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Journal articleJauneikaite E, Khan-Orakzai Z, Kapatai G, et al., 2016,
Nosocomial outbreak of drug resistant Streptococcus pneumoniae serotype 9V in an adult respiratory medicine ward
, Journal of Clinical Microbiology, Vol: 55, Pages: 776-782, ISSN: 1098-660XStreptococcus pneumoniae infections arising in hospitalized patients are often assumed to be sporadic, and linked to community carriage. Here, whole genome sequencing was used to demonstrate nosocomial acquisition of antimicrobially-resistant ST156-9V S. pneumoniae in 3 respiratory patients resulting in two bacteremias and one lower respiratory tract infection. Two of the cases arose in patients who had recently been discharged from hospital and were re-admitted from the community. Nosocomial spread was suspected solely because of a highly unusual resistance pattern and case presentations within 24h of one another. The outbreak highlights a potential for rapid transmission and short incubation period in the respiratory ward setting.
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Journal articleRawson T, Charani E, Moore L, et al., 2016,
Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study
, BMC Medicine, Vol: 14, ISSN: 1741-7015BackgroundThe inappropriate use of antimicrobials drives antimicrobial resistance. We conducted a study to map physician decision making processes for acute infection management in secondary care to identify potential targets for quality improvement interventions.MethodsNewly qualified to Consultant level physicians participated in semi-structured interviews. Interviews were audio recorded and transcribed verbatim for analysis using NVIVO11.0 software. Grounded theory methodology was applied. Analytical categories were created using constant comparison approach to the data and participants were recruited to the study until thematic saturation was reached. ResultsTwenty physicians were interviewed. The decision pathway for the management of acute infections follows a Bayesian-like step-wise approach, with information processed and systematically added to prior assumptions to guide management. The main emerging themes identified as determinants of the decision making of individual physicians were; (i) perceptions of providing “optimal” care for the patient with infection by providing rapid and often intravenous therapy; (ii) perceptions that stopping/de-escalating therapy was a senior doctor decision with junior trainees not expected to contribute; (iii) expectation of interactions with local guidelines and microbiology service advice. Feedback on review of junior doctor prescribing decisions was often lacking, causing frustration and confusion on appropriate practice within this cohort. ConclusionInterventions to improve infection management must incorporate mechanisms to promote distribution of responsibility for decisions made. The disparity between expectations of prescribers to start but not review/stop therapy requires addressing urgently with mechanisms to improve communication and feedback to junior prescribers to facilitate their continued development as prudent antimicrobial prescribers.
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Journal articleVila-Candel R, Navarro-Illana P, Navarro-Illana E, et al., 2016,
Determinants of seasonal influenza vaccination in pregnant women. A cross-sectional study in Valencia, Spain
, BMC Infectious Diseases, Vol: 16, ISSN: 1471-2334BackgroundIn most countries the coverage of seasonal influenza vaccination in pregnant women is low. We investigated the acceptance, reasons for rejection and professional involvement related to vaccine information in pregnant women in Valencia, Spain.MethodsObservational retrospective study in 200 pregnant women, 100 vaccinated and 100 unvaccinated, were interviewed during the 2014/2015 vaccination campaign. Electronic medical records, immunization registry and telephone interviews were used to determine reasons for vaccination and immunization rejection.Results40.5% of pregnant women in the health department were vaccinated. The midwife was identified as source of information for 89% of women. The vaccine was rejected due to low perceptions of risk of influenza infection (23%), lack of information (19%), considering the vaccine as superfluous (16%), close proximity of delivery date (13%) and fear of side effects (12%).ConclusionPregnant women in Spain declined to be vaccinated due to under-estimation of the risk of contracting or being harmed by influenza, and lack of information. Interventions aiming to optimize vaccination coverage should include information addressing the safety and effectiveness of the current vaccine together with improved professional training and motivation.
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Journal articleNaylor NR, Silva S, Kulasabanathan K, et al., 2016,
Methods for estimating the burden of antimicrobial resistance: a systematic literature review protocol
, Systematic Reviews, Vol: 5, ISSN: 2046-4053Background:Estimates of the burden of antimicrobial resistance (AMR) are needed to ascertain AMR impact, evaluate interventions and to allocate resources efficiently. Recent studies have estimated health, cost and economic burden relating to AMR, with outcomes of interest ranging from drug-bug resistance impact on mortality in a hospital setting to total economic impact of AMR on the global economy. However, recent collation of this information has been largely informal, with no formal quality assessment of the current evidence base (e.g. with predefined checklists). This review therefore aims to establish what perspectives and resulting methodologies have been used in establishing the burden of AMR, whilst also ascertaining the quality of these studies. Methods:The literature review will identify relevant literature using a systematic review methodology. MEDLINE, EMBASE, Scopus and EconLit will be searched utilising a predefined search string. Grey literature will be identified by searching within a predefined list of organisational websites. Independent screening of retrievals resultswill be performed in a two-stage process (abstracts and full texts), utilising a pre-defined inclusion and exclusion criteria. Data will be extracted into a data extraction table and descriptive examination will be performed. Study quality will be assessed using the Newcastle-Ottawa scales and the Philips checklists where appropriate. A narrative synthesis of the results will be presented. Discussion:This review will provide an overview of previous health, cost and economic definitions of burden and the resultant impact of these different definitions on the burden of AMR estimated. The review will also explore the methods that have been used to calculate this burden and discuss resulting study quality. This review can therefore act as a guide to methods for future research in this area.Trial Registration:This review has been registered with the PROSPERO International Prospective Regis
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Journal articleRawson T, Moore L, Hernandez B, et al., 2016,
Patient engagement with infection management in secondary care: a qualitative investigation of current experiences
, BMJ Open, Vol: 6, ISSN: 2044-6055Objective To understand patient engagement with decision-making for infection management in secondary care and the consequences associated with current practices.Design A qualitative investigation using in-depth focus groups.Participants Fourteen members of the public who had received antimicrobials from secondary care in the preceding 12 months in the UK were identified for recruitment. Ten agreed to participate. All participants had experience of infection management in secondary care pathways across a variety of South-East England healthcare institutes. Study findings were subsequently tested through follow-up focus groups with 20 newly recruited citizens.Results Participants reported feelings of disempowerment during episodes of infection in secondary care. Information is communicated in a unilateral manner with individuals ‘told’ that they have an infection and will receive an antimicrobial (often unnamed), leading to loss of ownership, frustration, anxiety and ultimately distancing them from engaging with decision-making. This poor communication drives individuals to seek information from alternative sources, including online, which is associated with concerns over reliability and individualisation. Failures in communication and information provision by clinicians in secondary care influence individuals’ future ideas about infections and their management. This alters their future actions towards antimicrobials and can drive prescription non-adherence and loss to follow-up.Conclusions Current infection management and antimicrobial prescribing practices in secondary care fail to engage patients with the decision-making process. Secondary care physicians must not view infection management episodes as discrete events, but as cumulative experiences which have the potential to shape future patient behaviour and understanding of antimicrobial use.
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Journal articleCastro-Sanchez E, Kyratsis Y, Iwami M, et al., 2016,
Serious electronic games as behavioural change interventions in healthcareassociated infections and infection prevention and control: a scoping review of the literature and future directions
, ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL, Vol: 5, ISSN: 2047-2994- Cite
- Citations: 13
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Journal articleMicallef C, Kildonavaciute K, Castro Sanchez EM, et al., 2016,
Patient and public understanding and knowledge of antimicrobial resistance and stewardship: should public campaigns change focus?
, Journal of Antimicrobial Chemotherapy, Vol: 72, Pages: 311-314, ISSN: 1460-2091BackgroundThe rising global tide of antimicrobial resistance is a well-described phenomenon. Employing effective and innovative antimicrobial stewardship strategies is an essential approach to combat this public health threat. Education of the public and patients is paramount to enable the success of such strategies.MethodsA panel of hospital multidisciplinary healthcare professionals was set up and a short quiz containing true/false statements around antimicrobial stewardship and resistance was designed and piloted. An educational leaflet with the correct replies and supporting information was also produced and disseminated. Participants were recruited on a single day (18 November 2015) from the hospital outpatient clinics and the hospital outpatient pharmacy waiting room.ResultsOne hundred and forty-five completed quizzes were returned, providing a total of 1450 answers. Overall, 934 of 1450 (64%) statements were scored correctly whilst 481 (33%) were scored incorrectly; 35 (3%) statements were left unscored. We speculate that these results may demonstrate that respondents understood the statements, as only a small proportion of statements were left unanswered. The question dealing with the definition of antimicrobial resistance and the question dealing with the definition of antimicrobial stewardship obtained the most incorrect replies (85% and 72%, respectively). However, a specific factual recall question regarding only one microorganism (MRSA) received the most correct responses (99%).ConclusionsWe describe a simple, innovative method of engagement with patients and the general public to help educate and disseminate important public health messages around antimicrobial resistance and stewardship. We also identified the need for public health campaigns to address the knowledge gaps found around this topic.
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Journal articleRawson T, Moore L, Gill D, et al., 2016,
Promoting medical student engagement with antimicrobial stewardship through involvement in undergraduate research
, Journal of Infection, Vol: 74, Pages: 200-202, ISSN: 1532-2742The National Health Service recognises the importance of research, teaching, and training tothe future success of the organisation and medical students are expected to qualify with thenecessary clinical, professional, and academic skills to support this. There is a wide variationin the level of cross-specialty engagement with Antimicrobial Stewardship (AMS) &Antimicrobial resistance (AMR) research at UK and international state-of-the-artconferences, with a heterogeneous level of importance also attributed amongst undergraduateand postgraduate training pathways across clinical medicine. It therefore seems apparent thatthe AMS-AMR agenda needs to be promoted from within specialties, rather than being‘pushed’ on them as an external agenda, to promote broad ownership and capacity within allclinical specialties that use antimicrobials. This must start early during undergraduate medicaltraining. We investigated whether the use of an online platform designed to facilitate medicalstudent research projects could be utilised to promote undergraduate engagement with AMSAMRat Imperial College School of Medicine between July 2015 and 2016. During thisperiod 12 applicants were appointed to 11 of the 13 advertised projects. So far, studentsundertaking these projects have achieved: 1 peer-reviewed publication, 3 national oralpresentations, 1 national prize, 1 international poster presentation, 3 national posterpresentations, and 2 further manuscripts are currently under peer-review. Furthermore,despite the students’ broad career interests there has been a high retention rate with studentsrequesting involvement in further AMS-AMR related activities. Further longitudinalassessment of this tool for promoting undergraduate engagement with AMS-AMR research isnow being explored.
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Journal articleVella V, Aylin PP, Moore L, et al., 2016,
Bed utilisation and increased risk of Clostridium difficile infections in acute hospitals in England in 2013/2014.
, BMJ Quality & Safety, ISSN: 2044-5423BACKGROUND: The study aimed to identify thresholds for hospital bed utilisation which are independently associated with significantly higher risks for Clostridium difficile infections (CDI) in acute hospitals in England. METHOD: A retrospective analysis was carried out on reported data from the English National Health Service (NHS) for the financial year 2013/2014. Reported rates of CDI were used as a proxy for hospital infection rates in acute NHS hospital trusts. Multivariate linear regression was used to assess the relationship between bed utilisation values and CDI controlling for confounding factors. Hospitals were finally plotted in a Pabon Lasso graph according to their average bed occupancy rate (BOR) and bed turnover rate (BTR) per year to visualise the relationship between bed utilisation and CDI. RESULTS: Among English hospital NHS trusts, increasing BTR and decreasing BOR were associated with a decrease in CDI. However, this effect was not large, and patient mix had a larger impact on CDI rates than bed utilisation. CONCLUSIONS: While policymakers and managers wishing to target healthcare providers with high CDI rates should look at bed utilisation measures, focusing on these alone is unlikely to have the desired impact. Instead, strategies to combat CDI must take a wider perspective on contributory factors at the institutional level.
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Journal articleCastro Sanchez EM, Moore LSP, Husson, et al., 2016,
What are the factors driving antimicrobial resistance? Perspectives from a public event in London, England
, BMC Infectious Diseases, Vol: 16, ISSN: 1471-2334BackgroundAntimicrobial resistance is driven by multiple factors. Resolving the threat to human and animal health presented by drug-resistant infections remains a societal challenge that demands close collaboration between scientists and citizens. We compared current public views about key contributing factors to antimicrobial resistance with those expressed by experts.MethodsOverarching factors contributing to antimicrobial resistance were identified following a review of literature. The factors were then described in plain language and attached to ballot boxes at a public engagement event organised by a university. Responses to each factor were counted at the end of the event.ResultsFour hundred five responses were received from 3750 visitors (11 % response rate). Nearly half of responses (192/405, 47 · 4 %) considered the misuse/overuse of antibiotics in humans as the main determinant of antimicrobial resistance. The misuse of antibiotics in animal health obtained 16 · 3 % (66/405) responses. However, the lack of quick tests to diagnose infections received 10/405 votes (2 · 47 %), and the lack of effective vaccines received one vote (0 · 25 %).ConclusionsThe majority of responses ascribed the emergence of drug-resistant infections to the misuse of antibiotics in human and animals. Suboptimal dosing, availability of diagnostics and environmental contamination were considered less influential on the development of antimicrobial resistance. The growing recognition of broader multifaceted drivers of drug resistance by experts is not yet echoed in the public mind.
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