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Journal articleMicallef C, Kildonavaciute K, Castro Sanchez EM, et al., 2016,
Is there a role for a bespoke app on antimicrobial stewardship targeting patients and the public?
, Clinical Infectious Diseases, Vol: 63, Pages: 140-141, ISSN: 1537-6591 -
Journal articleMoore LSP, Cunningham J, Donaldson H, 2016,
A clinical approach to managing Pseudomonas aeruginosa infections
, British Journal of Hospital Medicine, Vol: 77, Pages: C50-C54, ISSN: 1750-8460The Pseudomonas genus is a group of more than 140 bacterial species, all strictly aerobic Gram-negative rods, widely found in the environment, including in and around water sources. The most common species in the context of human health is Pseudomonas aeruginosa, where estimates of colonization vary from 3–5% in healthy individuals up to 20% among inpatients. However colonization does not equal infection, and despite these high rates of colonization and the potential for virulence, it is thought that fewer than 10% of inpatient infections are caused by P. aeruginosa.Specific bacterial virulence factors have been identified, the presence of which is associated with altered clinical outcomes. These virulence factors include the ability of P. aeruginosa to form biofilms (facilitating adherence to host epithelia and immunological evasion), produce extracellular proteases (to aid invasion), and directly deliver effector proteins (ExoY, ExoS, ExoT and, particularly relevant to pulmonary infections, ExoU) into the cytosol of host cells via a type III section system (Sawa et al, 2014). Yet with an inability to quickly and confidently discern virulence among P. aeruginosa in clinical laboratories, the dichotomy between colonization and infection can cause confusion in clinical practice, with potential for both under- and overtreating clinical conditions involving this bacteria. Clinical management of patients with P. aeruginosa is further complicated by the complex antimicrobial resistance of this organism. This article reviews the most common presentations associated with P. aeruginosa, appropriate investigations and their interpretation, management options, and implications for infection control and public health.
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Journal articleBryce A, Hay AD, Lane IF, et al., 2016,
Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis
, British Medical Journal, Vol: 352, ISSN: 1468-5833Objectives To systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous antibiotics prescribed in primary care and resistance.Design and data analysis Systematic review and meta-analysis. Pooled percentage prevalence of resistance to the most commonly used antibiotics in children in primary care, stratified by the OECD (Organisation for Economic Co-operation and Development) status of the study country. Random effects meta-analysis was used to quantify the association between previous exposure to antibiotics in primary care and resistance.Data sources Observational and experimental studies identified through Medline, Embase, Cochrane, and ISI Web of Knowledge databases, searched for articles published up to October 2015.Eligibility criteria for selecting studies Studies were eligible if they investigated and reported resistance in community acquired urinary tract infection in children and young people aged 0-17. Electronic searches with MeSH terms and text words identified 3115 papers. Two independent reviewers assessed study quality and performed data extraction.Results 58 observational studies investigated 77 783 E coli isolates in urine. In studies from OECD countries, the pooled prevalence of resistance was 53.4% (95% confidence interval 46.0% to 60.8%) for ampicillin, 23.6% (13.9% to 32.3%) for trimethoprim, 8.2% (7.9% to 9.6%) for co-amoxiclav, and 2.1% (0.8 to 4.4%) for ciprofloxacin; nitrofurantoin was the lowest at 1.3% (0.8% to 1.7%). Resistance in studies in countries outside the OECD was significantly higher: 79.8% (73.0% to 87.7%) for ampicillin, 60.3% (40.9% to 79.0%) for co-amoxiclav, 26.8% (11.1% to 43.0%) for ciprofloxacin, and 17.0% (9.8% to 24.2%) for nitrofurantoin. There was evidence that bacterial isolates from the urinary tract from individual children who had received previous
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Journal articleCastro Sanchez EM, Drumright LN, Gharbi, et al., 2016,
Mapping antimicrobial stewardship in undergraduate medical, dental, pharmacy, nursing and veterinary education in the United Kingdom
, PLOS One, Vol: 11, ISSN: 1932-6203ObjectivesTo investigate the teaching of antimicrobial stewardship (AS) in undergraduate healthcare educational degree programmes in the United Kingdom (UK).Participants and MethodsCross-sectional survey of undergraduate programmes in human and veterinary medicine, dentistry, pharmacy and nursing in the UK. The main outcome measures included prevalence of AS teaching; stewardship principles taught; estimated hours apportioned; mode of content delivery and teaching strategies; evaluation methodologies; and frequency of multidisciplinary learning.Results80% (112/140) of programmes responded adequately. The majority of programmes teach AS principles (88/109, 80.7%). ‘Adopting necessary infection prevention and control precautions’ was the most frequently taught principle (83/88, 94.3%), followed by 'timely collection of microbiological samples for microscopy, culture and sensitivity’ (73/88, 82.9%) and ‘minimisation of unnecessary antimicrobial prescribing’ (72/88, 81.8%). The ‘use of intravenous administration only to patients who are severely ill, or unable to tolerate oral treatment’ was reported in ~50% of courses. Only 32/88 (36.3%) programmes included all recommended principles.DiscussionAntimicrobial stewardship principles are included in most undergraduate healthcare and veterinary degree programmes in the UK. However, future professionals responsible for using antimicrobials receive disparate education. Education may be boosted by standardisation and strengthening of less frequently discussed principles.
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Journal articleYates TA, Khan PY, Knight GM, et al., 2016,
The transmission of <i>Mycobacterium tuberculosis</i> in high burden settings
, LANCET INFECTIOUS DISEASES, Vol: 16, Pages: 227-238, ISSN: 1473-3099- Cite
- Citations: 142
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Journal articleRawson TM, Moore LSP, Hatcher JC, et al., 2016,
Plasmid-mediated colistin resistance mechanisms: is it time to revise our approach to selective digestive decontamination?
, LANCET INFECTIOUS DISEASES, Vol: 16, Pages: 149-150, ISSN: 1473-3099- Author Web Link
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- Citations: 10
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Journal articleArdal C, Outterson K, Hoffman SJ, et al., 2016,
International cooperation to improve access to and sustain effectiveness of antimicrobials
, LANCET, Vol: 387, Pages: 296-307, ISSN: 0140-6736 -
Journal articleCastro Sanchez E, Chang PW, Vila-Candel R, et al., 2016,
Health literacy and infectious diseases: why does it matter?
, International Journal of Infectious Diseases, Vol: 43, Pages: 103-110, ISSN: 1878-3511OBJECTIVES: Multifactorial interventions are crucial to arrest the threat posed by infectious diseases. Public involvement requires adequate information, but determinants such as health literacy can impact on the effective use of such knowledge. The influence of health literacy on infectious diseases is examined in this paper. METHODS: Databases were searched from January 1999 through July 2015 seeking studies reporting on health literacy and infections such tuberculosis, malaria or influenza, or infection-related behaviours such as vaccination or hand hygiene. HIV was excluded as comprehensive reviews had already been published. RESULTS: Studies were found on antibiotic knowledge and use, adoption of influenza and MMR immunisations, screening for sexually transmitted and viral hepatitis infections. There was a lack of investigations on areas such as tuberculosis, malaria, hand hygiene or diarrhoeal diseases. CONCLUSIONS: Limited or insufficient health literacy was associated with reduced adoption of protective behaviours such as immunisation, or inadequate understanding of antibiotics, although the relation was not consistent. Large gaps remain related to infectious diseases with high clinical and societal impact such as tuberculosis or malaria.
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Journal articleMoore LSP, Owens DS, Jepson A, et al., 2016,
Waterborne Elizabethkingia meningoseptica in adult critical care
, Emerging Infectious Diseases, Vol: 22, Pages: 9-17, ISSN: 1080-6059Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E. meningoseptica acquisition (n = 13) to have an attributable morbidity rate of 54% (systemic inflammatory response syndrome >2, rising C-reactive protein, new radiographic changes), suggesting that E. meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-source–associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates across a wider London hospital network suggests this outbreak, and possibly other recently reported outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging pathogen.
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Journal articleZingg W, Castro Sanchez EM, Secci, et al., 2015,
Innovative tools for quality assessment: integrated quality criteria for review of multiple study designs (ICROMS)
, Public Health, ISSN: 0033-3506
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