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Sandoe JAT, Ahmed F, Arumugam P, Guleri A, Horner C, Howard P, Perry J, Prendergast BD, Schwiebert R, Steeds RP, Watkin R, Wendler O, Chambers JB. Expert consensus recommendations for the provision of infective endocarditis services: updated guidance from the Joint British Societies. Heart 2023; 109:e2. [PMID: 36898706 PMCID: PMC10423555 DOI: 10.1136/heartjnl-2022-321791] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Infective endocarditis (IE) remains a difficult condition to diagnose and treat and is an infection of high consequence for patients, causing long hospital stays, life-changing complications and high mortality. A new multidisciplinary, multiprofessional, British Society for Antimicrobial Chemotherapy (BSAC)-ledWorking Party was convened to undertake a focused systematical review of the literature and to update the previous BSAC guidelines relating delivery of services for patients with IE. A scoping exercise identified new questions concerning optimal delivery of care, and the systematic review identified 16 231 papers of which 20 met the inclusion criteria. Recommendations relating to endocarditis teams, infrastructure and support, endocarditis referral processes, patient follow-up and patient information, and governance are made as well as research recommendations. This is a report of a joint Working Party of the BSAC, British Cardiovascular Society, British Heart Valve Society, British Society of Echocardiography, Society of Cardiothoracic Surgeons of Great Britain and Ireland, British Congenital Cardiac Association and British Infection Association.
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Affiliation(s)
- Jonathan A T Sandoe
- Microbiology department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Fozia Ahmed
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- The University of Manchester, Manchester, UK
| | - Parthiban Arumugam
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Achyut Guleri
- Microbiology department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Carolyne Horner
- Formerly British Society of Antimicrobial Chemotherapy, Birmingham, UK
| | - Philip Howard
- NHS England North East & Yorkshire, Leeds, UK
- University of Leeds, Leeds, UK
| | - John Perry
- Microbiology department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Bernard D Prendergast
- Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Cleveland Clinic, London, UK
| | - Ralph Schwiebert
- Microbiology department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Richard Paul Steeds
- Cardiology department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Watkin
- Cardiology department, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, UK
| | - Olaf Wendler
- Cardiothoracic Surgery, King's College Hospital, King's Health Partners, London, UK
| | - John B Chambers
- Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Aldeyab MA, Bond SE, Gould I, Lee-Milner J, Spencer-Jones JJ, Guleri A, Sadeq A, Jirjees F, Lattyak WJ. Identification of antibiotic consumption targets for the management of Clostridioides difficile infection in hospitals- a threshold logistic modelling approach. Expert Rev Anti Infect Ther 2023; 21:1125-1134. [PMID: 37755320 DOI: 10.1080/14787210.2023.2263642] [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: 07/05/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND This study aims to demonstrate the utility of a threshold logistic approach to identifying thresholds for specific antibiotic use associated with Clostridioides difficile infection (CDI) in an English teaching hospital. METHODS A combined approach of nonlinear modeling and logistic regression, named threshold logistic, was used to identify thresholds and risk scores in hospital-level antibiotic use associated with hospital-onset, healthcare-associated (HOHA) CDI cases. RESULTS Using a threshold logistic regression approach, an incidence greater than 0.2645 cases/1000 occupied bed-days (OBD; 85th percentile) was determined as the cutoff rate to define a critical (high) incidence rate of HOHA CDI. Fluoroquinolones and piperacillin-tazobactam were found to have thresholds at 84.8 and 54 defined daily doses (DDD)/1000 OBD, respectively. Analysis of data allowed calculating risk scores for HOHA CDI incidence rates exceeding the 85th percentile, i.e. entering critical incidence level. The threshold-logistic model also facilitated performing 'what-if scenarios' on future values of fluoroquinolones and piperacillin-tazobactam use to understand how HOHA CDI incidence rates may be affected. CONCLUSION Using threshold logistic analysis, critical incidence levels and antibiotic use targets to control HOHA CDI were determined. Threshold logistic models can be used to inform and enhance the effective design and implementation of antimicrobial stewardship programs.
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Affiliation(s)
- Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Stuart E Bond
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Ian Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Jade Lee-Milner
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | | | - Achyut Guleri
- Infection/Clinical Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Adel Sadeq
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, UAE
| | - Feras Jirjees
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, UAE
| | - William J Lattyak
- Statistical Consulting Department, Scientific Computing Associates Corp, River Forest, IL, USA
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Bond SE, Lee-Milner J, Walker N, Spencer-Jones J, Sadiq A, Sarma J, Guleri A, Jagadeesan M, Cruise C. P02 Novel pharmacy roles strengthen the multidisciplinary hospital infection team. JAC Antimicrob Resist 2023. [DOI: 10.1093/jacamr/dlac133.006] [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: 01/20/2023] Open
Abstract
Abstract
Background
Pharmacists have an essential role to play in the NHS Long Term Plan. Hospital pharmacy departments need to develop novel roles to strengthen teams and improve patient care. In September 2017, Mid Yorkshire Hospitals NHS Trust appointed a consultant antimicrobial pharmacist along with an administrative apprentice to strengthen pharmacy and infection leadership and support the delivery of the antimicrobial resistance national targets. From January 2018 to June 2020, the infection team worked with locums but no substantive consultant microbiologists.
Objectives
To describe the benefits of developing novel pharmacy roles to strengthen an infection multidisciplinary team
Methods
A shortage of consultant microbiologists provided opportunities to develop and enhance other infection roles. These included one year of funding from Pathology for a Band 6 Specialist Pharmacy Technician. The role was subsequently funded by the Adult Community Services team to support the home intravenous antibiotic service. Senior support was provided by the Pathology Group Manager, Head of Infection Prevention and Control and Director of Pharmacy. The apprenticeship levy supported a Level 4 Data analyst qualification to develop the pharmacy administrator role. Two other infection roles were developed: Advanced Clinical Practitioner and Trainee Clinical Scientist, both of which could not be sustained for lack of adequate consultant microbiologist resources for clinical supervision within the team.
Results
The Specialist Pharmacy Technician coordinates the home intravenous antibiotic service. Clinical responsibility remains with the discharging consultant medical officer. The antimicrobial pharmacy team led the introduction of antibiotic elastomeric pumps for home use, saving 2500 inpatient bed days. Patient and staff feedback on the novel pharmacy roles has been positive. Band 5 Pharmacy Data Analyst – Antimicrobials responsibilities include clinical trial participation, data collection and analysis including ward level working, reporting and coordination of the audit programme. The role has enabled contribution to national research studies, including Antibiotic Review Kit (ARK-Hospital) and Procalcitonin: Evaluation of Antibiotic Use in COVID-19 Hospitalised Patients (PEACH). Through a new strategy, consultant microbiologist workforce has progressively grown back to three full time equivalents and a 4th post advertised, enabling an increase in participation in ward rounds, multidisciplinary team meetings, antimicrobial stewardship, infection prevention & control, Director of Infection Prevention and Control role and leading NIHR research trials. The consultant pharmacist remains in post as a senior leader, and also has a Trust role as Director of Innovation. This change provided funding for an increase from Band 3 to Band 5 data analyst, promotion of a senior Band 7 pharmacist to a Band 8a advanced clinical pharmacist, and conversion of a part time Band 7 pharmacist to a full-time role.
Discussion
An innovative approach to development of pharmacy, data, nurse and scientist roles has strengthened the infection service in a regional hospital and community services Trust. Pharmacy-led team meetings are now routine in the Trust allowing for more efficient use of consultant microbiologist time.
Conclusions
Potential future roles are further administrative support, pharmacy assistant, clinical nurse specialist – antimicrobials, and antimicrobial pharmacy team leader.
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Boyle M, Tennyson C, Guleri A, Walker A. Infective endocarditis: acne to zoonoses on the valve, an A to Z perspective. Br J Cardiol 2022; 29:25. [PMID: 36873726 PMCID: PMC9982663 DOI: 10.5837/bjc.2022.025] [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] [Indexed: 11/01/2022]
Abstract
Cutibacterium acnes (C. acnes), previously known as Propionibacterium acnes, is a rare cause of infective endocarditis (IE). We provide a review of the literature and describe two recent cases from a single centre to provide insight into the various clinical presentations, progression and management of patients with this infection. The primary objective of our review is to highlight the difficulty in the initial assessment of these patients with an aim to improve the time and accuracy of diagnosis and expedite subsequent treatment. There are currently no guidelines in the literature specific to the management of IE caused by C. acnes. Our secondary objectives are to disseminate information about the indolent course of the disease and add to the growing body of evidence around this rare, yet complex, cause of IE.
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Affiliation(s)
- Mark Boyle
- Junior Clinical Fellow Department of Cardiac Surgery, The Royal Brompton Hospital, Sydney Street, London, SW3 6NP
| | - Charlene Tennyson
- Cardiothoracic Registrar Department of Cardiothoracic Surgery, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9L
| | - Achyut Guleri
- Consultant Clinical Microbiologist Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Aberford Road, Wakefield, WF1 4DG
| | - Antony Walker
- Consultant Cardiothoracic Surgeon Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR
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Guleri A, More R, Sharma R, Wong M, Abdelrahman A. Use of dalbavancin in infective endocarditis: a case series. JAC Antimicrob Resist 2021; 3:dlab099. [PMID: 34396119 PMCID: PMC8360293 DOI: 10.1093/jacamr/dlab099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background Infective endocarditis, typically caused by Gram-positive organisms such as viridans group streptococci and Staphylococcus aureus, is associated with high mortality and morbidity and requires aggressive, prolonged antimicrobial treatment and sometimes surgery. Dalbavancin, a lipoglycopeptide active against Gram-positive pathogens, has a long half-life, which allows IV treatment as one dose or two doses with a prolonged interval, offering personalized treatment for complex psychosocial situations or facilitating early discharge. In the absence of randomized controlled trials in infective endocarditis, current evidence derives from real-world case series involving off-licence use. The Austrian Society for Infectious Disease and Tropical Medicine includes dalbavancin as an option for infective endocarditis. Objectives This retrospective case series reports use of dalbavancin in a small cohort of patients with infective endocarditis treated at Lancashire Cardiac Centre, Blackpool Teaching Hospitals Foundation Trust, UK. Results The pharmacy database included 11 patients in whom dalbavancin was used to address either complex psychosocial circumstances or the need for early discharge. The endocarditis multidisciplinary team selected dalbavancin from available treatment options. Structures affected by infective endocarditis included aortic, mitral and tricuspid valves; aortic composite grafts; implantable cardioverter defibrillator leads; and prosthetic aortic valves. Eight patients underwent surgery; three were managed conservatively with antibiotics. Dalbavancin was curative in all but one patient, whose signs and symptoms of infection improved. No patients developed adverse reactions. Conclusions Dalbavancin is an alternative treatment option at hospital discharge when conventional antibiotics may not be suitable due to complex psychosocial issues or early discharge is required.
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Affiliation(s)
- Achyut Guleri
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Ranjit More
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Rashmi Sharma
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Michelle Wong
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Amr Abdelrahman
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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Rajkumar C, Wilks M, Islam J, Ali K, Raftery J, Davies K, Timeyin J, Cheek E, Cohen J, Wright J, Natarajan U, Nicholl C, Dewhurst G, Fonseka M, Slovick D, Maskell P, Mukherjee S, Ali K, Nari R, Qureshi A, Gertner D, Khan Z, Shinh N, Bodmer C, Martin-Marero C, Poullis A, Pollok R, Ala A, Chauhan A, Patel M, Roberts H, Conroy S, McGowan D, Pathansali R, Yau C, Vasileiadis E, Guleri A, Orr D, Aldulami D. Do probiotics prevent antibiotic-associated diarrhoea? Results of a multicentre randomized placebo-controlled trial. J Hosp Infect 2020; 105:280-288. [DOI: 10.1016/j.jhin.2020.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/27/2020] [Indexed: 02/07/2023]
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Gordon M, Kagalwala T, Rezk K, Rawlingson C, Ahmed MI, Guleri A. Rapid systematic review of neonatal COVID-19 including a case of presumed vertical transmission. BMJ Paediatr Open 2020; 4:e000718. [PMID: 32574345 PMCID: PMC7252972 DOI: 10.1136/bmjpo-2020-000718] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To carry out a systematic review of the available studies on COVID-19 (coronavirus disease 2019) in neonates seen globally since the onset of the COVID-19 global pandemic in 2020. The paper also describes a premature baby with reverse transcription (RT)-PCR-positive COVID-19 seen at the Blackpool Teaching Hospitals NHS Foundation Trust, UK. DESIGN We conducted a multifaceted search of the Cumulative Index to Nursing and Allied Health Literature, Embase, Medline and PubMed from 1 December 2019 to 12 May 2020 to harvest articles from medical journals and publications reporting cases of COVID-19 in neonates from anywhere in the world. Additional searches were also done so as not to miss any important publications. Write-up was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the protocol for the review was registered with International Prospective Register of Systematic Reviews (PROSPERO), and risk of bias was analysed with the Newcastle-Ottawa tool. Additionally, the preterm neonate with COVID-19 from our hospital is also reported. RESULTS The systematic review has revealed eight studies where neonates have been described to have confirmed COVID-19, with low risk of bias. Of the 10 reported cases elsewhere, only three are likely to be vertically transmitted, while seven occurred in the postperinatal period and are likely to have been postnatally acquired. All neonates had a mild course, recovered fully and were negative on retesting. Our case of COVID-19 in a 32-week premature baby from the UK was delivered by emergency caesarean section, with the mother wearing a face mask and the family having no contact with the neonate, suggesting vertical transmission. On day 33, the neonate was asymptomatic but was still RT-PCR-positive on nasopharyngeal airway swab. CONCLUSIONS Neonatal infection is uncommon, with only two previously reported cases likely to be of vertical transmission. The case we report is still RT-PCR-positive on day 28 and is asymptomatic. Ongoing research is needed to ascertain the epidemiology of COVID-19 in neonates.
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Affiliation(s)
- Morris Gordon
- Biomedical evidence synthesis and translation to practice unit, University of Central Lancashire, Preston, UK
- Families division, Blackpool Victoria Hospital, Blackpool, UK
| | - Taher Kagalwala
- Families division, Blackpool Victoria Hospital, Blackpool, UK
| | - Karim Rezk
- Families division, Blackpool Victoria Hospital, Blackpool, UK
| | | | - M Idris Ahmed
- Families division, Blackpool Victoria Hospital, Blackpool, UK
| | - Achyut Guleri
- micrbiology department, Blackpool Victoria Hospital, Blackpool, UK
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Guleri A, Sharma R, Moon J. Developing a novel paperless E-referral pathway for Infection clinic at a large teaching hospital, community and primary care in northwest England: A novel strategy to spearhead the trust antimicrobial stewardship programme. Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Rashmi Sharma
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Jill Moon
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
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Chapman ALN, Patel S, Horner C, Green H, Guleri A, Hedderwick S, Snape S, Statham J, Wilson E, Gilchrist M, Seaton RA. Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK. JAC Antimicrob Resist 2019; 1:dlz026. [PMID: 34222901 PMCID: PMC8209972 DOI: 10.1093/jacamr/dlz026] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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] [Indexed: 12/12/2022] Open
Abstract
UK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) were published in 2012 and 2015 for adult and paediatric patients, respectively. Here we update the initial good practice recommendations in a combined document based on a further review of the OPAT literature and an extensive consultation process. As with the previous good practice recommendations, these updated recommendations are intended to provide pragmatic guidance for new and established OPAT services across a range of settings and to act as a set of quality indicators for service evaluation and quality improvement.
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Affiliation(s)
| | - Sanjay Patel
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carolyne Horner
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Helen Green
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Susan Snape
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Julie Statham
- South Warwickshire NHS Foundation Trust, Warwick, UK
| | | | | | - R Andrew Seaton
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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Thwaites GE, Scarborough M, Szubert A, Saramago Goncalves P, Soares M, Bostock J, Nsutebu E, Tilley R, Cunningham R, Greig J, Wyllie SA, Wilson P, Auckland C, Cairns J, Ward D, Lal P, Guleri A, Jenkins N, Sutton J, Wiselka M, Armando GR, Graham C, Chadwick PR, Barlow G, Gordon NC, Young B, Meisner S, McWhinney P, Price DA, Harvey D, Nayar D, Jeyaratnam D, Planche T, Minton J, Hudson F, Hopkins S, Williams J, Török ME, Llewelyn MJ, Edgeworth JD, Walker AS. Adjunctive rifampicin to reduce early mortality from Staphylococcus aureus bacteraemia: the ARREST RCT. Health Technol Assess 2019; 22:1-148. [PMID: 30382016 DOI: 10.3310/hta22590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteraemia is a common and frequently fatal infection. Adjunctive rifampicin may enhance early S. aureus killing, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death. OBJECTIVES To determine whether or not adjunctive rifampicin reduces bacteriological (microbiologically confirmed) failure/recurrence or death through 12 weeks from randomisation. Secondary objectives included evaluating the impact of rifampicin on all-cause mortality, clinically defined failure/recurrence or death, toxicity, resistance emergence, and duration of bacteraemia; and assessing the cost-effectiveness of rifampicin. DESIGN Parallel-group, randomised (1 : 1), blinded, placebo-controlled multicentre trial. SETTING UK NHS trust hospitals. PARTICIPANTS Adult inpatients (≥ 18 years) with meticillin-resistant or susceptible S. aureus grown from one or more blood cultures, who had received < 96 hours of antibiotic therapy for the current infection, and without contraindications to rifampicin. INTERVENTIONS Adjunctive rifampicin (600-900 mg/day, oral or intravenous) or placebo for 14 days in addition to standard antibiotic therapy. Investigators and patients were blinded to trial treatment. Follow-up was for 12 weeks (assessments at 3, 7, 10 and 14 days, weekly until discharge and final assessment at 12 weeks post randomisation). MAIN OUTCOME MEASURES The primary outcome was all-cause bacteriological (microbiologically confirmed) failure/recurrence or death through 12 weeks from randomisation. RESULTS Between December 2012 and October 2016, 758 eligible participants from 29 UK hospitals were randomised: 370 to rifampicin and 388 to placebo. The median age was 65 years [interquartile range (IQR) 50-76 years]. A total of 485 (64.0%) infections were community acquired and 132 (17.4%) were nosocomial; 47 (6.2%) were caused by meticillin-resistant S. aureus. A total of 301 (39.7%) participants had an initial deep infection focus. Standard antibiotics were given for a median of 29 days (IQR 18-45 days) and 619 (81.7%) participants received flucloxacillin. By 12 weeks, 62 out of 370 (16.8%) patients taking rifampicin versus 71 out of 388 (18.3%) participants taking the placebo experienced bacteriological (microbiologically confirmed) failure/recurrence or died [absolute risk difference -1.4%, 95% confidence interval (CI) -7.0% to 4.3%; hazard ratio 0.96, 95% CI 0.68 to 1.35; p = 0.81]. There were 4 (1.1%) and 5 (1.3%) bacteriological failures (p = 0.82) in the rifampicin and placebo groups, respectively. There were 3 (0.8%) versus 16 (4.1%) bacteriological recurrences (p = 0.01), and 55 (14.9%) versus 50 (12.9%) deaths without bacteriological failure/recurrence (p = 0.30) in the rifampicin and placebo groups, respectively. Over 12 weeks, there was no evidence of differences in clinically defined failure/recurrence/death (p = 0.84), all-cause mortality (p = 0.60), serious (p = 0.17) or grade 3/4 (p = 0.36) adverse events (AEs). However, 63 (17.0%) participants in the rifampicin group versus 39 (10.1%) participants in the placebo group experienced antibiotic or trial drug-modifying AEs (p = 0.004), and 24 (6.5%) participants in the rifampicin group versus 6 (1.5%) participants in the placebo group experienced drug-interactions (p = 0.0005). Evaluation of the costs and health-related quality-of-life impacts revealed that an episode of S. aureus bacteraemia costs an average of £12,197 over 12 weeks. Rifampicin was estimated to save 10% of episode costs (p = 0.14). After adjustment, the effect of rifampicin on total quality-adjusted life-years (QALYs) was positive (0.004 QALYs), but not statistically significant (standard error 0.004 QALYs). CONCLUSIONS Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S. aureus bacteraemia. FUTURE WORK Given the substantial mortality, other antibiotic combinations or improved source management should be investigated. TRIAL REGISTRATIONS Current Controlled Trials ISRCTN37666216, EudraCT 2012-000344-10 and Clinical Trials Authorisation 00316/0243/001. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Guy E Thwaites
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Alexander Szubert
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Jennifer Bostock
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Robert Tilley
- Department of Microbiology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | | | - Julia Greig
- Department of Infectious Diseases, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sarah A Wyllie
- Microbiology Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Peter Wilson
- Centre for Clinical Microbiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Cressida Auckland
- Microbiology Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Janet Cairns
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Pankaj Lal
- Microbiology Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Achyut Guleri
- Microbiology Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Neil Jenkins
- Department of Infectious Diseases and Tropical Medicine, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Julian Sutton
- Department of Microbiology and Virology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martin Wiselka
- Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Clive Graham
- Microbiology Department, North Cumbria University Hospitals NHS Trust, Cumbria, UK
| | - Paul R Chadwick
- Microbiology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Gavin Barlow
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - N Claire Gordon
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bernadette Young
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Meisner
- Microbiology Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Paul McWhinney
- Microbiology Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David A Price
- Department of Infectious Diseases, Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle, UK
| | - David Harvey
- Microbiology Department, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Deepa Nayar
- Microbiology Department, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Dakshika Jeyaratnam
- Department of Microbiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy Planche
- Department of Infectious Diseases and Tropical Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jane Minton
- Department of Infectious Diseases, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Fleur Hudson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Susan Hopkins
- Infectious Diseases Unit, Royal Free London NHS Foundation Trust, London, UK
| | - John Williams
- Department of Infectious Diseases, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - M Estee Török
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Martin J Llewelyn
- Department of Infectious Diseases, Brighton and Sussex Medical School, Brighton, UK
| | - Jonathan D Edgeworth
- Department of Immunology, Infectious and Inflammatory diseases, King's College London, London, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Medical Research Council Clinical Trials Unit, University College London, London, UK
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Sandoe JAT, Saeed K, Guleri A, Hand KS, Dillon R, Allen M, Mayes A, Glen F, Gonzalez-Ruiz A. Opportunities for antimicrobial stewardship in patients with acute bacterial skin and skin structure infections who are unsuitable for beta-lactam antibiotics: a multicenter prospective observational study. Ther Adv Infect Dis 2019; 6:2049936118823655. [PMID: 30783523 PMCID: PMC6365991 DOI: 10.1177/2049936118823655] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose: The objective of this prospective, observational study was to describe the treatment, severity assessment and healthcare resources required for management of patients with acute bacterial skin and skin structure infections who were unsuitable for beta-lactam antibiotic treatments. Methods: Patients were enrolled across five secondary care National Health Service hospitals. Eligible patients had a diagnosis of acute bacterial skin and skin structure infection and were considered unsuitable for beta-lactam antibiotics (e.g. confirmed/suspected methicillin-resistant Staphylococcus aureus, beta-lactam allergy). Data regarding diagnosis, severity of the infection, antibiotic treatment and patient management were collected. Results: 145 patients with acute bacterial skin and skin structure infection were included; 79% (n = 115) patients received greater than two antibiotic regimens; median length of the first antibiotic regimen was 2 days (interquartile range of 1–5); median time to switch from intravenous to oral antibiotics was 4 days (interquartile range of 3–8, n = 72/107); 25% (n = 10/40) patients with Eron class 1 infection had systemic inflammatory response syndrome, suggesting they were misclassified. A higher proportion of patients with systemic inflammatory response syndrome received treatment in an inpatient setting, and their length of stay was prolonged in comparison with patients without systemic inflammatory response syndrome. Conclusion: There exists an urgent need for more focused antimicrobial stewardship strategies and tools for standardised clinical assessment of acute bacterial skin and skin structure infection severity in patients who are unsuitable for beta-lactam antibiotics. This will lead to optimised antimicrobial treatment strategies and ensure effective healthcare resource utilisation.
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Affiliation(s)
| | - Kordo Saeed
- Hampshire Hospitals NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Kieran S Hand
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ryan Dillon
- Merck Sharp & Dohme UK Ltd. (MSD), Hoddesdon, UK
| | - Mike Allen
- Merck Sharp & Dohme UK Ltd. (MSD), Hoddesdon, UK
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Thwaites GE, Scarborough M, Szubert A, Nsutebu E, Tilley R, Greig J, Wyllie SA, Wilson P, Auckland C, Cairns J, Ward D, Lal P, Guleri A, Jenkins N, Sutton J, Wiselka M, Armando GR, Graham C, Chadwick PR, Barlow G, Gordon NC, Young B, Meisner S, McWhinney P, Price DA, Harvey D, Nayar D, Jeyaratnam D, Planche T, Minton J, Hudson F, Hopkins S, Williams J, Török ME, Llewelyn MJ, Edgeworth JD, Walker AS. Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2018; 391:668-678. [PMID: 29249276 PMCID: PMC5820409 DOI: 10.1016/s0140-6736(17)32456-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/27/2017] [Accepted: 08/30/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING UK National Institute for Health Research Health Technology Assessment.
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Affiliation(s)
- Guy E Thwaites
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
| | | | - Alexander Szubert
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Robert Tilley
- Plymouth Hospitals National Health Service (NHS) Trust, Plymouth, UK
| | - Julia Greig
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Peter Wilson
- University College London Hospital National Health Service Foundation Trust, London, UK
| | | | - Janet Cairns
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Pankaj Lal
- Aintree University Hospital NHS Foundation Trust, Aintree, UK
| | - Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Neil Jenkins
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Julian Sutton
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martin Wiselka
- Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Clive Graham
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | | | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - N Claire Gordon
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bernadette Young
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Meisner
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Paul McWhinney
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David A Price
- Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle, UK
| | - David Harvey
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Deepa Nayar
- County Durham and Darlington NHS Foundation Trust, Durham, UK
| | | | - Tim Planche
- St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Jane Minton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Fleur Hudson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - John Williams
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - M Estee Török
- University of Cambridge, Department of Medicine, Cambridge, UK
| | | | | | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Medical Research Council Clinical Trials Unit, University College London, London, UK
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Hamlett K, Abbas J, Williams C, Oremule B, Guleri A, Malik V. Developing an Algorithm for Early Diagnosis and Management of Malignant Otitis Externa. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | | | - A. Guleri
- Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Vikas Malik
- Blackpool Victoria Hospital, Blackpool, United Kingdom
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Guleri A, Utili R, Dohmen P, Hamed K. Effectiveness and safety of daptomycin in patients with infective endocarditis undergoing heart valve replacement: a subgroup analysis from real-world data. Ther Adv Infect Dis 2017. [PMID: 28634535 DOI: 10.1177/2049936117692297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/17/2022] Open
Abstract
BACKGROUND European Cubicin® Outcomes Registry and Experience (EU-CORE) was a retrospective, non-interventional, multicenter registry that collected real-world clinical outcomes following daptomycin use for the treatment of Gram-positive infections. EU-CORE data from patients with infective endocarditis (IE) who underwent heart valve replacement were analysed. METHODS Clinical outcomes were assessed as success (cured or improved), failure, or non-evaluable. Adverse events (AEs) were recorded for up to 30 days after daptomycin treatment. RESULTS Of 610 patients with IE, 198 [32.5%; left-sided IE (LIE), 166 (83.8%); right-sided IE (RIE), 21 (10.6%); both LIE and RIE, 11 (5.6%)] underwent heart valve replacement. Other than cardiovascular disease, renal disease (18.2%), sepsis (16.2%), and diabetes mellitus (15.2%) were the most significant underlying diseases. Major pathogens in patients with positive culture results (68.0%) were Staphylococcus aureus [36.8%; methicillin-resistant S. aureus (MRSA), 12.8%] and coagulase-negative staphylococci (CoNS; 31.6%). Daptomycin treatment [median duration (range), 21 days (1-112)] resulted in high clinical success in patients with S. aureus (88.4%; MRSA, 80.0%) and CoNS (81.1%) infections, with an overall success rate of 83.3%. Clinical success rate was high (90.0%) in patients who received daptomycin dose >6 mg/kg/day. Overall clinical success rate in patients followed for up to 2 years was 90.7%. AEs and serious AEs possibly related to daptomycin were reported in 6 (3.0%) and 4 (2.0%) patients, respectively. CONCLUSIONS Daptomycin treatment was effective and well tolerated with a sustained response in patients with IE who underwent heart valve surgery. A trend towards better clinical outcomes was observed with higher daptomycin doses.
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Affiliation(s)
- Achyut Guleri
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Riccardo Utili
- Second University of Naples and Monaldi Hospital, Napoli, Italy
| | - Pascal Dohmen
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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15
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Sandoe JAT, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Olson E, Perry JD, Prendergast BD, Spry MJ, Steeds RP, Tayebjee MH, Watkin R. New guidelines for prevention and management of implantable cardiac electronic device-related infection. Lancet 2015; 385:2225-6. [PMID: 26088482 DOI: 10.1016/s0140-6736(14)62249-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | | | - Philip Howard
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Ewan Olson
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Michael J Spry
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Richard P Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Muzahir H Tayebjee
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
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16
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Sandoe JAT, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Olson E, Perry JD, Prendergast BD, Spry MJ, Steeds RP, Tayebjee MH, Watkin R. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother 2014; 70:325-59. [PMID: 25355810 DOI: 10.1093/jac/dku383] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [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: 01/04/2023] Open
Abstract
Infections related to implantable cardiac electronic devices (ICEDs), including pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices, are increasing in incidence in the USA and are likely to increase in the UK, because more devices are being implanted. These devices have both intravascular and extravascular components and infection can involve the generator, device leads and native cardiac structures or various combinations. ICED infections can be life-threatening, particularly when associated with endocardial infection, and all-cause mortality of up to 35% has been reported. Like infective endocarditis, ICED infections can be difficult to diagnose and manage. This guideline aims to (i) improve the quality of care provided to patients with ICEDs, (ii) provide an educational resource for all relevant healthcare professionals, (iii) encourage a multidisciplinary approach to ICED infection management, (iv) promote a standardized approach to the diagnosis, management, surveillance and prevention of ICED infection through pragmatic evidence-rated recommendations, and (v) advise on future research projects/audit. The guideline is intended to assist in the clinical care of patients with suspected or confirmed ICED infection in the UK, to inform local infection prevention and treatment policies and guidelines and to be used in the development of educational and training material by the relevant professional societies. The questions covered by the guideline are presented at the beginning of each section.
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Affiliation(s)
| | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | | | - Philip Howard
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ewan Olson
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Michael J Spry
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Richard P Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Rose D, Guleri A, Tang A. Tropheryma whipplei endocarditis: the value of valve polymerase chain reaction in cardiac surgery. J Thorac Cardiovasc Surg 2014; 148:e195-7. [PMID: 24951019 DOI: 10.1016/j.jtcvs.2014.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/11/2014] [Accepted: 05/14/2014] [Indexed: 11/26/2022]
Affiliation(s)
- David Rose
- Lancashire Cardiac Centre, Blackpool, Lancashire, United Kingdom.
| | - Achyut Guleri
- Department of Clinical Microbiology, Blackpool Victoria Hospital, Blackpool, Lancashire, United Kingdom
| | - Augustine Tang
- Lancashire Cardiac Centre, Blackpool, Lancashire, United Kingdom; Lancaster University School of Health and Medicine, Bailrigg, Lancashire, United Kingdom
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Hope R, Blackburn RM, Verlander NQ, Johnson AP, Kearns A, Hill R, Hopkins S, Sheridan E, Livermore DM, Scarborough M, Majumdar S, Cunniffe J, Farrington M, Gouliouris T, Marodi C, Godwin P, Tuck A, Warren R, Coe P, Hassan I, Mannion P, Loudon K, Youngs E, Johnson A, Lee M, Weston V, Guleri A, Howe R, Matthew D, Cotterill S, Todd N, Patel B, Mlangeni D, Stockley JM, Spencer R, Gardner J, Thwaites G, Kirby A, Hopkins S, Crook D, Llewellyn M, Price J, Scarborough M, Morris Jones S, Tilley R. Vancomycin MIC as a predictor of outcome in MRSA bacteraemia in the UK context. J Antimicrob Chemother 2013; 68:2641-7. [DOI: 10.1093/jac/dkt234] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Wingfield T, Rowell S, Peel A, Puli D, Guleri A, Sharma R. Legionella pneumonia cases over a five-year period: a descriptive, retrospective study of outcomes in a UK district hospital. Clin Med (Lond) 2013; 13:152-9. [PMID: 23681863 PMCID: PMC4952631 DOI: 10.7861/clinmedicine.13-2-152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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] [Indexed: 11/27/2022]
Abstract
As the recent outbreaks in Edinburgh and Camarthen, UK, have shown, Legionella pneumonia (LP) remains a significant public health problem, which is not only confined to those who have travelled abroad. In both outbreaks and sporadic cases, diagnosis can go unrecognised. We reviewed the demographics, comorbidities, diagnosis, treatment and clinical outcome of LP cases over five years in a district general hospital in northwest England. Over half of LP cases were UK acquired and 'classic' clinical features were common. Clinical criteria for diagnosing LP were confirmed, but few sputum samples were sent to reference laboratories, limiting further essential epidemiological mapping of UK cases. Following current UK community-acquired pneumonia guidance would have missed nearly one quarter of LP cases in our series, potentially leading to further morbidity and mortality.
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Affiliation(s)
- Tom Wingfield
- Blackpool Teaching Hospitals NHS Foundation Trust, UK.
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Dohmen PM, Guleri A, Capone A, Utili R, Seaton RA, González-Ramallo VJ, Pathan R, Heep M, Chaves RL. Daptomycin for the treatment of infective endocarditis: results from a European registry. J Antimicrob Chemother 2012. [PMID: 23190763 DOI: 10.1093/jac/dks467] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Infective endocarditis (IE) is a complex infection associated with high mortality. Daptomycin, a cyclic lipopeptide antibiotic highly active against Gram-positive bacteria, has recently been incorporated into IE treatment guidelines. This retrospective analysis provides insights into the use of daptomycin in IE in the European Cubicin(®) Outcomes Registry Experience (EU-CORE(SM)) between 2006 and 2010. PATIENTS AND METHODS Three hundred and seventy-eight (10%) of 3621 enrolled patients received daptomycin for treatment of IE. Two hundred and fifty-nine (69%) had left-sided IE (LIE) and 182 patients (48%) underwent concomitant surgery. RESULTS Staphylococcus aureus was the most frequently identified pathogen (n=92; methicillin susceptible, n=50) and daptomycin was used empirically in 134 patients. Among cases of second-line therapy (n=312), the most common reason for switching to daptomycin was failure of the previous regimen (including glycopeptides and penicillins). Daptomycin was administered at 6 mg/kg in 224 patients and at ≥ 8 mg/kg in 72 patients. Clinical success rates were 80% overall, 91% for right-sided IE (RIE) and 76% for LIE, with similar rates seen for infections caused by methicillin-susceptible S. aureus (84%) and methicillin-resistant S. aureus (81%). The clinical success rate in patients treated with ≥ 8 mg/kg daptomycin was 90% [n=72 (RIE, 91%; LIE, 89%)]. No new safety signals were observed. CONCLUSIONS In patients with IE registered in EU-CORE, daptomycin was most frequently used as second-line treatment after treatment failure. The majority of patients had LIE and most commonly received daptomycin for the treatment of staphylococcal infections. Clinical success was high in this difficult-to-treat population. The role of doses ≥ 8 mg/kg per day in the empirical treatment of IE deserves further investigation.
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Affiliation(s)
- Pascal M Dohmen
- Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany.
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21
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Purohit M, Guleri A, Zacharias J. Salvage therapy with topical antifungal for Aspergillus fumigatus empyema complicating extrapleural pneumonectomy. Interact Cardiovasc Thorac Surg 2012; 15:518-9. [PMID: 22617507 DOI: 10.1093/icvts/ivs217] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe an unusual case of Aspergillus fumigatus empyema and bronchopleural fistulae after extrapleural pneumonectomy (EPP) and chemoradiotherapy (CRT), which was treated successfully under salvage conditions with debridement, an innovative topical antifungal application and supplemented systemic antifungal therapy and which went on for a definitive surgical procedure. Combinations of CRT and EPP have been recommended in a select group of patients with malignant mesothelioma. Irrespective of the combination, EPP is associated with mortality in the range of 4-15% and a complication rate as high as 62%.
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Affiliation(s)
- Manoj Purohit
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Teaching Hospital NHS Foundation Trust, Blackpool, UK.
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Guleri A, Kumar A, Morgan RJM, Hartley M, Roberts DH. Anaphylaxis to chlorhexidine-coated central venous catheters: a case series and review of the literature. Surg Infect (Larchmt) 2012; 13:171-4. [PMID: 22568873 DOI: 10.1089/sur.2011.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [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
BACKGROUND Anaphylactic reactions to chlorhexidine are rare but are being reported increasingly in association with a variety of products. METHODS We report three cases of anaphylaxis to chlorhexidine in patients presenting for cardiac surgery. RESULTS In each case, anaphylaxis was precipitated by the insertion of a central venous catheter impregnated with chlorhexidine acetate. Subsequent investigations confirmed chlorhexidine as the causal agent. CONCLUSION Extensive use of chlorhexidine to reduce hospital-acquired infections has the potential to sensitize a small proportion of patients, leading to life-threatening anaphylaxis on subsequent exposure.
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Affiliation(s)
- Achyut Guleri
- Department of Clinical Microbiology, Blackpool Victoria Hospital, Blackpool, Lancashire, UK.
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Przybylo M, Qulaghassi M, Guleri A. FP3.1 ‘Hand-hygiene champion junior doctor picks up the gauntlet’ a randomized prospective study of 3080 minutes of hand hygiene audit conducted by doctors. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60016-3] [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] [Indexed: 11/28/2022]
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Guleri A, Carter-Lindsay J, Lunt B, Palmer R, Harper N. P06.03 MRSA PCR screening: is it still a cost effective option during times of financial turbulence in NHS hospitals? J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60058-8] [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] [Indexed: 10/18/2022]
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Aggarwal S, Tipping J, McAlea B, Guleri A. P28.03 Dealing with MRSA decolonisation failures and cancelled surgeries during NHS financial turbulence: a clinico-economic modelling study. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60252-6] [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] [Indexed: 10/19/2022]
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Guleri A, Kumar A, Hartley M, Roberts D. OB1.2 Are we throwing caution to the winds? 3-cases of anaphylaxis to chlorhexidine coated central venous catheters at Lancashire cardiac centre. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60025-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Guleri A, Palmer R, Harper N, Woodrow K. P13.13 Value of realtime monitoring of comprehensive Clostridium difficile infection containment programme [CCDP] and impact of rise in clindamycin usage (DDD). J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60150-8] [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] [Indexed: 10/19/2022]
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Przybylo M, Lau M, Qulaghassi M, Khan A, Chang J, Guleri A. P29.33 MSSA blood stream infection – MRSA's evil twin!: a review of the epidemiology, risk factors and outcomes among hospitalised patients with MSSA/MRSA BSI. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60294-0] [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] [Indexed: 12/01/2022]
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Przybylo M, Qulaghassi M, Guleri A, Moon J. P13.05 ‘A distressing experience’: a study of the psycho-social aspects of Clostridium difficile infection. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60142-9] [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] [Indexed: 10/19/2022]
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Przybylo M, Summers S, Purohit M, Guleri A. P29.34 MRSA screening in cardiac intensive care – the Achilles’ heel: a clinical audit and survey of outcomes at Lancashire cardiac centre. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60295-2] [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] [Indexed: 10/19/2022]
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Przybylo M, Summers S, Guleri A, Qulaghassi M. P04.01 ‘The 6 Million Dollar Man’: An unusual case of adaptative commensalism with multidrug resistant bacteria in a surgical patient treated for 18 months. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60049-7] [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] [Indexed: 11/16/2022]
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Lau MI, Foo FJ, Bury R, Guleri A, Kiruparan P. Osteomyelitis of the iliac crest: a rare complication following perforated appendicitis. Surg Infect (Larchmt) 2010; 11:397-402. [PMID: 20055574 DOI: 10.1089/sur.2009.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Appendicitis is a common surgical emergency with numerous postoperative infective complications. We report an unusual case of iliac crest osteomyelitis as a late complication following emergency appendectomy for perforated gangrenous appendicitis. METHODS Review of the pertinent English language literature. RESULTS To the best of our knowledge, this is the first report in the English literature to describe iliac crest osteomyelitis as an infective complication of perforated gangrenous appendicitis. The diagnosis was made with the aid of magnetic resonance imaging and radioisotope bone scans. The complication was treated successfully with broad-spectrum intravenous antibiotics and physiotherapy. CONCLUSION Iliac crest osteomyelitis is indeed a rare complication of appendicitis. A heightened awareness and better understanding of this complication would necessitate early diagnosis and treatment.
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Affiliation(s)
- Michael I Lau
- Department of General Surgery, Victoria Hospital, Blackpool, Lancashire, United Kingdom
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Guleri A, Sharma R, Smith GW. Prevalence and risk factors for MRSA in adult emergency admissions: a case for screening all patients? J Hosp Infect 2007; 67:96-7. [PMID: 17719680 DOI: 10.1016/j.jhin.2007.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2007] [Accepted: 06/28/2007] [Indexed: 11/28/2022]
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Dancer SJ, Coyne M, Robertson C, Thomson A, Guleri A, Alcock S. Antibiotic use is associated with resistance of environmental organisms in a teaching hospital. J Hosp Infect 2006; 62:200-6. [PMID: 16324769 DOI: 10.1016/j.jhin.2005.06.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Accepted: 06/22/2005] [Indexed: 10/25/2022]
Abstract
An intensive care unit (ICU), acute stroke unit (ASU) and medical day bed unit (MDBU) underwent a standardized four-month environmental screening programme. The aim was to examine environmental organisms from these wards and compare bacterial resistances in association with antimicrobial usage. Hand-touch and other sites were screened using commercial dip-slides, and staff were asked to provide fingertip cultures. Patient blood isolates were retained throughout the study. Organisms were quantitatively and qualitatively assessed including antimicrobial susceptibility testing. Antibiotic consumption data in defined daily doses/1000 patient-days were obtained for each unit for the previous year. Two hundred and seventy-six staphylococci and 67 Gram-negative bacilli were recovered. Antibiotic resistance was significantly associated with individual wards for staphylococci (P<0.0001) and coliforms (P=0.04), and trends were also demonstrated for other Gram-negative organisms (P=0.06) despite fewer numbers. Antibiotic consumption on the ICU was six-fold higher than on the ASU and MDBU. Associations were found between consumption of selected antibiotic groups and corresponding resistances among staphylococci and Gram-negative bacilli. Antibacterial resistance was the only significant difference between environmental bacteria from different wards, and appeared to reflect prescribing pressure. Visual inspection of a ward may not provide a reliable guide regarding the presence of multi-resistant organisms in the hospital environment or the potential risk of infection. These findings have implications for local antibiotic policies, infection control and cleaning schedules.
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Affiliation(s)
- S J Dancer
- Health Protection Scotland, Glasgow, UK.
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Guleri A, Samavedam S, Corcoran G. Rhinocerebral zygomycosis — diagnostic dilemma for emergency physician: is reduction in morbidity and mortality possible in this rare but deadly disease? Int J Infect Dis 2002. [DOI: 10.1016/s1201-9712(02)90287-0] [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] [Indexed: 11/26/2022] Open
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