Imperial College London

Dr Jon Otter

Faculty of MedicineDepartment of Infectious Disease

Honorary Senior Lecturer
 
 
 
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Clarence WingSt Mary's Campus

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Summary

 

Publications

Publication Type
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140 results found

Ledwoch K, Dancer SJ, Otter JA, Maillard J-Yet al., 2021, Dirty QWERTY: there's no ESC!, JOURNAL OF HOSPITAL INFECTION, Vol: 117, Pages: 184-185, ISSN: 0195-6701

Journal article

Graves N, Mitchell BG, Otter JA, Kiernan Met al., 2021, The cost-effectiveness of temporary single-patient rooms to reduce risks of healthcare-associated infection, JOURNAL OF HOSPITAL INFECTION, Vol: 116, Pages: 21-28, ISSN: 0195-6701

Journal article

Birgand G, Mutters N, Otter J, Eichel VM, Lepelletier D, Morgan DJ, Lucet J-Cet al., 2021, Variation of national and international guidelines on respiratory protection for healthcare professionals during the COVID-19 pandemic, Jama Network Open, Vol: 4, Pages: 1-5, ISSN: 2574-3805

Journal article

Ledwoch K, Dancer SJ, Otter JA, Kerr K, Roposte D, Maillard J-Yet al., 2021, How dirty is your QWERTY? The risk of healthcare pathogen transmission from computer keyboards, JOURNAL OF HOSPITAL INFECTION, Vol: 112, Pages: 31-36, ISSN: 0195-6701

Journal article

Martischang R, Tartari E, Kilpatrick C, Mackenzie G, Carter V, Castro-Sanchez E, Marquez-Villarreal H, Otter JA, Perencevich E, Silber D, Storr J, Tetro J, Voss A, Pittet Det al., 2021, Enhancing engagement beyond the conference walls: analysis of Twitter use at #ICPIC2019 infection prevention and control conference, Antimicrobial Resistance and Infection Control, Vol: 10, Pages: 1-10, ISSN: 2047-2994

BackgroundSocial media may provide a tool, when coupled with a patient-included™ conference, to enhance the engagement among the general public. We describe authors and potential readers of Twitter content surrounding a patient-included™ scientific congress, the International Consortium for Prevention and Infection Control (ICPIC) 2019.MethodsRetrospective observational analysis of Twitter users posting with the #ICPIC2019 hashtag during the conference. Tweet authors, overall followers, and active followers were categorized according to their Twitter biographies using unsupervised learning. Diversity of professional backgrounds of Tweet authors and their followers was explored. Network analysis explored connectedness between the reach of authors.ResultsIn total, 1264 participants attended ICPIC 2019, of which 28 were patients. From September 7 to 16, 2019, we were able to categorize 235′620 (41%) followers linked to 474 (76%) authors. Among authors and followers, respectively 34% and 14% were healthcare workers, 11% and 15% were from industry representatives, 8% and 7% were academic researchers. On average, 23% (range 9–39%) followers belonged to the same categories as authors. Among all followers categorized, only 582/235 620 (0.25%) interacted with original messages, including healthcare workers (37%), global and public health (12%), academic research (11%) and those from industry (11%). Though the similarity between Tweet authors and followers was supported by network analysis, we also observed that non-healthcare workers (including patients) appeared to have more diverse followers.ConclusionsWe observed the participation of numerous Tweet authors and followers from diverse professional backgrounds potentially supporting the benefit of including patients in conferences to reach a more general, non-specialized public.

Journal article

Price JR, Mookerjee S, Dyakova E, Myall A, Leung W, Wei├če AY, Shersing Y, Brannigan ET, Galletly T, Muir D, Randell P, Davies F, Bolt F, Barahona M, Otter JA, Holmes AHet al., 2021, Development and delivery of a real-time hospital-onset COVID-19 surveillance system using network analysis, Clinical Infectious Diseases, Vol: 72, Pages: 82-89, ISSN: 1058-4838

BackgroundUnderstanding nosocomial acquisition, outbreaks and transmission chains in real-time will be fundamental to ensuring infection prevention measures are effective in controlling COVID-19 in healthcare. We report the design and implementation of a hospital-onset COVID-19 infection (HOCI) surveillance system for an acute healthcare setting to target prevention interventions.MethodsThe study took place in a large teaching hospital group in London, UK. All patients tested for SARS-CoV-2 between 4th March and 14th April 2020 were included. Utilising data routinely collected through electronic healthcare systems we developed a novel surveillance system for determining and reporting HOCI incidence and providing real-time network analysis. We provided daily reports on incidence and trends over time to support HOCI investigation, and generated geo-temporal reports using network analysis to interrogate admission pathways for common epidemiological links to infer transmission chains. By working with stakeholders the reports were co-designed for end users.ResultsReal-time surveillance reports revealed: changing rates of HOCI throughout the course of the COVID-19 epidemic; key wards fuelling probable transmission events; HOCIs over-represented in particular specialities managing high-risk patients; the importance of integrating analysis of individual prior pathways; and the value of co-design in producing data visualisation. Our surveillance system can effectively support national surveillance.ConclusionsThrough early analysis of the novel surveillance system we have provided a description of HOCI rates and trends over time using real-time shifting denominator data. We demonstrate the importance of including the analysis of patient pathways and networks in characterising risk of transmission and targeting infection control interventions.

Journal article

Abbas M, Abbas M, Zhu NJ, Mookerjee S, Bolt F, Otter JA, Holmes AH, Price JRet al., 2021, Hospital-onset COVID-19 infection surveillance systems: a systematic review, Journal of Hospital Infection

Journal article

Castro-Sanchez E, Alexander CM, Atchison C, Patel D, Leung W, Calamita ME, Garcia DM, Cimpeanu C, Mumbwatasai JM, Ramid D, Doherty K, Grewal HS, Otter JA, Wells EMet al., 2020, Evaluation of a personal protective equipment (PPE) support programme ('PPE Helpers') for staff during the COVID-19 pandemic in London, Journal of Hospital Infection, Vol: 109, Pages: 68-7, ISSN: 0195-6701

BackgroundThe COVID-19 pandemic has presented one of the biggest challenges to healthcare providers worldwide. The appropriate use of Personal Protective Equipment (PPE) has been essential to ensuring staff and patient safety. To counteract sub-optimal PPE practice, a PPE helper programme was developed at a large London hospital group. Based on a behaviour change model of Capability, Opportunity and Motivation (COM-B), the programme provided PPE support, advice and education to ward staff.AimEvaluation of the PPE Helper Programme.MethodsClinical and non-clinical ward staff completed a questionnaire informed by the Theoretical Domains Framework and COM-B. The questionnaire was available in paper and electronic versions. Quantitative responses were analysed using descriptive and non-parametric statistics, free-text responses were analysed thematically.FindingsOver a six-week period, PPE helpers made 268 ward visits. Overall, 261 questionnaires were available for analysis. Across the Trust, 68% of respondents reported having had contact with a PPE helper. Staff who had encountered a PPE helper responded significantly more positively to a range of statements about using PPE than those who had not. Black and Minority Ethnic (BAME) staff were significantly more anxious in relation to the adequacy of PPE. Non-clinical and redeployed staff (e.g. domestic staff) were most positive about the impact of PPE helpers. Free-text comments showed that staff found the programme supportive and would have liked it earlier in the pandemic.ConclusionA PPE Helper programme is a feasible and beneficial intervention for providing support, advice and education to ward staff during infectious disease outbreaks.

Journal article

Ellington MJ, Davies F, Jauneikaite E, Hopkins KL, Turton JF, Adams G, Pavlu J, Innes AJ, Eades C, Brannigan ET, Findlay J, White L, Bolt F, Kadhani T, Chow Y, Patel B, Mookerjee S, Otter JA, Sriskandan S, Woodford N, Holmes Aet al., 2020, A multi-species cluster of GES-5 carbapenemase producing Enterobacterales linked by a geographically disseminated plasmid, Clinical Infectious Diseases, Vol: 71, Pages: 2553-2560, ISSN: 1058-4838

BACKGROUND: Early and accurate treatment of infections due to carbapenem-resistant organisms is facilitated by rapid diagnostics but rare resistance mechanisms can compromise detection. One year after a GES-5 carbapenemase-positive Klebsiella oxytoca infection was identified by whole genome sequencing (WGS) (later found to be part of a cluster of three cases), a cluster of 11 patients with GES-5-positive K. oxytoca was identified over 18 weeks in the same hospital.METHODS: Bacteria were identified by MALDI-TOF, antimicrobial susceptibility testing followed EUCAST guidelines. Ertapenem-resistant isolates were referred to Public Health England for characterization using PCR detection of GES, pulse-field gel electrophoresis (PFGE) and WGS for the second cluster.RESULTS: The identification of the first GES-5 K. oxytoca isolate was delayed, being identified on WGS. A GES-gene PCR informed the occurrence of the second cluster in real-time. In contrast to PFGE, WGS phylogenetic analysis refuted an epidemiological link between the two clusters; it also suggested a cascade of patient-to-patient transmission in the later cluster. A novel GES-5-encoding plasmid was present in K. oxytoca,E. coli and E. cloacae isolates from unlinked patients within the same hospital group and in human and wastewater isolates from three hospitals elsewhere in the UK.CONCLUSIONS: Genomic sequencing revolutionized the epidemiological understanding of the clusters, it also underlined the risk of covert plasmid propagation in healthcare settings and revealed the national distribution of the resistance-encoding plasmid. Sequencing results also informed and led to the ongoing use of enhanced diagnostic tests for detecting carbapenemases locally and nationally.

Journal article

Otter JA, Mookerjee S, Davies F, Bolt F, Dyakova E, Shersing Y, Boonyasiri A, Weisse AY, Gilchrist M, Galletly TJ, Brannigan ET, Holmes AHet al., 2020, Detecting carbapenemase-producing Enterobacterales (CPE): an evaluation of an enhanced CPE infection control and screening programme in acute care, JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, Vol: 75, Pages: 2670-2676, ISSN: 0305-7453

Journal article

Zhou J, Otter JA, Price JR, Cimpeanu C, Garcia DM, Kinross J, Boshier PR, Mason S, Bolt F, Holmes AH, Barclay WSet al., 2020, Investigating SARS-CoV-2 surface and air contamination in an acute healthcare setting during the peak of the COVID-19 pandemic in London, Clinical Infectious Diseases, Vol: 2020, Pages: 1-1, ISSN: 1058-4838

BACKGROUND: Evaluation of SARS-CoV-2 surface and air contamination during the COVID-19 pandemic in London. METHODS: We performed this prospective cross-sectional observational study in a multi-site London hospital. Air and surface samples were collected from seven clinical areas, occupied by patients with COVID-19, and a public area of the hospital. Three or four 1.0 m3 air samples were collected in each area using an active air sampler. Surface samples were collected by swabbing items in the immediate vicinity of each air sample. SARS-CoV-2 was detected by RT-qPCR and viral culture; the limit of detection for culturing SARS-CoV-2 from surfaces was determined. RESULTS: Viral RNA was detected on 114/218 (52.3%) of surfaces and 14/31 (38.7%) air samples but no virus was cultured. The proportion of surface samples contaminated with viral RNA varied by item sampled and by clinical area. Viral RNA was detected on surfaces and in air in public areas of the hospital but was more likely to be found in areas immediately occupied by COVID-19 patients than in other areas (67/105 (63.8%) vs. 29/64 (45.3%) (odds ratio 0.5, 95% confidence interval 0.2-0.9, p=0.025, Chi squared test)). The high PCR Ct value for all samples (>30) indicated that the virus would not be culturable. CONCLUSIONS: Our findings of extensive viral RNA contamination of surfaces and air across a range of acute healthcare settings in the absence of cultured virus underlines the potential risk from environmental contamination in managing COVID-19, and the need for effective use of PPE, physical distancing, and hand/surface hygiene.

Journal article

Peters A, Parneix P, Otter J, Pittet Det al., 2020, Putting some context to the aerosolization debate around SARS-CoV-2, JOURNAL OF HOSPITAL INFECTION, Vol: 105, Pages: 381-382, ISSN: 0195-6701

Journal article

Rodriguez Manzano J, Moser N, Malpartida Cardenas K, Moniri A, Fisarova L, Pennisi I, Boonyasiri A, Jauneikaite E, Abdolrasouli A, Otter J, Bolt F, Davies F, Didelot X, Holmes A, Georgiou Pet al., 2020, Rapid detection of mobilized colistin resistance using a nucleic acid based lab-on-a-chip diagnostic system, Scientific Reports, Vol: 10, ISSN: 2045-2322

The increasing prevalence of antimicrobial resistance is a serious threat to global public health. One of the most concerning trends is the rapid spread of Carbapenemase-Producing Organisms (CPO), where colistin has become the last-resort antibiotic treatment. The emergence of colistin resistance, including the spread of mobilized colistin resistance (mcr) genes, raises the possibility of untreatable bacterial infections and motivates the development of improved diagnostics for the detection of colistin-resistant organisms. This work demonstrates a rapid response for detecting the most recently reported mcr gene, mcr−9, using a portable and affordable lab-on-a-chip (LoC) platform, offering a promising alternative to conventional laboratory-based instruments such as real-time PCR (qPCR). The platform combines semiconductor technology, for non-optical real-time DNA sensing, with a smartphone application for data acquisition, visualization and cloud connectivity. This technology is enabled by using loop-mediated isothermal amplification (LAMP) as the chemistry for targeted DNA detection, by virtue of its high sensitivity, specificity, yield, and manageable temperature requirements. Here, we have developed the first LAMP assay for mcr−9 - showing high sensitivity (down to 100 genomic copies/reaction) and high specificity (no cross-reactivity with other mcr variants). This assay is demonstrated through supporting a hospital investigation where we analyzed nucleic acids extracted from 128 carbapenemase-producing bacteria isolated from clinical and screening samples and found that 41 carried mcr−9 (validated using whole genome sequencing). Average positive detection times were 6.58 ± 0.42 min when performing the experiments on a conventional qPCR instrument (n = 41). For validating the translation of the LAMP assay onto a LoC platform, a subset of the samples were tested (n = 20), showing average detection times o

Journal article

Gordon J, Darlington O, McEwan P, Lumley M, Taie A, Hicks M, Charbonneau C, Blake A, Hawkins N, Goldenberg S, Otter J, Wilcox Met al., 2020, Estimating the Value of New Antimicrobials in the Context of Antimicrobial Resistance: Development and Application of a Dynamic Disease Transmission Model, PHARMACOECONOMICS, Vol: 38, Pages: 857-869, ISSN: 1170-7690

Journal article

Otter J, Brophy K, Palmer J, Harrison N, Riley J, Williams D, Larrouy-Maumus Get al., 2020, Smart surfaces to tackle infection and antimicrobial resistance, Briefing Paper

Report

Birgand G, Troughton R, Mariano V, Hettiaratchy S, Hopkins S, Otter JA, Holmes Aet al., 2020, How do surgeons feel about the “Getting it Right First Time” national audit? Results from a qualitative assessment., Journal of Hospital Infection, Vol: 104, Pages: 328-331, ISSN: 0195-6701

The implementation of thenational“Getting It Right First Time” (GIRFT)was assessed by interviewing six surgeonsinvolvedat various levelsinsurgical site infection (SSI) audit.The positive impacts were to create new professional collaboration, improve stakeholder engagement, and increase the profile of SSIs. One particular knowledgegap highlighted was that some participantshad been unaware until that point of the criteria for diagnosing an SSI. The quality of data collected was felt poor due to methodological flaws. The audit was described as highly time-consuming and unsustainableif leaning on junior surgeons, without protectedtimeanddesignatedresponsibility.

Journal article

Birgand G, Mutters NT, Ahmad R, Tacconelli E, Lucet J-C, Holmes Aet al., 2020, Risk perception of the antimicrobial resistance by infection control specialists in Europe: a case-vignette study, Antimicrobial Resistance and Infection Control, Vol: 9, ISSN: 2047-2994

BackgroundUsing case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients.MethodsIn this study, sixteen case-vignettes were developed to simulate hospitalised patient scenarios in the field of AMR and IC. A total of 245 IC specialists working in different hospitals from 15 European countries were contacted, among which 149 agreed to participate in the study. Using an online database, each participant scored five randomly-assigned case-vignettes, regarding the perceived risk associated with six different multidrug resistant organisms (MDRO). The intra-class correlation coefficient (ICC), varying from 0 (poor) to 1 (perfect), was used to assess the agreement for the risk on a 7-point Likert scale. High risk and low/neutral risk scorers were compared regarding their national, organisational and individual characteristics.ResultsBetween January and May 2017, 149 participants scored 655 case-vignettes. The perceptions of the individual (clinical outcome) and collective (spread) risks were consistently lower than other MDRO for extended spectrum beta-lactamase producing Enterobacteriaceae cases and higher for carbapenemase producing Enterobacteriaceae (CPE) cases. Regarding CPE cases, answers were influenced more by the resistance pattern (93%) than for other MDRO. The risk associated with vancomycin resistant Enterococci cases was considered higher for the collective impact than for the individual outcome (63% vs 40%). The intra-country agreement regarding the individual risk was globally poor varying from 0.00 (ICC: 0–0.25) to 0.51 (0.18–0.85). The overall agreement across countries was poor at 0.20 (0.07–0.33). IC specialists working in hospitals preserved from MDROs perceived a higher individual (local, p = 0.01; national, p < 0.01) and collective risk (local and national p 

Journal article

Vink JP, Otter JA, Edgeworth JD, 2020, Carbapenemase-producing Enterobacteriaceae - once positive always positive?, CURRENT OPINION IN GASTROENTEROLOGY, Vol: 36, Pages: 9-16, ISSN: 0267-1379

Journal article

Otter JA, Natale A, Batra R, Auguet OT, Dyakova E, Goldenberg SD, Edgeworth JDet al., 2019, Individual- and community-level risk factors for ESBL Enterobacteriaceae colonization identified by universal admission screening in London, CLINICAL MICROBIOLOGY AND INFECTION, Vol: 25, Pages: 1259-1265, ISSN: 1198-743X

Journal article

Ming DK, Otter JA, Ghani R, Brannigan ET, Boonyasiri A, Mookerjee S, Gilchrist M, Holmes AH, Davies Fet al., 2019, Clinical risk stratification and antibiotic management of NDM and OXA-48 carbapenemase-producing Enterobacteriaceae bloodstream infections in the UK, Journal of Hospital Infection, Vol: 102, Pages: 95-97, ISSN: 0195-6701

Journal article

Patel A, Parikh P, Dunn AN, Otter JA, Thota P, Fraser TG, Donskey CJ, Deshpande Aet al., 2019, Effectiveness of daily chlorhexidine bathing for reducing gram-negative infections: A meta-analysis, INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, Vol: 40, Pages: 392-399, ISSN: 0899-823X

Journal article

Otter JA, 2019, Can cleaning REACH further in reducing hospital infections?, LANCET INFECTIOUS DISEASES, Vol: 19, Pages: 345-347, ISSN: 1473-3099

Journal article

Otter JA, Galtelly TJ, Davies F, Hitchcock J, Gilchrist MJ, Dyakova E, Mookerjee S, Holmes AH, Brannigan ETet al., 2019, Planning to halve Gram-negative bloodstream infection: getting to grips with healthcare-associated Escherichia coli bloodstream infection sources, JOURNAL OF HOSPITAL INFECTION, Vol: 101, Pages: 129-133, ISSN: 0195-6701

Journal article

Marbach H, Vizcay-Barrena G, Memarzadeh K, Otter JA, Pathak S, Allaker RR, Harvey RD, Edgeworth JDet al., 2019, Tolerance of MRSA ST239-TW to chlorhexidine-based decolonization: Evidence for keratinocyte invasion as a mechanism of biocide evasion, JOURNAL OF INFECTION, Vol: 78, Pages: 119-126, ISSN: 0163-4453

Journal article

Otter JA, Yezli S, Barbut F, Perl TMet al., 2019, An overview of automated room disinfection systems: When to use them and how to choose them, Decontamination in Hospitals and Healthcare, Pages: 323-369, ISBN: 9780081025659

Conventional disinfection methods are limited by reliance on the operator to ensure appropriate selection, formulation, distribution, and contact time of the agent. Automated room disinfection (ARD) systems remove or reduce reliance on operators and so they have the potential to improve the efficacy of terminal disinfection. The most commonly used systems are hydrogen peroxide vapor (H2O2 vapor), aerosolized hydrogen peroxide (aHP), and ultraviolet (UV) light. These systems have important differences in their active agent, delivery mechanism, efficacy, process time, and ease of use. The choice of ARD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation, and cost considerations.

Book chapter

Peters A, Otter J, Moldovan A, Parneix P, Voss A, Pittet Det al., 2018, Keeping hospitals clean and safe without breaking the bank; summary of the Healthcare Cleaning Forum 2018, ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL, Vol: 7, ISSN: 2047-2994

Journal article

Mizuno S, Iwami M, Kunisawa S, Naylor N, Yamashita K, Kyratsis Y, Meads G, Otter J, Holmes A, Ahmad Ret al., 2018, Comparison of national strategies to reduce methicillin-resistant Staphylococcus aureus (MRSA) infections in Japan and England, Journal of Hospital Infection, Vol: 100, Pages: 280-298, ISSN: 0195-6701

BackgroundNational responses to healthcare-associated infections vary between high-income countries but when analysed for contextual comparability, interventions can be assessed for transferability.AimTo identify learning from country-level approaches to addressing meticillin-resistant Staphylococcus aureus (MRSA) in Japan and England.MethodsA longitudinal analysis (2000-17), comparing epidemiological trends and policy interventions. Data from 441 textual sources concerning infection prevention and control (IPC), surveillance, and antimicrobial stewardship interventions were systematically coded for: type - mandatory requirements, recommendations, or national campaigns; method - restrictive, persuasive, structural in nature; level of implementation - macro (national), meso (organisational), micro (individual) levels. Healthcare organisational structures and role of media were also assessed.FindingsIn England significant reduction has been achieved in number of reported MRSA bloodstream infections. In Japan, in spite of reductions, MRSA remains a predominant infection. Both countries face new threats in the emergence of drug-resistant Escherichia coli. England has focused on national mandatory and structural interventions, supported by a combination of outcomes-based incentives and punitive mechanisms, and multidisciplinary IPC hospital teams. Japan has focused on (non-mandatory) recommendations and primarily persuasive interventions, supported by process-based incentives, with voluntary surveillance. Areas for development in Japan include resourcing of dedicated data management support and implementation of national campaigns for healthcare professionals and the public.ConclusionPolicy interventions need to be relevant to local epidemiological trends, while acceptable within health system cultures and public expectations. Cross-national learning can help inform the right mix of interventions to create sustainable and resilient systems for future infection and econom

Journal article

Ledwoch K, Dancer SJ, Otter JA, Kerr K, Roposte D, Rushton L, Weiser R, Mahenthiralingam E, Muir DD, Maillard J-Yet al., 2018, Beware biofilm! Dry biofilms containing bacterial pathogens on multiple healthcare surfaces; a multi-centre study, JOURNAL OF HOSPITAL INFECTION, Vol: 100, Pages: E47-E56, ISSN: 0195-6701

Journal article

Mookerjee S, Dyakova E, Davies F, Bamford K, Brannigan ET, Holmes A, Otter JAet al., 2018, Evaluating serial screening cultures to detect carbapenemase-producing Enterobacteriaceae following hospital admission, JOURNAL OF HOSPITAL INFECTION, Vol: 100, Pages: 15-20, ISSN: 0195-6701

Journal article

Knight GM, Dyakova E, Mookerjee S, Davies F, Brannigan E, Otter J, Holmes Aet al., 2018, Fast and expensive (PCR) or cheap and slow (culture)? A mathematical modelling study to explore screening for carbapenem resistance in UK hospitals, BMC Medicine, Vol: 16, ISSN: 1741-7015

BackgroundEnterobacteriaceae are a common cause of hospital infections. Carbapenems are a clinically effective treatment of such infections. However, resistance is on the rise. In particular, carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are increasingly common. In order to limit spread in clinical settings, screening and isolation is being recommended, but many different screening methods are available. We aimed to compare the impact and costs of three algorithms for detecting CP-CRE carriage.MethodsWe developed an individual-based simulation model to compare three screening algorithms using data from a UK National Health Service (NHS) trust. The first algorithm, “Direct PCR”, was highly sensitive/specific and quick (half a day), but expensive. The second, “Culture + PCR”, was relatively sensitive/specific but slower, requiring 2.5 days. A third algorithm, “PHE”, repeated the “Culture + PCR” three times with an additional PCR. Scenario analysis was used to compare several levels of CP-CRE prevalence and coverage of screening, different specialities as well as isolation strategies. Our outcomes were (1) days that a patient with CP-CRE was not detected and hence not isolated (“days at risk”), (2) isolation bed days, (3) total costs and (4) mean cost per CP-CRE risk day averted per year. We also explored limited isolation bed day capacity.ResultsWe found that although a Direct PCR algorithm would reduce the number of CP-CRE days at risk, the mean cost per CP-CRE risk day averted per year was substantially higher than for a Culture + PCR algorithm. For example, in our model of an intensive care unit, during a year with a 1.6% CP-CRE prevalence and 63% screening coverage, there were 508 (standard deviation 15), 642 (14) and 655 (14) days at risk under screening algorithms Direct PCR, Culture + PCR and PHE respectively, with mean costs per risk day averted of £192, £61 and

Journal article

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