","DOIUrl":"https://doi.org/10.1111/imj.70625","url":null,"abstract":"","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between discharge summary timeliness and clinical outcomes among general medicine patients.","authors":"Cutie Kannampuzha, Yogesh Sharma, Campbell Thompson, Arduino Mangoni","doi":"10.1111/imj.70623","DOIUrl":"https://doi.org/10.1111/imj.70623","url":null,"abstract":"<p><strong>Background: </strong>Timely discharge summaries are critical for optimal care transitions; however, evidence linking timeliness with patient outcomes remains inconsistent.</p><p><strong>Aim: </strong>This study examined the association between summary completion time and 30-day readmission and mortality among general medical patients.</p><p><strong>Methods: </strong>This retrospective cohort study at a South Australian tertiary teaching hospital included adult general medical admissions between July 2022 and June 2023. Discharge summaries were categorised as completed within 24 h, 24-48 h or beyond 48 h. The primary outcome was a composite of 30-day readmission or death; secondary outcomes were 30-day readmission and mortality assessed separately. Multivariable logistic regression adjusted for age, sex, comorbidities, frailty and measures of healthcare utilisation with results reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Among 4703 admissions, 21.9% had discharge summaries completed more than 48 h after discharge, while 78.1% were completed within 48 h, and 26.8% experienced the composite outcome - these patients were older, with higher comorbidity and frailty (P < 0.05). Discharge summary completion beyond 48 h was independently associated with higher odds of the composite outcome (aOR 1.42, 95% CI 1.13-1.77, P < 0.001) and mortality (aOR 1.95, 95% CI 1.29-2.96, P = 0.002), but not 30-day readmission (aOR 1.14, 95% CI 0.90-1.43, P = 0.622). Among patients who died within 30 days, 51.3% of deaths occurred within a median of 7 days from discharge (interquartile range 3-16).</p><p><strong>Conclusions: </strong>Discharge summaries completed after 48 h were associated with adverse 30-day outcomes, particularly mortality. The clustering of death within the first week after discharge highlights the vulnerability of the post-discharge period and underscores the importance of timely communication between hospital and primary care providers.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crossover effect: causal machine learning reveals opposing mortality responses to mean arterial pressure targets among phenotypically distinct hypertensive patients with septic shock","authors":"Zekai Yu","doi":"10.1111/imj.70515","DOIUrl":"10.1111/imj.70515","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To quantify the heterogeneity of treatment effects of higher versus standard MAP targets on 28-day mortality, to identify distinct clinical phenotypes that respond differentially to MAP targets, and to derive simple bedside decision rules to guide individualised haemodynamic management.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Current guidelines recommend a uniform mean arterial pressure (MAP) target of ≥65 mmHg for septic shock. However, trials like SEPSISPAM found no mortality benefit from higher targets in hypertensive patients. We hypothesised that this null finding results from the masking of heterogeneous treatment effects (HTEs) among phenotypically distinct individuals.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a retrospective cohort study of 7665 hypertensive patients with septic shock from the Medical Information Mart for Intensive Care IV database (version 3.1). The primary exposure was time-weighted average MAP (TWA-MAP) during the first 24 h, dichotomised into high target (&gt;75 mmHg) versus standard target (65–75 mmHg). The primary outcome was 28-day mortality. Individual treatment effects (ITEs) were estimated using a T-Learner causal machine learning framework with gradient boosting. Patients were stratified by ITE quartiles, and a Classification and Regression Tree (CART) was used to derive bedside clinical rules.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We observed marked HTE (ITE range: −0.54 to +0.86). In the Strong Benefit group (Decompensated Phenotype) – characterised by tachycardia, hyperlactatemia and renal dysfunction – the high MAP target dramatically reduced 28-day mortality from 62.6% to 22.9% (absolute risk reduction = 39.7%, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Conversely, in the Harm group (Frail Phenotype) – characterised by older age and lower heart rate – the high target increased mortality from 14.7% to 33.9% (ARR = −19.2%, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). The CART model identified heart rate &gt;105 bpm and creatinine &gt;1.65 mg/dL as simple bedside criteria to identify patients likely to benefit from higher targets.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The impact of higher MAP targets in hypertensive septic shock exhibits a distinct crossover pattern: life-saving in decompensated patients but harmful in frail patients. This HTE explains the null results of previous landmark trials. Utilising simple parameters like heart rate and creatinine can guide a shift from ‘one-size-fits-all’ targets towards precision haemodynamic management.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1617-1629"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of data routinely collected by Australian hospitals for identifying infective endocarditis, causative organisms and clinical outcomes: a diagnostic accuracy study","authors":"Ruturaj Vaidya,&nbsp;Nalin Kataria,&nbsp;Jason Zou,&nbsp;Quan Li,&nbsp;Sunnya Khawaja,&nbsp;Trang Dang,&nbsp;Susan Smith,&nbsp;Katherine Lau,&nbsp;Russell Denman,&nbsp;Yong Wee,&nbsp;Bronwyn Learmouth,&nbsp;Bo Janoschka,&nbsp;John Sedgwick,&nbsp;Robert Horvath,&nbsp;Isuru Ranasinghe","doi":"10.1111/imj.70498","DOIUrl":"10.1111/imj.70498","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Infective endocarditis (IE) is a life-threatening condition, and the surveillance of the incidence is important for monitoring disease trends. Administrative data routinely collected by hospitals offer a feasible and inexpensive method for surveillance of patients with IE, yet the accuracy of coding of IE, causative organisms and outcomes is uncertain.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To evaluate the diagnostic accuracy of routinely collected Australian hospital administrative data for identifying IE, causative organisms and selected clinical outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Using a cross-sectional design, we included all hospitalisations with International Classification of Diseases, 10th revision, Australian Modification (ICD10-AM) codes for IE from 1 January 2020 to 30 June 2023 at a quaternary referral centre. IE cases not captured by coding were ascertained by reviewing clinical data sources (echocardiogram reports, cardiothoracic surgical and device implantation registries and an IE biobank). We used a definite, possible or pathological diagnosis of IE as per the European Society of Cardiology (ESC) Modified criteria for IE as the reference standard for diagnosing IE.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We identified 353 hospitalisations with principal or secondary ICD10-AM diagnosis codes at discharge. Of these, 313 patients had IE as per the ESC Modified criteria. A further 51 patients (14%) with IE meeting the ESC modified criteria = were found not captured by coding during the same period. ICD10-AM codes for IE had an overall sensitivity of 0.86 (95% confidence interval (CI) 0.82–0.90), specificity of 1.00 (95% CI 1.00–1.00), a positive predictive value of 0.89 (95% CI 0.85–0.92) and a negative predictive value of 1.00 (95% CI 0.99–1.00). Coding identified the causative organism with an overall sensitivity of 0.77 (95% CI 0.72–0.81) and specificity of 1.00 (95% CI 1.00–1.00), with high accuracy for the most common organism, &lt;i&gt;Staphylococcus aureus&lt;/i&gt; (sensitivity 0.88, 95% CI 0.80–0.93; specificity 0.95, 95% CI 0.89–0.98). Coding demonstrated high accuracy for detection of in-hospital deaths (sensitivity 0.91, 95% CI 0.75–0.98; specificity 1.00, 95% CI 1.00–1.00) and surgical management (sensitivity 0.91, 95% CI 0.86–0.94; specificity 1.00, 95% CI 1.00–1.00) with lower sensitivity and specificity for other outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1544-1552"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70498","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legionella pneumophila pneumonia in South Eastern Sydney: diagnosis, prognosis and public health outcomes","authors":"Sue Qian,&nbsp;Nickson Ning,&nbsp;Kelli Snyders,&nbsp;Misha Klingstrom,&nbsp;Pam Konecny,&nbsp;Vicky Sheppeard,&nbsp;Rachael Roberts,&nbsp;Georgia Shimmin,&nbsp;Robert Stevens,&nbsp;Richard Sullivan","doi":"10.1111/imj.70506","DOIUrl":"10.1111/imj.70506","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Legionellosis causes more severe disease than other aetiologies of community-acquired pneumonia (CAP). Early recognition and treatment of <i>Legionella</i> pneumonia reduce mortality. Urinary antigen testing (UAT) has facilitated rapid and reliable diagnosis of <i>Legionella</i> pneumonia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aims of this study were as follows: (i) identify characteristics of CAP patients more likely to be associated with a positive <i>Legionella</i> UAT, (ii) identify clinical features of <i>Legionella</i> pneumonia associated with higher risk of intensive care unit (ICU) admission and (iii) describe public health interventions resulting from positive <i>Legionella</i> UATs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a case–control study of CAP patients admitted at two South-Eastern Sydney hospitals between January 2015 and March 2024 who underwent <i>Legionella</i> UAT. Multivariable logistic regression was used to identify characteristics associated with a positive <i>Legionella</i> UAT and ICU admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 13 697 <i>Legionella</i> UATs during the study period, and 51 (0.4%) were positive. A total of 100% of the <i>Legionella</i> UAT-positive cases could be detected by conducting <i>Legionella</i> UAT in CAP patients with at least one of the following characteristics: &gt;20 standard alcoholic drinks/week, confusion, failure of outpatient antibiotic therapy, diarrhoea, myalgias, temperature &gt;40°C, serum sodium &lt;137 mmol/L and CRP &gt;300 mg/L. CURB-65 score, CRP and heart rate were independent factors associated with ICU admission. Positive <i>Legionella</i> UAT results led to 11 regulatory actions under the Public Health Act.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study identified characteristics of CAP patients more likely to be associated with a positive <i>Legionella</i> UAT. Future prospective studies with greater power and in different populations may assist in refining this model to create a clinical decision-making tool to determine the appropriateness of <i>Legionella</i> UAT in CAP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1575-1583"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70506","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}