1
|
Hickok NJ, Li B, Oral E, Zaat SAJ, Armbruster DA, Atkins GJ, Chen AF, Coraça-Huber DC, Dai T, Greenfield EM, Kasinath R, Libera M, Marques CNH, Moriarty TF, Scott Phillips K, Raghuraman K, Ren D, Rimondini L, Saeed K, Schaer TP, Schwarz EM, Spiegel C, Stoodley P, Truong VK, Tsang STJ, Wildemann B, Zelmer AR, Zinkernagel AS. The 2023 Orthopedic Research Society's international consensus meeting on musculoskeletal infection: Summary from the in vitro section. J Orthop Res 2024; 42:512-517. [PMID: 38146070 DOI: 10.1002/jor.25774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023]
Abstract
Antimicrobial strategies for musculoskeletal infections are typically first developed with in vitro models. The In Vitro Section of the 2023 Orthopedic Research Society Musculoskeletal Infection international consensus meeting (ICM) probed our state of knowledge of in vitro systems with respect to bacteria and biofilm phenotype, standards, in vitro activity, and the ability to predict in vivo efficacy. A subset of ICM delegates performed systematic reviews on 15 questions and made recommendations and assessment of the level of evidence that were then voted on by 72 ICM delegates. Here, we report recommendations and rationale from the reviews and the results of the internet vote. Only two questions received a ≥90% consensus vote, emphasizing the disparate approaches and lack of established consensus for in vitro modeling and interpretation of results. Comments on knowledge gaps and the need for further research on these critical MSKI questions are included.
Collapse
Affiliation(s)
- Noreen J Hickok
- Department of Orthopaedic Surgery, Department of Biochemistry & Molecular Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bingyun Li
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sebastian A J Zaat
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gerald J Atkins
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Débora C Coraça-Huber
- Research Laboratory for Implant Associated Infections (Biofilm Lab), University Hospital for Orthopedics and Traumatology, Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tianhong Dai
- Harvard Medical School, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Edward M Greenfield
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indiana Center for Musculoskeletal Health, Indianapolis, Indiana, USA
| | | | - Matthew Libera
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, New Jersey, USA
| | - Cláudia N H Marques
- Department of Biological Sciences, Binghamton Biofilm Research Center, Binghamton University, Binghamton, New York, USA
| | | | - K Scott Phillips
- Laboratory of Analytical Chemistry, Division of Biological Standards and Quality Control, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Dacheng Ren
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, New York, USA
| | - Lia Rimondini
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Kordo Saeed
- University Hospital Southampton NHS Foundation Trust, Winchester and Basingstoke, UK
- University of Southampton, Southampton, UK
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Edward M Schwarz
- Center for Musculoskeletal Research, University of Rochester, Rochester, New York, USA
| | - Christopher Spiegel
- Research Laboratory for Biofilms and Implant Associated Infections (BIOFILM LAB), Experimental Orthopedics, University Hospital for Orthopedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Stoodley
- Department Microbial Infection and Immunity and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Vi Khanh Truong
- Biomedical Nanoengineering Laboratory, College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Shao-Ting Jerry Tsang
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, Scotland, UK
| | - Britt Wildemann
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Anja R Zelmer
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Moriarty TF, Hickok NJ, Saeed K, Schaer TP, Chen AF, Schwarz EM. The 2023 Orthopaedic Research Society International Consensus Meeting on musculoskeletal infection. J Orthop Res 2024; 42:497-499. [PMID: 37823833 DOI: 10.1002/jor.25714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
The Orthopaedic Research Society's Research Interest Group completed its international consensus meeting (ICM) on musculoskeletal infections (MSKI) following the 2023 Annual Meeting. The work products from this ICM include the 65 questions with recommendation and rationale, and the voting results from the 72 delegates. There are also five Consensus Articles in this issue of the Journal of Orthopaedic Research from the ICM Sections: Host Immunity, Established Infection-Treatment, Clinical Questions not addressed by the prior MSKI ICMs, In Vitro, and Animal Models. This Introduction summarizes the 3-year Delphi process used by the ICM with timelines and critical milestones. It also highlights several challenges that had to be addressed, and a large body of work that remains.
Collapse
Affiliation(s)
| | - Noreen J Hickok
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kordo Saeed
- University Hospital Southampton, NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Thomas P Schaer
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Antonia F Chen
- Department of Orthpaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward M Schwarz
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester, Rochester, New York, USA
| |
Collapse
|
3
|
Pascual S, Noble B, Ahmad-Saeed N, Aldridge C, Ambretti S, Amit S, Annett R, O'Shea S, Barbui A, Barlow G, Barrett L, Berth M, Bondi A, Boran N, Boyd S, Chaves C, Clauss M, Davies P, Dianzo-Delgado I, Esteban J, Fuchs S, Friis-Hansen L, Goldenberger D, Golle A, Groonroos J, Hoffmann I, Hoffmann T, Hughes H, Ivanova M, Jezek P, Jones G, Ceren Karahan Z, Lass-Flörl C, Laurent F, Leach L, Horsbøll Pedersen ML, Loiez C, Lynch M, Maloney R, Marsh M, Milburn O, Mitchell S, Moore L, Moffat L, Murdjeva M, Murphy M, Nayar D, Nigrisoli G, O'Sullivan F, Öz B, Peach T, Petridou C, Prinz M, Rak M, Reidy N, Rossolini G, Roux AL, Ruiz-Garbajosa P, Saeed K, Salar-Vidal L, Salas Venero C, Selvaratnam M, Senneville E, Starzengruber P, Talbot B, Taylor V, Trebše R, Wearmouth D, Willinger B, Wouthuyzen-Bakker M, Couturier B, Allantaz F. Potential value of a rapid syndromic multiplex PCR for the diagnosis of native and prosthetic joint infections: a real-world evidence study. J Bone Jt Infect 2024; 9:87-97. [PMID: 38601005 PMCID: PMC11002912 DOI: 10.5194/jbji-9-87-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/01/2023] [Indexed: 04/12/2024] Open
Abstract
Introduction: The BIOFIRE Joint Infection (JI) Panel is a diagnostic tool that uses multiplex-PCR testing to detect microorganisms in synovial fluid specimens from patients suspected of having septic arthritis (SA) on native joints or prosthetic joint infections (PJIs). Methods: A study was conducted across 34 clinical sites in 19 European and Middle Eastern countries from March 2021 to June 2022 to assess the effectiveness of the BIOFIRE JI Panel. Results: A total of 1527 samples were collected from patients suspected of SA or PJI, with an overall agreement of 88.4 % and 85 % respectively between the JI Panel and synovial fluid cultures (SFCs). The JI Panel detected more positive samples and microorganisms than SFC, with a notable difference on Staphylococcus aureus, Streptococcus species, Enterococcus faecalis, Kingella kingae, Neisseria gonorrhoeae, and anaerobic bacteria. The study found that the BIOFIRE JI Panel has a high utility in the real-world clinical setting for suspected SA and PJI, providing diagnostic results in approximately 1 h. The user experience was positive, implying a potential benefit of rapidity of results' turnover in optimising patient management strategies. Conclusion: The study suggests that the BIOFIRE JI Panel could potentially optimise patient management and antimicrobial therapy, thus highlighting its importance in the clinical setting.
Collapse
Affiliation(s)
| | | | - Nusreen Ahmad-Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Catherine Aldridge
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Simone Ambretti
- S. Orsola Bologna, Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Rachel Annett
- University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Shaan Ashk O'Shea
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Anna Maria Barbui
- San Giovanni Battista, Department of Public Health and Pediatrics Microbiology and Virology Unit, Città della Salute e della Scienza, Turin, Italy
| | - Gavin Barlow
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | | | | | - Alessandro Bondi
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Nicola Boran
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sara E. Boyd
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Catarina Chaves
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Peter Davies
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
| | - Ileana T. Dianzo-Delgado
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Jaime Esteban
- Dept. of Clinical Microbiology, IIS-Fundación Jiménez Díaz, CIBERINFEC-CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Stefan Fuchs
- Institute of Hygiene and Medical Microbiology Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Lennart Friis-Hansen
- Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
- Dept. Clinical Microbiology at Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Ines Hoffmann
- MVZ Labor Dr. Reising-Ackermann und Kollegen, Limbach Leipzig, Germany
| | | | - Harriet Hughes
- University Hospital of Wales, Cardiff, Wales, United Kingdom
| | | | - Peter Jezek
- Regional Hospital Příbram, Příbram, Czech Republic
| | - Gwennan Jones
- University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Zeynep Ceren Karahan
- Ankara University School of Medicine Department of Medical Microbiology, Ankara, Türkiye
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology Medizinische Universität Innsbruck, Innsbruck, Austria
| | | | - Laura Leach
- Oxford University Hospitals (OUH), Oxford, United Kingdom
| | - Matilde Lee Horsbøll Pedersen
- Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
- Dept. Clinical Microbiology at Rigshospitalet, Copenhagen, Denmark
| | - Caroline Loiez
- Centre Hospitalier Universitaire de Lille, Lille, France
| | - Maureen Lynch
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Martin Marsh
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Olivia Milburn
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | | | - Luke S. P. Moore
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Lynn Moffat
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
| | | | - Michael E. Murphy
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
| | - Deepa Nayar
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Giacomo Nigrisoli
- S. Orsola Bologna, Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Büşra Öz
- Ankara University School of Medicine Department of Medical Microbiology, Ankara, Türkiye
| | - Teresa Peach
- University Hospital of Wales, Cardiff, Wales, United Kingdom
| | | | | | - Mitja Rak
- Koper lab, Orthopedic Hospital Valdoltra, Valdoltra, Slovenia
| | - Niamh Reidy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Patricia Ruiz-Garbajosa
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III. Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Kordo Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Llanos Salar-Vidal
- Dept. of Clinical Microbiology, IIS-Fundación Jiménez Díaz, CIBERINFEC-CIBER de Enfermedades Infecciosas, Madrid, Spain
| | | | | | | | | | - Ben Talbot
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
| | - Vanessa Taylor
- University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Rihard Trebše
- Koper lab, Orthopedic Hospital Valdoltra, Valdoltra, Slovenia
| | | | | | | | | | | |
Collapse
|
4
|
Watson A, Yadollahi S, Fahmy A, Mahar S, Fritche D, Beecham R, Saeed K, Dushianthan A. Non-Invasive Ventilation for Community-Acquired Pneumonia: Outcomes and Predictors of Failure from an ICU Cohort. Medicina (Kaunas) 2023; 60:81. [PMID: 38256342 PMCID: PMC10821344 DOI: 10.3390/medicina60010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The use of non-invasive ventilation (NIV) for community-acquired pneumonia (CAP) remains controversial. NIV failure in the setting of acute hypoxemic respiratory failure is associated with increased mortality, highlighting the need for careful patient selection. Methods and Methods: This is a retrospective observational cohort study. We included 140 patients with severe CAP, treated with either NIV or invasive mechanical ventilation (IMV) as their primary oxygenation strategy. Results: The median PaO2/FiO2 ratio and SOFA score upon ICU admission were 151 mmHg and 6, respectively. We managed 76% of patients with NIV initially and report an NIV success rate of 59%. Overall, the 28-day mortality was 25%, whilst for patients with NIV success, the mortality was significantly lower at 13%. In the univariate analysis, NIV failure was associated with the SOFA score (OR 1.33), the HACOR score (OR 1.14) and the presence of septic shock (OR 3.99). The SOFA score has an AUC of 0.75 for NIV failure upon ICU admission, whilst HACOR has an AUC of 0.76 after 2 h of NIV. Conclusions: Our results suggest that a SOFA ≤ 4 and an HACOR ≤ 5 are reasonable thresholds to identify patients with severe CAP likely to benefit from NIV.
Collapse
Affiliation(s)
- Adam Watson
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
| | - Sina Yadollahi
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
| | - Alexander Fahmy
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
| | - Sania Mahar
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
| | - Dominic Fritche
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
| | - Ryan Beecham
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
| | - Kordo Saeed
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
- Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (A.W.); (S.M.); (R.B.)
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (D.F.); (K.S.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| |
Collapse
|
5
|
Wilson J, Griffin H, Görzig A, Prieto J, Saeed K, Garvey MI, Holden E, Tingle A, Loveday H. Identifying patients at increased risk of non-ventilator-associated pneumonia on admission to hospital: a pragmatic prognostic screening tool to trigger preventative action. J Hosp Infect 2023; 142:49-57. [PMID: 37820778 DOI: 10.1016/j.jhin.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Non-ventilator healthcare-associated pneumonia (NV-HAP) is an important healthcare-associated infection. This study tested the feasibility of using routine admission data to identify those patients at high risk of NV-HAP who could benefit from targeted, preventive interventions. METHODS Patients aged ≥64 years who developed NV-HAP five days or more after admission to elderly-care wards, were identified by retrospective case note review together with matched controls. Data on potential predictors of NV-HAP were captured from admission records. Multi-variate analysis was used to build a prognostic screening tool (PRHAPs); acceptability and feasibility of the tool was evaluated. RESULTS A total of 382 cases/381 control patients were included in the analysis. Ten predictors were included in the final model; nine increased the risk of NV-HAP (OR between 1.68 and 2.42) and one (independent mobility) was protective (OR 0.48; 95% CI 0.30-0.75). The model correctly predicted 68% of the patients with and without NV-HAP; sensitivity 77%; specificity 61%. The PRHAPs tool risk score was 60% or more if two predictors were present and over 70% if three were present. An expert consensus group supported incorporating the PRHAPs tool into electronic logic systems as an efficient mechanism to identify patients at risk of NV-HAP and target preventative strategies. CONCLUSIONS This prognostic screening (PRHAPs) tool, applied to data routinely collected when a patient is admitted to hospital, could enable staff to identify patients at greatest risk of NV-HAP, target scarce resources in implementing a prevention care bundle, and reduce the use of antimicrobial agents.
Collapse
Affiliation(s)
- J Wilson
- Richard Wells Research Centre, University of West London, Brentford, UK.
| | - H Griffin
- Richard Wells Research Centre, University of West London, Brentford, UK
| | - A Görzig
- School of Human Sciences, University of Greenwich, London, UK
| | - J Prieto
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - K Saeed
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M I Garvey
- Department of Clinical Microbiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - E Holden
- Department of Clinical Microbiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Tingle
- Richard Wells Research Centre, University of West London, Brentford, UK
| | - H Loveday
- Richard Wells Research Centre, University of West London, Brentford, UK
| |
Collapse
|
6
|
Watson A, Beecham R, Grocott MPW, Saeed K, Dushianthan A. Severe Parainfluenza Viral Infection-A Retrospective Study of Adult Intensive Care Patients. J Clin Med 2023; 12:7106. [PMID: 38002717 PMCID: PMC10672094 DOI: 10.3390/jcm12227106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
There is little known about parainfluenza virus (PIV) infection in adult intensive care unit (ICU) patients. Here, we aim to describe the characteristics, clinical course and outcomes of PIV infection in adults requiring intensive care. In this retrospective study of consecutive patients admitted to our ICU with confirmed PIV infection over a 7-year period, we report the patient characteristics, laboratory tests and prognostic scores on ICU admission. The main outcomes reported are 30-day mortality and organ support required. We included 50 patients (52% male, mean age 67.6 years). The mean PaO2/FiO2 and neutrophil/lymphocyte ratios on ICU admission were 198 ± 82 mmHg and 15.7 ± 12.5. Overall, 98% of patients required respiratory support and 24% required cardiovascular support. The median length of ICU stay was 5.9 days (IQR 3.7-9.1) with a 30-day mortality of 40%. In conclusion, PIV infection in adult ICU patients is associated with significant mortality and morbidity. There were significant differences between patients who presented with primary hypoxemic respiratory failure and hypercapnic respiratory failure.
Collapse
Affiliation(s)
- Adam Watson
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Ryan Beecham
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
| | - Michael P. W. Grocott
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Kordo Saeed
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Department of Microbiology, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| |
Collapse
|
7
|
Hughes T, Bowen D, Saeed K, Juliebø-Jones P, Somani B. Management of Fournier's gangrene: a practical guide for clinicians. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 37769264 DOI: 10.12968/hmed.2023.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Fournier's gangrene is a localised form of necrotising fasciitis affecting the external genitalia, perineal and perianal regions. Although rare, it is associated with high rates of morbidity and mortality, so clinician awareness is essential for prompt treatment. Risk factors include diabetes mellitus, hypertension, chronic alcoholism and immunosuppression. Perineal pain in patients with sepsis should be treated with a high level of suspicion and early surgical referral is required as prompt debridement can improve outcomes. Repeated surgical intervention and antimicrobial therapy are often needed and recovery can take a long time, with a long-term impact on quality of life. This article discusses the natural history of Fournier's gangrene, aetiology, risk factors, investigations and treatments with an algorithm to support clinical practice.
Collapse
Affiliation(s)
- Thomas Hughes
- Department of Urology, South Warwickshire University NHS Foundation Trust, Warwick, UK
| | - Daniel Bowen
- Department of Urology, Mid and South Essex NHS Foundation Trust, Chelmsford, UK
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
8
|
Panca M, Blackstone J, Stirrup O, Cutino-Moguel MT, Thomson E, Peters C, Snell LB, Nebbia G, Holmes A, Chawla A, Machin N, Taha Y, Mahungu T, Saluja T, de Silva TI, Saeed K, Pope C, Shin GY, Williams R, Darby A, Smith DL, Loose M, Robson SC, Laing K, Partridge DG, Price JR, Breuer J. Evaluating the cost implications of integrating SARS-CoV-2 genome sequencing for infection prevention and control investigation of nosocomial transmission within hospitals. J Hosp Infect 2023; 139:23-32. [PMID: 37308063 PMCID: PMC10257337 DOI: 10.1016/j.jhin.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COG-UK hospital-onset COVID-19 infection (HOCI) trial evaluated the impact of SARS-CoV-2 whole-genome sequencing (WGS) on acute infection, prevention, and control (IPC) investigation of nosocomial transmission within hospitals. AIM To estimate the cost implications of using the information from the sequencing reporting tool (SRT), used to determine likelihood of nosocomial infection in IPC practice. METHODS A micro-costing approach for SARS-CoV-2 WGS was conducted. Data on IPC management resource use and costs were collected from interviews with IPC teams from 14 participating sites and used to assign cost estimates for IPC activities as collected in the trial. Activities included IPC-specific actions following a suspicion of healthcare-associated infection (HAI) or outbreak, as well as changes to practice following the return of data via SRT. FINDINGS The mean per-sample costs of SARS-CoV-2 sequencing were estimated at £77.10 for rapid and £66.94 for longer turnaround phases. Over the three-month interventional phases, the total management costs of IPC-defined HAIs and outbreak events across the sites were estimated at £225,070 and £416,447, respectively. The main cost drivers were bed-days lost due to ward closures because of outbreaks, followed by outbreak meetings and bed-days lost due to cohorting contacts. Actioning SRTs, the cost of HAIs increased by £5,178 due to unidentified cases and the cost of outbreaks decreased by £11,246 as SRTs excluded hospital outbreaks. CONCLUSION Although SARS-CoV-2 WGS adds to the total IPC management cost, additional information provided could balance out the additional cost, depending on identified design improvements and effective deployment.
Collapse
Affiliation(s)
- M Panca
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
| | - J Blackstone
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - O Stirrup
- Institute for Global Health, UCL, London, UK
| | | | - E Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - C Peters
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - L B Snell
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - G Nebbia
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Holmes
- Imperial College Healthcare NHS Trust, London, UK
| | - A Chawla
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N Machin
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Y Taha
- Departments of Virology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - T Mahungu
- Royal Free NHS Foundation Trust, London, UK
| | - T Saluja
- Sandwell and West Birmingham NHS Trust, UK
| | - T I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, The University of Sheffield, Sheffield, UK
| | - K Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Pope
- St George's University Hospitals NHS Foundation Trust, London, UK; Institute for Infection and Immunity, St George's University of London, London, UK
| | - G Y Shin
- University College London Hospitals NHS Foundation Trust, London, UK
| | - R Williams
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - A Darby
- Centre for Genomic Research, University of Liverpool, Liverpool, UK
| | - D L Smith
- Department of Applied Sciences, Northumbria University, Newcastle, UK
| | - M Loose
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - S C Robson
- Centre for Enzyme Innovation & School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK
| | - K Laing
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - D G Partridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J R Price
- Imperial College Healthcare NHS Trust, London, UK
| | - J Breuer
- Department of Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, UCL, London, UK
| |
Collapse
|
9
|
Moore N, Williams R, Mori M, Bertolusso B, Vernet G, Lynch J, Philipson P, Ledgerwood T, Kidd SP, Thomas C, Garcia-Arias V, Young M, Saeed K, Gordon K, Cortes N. Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting. J Clin Pathol 2023; 76:400-406. [PMID: 34996755 PMCID: PMC8761594 DOI: 10.1136/jclinpath-2021-207750] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/14/2021] [Indexed: 02/02/2023]
Abstract
AIMS There is a lack of biomarkers validated for assessing clinical deterioration in patients with COVID-19 on presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of C reactive protein (CRP), procalcitonin, mid-regional proadrenomedullin (MR-proADM) and white cell count to support prediction of clinical outcomes. METHODS 135 patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via reverse-transcription-qPCR were included. Biomarkers from within 24 hours of presentation were used to predict disease progression by Cox regression and area under the receiver operating characteristic curves. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, critical care admission and non-invasive ventilation (NIV) use. RESULTS Elevated MR-proADM was shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular disease, renal disease and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and NIV. CONCLUSIONS The measurement of MR-proADM and CRP in patients with confirmed COVID-19 infection on admission shows significant potential to support clinicians in identifying those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions.
Collapse
Affiliation(s)
- Nathan Moore
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Rebecca Williams
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Matilde Mori
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Gabrielle Vernet
- Emergency Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Jessica Lynch
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Pete Philipson
- University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, UK
| | - Thomas Ledgerwood
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Stephen P Kidd
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Claire Thomas
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Michelle Young
- Biochemsitry Department, Whittington Hospital, London, UK
| | - Kordo Saeed
- Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kirsty Gordon
- Biochemistry Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Nicholas Cortes
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
10
|
Catton T, Umpleby H, Dushianthan A, Saeed K. Provision of Microbiology, Infection Services and Antimicrobial Stewardship in Intensive Care: A Survey across the Critical Care Networks in England and Wales. Antibiotics (Basel) 2023; 12:antibiotics12040768. [PMID: 37107130 PMCID: PMC10135214 DOI: 10.3390/antibiotics12040768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Infection rounds in Intensive Care Units (ICU) can impact antimicrobial stewardship (AMS). The aim of this survey was to assess the availability of microbiology, infection, AMS services, and antimicrobial prescribing practices in the UK ICUs. An online questionnaire was sent to clinical leads for ICUs in each region listed in the Critical Care Network for the UK. Out of 217 ICUs, 87 deduplicated responses from England and Wales were analyzed. Three-quarters of those who responded had a dedicated microbiologist, and 50% had a dedicated infection control prevention nurse. Infection rounds varied in their frequency, with 10% providing phone advice only. Antibiotic guidance was available in 99% of the units; only 8% of those were ICU-specific. There were variations in the availability of biomarkers & the duration of antibiotics prescribed for pneumonia (community, hospital, or ventilator), urinary, intra-abdominal, and line infections/sepsis. Antibiotic consumption data were not routinely discussed in a multi-disciplinary meeting. The electronic prescription was available in ~60% and local antibiotic surveillance data in only 47% of ICUs. The survey highlights variations in practice and AMS services and may offer the opportunity to further collaborations and share learnings to support the safe use of antimicrobials in the ICU.
Collapse
Affiliation(s)
- Tim Catton
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Helen Umpleby
- Department of Infection, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Romsey Road, Winchester SO22 5DG, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the University of Southampton, Tremona Road, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Kordo Saeed
- Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| |
Collapse
|
11
|
Saeed K, Ahmad-Saeed N, Annett R, Barlow G, Barrett L, Boyd SE, Boran N, Davies P, Hughes H, Jones G, Leach L, Lynch M, Nayar D, Maloney RJ, Marsh M, Milburn O, Mitchell S, Moffat L, Moore LSP, Murphy ME, O'Shea SA, O'Sullivan F, Peach T, Petridou C, Reidy N, Selvaratnam M, Talbot B, Taylor V, Wearmouth D, Aldridge C. A multicentre evaluation and expert recommendations of use of the newly developed BioFire Joint Infection polymerase chain reaction panel. Eur J Clin Microbiol Infect Dis 2023; 42:169-176. [PMID: 36474096 PMCID: PMC9836977 DOI: 10.1007/s10096-022-04538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Septic arthritis is a serious condition with significant morbidity and mortality, routinely diagnosed using culture. The FDA has recently approved the rapid molecular BioFire® Joint Infection Panel (BJIP) for synovial fluid. We aimed to evaluate the BJIP compared to culture and its potential use in patient management. A multicentre retrospective evaluation of BJIP was conducted in the UK and Ireland. Positive percent agreement (PPA) and negative percent agreement (NPA) were calculated between the BJIP and routine culture. A multidisciplinary team (MDT) discussion addressing the optimal or potential case use of the assay practice was facilitated. Three hundred ninety-nine surplus synovial fluid samples (~ 70% from native joints) from eight centres were processed using BJIP in addition to routine culture. An increased yield of positive results was detected using BJIP compared to routine culture (98 vs 83), giving an overall PPA of 91.6% and overall NPA of 93% for the BJIP compared to culture results. The BJIP detected resistant markers and additional organisms that could influence antibiotic choices including Neisseria gonorrhoeae and Kingella kingae. The MDT agreed that the assay could be used, in addition to standard methods, in adult and children patients with specialist advice use based on local needs. Rapid results from BJIP were assessed as having potential clinical impact on patient management. Organisms not included in the panel may be clinically significant and may limit the value of this test for PJI.
Collapse
Affiliation(s)
- Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
| | - Nusreen Ahmad-Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rachel Annett
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Gavin Barlow
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Experimental Medicine & Biomedicine, York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, UK
| | | | - Sara E Boyd
- Chelsea and Westminster NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, North West London Pathology, Fulham Palace Road, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, Du Cane Road, London, UK
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, L69 3GE, UK
| | - Nicola Boran
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter Davies
- Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, New Lister Building, Alexandra Parade, Glasgow, UK
| | - Harriet Hughes
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Gwennan Jones
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Laura Leach
- Oxford University Hospitals (OUH), Oxford, UK
| | - Maureen Lynch
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Deepa Nayar
- Department of Microbiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Robert J Maloney
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Martin Marsh
- Department of Orthopaedics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Olivia Milburn
- Department of Microbiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Shanine Mitchell
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Lynn Moffat
- Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, New Lister Building, Alexandra Parade, Glasgow, UK
| | - Luke S P Moore
- Chelsea and Westminster NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, North West London Pathology, Fulham Palace Road, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, Du Cane Road, London, UK
| | - Michael E Murphy
- Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, New Lister Building, Alexandra Parade, Glasgow, UK
- College of Medical, Veterinary & Life Sciences, Wolfson Medical School Building, University of Glasgow, Glasgow, UK
| | - Shaan Ashk O'Shea
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fionnuala O'Sullivan
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Teresa Peach
- Health Protection and Infection Division, Capital Quarter, Public Health Wales, Cardiff, Wales, UK
| | - Christina Petridou
- Department of Infection, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - Niamh Reidy
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Ben Talbot
- Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, New Lister Building, Alexandra Parade, Glasgow, UK
| | - Vanessa Taylor
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Deborah Wearmouth
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Catherine Aldridge
- Department of Microbiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| |
Collapse
|
12
|
Munro AP, Hungwe C, Patel P, Ward N, Struthers S, Saeed K. The utility of point of care testing of procalcitonin in paediatric acute assessment. Infez Med 2022; 30:587-592. [PMID: 36482951 PMCID: PMC9714994 DOI: 10.53854/liim-3004-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/29/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Febrile illnesses are a common cause of presentation in acute pediatrics, with biomarkers frequently used to help differentiate mild infections from serious bacterial infections (SBI). We aimed to see if a point of care test for procalcitonin could help to reduce antibiotic use and avoid unnecessary admission. PATIENTS AND METHODS A point of care procalcitonin machine which produces results within 20 minutes was introduced to two pediatric assessment units across both sites of a secondary-care hospital trust, alongside guidance for when tested would be appropriate. We performed a prospective, observational, pilot service evaluation, of all children tested during the study period of November 2018 to March 2019. We collected data at the time of testing, including the indication for testing and plan prior to testing, then retrospectively collected outcome data for children tested including diagnosis, treatment and whether the child was admitted to hospital. RESULTS 68 tests were performed over 5 months. There are differing denominators due to missing data. Children were predominantly male (40/68, 58.8%) and pre-school age (median age 2.9y, Q1-Q3 1.3-6.7). Severity of illness was low, with 7/54 (11.5%) triggering sepsis tools. The primary indication for testing was febrile illness with no source of infection and some concerning features (31/59, 52.5%). Following testing, 35/67 (52.5%) of patients were admitted and 31/67 (47.1%) had IV antibiotics. A low procalcitonin (<0.5 ng/L) was observed in 46/67 (69.1%) of patients, however 21/46 (45.7%) of these children were admitted and 16/46 (34.8%) were given IV antibiotics. Procalcitonin performed poorly at detecting SBIs in this cohort (result >0.5 ng/L for 1/5 SBIs). CONCLUSION There was no clear impact of point of care procalcitonin on admission or antibiotic prescribing in this small pilot study. Clinicians often tested for reasons outside the recommended scenarios and often treated "low risk" patients, as determined by low procalcitonin, with antibiotics. These effects may be due to low familiarity with procalcitonin as a biomarker.
Collapse
Affiliation(s)
- Alasdair P.S. Munro
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton,
United Kingdom,University of Southampton, Southampton,
United Kingdom
| | - Charles Hungwe
- Department of Pediatrics, Basingstoke and North Hampshire Hospital, Basingstoke,
United Kingdom
| | - Pratisksha Patel
- Department of Pediatrics, Royal Hampshire County Hospital, Winchester,
United Kingdom
| | - Nick Ward
- Department of Pediatrics, Basingstoke and North Hampshire Hospital, Basingstoke,
United Kingdom
| | - Simon Struthers
- Department of Pediatrics, Royal Hampshire County Hospital, Winchester,
United Kingdom
| | - Kordo Saeed
- University of Southampton, Southampton,
United Kingdom,Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton,
United Kingdom
| |
Collapse
|
13
|
Alkasaby MA, Baingana F, Bosu WK, Abdulaziz M, Mwaisaka R, Kakunze A, Keita N, Saeed K, Eaton J, Walker I. Integrating mental health into emergency preparedness and response: lessons learned from Covid-19. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The COVID-19 crisis has disrupted health systems all over the world. In a survey by the WHO, 93% of the countries reported disruption in their mental health services. This research assessed the extent to which mental health was included in the national response to the COVID-19 pandemic in African countries. It also explored barriers and enablers to mental health integration into the COVID-19 response. Lessons learned from COVID-19 can help improve the response to future public health emergencies.
Methods
A web-based survey was sent to mental health focal points in 55 African countries. The survey assessed the perceived degree of implementation of the Inter-Agency Standing Committee (IASC) “14 Globally Recommended Activities” for mental health response to COVID-19. This was followed by in-depth interviews to explore barriers and enablers to mental health integration into the COVID-19 response.
Results
Responses were received from 28 countries. Lack of political will, poor funding, limited human resources, and weak pre-existing mental health systems were the key challenges in addressing mental health needs during COVID-19. Participants highlighted the need to capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the longer term. They have also stressed the importance of sustaining and strengthening the new partnerships and service delivery models that emerged during the COVID-19 pandemic.
Conclusions
The number of recommended mental health activities implemented during the COVID-19 pandemic varied considerably across African countries. Several factors limit mental health integration into emergency response. However, there are signs of optimism, as mental health gained some attention during COVID-19, which can be built on to integrate mental health into emergency response and strengthen health systems in the long term.
Key messages
• Capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the long term.
• Sustain and strengthen the new partnerships and service delivery models that emerged during the COVID-19 pandemic.
Collapse
Affiliation(s)
- MA Alkasaby
- UK Public Health Rapid Support Team, UK Health Security Agency, LSHTM , London, UK
- Centre for Global Mental Health, LSHTM , London, UK
| | - F Baingana
- Regional Advisor for Mental Health, WHO Regional Office for Africa , Brazzaville, Congo (Brazzaville)
| | - WK Bosu
- West African Health Organisation , Bobo-Dioulasso, Burkina Faso
| | - M Abdulaziz
- Africa Centres for Disease Control and Prevention , Addis Ababa, Ethiopia
| | - R Mwaisaka
- East, Central and Southern African Health Community , Arusha, Tanzania
| | - A Kakunze
- Africa Centres for Disease Control and Prevention , Addis Ababa, Ethiopia
| | - N Keita
- West African Health Organisation , Bobo-Dioulasso, Burkina Faso
| | - K Saeed
- Regional Advisor for Mental Health, WHO Regional Office for Eastern Mediterranean , Cairo, Egypt
| | - J Eaton
- Centre for Global Mental Health, LSHTM , London, UK
- CBM Global Disability and Inclusion , Amstelveen, Netherlands
| | - I Walker
- Office for Health Improvement and Disparities, Department of Health and Social Care , London, UK
| |
Collapse
|
14
|
Dailly S, Boatswain E, Brooks J, Campbell G, Dallow K, Dushianthan A, Glover S, Griffiths M, Gupta S, Austin J, Chambers R, Jeremiah S, Morris C, Mahobia N, Poxon M, Rickman A, Jaques H, Yam T, Saeed K. Aspergillus in COVID-19 intensive care unit; what is lurking above your head? J Infect Prev 2022; 23:278-284. [PMID: 36277859 PMCID: PMC9475376 DOI: 10.1177/17571774221127548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Through routine respiratory samples surveillance among COVID-19 patients in
the intensive care, three patients with aspergillus were identified in a
newly opened general intensive care unit during the second wave of the
pandemic. Methodology As no previous cases of aspergillus had occurred since the unit had opened.
An urgent multidisciplinary outbreak meeting was held. The possible sources
of aspergillus infection were explored. The multidisciplinary approach
enabled stakeholders from different skills to discuss possible sources and
management strategies. Environmental precipitants like air handling units
were considered and the overall clinical practice was reviewed. Settle
plates were placed around the unit to identify the source. Reports of recent
water leaks were also investigated. Results Growth of aspergillus on a settle plate was identified the potential source
above a nurse’s station. This was the site of a historic water leak from the
ceiling above, that resolved promptly and was not investigated further.
Subsequent investigation above the ceiling tiles found pooling of water and
mould due to a slow water leak from a pipe. Conclusion Water leaks in patient areas should be promptly notified to infection
prevention. Detailed investigation to ascertain the actual cause of the leak
and ensure any remedial work could be carried out swiftly. Outbreak meetings
that include diverse people with various expertises (clinical and
non-clinical) can enable prompt identification and resolution of
contaminated areas to minimise risk to patients and staff. During
challenging pandemic periods hospitals must not lose focus on other clusters
and outbreaks occurring simultaneously.
Collapse
Affiliation(s)
- Sue Dailly
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Erin Boatswain
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Julie Brooks
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Glen Campbell
- Estates, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Katy Dallow
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ahilanandan Dushianthan
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Glover
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Melanie Griffiths
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Gupta
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James Austin
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert Chambers
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Jeremiah
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Charlotte Morris
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nitin Mahobia
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martyn Poxon
- Estates, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Rickman
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Helen Jaques
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tatshing Yam
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
15
|
Stirrup O, Blackstone J, Mapp F, MacNeil A, Panca M, Holmes A, Machin N, Shin GY, Mahungu T, Saeed K, Saluja T, Taha Y, Mahida N, Pope C, Chawla A, Cutino-Moguel MT, Tamuri A, Williams R, Darby A, Robertson DL, Flaviani F, Nastouli E, Robson S, Smith D, Laing K, Monahan I, Kele B, Haldenby S, George R, Bashton M, Witney AA, Byott M, Coll F, Chapman M, Peacock SJ, Hughes J, Nebbia G, Partridge DG, Parker M, Price JR, Peters C, Roy S, Snell LB, de Silva TI, Thomson E, Flowers P, Copas A, Breuer J. Effectiveness of rapid SARS-CoV-2 genome sequencing in supporting infection control for hospital-onset COVID-19 infection: multicenter, prospective study. eLife 2022; 11:78427. [PMID: 36098502 PMCID: PMC9596156 DOI: 10.7554/elife.78427] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. Methods: We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data-collection period, followed by intervention periods comprising 8 weeks of 'rapid' (<48h) and 4 weeks of 'longer-turnaround' (5-10 day) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital onset COVID-19 infections (HOCIs; detected ≥48h from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on incidence of probable/definite hospital-acquired infections (HAIs) was evaluated. Results: A total of 2170 HOCI cases were recorded from October 2020-April 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (incidence rate ratio 1.60, 95%CI 0.85-3.01; P=0.14) or rapid (0.85, 0.48-1.50; P=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8% and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2% and 11.6% of cases where the report was returned. In a 'per-protocol' sensitivity analysis there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources. Conclusion: While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days. Funding: COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) [grant code: MC_PC_19027], and Genome Research Limited, operating as the Wellcome Sanger Institute. Clinical trial number: ClinicalTrials.gov Identifier: NCT04405934.
Collapse
Affiliation(s)
- Oliver Stirrup
- Institute for Global Health, University College London, London, United Kingdom
| | - James Blackstone
- The Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Fiona Mapp
- Institute for Global Health, University College London, London, United Kingdom
| | - Alyson MacNeil
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Monica Panca
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Alison Holmes
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas Machin
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gee Yen Shin
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tabitha Mahungu
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Kordo Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Tranprit Saluja
- Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Yusri Taha
- Department of Virology and Infectious Diseases, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Nikunj Mahida
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Cassie Pope
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Anu Chawla
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Asif Tamuri
- Research Computing, University College London, London, United Kingdom
| | - Rachel Williams
- Department of Genetics and Genomic Medicine, University College London, London, United Kingdom
| | - Alistair Darby
- Centre for Genomic Research, University of Liverpool, Liverpool, United Kingdom
| | - David L Robertson
- MRC-University of Glasgow Centre For Virus Research, University of Glasgow, Glasgow, United Kingdom
| | - Flavia Flaviani
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Eleni Nastouli
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Samuel Robson
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, United Kingdom
| | - Darren Smith
- Department of Applied Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Kenneth Laing
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Irene Monahan
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | | | - Sam Haldenby
- Centre for Genomic Research, University of Liverpool, Liverpool, United Kingdom
| | - Ryan George
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Bashton
- Department of Applied Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Adam A Witney
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Matthew Byott
- Advanced Pathogen Diagnostics, University College London, London, United Kingdom
| | - Francesc Coll
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, United Kingdom
| | - Gaia Nebbia
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David G Partridge
- Directorate of Laboratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew Parker
- Sheffield Bioinformatics Core, University of Sheffield, Sheffield, United Kingdom
| | | | | | - Sunando Roy
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Luke B Snell
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Thushan I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Emma Thomson
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, United Kingdom
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Andrew Copas
- Institute for Global Health, University College London, London, United Kingdom
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, United Kingdom
| |
Collapse
|
16
|
Poole S, Tanner AR, Naidu VV, Borca F, Phan H, Saeed K, Grocott MPW, Dushianthan A, Moyses H, Clark TW. Molecular point-of-care testing for lower respiratory tract pathogens improves safe antibiotic de-escalation in patients with pneumonia in the ICU: results of a randomised controlled trial. J Infect 2022; 85:625-633. [PMID: 36096312 DOI: 10.1016/j.jinf.2022.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Effective treatment of pneumonia requires timely administration of appropriate antimicrobials but standard diagnostic tests take around 48 hours to generate results. Highly accurate, rapid molecular tests have been developed for identifying organisms in lower respiratory tract samples, however their impact on antibiotic use is unknown. The aim of this study was to assess the impact of syndromic molecular point-of-care testing compared to conventional diagnostic testing, on antibiotic use. METHODS In this pragmatic, randomised controlled trial, we enrolled critically ill adults with pneumonia. Patients were assigned (1:1) to molecular testing of samples at the point-of-care or routine clinical care. The primary outcome was the proportion of patients who received results-directed antimicrobial therapy. RESULTS 200 patients were randomly assigned to point-of-care testing (n=100) or the control group (n=100). 85 patients had community acquired pneumonia (42 in the mPOCT group and 43 in the control group), 69 hospital acquired pneumonia (30 in mPOCT and 39 in control) and 46 ventilator associated pneumonia (28 in mPOCT and 18 in control). The median [IQR] time to results was 1.7 [1.6-1.9] hours for point-of-care testing and 66.7 [56.7-88.5] hours for standard diagnostics (difference of -65.0 hours, 95%CI -68.0 to -62.0; p<0.0001). 71 (71%) patients in the point-of-care testing arm had pathogens detected compared to 51 (51%) in the control arm (difference of 20%, 95%CI 7 to 33; p=0.004). 80 (80%) of patients in the point-of-care group received results-directed therapy, compared with 29 (29%) of 99 in the control group (difference of 51%, 95%CI 39-63; p<0.0001). Time to results-directed therapy was 2.3 [1.8-7.2] hours in the mPOCT group and 46.1 [23.0-51.5] hours in the control group (difference of -43.8 hours, 95% CI -48.9 to -38.6; p<0.0001). 42 (42%) patients in mPOCT group had antibiotics de-escalated compared with 8 (8%) of 98 in the control group (difference of 34%, 95%CI 23-45; p<0.0001). Time to de-escalation was 4.8 [2.4-13.0] hours in the mPOCT group compared with 46.5 [26.3-48.6] hours in the control group (difference of -41.4 hours, 95%CI -53 to -29.7; p<0.0001). There was no major difference in antibiotic duration or in clinical or safety outcomes between the two groups. CONCLUSIONS Use of molecular point-of-care testing in patients with pneumonia returned results more rapidly and identified more pathogens than conventional testing. This was associated with improvements in appropriate antimicrobial use and appeared safe.
Collapse
Affiliation(s)
- Stephen Poole
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Alex R Tanner
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vasanth V Naidu
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Florina Borca
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical Informatics Research Unit, University of Southampton, Southampton, UK
| | - Hang Phan
- Clinical Informatics Research Unit, University of Southampton, Southampton, UK
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Michael P W Grocott
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ahilanandan Dushianthan
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Helen Moyses
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan W Clark
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Post-Doctoral Fellowship Programme, UK
| |
Collapse
|
17
|
Sozio E, Moore NA, Fabris M, Ripoli A, Rumbolo F, Minieri M, Boverio R, Rodríguez Mulero MD, Lainez-Martinez S, Martínez Martínez M, Calvo D, Gregoriano C, Williams R, Brazzi L, Terrinoni A, Callegari T, Hernández Olivo M, Esteban-Torrella P, Calcerrada I, Bernasconi L, Kidd SP, Sbrana F, Miguens I, Gordon K, Visentini D, Legramante JM, Bassi F, Cortes N, Montrucchio G, Di Lecce VN, Lauritano EC, García de Guadiana-Romualdo L, González del Castillo J, Bernal-Morell E, Andaluz-Ojeda D, Schuetz P, Curcio F, Tascini C, Saeed K. Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin. Respir Res 2022; 23:221. [PMID: 36031619 PMCID: PMC9420187 DOI: 10.1186/s12931-022-02151-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mid-Regional pro-Adrenomedullin (MR-proADM) is an inflammatory biomarker that improves the prognostic assessment of patients with sepsis, septic shock and organ failure. Previous studies of MR-proADM have primarily focussed on bacterial infections. A limited number of small and monocentric studies have examined MR-proADM as a prognostic factor in patients infected with SARS-CoV-2, however there is need for multicenter validation. An evaluation of its utility in predicting need for hospitalisation in viral infections was also performed. Methods An observational retrospective analysis of 1861 patients, with SARS-CoV-2 confirmed by RT-qPCR, from 10 hospitals across Europe was performed. Biomarkers, taken upon presentation to Emergency Departments (ED), clinical scores, patient demographics and outcomes were collected. Multiclass random forest classifier models were generated as well as calculation of area under the curve analysis. The primary endpoint was hospital admission with and without death. Results Patients suitable for safe discharge from Emergency Departments could be identified through an MR-proADM value of ≤ 1.02 nmol/L in combination with a CRP (C-Reactive Protein) of ≤ 20.2 mg/L and age ≤ 64, or in combination with a SOFA (Sequential Organ Failure Assessment) score < 2 if MR-proADM was ≤ 0.83 nmol/L regardless of age. Those at an increased risk of mortality could be identified upon presentation to secondary care with an MR-proADM value of > 0.85 nmol/L, in combination with a SOFA score ≥ 2 and LDH > 720 U/L, or in combination with a CRP > 29.26 mg/L and age ≤ 64, when MR-proADM was > 1.02 nmol/L. Conclusions This international study suggests that for patients presenting to the ED with confirmed SARS-CoV-2 infection, MR-proADM in combination with age and CRP or with the patient’s SOFA score could identify patients at low risk where outpatient treatment may be safe.
Collapse
|
18
|
Jennings M, Burova M, Hamilton LG, Hunter E, Morden C, Pandya D, Beecham R, Moyses H, Saeed K, Afolabi PR, Calder PC, Dushianthan A. Body mass index and clinical outcome of severe COVID-19 patients with acute hypoxic respiratory failure: Unravelling the “obesity paradox” phenomenon. Clin Nutr ESPEN 2022; 51:377-384. [PMID: 36184231 PMCID: PMC9356629 DOI: 10.1016/j.clnesp.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
Background and aims Although obesity have been generally shown to be an independent risk factor for poor outcomes in COVID-19 infection, some studies demonstrate a paradoxical protective effect (“obesity paradox”). This study examines the influence of obesity categories on clinical outcomes of severe COVID-19 patients admitted to an intensive care unit with acute hypoxic respiratory failure requiring either non-invasive or invasive mechanical ventilation. Methods This is a single centre, retrospective study of consecutive COVID-19 patients admitted to the intensive care unit between 03/2020 to 03/2021. Patients were grouped according to the NICE Body Mass Index (BMI) category. Admission variables including age, sex, comorbidities, and ICU severity indices (APACHE-II, SOFA and PaO2/FiO2) were collected. Data were compared between BMI groups for outcomes such as need for invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and 28-day and overall hospital mortality. Results 340 patients were identified and of those 333 patients had their BMI documented. Just over half of patients (53%) had obesity. Those with extreme obesity (obesity groups II and III) were younger with fewer comorbidities, but were more hypoxaemic at presentation, than the healthy BMI group. Although non-significant, obesity groups II and III paradoxically showed a lower in-hospital mortality than the healthy weight group. However, adjusted (age, sex, APACHE-II and CCI) competing risk regression analysis showed three-times higher mortality in obese category I (sub-distribution hazard ratio = 3.32 (95% CI 1.30–8.46), p = 0.01) and a trend to higher mortality across all obesity groups compared to the healthy weight group. Conclusions In this cohort, those with obesity were at higher risk of mortality after adjustment for confounders. We did not identify an “obesity paradox” in this cohort. The obesity paradox may be explained by confounding factors such as younger age, fewer comorbidities, and less severe organ failures. The impact of obesity on indicators of morbidity including likelihood of requirement for organ support measures was not conclusively demonstrated and requires further scrutiny.
Collapse
Affiliation(s)
- Michael Jennings
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Maria Burova
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Laura G Hamilton
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Elsie Hunter
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Clare Morden
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Darshni Pandya
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Ryan Beecham
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Helen Moyses
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Paul R Afolabi
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Philip C Calder
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK.
| |
Collapse
|
19
|
Dushianthan A, Griffiths M, Hall F, Nolan K, Richardson D, Skinner B, Matthews L, Charles D, Elsheikh R, Pignatari R, Rahman R, Theivendrampillai S, Egglestone R, Stokes A, Danibenvenutti G, Stewart M, Celinski M, Cusack R, Gupta S, Saeed K. Caring for COVID-19 patients through a pandemic in the intensive care setting: A narrative review. WIREs Mech Dis 2022; 14:e1577. [PMID: 35835688 PMCID: PMC9350295 DOI: 10.1002/wsbm.1577] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/20/2022] [Accepted: 06/23/2022] [Indexed: 12/21/2022]
Abstract
Since the declaration of the novel SARS-CoV-2 virus pandemic, health systems/ health-care-workers globally have been overwhelmed by a vast number of COVID-19 related hospitalizations and intensive care unit (ICU) admissions. During the early stages of the pandemic, the lack of formalized evidence-based guidelines in all aspects of patient management was a significant challenge. Coupled with a lack of effective pharmacotherapies resulted in unsatisfactory outcomes in ICU patients. The anticipated increment in ICU surge capacity was staggering, with almost every ICU worldwide being advised to increase their capacity to allow adequate care provision in response to multiple waves of the pandemic. This increase in surge capacity required advanced planning and reassessments at every stage, taking advantage of experienced gained in combination with emerging evidence. In University Hospital Southampton General Intensive Care Unit (GICU), despite the initial lack of national and international guidance, we enhanced our ICU capacity and developed local guidance on all aspects of care to address the rapid demand from the increasing COVID-19 admissions. The main element of this success was a multidisciplinary team approach intertwined with equipment and infrastructural reorganization. This narrative review provides an insight into the approach adopted by our center to manage patients with COVID-19 critical illness, exploring the initial planning process, including contingency preparations to accommodate (360% capacity increment) and adaptation of our management pathways as more evidence emerged throughout the pandemic to provide the most appropriate levels of care to our patients. We hope our experience will benefit other intensive care units worldwide. This article is categorized under: Infectious Diseases > Genetics/Genomics/Epigenetics.
Collapse
Affiliation(s)
- Ahilanadan Dushianthan
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Melanie Griffiths
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fiona Hall
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kathleen Nolan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dominic Richardson
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Benjamin Skinner
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lewis Matthews
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David Charles
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Razaz Elsheikh
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Renato Pignatari
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rezaur Rahman
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Rebecca Egglestone
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aaron Stokes
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Giovani Danibenvenutti
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Stewart
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Celinski
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rebecca Cusack
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Gupta
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kordo Saeed
- Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Infection, Microbiology Laboratory, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
20
|
Russell AR, Petridou C, Saeed K, Jeppessen C, Sheridan E, Okyere S, Lee M, Dryden M, Lovett J. Review of the clinical spectrum of typical and atypical Lyme neuroborreliosis in southwest England. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundLyme disease is endemic in the UK with a high incidence in southwest England. Neurological involvement occurs in approximately 5% of infected individuals. Previous reviews in southwest England have shown a consistent phenotype in most cases, however anecdotal review suggests a small number of atypical cases, with diverse presentations, which provide a diagnostic challenge, even to experienced neurologists.MethodsWe performed a retrospective, observational study of all identified cases (positive screening ELISA confirmed by immunoblot and neurological symptoms) of neuroborreliosis from six hospitals between January 2015 and December 2017. In addition, we reviewed atypical cases seen over the last decade in the regional neurosciences centre in depth.Results72 patients were included in the observational study. 83% had characteristics of Bannwarth’s syndrome (cranial neuropathy, radiculopathy and CSF pleocytosis). Unusual cases included mononeu- ritis multiplex.Central nervous system involvement was rare. We saw cases presenting with cerebrovascular events, meningitis and encephalitis. Complete resolution of symptoms was reported in 72% of patients. 28% of patients reported residual symptoms, most commonly fatigue and memory problems.ConclusionsThis is the largest UK review of neuroborreliosis. The presentation is usually typical, but atypical presentations vary and can be challenging. The majority of patients recover fully.amyrossrussell@gmail.com
Collapse
|
21
|
Cotton E, Geraghty R, Umranikar S, Saeed K, Somani B. Prevalence of asymptomatic bacteriuria among pregnant women and changes in antibiotic resistance: a 6-year retrospective study. Journal of Clinical Urology 2022. [DOI: 10.1177/20514158221095672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Asymptomatic bacteriuria (ASB) during pregnancy is a risk factor for development of urinary tract infections and pyelonephritis, which can lead to maternal and foetal consequences. This study aimed to determine the prevalence of ASB during pregnancy, the most common causative pathogens and their resistance patterns. Methods: A retrospective analysis was performed using microbiology laboratory data from urine sample cultures from pregnant women collected at our University hospital over a 6-year period (2014–2019). Identification and susceptibility testing were performed using standard microbiology procedures based on British Society of Antimicrobial Chemotherapy and European Committee on Antimicrobial Susceptibility Testing. Results: From a total of 18,938 urine samples, 1522 (8.04%) were positive for bacteriuria, the most common isolates were Escherichia coli and Coliform (lactose fermenters) ( n = 1171, 76.9%), followed by Enterococcus faecalis and other enterococci ( n = 191, 12.5%). In 2019, the resistance of E. coli was 56.8%, 25.3% and 4.7% to amoxicillin, trimethoprim and gentamicin, respectively, with an increasing pattern of resistance to trimethoprim and gentamicin from 2014 to 2019. The resistance rates to nitrofurantoin were 1% and 5.5% for E. coli and Group B Streptococcus, respectively. Conclusion: Our study shows the trends of antimicrobial resistance in this vulnerable group and will help confirm treatment effectiveness and direct guideline recommendations locally and internationally. Level of Evidence: 2b
Collapse
Affiliation(s)
- Erin Cotton
- Faculty of Medicine Health and Life Sciences, University of Southampton, Southampton, UK
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Sameer Umranikar
- Department of Obstetrics, University Hospital Southampton, Southampton, UK
| | - Kordo Saeed
- Department of Microbiology, University of Southampton, Southampton, UK
| | - Bhaskar Somani
- Faculty of Medicine Health and Life Sciences, University of Southampton, Southampton, UK
- Department of Urology, University Hospital Southampton, Southampton, UK
| |
Collapse
|
22
|
Dadhwal K, Stonham R, Breen H, Poole S, Saeed K, Dushianthan A. Severe COVID‐19 pneumonia in an intensive care setting and comparisons with historic severe viral pneumonia due to other viruses. Clinical Respiratory J 2022; 16:301-308. [PMID: 35202498 PMCID: PMC9060033 DOI: 10.1111/crj.13482] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/20/2021] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
Purpose Severe viral pneumonia is associated with significant morbidity and mortality. Recent COVID‐19 pandemic continues to impose significant health burden worldwide, and individual pandemic waves often lead to a large surge in the intensive care unit (ICU) admissions for respiratory support. Comparisons of severe SARS‐CoV‐2 pneumonia with other seasonal and nonseasonal severe viral infections are rarely studied in an intensive care setting. Methods A retrospective cohort study comparing patients admitted to ICU with COVID‐19 between March and June 2020 and those with viral pneumonias between January and December 2019. We compared patient specific demographic variables, duration of illness, ICU organ supportive measures and outcomes between both groups. Results Analysis of 93 COVID‐19 (Group 1) and 52 other viral pneumonia patients (Group 2) showed an increased proportion of obesity (42% vs. 23%, p = 0.02), non‐White ethnicities (41% vs. 6%, p < 0.001) and diabetes mellitus (30% vs. 13%, p = 0.03) in Group 1, with lower prevalence of chronic obstructive pulmonary disease (COPD)/asthma (16% vs. 34%, p = 0.02). In Group 1, the neutrophil to lymphocyte ratio was much lower (6.7 vs. 10, p = 0.006), and invasive mechanical ventilation (58% vs. 26%, p < 0.001) was more common. Length of ICU (8 vs. 4, p < 0.001) and hospital stay (22 vs. 11, p < 0.001) was prolonged in Group 1, with no significant difference in mortality. Influenza A and rhinovirus were the most common pathogens in Group 2 (26% each). Conclusions Key differences were identified within demographics (obesity, ethnicity, age, ICU scores, comorbidities) and organ support. Despite these variations, there were no significant differences in mortality between both groups. Further studies with larger sample sizes would allow for further assessment of clinical parameters in these patients.
Collapse
Affiliation(s)
- Kiran Dadhwal
- General Intensive Care Unit University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Rosalind Stonham
- General Intensive Care Unit University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Hannah Breen
- Department of Microbiology University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Stephen Poole
- Faculty of Medicine, University Hospital Southampton University of Southampton Southampton UK
| | - Kordo Saeed
- Department of Microbiology University Hospital Southampton NHS Foundation Trust Southampton UK
- Faculty of Medicine, University Hospital Southampton University of Southampton Southampton UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit University Hospital Southampton NHS Foundation Trust Southampton UK
- Faculty of Medicine, University Hospital Southampton University of Southampton Southampton UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton University of Southampton Southampton UK
| |
Collapse
|
23
|
Austin P, Hand K, Macnaughtan J, Saeed K, Harding S, Smith C, Elia M. An evidence-based surveillance tool to identify and report catheter/cannula bloodstream infection in patients receiving parenteral nutrition. Nutrition 2022; 98:111639. [DOI: 10.1016/j.nut.2022.111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/10/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
|
24
|
|
25
|
Shahi AK, Ahmed-Saeed N, Taylor I, Kiernan S, Mahobia N, Pelosi E, Saeed K. Environmental contamination and personal protective equipment contamination with SARS-CoV-2 virus in a real-life clinical setting. J Infect Prev 2022; 23:7-10. [PMID: 35126674 PMCID: PMC8811231 DOI: 10.1177/17571774211033348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/19/2021] [Indexed: 01/03/2023] Open
Abstract
The importance of SARS-CoV-2 transmission via contact routes and its stability on surfaces is becoming increasingly recognised. There is ongoing concern that patients can become infected through person-to-person spread and environment-to-person spread. This study assessed whether SARS-CoV-2 viral RNA can be detected in the environment either on staff members' personal protective equipment (PPE), on high-touch surfaces or around the bedspace of COVID-19-positive patients in a range of different ward settings to evaluate if there was any contamination of these. Results showed all PPE and high-touch surface swabs were negative. All swabs taken in the negative-pressure room where aerosol-generating procedures (AGPs) were being undertaken detected viral RNA (5/5 positive), whereas there was minimal contamination in the intensive therapy unit (1/5 positive) and none detected in the cohort bay. These findings would be consistent with the understanding that areas where AGPs are regularly performed are at higher risk of environmental contamination.
Collapse
Affiliation(s)
- Avneet K Shahi
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK,Avneet K Shahi, Department of Infection, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
| | - Nusreen Ahmed-Saeed
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Isobel Taylor
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Sharon Kiernan
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Nitin Mahobia
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Emanuela Pelosi
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Kordo Saeed
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK,Department of Experimental Sciences, University of Southampton, School of Medicine, Southampton, UK
| |
Collapse
|
26
|
Reed TAN, Shtaya A, Beard K, Saeed K, Glover S, Fabian M, Baraka M, McGillion S. Aspergillus fumigatus causing vertebral osteomyelitis in an immunocompetent patient: a case report and literature review. Infez Med 2022; 31:108-112. [PMID: 36908391 PMCID: PMC9994825 DOI: 10.53854/liim-3101-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/28/2023] [Indexed: 03/07/2023]
Abstract
Aspergillus vertebral osteomyelitis causing deformity in immunocompetent patients is uncommon. We describe a previously healthy 68-year-old male who was referred after 2 years of lower thoracic back pain and gibbus. His inflammatory markers and HIV test were normal. Imaging demonstrated bony destruction of T12/L1 and L2 with vertebral collapse. Following inconclusive CT-guided biopsy, he underwent reconstructive spinal surgery. Histopathology showed fungi and Aspergillus fumigatus was cultured. He was treated with isavuconazole 200 mg once daily for 12 months with a satisfactory clinical outcome. We present a summary of recently published cases of atraumatic Aspergillus vertebral osteomyelitis in immunocompetent patients without risk factors. Fungal infection should be considered in culture-negative spondylodiscitis, even in the absence of risk factors.
Collapse
Affiliation(s)
- Thomas A N Reed
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anan Shtaya
- University of Southampton, Clinical and Experimental Sciences, Southampton, UK.,Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kate Beard
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton, Clinical and Experimental Sciences, Southampton, UK
| | - Sarah Glover
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Fabian
- Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mohammad Baraka
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen McGillion
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
27
|
Houghton R, Moore N, Williams R, El-Bakri F, Peters J, Mori M, Vernet G, Lynch J, Lewis H, Tavener M, Durham T, Bowyer J, Saeed K, Pollara G. C-reactive protein-guided use of procalcitonin in COVID-19. JAC Antimicrob Resist 2021; 3:dlab180. [PMID: 34859223 PMCID: PMC8633792 DOI: 10.1093/jacamr/dlab180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/03/2021] [Indexed: 01/31/2023] Open
Abstract
Background A low procalcitonin (PCT) concentration facilitates exclusion of bacterial co-infections in COVID-19, but high costs associated with PCT measurements preclude universal adoption. Changes in inflammatory markers, including C-reactive protein (CRP), can be concordant, and predicting low PCT concentrations may avoid costs of redundant tests and support more cost-effective deployment of this diagnostic biomarker. Objectives To explore whether, in COVID-19, low PCT values could be predicted by the presence of low CRP concentrations. Methods Unselected cohort of 224 COVID-19 patients admitted to hospital that underwent daily PCT and CRP measurements as standard care. Both 0.25 ng/mL and 0.5 ng/mL were used as cut-offs for positive PCT test results. Geometric mean was used to define high and low CRP values at each timepoint assessed. Results Admission PCT was <0.25 ng/mL in 160/224 (71.4%), 0.25–0.5 ng/mL in 27 (12.0%) and >0.5 ng/mL in 37 (16.5%). Elevated PCT was associated with increased risk of death (P = 0.0004) and was more commonly associated with microbiological evidence of bacterial co-infection (P < 0.0001). For high CRP values, significant heterogeneity in PCT measurements was observed, with maximal positive predictive value of 50% even for a PCT cut-off of 0.25 ng/mL. In contrast, low CRP was strongly predictive of low PCT concentrations, particularly <0.5 ng/mL, with a negative predictive value of 97.6% at time of hospital admission and 100% 48 hours into hospital stay. Conclusions CRP-guided PCT testing algorithms can reduce unnecessary PCT measurement and costs, supporting antimicrobial stewardship strategies in COVID-19.
Collapse
Affiliation(s)
| | - Nathan Moore
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | | | | | | | - Matilde Mori
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | | | - Jessica Lynch
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Henry Lewis
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | | | - Tom Durham
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Jack Bowyer
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Kordo Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Medicine, University of Southampton, Southampton, UK
| | - Gabriele Pollara
- Royal Free London NHS Foundation Trust, London, UK.,University College London, London, UK
| |
Collapse
|
28
|
Abstract
Recurrent urinary tract infections are a common problem faced by clinicians across many specialities. For the patient, recurrent urinary tract infections can be burdensome and detrimental to their quality of life. For the clinician, they can be challenging to manage, and the socioeconomic burden on healthcare systems can also be substantial. Investigations serve to rule out any underlying structural or pathological abnormalities. In conjunction with behavioural prevention methods, treatment strategies include antibiotic and non-antibiotic approaches and holistic management approaches. This article provides an overview of the investigation and treatment of urinary tract infections and includes algorithms which can be used in daily clinical practice.
Collapse
Affiliation(s)
- Thomas Hughes
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Louis Saada
- Department of Medicine, Guy's and St Thomas' Hospital, London, UK
| | - Kordo Saeed
- Department of Microbiology, Great Western Hospital, Swindon, UK
| | | |
Collapse
|
29
|
Boshier FAT, Venturini C, Stirrup O, Guerra-Assunção JA, Alcolea-Medina A, Becket AH, Byott M, Charalampous T, Filipe ADS, Frampton D, Glaysher S, Khan T, Kulasegara-Shylini R, Kele B, Monahan IM, Mollett G, Parker M, Pelosi E, Randell P, Roy S, Taylor JF, Weller SJ, Wilson-Davies E, Wade P, Williams R, Copas AJ, Cutino-Moguel T, Freemantle N, Hayward AC, Holmes A, Hughes J, Mahungu TW, Nebbia G, Nastouli E, Partridge DG, Pope CF, Price JR, Robson SC, Saeed K, Shin GY, de Silva TI, Snell LB, Thomson EC, Witney AA, Breuer J. The Alpha variant was not associated with excess nosocomial SARS-CoV-2 infection in a multi-centre UK hospital study. J Infect 2021; 83:693-700. [PMID: 34610391 PMCID: PMC8487101 DOI: 10.1016/j.jinf.2021.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Recently emerging SARS-CoV-2 variants have been associated with an increased rate of transmission within the community. We sought to determine whether this also resulted in increased transmission within hospitals. METHODS We collected viral sequences and epidemiological data of patients with community and healthcare associated SARS-CoV-2 infections, sampled from 16th November 2020 to 10th January 2021, from nine hospitals participating in the COG-UK HOCI study. Outbreaks were identified using ward information, lineage and pairwise genetic differences between viral sequences. RESULTS Mixed effects logistic regression analysis of 4184 sequences showed healthcare-acquired infections were no more likely to be identified as the Alpha variant than community acquired infections. Nosocomial outbreaks were investigated based on overlapping ward stay and SARS-CoV-2 genome sequence similarity. There was no significant difference in the number of patients involved in outbreaks caused by the Alpha variant compared to outbreaks caused by other lineages. CONCLUSIONS We find no evidence to support it causing more nosocomial transmission than previous lineages. This suggests that the stringent infection prevention measures already in place in UK hospitals contained the spread of the Alpha variant as effectively as other less transmissible lineages, providing reassurance of their efficacy against emerging variants of concern.
Collapse
Affiliation(s)
- Florencia A T Boshier
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Cristina Venturini
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, United Kingdom
| | - José Afonso Guerra-Assunção
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Adela Alcolea-Medina
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Infection Sciences, Viapath, London, United Kingdom
| | - Angela H Becket
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth PO1 2DT, United Kingdom; School of Biological Sciences, University of Portsmouth, Portsmouth PO1 2DY, United Kingdom
| | - Matthew Byott
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom; The Francis Crick Institute, London, United Kingdom
| | - Themoula Charalampous
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Ana da Silva Filipe
- MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Dan Frampton
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Infection and Immunity, University College London, London, United Kingdom
| | - Sharon Glaysher
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom
| | - Tabassum Khan
- Division of Infection, The Royal London Hospital, Barts Health, United Kingdom
| | | | - Beatrix Kele
- Division of Infection, The Royal London Hospital, Barts Health, United Kingdom
| | - Irene M Monahan
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Guy Mollett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Matthew Parker
- Sheffield Bioinformatics Core, The University of Sheffield, Sheffield, United Kingdom; Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, United Kingdom; Sheffield Biomedical Research Centre, The University of Sheffield, Sheffield, United Kingdom
| | - Emanuela Pelosi
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Paul Randell
- Department of Infection and Immunity, North West London Pathology, London, United Kingdom
| | - Sunando Roy
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Joshua F Taylor
- Department of Microbiology, South West London Pathology, Jenner Wing, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Sophie J Weller
- Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Eleri Wilson-Davies
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Phillip Wade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The Florey Institute for Host-Pathogen Interactions and Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Rachel Williams
- Department of Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Andrew J Copas
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Nick Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Alison Holmes
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, United Kingdom; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Tabitha W Mahungu
- Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Gaia Nebbia
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Eleni Nastouli
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; The Francis Crick Institute, London, United Kingdom
| | - David G Partridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The Florey Institute for Host-Pathogen Interactions and Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Cassie F Pope
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom; Infection Care Group, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | - James R Price
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Samuel C Robson
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth PO1 2DT, United Kingdom; School of Biological Sciences, University of Portsmouth, Portsmouth PO1 2DY, United Kingdom; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, United Kingdom
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, United Kingdom; Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Tremona Road, Southampton, United Kingdom
| | - Gee Yen Shin
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Thushan I de Silva
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The Florey Institute for Host-Pathogen Interactions and Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Luke B Snell
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Adam A Witney
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Judith Breuer
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
30
|
Stonham R, Monck C, Orchard L, Baker L, Ahmad-Saeed N, Friar S, Samaraweera B, Mahanama A, Pelosi E, Wilson-Davies E, Dushianthan A, Saeed K. Can a quantitative assessment of SARS-CoV-2 PCR predict degree of severity and outcomes in critical care patients with COVID-19? Infez Med 2021; 29:386-392. [PMID: 35146343 PMCID: PMC8805500 DOI: 10.53854/liim-2903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/04/2021] [Indexed: 06/14/2023]
Abstract
Real-Time polymerase chain reaction (qPCR) is the gold standard diagnostic method for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cycle threshold (Ct) is defined as the number of heating and cooling cycles required during the PCR process. Ct-values are inversely proportional to the amount of target nucleic acid in a sample. Our aim, in this retrospective study, was to determine the impact of serial SARS-CoV-2 qPCR Ct-values on: mortality, need for mechanical ventilation (MV) and development of acute kidney injury (AKI) in patients admitted to the intensive care unit (ICU) with COVID-19. Ct values were evaluated during the time points from pre-ICU admission to week 1, week 2 and week 3 during ICU stay; impact on mortality, need for MV and AKI was determined. There was a continuous increment in Ct-values over the ICU stay from 1st week through to 3rd week. Although not significant, lower ICU 1st week Ct-values were associated with Black ethnicity, increased need for MV and mortality. However, patients who had developed AKI at any stage of their illness had significantly lower Ct-values compared to those with normal renal function. When ICU 1st-week Ct-values are subcategorised as <20, 20-30 and >30 the 28-day survival probability was less for patients with Ct-values of <20. This report shows that the impact of Ct-values and outcomes, especially AKI, among patients at different time points prior to and during ICU stay, larger studies are required to confirm out findings.
Collapse
Affiliation(s)
- Rosalind Stonham
- General Intensive Care Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Chantelle Monck
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Laurence Orchard
- General Intensive Care Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Laurence Baker
- General Intensive Care Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Nusreen Ahmad-Saeed
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Simon Friar
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Buddhini Samaraweera
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Ministry of Health, Sri-Lanka
| | - Adhyana Mahanama
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Ministry of Health, Sri-Lanka
| | - Emanuela Pelosi
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Eleri Wilson-Davies
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
| | - Kordo Saeed
- Faculty of Medicine, University of Southampton, Southampton, UK
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
31
|
Dushianthan A, Abdul N, Dmochowski J, James I, Heesom L, Westwood J, Effney J, Bruty S, Saeed K, Rangarajan S, Kazmi R. Predictive Role of Haematological Determinants on Outcomes of Critically Ill COVID-19 Patients Admitted to Intensive Care Unit. Cureus 2021; 13:e16764. [PMID: 34476137 PMCID: PMC8403496 DOI: 10.7759/cureus.16764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The mortality of patients admitted to the intensive care unit (ICU) with COVID-19 remains significantly high. Severe COVID-19 pneumonia is characterised by refractory hypoxemia with significant shunting due to a combination of alveolar damage, vascular vasoconstriction, and occlusion due to microthrombi. Similar pathological features are seen in extra-pulmonary organs. However, the influence of thrombotic markers on the risk of mechanical ventilation (MV) and the development of acute kidney injury (AKI) is not fully defined. Methods: This was a cross-sectional evaluation of haemostatic and thrombotic markers of COVID-19 patients admitted to the ICU to determine their predictability for the development of thromboembolism and the need for non-invasive or invasive MV, development of AKI, and mortality. Results: An extended coagulation profile was obtained in 71 SARS-CoV-2 positive patients admitted to the ICU. All patients had acute severe hypoxic respiratory failure and required non-invasive or invasive MV. There were increases in peak D-dimer (3.0 mg/L), factor VIII levels (255 IU/dL) vWF antigen (471 IU/dL) with low ADAMTS13 activity (54.7 IU/dL) compared to the reference ranges. Peak D-dimer was consistently raised in patients who developed AKI and required invasive MV. ADAMTS13/vWF/platelet axis was associated with disease severity, multi-organ dysfunction, and mortality. Conclusions: Haematological abnormalities are a common feature of severe COVID-19 pneumonia. We found peak D-dimer and vWF-ADAMTS13-platelet axis are associated with increased ICU severity and outcome in severe COVID-19 patients admitted to ICU. Larger studies are needed to evaluate this more comprehensively.
Collapse
Affiliation(s)
- Ahilanandan Dushianthan
- Faculty of Medicine, University of Southampton, Southampton, GBR.,National Institute for Health Research Southampton Clinical Research Facility and National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, GBR.,General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Nabil Abdul
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Josh Dmochowski
- Haematology, University Hospital Southmapton, Southampton, GBR
| | - Izabela James
- Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Lesley Heesom
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Jennifer Westwood
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Judith Effney
- Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Sarah Bruty
- Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Kordo Saeed
- Microbiology Innovation and Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Savita Rangarajan
- Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Rashid Kazmi
- Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| |
Collapse
|
32
|
Stirrup O, Boshier F, Venturini C, Guerra-Assunção JA, Alcolea-Medina A, Beckett A, Charalampous T, da Silva Filipe A, Glaysher S, Khan T, Kulasegaran Shylini R, Kele B, Monahan I, Mollett G, Parker M, Pelosi E, Randell P, Roy S, Taylor J, Weller S, Wilson-Davies E, Wade P, Williams R, Copas A, Cutino-Moguel MT, Freemantle N, Hayward AC, Holmes A, Hughes J, Mahungu T, Nebbia G, Partridge D, Pope C, Price J, Robson S, Saeed K, de Silva T, Snell L, Thomson E, Witney AA, Breuer J. SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study. BMJ Open Respir Res 2021; 8:e001029. [PMID: 34544733 PMCID: PMC8453594 DOI: 10.1136/bmjresp-2021-001029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND SARS-CoV-2 lineage B.1.1.7 has been associated with an increased rate of transmission and disease severity among subjects testing positive in the community. Its impact on hospitalised patients is less well documented. METHODS We collected viral sequences and clinical data of patients admitted with SARS-CoV-2 and hospital-onset COVID-19 infections (HOCIs), sampled 16 November 2020 to 10 January 2021, from eight hospitals participating in the COG-UK-HOCI study. Associations between the variant and the outcomes of all-cause mortality and intensive therapy unit (ITU) admission were evaluated using mixed effects Cox models adjusted by age, sex, comorbidities, care home residence, pregnancy and ethnicity. FINDINGS Sequences were obtained from 2341 inpatients (HOCI cases=786) and analysis of clinical outcomes was carried out in 2147 inpatients with all data available. The HR for mortality of B.1.1.7 compared with other lineages was 1.01 (95% CI 0.79 to 1.28, p=0.94) and for ITU admission was 1.01 (95% CI 0.75 to 1.37, p=0.96). Analysis of sex-specific effects of B.1.1.7 identified increased risk of mortality (HR 1.30, 95% CI 0.95 to 1.78, p=0.096) and ITU admission (HR 1.82, 95% CI 1.15 to 2.90, p=0.011) in females infected with the variant but not males (mortality HR 0.82, 95% CI 0.61 to 1.10, p=0.177; ITU HR 0.74, 95% CI 0.52 to 1.04, p=0.086). INTERPRETATION In common with smaller studies of patients hospitalised with SARS-CoV-2, we did not find an overall increase in mortality or ITU admission associated with B.1.1.7 compared with other lineages. However, women with B.1.1.7 may be at an increased risk of admission to intensive care and at modestly increased risk of mortality.
Collapse
Affiliation(s)
- Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Florencia Boshier
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Cristina Venturini
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - José Afonso Guerra-Assunção
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Adela Alcolea-Medina
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
- Infection Sciences, Viapath, London, UK
| | - Angela Beckett
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
- School of Biological Sciences, University of Portsmouth, Portsmouth, UK
| | - Themoula Charalampous
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
| | | | - Sharon Glaysher
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Tabassum Khan
- Division of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Beatrix Kele
- Division of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Irene Monahan
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Guy Mollett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Matthew Parker
- Sheffield Bioinformatics Core, The University of Sheffield, Sheffield, UK
- Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, UK
- Sheffield Biomedical Research Centre, The University of Sheffield, Sheffield, UK
| | - Emanuela Pelosi
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Randell
- Department of Infection and Immunity, North West London Pathology, London, UK
| | - Sunando Roy
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joshua Taylor
- Department of Microbiology, South West London Pathology, St. George's Hospital, London, UK
| | - Sophie Weller
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
| | - Eleri Wilson-Davies
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Phillip Wade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Rachel Williams
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alison Holmes
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Tabitha Mahungu
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
| | - Gaia Nebbia
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
- Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - David Partridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Cassie Pope
- Institute for Infection and Immunity, St George's University of London, London, UK
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - James Price
- Imperial College Healthcare NHS Trust, London, UK
| | - Samuel Robson
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Kordo Saeed
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Thushan de Silva
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Luke Snell
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
- Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Emma Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Adam A Witney
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Judith Breuer
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
33
|
Luqman L, Saeed K, Muhammad K, Ahmad MS, Akbar F, Rasool A, Israr M, Jabeen H, Mehmood SA, Ahmed S, Alam A, Ullah S, Saeed N, Usman K, Hussain I, El Halim HMA, Khan W, Shah M. Biodiversity of orb-web spiders (family: araneidae) of buner valley, Pakistan. BRAZ J BIOL 2021; 82:e238339. [PMID: 34161423 DOI: 10.1590/1519-6984.238339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/28/2020] [Indexed: 11/21/2022] Open
Abstract
The present research was carried out to explore the spider fauna of Buner valley with taxonomic study from February 2018 to January 2019. For this purpose samples were collected, four times at each month from 4 tehsils: Daggar, Gagra, Mandan and Totalai. Two methods were used, hand picking and sweep net for collection of samples. During day and night, three habitats, arid area, agriculture land and building area were search for collection. A total of 534 samples of spider were collected from four sampling sites, in which 379 were belonging to family Araniedae. After confirmation, the identified species were belonging to 8 genera (Neoscona, Argiope, Cyclosa, Araneus, Cyrtophora, Larinia, Erivoxia and Poltys) and 19 species. 18 of them were identified to specie level while a single specie to its generic level. The genus Neoscona was the dominant genus 26.31% having 5 species while the genus Argiope 21.05% is the second dominant having 4 species followed by Cyclosa 15.78% having 3 species followed by Cyrtophora and Araneus 10.52% having two species both. The Poltys and Larinia 5.26% are the rarest genera represent single-single specie both. Statistical analysis show that specie richness (D) = 5.77, Simpson index (1-D) = 0.87, Shannon index (H) = 2.33. Diversity of spiders was evenly distributed and calculated Evenness value was H/InS = 0.5408. There is also few atypical species and Fisher alpha estimate high value (Fisher α) = 4.42. Chao-1 estimated we have reported 22 species.
Collapse
Affiliation(s)
- L Luqman
- Department of Zoology, University of Buner, Khyber Pakhtunkhwa, Pakistan
| | - K Saeed
- Department of Zoology, University of Buner, Khyber Pakhtunkhwa, Pakistan
| | - K Muhammad
- Department of Genetics, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakista
| | - M S Ahmad
- Department of Zoology, University of Swabi, Khyber Pakhtunkhwa, Pakistan
| | - F Akbar
- Centre for Biotechnology & Microbiology, University of Swat, Khyber Pakhtunkhwa, Pakistan
| | - A Rasool
- Centre for Biotechnology & Microbiology, University of Swat, Khyber Pakhtunkhwa, Pakistan
| | - M Israr
- Department of Forensic Sciences, University of Swat, Khyber Pakhtunkhwa, Pakistan
| | - H Jabeen
- Department of Microbiology, Women University Mardan, Khyber Pakhtunkhwa, Pakistan
| | - S A Mehmood
- Department of Zoology, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - S Ahmed
- Department of Zoology, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - A Alam
- Department of Zoology, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - S Ullah
- Department of Zoology, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - N Saeed
- Department of Zoology, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - K Usman
- Department of Zoology, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - I Hussain
- Department of Zoology, Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan
| | | | - W Khan
- Department of Zoology, University of Malakand, Chakdara, Khyber Pakhtunkhwa, Pakistan
| | - M Shah
- Centre for Animal Sciences & Fisheries, University of Swat, Khyber Pakhtunkhwa, Pakistan
| |
Collapse
|
34
|
Ullah N, Ullah I, Israr M, Rasool A, Akbar F, Ahmad MS, Ahmad S, Mehmood SA, Jabeen H, Saeed K, Khan W, Siraj M, Shah M. Comparative brain analysis of wild and hatchery reared Mahseer (Tor putitora) relative to their body weight and length. BRAZ J BIOL 2021; 82:e231509. [PMID: 34076158 DOI: 10.1590/1519-6984.231509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 09/14/2020] [Indexed: 11/22/2022] Open
Abstract
The present study was aimed at comparing the brain size of mahseer (Tor putitora) in relation to their body weight and standard length, to investigate the potential impact of rearing environment on brain development in fish. The weight of the brain and three of its subdivisions cerebellum (CB), optic tectum (OT), and telencephalon (TC) were measured for both wild and hatchery-reared fish. The data was analysed using multiple analysis of covariance (MANCOVA), analysis of covariance (ANCOVA), and discriminate function analysis (DFA). We found the fish reared under hatchery conditions exhibit smaller brain size related to body weight, when compared to the wild ones. A significant (p<0.5) difference was observed in the length of CB and OT concerning the standard body length while no significant difference was found in TC of the fish from both the origins. The results of the current study highlight a logical assumption that neural deficiency affects the behaviour of fish, that's why the captive-reared fish show maladaptive response and face fitness decline when released to the natural environment for wild stock enhancement. The current study concluded that hatchery-reared fish exhibit variations in gross brain morphology as compared to their wild counterpart.
Collapse
Affiliation(s)
- N Ullah
- Centre for Animal Sciences and Fisheries, University of Swat, Swat, Pakistan
| | - I Ullah
- Centre for Animal Sciences and Fisheries, University of Swat, Swat, Pakistan
| | - M Israr
- Department of Forensics Sciences, University of Swat, Swat, Pakistan
| | - A Rasool
- Centre for Biotechnology and Microbiology, University of Swat, Swat, Pakistan
| | - F Akbar
- Centre for Biotechnology and Microbiology, University of Swat, Swat, Pakistan
| | - M S Ahmad
- Department of Zoology, University of Swabi, Swabi, Pakistan
| | - S Ahmad
- Department of Zoology, Hazara University Mansehra, Mansehra, Pakistan
| | - S A Mehmood
- Department of Zoology, Hazara University Mansehra, Mansehra, Pakistan
| | - H Jabeen
- Department of Microbiology, Women University Mardan, Mardan, Pakistan
| | - K Saeed
- Department of Zoology, University of Buner, Buner, Pakistan
| | - W Khan
- Department of Zoology, University of Malakand, Chakdara, Pakistan
| | - M Siraj
- Department of Zoology, Abbottabad University of Science & Technology, Abbottabad, Pakistan
| | - M Shah
- Centre for Animal Sciences and Fisheries, University of Swat, Swat, Pakistan
| |
Collapse
|
35
|
Hussain I, Mehmood SA, Ahmed S, Salim M, Hussain A, Noureen S, Ahmed D, Israr M, Akbar F, Rasool A, Jabeen H, Saeed K, Alam A, Sanaullah, Usman K, Saeed N, Khan W, Shah M. Systematic analysis of leisler's bat Nyctalus leisleri (Kuhl, 1817) captured from FATA region, Pakistan. BRAZ J BIOL 2021; 82:e238337. [PMID: 33978080 DOI: 10.1590/1519-6984.238337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/28/2020] [Indexed: 11/21/2022] Open
Abstract
Extensive field surveys were carried out to explore the distribution of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) in selected area of FATA regions, Pakistan. Specimens of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) (n5) were collected from Kurram Agency (Shublan) (N33.8229788 E70.1634414) at elevation 1427m and Khyber Agency (Landi Kotel) (N34.0909899 E71.1457517) at elevation 1091m for two years survey extending from May 2013 through August 2015. The mean head and body length, hind foot length, ear length and tail length the Nyctalus leisleri specimens captured from the study area was 65.08 ± 1.58 mm, 44.06 ± 0.52 mm, 8.38 ± 0.60 mm, 13.20 ± 0.99 mm and 39.46 ± 1.46 mm, respectively. For molecular analysis the sequences of COI gene were obtained and analyzed. The mean intraspecific divergences of Nyctalus leisleri was 0.04%. The mean interspecific divergences of Nyctalus noctula and Nyctalus leisleri was 0.2%. The mean concentration of each nucleotides was A = (26.3%), T = (32.8%), G = (15.9%) and C = (25.0%). The mean A+T contents were 59.2%and C+G were 40.9%. In the phylogenetic tree Nyctalus leisleri and Nyctalus noctula clustered with significant bootstrap support value.
Collapse
Affiliation(s)
- I Hussain
- Hazara University Mansehra, Department of Zoology, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - S A Mehmood
- Hazara University Mansehra, Department of Zoology, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - S Ahmed
- Hazara University Mansehra, Department of Zoology, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - M Salim
- University of Haripur, Department of Forestry and Wildlife Management, Haripur, Khyber-Pakhtunkhwa, Pakistan
| | - A Hussain
- University of Haripur, Department of Forestry and Wildlife Management, Haripur, Khyber-Pakhtunkhwa, Pakistan
| | - S Noureen
- University of Haripur, Department of Forestry and Wildlife Management, Haripur, Khyber-Pakhtunkhwa, Pakistan
| | - D Ahmed
- University of Haripur, Department of Medical Lab Technology, Haripur, Khyber-Pakhtunkhwa, Pakistan
| | - M Israr
- University of Swat, Department of Forensic Sciences, Swat, Khyber-Pakhtunkhwa, Pakistan
| | - F Akbar
- University of Swat, Centre for Biotechnology & Microbiology, Swat, Khyber-Pakhtunkhwa, Pakistan
| | - A Rasool
- University of Swat, Centre for Biotechnology & Microbiology, Swat, Khyber-Pakhtunkhwa, Pakistan
| | - H Jabeen
- Women University Mardan, Department of Microbiology, Mardan, Khyber Pakhtunkhwa, Pakistan
| | - K Saeed
- University of Buner, Department of Zoology, Swari, Khyber Pakhtunkhwa, Pakistan
| | - A Alam
- Hazara University Mansehra, Department of Zoology, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - Sanaullah
- Hazara University Mansehra, Department of Zoology, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - K Usman
- Hazara University Mansehra, Department of Zoology, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - N Saeed
- Hazara University Mansehra, Department of Zoology, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - W Khan
- University of Malakand, Department of Zoology, Chakdara, Khyber Pakhtunkhwa, Pakistan
| | - M Shah
- University of Swat, Centre for Animal Science & Fisheries, Saidu Sharif, Khyber Pakhtunkhwa, Pakistan
| |
Collapse
|
36
|
Russell Day H, Bond JB, Gupta B, Saeed K, Breazzano MP. Should Routine Eye Examinations Be Included in Treatment Bundles for Patients with Candidemia? J Infect Dis 2021; 224:1626-1627. [DOI: 10.1093/infdis/jiab182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/30/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- H Russell Day
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John B Bond
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bhaskar Gupta
- Ophthalmology Department, Southampton University Hospitals NHS Foundation Trust, Southampton, United Kingdom
| | - Kordo Saeed
- Microbiology Department, Southampton University Hospitals NHS Foundation Trust, Southampton, United Kingdom
| | - Mark P Breazzano
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
37
|
Saeed K, Legramante JM, Angeletti S, Curcio F, Miguens I, Poole S, Tascini C, Sozio E, Del Castillo JG. Mid-regional pro-adrenomedullin as a supplementary tool to clinical parameters in cases of suspicion of infection in the emergency department. Expert Rev Mol Diagn 2021; 21:397-404. [PMID: 33736553 DOI: 10.1080/14737159.2021.1902312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mid-regional proadrenomedullin (MR-proADM), a novel biomarker, has recently gained interest particularly with regards to its potential in assisting clinicians' decision making in patients with suspicion of infection in the emergency department (ED). A group of international experts, with research and experience in MR-proADM applications, produced this review based on their own experience and the currently available literature. AREAS COVERED The review provides evidence related to MR-proADM as a triaging tool in avoiding unnecessary admissions to hospital and/or inadequate discharge, and identifying patients most at risk of deterioration. It also covers the use of MR-proADM in the context of COVID-19. Moreover, the authors provide a proposal on how to incorporate MR-proADM into patients' clinical pathways in an ED setting. EXPERT OPINION The data we have so far on the application of MR-proADM in the ED is promising. Incorporating it into clinical scoring systems may aid the clinician's decision making and recognizing the 'ill looking well' and the 'well looking ill' sooner. However there are still many gaps in our knowledge especially during the ongoing COVID-19 waves. There is also a need for cost-effectiveness analysis studies especially in the era of increasing cost pressures on health systems globally.
Collapse
Affiliation(s)
- Kordo Saeed
- Microbiology Innovation and Research UNIT, Department of Infection, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,School of Medicine, University of Southampton, Southampton, UK
| | | | - Silvia Angeletti
- Clinical Pathology, University Hospital Campus Bio-Medico of Rome Science Unit, University Campus Bio-Medico of Rome, Faculty of Medicine University Campus Bio-Medico of Rome, Italy
| | - Francesco Curcio
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Iria Miguens
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Stephen Poole
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carlo Tascini
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | | |
Collapse
|
38
|
Schwarz EM, McLaren AC, Sculco TP, Brause B, Bostrom M, Kates SL, Parvizi J, Alt V, Arnold WV, Carli A, Chen AF, Choe H, Coraça‐Huber DC, Cross M, Ghert M, Hickok N, Jennings JA, Joshi M, Metsemakers W, Ninomiya M, Nishitani K, Oh I, Padgett D, Ricciardi B, Saeed K, Sendi P, Springer B, Stoodley P, Wenke JC. Adjuvant antibiotic-loaded bone cement: Concerns with current use and research to make it work. J Orthop Res 2021; 39:227-239. [PMID: 31997412 PMCID: PMC7390691 DOI: 10.1002/jor.24616] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 02/04/2023]
Abstract
Antibiotic-loaded bone cement (ALBC) is broadly used to treat orthopaedic infections based on the rationale that high-dose local delivery is essential to eradicate biofilm-associated bacteria. However, ALBC formulations are empirically based on drug susceptibility from routine laboratory testing, which is known to have limited clinical relevance for biofilms. There are also dosing concerns with nonstandardized, surgeon-directed, hand-mixed formulations, which have unknown release kinetics. On the basis of our knowledge of in vivo biofilms, pathogen virulence, safety issues with nonstandardized ALBC formulations, and questions about the cost-effectiveness of ALBC, there is a need to evaluate the evidence for this clinical practice. To this end, thought leaders in the field of musculoskeletal infection (MSKI) met on 1 August 2019 to review and debate published and anecdotal information, which highlighted four major concerns about current ALBC use: (a) substantial lack of level 1 evidence to demonstrate efficacy; (b) ALBC formulations become subtherapeutic following early release, which risks induction of antibiotic resistance, and exacerbated infection from microbial colonization of the carrier; (c) the absence of standardized formulation protocols, and Food and Drug Administration-approved high-dose ALBC products to use following resection in MSKI treatment; and (d) absence of a validated assay to determine the minimum biofilm eradication concentration to predict ALBC efficacy against patient specific micro-organisms. Here, we describe these concerns in detail, and propose areas in need of research.
Collapse
Affiliation(s)
- Edward M. Schwarz
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Alex C. McLaren
- Department of Orthopaedic Surgery, College of Medicine‐Phoenix University of Arizona Phoenix Arizona
| | - Thomas P. Sculco
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Barry Brause
- Department of Infectious Diseases, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Mathias Bostrom
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Stephen L. Kates
- Department of Orthopaedic Surgery Virginia Commonwealth University Richmond Virginia
| | - Javad Parvizi
- Department of Orthopaedics Rothman Institute at Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Volker Alt
- Department of Trauma Surgery University Medical Centre Regensburg Regensburg Germany
| | - William V. Arnold
- Department of Orthopaedics Rothman Institute at Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Alberto Carli
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Antonia F. Chen
- Department of Orthopaedics, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts
| | - Hyonmin Choe
- Department of Orthopaedic Yokohama City University Yokohama Japan
| | - Débora C. Coraça‐Huber
- Department of Orthopaedic Surgery, Experimental Orthopedics, Research Laboratory for Biofilms and Implant Associated Infections Medical University of Innsbruck Innsbruck Austria
| | - Michael Cross
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery McMaster University Hamilton Ontario Canada
| | - Noreen Hickok
- Department of Orthopaedic Surgery, Department of Biochemistry & Molecular Biology Thomas Jefferson University Philadelphia Pennsylvania
| | | | - Manjari Joshi
- Division of Infectious Diseases, R Adams Cowley Shock Trauma Center University of Maryland Baltimore Maryland
| | | | - Mark Ninomiya
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Kohei Nishitani
- Department of Orthopaedic Surgery Graduate School of Medicine, Kyoto University Sakyo Kyoto Japan
| | - Irvin Oh
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Douglas Padgett
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Benjamin Ricciardi
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Kordo Saeed
- Southampton University Hospitals NHS Foundation Trust, Department of Microbiology, Microbiology and Innovation Research Unit (MIRU) and University of Southampton, School of Medicine Southampton UK
| | - Parham Sendi
- Institute for Infectious Diseases University of Bern, Bern and Department of Infectious Diseases, Hospital Epidemiology and Department of Orthopaedics and Traumatology, University of Basel Basel Switzerland
- Department of Orthopaedics and Traumatology University Hospital Basel Basel Switzerland
| | - Bryan Springer
- Department of Orthopaedic Surgery, OrthoCarolina Hip and Knee Center Atrium Musculoskeletal Institute Charlotte North Carolina
| | - Paul Stoodley
- Department of Microbial Infection and Immunity and Orthopaedics The Ohio State University Columbus Ohio
| | - Joseph C. Wenke
- Orthopaedic Trauma Department U.S. Army Institute of Surgical Research Fort Sam Houston Texas
| | | |
Collapse
|
39
|
Saeed K, Sendi P, Arnold WV, Bauer TW, Coraça-Huber DC, Chen AF, Choe H, Daiss JL, Ghert M, Hickok NJ, Nishitani K, Springer BD, Stoodley P, Sculco TP, Brause BD, Parvizi J, McLaren AC, Schwarz EM. Bacterial toxins in musculoskeletal infections. J Orthop Res 2021; 39:240-250. [PMID: 32255540 PMCID: PMC7541548 DOI: 10.1002/jor.24683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/27/2020] [Accepted: 04/01/2020] [Indexed: 02/04/2023]
Abstract
Musculoskeletal infections (MSKIs) remain a major health burden in orthopaedics. Bacterial toxins are foundational to pathogenesis in MSKI, but poorly understood by the community of providers that care for patients with MSKI, inducing an international group of microbiologists, infectious diseases specialists, orthopaedic surgeons and biofilm scientists to review the literature in this field to identify key topics and compile the current knowledge on the role of toxins in MSKI, with the goal of illuminating potential impact on biofilm formation and dispersal as well as therapeutic strategies. The group concluded that further research is needed to maximize our understanding of the effect of toxins on MSKIs, including: (i) further research to identify the roles of bacterial toxins in MSKIs, (ii) establish the understanding of the importance of environmental and host factors and in vivo expression of toxins throughout the course of an infection, (iii) establish the principles of drug-ability of antitoxins as antimicrobial agents in MSKIs, (iv) have well-defined metrics of success for antitoxins as antiinfective drugs, (v) design a cocktail of antitoxins against specific pathogens to (a) inhibit biofilm formation and (b) inhibit toxin release. The applicability of antitoxins as potential antimicrobials in the era of rising antibiotic resistance could meet the needs of day-to-day clinicians.
Collapse
Affiliation(s)
- Kordo Saeed
- University Hospital Southampton NHS Foundation Trust, Department of Microbiology, Microbiology Innovation and Research Unit (MIRU), Southampton, UK; and University of Southampton, School of Medicine, Southampton UK
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology/ Department of Orthopaedics and Traumatology, University Hospital Basel, University Basel, Basel, Switzerland
| | - William V. Arnold
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Thomas W. Bauer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, Hospital for Special Surgery, New York, NY, USA
| | - Débora C. Coraça-Huber
- Research Laboratory for Implant Associated Infections (Biofilm Lab), Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Antonia F. Chen
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - John L. Daiss
- Center for Musculoskeletal Research, School of Medicine and Dentistry University of Rochester, Rochester, NY, USA
| | - Michelle Ghert
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Noreen J. Hickok
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Bryan D. Springer
- OrthoCarolina Hip and Knee Center, Atrium Musculoskeletal Institute, Charlotte, NC, USA
| | - Paul Stoodley
- Departments of Microbial Infection and Immunity and OrthopedicsInfectious Diseases Institute, The Ohio State University, 716 Biomedical Research Tower, 460 West 12th Avenue, Columbus OH, Canada
- National Centre for Microbial Tribology at Southampton (nCATS), National Biofilm Innovation Centre (NBIC), Mechanical Engineering, University of Southampton, Southampton, UK.
| | - Thomas P. Sculco
- Department of Orthopaedic Surgery, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Barry D. Brause
- Department of Infectious Diseases, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Javad Parvizi
- Department of Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alex C. McLaren
- Department of Orthopaedic Surgery, University of Arizona, College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Edward M. Schwarz
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester, Rochester, NY, USA
| |
Collapse
|
40
|
Orchard L, Baldry M, Nasim-Mohi M, Monck C, Saeed K, Grocott MPW, Ahilanandan D. Vitamin-D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 patients. Clin Chem Lab Med 2021; 59:1155-1163. [PMID: 33554566 DOI: 10.1515/cclm-2020-1567] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/28/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The pattern of global COVID-19 has caused many to propose a possible link between susceptibility, severity and vitamin-D levels. Vitamin-D has known immune modulatory effects and deficiency has been linked to increased severity of viral infections. METHODS We evaluated patients admitted with confirmed SARS-COV-2 to our hospital between March-June 2020. Demographics and outcomes were assessed for those admitted to the intensive care unit (ICU) with normal (>50 nmol/L) and low (<50 nmol/L) vitamin-D. RESULTS There were 646 SARS-COV-2 PCR positive hospitalisations and 165 (25.5%) had plasma vitamin-D levels. Fifty patients were admitted to ICU. There was no difference in vitamin-D levels of those hospitalised (34, IQR 18.5-66 nmol/L) and those admitted to the ICU (31.5, IQR 21-42 nmol/L). Higher proportion of vitamin-D deficiency (<50 nmol/L) noted in the ICU group (82.0 vs. 65.2%). Among the ICU patients, low vitamin D level (<50 nmol/L) was associated with younger age (57 vs. 67 years, p=0.04) and lower cycle threshold (CT) real time polymerase chain reaction values (RT-PCR) (26.96 vs. 33.6, p=0.02) analogous to higher viral loads. However, there were no significant differences in ICU clinical outcomes (invasive and non-invasive mechanical ventilation, acute kidney injury and mechanical ventilation and hospital days) between patients with low and normal vitamin-D levels. CONCLUSIONS Despite the association of low vitamin-D levels with low CT values, there is no difference in clinical outcomes in this small cohort of critically ill COVID-19 patients. The complex relationship between vitamin-D levels and COVID-19 infection needs further exploration with large scale randomized controlled trials.
Collapse
Affiliation(s)
- Laurence Orchard
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Matthew Baldry
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Myra Nasim-Mohi
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chantelle Monck
- Southampton Specialist Virology Centre, University of Southampton School of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kordo Saeed
- Microbiology Innovation and Research Unit, Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton University, Hospital Southampton, Southampton, UK
| | - Michael P W Grocott
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton University, Hospital Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
| | - Dushianthan Ahilanandan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton University, Hospital Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
| |
Collapse
|
41
|
Gregoriano C, Koch D, Kutz A, Haubitz S, Conen A, Bernasconi L, Hammerer-Lercher A, Saeed K, Mueller B, Schuetz P. The vasoactive peptide MR-pro-adrenomedullin in COVID-19 patients: an observational study. Clin Chem Lab Med 2021; 59:995-1004. [PMID: 33554516 DOI: 10.1515/cclm-2020-1295] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Midregional pro-adrenomedullin (MR-proADM) is a vasoactive peptide with key roles in reducing vascular hyperpermeability and thereby improving endothelial stability during infection. While MR-proADM is useful for risk stratification in patients with sepsis, clinical data about prediction accuracy in patients with severe acute respiratory syndrome coronavirus 2 disease (COVID-19) is currently missing. METHODS We included consecutively adult patients hospitalized for confirmed COVID-19 at a tertiary care center in Switzerland between February and April 2020. We investigated the association of MR-proADM levels with in-hospital mortality in logistic regression and discrimination analyses. RESULTS Of 89 included COVID-19 patients, 19% (n=17) died while in the hospital. Median admission MR-proADM levels (nmol/L) were increased almost 1.5-fold increased in non-survivors compared to survivors (1.3 [interquartile range IQR 1.1-2.3]) vs. 0.8 [IQR 0.7-1.1]) and showed good discrimination (area under the curve 0.78). An increase of 1 nmol/L of admission MR-proADM was independently associated with a more than fivefold increase in in-hospital mortality (adjusted odds ratio of 5.5, 95% confidence interval 1.4-21.4, p=0.015). An admission MR-proADM threshold of 0.93 nmol/L showed the best prognostic accuracy for in-hospital mortality with a sensitivity of 93%, a specificity of 60% and a negative predictive value of 97%. Kinetics of follow-up MR-proADM provided further prognostic information for in-hospital treatment. CONCLUSIONS Increased levels of MR-proADM on admission and during hospital stay were independently associated with in-hospital mortality and may allow a better risk stratification, and particularly rule-out of fatal outcome, in COVID-19 patients.
Collapse
Affiliation(s)
- Claudia Gregoriano
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland
| | - Anna Conen
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Kordo Saeed
- Microbiology Innovation and Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton, School of Medicine Tremona Road Southampton, Southampton, UK
| | - Beat Mueller
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
42
|
Saeed K, Pelosi E, Mahobia N, White N, Labdon C, Ahmad-Saeed N, Grieves A, Johnstone P, Higgs D, Jeramiah S, Dailly S, Henderson T, Stringfellow M, Wilson-Davies E, Grundy P. Investigations, actions and learning from an outbreak of SARS-CoV-2 infection among healthcare workers in the United Kingdom. J Infect Prev 2020; 22:156-161. [PMID: 34295376 DOI: 10.1177/1757177420976798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/26/2020] [Indexed: 01/14/2023] Open
Abstract
Background We report an outbreak of SARS coronavirus-2 (SARS-CoV-2) infection among healthcare workers (HCW) in an NHS elective healthcare facility. Methodology A narrative chronological account of events after declaring an outbreak of SARS-CoV-2 among HCWs. As part of the investigations, HCWs were offered testing during the outbreak. These were: (1) screening by real-time reverse transcriptase polymerase chain reaction (RT- PCR) to detect a current infection; and (2) serum samples to determine seroprevalence. Results Over 180 HCWs were tested by real-time RT-PCR for SARS-CoV-2 infection. The rate of infection was 15.2% (23.7% for clinical or directly patient-facing HCWs vs. 4.8% in non-clinical non-patient-facing HCWs). Of the infected HCWs, 57% were asymptomatic. Seroprevalence (SARS-CoV-2 IgG) among HCWs was 13%. It was challenging to establish an exact source for the outbreak. The importance of education, training, social distancing and infection prevention practices were emphasised. Additionally, avoidance of unnecessary transfer of patients and minimising cross-site working for staff and early escalation were highlighted. Establishing mass and regular screening for HCWs are also crucial to enabling the best care for patients while maintaining the wellbeing of staff. Conclusion To our knowledge, this is the first UK outbreak report among HCWs and we hope to have highlighted some key issues and learnings that can be considered by other NHS staff and HCWs globally when dealing with such a task in future.
Collapse
Affiliation(s)
- Kordo Saeed
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK.,Department of Experimental Sciences, School of Medicine, University of Southampton, Southampton, UK
| | - Emanuela Pelosi
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Nitin Mahobia
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Nicola White
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Christopher Labdon
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Nusreen Ahmad-Saeed
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Ashley Grieves
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Penelope Johnstone
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - David Higgs
- Trauma and Orthopaedics Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Jeramiah
- Infection Prevention Department, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Sue Dailly
- Infection Prevention Department, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | | | | | - Eleri Wilson-Davies
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Paul Grundy
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| |
Collapse
|
43
|
Jog M, Zudovaite I, O'Dwyer M, Saeed K, Singh T. Single-use lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical spray; can it now be employed as a multi-use atomiser? J Laryngol Otol 2020; 134:1-4. [PMID: 32940198 DOI: 10.1017/s0022215120001917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigated the risk of contamination of lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution after modification of the application technique. METHODS This paper reports a prospective basic sciences study involving 22 study samples and 1 control sample of the lidocaine hydrochloride and phenylephrine hydrochloride topical anaesthetic spray. The samples were assessed for microbiological contamination after a single use on patients using a modified application technique. The modification involves keeping the nozzle (actuator) pressed down whilst withdrawing the spray to at least 30 cm (1 ft) from the patient, before releasing the nozzle (actuator) and subsequently reapplying the spray. RESULTS Three of the 23 samples confirmed bacterial growth in the bottle contents, but there was no growth in any of the samples from the pump. These bacteria are considered to be contaminants. CONCLUSION There is a potential to use the lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution as a multi-use spray by changing the actuator between patients. This would have significant beneficial cost implications without the attendant infection control risk.
Collapse
Affiliation(s)
- M Jog
- Department of Otolaryngology, University Hospital Southampton NHS Foundation Trust, UK
| | - I Zudovaite
- Department of Microbiology, University Hospital Southampton NHS Foundation Trust and Microbiology and Innovation Research Unit, UK
| | - M O'Dwyer
- Department of Microbiology, University Hospital Southampton NHS Foundation Trust and Microbiology and Innovation Research Unit, UK
| | - K Saeed
- Department of Microbiology, University Hospital Southampton NHS Foundation Trust and Microbiology and Innovation Research Unit, UK
- School of Medicine, University of Southampton, UK
| | - T Singh
- Department of Otolaryngology, University Hospital Southampton NHS Foundation Trust, UK
| |
Collapse
|
44
|
Poole S, Townsend J, Wertheim H, Kidd SP, Welte T, Schuetz P, Luyt CE, Beishuizen A, Jensen JUS, Del Castillo JG, Plebani M, Saeed K. How are rapid diagnostic tests for infectious diseases used in clinical practice: a global survey by the International Society of Antimicrobial Chemotherapy (ISAC). Eur J Clin Microbiol Infect Dis 2020; 40:429-434. [PMID: 32902760 PMCID: PMC7478941 DOI: 10.1007/s10096-020-04031-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
Abstract
Novel rapid diagnostic tests (RDTs) offer huge potential to optimise clinical care and improve patient outcomes. In this study, we aim to assess the current patterns of use around the world, identify issues for successful implementation and suggest best practice advice on how to introduce new tests. An electronic survey was devised by the International Society of Antimicrobial Chemotherapy (ISAC) Rapid Diagnostics and Biomarkers working group focussing on the availability, structure and impact of RDTs around the world. It was circulated to ISAC members in December 2019. Results were collated according to the UN human development index (HDI). 81 responses were gathered from 31 different countries. 84% of institutions reported the availability of any test 24/7. In more developed countries, this was more for respiratory viruses, whereas in high and medium/low developed countries, it was for HIV and viral hepatitis. Only 37% of those carrying out rapid tests measured the impact. There is no 'one-size fits all' solution to RDTs: the requirements must be tailored to the healthcare setting in which they are deployed and there are many factors that should be considered prior to this.
Collapse
Affiliation(s)
- Stephen Poole
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Heiman Wertheim
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - Stephen P Kidd
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Tobias Welte
- Department of Respiratory Medicine and member of the German Centre of Lung Research, Medizinische Hochschule, Hannover, Germany
| | - Philipp Schuetz
- Internal Medicine and Emergency Medicine Endocrinology, Diabetes & Clinical Nutrition Medical University, Department Kantonsspital Aarau, Tellstrasse CH, -5001, Aarau, Switzerland
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Jens-Ulrik Stæhr Jensen
- Department of Internal Medicine, Respiratory Medicine Section, Herlev-Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | | | - Mario Plebani
- School of Medicine and Surgery, University of Padova, & Centre of Biomedical Research, Vento Region, Padova, Italy
| | - Kordo Saeed
- School of Medicine, University of Southampton, Southampton, UK. .,Microbiology Innovation and Research Unit (MIRU), Microbiology Department, Southampton University Hospitals NHS Foundation Trust, Southampton, SO16 6YD, UK.
| |
Collapse
|
45
|
Schuetz P, Beishuizen A, Broyles M, Ferrer R, Gavazzi G, Gluck EH, González Del Castillo J, Jensen JU, Kanizsai PL, Kwa ALH, Krueger S, Luyt CE, Oppert M, Plebani M, Shlyapnikov SA, Toccafondi G, Townsend J, Welte T, Saeed K. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clin Chem Lab Med 2020; 57:1308-1318. [PMID: 30721141 DOI: 10.1515/cclm-2018-1181] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 12/16/2018] [Indexed: 12/16/2022]
Abstract
Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the fixed cut-offs to only one for mild to moderate and one for severe disease (0.25 μg/L and 0.5 μg/L, respectively). Further, guidance on interpretation of PCT results to initiate, withhold or discontinue ABx treatment was included. Conclusions A combination of clinical patient assessment with PCT levels in well-defined ABS algorithms, in context with continuous education and regular feedback to all ABS stakeholders, has the potential to improve the diagnostic and therapeutic management of patients suspected of bacterial infection, thereby improving ABS effectiveness.
Collapse
Affiliation(s)
- Philipp Schuetz
- Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.,University of Basel, Basel, Switzerland, Phone: +41 (0) 79 365 10 06, Fax: 41 (0) 62 838 9524
| | | | | | - Ricard Ferrer
- Department of Intensive Care. Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gaetan Gavazzi
- University Clinics of Geriatrics, University Hospital of Grenoble-Alpes, GREPI EA7408 University of Grenoble Alpes, Grenoble, France
| | | | | | - Jens-Ulrik Jensen
- Respiratory Medicine Section, Department of Internal Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark.,CHIP & PERSIMUNE, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | | | - Andrea Lay Hoon Kwa
- Singapore General Hospital, Singapore, Singapore; Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Stefan Krueger
- Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf, Germany.,Clinic for Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michael Oppert
- Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Mario Plebani
- Azienda Ospedaliera-Universitata di Padova, Padua, Italy
| | - Sergey A Shlyapnikov
- Severe Sepsis Center, Scientific Research Institute of Emergency, St. Petersburg, Russian Federation.,North-West University-Mechnikov, St. Petersburg, Russian Federation
| | - Giulio Toccafondi
- Department for Health of the Tuscany Region, Clinical Risk Management and Patient Safety Centre of Tuscany Region, Florence, Italy
| | | | - Tobias Welte
- University of Hannover, Hannover Medical School, Hannover, Germany; and Member of the German Center of Lung Research
| | - Kordo Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, UK.,University of Southampton, School of Medicine, Southampton, UK
| |
Collapse
|
46
|
Heesom L, Rehnberg L, Nasim-Mohi M, Jackson AIR, Celinski M, Dushianthan A, Cook P, Rivinberg W, Saeed K. Procalcitonin as an antibiotic stewardship tool in COVID-19 patients in the intensive care unit. J Glob Antimicrob Resist 2020; 22:782-784. [PMID: 32717489 PMCID: PMC7381395 DOI: 10.1016/j.jgar.2020.07.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Lesley Heesom
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton, UK
| | - Lucas Rehnberg
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton, UK
| | - Myra Nasim-Mohi
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton, UK
| | - Alexander I R Jackson
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Michael Celinski
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton, UK
| | - Ahilanadan Dushianthan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton, UK
| | - Paul Cook
- Department of Biochemistry University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - William Rivinberg
- Department of Biochemistry University Hospital Southampton NHS Foundation Trust, University of Southampton School of Medicine, Southampton, UK
| | - Kordo Saeed
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospitals Southampton NHS Foundation Trust, and University of Southampton School of Medicine, Southampton, UK; International Society of Antimicrobial Chemotherapy (ISAC), Chair of Rapid Diagnostics and Biomarker Working Group.
| |
Collapse
|
47
|
Wilson DC, Schefold JC, Baldirà J, Spinetti T, Saeed K, Elke G. Adrenomedullin in COVID-19 induced endotheliitis. Crit Care 2020; 24:411. [PMID: 32646523 PMCID: PMC7347255 DOI: 10.1186/s13054-020-03151-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/03/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Darius Cameron Wilson
- Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Institut of Research, Barcelona, Spain.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jaume Baldirà
- Intensive Care Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Thibaud Spinetti
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kordo Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| |
Collapse
|
48
|
Guerreiro FD, Mumith A, Saeed K. Serum Procalcitonin as an adjunct in diagnosing prosthetic joint infection in total knee replacement and total hip replacement. Infez Med 2020; 28:6-10. [PMID: 32172255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There are still many unknowns regarding the potential application of Procalcitonin (PCT) as an adjunct to aid the diagnosis of Prosthetic Joint Infection. A systematic review searching scientific articles was performed with keywords "Procalcitonin", "Total Hip Replacement", and "Total Knee Replacement" (n=123). After review of the abstract and full text for relevance, ten articles were included (n=10). Serum PCT levels for chronic Total Hip Replacement (THR) and Total Knee Replacement (TKR) have a range of mean values from 1.5 ng/ml to 14.2 ng/ml. Specificity ranges from 0.27 to 0.98, while sensitivity is from 0.33 to 0.9. On primary THR/TKR with confirmation of non-infected status, serum PCT peaks between 1-3 days post-operatively, with peak levels varying from 0.12 - 0.79 ng/ml. Based on this review, serum PCT is not a good adjunct in diagnosing Prosthetic Joint Infection (PJI). Synovial fluid PCT fluid may add better clinical support but requires further studies. There were several limitations with this review: the studies are small and heterogeneous, there was a variable definition of PJI, and there was a wide range of mean values, sensitivity and specificity.
Collapse
Affiliation(s)
| | - Aadil Mumith
- Royal Hampshire County Hospital, Hampshire Hospital NHS Foundation Trust, Winchester, England, United Kingdom
| | - Kordo Saeed
- University Hospital Southampton NHS Foundation Trust and University of Southampton, England, United Kingdom
| |
Collapse
|
49
|
Cox E, Saeed K, White G. Procalcitonin use in the presence of ambiguous physiological parameters: a help or a hindrance on the acute medical unit? J Hosp Infect 2019; 104:395-396. [PMID: 31738989 DOI: 10.1016/j.jhin.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Affiliation(s)
- E Cox
- Royal Hampshire County Hospital, Winchester, UK.
| | - K Saeed
- Royal Hampshire County Hospital, Winchester, UK
| | - G White
- Royal Hampshire County Hospital, Winchester, UK
| |
Collapse
|
50
|
Mawer D, Byrne F, Drake S, Brown C, Prescott A, Warne B, Bousfield R, Skittrall JP, Ramsay I, Somasunderam D, Bevan M, Coslett J, Rao J, Stanley P, Kennedy A, Dobson R, Long S, Obisanya T, Esmailji T, Petridou C, Saeed K, Brechany K, Davis-Blue K, O'Horan H, Wake B, Martin J, Featherstone J, Hall C, Allen J, Johnson G, Hornigold C, Amir N, Henderson K, McClements C, Liew I, Deshpande A, Vink E, Trigg D, Guilfoyle J, Scarborough M, Scarborough C, Wong THN, Walker T, Fawcett N, Morris G, Tomlin K, Grix C, O'Cofaigh E, McCaffrey D, Cooper M, Corbett K, French K, Harper S, Hayward C, Reid M, Whatley V, Winfield J, Hoque S, Kelly L, King I, Bradley A, McCullagh B, Hibberd C, Merron M, McCabe C, Horridge S, Taylor J, Koo S, Elsanousi F, Saunders R, Lim F, Bond A, Stone S, Milligan ID, Mack DJF, Nagar A, West RM, Wilcox MH, Kirby A, Sandoe JAT. Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea. J Hosp Infect 2019; 103:200-209. [PMID: 31077777 DOI: 10.1016/j.jhin.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.
Collapse
Affiliation(s)
- D Mawer
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.
| | - F Byrne
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - S Drake
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - C Brown
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - A Prescott
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - B Warne
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - R Bousfield
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - J P Skittrall
- Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK
| | - I Ramsay
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - D Somasunderam
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - M Bevan
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Coslett
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Rao
- Department of Microbiology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK
| | - P Stanley
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - A Kennedy
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - R Dobson
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - S Long
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Obisanya
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Esmailji
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - C Petridou
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Brechany
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Davis-Blue
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - H O'Horan
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - B Wake
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - J Martin
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - J Featherstone
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - C Hall
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - J Allen
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - G Johnson
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - C Hornigold
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - N Amir
- Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | - K Henderson
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - C McClements
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - I Liew
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - A Deshpande
- Department of Microbiology, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - E Vink
- Department of Microbiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - D Trigg
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J Guilfoyle
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - M Scarborough
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - C Scarborough
- Nuffield Department of Medicine, University of Oxford, OX3 7FZ, UK
| | - T H N Wong
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - T Walker
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - N Fawcett
- Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - G Morris
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - K Tomlin
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - C Grix
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - E O'Cofaigh
- Department of Medicine, Friarage Hospital, South Tees Hospital NHS Foundation Trust, Northallerton, DL6 1JG, UK
| | - D McCaffrey
- Department of Infection Prevention & Control, James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesborough, TS4 3BW, UK
| | - M Cooper
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K Corbett
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K French
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Harper
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - C Hayward
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - M Reid
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - V Whatley
- Corporate Support Services, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - J Winfield
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Hoque
- Department of Microbiology, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - L Kelly
- Department of Infection Prevention & Control, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - I King
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - A Bradley
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - B McCullagh
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C Hibberd
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - M Merron
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C McCabe
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - S Horridge
- Department of Microbiology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - J Taylor
- Department of Virology and Molecular Pathology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - S Koo
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Elsanousi
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - R Saunders
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Lim
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - A Bond
- Department of Microbiology, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK
| | - S Stone
- Royal Free Campus, University College Medical School, London, NW3 2QG, UK
| | - I D Milligan
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - D J F Mack
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - A Nagar
- Department of Microbiology, Antrim Area Hospital, Northern Health and Social Care Trust, Bush Road, Antrim, BT41 2RL, UK
| | - R M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - M H Wilcox
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - A Kirby
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
| | - J A T Sandoe
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
| |
Collapse
|