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Eyre DW, Lumley SF, O'Donnell D, Campbell M, Sims E, Lawson E, Warren F, James T, Cox S, Howarth A, Doherty G, Hatch SB, Kavanagh J, Chau KK, Fowler PW, Swann J, Volk D, Yang-Turner F, Stoesser N, Matthews PC, Dudareva M, Davies T, Shaw RH, Peto L, Downs LO, Vogt A, Amini A, Young BC, Drennan PG, Mentzer AJ, Skelly DT, Karpe F, Neville MJ, Andersson M, Brent AJ, Jones N, Martins Ferreira L, Christott T, Marsden BD, Hoosdally S, Cornall R, Crook DW, Stuart DI, Screaton G, Peto TEA, Holthof B, O'Donnell AM, Ebner D, Conlon CP, Jeffery K, Walker TM. Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study. eLife 2020; 9:e60675. [PMID: 32820721 PMCID: PMC7486122 DOI: 10.7554/elife.60675] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [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: 07/02/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using naso-/oro-pharyngeal PCR testing and immunoassays for IgG antibodies. 1128/10,034 (11.2%) staff had evidence of Covid-19 at some time. Using questionnaire data provided on potential risk-factors, staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.82 [95%CI 3.45-6.72]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (22.6% vs. 8.6% elsewhere) (aOR 2.47 [1.99-3.08]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.52 [1.07-2.16]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit staff were relatively protected (0.44 [0.28-0.69]), likely by a bundle of PPE-related measures. Positive results were more likely in Black (1.66 [1.25-2.21]) and Asian (1.51 [1.28-1.77]) staff, independent of role or working location, and in porters and cleaners (2.06 [1.34-3.15]).
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Affiliation(s)
- David W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health EnglandOxfordUnited Kingdom
| | - Sheila F Lumley
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Denise O'Donnell
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Mark Campbell
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Elizabeth Sims
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Elaine Lawson
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Fiona Warren
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Tim James
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Stuart Cox
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Alison Howarth
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - George Doherty
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Stephanie B Hatch
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Target Discovery Institute, University of OxfordOxfordUnited Kingdom
| | - James Kavanagh
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Kevin K Chau
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Philip W Fowler
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Jeremy Swann
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Denis Volk
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Fan Yang-Turner
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Nicole Stoesser
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health EnglandOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Philippa C Matthews
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Maria Dudareva
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Timothy Davies
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Robert H Shaw
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Leon Peto
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Louise O Downs
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Alexander Vogt
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Ali Amini
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Bernadette C Young
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | | | - Alexander J Mentzer
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Donal T Skelly
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Fredrik Karpe
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Radcliffe Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Matt J Neville
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Radcliffe Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Monique Andersson
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Andrew J Brent
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Nicola Jones
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | | | - Thomas Christott
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Brian D Marsden
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Kennedy Institute of Rheumatology Research, University of OxfordOxfordUnited Kingdom
| | - Sarah Hoosdally
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Richard Cornall
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Derrick W Crook
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - David I Stuart
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Gavin Screaton
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Timothy EA Peto
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- NIHR Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Bruno Holthof
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | | | - Daniel Ebner
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Target Discovery Institute, University of OxfordOxfordUnited Kingdom
| | - Christopher P Conlon
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Katie Jeffery
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Timothy M Walker
- Oxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Oxford University Clinical Research UnitHo Chi Minh CityViet Nam
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Chin PKL, Drennan PG, Gardiner SJ, Zhang M, Dalton SC, Chambers ST, Begg EJ. Total flucloxacillin plasma concentrations poorly reflect unbound concentrations in hospitalized patients with Staphylococcus aureus bacteraemia. Br J Clin Pharmacol 2018; 84:2311-2316. [PMID: 29908071 DOI: 10.1111/bcp.13673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/12/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 10/14/2022] Open
Abstract
AIMS Flucloxacillin dosing may be guided by measurement of its total plasma concentrations. Flucloxacillin is highly protein bound with fraction unbound in plasma (fu ) of around 0.04 in healthy individuals. The utility of measuring unbound flucloxacillin concentrations for patients outside the intensive care unit (ICU) is not established. We aimed to compare flucloxacillin fu in non-ICU hospitalised patients against healthy volunteers, and to examine the performance of a published model for predicting unbound concentrations, using total flucloxacillin and plasma albumin concentrations. METHODS Data from 12 healthy volunteers (248 samples) and 47 hospitalized patients (61 samples) were examined. Plasma flucloxacillin concentrations were measured using a validated liquid chromatography-tandem mass spectrometry method. Flucloxacillin fu for the two groups was compared using a generalized estimating equation model to account for clustered observations. The performance of the single protein binding site prediction model in hospitalized patients was compared with measured unbound concentrations using Bland-Altman plots. RESULTS The median (range) flucloxacillin fu for healthy (median albumin 45 g l-1 ) and hospitalized individuals (median albumin 30 g l-1 ) were 0.04 (0.02-0.07) and 0.10 (0.05-0.37), respectively (P < 0.0001). The prediction model underpredicted unbound flucloxacillin concentrations with a mean bias (95% limits of agreement) of -54% (-137%, +30%). CONCLUSIONS The flucloxacillin fu values observed in our cohort of hospitalized patients had a wide range and were greater than those of healthy individuals. Unbound flucloxacillin plasma concentrations were predicted poorly by the model. Instead, unbound concentrations should be measured to guide dosing.
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Affiliation(s)
- Paul Ken Leong Chin
- Department of Medicine, University of Otago, Christchurch, New Zealand.,Department of Clinical Pharmacology, Canterbury District Health Board, Christchurch, New Zealand
| | - Philip George Drennan
- Department of Clinical Pharmacology, Canterbury District Health Board, Christchurch, New Zealand
| | - Sharon Jane Gardiner
- Antimicrobial Pharmacist, Departments of Clinical Pharmacology, Infectious Diseases and Pharmacy, Christchurch Hospital, Christchurch, New Zealand
| | - Mei Zhang
- Department of Medicine, University of Otago, Christchurch, and Toxicology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Simon Charles Dalton
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | | | - Evan James Begg
- Department of Medicine, University of Otago, Christchurch, New Zealand
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