Publications
440 results found
Gharbi M, Moore LSP, Castro Sanchez E, et al., 2016, A needs assessment study for optimising prescribing practice in secondary care junior doctors: The Antibiotic Prescribing Education among Doctors (APED), BMC Infectious Diseases, Vol: 16, ISSN: 1471-2334
Introduction: Appropriate antimicrobial prescribing is essential for patient care, yet up tohalf of antimicrobial prescriptions written in the UK are sub-optimal. Improvingprescriber education has recently been promoted as a mechanism to optimiseantimicrobial use, but identification of key learning objectives to facilitate this is so farlacking. Using qualitative methods we investigated junior doctor knowledge, attitudes,and behaviours around antimicrobial prescribing to identify key areas to address infuture educational programmes.Methods: A cross-sectional survey of qualified doctors in training in West London wasundertaken exploring antimicrobial prescribing practices and educational needs.Results: Among 140 junior doctors from 5 London hospitals, a third (34%) reportedprescribing primarily unsupervised, and two thirds (67%) reported difficulties obtainingprescribing support outside of hours. 20% stated not feeling confident in writing anantimicrobial prescription, but confidence was increased through having confirmatorydiagnostic results (24%) and obtaining advice from a senior doctor (26%); whether thissenior was from their own specialty, or an infection-specialist, varied significantly(p<0.01) by experience. Only a small percentage (5-13%; depending on number ofyears post-qualification) of participants stated their previous antimicrobial educationwas effective. 60% of those in their first year post qualification reported wanting furthereducation in antimicrobial prescribing, rising to 74% among more experienced juniordoctors. Specific areas of educational need identified were (i) principles of antimicrobialprescribing, (ii) diagnosis of infections, (iii) clinical review of patients with infections, (iv)prescribing in the context of antimicrobial resistance, and (v) laboratory testing and testresults.Discussion: A significant proportion of junior doctors report lone prescribing ofantimicrobials in the context of low self-perceived confidence and knowledge in
Boyd S, Charani E, Lyons T, et al., 2016, Information provision for antibacterial dosing in the obese patient: a sizeable absence?, Journal of Antimicrobial Chemotherapy, ISSN: 1460-2091
Rawson TM, Butters TP, Moore LS, et al., 2016, Exploring the coverage of antimicrobial stewardship across UK clinical postgraduate training curricula, Journal of Antimicrobial Chemotherapy, Vol: 71, Pages: 3284-3292, ISSN: 1460-2091
OBJECTIVES: Antimicrobial resistance (AMR) is a global political and patient safety issue. With ongoing strategic interventions to improve the shape of UK postgraduate clinical training, ensuring that all clinicians have appropriate knowledge and practical skills in the area of AMR is essential. To assess this, a cross-sectional analysis was undertaken of the coverage and quality of antimicrobial stewardship (AMS)/AMR within UK postgraduate clinical training curricula. METHODS: UK clinical specialty training curricula were identified. Topics and individual learning points relating to AMS or AMR were extracted for each specialty. Learning points were quality assessed against the expected level of clinical competence. Inter-specialty analysis was performed. RESULTS: Overall 37 specialties were assessed, equating to 2318 topics and 42 527 learning points. Of these, 8/2318 (0.3%) topics and 184/42 527 (0.4%) learning points were related to AMS/AMR. Infectious diseases represented all eight topics and 43/184 (23%) of the learning points. In contrast, primary care, which is responsible for the highest proportion of antimicrobial usage, had no topics and only 2/1368 (0.15%) of the AMS/AMR learning points. This paucity of representation was reflected across most of the remaining specialties. On quality assessment, the majority of learning points (111/184; 60%) required knowledge only, with no demonstration of behaviour in clinical practice required. CONCLUSIONS: Coverage of AMS/AMR is poor across the majority of UK postgraduate clinical training curricula, with little depth of learning required. Given the threat of AMR, and evolving changes in clinical training pathways, we call for cross-specialty action to address this current lack of engagement.
Laxminarayan R, Amabile-Cuevas CF, Cars O, et al., 2016, UN High-Level Meeting on antimicrobials - what do we need?, Lancet, Vol: 388, Pages: 218-220, ISSN: 1474-547X
Rawson T, Moore LS, Holmes AH, 2016, Amoxicillin for Severe Acute Malnutrition in Children, New England Journal of Medicine, Vol: 375, Pages: 190-192, ISSN: 1533-4406
Micallef C, Mcleod M, Castro Sanchez EM, et al., 2016, An Evidence-Based Antimicrobial Stewardship Smartphone App for Hospital Outpatients: Survey-based Needs Assessment Among Patients, Journal of Medical Internet Research, Vol: 4, ISSN: 1439-4456
Background: Current advances in modern technology have enabled the development and utilization of electronic medicalsoftware apps for both mobile and desktop computing devices. A range of apps on a large variety of clinical conditions for patientsand the public are available, but very few target antimicrobials or infections.Objective: We sought to explore the use of different antimicrobial information resources with a focus on electronic platforms,including apps for portable devices, by outpatients at two large, geographically distinct National Health Service (NHS) teachinghospital trusts in England. We wanted to determine whether there is demand for an evidence-based app for patients, to garnertheir perceptions around infections/antimicrobial prescribing, and to describe patients’ experiences of their interactions withhealth care professionals in relation to this topic.Methods: A cross-sectional survey design was used to investigate aspects of antimicrobial prescribing and electronic devicesexperienced by patients at four hospitals in London and a teaching hospital in the East of England.Results: A total of 99 surveys were completed and analyzed. A total of 82% (80/98) of respondents had recently been prescribedantimicrobials; 87% (85/98) of respondents were prescribed an antimicrobial by a hospital doctor or through their generalpractitioner (GP) in primary care. Respondents wanted information on the etiology (42/65, 65%) and prevention and/or management(32/65, 49%) of their infections, with the infections reported being upper and lower respiratory tract, urinary tract, oral, and skinand soft tissue infections. All patients (92/92, 100%) desired specific information on the antimicrobial prescribed. Approximatelyhalf (52/95, 55%) stated it was “fine” for doctors to use a mobile phone/tablet computer during the consultation while 13% (12/95)did not support the idea of doctors accessing health care information in this way. Although only 30% (27/89)
Holmes AH, Gill SK, Hui K, et al., 2016, Increased airway glucose increases airway bacterial load in hyperglycaemia, Scientific Reports, Vol: 6, ISSN: 2045-2322
Diabetes is associated with increased frequency of hospitalization due to bacterial lung infection.We hypothesize that increased airway glucose caused by hyperglycaemia leads to increasedbacterial loads. In critical care patients, we observed that respiratory tract bacterial colonisationis significantly more likely when blood glucose is high. We engineered mutants in genesaffecting glucose uptake and metabolism (oprB, gltK, gtrS and glk) in Pseudomonas aeruginosa,strain PAO1. These mutants displayed attenuated growth in minimal medium supplemented withglucose as the sole carbon source. The effect of glucose on growth in vivo was tested usingstreptozocin-induced, hyperglycaemic mice, which have significantly greater airway glucose.Bacterial burden in hyperglycaemic animals was greater than control animals when infected withwild type but not mutant PAO1. Metformin pre-treatment of hyperglycaemic animals reducedboth airway glucose and bacterial load. These data support airway glucose as a criticaldeterminant of increased bacterial load during diabetes.
Vella V, Moore LS, Robotham JV, et al., 2016, Isolation demand from carbapenemase-producing Enterobacteriaceae screening strategies based on a West London hospital network, Journal of Hospital Infection, Vol: 94, Pages: 118-124, ISSN: 1532-2939
OBJECTIVE: To estimate the isolation demands arising from high-risk specialty-based screening for carbapenemase-producing Enterobacteriaceae (CPE), and the potential fraction of CPE burden detected. METHODS: Clinical specialty groups from three London hospitals were ranked by incidence of carbapenem resistance among Escherichia coli and Klebsiella spp. Contact precaution bed-days were estimated for three screening strategies: Strategy 1, 'circulation science and renal medicine'; Strategy 2, Strategy 1 plus 'specialist services'; and Strategy 3, Strategy 2 plus 'private patients'. Isolation bed occupancy rates and potential CPE detection rates were estimated. RESULTS: Of 99,105 admissions to the three hospitals in Financial Year 2014/15, Strategies 1, 2 and 3 would have screened 4371 (4.4%), 7482 (7.6%), and 13,542 (13.7%) patients, respectively. The specialties' isolation bed occupancy rates varied between 3% and 696% depending on strategy, number of consecutive tests, and whether or not pre-emptive isolation had been applied. Expected detection rates of the potential CPE burden in the hospital network would have varied between 17.1% and 47.5%. CONCLUSIONS: High-risk specialty-based screening has the potential to detect nearly half of the potential CPE burden, and would be more pragmatic than patient-level risk-factor-based screening. Pre-emptive isolation increases isolation requirements substantially. CPE screening strategies need to balance risk and resources.
Micallef 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
Rawson TM, Moore LSP, Hernandez B, et al., 2016, Missed opportunities for shared decision making in antimicrobial stewardship: The potential consequences of a lack of patient engagement in secondary care, International Journal of Infectious Diseases, Vol: 45, Pages: 122-123, ISSN: 1878-3511
Background: Within infectious diseases in secondary care, understanding of the potential for behavioural changes arising from patient involvement in antimicrobial decision making is lacking. Shared decision making is becoming part of international policy. The United States have passed it into legislation and the United Kingdom has implemented a number of national interventions across healthcare pathways. This study aims to understand the level of patient involvement in decision making around antimicrobial use in secondary care and the potential consequences associated with it.Methods & Materials: Fourteen members of the public who had received antimicrobials from secondary care in the preceding 12 months were recruited to participate in group interviews. Group interactions were audio-recorded, transcribed verbatim, and thematically analysed.Results: Participants reported feelings of disempowerment during episodes of infection in secondary care. Information is currently 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 participation in decision making. This poor communication drives individuals to seek information from alternative sources, including on-line resources, which are associated with concerns over reliability and individualisation. This failure of communication and information provision from clinicians in secondary care influences individual's future ideas about infections and their management. This alters their future actions towards infections and antimicrobials and can drive non-adherence to prescribed antimicrobial regimes and loss-to-follow-up after discharge from secondary care.Conclusion: Current infection management and antimicrobial prescribing practices in secondary care may be failing to engage patients in the decision making process. It is vital that second
Holmes A, Ahmad R, Kiernan M, 2016, Lessons in implementing infection prevention., J Infect Prev, Vol: 17, Pages: 84-89, ISSN: 1757-1774
This paper has been developed from a conference presentation given by Professor Alison Holmes at the IPS Learning Labs launch event (2015). In it the implementation of research into clinical practice is discussed with reference to the upcoming Health Foundation Spotlight Report. The difficulties of engaging those in clinical practice are discussed with the importance of involvement of clinical leaders being highlighted. The importance of recognising that implementation science as a social process to bring credibility and legitimacy is also stressed. Following this, the Spotlight Report that is focused on strengthening implementation in the UK is discussed. There remains considerable scope for improvement and the impact of surveillance, targets and fatigue are considered. The tension between top-down and bottom-up approaches to implementation are discussed and a recommendation for a blended approach when implementing measures that are the components of an organisational infection prevention and control strategy is proposed. There also needs to be more scrutiny of the reasons for the failure of research implementation through an examination of the 'soft periphery' that comprises the organisational structure, systems and people that will be responsible for implementing and sustaining an intervention.
Castro 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: 1932-6203
ObjectivesTo 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.
Rawson 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
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- Citations: 9
Ardal 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
Castro 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: 1878-3511
OBJECTIVES: 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.
Moore LSP, Owens DS, Jepson A, et al., 2016, Waterborne Elizabethkingia meningoseptica in adult critical care, Emerging Infectious Diseases, Vol: 22, Pages: 9-17, ISSN: 1080-6059
Elizabethkingia 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.
Zingg 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
Holmes A, Dixon-Woods M, Ahmad R, et al., 2015, Infection prevention and control: lessons from acute care in England. Towards a whole health economy approach, Infection prevention and control: lessons from acute care in England, Publisher: Health Foundation
Hansen S, Zingg W, Ahmad R, et al., 2015, Organization of infection control in European hospitals, JOURNAL OF HOSPITAL INFECTION, Vol: 91, Pages: 338-345, ISSN: 0195-6701
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- Citations: 39
Hansen S, Schwab F, Gastmeier P, et al., 2015, Provision and consumption of alcohol-based hand rubs in European hospitals, CLINICAL MICROBIOLOGY AND INFECTION, Vol: 21, Pages: 1047-1051, ISSN: 1198-743X
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- Citations: 23
Otter JA, Mutters NT, Tacconelli E, et al., 2015, Controversies in guidelines for the control of multidrug-resistant Gram-negative bacteria in EU countries, CLINICAL MICROBIOLOGY AND INFECTION, Vol: 21, Pages: 1057-1066, ISSN: 1198-743X
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- Citations: 59
Holmes AH, Moore LSP, Sundsfjord A, et al., 2015, Understanding the mechanisms and drivers of antimicrobial resistance, Lancet, Vol: 387, Pages: 176-187, ISSN: 1474-547X
To combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is affected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Strategies to reduce antimicrobial resistance by removing antimicrobial selective pressure alone rely upon resistance imparting a fitness cost, an effect not always apparent. Minimising resistance should therefore be considered comprehensively, by resistance mechanism, microorganism, antimicrobial drug, host, and context; parallel to new drug discovery, broad ranging, multidisciplinary research is needed across these five levels, interlinked across the health-care, agriculture, and environment sectors. Intelligent, integrated approaches, mindful of potential unintended results, are needed to ensure sustained, worldwide access to effective antimicrobials.
Ahmad R, Iwami M, Castro-Sanchez E, et al., 2015, Defining the user role in infection control, Journal of Hospital Infection, Vol: 92, Pages: 321-327, ISSN: 1532-2939
BackgroundHealth policy initiatives continue to recognize the valuable role of patients and the public in improving safety, advocating the availability of information as well as involvement at the point of care. In infection control, there is a limited understanding of how users interpret the plethora of publicly available information about hospital performance, and little evidence to support strategies that include reminding healthcare staff to adhere to hand hygiene practices.AimTo understand how users define their own role in patient safety, specifically in infection control.MethodsThrough group interviews, self-completed questionnaires and scenario evaluation, user views of 41 participants (15 carers and 26 patients with recent experience of inpatient hospital care in London, UK) were collected and analysed. In addition, the project's patient representative performed direct observation of the research event to offer inter-rater reliability of the qualitative analysis.FindingsUsers considered evidence of systemic safety-related failings when presented with hospital choices, and did not discount hospitals with high (‘red’ flagged) rates of meticillin-resistant Staphylococcus aureus. Further, users considered staff satisfaction within the workplace over and above user satisfaction. Those most dissatisfied with the care they received were unlikely to ask staff, ‘Have you washed your hands?’ConclusionThis in-depth qualitative analysis of views from a relatively informed user sample shows ‘what matters’, and provides new avenues for improvement initiatives. It is encouraging that users appear to take a holistic view of indicators. There is a need for strategies to improve dimensions of staff satisfaction, along with understanding the implications of patient satisfaction.
Rawson TM, Moore LSP, Gilchrist MJ, et al., 2015, Antimicrobial stewardship: are we failing in cross-specialty clinical engagement?, Journal of Antimicrobial Chemotherapy, Vol: 71, Pages: 554-559, ISSN: 1460-2091
Background Antimicrobial resistance (AMR) is a public health priority and leading patient safety issue. Globally, antimicrobial stewardship (AMS) has been integral in promoting therapeutic optimization whilst minimizing harmful antimicrobial use. A cross-sectional, observational study was undertaken to investigate the coverage of AMS and antibacterial resistance across clinical scientific conferences in 2014, as a surrogate marker for current awareness and attributed importance.Methods Clinical specialties were identified, and the largest corresponding clinical scientific/research conferences in 2014 determined (i) within the UK and (ii) internationally. Conference characteristics and abstracts were interrogated and analysed to determine those related to AMS and AMR. Inter-specialty variation was assessed using χ2 or Fisher's exact statistical analysis.Results In total, 45 conferences from 23 specialties were analysed representing 59 682 accepted abstracts. The UK had a significantly greater proportion of AMS-AMR-related abstracts compared with international conferences [2.8% (n = 221/7843) compared with 1.8% (n = 942/51 839); P < 0.001]. Infection conferences contained the greatest proportion of AMS-AMR abstracts, representing 20% (732/3669) of all abstracts [UK 66% (80/121) and international 18% (652/3548); P < 0.0001]. AMS-AMR coverage across all general specialties was poor [intensive care 9% (116/1287), surgical 1% (8/757) and medical specialties 0.64% (332/51 497)] despite high usage of antimicrobials across all.Conclusions Despite current AMS-AMR strategies being advocated by infection specialists and discussed by national and international policy makers, AMS-AMR coverage remained limited across clinical specialty scientific conferences in 2014. We call for further intervention to ensure specialty engagement with AMS programmes and promote the AMR agenda across clinical practice.
Holmes A, 2015, FDR's Ambassadors and the Diplomacy of Crisis: From the Rise of Hitler to the End of World War II., INTERNATIONAL HISTORY REVIEW, Vol: 37, Pages: 1111-1112, ISSN: 0707-5332
Birgand GJC, Bourigault C, Moore L, et al., 2015, Measures to eradicate multidrug-resistant organism outbreaks: How much does it cost?, Clinical Microbiology and Infection, Vol: 22, Pages: 162.e1-162.e9, ISSN: 1469-0691
This study aimed to assess the economic burden of infection control measures that succeeded in eradicating multidrug resistant organisms (MDROs) in emerging epidemic contexts in hospital settings. Medline, Embase and Ovid databases were systematically interrogated for original English language articles detailing costs associated with strict measures to eradicate MDROs published between 1st January 1974 and 2nd November 2014. This study was conducted in accordance with the PRISMA guidelines. Overall, 13 original articles were retrieved reporting data on several MDROs including; glycopeptide resistant enterococci (n=5), carbapenemase producing Enterobacteriacae (n=1), meticillin resistant Staphylococcus aureus (n=5) and carbapenem-resistant Acinetobacter baumannii (n=2). Overall, the cost of strict measures to eradicate MDROs ranged from €285 to €57,532 per positive patient. The major component of these overall costs was related to interruption of new admissions, representing from €2,466 to €47,093 per positive patient (69% of the overall cost in mean, range: 13 - 100), followed by mean laboratory costs of €628 to €5,849 (24%, range: 3.3 - 56.7), staff reinforcement €6,204 to €148,381 (22%, range: 3.3 – 52) and contact precautions €166 to €10,438 per positive patient (18%, range: 0.7 - 43.3). Published data on the economic burden of strict measures to eradicate MDRO are limited, heterogeneous, and weakened by several methodological flaws. Novel economic studies should be performed to assess the financial impact of current policies and identify the most cost-effective strategies to eradicate emerging MDROs in healthcare facilities.
Venanzio V, Gharbi M, Moore LSP, et al., 2015, Screening suspected cases for carbapenemase-producing Enterobacteriaceae, inclusion criteria and demand, JOURNAL OF INFECTION, Vol: 71, Pages: 493-495, ISSN: 0163-4453
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- Citations: 7
Charani E, Gharbi M, Frost G, et al., 2015, Antimicrobial therapy in obesity: a multicentre cross-sectional study., Journal of Antimicrobial Chemotherapy, Vol: 70, Pages: 2906-2912, ISSN: 1460-2091
Objectives Evidence indicates a relationship between obesity and infection. We assessed the prevalence of obesity in hospitalized patients and evaluated its impact on antimicrobial management.Methods Three National Health Service hospitals in London in 2011–12 were included in a cross-sectional study. Data from all adult admissions units and medical and surgical wards were collected. Patient data were collected from the medication charts and nursing and medical notes. Antimicrobial therapy was defined as ‘complicated’ if the patient's therapy met two or more of the following criteria: (i) second- or third-line therapy according to local policy; (ii) intravenous therapy where an alternative oral therapy was appropriate; (iii) longer than the recommended duration of therapy as per local policy recommendations; (iv) repeated courses of therapy to treat the same infection; and (v) specialist advice on antimicrobial therapy provided by the medical microbiology or infectious diseases teams.Results Of the 1014 patients included in this study, 22% (225) were obese, 69% (696) were normal/overweight and 9% (93) were underweight. Obese patients were significantly more likely to have more complicated antimicrobial therapy than normal/overweight and underweight patients (36% versus 19% and 23%, respectively, P = 0.002). After adjustment for hospital, age group, comorbidities and the type of infection, obese patients remained at significantly increased odds of receiving complicated antimicrobial therapy compared with normal/overweight patients (OR = 2.01, 95% CI 1.75–3.45).Conclusions One in five hospitalized patients is obese. Compared with the underweight and normal/overweight, the antimicrobial management in the obese is significantly more complicated.
Castro Sanchez EM, Spanoudakis E, Holmes A, 2015, Readability of Ebola information on websites of public health agencies, United States, United Kingdom, Canada, Australia, and Europe, Emerging Infectious Diseases, Vol: 21, ISSN: 1080-6059
Public involvement in efforts to control the current Ebola virus disease epidemic requires understandable information. We reviewed the readability of Ebola information from public health agencies in non–Ebola-affected areas. A substantial proportion of citizens would have difficulty understanding existing information, which would potentially hinder effective health-seeking behaviors.
Zingg W, Holmes A, Magiorakos A-P, et al., 2015, Health-care-associated infections Reply, LANCET INFECTIOUS DISEASES, Vol: 15, Pages: 764-764, ISSN: 1473-3099
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