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Lehmann DM, Cohen N, Lin IH, Alexander S, Kathuria R, Kerpelev M, Taur Y, Seo SK. Analyzing Adherence to the 2016 Infectious Diseases Society of America Guidelines for Candidemia in Cancer Patients. Open Forum Infect Dis 2022; 9:ofac555. [PMID: 36540383 PMCID: PMC9757685 DOI: 10.1093/ofid/ofac555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Candidemia is associated with morbidity and mortality in cancer patients. We analyzed adherence to the 2016 Infectious Diseases Society of America (IDSA) candidiasis guidelines and the reasons for guideline nonadherence. We also investigated whether matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) improved time to effective antifungal therapy compared with historical data (median, 43.2 hours). Methods Cancer patients with candidemia between 1/1/17 and 12/31/19 were included. Adherence to 7 individual IDSA guideline components was assessed. Composite IDSA guideline adherence (defined as meeting ≥6 guideline components) was also assessed. Charts were reviewed to examine reasons for noncompliance. Results Of 157 patients with candidemia, 150 (95.5%) had infectious disease (ID) consultation. The median total time from blood culture collection to antifungal initiation was 42.1 hours. Excluding 39 patients with short treatment due to death, there was 100% adherence with surveillance blood cultures, followed by antifungal susceptibility testing (117/118, 99.2%), initial appropriate therapy (117/118, 99.2%), antifungal duration (110/118, 93.2%), line removal (82/91, 90.1%), eye exams (93/118, 78.8%), and step-down therapy (69/94, 73.4%). A quarter (30/118) did not meet composite IDSA guideline adherence. Univariate logistic regression suggested a relationship between poor cancer prognosis and incomplete adherence to the 2016 IDSA candidiasis guidelines (odds ratio, 8.6; 95% CI, 1.6-47). Conclusions The addition of MALDI-TOF did not shorten time to effective antifungal therapy. Nearly all patients were seen by ID for candidemia. Poor cancer prognosis was a common factor for incomplete composite adherence to the 2016 IDSA candidiasis guidelines.
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Affiliation(s)
| | | | - I-Hsin Lin
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Marina Kerpelev
- Information Systems, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ying Taur
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Joan and Sanford Weill Cornell Medical College, New York, New York, USA
| | - Susan K Seo
- Correspondence: S. K. Seo, MD, Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 ()
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Humphreys H, Burke L, O'Connell K, Keogan M. Answering Ireland's call: pathology during the COVID-19 pandemic. J Clin Pathol 2022; 75:721-723. [PMID: 35863884 DOI: 10.1136/jclinpath-2022-208323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons, Dublin, Ireland
| | - Louise Burke
- Department of Pathology, Cork University Hospital/University College Cork, Cork, Ireland
| | | | - Mary Keogan
- Department of Immunology, Beaumont Hospital, Dublin, Ireland
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Hicks T, Winter A, Green K, Kierkegaard P, Price DA, Body R, Allen AJ, Graziadio S. Care pathway and prioritization of rapid testing for COVID-19 in UK hospitals: a qualitative evaluation. BMC Health Serv Res 2021; 21:532. [PMID: 34059036 PMCID: PMC8165513 DOI: 10.1186/s12913-021-06460-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/22/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The second wave of the coronavirus pandemic is now established, occurring at a time of winter pressure on acute care in the NHS. This is likely to be more challenging then the first wave for the diagnosis of COVID-19 because of the similar symptomology with other respiratory conditions highly prevalent in winter. This study sought to understand the care pathways in place in UK NHS hospitals during the first wave (March-July 2020) for identification of patients with COVID-19 and to learn lessons to inform optimal testing strategies within the COVID-19 National Diagnostic Research and Evaluation Platform (CONDOR). DESIGN, SETTING & PARTICIPANTS Sixteen hospital-based clinicians from 12 UK NHS Trusts covering 10 different specialties were interviewed following a semi-structured topic guide. Data were coded soon after the interviews and analysed thematically. RESULTS We developed a diagrammatic, high-level visualisation of the care pathway describing the main clinical decisions associated with the diagnosis and management of patients with suspected COVID-19. COVID-19 testing influenced infection control considerations more so than treatment decisions. Two main features of service provision influenced the patient management significantly: access to rapid laboratory testing and the number of single occupancy rooms. If time to return of result was greater than 24 h, patients with a presumptive diagnosis would often be cohorted based on clinical suspicion alone. Undetected COVID-19 during this time could therefore lead to an increased risk of viral transmission. CONCLUSIONS During the winter months, priority for provision of rapid testing at admission should be given to hospitals with limited access to laboratory services and single room availability. Access to rapid testing is essential for urgent decisions related to emergency surgery, maternity services and organ transplant. The pathway and prioritization of need will inform the economic modelling, clinical evaluations, and implementation of new clinical tests in UK.
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Affiliation(s)
- Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
- The Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK.
| | - Amanda Winter
- NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- The Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
| | - Kile Green
- NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- CRUK Convergence Science Centre, Institute of Cancer Research & Imperial College London, London, UK
| | - D Ashley Price
- NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- The Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, M13 9PL, UK
- Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Sara Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-Operative, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- The Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK
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4
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Warner J, Rush C. Tropical fever in remote tropics: tuberculosis or melioidosis, it depends on the lab. MICROBIOLOGY AUSTRALIA 2021. [DOI: 10.1071/ma21049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diagnostics tests used to identify the cause of infection using proteomics and genomics have revolutionised microbiology laboratories in recent times. However, approaches to build the capacity of clinical microbiology services in the rural tropics by simply transplanting these approaches have proven difficult to sustain. Tropical fever in the remote tropics is, by definition, a clinical diagnosis where the aetiology of fever is not known, treatment is empirical, guided by clinical suspicion with treatment failure often attributed to incorrect diagnosis or antimicrobial resistance. Tuberculosis (TB) in rural Papua New Guinea (PNG) is mostly diagnosed clinically, perhaps supported by microscopy. In fact, a ‘tuberculosis patient’ in rural PNG is included in the TB register upon commencement of TB treatment with or without any laboratory-based evidence of infection. The roll-out of GeneXpert is continuing to transform TB diagnostic certainty in TB endemic communities. Melioidosis is endemic in tropical regions and is increasingly reported to mimic TB. Isolation and identification of the causative agent Burkholderia pseudomallei remains the gold standard. Here, we discuss the increasing divide between rural and urban approaches to laboratory-based infection diagnosis using these two enigmatic tropical infectious diseases, in rural PNG, as examples.
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Petrlova J, Petruk G, Huber RG, McBurnie EW, van der Plas MJA, Bond PJ, Puthia M, Schmidtchen A. Thrombin-derived C-terminal fragments aggregate and scavenge bacteria and their proinflammatory products. J Biol Chem 2020; 295:3417-3430. [PMID: 32034093 PMCID: PMC7076200 DOI: 10.1074/jbc.ra120.012741] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/04/2020] [Indexed: 12/15/2022] Open
Abstract
Thrombin-derived C-terminal peptides (TCPs), including a major 11-kDa fragment (TCP96), are produced through cleavage by human neutrophil elastase and aggregate lipopolysaccharide (LPS) and the Gram-negative bacterium Escherichia coli. However, the physiological roles of TCP96 in controlling bacterial infections and reducing LPS-induced inflammation are unclear. Here, using various biophysical methods, in silico molecular modeling, microbiological and cellular assays, and animal models, we examined the structural features and functional roles of recombinant TCP96 (rTCP96) in the aggregation of multiple bacteria and the Toll-like receptor (TLR) agonists they produce. We found that rTCP96 aggregates both Gram-negative and Gram-positive bacteria, including Staphylococcus aureus and Pseudomonas aeruginosa, and their cell-wall components LPS, lipid A, and lipoteichoic acid (LTA). The Gram-negative bacteria E. coli and P. aeruginosa were particularly sensitive to aggregation-induced bacterial permeabilization and killing. As a proof of concept, we show that rTCP96 reduces LPS-induced NF-κB activation in human monocytes, as well as in mouse models of LPS-induced subcutaneous inflammation. Moreover, in a mouse model of subcutaneous inoculation with P. aeruginosa, rTCP96 reduced bacterial levels. Together, these results link TCP-mediated aggregation of endotoxins and bacteria in vitro to attenuation of inflammation and bacterial levels in vivo.
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Affiliation(s)
- Jitka Petrlova
- Department of Clinical Sciences, Division of Dermatology and Venereology, Lund University, Lund SE-22184, Sweden.
| | - Ganna Petruk
- Department of Clinical Sciences, Division of Dermatology and Venereology, Lund University, Lund SE-22184, Sweden
| | | | - Eilish W McBurnie
- Bioinformatics Institute (A*STAR), Singapore SG-138671; Department of Chemistry, University of Southampton, Southampton UK-SO17 1BJ, United Kingdom
| | - Mariena J A van der Plas
- Department of Clinical Sciences, Division of Dermatology and Venereology, Lund University, Lund SE-22184, Sweden; Department of Pharmacy, University of Copenhagen, Copenhagen DK-2100, Denmark
| | - Peter J Bond
- Bioinformatics Institute (A*STAR), Singapore SG-138671; Department of Biological Sciences, National University of Singapore, Singapore SG-117558
| | - Manoj Puthia
- Department of Clinical Sciences, Division of Dermatology and Venereology, Lund University, Lund SE-22184, Sweden
| | - Artur Schmidtchen
- Department of Clinical Sciences, Division of Dermatology and Venereology, Lund University, Lund SE-22184, Sweden; Department of Biomedical Sciences, Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen DK-2400, Denmark
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Dewar S, Vass D, MacKenzie FM, Parcell BJ. Point-of-care testing by healthcare workers for detection of meticillin-resistant Staphylococcus aureus, Clostridioides difficile, and norovirus. J Hosp Infect 2019; 103:447-453. [PMID: 31404566 DOI: 10.1016/j.jhin.2019.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/01/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The feasibility of introducing three separate Cepheid GeneXpert® assays was assessed: Xpert SA Nasal Complete, Xpert C. difficile, and Xpert Norovirus for point-of-care testing (POCT) on a ward in a district general hospital. AIM To establish a seven-day/24 h POCT service for meticillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile, and norovirus operated solely by healthcare workers (HCWs). METHODS The Cepheid GeneXpert assays performance characteristics were assessed by comparing the assays to traditional central laboratory methods in terms of clinical turnaround times, hands-on time, number of process steps, time to result and diagnostic accuracy. HCW feedback was collected to consider the potential added value of applying this technology to improve patient flow and clinical care. FINDINGS In total 1170 tests were carried out over the 16-month study period. The assays significantly reduced hands-on time, process steps, and time to result for identification of all three micro-organisms. Overall agreement with central laboratory testing was >98% for all three assays. Staff members fed back that POCT had a positive impact in terms of clinical utility. CONCLUSION Xpert SA Nasal Complete for MRSA detection, Xpert C. difficile, and Xpert Norovirus can be used as POCT solely by HCWs in a ward setting. Each assay was used throughout a seven-day/24 h period with potential positive impact on bed management and patient care.
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Affiliation(s)
- S Dewar
- Medical Microbiology, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - D Vass
- Stroke Ward & Acute Medical Admissions Unit, Dr Gray's Hospital, Elgin, UK
| | - F M MacKenzie
- Medical Microbiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - B J Parcell
- Medical Microbiology, Ninewells Hospital and Medical School, Dundee, UK
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Parsonage B, Hagglund PK, Keogh L, Wheelhouse N, Brown RE, Dancer SJ. Control of Antimicrobial Resistance Requires an Ethical Approach. Front Microbiol 2017; 8:2124. [PMID: 29163414 PMCID: PMC5673829 DOI: 10.3389/fmicb.2017.02124] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 10/18/2017] [Indexed: 01/18/2023] Open
Abstract
Ethical behavior encompasses actions that benefit both self and society. This means that tackling antimicrobial resistance (AMR) becomes an ethical obligation, because the prospect of declining anti-infectives affects everyone. Without preventive action, loss of drugs that have saved lives over the past century, will condemn ourselves, people we know, and people we don't know, to unacceptable risk of untreatable infection. Policies aimed at extending antimicrobial life should be considered within an ethical framework, in order to balance the choice, range, and quality of drugs against stewardship activities. Conserving availability and effectiveness for future use should not compromise today's patients. Practices such as antimicrobial prophylaxis for healthy people 'at risk' should receive full debate. There are additional ethical considerations for AMR involving veterinary care, agriculture, and relevant bio-industries. Restrictions for farmers potentially threaten the quality and quantity of food production with economic consequences. Antibiotics for companion animals do not necessarily spare those used for humans. While low-income countries cannot afford much-needed drugs, pharmaceutical companies are reluctant to develop novel agents for short-term return only. Public demand encourages over-the-counter, internet, black market, and counterfeit drugs, all of which compromise international control. Prescribers themselves require educational support to balance therapeutic choice against collateral damage to both body and environment. Predicted mortality due to AMR provides justification for international co-operation, commitment and investment to support surveillance and stewardship along with development of novel antimicrobial drugs. Ethical arguments for, and against, control of antimicrobial resistance strategies are presented and discussed in this review.
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Affiliation(s)
- Ben Parsonage
- Department of Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Philip K Hagglund
- Department of Engineering, Luleå University of Technology, Luleå, Sweden
| | - Lloyd Keogh
- Department of Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Nick Wheelhouse
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Richard E Brown
- Department of Engineering, University of Strathclyde, Glasgow, United Kingdom.,Sophrodyne Ltd., Glasgow, United Kingdom
| | - Stephanie J Dancer
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom.,Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, Bothwell, United Kingdom
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Abstract
Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs.
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10
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Joseph A, Mahida N. Antimicrobial stewardship in secondary care: what are we trying to achieve? J Hosp Infect 2016; 93:392-4. [DOI: 10.1016/j.jhin.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 11/16/2022]
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Simões AS, Couto I, Toscano C, Gonçalves E, Póvoa P, Viveiros M, Lapão LV. Prevention and Control of Antimicrobial Resistant Healthcare-Associated Infections: The Microbiology Laboratory Rocks! Front Microbiol 2016; 7:855. [PMID: 27375577 PMCID: PMC4895126 DOI: 10.3389/fmicb.2016.00855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/23/2016] [Indexed: 12/30/2022] Open
Abstract
In Europe, each year, more than four milion patients acquire a healthcare-associated infection (HAI) and almost 40 thousand die as a direct consequence of it. Regardless of many stategies to prevent and control HAIs, they remain an important cause of morbidity and mortality worldwide with a significant economic impact: a recent estimate places it at the ten billion dollars/year. The control of HAIs requires a prompt and efficient identification of the etiological agent and a rapid communication with the clinician. The Microbiology Laboratory has a significant role in the prevention and control of these infections and is a key element of any Infection Control Program. The work of the Microbiology Laboratory covers microbial isolation and identification, determination of antimicrobial susceptibility patterns, epidemiological surveillance and outbreak detection, education, and report of quality assured results. In this paper we address the role and importance of the Microbiology Laboratory in the prevention and control of HAI and in Antibiotic Stewardship Programs and how it can be leveraged when combined with the use of information systems. Additionally, we critically review some challenges that the Microbiology Laboratory has to deal with, including the selection of analytic methods and the proper use of communication channels with other healthcare services.
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Affiliation(s)
- Alexandra S. Simões
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
| | - Isabel Couto
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
| | - Cristina Toscano
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, LisbonPortugal
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, LisbonPortugal
| | - Elsa Gonçalves
- Laboratório de Microbiologia Clínica e Biologia Molecular, Serviço de Patologia Clínica, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, LisbonPortugal
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, LisbonPortugal
| | - Pedro Póvoa
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, LisbonPortugal
- Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, LisbonPortugal
| | - Miguel Viveiros
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
| | - Luís V. Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
- WHO Collaborating Center for Health Workforce Policy and Planning, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, LisbonPortugal
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Baxter M, Islam G, Parsons H, Enoch D, Fry C, Kiernan M, Mahida N. A new infection trainee education programme from the Healthcare Infection Society. J Hosp Infect 2016; 93:157-8. [DOI: 10.1016/j.jhin.2016.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
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13
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Microbiology service centralization: a step too far? J Hosp Infect 2016; 93:109. [DOI: 10.1016/j.jhin.2015.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/24/2015] [Indexed: 11/18/2022]
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Combined infection training: a perspective from Ireland. J Hosp Infect 2016; 93:113-4. [DOI: 10.1016/j.jhin.2016.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 11/19/2022]
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Mahida N. The white coat, microbiology service centralization, and combined infection training: what is happening to infection prevention and control? J Hosp Infect 2015; 91:289-91. [PMID: 26520591 DOI: 10.1016/j.jhin.2015.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- N Mahida
- Nottingham University Hospitals, Clinical Microbiology, Nottingham, UK.
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