Publications
56 results found
Chapman ALN, Patel S, Horner C, et al., 2019, Outpatient parenteral antimicrobial therapy: updated recommendations from the UK., J Antimicrob Chemother, Vol: 74, Pages: 3125-3127
Outpatient parenteral antimicrobial therapy (OPAT) offers safe, effective and patient-centred care for adults and children. The OPAT UK good practice recommendations for adults and children have recently been updated through a process of literature review, expert consensus and extensive stakeholder consultation. Here we discuss the key changes in the updated recommendations in the context of recent developments, including novel antimicrobial agents and delivery devices, the place of oral antimicrobials as an alternative to intravenous therapy, new OPAT service models and the broader antimicrobial stewardship agenda.
Chapman ALN, Patel S, Horner C, et al., 2019, Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK., JAC Antimicrob Resist, Vol: 1
UK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) were published in 2012 and 2015 for adult and paediatric patients, respectively. Here we update the initial good practice recommendations in a combined document based on a further review of the OPAT literature and an extensive consultation process. As with the previous good practice recommendations, these updated recommendations are intended to provide pragmatic guidance for new and established OPAT services across a range of settings and to act as a set of quality indicators for service evaluation and quality improvement.
Hatcher J, Costelloe C, Cele R, et al., 2019, Factors associated with successful completion of outpatient parenteral antibiotic therapy (OPAT): A 10-year review from a large West London service, INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, Vol: 54, Pages: 207-214, ISSN: 0924-8579
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- Citations: 7
Otter JA, Galtelly TJ, Davies F, et al., 2019, Planning to halve Gram-negative bloodstream infection: getting to grips with healthcare-associated <i>Escherichia coli</i> bloodstream infection sources, JOURNAL OF HOSPITAL INFECTION, Vol: 101, Pages: 129-133, ISSN: 0195-6701
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- Citations: 11
Rawson TM, Hernandez B, Moore L, et al., 2018, Supervised machine learning for the prediction of infection on admission to hospital: a prospective observational cohort study, Journal of Antimicrobial Chemotherapy
Nathwani D, Guise T, Gilchrist M, 2017, e-learning for global antimicrobial stewardship, LANCET INFECTIOUS DISEASES, Vol: 17, Pages: 579-579, ISSN: 1473-3099
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- Citations: 6
Castro Sanchez EM, Gilchrist M, McEwen J, et al., 2017, Antimicrobial stewardship: widening the collaborative approach, Journal of Antimicrobial Stewardship
Anti microbial stewardship programs (ASPs) would benefit from the participation of nurses to strengthen the increasingly complex mix of clinical, educational, research, organizational and political interventions included within ASPs.
Jenkins A, Hills T, Santillo M, et al., 2017, Extended stability of antimicrobial agents in administration devices, JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, Vol: 72, Pages: 1217-1220, ISSN: 0305-7453
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- Citations: 21
Goff DA, Kullar R, Goldstein EJC, et al., 2017, A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fail, LANCET INFECTIOUS DISEASES, Vol: 17, Pages: E56-E63, ISSN: 1473-3099
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- Citations: 142
Rawson T, Moore L, Tivey A, et al., 2017, Behaviour change interventions to influence antimicrobial prescribing: a cross-sectional analysis of reports from UK state-of-the-art scientific conferences, Antimicrobial Resistance and Infection Control, Vol: 6, ISSN: 2047-2994
BackgroundTo improve the quality of antimicrobial stewardship (AMS) interventions the application of behavioural sciences supported by multidisciplinary collaboration has been recommended. We analysed major UK scientific research conferences to investigate AMS behaviour change intervention reporting. MethodsLeading UK 2015 scientific conference abstracts for 30 clinical specialties were identified and interrogated. All AMS and/or antimicrobial resistance(AMR) abstracts were identified using validated search criteria. Abstracts were independently reviewed by four researchers with reported behavioural interventions classified using a behaviour change taxonomy. ResultsConferences ran for 110 days with >57,000 delegates. 311/12,313(2.5%) AMS-AMR abstracts (oral and poster) were identified. 118/311(40%) were presented at the UK’s infectious diseases/microbiology conference. 56/311(18%) AMS-AMR abstracts described behaviour change interventions. These were identified across 12/30(40%) conferences. The commonest abstract reporting behaviour change interventions were quality improvement projects [44/56 (79%)]. In total 71 unique behaviour change functions were identified. Policy categories; “guidelines” (16/71) and “service provision” (11/71) were the most frequently reported. Intervention functions; “education” (6/71), “persuasion” (7/71), and “enablement” (9/71) were also common. Only infection and primary care conferences reported studies that contained multiple behaviour change interventions. The remaining 10 specialties tended to report a narrow range of interventions focusing on “guidelines” and “enablement”. ConclusionDespite the benefits of behaviour change interventions on antimicrobial prescribing, very few AMS-AMR studies reported implementing them in 2015. AMS interventions must focus on promoting behaviour change towards antimicrobial prescribing. Greater focus must b
Rawson T, Charani E, Moore L, et al., 2016, Vancomycin therapy in secondary care; investigating factors that impact therapeutic target attainment, Journal of Infection, Vol: 74, Pages: 320-324, ISSN: 1532-2742
Otter JA, Burgess P, Davies F, et al., 2016, Counting the cost of an outbreak of carbapenemase-producing Enterobacteriaceae: an economic evaluation from a hospital perspective., Clinical Microbiology and Infection, ISSN: 1469-0691
OBJECTIVE: To perform an economic evaluation on the cost associated with an outbreak of carbapenemase-producing Enterobacteriaceae (CPE). METHODS: We performed an observational economic evaluation of an outbreak of CPE (NDM-producing Klebsiella pneumoniae) affecting 40 patients in a group of five hospitals across three sites in West London. Costs were split into actual expenditure (including anti-infective costs, enhanced CPE screening, contact precautions, temporary ward-based monitors of hand and environmental practice, and environmental decontamination), and 'opportunity cost' (staff time, bed closures, and elective surgical missed revenue). Costs are estimated from the hospital perspective over the 10 month duration of the outbreak. RESULTS: The outbreak cost €1.1m over 10 months (range €0.9-1.4m), comprising €312,000 of actual expenditure, and €822,000 (range €631,000-€1.1m) in opportunity cost. An additional €153,000 was spent on Estates renovations prompted by the outbreak. Actual expenditure comprised: €54,000 on anti-infectives for 18 patients treated, €94,000 on laboratory costs for screening, €73,000 on contact precautions for 1831 contact precautions patient days, €42,000 for hydrogen peroxide vapour decontamination of 24 single rooms, €43,000 on 2592 hours of ward-based monitors, and €6,000 of expenditure related to ward and bay closures. Opportunity costs comprised: €244,000related to 840 lost bed days (range 0-2196 bed days, €0-€435,000), €349,000 in missed revenue from 72 elective surgical procedures, and €228,000 in staff time (range €205,000-€251,000). Reduced capacity to perform elective surgical procedures related to bed closures (€349,000) represented the greatest cost. CONCLUSIONS: The cost estimates that we present suggest that CPE outbreaks are highly costly.
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)
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.
Gilchrist M, Wade P, Ashiru-Oredope D, et al., 2015, Antimicrobial Stewardship from Policy to Practice: Experiences from UK Antimicrobial Pharmacists., Infect Dis Ther, Vol: 4, Pages: 51-64, ISSN: 2193-8229
Antimicrobial stewardship in the UK has evolved dramatically in the last 15 years. Factors driving this include initial central funding for specialist pharmacists and mandatory reductions in healthcare-associated infections (particularly Clostridium difficile infection). More recently, the introduction of national stewardship guidelines, and an increased focus on stewardship as part of the UK five-year antimicrobial resistance strategy, have accelerated and embedded developments. Antimicrobial pharmacists have been instrumental in effecting changes at an organizational and national level. This article describes the evolution of the antimicrobial pharmacist role, its impact, the progress toward the actions listed in the five-year resistance strategy, and novel emerging areas in stewardship in the UK.
Sneddon J, Gilchrist M, Wickens H, 2015, Development of an expert professional curriculum for antimicrobial pharmacists in the UK., J Antimicrob Chemother, Vol: 70, Pages: 1277-1280
The role of antimicrobial pharmacists has changed considerably over the past 15 years. We describe here the development and ratification of a new expert professional curriculum to guide the training and development of antimicrobial specialist pharmacists. The curriculum has been developed by the UK Clinical Pharmacy Association Pharmacy Infection Network and endorsed by the Royal Pharmaceutical Society as a tool to support pharmacists in meeting the requirements for joining the Royal Pharmaceutical Society Faculty. This new resource has also been endorsed by PHE, the Scottish Antimicrobial Prescribing Group and the BSAC, and will support antimicrobial pharmacists in delivery of antimicrobial stewardship, which will in turn help the fight against antimicrobial resistance.
Gharbi M, Moore LSP, Gilchrist M, et al., 2015, Forecasting carbapenem resistance from antimicrobial consumption surveillance: Lessons learnt from an OXA-48-producing Klebsiella pneumoniae outbreak in a West London renal unit, International Journal of Antimicrobial Agents, Vol: 46, Pages: 150-156, ISSN: 1872-7913
This study aimed to forecast the incidence rate of carbapenem resistance and to assess the impact of an antimicrobial stewardship intervention using routine antimicrobial consumption surveillance data. Following an outbreak of OXA-48-producing Klebsiella pneumoniae (January 2008–April 2010) in a renal cohort in London, a forecasting ARIMA model was derived using meropenem consumption data [defined daily dose per 100 occupied bed-days (DDD/100 OBD)] from 2005–2014 as a predictor of the incidence rate of OXA-48-producing organisms (number of new cases/year/100,000 OBD). Interrupted times series assessed the impact of meropenem consumption restriction as part of the outbreak control. Meropenem consumption at lag −1 year (the preceding year), highly correlated with the incidence of OXA-48-producing organisms (r = 0.71; P = 0.005), was included as a predictor within the forecasting model. The number of cases/100,000 OBD for 2014–2015 was estimated to be 4.96 (95% CI 2.53–7.39). Analysis of meropenem consumption pre- and post-intervention demonstrated an increase of 7.12 DDD/100 OBD/year (95% CI 2.97–11.27; P < 0.001) in the 4 years preceding the intervention, but a decrease thereafter. The change in slope was −9.11 DDD/100 OBD/year (95% CI −13.82 to −4.39). Analysis of alternative antimicrobials showed a significant increase in amikacin consumption post-intervention from 0.54 to 3.41 DDD/100 OBD/year (slope +0.72, 95% CI 0.29–1.15; P = 0.01). Total antimicrobials significantly decreased from 176.21 to 126.24 DDD/100 OBD/year (P = 0.05). Surveillance of routinely collected antimicrobial consumption data may provide a key warning indicator to anticipate increased incidence of carbapenem-resistant organisms. Further validation using real-time data is needed.
Rawson TM, Moore LSP, Gilchrist MJ, et al., 2015, Antimicrobial stewardship: are we failing in cross-specialty clinical engagement?, Journal of Antimicrobial Chemotherapy, ISSN: 1460-2091
Gilchrist M, Seaton RA, 2015, Outpatient parenteral antimicrobial therapy and antimicrobial stewardship: challenges and checklists., J Antimicrob Chemother, Vol: 70, Pages: 965-970
Outpatient parenteral antimicrobial therapy (OPAT) has become, for many countries, an established form of healthcare delivery. At the same time, there have been calls to ensure the prudent use of the existing antimicrobial armamentarium. For OPAT, this presents a dilemma. On one hand, stewardship principles look for the most effective agent with minimal collateral effects. In OPAT, whilst the aims of the service are similar, convenience of dosing to optimize early hospital discharge or admission avoidance may take precedence over an agent's spectrum of activity. This brief article aims to highlight the importance and explore the challenges of antimicrobial stewardship in the context of OPAT. Within the UK, the safe and effective use of antimicrobials is modelled around the IDSA/Society for Healthcare Epidemiology of America stewardship practice guidelines with local customization where appropriate. Current UK stewardship practice principles were compared with published good practice recommendations for OPAT to identify how OPAT could support the broader antimicrobial stewardship agenda. It is essential that antimicrobial stewardship teams should understand the challenges faced in the non-inpatient setting and the potential benefits/lower risks associated with avoided admission or shortened hospital stay in this population. Within its limitations, OPAT should practise stewardship principles, including optimization of intravenous to oral switch and the reporting of outcomes, healthcare-associated infections and re-admission rates. OPAT should report to the antimicrobial stewardship team. Ideally the OPAT team should be formally represented within the stewardship framework. A checklist has been proposed to aid OPAT services in ensuring they meet their stewardship agenda.
Jones GR, Cumming DVE, Honeywell G, et al., 2015, How is income generated by outpatient parenteral antibiotic treatment (OPAT) in the UK? Analysis of payment tariffs for cellulitis, JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, Vol: 70, Pages: 1236-1240, ISSN: 0305-7453
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- Citations: 8
Trivedi KK, Dumartin C, Gilchrist M, et al., 2014, Identifying best practices across three countries: hospital antimicrobial stewardship in the United Kingdom, France, and the United States., Clin Infect Dis, Vol: 59 Suppl 3, Pages: S170-S178
Rational antimicrobial use can be achieved through antimicrobial stewardship--a coordinated set of strategies designed to improve the appropriate use of antimicrobial agents. There are encouraging examples of antimicrobial stewardship programs from different parts of the world; however, the structure of these programs varies by hospital and country. In an effort to identify best practices in hospitals, we describe legislative requirements, antimicrobial stewardship program infrastructure, strategies and outcomes in 3 countries that have established programs--the United Kingdom, France, and the United States.
Moore LSP, Freeman R, Gilchrist MJ, et al., 2014, Homogeneity of antimicrobial policy, yet heterogeneity of antimicrobial resistance: antimicrobial non-susceptibility among 108717 clinical isolates from primary, secondary and tertiary care patients in London., Journal of Antimicrobial Chemotherapy, Vol: 69, Pages: 3409-3422, ISSN: 1460-2091
Objectives We examined the 4 year trend in antimicrobial susceptibilities and prescribing across levels of care at two London teaching hospitals and their multisite renal unit, and for the surrounding community.Methods Laboratory and pharmacy information management systems were interrogated, with antimicrobial use and susceptibilities analysed between hospitals, within hospitals and over time.Results A total of 108 717 isolates from 71 687 patients were identified, with significant differences (at P < 0.05) in antimicrobial susceptibility between and within hospitals. Across the 4 years, rates of ESBL-/AmpC-producing Enterobacteriaceae ranged from 6.4% to 10.7% among community isolates, 17.8% to 26.9% at ward level and 25.2% to 52.5% in critical care. Significant variations were also demonstrated in glycopeptide-resistant enterococci (ward level 6.2%–17.4%; critical care 21.9%–56.3%), MRSA (ward level 18.5%–38.2%; critical care 12.5%–47.9%) and carbapenem-resistant Pseudomonas spp. (ward level 8.3%–16.9%; critical care 19.9%–53.7%). Few instances of persistently higher resistance were seen between the hospitals in equivalent cohorts, despite persistently higher antimicrobial use in Hospital 1 than Hospital 2. We found significant fluctuations in non-susceptibility year on year across the cohorts, but with few persistent trends.Conclusions The marked heterogeneity of antimicrobial susceptibilities between hospitals, within hospitals and over time demands detailed, standardized surveillance and appropriate benchmarking to identify possible drivers and effective interventions. Homogeneous antimicrobial policies are unlikely to continue to be suitable as individual hospitals join hospital networks, and policies should be tailored to local resistance rates, at least at the hospital level, and possibly with finer resolution, particularly for critical care.
King D, Jabbar A, Charani E, et al., 2014, Redesigning the 'choice architecture' of hospital prescription charts: a mixed methods study incorporating in situ simulation testing, BMJ OPEN, Vol: 4, ISSN: 2044-6055
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- Citations: 9
Lyons T, Neff KJ, Benn J, et al., 2013, Body mass index and diabetes status do not affect postoperative infection rates after bariatric surgery, SURGERY FOR OBESITY AND RELATED DISEASES, Vol: 10, Pages: 291-297, ISSN: 1550-7289
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- Citations: 12
Thakkar K, Gilchrist M, Dickinson E, et al., 2011, A quality improvement programme to increase compliance with an anti-infective prescribing policy, JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, Vol: 66, Pages: 1916-1920, ISSN: 0305-7453
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- Citations: 26
Gilchrist M, Franklin BD, Patel JP, 2008, An outpatient parenteral antibiotic therapy (OPAT) map to identify risks associated with an OPAT service, JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, Vol: 62, Pages: 177-183, ISSN: 0305-7453
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- Citations: 35
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