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Ashiru-Oredope D, Cunningham N, Casale E, Muller-Pebody B, Hope R, Brown CS, Hopkins S. Reporting England's progress towards the ambitions in the UK action plan for antimicrobial resistance: the English surveillance programme for antimicrobial utilisation and resistance (ESPAUR). J Antimicrob Chemother 2023; 78:2387-2391. [PMID: 37596897 DOI: 10.1093/jac/dkad248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
The plans for a new antimicrobial utilization and resistance national surveillance programme, alongside the development of quality measures and methods to monitor unintended outcomes of antimicrobial stewardship and both public and professional behaviour interventions were published in 2013. Since then, England has published an annual surveillance report including outlining progress against the ambitions of the UK national action plans on antimicrobial resistance (2013 to 2018 and 2019 to 2024). A decade later we provide a brief update on progress so far, with a focus on key highlights from the latest report published in November 2022. We also provide our recommendations for areas of focus as we move into the next decade. From an initial focus on antibiotic consumption and resistance, the report now includes surveillance data for antifungals, antivirals (including novel agents, such as those targeting SARS-CoV-2) and antimalarials. Evaluation of key stewardship interventions including professional and public engagement initiatives are also reported, as well as progress against NHS England's (NHSE's) improvement measures.
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Affiliation(s)
- Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, Clinical and Public Health Group, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Neil Cunningham
- Clinical and Public Health Group, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Ella Casale
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, Clinical and Public Health Group, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Berit Muller-Pebody
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, Clinical and Public Health Group, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Russell Hope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, Clinical and Public Health Group, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Colin S Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, Clinical and Public Health Group, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Susan Hopkins
- Clinical and Public Health Group, United Kingdom Health Security Agency (UKHSA), London, UK
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2
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Channon-Wells S, Elmes J, Muller-Pebody B, McGarrity O, Chappell F, Drysdale SB, Ashiru-Oredope D, Patel S, Demirjian A. National point-prevalence survey of healthcare-associated infections and antimicrobial use: UK-PAS/UKHSA joint call to action for all paediatric services. J Antimicrob Chemother 2023; 78:2392-2394. [PMID: 37611224 PMCID: PMC10805576 DOI: 10.1093/jac/dkad265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
The negative impact of high antimicrobial use (AMU), antimicrobial resistance and healthcare-associated infections (HCAIs) on children is concerning. However, a lack of available paediatric data makes it challenging to design and implement interventions that would improve health outcomes in this population, and impedes efforts to secure additional resources. The upcoming 2023 national point-prevalence survey of HCAIs and AMU in hospitals, led by the UK Health Security Agency, is an opportunity to collect valuable information, which will enable healthcare providers and policy makers to optimize antimicrobial stewardship and infection prevention practices in all populations, including children. These data will facilitate benchmarking and sharing of best practice, internally, nationally and internationally. This is a joint call to action asking all healthcare professionals-particularly in paediatrics-to nominate a lead for their institution and participate in this survey, to ensure appropriate paediatric representation, and help protect children from these growing threats.
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Affiliation(s)
- Samuel Channon-Wells
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
| | - Jocelyn Elmes
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Berit Muller-Pebody
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Orlagh McGarrity
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Department of Pharmacy, Great Ormond Street Hospital, London, UK
| | - Faye Chappell
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
| | - Simon B Drysdale
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Centre for Paediatric and Neonatal Infection, St George’s, University of London, London, UK
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Sanjay Patel
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
| | - Alicia Demirjian
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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3
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Naylor NR, Evans S, Pouwels KB, Troughton R, Lamagni T, Muller-Pebody B, Knight GM, Atun R, Robotham JV. Quantifying the primary and secondary effects of antimicrobial resistance on surgery patients: Methods and data sources for empirical estimation in England. Front Public Health 2022; 10:803943. [PMID: 36033764 PMCID: PMC9413182 DOI: 10.3389/fpubh.2022.803943] [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: 10/28/2021] [Accepted: 07/04/2022] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance (AMR) may negatively impact surgery patients through reducing the efficacy of treatment of surgical site infections, also known as the "primary effects" of AMR. Previous estimates of the burden of AMR have largely ignored the potential "secondary effects," such as changes in surgical care pathways due to AMR, such as different infection prevention procedures or reduced access to surgical procedures altogether, with literature providing limited quantifications of this potential burden. Former conceptual models and approaches for quantifying such impacts are available, though they are often high-level and difficult to utilize in practice. We therefore expand on this earlier work to incorporate heterogeneity in antimicrobial usage, AMR, and causative organisms, providing a detailed decision-tree-Markov-hybrid conceptual model to estimate the burden of AMR on surgery patients. We collate available data sources in England and describe how routinely collected data could be used to parameterise such a model, providing a useful repository of data systems for future health economic evaluations. The wealth of national-level data available for England provides a case study in describing how current surveillance and administrative data capture systems could be used in the estimation of transition probability and cost parameters. However, it is recommended that such data are utilized in combination with expert opinion (for scope and scenario definitions) to robustly estimate both the primary and secondary effects of AMR over time. Though we focus on England, this discussion is useful in other settings with established and/or developing infectious diseases surveillance systems that feed into AMR National Action Plans.
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Affiliation(s)
- Nichola R. Naylor
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, Antimicrobial Resistance (AMR) Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom,Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom,*Correspondence: Nichola R. Naylor
| | - Stephanie Evans
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
| | - Koen B. Pouwels
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, United Kingdom,The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, United Kingdom
| | - Rachael Troughton
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom
| | - Theresa Lamagni
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
| | - Berit Muller-Pebody
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
| | - Gwenan M. Knight
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, Antimicrobial Resistance (AMR) Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Julie V. Robotham
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom,Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
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4
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Naylor NR, Evans S, Pouwels KB, Troughton R, Lamagni T, Muller-Pebody B, Knight GM, Atun R, Robotham JV. Quantifying the primary and secondary effects of antimicrobial resistance on surgery patients: Methods and data sources for empirical estimation in England. Front Public Health 2022. [DOI: 10.5210.3389/fpubh.2022.803943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) may negatively impact surgery patients through reducing the efficacy of treatment of surgical site infections, also known as the “primary effects” of AMR. Previous estimates of the burden of AMR have largely ignored the potential “secondary effects,” such as changes in surgical care pathways due to AMR, such as different infection prevention procedures or reduced access to surgical procedures altogether, with literature providing limited quantifications of this potential burden. Former conceptual models and approaches for quantifying such impacts are available, though they are often high-level and difficult to utilize in practice. We therefore expand on this earlier work to incorporate heterogeneity in antimicrobial usage, AMR, and causative organisms, providing a detailed decision-tree-Markov-hybrid conceptual model to estimate the burden of AMR on surgery patients. We collate available data sources in England and describe how routinely collected data could be used to parameterise such a model, providing a useful repository of data systems for future health economic evaluations. The wealth of national-level data available for England provides a case study in describing how current surveillance and administrative data capture systems could be used in the estimation of transition probability and cost parameters. However, it is recommended that such data are utilized in combination with expert opinion (for scope and scenario definitions) to robustly estimate both the primary and secondary effects of AMR over time. Though we focus on England, this discussion is useful in other settings with established and/or developing infectious diseases surveillance systems that feed into AMR National Action Plans.
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5
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Muller-Pebody B, Sinnathamby MA, Warburton F, Rooney G, Andrews N, Whitaker H, Henderson KL, Tsang C, Hopkins S, Pebody RG. Impact of the childhood influenza vaccine programme on antibiotic prescribing rates in primary care in England. Vaccine 2021; 39:6622-6627. [PMID: 34627625 DOI: 10.1016/j.vaccine.2021.09.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
Vaccines are a key part of the global strategy to tackle antimicrobial resistance (AMR) since prevention of infection should reduce antibiotic use. England commenced national rollout of a live attenuated influenza vaccine (LAIV) programme for children aged 2-3 years together with a series of geographically discrete pilot areas for primary school age children in 2013 extending to older children in subsequent seasons. We investigated vaccine programme impact on community antibiotic prescribing rates. Antibiotic prescribing incidence rates for respiratory (RTI) and urinary tract infections (UTI; controls) were calculated at general practice (GP) level by age category (children<=10 years/adults) and season for LAIV pilot and non-pilot areas between 2013/14 and 2015/16. To estimate the LAIV (primary school age children only) intervention effect, a random effects model was fitted. A multivariable random-effects Poisson regression investigated the association of antibiotic prescribing rates in children with LAIV uptake (2-3-year-olds only) at GP practice level. RTI antibiotic prescribing rates for children <=10 years and adults showed clear seasonal trends and were lower in LAIV-pilot and non-pilot areas after the introduction of the LAIV programme in 2013. The reductions for RTI prescriptions (children) were similar (within 3%) in all areas, which coincided with the start the UK AMR strategy. Antibiotic prescribing was significantly (p < 0.0001) related to LAIV uptake in 2-3-year-olds with antibiotic prescribing reduced by 2.7% (95% CI: 2.1% to 3.4%) for every 10% increase in uptake. We found no evidence the LAIV programme for primary school age children resulted in reductions in RTI antibiotic prescribing, however we detected a significant inverse association between increased vaccine uptake in pre-school age children and antibiotic prescribing at GP level. The temporal association of reduced RTI and UTI antibiotic prescribing with the launch of the UK's AMR Strategy in 2013 highlights the importance of a multifaceted approach to tackle AMR.
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Affiliation(s)
- Berit Muller-Pebody
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England (PHE), London, United Kingdom
| | - Mary A Sinnathamby
- Immunisation and Countermeasures, National Infection Service, Public Health England (PHE), London, United Kingdom.
| | - Fiona Warburton
- Statistics and Modelling Department, National Infection Service, Public Health England (PHE), London, United Kingdom
| | - Graeme Rooney
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England (PHE), London, United Kingdom
| | - Nick Andrews
- Statistics and Modelling Department, National Infection Service, Public Health England (PHE), London, United Kingdom
| | - Heather Whitaker
- Statistics and Modelling Department, National Infection Service, Public Health England (PHE), London, United Kingdom
| | - Katherine L Henderson
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England (PHE), London, United Kingdom
| | - Camille Tsang
- Immunisation and Countermeasures, National Infection Service, Public Health England (PHE), London, United Kingdom
| | - Susan Hopkins
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England (PHE), London, United Kingdom
| | - Richard G Pebody
- Immunisation and Countermeasures, National Infection Service, Public Health England (PHE), London, United Kingdom
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6
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Lipworth S, Hough N, Weston N, Muller-Pebody B, Phin N, Myers R, Chapman S, Flight W, Alexander E, Smith EG, Robinson E, Peto TEA, Crook DW, Walker AS, Hopkins S, Eyre DW, Walker TM. Epidemiology of Mycobacterium abscessus in England: an observational study. Lancet Microbe 2021; 2:e498-e507. [PMID: 34632432 PMCID: PMC8481905 DOI: 10.1016/s2666-5247(21)00128-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Mycobacterium abscessus has emerged as a significant clinical concern following reports that it is readily transmissible in health-care settings between patients with cystic fibrosis. We linked routinely collected whole-genome sequencing and health-care usage data with the aim of investigating the extent to which such transmission explains acquisition in patients with and without cystic fibrosis in England. METHODS In this retrospective observational study, we analysed consecutive M abscessus whole-genome sequencing data from England (beginning of February, 2015, to Nov 14, 2019) to identify genomically similar isolates. Linkage to a national health-care usage database was used to investigate possible contacts between patients. Multivariable regression analysis was done to investigate factors associated with acquisition of a genomically clustered strain (genomic distance <25 single nucleotide polymorphisms [SNPs]). FINDINGS 2297 isolates from 906 patients underwent whole-genome sequencing as part of the routine Public Health England diagnostic service. Of 14 genomic clusters containing isolates from ten or more patients, all but one contained patients with cystic fibrosis and patients without cystic fibrosis. Patients with cystic fibrosis were equally likely to have clustered isolates (258 [60%] of 431 patients) as those without cystic fibrosis (322 [63%] of 513 patients; p=0·38). High-density phylogenetic clusters were randomly distributed over a wide geographical area. Most isolates with a closest genetic neighbour consistent with potential transmission had no identifiable relevant epidemiological contacts. Having a clustered isolate was independently associated with increasing age (adjusted odds ratio 1·14 per 10 years, 95% CI 1·04-1·26), but not time spent as an hospital inpatient or outpatient. We identified two sibling pairs with cystic fibrosis with genetically highly divergent isolates and one pair with closely related isolates, and 25 uninfected presumed household contacts with cystic fibrosis. INTERPRETATION Previously identified widely disseminated dominant clones of M abscessus are not restricted to patients with cystic fibrosis and occur in other chronic respiratory diseases. Although our analysis showed a small number of cases where person-to-person transmission could not be excluded, it did not support this being a major mechanism for M abscessus dissemination at a national level in England. Overall, these data should reassure patients and clinicians that the risk of acquisition from other patients in health-care settings is relatively low and motivate future research efforts to focus on identifying routes of acquisition outside of the cystic fibrosis health-care-associated niche. FUNDING The National Institute for Health Research, Health Data Research UK, The Wellcome Trust, The Medical Research Council, and Public Health England.
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Affiliation(s)
- Samuel Lipworth
- Nuffield Department of Medicine, University of Oxford, Oxford, UK,Oxford University Hospitals NHS Foundation Trust, Oxford, UK,Correspondence to: Dr Samuel Lipworth, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - Natasha Hough
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Natasha Weston
- National Mycobacterial Reference Service-Central and North, Public Health England, Public Health Laboratory, Birmingham, UK
| | - Berit Muller-Pebody
- Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging and Zoonotic Infections and Travel Migrant Health Division, National Infection Service, Public Health England, London, UK
| | - Nick Phin
- Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging and Zoonotic Infections and Travel Migrant Health Division, National Infection Service, Public Health England, London, UK
| | - Richard Myers
- Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging and Zoonotic Infections and Travel Migrant Health Division, National Infection Service, Public Health England, London, UK
| | - Stephen Chapman
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William Flight
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eliza Alexander
- National Mycobacterial Reference Service-South, Public Health England, London, UK
| | - E Grace Smith
- National Mycobacterial Reference Service-Central and North, Public Health England, Public Health Laboratory, Birmingham, UK
| | - Esther Robinson
- National Mycobacterial Reference Service-Central and North, Public Health England, Public Health Laboratory, Birmingham, UK
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, UK,Oxford University Hospitals NHS Foundation Trust, Oxford, UK,NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Derrick W Crook
- Nuffield Department of Medicine, University of Oxford, Oxford, UK,Oxford University Hospitals NHS Foundation Trust, Oxford, UK,NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Susan Hopkins
- Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging and Zoonotic Infections and Travel Migrant Health Division, National Infection Service, Public Health England, London, UK
| | - David W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Timothy M Walker
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK,Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
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7
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Gerver SM, Guy R, Wilson K, Thelwall S, Nsonwu O, Rooney G, Brown CS, Muller-Pebody B, Hope R, Hall V. National surveillance of bacterial and fungal coinfection and secondary infection in COVID-19 patients in England: lessons from the first wave. Clin Microbiol Infect 2021; 27:1658-1665. [PMID: 34481722 PMCID: PMC8186130 DOI: 10.1016/j.cmi.2021.05.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 12/28/2022]
Abstract
Objectives The impact of bacterial/fungal infections on the morbidity and mortality of persons with coronavirus disease 2019 (COVID-19) remains unclear. We have investigated the incidence and impact of key bacterial/fungal infections in persons with COVID-19 in England. Methods We extracted laboratory-confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (1st January 2020 to 2nd June 2020) and blood and lower-respiratory specimens positive for 24 genera/species of clinical relevance (1st January 2020 to 30th June 2020) from Public Health England's national laboratory surveillance system. We defined coinfection and secondary infection as a culture-positive key organism isolated within 1 day or 2–27 days, respectively, of the SARS-CoV-2-positive date. We described the incidence and timing of bacterial/fungal infections and compared characteristics of COVID-19 patients with and without bacterial/fungal infection. Results 1% of persons with COVID-19 (2279/223413) in England had coinfection/secondary infection, of which >65% were bloodstream infections. The most common causative organisms were Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae. Cases with coinfection/secondary infections were older than those without (median 70 years (IQR 58–81) versus 55 years (IQR 38–77)), and a higher percentage of cases with secondary infection were of Black or Asian ethnicity than cases without (6.7% versus 4.1%, and 9.9% versus 8.2%, respectively, p < 0.001). Age-sex-adjusted case fatality rates were higher in COVID-19 cases with a coinfection (23.0% (95%CI 18.8–27.6%)) or secondary infection (26.5% (95%CI 14.5–39.4%)) than in those without (7.6% (95%CI 7.5–7.7%)) (p < 0.005). Conclusions Coinfection/secondary bacterial/fungal infections were rare in non-hospitalized and hospitalized persons with COVID-19, varied by ethnicity and age, and were associated with higher mortality. However, the inclusion of non-hospitalized persons with asymptomatic/mild COVID-19 likely underestimated the rate of secondary bacterial/fungal infections. This should inform diagnostic testing and antibiotic prescribing strategy.
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Affiliation(s)
- Sarah M Gerver
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Rebecca Guy
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Kate Wilson
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Simon Thelwall
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Olisaeloka Nsonwu
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Graeme Rooney
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Colin S Brown
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Berit Muller-Pebody
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Russell Hope
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Victoria Hall
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
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8
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Stowe J, Tessier E, Zhao H, Guy R, Muller-Pebody B, Zambon M, Andrews N, Ramsay M, Lopez Bernal J. Interactions between SARS-CoV-2 and influenza, and the impact of coinfection on disease severity: a test-negative design. Int J Epidemiol 2021; 50:1124-1133. [PMID: 33942104 PMCID: PMC8135706 DOI: 10.1093/ije/dyab081] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The impact of SARS-CoV-2 alongside influenza is a major concern in the northern hemisphere as winter approaches. METHODS Test data for influenza and SARS-CoV-2 from national surveillance systems between 20 January 2020 and 25 April 2020 were used to estimate influenza infection on the risk of SARS-CoV-2 infection. A test-negative design was used to assess the odds of SARS-CoV-2 in those who tested positive for influenza compared with those who tested negative. The severity of SARS-CoV-2 was also assessed using univariable and multivariable analyses. RESULTS The risk of testing positive for SARS-CoV-2 was 58% lower among influenza-positive cases and patients with a coinfection had a risk of death of 5.92 (95% confidence interval: 3.21-10.91) times greater than among those with neither influenza nor SARS-CoV-2. The odds of ventilator use or death and intensive care unit admission or death were greatest among coinfected patients. CONCLUSIONS Coinfection of these viruses could have a significant impact on morbidity, mortality and health-service demand.
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Affiliation(s)
- Julia Stowe
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Elise Tessier
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - H Zhao
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Rebecca Guy
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - Berit Muller-Pebody
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - Maria Zambon
- Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Mary Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Jamie Lopez Bernal
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
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9
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Andrews A, Budd EL, Hendrick A, Ashiru-Oredope D, Beech E, Hopkins S, Gerver S, Muller-Pebody B. Surveillance of Antibacterial Usage during the COVID-19 Pandemic in England, 2020. Antibiotics (Basel) 2021; 10:841. [PMID: 34356762 PMCID: PMC8300678 DOI: 10.3390/antibiotics10070841] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/19/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Changes in antibacterial prescribing during the COVID-19 pandemic were anticipated given that the clinical features of severe respiratory infection syndrome caused by SARS-CoV-2 mirror bacterial respiratory tract infections. Antibacterial consumption was measured in items/1000 population for primary care and in Defined Daily Doses (DDDs)/1000 admissions for secondary care in England from 2015 to October 2020. Interrupted time-series analyses were conducted to evaluate the effects of the pandemic on antibacterial consumption. In the community, the rate of antibacterial items prescribed decreased further in 2020 (by an extra 1.4% per month, 95% CI: -2.3 to -0.5) compared to before COVID-19. In hospitals, the volume of antibacterial use decreased during COVID-19 overall (-12.1% compared to pre-COVID, 95% CI: -19.1 to -4.4), although the rate of usage in hospitals increased steeply in April 2020. Use of antibacterials prescribed for respiratory infections and broad-spectrum antibacterials (predominately 'Watch' antibacterials in hospitals) increased in both settings. Overall volumes of antibacterial use at the beginning of the COVID-19 pandemic decreased in both primary and secondary settings, although there were increases in the rate of usage in hospitals in April 2020 and in specific antibacterials. This highlights the importance of antimicrobial stewardship during pandemics to ensure appropriate prescribing and avoid negative consequences on patient outcomes and antimicrobial resistance.
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Affiliation(s)
- Amelia Andrews
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | - Emma L. Budd
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
| | - Aoife Hendrick
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | | | - Susan Hopkins
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | - Sarah Gerver
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | - Berit Muller-Pebody
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
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10
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Sharp A, Muller-Pebody B, Charlett A, Patel B, Gorton R, Lambourne J, Cummins M, Alcolea-Medina A, Wilks M, Smith R, Mack D, Hopkins S, Dodgson A, Burns P, Perera N, Lim F, Rao G, Khanna P, Johnson E, Borman A, Schelenz S, Guy R, Conneely J, Manuel RJ, Brown CS. Screening for Candida auris in patients admitted to eight intensive care units in England, 2017 to 2018. Euro Surveill 2021; 26:1900730. [PMID: 33632376 PMCID: PMC7908068 DOI: 10.2807/1560-7917.es.2021.26.8.1900730] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/01/2020] [Indexed: 12/29/2022] Open
Abstract
BackgroundCandida auris is an emerging multidrug-resistant fungal pathogen associated with bloodstream, wound and other infections, especially in critically ill patients. C. auris carriage is persistent and is difficult to eradicate from the hospital environment.AimWe aimed to pilot admission screening for C. auris in intensive care units (ICUs) in England to estimate prevalence in the ICU population and to inform public health guidance.MethodsBetween May 2017 and April 2018, we screened admissions to eight adult ICUs in hospitals with no previous cases of C. auris, in three major cities. Swabs were taken from the nose, throat, axilla, groin, perineum, rectum and catheter urine, then cultured and identified using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Patient records were linked to routine ICU data to describe and compare the demographic and health indicators of the screened cohort with a national cohort of ICU patients admitted between 2016 and 2017.ResultsAll C. auris screens for 921 adults from 998 admissions were negative. The upper confidence limit of the pooled prevalence across all sites was 0.4%. Comparison of the screened cohort with the national cohort showed it was broadly similar to the national cohort with respect to demographics and co-morbidities.ConclusionThese findings imply that C. auris colonisation among patients admitted to ICUs in England is currently rare. We would not currently recommend widespread screening for C. auris in ICUs in England. Hospitals should continue to screen high-risk individuals based on local risk assessment.
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Affiliation(s)
- Ashley Sharp
- Field Epidemiology Training Programme, Public Health England, London, United Kingdom
| | | | - Andre Charlett
- National Infection Service, Public Health England, London, United Kingdom
| | - Bharat Patel
- National Infection Service, Public Health England, London, United Kingdom
| | - Rebecca Gorton
- Health Service Laboratories, LLP, London, United Kingdom
| | | | | | | | - Mark Wilks
- Barts Health NHS Trust, London, United Kingdom
| | - Robin Smith
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Damien Mack
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Susan Hopkins
- National Infection Service, Public Health England, London, United Kingdom
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Andrew Dodgson
- National Infection Service, Public Health England, London, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Phillipa Burns
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Nelun Perera
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Felicia Lim
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Gopal Rao
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Priya Khanna
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Elizabeth Johnson
- National Infection Service, Public Health England, London, United Kingdom
| | - Andrew Borman
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Rebecca Guy
- National Infection Service, Public Health England, London, United Kingdom
| | - Joanna Conneely
- National Infection Service, Public Health England, London, United Kingdom
| | - Rohini J Manuel
- National Infection Service, Public Health England, London, United Kingdom
| | - Colin S Brown
- National Infection Service, Public Health England, London, United Kingdom
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
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11
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Gilbert R, Brown M, Faria R, Fraser C, Donohue C, Rainford N, Grosso A, Sinha AK, Dorling J, Gray J, Muller-Pebody B, Harron K, Moitt T, McGuire W, Bojke L, Gamble C, Oddie SJ. Antimicrobial-impregnated central venous catheters for preventing neonatal bloodstream infection: the PREVAIL RCT. Health Technol Assess 2020; 24:1-190. [PMID: 33174528 DOI: 10.3310/hta24570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Clinical trials show that antimicrobial-impregnated central venous catheters reduce catheter-related bloodstream infection in adults and children receiving intensive care, but there is insufficient evidence for use in newborn babies. OBJECTIVES The objectives were (1) to determine clinical effectiveness by conducting a randomised controlled trial comparing antimicrobial-impregnated peripherally inserted central venous catheters with standard peripherally inserted central venous catheters for reducing bloodstream or cerebrospinal fluid infections (referred to as bloodstream infections); (2) to conduct an economic evaluation of the costs, cost-effectiveness and value of conducting additional research; and (3) to conduct a generalisability analysis of trial findings to neonatal care in the NHS. DESIGN Three separate studies were undertaken, each addressing one of the three objectives. (1) This was a multicentre, open-label, pragmatic randomised controlled trial; (2) an analysis was undertaken of hospital care costs, lifetime cost-effectiveness and value of information from an NHS perspective; and (3) this was a retrospective cohort study of bloodstream infection rates in neonatal units in England. SETTING The randomised controlled trial was conducted in 18 neonatal intensive care units in England. PARTICIPANTS Participants were babies who required a peripherally inserted central venous catheter (of 1 French gauge in size). INTERVENTIONS The interventions were an antimicrobial-impregnated peripherally inserted central venous catheter (coated with rifampicin-miconazole) or a standard peripherally inserted central venous catheter, allocated randomly (1 : 1) using web randomisation. MAIN OUTCOME MEASURE Study 1 - time to first bloodstream infection, sampled between 24 hours after randomisation and 48 hours after peripherally inserted central venous catheter removal. Study 2 - cost-effectiveness of the antimicrobial-impregnated peripherally inserted central venous catheter compared with the standard peripherally inserted central venous catheters. Study 3 - risk-adjusted bloodstream rates in the trial compared with those in neonatal units in England. For study 3, the data used were as follows: (1) case report forms and linked death registrations; (2) case report forms and linked death registrations linked to administrative health records with 6-month follow-up; and (3) neonatal health records linked to infection surveillance data. RESULTS Study 1, clinical effectiveness - 861 babies were randomised (antimicrobial-impregnated peripherally inserted central venous catheter, n = 430; standard peripherally inserted central venous catheter, n = 431). Bloodstream infections occurred in 46 babies (10.7%) randomised to antimicrobial-impregnated peripherally inserted central venous catheters and in 44 (10.2%) babies randomised to standard peripherally inserted central venous catheters. No difference in time to bloodstream infection was detected (hazard ratio 1.11, 95% confidence interval 0.73 to 1.67; p = 0.63). Secondary outcomes of rifampicin resistance in positive blood/cerebrospinal fluid cultures, mortality, clinical outcomes at neonatal unit discharge and time to peripherally inserted central venous catheter removal were similar in both groups. Rifampicin resistance in positive peripherally inserted central venous catheter tip cultures was higher in the antimicrobial-impregnated peripherally inserted central venous catheter group (relative risk 3.51, 95% confidence interval 1.16 to 10.57; p = 0.02) than in the standard peripherally inserted central venous catheter group. Adverse events were similar in both groups. Study 2, economic evaluation - the mean cost of babies' hospital care was £83,473. Antimicrobial-impregnated peripherally inserted central venous catheters were not cost-effective. Given the increased price, compared with standard peripherally inserted central venous catheters, the minimum reduction in risk of bloodstream infection for antimicrobial-impregnated peripherally inserted central venous catheters to be cost-effective was 3% and 15% for babies born at 23-27 and 28-32 weeks' gestation, respectively. Study 3, generalisability analysis - risk-adjusted bloodstream infection rates per 1000 peripherally inserted central venous catheter days were similar among babies in the trial and in all neonatal units. Of all bloodstream infections in babies receiving intensive or high-dependency care in neonatal units, 46% occurred during peripherally inserted central venous catheter days. LIMITATIONS The trial was open label as antimicrobial-impregnated and standard peripherally inserted central venous catheters are different colours. There was insufficient power to determine differences in rifampicin resistance. CONCLUSIONS No evidence of benefit or harm was found of peripherally inserted central venous catheters impregnated with rifampicin-miconazole during neonatal care. Interventions with small effects on bloodstream infections could be cost-effective over a child's life course. Findings were generalisable to neonatal units in England. Future research should focus on other types of antimicrobial impregnation of peripherally inserted central venous catheters and alternative approaches for preventing bloodstream infections in neonatal care. TRIAL REGISTRATION Current Controlled Trials ISRCTN81931394. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 57. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK, London, UK
| | - Michaela Brown
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Rita Faria
- Centre for Health Economics, University of York, York, UK
| | - Caroline Fraser
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Chloe Donohue
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Naomi Rainford
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | | | | | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Dalhousie University IWK Health Centre, Halifax, NS, Canada
| | - Jim Gray
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Tracy Moitt
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
| | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Sam J Oddie
- Centre for Reviews and Dissemination, University of York, York, UK.,Bradford Neonatology, Bradford Royal Infirmary, Bradford, UK
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12
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Budd E, Cramp E, Sharland M, Hand K, Howard P, Wilson P, Wilcox M, Muller-Pebody B, Hopkins S. Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: being AWaRe. J Antimicrob Chemother 2020; 74:3384-3389. [PMID: 31361000 DOI: 10.1093/jac/dkz321] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Appropriate use of and access to antimicrobials are key priorities of global strategies to combat antimicrobial resistance (AMR). The WHO recently classified key antibiotics into three categories (AWaRe) to improve access (Access), monitor important antibiotics (Watch) and preserve effectiveness of 'last resort' antibiotics (Reserve). This classification was assessed for antibiotic stewardship and quality improvement in English hospitals. METHODS Using an expert elicitation exercise, antibiotics used in England but not included in the WHO AWaRe index were added to an appropriate category following a workshop consensus exercise with national experts. The methodology was tested using national antibiotic prescribing data and presented by primary and secondary care. RESULTS In 2016, 46/108 antibiotics included within the WHO AWaRe index were routinely used in England and an additional 25 antibiotics also commonly used in England were not included in the WHO AWaRe index. WHO AWaRe-excluded and -included antibiotics were reviewed and reclassified according to the England-adapted AWaRE index with the justification by experts for each addition or alteration. Applying the England-adapted AWaRe index, Access antibiotics accounted for the majority (60.9%) of prescribing, followed by Watch (37.9%) and Reserve (0.8%); 0.4% of antibiotics remained unclassified. There was unexplained 2-fold variation in prescribing between hospitals within each AWaRe category, highlighting the potential for quality improvement. CONCLUSIONS We have adapted the WHO AWaRe index to create a specific index for England. The AWaRe index provides high-level understanding of antibiotic prescribing. Subsequent to this process the England AWaRe index is now embedded into national antibiotic stewardship policy and incentivized quality improvement schemes.
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Affiliation(s)
- Emma Budd
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK.,English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), London, UK
| | - Emma Cramp
- English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), London, UK.,NHS Improvement, Patient Safety Domain, London, UK
| | - Mike Sharland
- St George's University of London, London, UK.,Department of Health and Social Care Scientific Advisory Committee on Antibiotic Prescribing, Resistance and Healthcare-Associated Infection (APRHAI), London, UK
| | - Kieran Hand
- Department of Health and Social Care Scientific Advisory Committee on Antibiotic Prescribing, Resistance and Healthcare-Associated Infection (APRHAI), London, UK.,University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Philip Howard
- English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), London, UK.,NHS Improvement, Patient Safety Domain, London, UK.,Leeds Teaching Hospitals, University of Leeds, Leeds, UK
| | - Peter Wilson
- Department of Health and Social Care Scientific Advisory Committee on Antibiotic Prescribing, Resistance and Healthcare-Associated Infection (APRHAI), London, UK.,UCLH NHS Foundation Trust, London, UK
| | - Mark Wilcox
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK.,Department of Health and Social Care Scientific Advisory Committee on Antibiotic Prescribing, Resistance and Healthcare-Associated Infection (APRHAI), London, UK.,Leeds Teaching Hospitals, University of Leeds, Leeds, UK
| | - Berit Muller-Pebody
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK.,English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), London, UK
| | - Susan Hopkins
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK.,English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), London, UK
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13
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Freeman R, Ironmonger D, Hopkins KL, Puleston R, Staves P, Hope R, Muller-Pebody B, Brown CS, Hopkins S, Johnson AP, Woodford N, Oliver I. Epidemiology of carbapenemase-producing Enterobacterales in England, May 2015-March 2019: national enhanced surveillance findings and approach. Infect Prev Pract 2020; 2:100051. [PMID: 34368709 DOI: 10.1016/j.infpip.2020.100051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/28/2020] [Indexed: 11/29/2022] Open
Abstract
Background In response to increasing numbers of carbapenemase-producing Enterobacterales (CPE) in England, Public Health England (PHE) launched an electronic reporting system (ERS) for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria. Our study aimed to describe system engagement and the epidemiology of CPE in England. Methods Engagement with the ERS was assessed by calculating the proportion of referrals submitted this system. ERS data were extracted and cases defined as patients with CPE isolated from a screening or clinical specimen in England between 1st May 2015 to 31st March 2019. Descriptive summary statistics for each variable were prepared. Results The ERS processed 12,656 suspected CPE reports. Uptake of the ERS by local microbiology laboratories varied, with approximately 70% of referrals made via the ERS by April 2016; this steadily decreased after March 2018. Six-thousand eight-hundred and fifty-seven cases were included in the analysis. Most cases were from colonised patients (80.6%) rather than infected, and the majority were inpatients in acute hospital settings (87.3%). Carbapenemases were most frequently detected in Klebsiella pneumoniae (39.1%) and Escherichia coli (30.3%). The most frequently identified carbapenemase families were OXA-48-like (45.1%) and KPC (26.4%). Enhanced data variables were poorly completed. Conclusions The ERS has provided some insight into the epidemiology of CPE in England. An increasing number of routine diagnostic laboratories have introduced methods to routinely identify acquired carbapenemases and PHE has modified its approach to ensure robust surveillance, which is an essential aspect of an effective response to prevent and control the spread of CPE.
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Affiliation(s)
- Rachel Freeman
- National Infection Service, Public Health England, London, UK
| | - Dean Ironmonger
- National Infection Service, Public Health England, Birmingham, UK
| | - Katie L Hopkins
- National Infection Service, Public Health England, London, UK
| | - Richard Puleston
- National Infection Service, Public Health England, Nottingham, UK
| | - Peter Staves
- National Infection Service, Public Health England, London, UK
| | - Russell Hope
- National Infection Service, Public Health England, London, UK
| | | | - Colin S Brown
- National Infection Service, Public Health England, London, UK
| | - Susan Hopkins
- National Infection Service, Public Health England, London, UK
| | - Alan P Johnson
- National Infection Service, Public Health England, London, UK
| | - Neil Woodford
- National Infection Service, Public Health England, London, UK
| | - Isabel Oliver
- National Infection Service, Public Health England, Bristol, UK
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14
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Mesa Varona O, Chaintarli K, Muller-Pebody B, Anjum MF, Eckmanns T, Norström M, Boone I, Tenhagen BA. Monitoring Antimicrobial Resistance and Drug Usage in the Human and Livestock Sector and Foodborne Antimicrobial Resistance in Six European Countries. Infect Drug Resist 2020; 13:957-993. [PMID: 32308439 PMCID: PMC7140725 DOI: 10.2147/idr.s237038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 11/01/2019] [Accepted: 02/26/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR), associated with antimicrobial use (AMU), is a major public concern. Surveillance and monitoring systems are essential to assess and control the trends in AMU and AMR. However, differences in the surveillance and monitoring systems between countries and sectors make comparisons challenging. The purpose of this article is to describe all surveillance and monitoring systems for AMU and AMR in the human and livestock sectors, as well as national surveillance and monitoring systems for AMR in food, in six European countries (Spain, Germany, France, the Netherlands, the United Kingdom and Norway) as a baseline for developing suggestions to overcome current limitations in comparing AMU and AMR data. METHODS A literature search in 2018 was performed to identify relevant peer-reviewed articles and national and European grey reports as well as AMU/AMR databases. RESULTS Comparison of AMU and AMR systems across the six countries showed a lack of standardization and harmonization with different AMU data sources (prescription vs sales data) and units of AMU and AMR being used. The AMR data varied by sample type (clinical/non-clinical), laboratory method (disk diffusion, microdilution, and VITEK, among others), data type, ie quantitative (minimum inhibition concentration (MIC) in mg/L/inhibition zone (IZ) in mm) vs qualitative data (susceptible-intermediate-resistant (SIR)), the standards used (EUCAST/CLSI among others), and/or the evaluation criteria adopted (epidemiological or clinical). DISCUSSION A One Health approach for AMU and AMR requires harmonization in various aspects between human, animal and food systems at national and international levels. Additionally, some overlap between systems of AMU and AMR has been encountered. Efforts should be made to improve standardization and harmonization and allow more meaningful analyses of AMR and AMU surveillance data under a One Health approach.
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Affiliation(s)
- Octavio Mesa Varona
- Department of Biological Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Katerina Chaintarli
- Department of Bacteriology, Animal and Plant Health Agency (APHA), Addlestone, Surrey, UK
| | - Berit Muller-Pebody
- Healthcare-Associated Infections & Antimicrobial Resistance Division, National Infection Service, Public Health England (PHE), London, UK
| | - Muna F Anjum
- Department of Bacteriology, Animal and Plant Health Agency (APHA), Addlestone, Surrey, UK
| | - Tim Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Madelaine Norström
- Department of Analysis and Diagnostics, Section of Epidemiology, Norwegian Veterinary Institute (NVI), Oslo, Norway
| | - Ides Boone
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Bernd-Alois Tenhagen
- Department of Biological Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
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15
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Quan TP, Muller-Pebody B, Fawcett N, Young BC, Minaji M, Sandoe J, Hopkins S, Crook D, Peto T, Johnson AP, Walker AS. Investigation of the impact of the NICE guidelines regarding antibiotic prophylaxis during invasive dental procedures on the incidence of infective endocarditis in England: an electronic health records study. BMC Med 2020; 18:84. [PMID: 32238164 PMCID: PMC7114779 DOI: 10.1186/s12916-020-01531-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 09/20/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infective endocarditis is an uncommon but serious infection, where evidence for giving antibiotic prophylaxis before invasive dental procedures is inconclusive. In England, antibiotic prophylaxis was offered routinely to patients at risk of infective endocarditis until March 2008, when new guidelines aimed at reducing unnecessary antibiotic use were issued. We investigated whether changes in infective endocarditis incidence could be detected using electronic health records, assessing the impact of inclusion criteria/statistical model choice on inferences about the timing/type of any change. METHODS Using national data from Hospital Episode Statistics covering 1998-2017, we modelled trends in infective endocarditis incidence using three different sets of inclusion criteria plus a range of regression models, identifying the most likely date for a change in trends if evidence for one existed. We also modelled trends in the proportions of different organism groups identified during infection episodes, using secondary diagnosis codes and data from national laboratory records. Lastly, we applied non-parametric local smoothing to visually inspect any changes in trend around the guideline change date. RESULTS Infective endocarditis incidence increased markedly over the study (22.2-41.3 per million population in 1998 to 42.0-67.7 in 2017 depending on inclusion criteria). The most likely dates for a change in incidence trends ranged from September 2001 (uncertainty interval August 2000-May 2003) to May 2015 (March 1999-January 2016), depending on inclusion criteria and statistical model used. For the proportion of infective endocarditis cases associated with streptococci, the most likely change points ranged from October 2008 (March 2006-April 2010) to August 2015 (September 2013-November 2015), with those associated with oral streptococci decreasing in proportion after the change point. Smoothed trends showed no notable changes in trend around the guideline date. CONCLUSIONS Infective endocarditis incidence has increased rapidly in England, though we did not detect any change in trends directly following the updated guidelines for antibiotic prophylaxis, either overall or in cases associated with oral streptococci. Estimates of when changes occurred were sensitive to inclusion criteria and statistical model choice, demonstrating the need for caution in interpreting single models when using large datasets. More research is needed to explore the factors behind this increase.
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Affiliation(s)
- T Phuong Quan
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK. .,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. .,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK.
| | | | - Nicola Fawcett
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Bernadette C Young
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Mehdi Minaji
- National Infection Service, Public Health England, Colindale, London, UK
| | - Jonathan Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, LS1 3EX, UK
| | - Susan Hopkins
- National Infection Service, Public Health England, Colindale, London, UK
| | - Derrick Crook
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Timothy Peto
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Alan P Johnson
- National Infection Service, Public Health England, Colindale, London, UK
| | - A Sarah Walker
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Microbiology Level 7, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
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16
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Fraser C, Muller-Pebody B, Blackburn R, Gray J, Oddie SJ, Gilbert RE, Harron K. Linking surveillance and clinical data for evaluating trends in bloodstream infection rates in neonatal units in England. PLoS One 2019; 14:e0226040. [PMID: 31830076 PMCID: PMC6907823 DOI: 10.1371/journal.pone.0226040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate variation in trends in bloodstream infection (BSI) rates in neonatal units (NNUs) in England according to the data sources and linkage methods used. METHODS We used deterministic and probabilistic methods to link clinical records from 112 NNUs in the National Neonatal Research Database (NNRD) to national laboratory infection surveillance data from Public Health England. We calculated the proportion of babies in NNRD (aged <1 year and admitted between 2010-2017) with a BSI caused by clearly pathogenic organisms between two days after admission and two days after discharge. We used Poisson regression to determine trends in the proportion of babies with BSI based on i) deterministic and probabilistic linkage of NNRD and surveillance data (primary measure), ii) deterministic linkage of NNRD-surveillance data, iii) NNRD records alone, and iv) linked NNRD-surveillance data augmented with clinical records of laboratory-confirmed BSI in NNRD. RESULTS Using deterministic and probabilistic linkage, 5,629 of 349,740 babies admitted to a NNU in NNRD linked with 6,660 BSI episodes accounting for 38% of 17,388 BSI records aged <1 year in surveillance data. The proportion of babies with BSI due to clearly pathogenic organisms during their NNU admission was 1.0% using deterministic plus probabilistic linkage (primary measure), compared to 1.0% using deterministic linkage alone, 0.6% using NNRD records alone, and 1.2% using linkage augmented with clinical records of BSI in NNRD. Equivalent proportions for babies born before 32 weeks of gestation were 5.0%, 4.8%, 2.9% and 5.9%. The proportion of babies who linked to a BSI decreased by 7.5% each year (95% confidence interval [CI]: -14.3%, -0.1%) using deterministic and probabilistic linkage but was stable using clinical records of BSI or deterministic linkage alone. CONCLUSION Linkage that combines BSI records from national laboratory surveillance and clinical NNU data sources, and use of probabilistic methods, substantially improved ascertainment of BSI and estimates of BSI trends over time, compared with single data sources.
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Affiliation(s)
- Caroline Fraser
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- * E-mail:
| | | | - Ruth Blackburn
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Jim Gray
- Microbiology, Birmingham Women’s & Children’s Hospitals, Birmingham, United Kingdom
| | - Sam J. Oddie
- Bradford Neonatology, Bradford Royal Infirmary, Bradford, United Kingdom
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Ruth E. Gilbert
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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17
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Aliabadi S, Honeyford K, Jauneikaite E, Muller-Pebody B, Costelloe C. Risk factors for E. coli Susceptibility in Bloods Stream Infections in England Between 2013-2017. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Antimicrobial resistance (AMR) is a significant threat to global health. Escherichia coli is a frequent cause of Gram-Negative Bloodstream Infections (GNBSIs) and a key organism that contributes to the burden of AMR. This was a cross-sectional surveillance study that looked at 154,791 isolates between 1st January 2013 and 31st December 2017. Analysis was performed using routine surveillance data from Public Health England (PHE) containing data on the incidence and susceptibility results of E. coli bacteraemia. Exposure variables extracted were potential risk factors for AMR. The outcome variable was resistance to at least one antibiotic. Descriptive statistics and graphs were used to summarise the data. Associations between variables and the resistance to at least one antibiotic were assessed using univariate logistic regression. A multivariable logistic regression examined adjusted associations between the variables and resistance to at least one antibiotic. The final model included variables that showed strong evidence of association with resistance to at least one antibiotic. 43.2% of isolates were resistant to at least one antibiotic. Logistic regression showed an association between resistance of E. coli isolates to at least one antibiotic and children of school age (1.39 OR, 95% CI: 1.18-1.64; p ≤ 0.001), isolates taken from patients in Greater Manchester (1.50 OR, 95% CI: 1.41-1.60; p ≤ 0.001) and isolates taken from male patients (1.14 OR, 95% CI: 1.11-1.17; p ≤ 0.001), on adjustment. Visual assessment of trend graphs showed a decrease in resistance for common carbapenems and piperacillin/tazobactam. Prevalence of resistance has increased for common cephalosporins, gentamicin, and co-amoxiclav. Initial analyses suggest an increase in rates of E. coli resistance to at least one antibiotic in GNBSIs between 2013 and 2017 in England. Findings of this study have implications for appropriate antibiotic prescribing guidelines and for directing future AMR policies.
Key messages
Initial analysis of the dataset suggests that rates of AMR of E. coli in BSIs have increased between 2013 and 2017. There is evidence of an increase in E.coli infections that are resistant to cephalosporins over time and a decrease in E.coli infections that are resistant to carbapenems.
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Affiliation(s)
- S Aliabadi
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - K Honeyford
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - E Jauneikaite
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - C Costelloe
- Department of Primary Care and Public Health, Imperial College London, London, UK
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18
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Fawcett N, Young B, Peto L, Quan TP, Gillott R, Wu J, Middlemass C, Weston S, Crook DW, Peto TEA, Muller-Pebody B, Johnson AP, Walker AS, Sandoe JAT. 'Caveat emptor': the cautionary tale of endocarditis and the potential pitfalls of clinical coding data-an electronic health records study. BMC Med 2019; 17:169. [PMID: 31481119 PMCID: PMC6724235 DOI: 10.1186/s12916-019-1390-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diagnostic codes from electronic health records are widely used to assess patterns of disease. Infective endocarditis is an uncommon but serious infection, with objective diagnostic criteria. Electronic health records have been used to explore the impact of changing guidance on antibiotic prophylaxis for dental procedures on incidence, but limited data on the accuracy of the diagnostic codes exists. Endocarditis was used as a clinically relevant case study to investigate the relationship between clinical cases and diagnostic codes, to understand discrepancies and to improve design of future studies. METHODS Electronic health record data from two UK tertiary care centres were linked with data from a prospectively collected clinical endocarditis service database (Leeds Teaching Hospital) or retrospective clinical audit and microbiology laboratory blood culture results (Oxford University Hospitals Trust). The relationship between diagnostic codes for endocarditis and confirmed clinical cases according to the objective Duke criteria was assessed, and impact on estimations of disease incidence and trends. RESULTS In Leeds 2006-2016, 738/1681(44%) admissions containing any endocarditis code represented a definite/possible case, whilst 263/1001(24%) definite/possible endocarditis cases had no endocarditis code assigned. In Oxford 2010-2016, 307/552(56%) reviewed endocarditis-coded admissions represented a clinical case. Diagnostic codes used by most endocarditis studies had good positive predictive value (PPV) but low sensitivity (e.g. I33-primary 82% and 43% respectively); one (I38-secondary) had PPV under 6%. Estimating endocarditis incidence using raw admission data overestimated incidence trends twofold. Removing records with non-specific codes, very short stays and readmissions improved predictive ability. Estimating incidence of streptococcal endocarditis using secondary codes also overestimated increases in incidence over time. Reasons for discrepancies included changes in coding behaviour over time, and coding guidance allowing assignment of a code mentioning 'endocarditis' where endocarditis was never mentioned in the clinical notes. CONCLUSIONS Commonly used diagnostic codes in studies of endocarditis had good predictive ability. Other apparently plausible codes were poorly predictive. Use of diagnostic codes without examining sensitivity and predictive ability can give inaccurate estimations of incidence and trends. Similar considerations may apply to other diseases. Health record studies require validation of diagnostic codes and careful data curation to minimise risk of serious errors.
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Affiliation(s)
- Nicola Fawcett
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. .,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. .,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. .,Microbiology Level 7, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | - Bernadette Young
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Leon Peto
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - T Phuong Quan
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
| | - Richard Gillott
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, LS1 3EX, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, LS2 9LU, UK
| | - Chris Middlemass
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Sheila Weston
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Derrick W Crook
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
| | - Tim E A Peto
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
| | | | - Alan P Johnson
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,National Infection Service, Public Health England, Colindale, London, UK
| | - A Sarah Walker
- National Institute for Health Research (NIHR) Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,NIHR Biomedical Research Centre, Oxford, OX3 9DU, UK
| | - Jonathan A T Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, LS1 3EX, UK
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19
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Ladhani SN, Henderson KL, Muller-Pebody B, Ramsay ME, Riordan A. Risk of invasive bacterial infections by week of age in infants: prospective national surveillance, England, 2010-2017. Arch Dis Child 2019; 104:874-878. [PMID: 31147318 DOI: 10.1136/archdischild-2018-316191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/04/2019] [Accepted: 04/20/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the incidence of laboratory-confirmed, invasive bacterial infections (IBIs) by week of age in infants over a 7-year period. DESIGN Analysis of prospective national surveillance data for England. SETTING National Health Service hospitals in England. PATIENTS Infants aged <1 year who were hospitalised with IBI. MAIN OUTCOME MEASURES IBI incidence by week of age, incidence rate ratio (IRR) at 8, 12 and 16 weeks compared with the first week of life, and the main pathogens responsible for IBI. RESULTS There were 22 075 IBI episodes between 2010/2011 and 2016/2017. The lowest annual cases were in 2011/2012 (n=2 799; incidence, 412/100 000 population), increasing year-on-year to 3 698 cases in 2016/2017 (incidence, 552/100 000 population). The incidence was highest in the first week of life and then declined rapidly. In 2016/2017, compared with the first week of life, weekly IBI incidence was 92% lower at 8 weeks (IRR 0.08; 95% CI 0.06 to 0.10) and 96% lower at 16 weeks of age (IRR 0.04; 95% CI 0.03 to 0.06). In 2016/2017, Escherichia coli was the most prevalent pathogen responsible for IBI (n=592, 16.0%), followed by group B Streptococci (n=493, 13.3%), Staphylococcus aureus (n=400, 10.8%) and Enterococci (n=304, 8.2%). The other pathogens were individually responsible for <5% of total cases. There were differences in age distribution of the pathogens with increasing age. CONCLUSION IBI incidence declines rapidly after the first week of life, such that infants have a very low risk of IBI by the time they are eligible for their routine immunisations from 8 weeks of age.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, UK.,Paediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - Katherine L Henderson
- Healthcare Associated Infection and Antimicrobial Resistance Division, Public Health England, London, UK
| | - Berit Muller-Pebody
- Healthcare Associated Infection and Antimicrobial Resistance Division, Public Health England, London, UK
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Andrew Riordan
- Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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20
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Pouwels KB, Muller-Pebody B, Smieszek T, Hopkins S, Robotham JV. Selection and co-selection of antibiotic resistances among Escherichia coli by antibiotic use in primary care: An ecological analysis. PLoS One 2019; 14:e0218134. [PMID: 31181106 PMCID: PMC6557515 DOI: 10.1371/journal.pone.0218134] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background The majority of studies that link antibiotic usage and resistance focus on simple associations between the resistance against a specific antibiotic and the use of that specific antibiotic. However, the relationship between antibiotic use and resistance is more complex. Here we evaluate selection and co-selection by assessing which antibiotics, including those mainly prescribed for respiratory tract infections, are associated with increased resistance to various antibiotics among Escherichia coli isolated from urinary samples. Methods Monthly primary care prescribing data were obtained from National Health Service (NHS) Digital. Positive E. coli records from urine samples in English primary care (n = 888,207) between April 2014 and January 2016 were obtained from the Second Generation Surveillance System. Elastic net regularization was used to evaluate associations between prescribing of different antibiotic groups and resistance against amoxicillin, cephalexin, ciprofloxacin, co-amoxiclav and nitrofurantoin at the clinical commissioning group (CCG) level. England is divided into 209 CCGs, with each NHS practice prolonging to one CCG. Results Amoxicillin prescribing (measured in DDD/ 1000 inhabitants / day) was positively associated with amoxicillin (RR 1.03, 95% CI 1.01–1.04) and ciprofloxacin (RR 1.09, 95% CI 1.04–1.17) resistance. In contrast, nitrofurantoin prescribing was associated with lower levels of resistance to amoxicillin (RR 0.92, 95% CI 0.84–0.97). CCGs with higher levels of trimethoprim prescribing also had higher levels of ciprofloxacin resistance (RR 1.34, 95% CI 1.10–1.59). Conclusion Amoxicillin, which is mainly (and often unnecessarily) prescribed for respiratory tract infections is associated with increased resistance against various antibiotics among E. coli causing urinary tract infections. Our findings suggest that when predicting the potential impact of interventions on antibiotic resistances it is important to account for use of other antibiotics, including those typically used for other indications.
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Affiliation(s)
- Koen B. Pouwels
- Modelling and Economics Unit, National Infection Service, Public Health England, London, United Kingdom
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Berit Muller-Pebody
- Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, United Kingdom
| | - Timo Smieszek
- Modelling and Economics Unit, National Infection Service, Public Health England, London, United Kingdom
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
| | - Susan Hopkins
- Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom
- Directorate of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Julie V. Robotham
- Modelling and Economics Unit, National Infection Service, Public Health England, London, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, United Kingdom
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21
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Jermacane D, Coope CM, Ironmonger D, Cleary P, Muller-Pebody B, Hope R, Hopkins S, Puleston R, Freeman R, Hopkins KL, Johnson AP, Woodford N, Oliver I. An evaluation of the electronic reporting system for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria in England. J Hosp Infect 2019; 102:17-24. [PMID: 30641097 DOI: 10.1016/j.jhin.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/03/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND An electronic reporting system (ERS) for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria (CPGNB) was launched by Public Health England in May 2015. AIM This evaluation aimed to assess uptake, timeliness and completeness of data provided and explore potential barriers and facilitators to adopting the system. METHODS The evaluation comprised a retrospective analysis of surveillance data and semi-structured interviews with ERS users. FINDINGS The proportion of organisms referred for investigation of carbapenem resistance via ERS increased over the first 12 months post-implementation from 35% to 73%; uptake varied widely across regions of England. Completeness of enhanced data fields was poor in 78% of submitted isolates. The median number of days to report confirmatory test results via ERS was 1 day for the regional service and nine days for the national reference laboratory, which additionally conducts phenotypic testing to confirm carbapenemase negativity. Hindrances to ERS utility included: a lack of designated, ongoing resource for system maintenance, technical support and development; uncertainty about how and when to use ERS and workload. Incomplete data prevented gaining a better understanding of important risk factors and transmission routes of CPGNB in England. CONCLUSION The ERS is the only surveillance system in England with the potential to gather intelligence on important risk factors for CPGNB to inform public health measures to control their spread. Although the ERS captures more information on CPGNB than other surveillance systems, timeliness and completeness of the enhanced data require substantial improvements in order to deliver the desired health benefits.
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Affiliation(s)
- D Jermacane
- Field Service, National Infection Service, Public Health England, UK
| | - C M Coope
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.
| | - D Ironmonger
- Field Service, National Infection Service, Public Health England, UK
| | - P Cleary
- Field Service, National Infection Service, Public Health England, UK
| | - B Muller-Pebody
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Hope
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - S Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Puleston
- Field Service, National Infection Service, Public Health England, UK
| | - R Freeman
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - K L Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - A P Johnson
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - N Woodford
- National Infection Service Laboratories, Public Health England, London, UK
| | - I Oliver
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
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22
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Lishman H, Costelloe C, Hopkins S, Johnson AP, Hope R, Guy R, Muller-Pebody B, Holmes A, Aylin P. Exploring the relationship between primary care antibiotic prescribing for urinary tract infections, Escherichia coli bacteraemia incidence and antimicrobial resistance: an ecological study. Int J Antimicrob Agents 2018; 52:790-798. [DOI: 10.1016/j.ijantimicag.2018.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 08/13/2018] [Accepted: 08/18/2018] [Indexed: 11/16/2022]
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23
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Fraser C, Gilbert R, Blackburn R, Muller-Pebody B, Harron K. Challenges in linking administrative data for monitoring bloodstream infection in neonatal units in England and Wales. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionMonitoring risk-adjusted trends of neonatal bloodstream infection (BSI) is vital and linkage of neonatal electronic health records to national infection surveillance enables this. We demonstrate why changes in data quality and collection methods over time must be accounted for to minimise spurious findings.
Objectives and ApproachFirst, we determined the effect of a system change in 2014 (changed from only clinically relevant BSI to automated reporting of all BSI), by investigating changes in number of all BSI and BSI excluding the contaminants coagulase-negative staphylococci for infants aged <1 year reported to infection surveillance, using interrupted-time-series Poisson regression. Second, we evaluated the impact of changes in identifier completeness over time in each database, and determined variation in infection rates according to linkage method (deterministic linkage on NHS number or probabilistic linkage). Third, we will use multiple imputation when link status cannot be determined due to missing identifiers.
ResultsThe number of BSI reported to infection surveillance system following the change in data collection increased by 34% (incidence rate ratio (IRR) of 1.34, 95% confidence interval 1.28-1.40) for all BSI compared to 19% (IRR 1.19, 1.12-1.27) excluding coagulase-negative staphylococci. Completeness of NHS number in infection surveillance increased from 69% (3,296/4,792) in 2010 to 92% (3,037/3,307) in 2017. We linked 12,003 neonatal admissions to 15,571 BSI episodes (2% of 497,936 admissions and 41% of 37,660 BSI). The proportion of links that were deterministic changed from 83% (1,089/1,307) in 2010 to 96% (968/1,008) in 2017. There were 12,094 BSI for which the link status could not be determined due to missing identifiers; multiple imputation will be used to determine if any are links.
Conclusion/ImplicationsSpurious trends in infection incidence can arise from changes in data collection and quality, impacting the quality of linkage to clinical data. Data quality and system changes must be explored in each source dataset before analysis. Probabilistic linkage and imputation of missing data minimises spurious findings due to data quality.
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24
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Pouwels KB, Robotham JV, McNulty CAM, Muller-Pebody B, Hopkins S. Prevalence of resistance to antibiotics in children's urinary Escherichia coli isolates estimated using national surveillance data. J Antimicrob Chemother 2018; 73:2268-2269. [PMID: 29726990 DOI: 10.1093/jac/dky159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- K B Pouwels
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK.,Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J V Robotham
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - C A M McNulty
- Primary Care Unit, Public Health England, Gloucester Royal Hospital, Gloucester, UK
| | - B Muller-Pebody
- Healthcare-Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, London, UK
| | - S Hopkins
- Healthcare-Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, London, UK.,Directorate of Infection, Royal Free London NHS Foundation Trust, London, UK
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Sharp A, Borman AM, Perera N, Randle M, Braham S, Taori S, Charlett A, Guy R, Muller-Pebody B, Manuel R, Brown CS. Assessing routine diagnostic methods for detecting Candida auris in England. J Infect 2018; 77:448-454. [PMID: 30063914 DOI: 10.1016/j.jinf.2018.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Ashley Sharp
- Field Epidemiology Training Programme, Public Health England, United Kingdom.
| | - Andrew M Borman
- UK National Mycology Reference Laboratory, Public Health England, United Kingdom
| | - Nelun Perera
- University Hospitals of Leicester NHS Trust, United Kingdom
| | - Mark Randle
- University Hospitals of Leicester NHS Trust, United Kingdom
| | | | - Surabhi Taori
- Kings College Hospital NHS Foundation Trust, United Kingdom
| | - Andre Charlett
- National Infection Service, Public Health England, United Kingdom
| | - Rebecca Guy
- National Infection Service, Public Health England, United Kingdom
| | | | - Rohini Manuel
- Public Health Laboratory London, Public Health England, United Kingdom
| | - Colin S Brown
- National Infection Service, Public Health England, United Kingdom; Royal Free London NHS Foundation Trust, United Kingdom
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Fraser C, Gilbert R, Blackburn R, Muller-Pebody B, Harron K. Challenges in linking administrative data for monitoring bloodstream infection in neonatal units in England and Wales. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i2.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Monitoring risk-adjusted trends of neonatal bloodstream infection is vital and linkage of neonatal electronic health records to national infection surveillance enables this. We demonstrate why changes in data quality over time must be accounted for to minimise spurious findings.
First, we evaluated the impact of changes in identifier completeness over time in each database, and determined variation in infection rates according to linkage method (deterministic linkage on NHS number or probabilistic linkage). Second, we will use multiple imputation when link status cannot be determined due to missing identifiers.
Completeness of NHS number in infection surveillance increased from 69% (3,296/4,792) in 2010 to 92% (3,037/3,307) in 2017. We linked 12,003 neonatal admissions to 15,571 infection episodes (2% of 497,936 admissions and 41% of 37,660 infections). The proportion of links that were deterministic changed from 83% (1,089/1,307) in 2010 to 96% (968/1,008) in 2017. Link status could not be determined for 12,094 infections due to missing identifiers; multiple imputation will be used to determine if any are links.
Spurious infection incidence rates can arise from changes in data quality, impacting the quality of linkage to clinical data. Linkage and imputation of missing data minimises spurious findings due to data quality.
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Pouwels KB, Freeman R, Muller-Pebody B, Rooney G, Henderson KL, Robotham JV, Smieszek T. Association between use of different antibiotics and trimethoprim resistance: going beyond the obvious crude association. J Antimicrob Chemother 2018; 73:1700-1707. [DOI: 10.1093/jac/dky031] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/15/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Koen B Pouwels
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, UK
| | - Rachel Freeman
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Berit Muller-Pebody
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Graeme Rooney
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Katherine L Henderson
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Julie V Robotham
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - Timo Smieszek
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, UK
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28
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Micallef C, Ashiru-Oredope D, Hansraj S, Denning DW, Agrawal SG, Manuel RJ, Schelenz S, Guy R, Muller-Pebody B, Patel R, Howard P, Hopkins S, Johnson E, Enoch DA. An investigation of antifungal stewardship programmes in England. J Med Microbiol 2017; 66:1581-1589. [PMID: 29068278 DOI: 10.1099/jmm.0.000612] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE We sought to explore the current status of antifungal stewardship (AFS) initiatives across National Health Service (NHS) Trusts within England, the challenges and barriers, as well as ways to improve current AFS programmes. METHODOLOGY An electronic survey was sent to all 155 acute NHS Trusts in England. A total of 47 Trusts, corresponding to 30 % of English acute Trusts, responded to the the survey; 46 Trusts (98 %) had an antimicrobial stewardship (AMS) programme but only 5 (11 %) had a dedicated AFS programme. Overall, 20 (43 %) Trusts said they included AFS as part of their AMS programmes. From those conducting AFS programmes, 7 (28 %) have an AFS/management team, 16 (64 %) monitor and report on antifungal usage, 5 (20 %) have dedicated AFS ward rounds and 12 (48 %) are directly involved in the management of invasive fungal infections.Results/Key findings. Altogether, 13 acute Trusts (52 %) started their AFS programme to manage costs, whilst 12 (48 %) commenced the programme due to clinical need; 27 (73 %) declared that they would increase their AFS initiatives if they could. Of those without an AFS programme, 14 (67 %) responded that this was due to lack of resources/staff time. Overall, 12 Trusts (57 %) responded that the availability of rapid diagnostics and clinical support would enable them to conduct AFS activities. CONCLUSION Although a minority of Trusts conduct dedicated AFS programmes, nearly half include AFS as part of routine AMS activities. Cost issues are the main driver for AFS, followed by clinical need. The availability of rapid diagnostics and clinical support could help increase AFS initiatives.
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Affiliation(s)
- Christianne Micallef
- Pharmacy Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - Diane Ashiru-Oredope
- Antimicrobial Resistance Programme, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Sejal Hansraj
- Antimicrobial Resistance Programme, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Samir G Agrawal
- Bart's Health NHS Trust and Blizard Institute, Queen Mary University of London, London, UK
| | - Rohini J Manuel
- National Infection Service, Public Health England, Public Health Laboratory London, London, UK
| | - Silke Schelenz
- Royal Brompton Hospital & Harefield Hospitals NHS FT, Sydney Street, London SW3 6NP, UK
| | - Rebecca Guy
- Healthcare Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, UK
| | - Berit Muller-Pebody
- Healthcare Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, UK
| | - Rakhee Patel
- Pharmacy Department, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Darenth Wood Road, Dartford, Kent DA2 8DA, UK
| | - Philip Howard
- Pharmacy Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Susan Hopkins
- Healthcare Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, UK
| | - Elizabeth Johnson
- Public Health England South West Laboratory, Myrtle Road, Kingsdown, Bristol BS2 8EL, UK
| | - David A Enoch
- National Infection Service, Public Health England, Microbiology Laboratory, Addenbrook's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Johnson AP, Muller-Pebody B, Budd E, Ashiru-Oredope D, Ladenheim D, Hain D, Hope R, Bhattacharya A, Elgohari S, Guy R, Henderson K, Puleston R, Rooney G, Thelwall S, Wellington E, Lamagni T, Hopkins S. Improving feedback of surveillance data on antimicrobial consumption, resistance and stewardship in England: putting the data at your Fingertips. J Antimicrob Chemother 2017; 72:953-956. [PMID: 27999049 DOI: 10.1093/jac/dkw536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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
The provision of better access to and use of surveillance data is a key component of the UK 5 Year Antimicrobial Resistance (AMR) Strategy. Since April 2016, PHE has made data on practice (infection prevention and control; antimicrobial stewardship) and outcome (prevalence of AMR, antibiotic use and healthcare-associated infections) available through Fingertips, a publicly accessible web tool (https://fingertips.phe.org.uk/profile/amr-local-indicators). Fingertips provides access to a wide range of public health data presented as thematic profiles, with the above data being available through the 'AMR local indicators' profile. Local data on a range of indicators can be viewed at the level of National Health Service acute trusts, Clinical Commissioning Groups or general practitioner practices, all of which can be compared with the corresponding aggregate values for England to allow benchmarking. The data can be viewed in a range of formats including an overview showing counts and rates, interactive maps, spine charts and graphs that show temporal trends over a range of time scales or allow correlations between pairs of indicators. The aim of the AMR local indicators profile on Fingertips is to support the development of local action plans to optimize antibiotic prescribing and reduce AMR and healthcare-associated infections. Provision of access to relevant information in an easy to use format will help local stakeholders, including healthcare staff, commissioners, Directors of Public Health, academics and the public, to benchmark relevant local AMR data and to monitor the impact of local initiatives to tackle AMR over time.
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Affiliation(s)
- Alan P Johnson
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Berit Muller-Pebody
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Emma Budd
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK.,Antimicrobial Resistance Programme, Public Health England, London, UK
| | | | - David Ladenheim
- Antimicrobial Resistance Programme, Public Health England, London, UK
| | - Doris Hain
- Public Health Data Science, Public Health England, Cambridge, UK
| | - Russell Hope
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Alex Bhattacharya
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Suzanne Elgohari
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Rebecca Guy
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Katherine Henderson
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Richard Puleston
- Field Epidemiology Service East Midlands, National Infection Service, Public Health England, Nottingham, UK
| | - Graeme Rooney
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK.,Antimicrobial Resistance Programme, Public Health England, London, UK
| | - Simon Thelwall
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Edgar Wellington
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Theresa Lamagni
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - Susan Hopkins
- Antimicrobial Resistance Programme, Public Health England, London, UK
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Harron K, Mok Q, Dwan K, Ridyard CH, Moitt T, Millar M, Ramnarayan P, Tibby SM, Muller-Pebody B, Hughes DA, Gamble C, Gilbert RE. CATheter Infections in CHildren (CATCH): a randomised controlled trial and economic evaluation comparing impregnated and standard central venous catheters in children. Health Technol Assess 2016; 20:vii-xxviii, 1-219. [PMID: 26935961 DOI: 10.3310/hta20180] [Citation(s) in RCA: 18] [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: 12/19/2022] Open
Abstract
BACKGROUND Impregnated central venous catheters (CVCs) are recommended for adults to reduce bloodstream infection (BSI) but not for children. OBJECTIVE To determine the effectiveness of impregnated compared with standard CVCs for reducing BSI in children admitted for intensive care. DESIGN Multicentre randomised controlled trial, cost-effectiveness analysis from a NHS perspective and a generalisability analysis and cost impact analysis. SETTING 14 English paediatric intensive care units (PICUs) in England. PARTICIPANTS Children aged < 16 years admitted to a PICU and expected to require a CVC for ≥ 3 days. INTERVENTIONS Heparin-bonded, antibiotic-impregnated (rifampicin and minocycline) or standard polyurethane CVCs, allocated randomly (1 : 1 : 1). The intervention was blinded to all but inserting clinicians. MAIN OUTCOME MEASURE Time to first BSI sampled between 48 hours after randomisation and 48 hours after CVC removal. The following data were used in the trial: trial case report forms; hospital administrative data for 6 months pre and post randomisation; and national-linked PICU audit and laboratory data. RESULTS In total, 1859 children were randomised, of whom 501 were randomised prospectively and 1358 were randomised as an emergency; of these, 984 subsequently provided deferred consent for follow-up. Clinical effectiveness - BSIs occurred in 3.59% (18/502) of children randomised to standard CVCs, 1.44% (7/486) of children randomised to antibiotic CVCs and 3.42% (17/497) of children randomised to heparin CVCs. Primary analyses comparing impregnated (antibiotic and heparin CVCs) with standard CVCs showed no effect of impregnated CVCs [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.37 to 1.34]. Secondary analyses showed that antibiotic CVCs were superior to standard CVCs (HR 0.43, 95% CI 0.20 to 0.96) but heparin CVCs were not (HR 1.04, 95% CI 0.53 to 2.03). Time to thrombosis, mortality by 30 days and minocycline/rifampicin resistance did not differ by CVC. Cost-effectiveness - heparin CVCs were not clinically effective and therefore were not cost-effective. The incremental cost of antibiotic CVCs compared with standard CVCs over a 6-month time horizon was £1160 (95% CI -£4743 to £6962), with an incremental cost-effectiveness ratio of £54,057 per BSI avoided. There was considerable uncertainty in costs: antibiotic CVCs had a probability of 0.35 of being dominant. Based on index hospital stay costs only, antibiotic CVCs were associated with a saving of £97,543 per BSI averted. The estimated value of health-care resources associated with each BSI was £10,975 (95% CI -£2801 to £24,751). Generalisability and cost-impact - the baseline risk of BSI in 2012 for PICUs in England was 4.58 (95% CI 4.42 to 4.74) per 1000 bed-days. An estimated 232 BSIs could have been averted in 2012 using antibiotic CVCs. The additional cost of purchasing antibiotic CVCs for all children who require them (£36 per CVC) would be less than the value of resources associated with managing BSIs in PICUs with standard BSI rates of > 1.2 per 1000 CVC-days. CONCLUSIONS The primary outcome did not differ between impregnated and standard CVCs. However, antibiotic-impregnated CVCs significantly reduced the risk of BSI compared with standard and heparin CVCs. Adoption of antibiotic-impregnated CVCs could be beneficial even for PICUs with low BSI rates, although uncertainty remains whether or not they represent value for money to the NHS. Limitations - inserting clinicians were not blinded to allocation and a lower than expected event rate meant that there was limited power for head-to-head comparisons of each type of impregnation. Future work - adoption of impregnated CVCs in PICUs should be considered and could be monitored through linkage of electronic health-care data and clinical data on CVC use with laboratory surveillance data on BSI. TRIAL REGISTRATION ClinicalTrials.gov NCT01029717. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katie Harron
- Institute of Child Health, University College London, London, UK
| | - Quen Mok
- Great Ormond Street Hospital, London, UK
| | - Kerry Dwan
- Medicines for Children Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Colin H Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Tracy Moitt
- Medicines for Children Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | | | | | | | - Berit Muller-Pebody
- Healthcare Associated Infection and Antimicrobial Resistance (HCAI & AMR) Department, National Infection Service, Public Health England, London, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Carrol Gamble
- Medicines for Children Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Ruth E Gilbert
- Institute of Child Health, University College London, London, UK
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Freeman R, Ironmonger D, Puleston R, Hopkins K, Staves P, Cleary P, Hope R, Muller-Pebody B, Hopkins S, Hawkey PM, Woodford N, Johnson AP. Carbapenemase-Producing Gram-Negative Bacteria in England: Results From the First Year of Enhanced Surveillance. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.200] [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: 11/13/2022] Open
Affiliation(s)
- Rachel Freeman
- National Infection Service, Public Health England, London, United Kingdom
| | - Dean Ironmonger
- National Infection Service, Public Health England, Birmingham, United Kingdom
| | - Richard Puleston
- National Infection Service, Public Health England, Nottingham, United Kingdom
| | - Katie Hopkins
- National Infection Service, Public Health England, London, United Kingdom
| | - Peter Staves
- National Infection Service, Public Health England, London, United Kingdom
| | - Paul Cleary
- National Infection Service, Public Health England, Liverpool, United Kingdom
| | - Russell Hope
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, United Kingdom
| | | | - Susan Hopkins
- Public Health Strategy Division, Public Health England, London, United Kingdom
| | - Peter M. Hawkey
- National Infection Service, Public Health England, Birmingham, United Kingdom
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom
| | - Neil Woodford
- National Infection Service, Public Health England, London, United Kingdom
| | - Alan P. Johnson
- National Infection Service, Public Health England, London, United Kingdom
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Freeman R, Ironmonger D, Puleston R, Hopkins K, Welfare W, Hope R, Staves P, Shemko M, Hopkins S, Cleary P, Patel B, Muller-Pebody B, Li X, Alvarez-Buylla A, Hawkey P, Johnson A, Woodford N, Oliver I. Enhanced surveillance of carbapenemase-producing Gram-negative bacteria to support national and international prevention and control efforts. Clin Microbiol Infect 2016; 22:896-897. [DOI: 10.1016/j.cmi.2016.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/15/2016] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
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Doumith M, Godbole G, Ashton P, Larkin L, Dallman T, Day M, Day M, Muller-Pebody B, Ellington MJ, de Pinna E, Johnson AP, Hopkins KL, Woodford N. Detection of the plasmid-mediated mcr-1 gene conferring colistin resistance in human and food isolates of Salmonella enterica and Escherichia coli in England and Wales. J Antimicrob Chemother 2016; 71:2300-5. [PMID: 27090630 DOI: 10.1093/jac/dkw093] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/29/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In response to the first report of transmissible colistin resistance mediated by the mcr-1 gene in Escherichia coli and Klebsiella spp. from animals and humans in China, we sought to determine its presence in Enterobacteriaceae isolated in the UK. METHODS The PHE archive of whole-genome sequences of isolates from surveillance collections, submissions to reference services and research projects was retrospectively analysed for the presence of mcr-1 using Genefinder. The genetic environment of the gene was also analysed. RESULTS Rapid screening of the genomes of ∼24 000 Salmonella enterica, E. coli, Klebsiella spp., Enterobacter spp., Campylobacter spp. and Shigella spp. isolated from food or humans identified 15 mcr-1-positive isolates. These comprised: 10 human S. enterica isolates submitted between 2012 and 2015 (8 Salmonella Typhimurium, 1 Salmonella Paratyphi B var Java and 1 Salmonella Virchow) from 10 patients; 3 isolates of E. coli from 2 patients; and 2 isolates of Salmonella Paratyphi B var Java from poultry meat imported from the EU. The mcr-1 gene was located on diverse plasmids belonging to the IncHI2, IncI2 and IncX4 replicon types and its association with ISApl1 varied. Six mcr-1-positive S. enterica isolates were from patients who had recently travelled to Asia. CONCLUSIONS Analysis of WGS data allowed rapid confirmation of the presence of the plasmid-mediated colistin resistance gene mcr-1 in diverse genetic environments and plasmids. It has been present in E. coli and Salmonella spp. harboured by humans in England and Wales since at least 2012.
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Affiliation(s)
- Michel Doumith
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Gauri Godbole
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Philip Ashton
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Lesley Larkin
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Tim Dallman
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Martin Day
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Michaela Day
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | | | | | | | - Alan P Johnson
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Katie L Hopkins
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Neil Woodford
- National Infection Service, Public Health England, London NW9 5EQ, UK
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34
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Harron K, Mok Q, Hughes D, Muller-Pebody B, Parslow R, Ramnarayan P, Gilbert R. Generalisability and Cost-Impact of Antibiotic-Impregnated Central Venous Catheters for Reducing Risk of Bloodstream Infection in Paediatric Intensive Care Units in England. PLoS One 2016; 11:e0151348. [PMID: 26999045 PMCID: PMC4801221 DOI: 10.1371/journal.pone.0151348] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/28/2016] [Indexed: 11/19/2022] Open
Abstract
Background We determined the generalisability and cost-impact of adopting antibiotic-impregnated CVCs in all paediatric intensive care units (PICUs) in England, based on results from a large randomised controlled trial (the CATCH trial; ISRCTN34884569). Methods BSI rates using standard CVCs were estimated through linkage of national PICU audit data (PICANet) with laboratory surveillance data. We estimated the number of BSI averted if PICUs switched from standard to antibiotic-impregnated CVCs by applying the CATCH trial rate-ratio (0.40; 95% CI 0.17,0.97) to the BSI rate using standard CVCs. The value of healthcare resources made available by averting one BSI as estimated from the trial economic analysis was £10,975; 95% CI -£2,801,£24,751. Results The BSI rate using standard CVCs was 4.58 (95% CI 4.42,4.74) per 1000 CVC-days in 2012. Applying the rate-ratio gave 232 BSI averted using antibiotic CVCs. The additional cost of purchasing antibiotic-impregnated compared with standard CVCs was £36 for each child, corresponding to additional costs of £317,916 for an estimated 8831 CVCs required in PICUs in 2012. Based on 2012 BSI rates, management of BSI in PICUs cost £2.5 million annually (95% uncertainty interval: -£160,986, £5,603,005). The additional cost of antibiotic CVCs would be less than the value of resources associated with managing BSI in PICUs with standard BSI rates >1.2 per 1000 CVC-days. Conclusions The cost of introducing antibiotic-impregnated CVCs is less than the cost associated with managing BSIs occurring with standard CVCs. The long-term benefits of preventing BSI could mean that antibiotic CVCs are cost-effective even in PICUs with extremely low BSI rates.
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Affiliation(s)
- Katie Harron
- Institute of Child Health, University College London, 30 Guilford Street, London WC1 N 1EH, United Kingdom
- * E-mail:
| | - Quen Mok
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, WC1N 3JH, United Kingdom
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ, United Kingdom
| | | | | | - Padmanabhan Ramnarayan
- Children’s Acute Transport Service, Great Ormond Street Hospital, London, WC1N 3JH, United Kingdom
| | - Ruth Gilbert
- Institute of Child Health, University College London, 30 Guilford Street, London WC1 N 1EH, United Kingdom
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35
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Guy R, Geoghegan L, Heginbothom M, Howe R, Muller-Pebody B, Reilly JS, Wilson J, Wiuff C, Wyatt T, Johnson AP. Non-susceptibility of Escherichia coli, Klebsiella spp., Pseudomonas spp., Streptococcus pneumoniae and Staphylococcus aureus in the UK: temporal trends in England, Northern Ireland, Scotland and Wales. J Antimicrob Chemother 2016; 71:1564-9. [PMID: 26892779 DOI: 10.1093/jac/dkw018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/14/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To monitor and compare trends in the non-susceptibility of bloodstream isolates of pathogens to key antibiotics in the constituent countries of the UK between 2010 and 2014. METHODS Routinely generated antibiotic susceptibility test results for bloodstream isolates of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Pseudomonas spp., Streptococcus pneumoniae and Staphylococcus aureus were collected from hospital microbiology laboratories in each country. RESULTS With the exception of a decrease in the proportion of S. aureus that were MRSA, non-susceptibility to key antibiotics among the pathogens studied remained largely unchanged over the 5 year study period, with any increases in non-susceptibility being small. Although some intercountry variation in the proportions of non-susceptible isolates was seen, apart from MRSA, the differences were generally small (<5%) and fluctuated from year to year, with no country showing consistently higher or lower rates of resistance. CONCLUSIONS Collaboration between the constituent countries of the UK allows an integrated approach to nationwide surveillance of antibiotic resistance.
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Affiliation(s)
- Rebecca Guy
- Centre for Infectious Disease Surveillance and Control, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Lourda Geoghegan
- Health Protection Service, Public Health Agency, Belfast BT2 8BS, UK
| | - Maggie Heginbothom
- Antimicrobial Resistance Programme, Public Health Wales, Cardiff CF10 3NW, UK
| | - Robin Howe
- Department of Microbiology, Public Health Wales, Cardiff CF14 4XW, UK
| | - Berit Muller-Pebody
- Centre for Infectious Disease Surveillance and Control, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Jacqui S Reilly
- Health Protection Scotland, NHS National Services Scotland, Glasgow G2 6QE, UK
| | - Julie Wilson
- Health Protection Scotland, NHS National Services Scotland, Glasgow G2 6QE, UK
| | - Camilla Wiuff
- Health Protection Scotland, NHS National Services Scotland, Glasgow G2 6QE, UK
| | - Tim Wyatt
- Health Protection Service, Public Health Agency, Belfast BT2 8BS, UK
| | - Alan P Johnson
- Centre for Infectious Disease Surveillance and Control, National Infection Service, Public Health England, London NW9 5EQ, UK
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Guy R, Lamagni T, Muller-Pebody B. Antifungal Resistance in England: Results From National Surveillance of Invasive Mycoses. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1375] [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: 11/12/2022] Open
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Muller-Pebody B, Ladenheim D, Fuller C, Ashiru-Oredope D, Hopkins S. Validation of national hospital antimicrobial consumption data in England. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475149 DOI: 10.1186/2047-2994-4-s1-p172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Green N, Johnson AP, Henderson KL, Muller-Pebody B, Thelwall S, Robotham JV, Sharland M, Wolkewitz M, Deeny SR. Quantifying the Burden of Hospital-Acquired Bloodstream Infection in Children in England by Estimating Excess Length of Hospital Stay and Mortality Using a Multistate Analysis of Linked, Routinely Collected Data. J Pediatric Infect Dis Soc 2015; 4:305-12. [PMID: 26582869 DOI: 10.1093/jpids/piu073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/14/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hospital-acquired bloodstream infection (HA-BSI) is associated with substantial morbidity, mortality, and healthcare costs in all patient populations. Young children have been shown to have a high rate of healthcare-associated infections compared with the adult population. We aimed to quantify the excess mortality and length of stay in pediatric patients from HA-BSI. METHODS We analyzed data collected retrospectively from a probabilistically linked national database of pediatric (aged 1 month-18 years) in-patients with a microbiologically confirmed HA-BSI in England between January and March 2009. A time-dependent Cox regression model was fit to determine the presence of any effect. Furthermore, a multistate model, adjusted for the time to onset of HA-BSI, was used to compare outcomes in patients with HA-BSI to those without HA-BSI. We further adjusted for patients' characteristics as recorded in hospital admission data. RESULTS The dataset comprised 333 605 patients, with 214 cases of HA-BSI. After adjustment for time to HA-BSI and comorbidities, the hazard for discharge (dead or alive) from hospital for patients with HA-BSI was 0.9 times (95% confidence interval [CI], .8-1.1) that of noninfected patients. Excess length of stay associated with all-cause HA-BSI was 1.6 days (95% CI, .2-3.0), although this duration varied by pathogen. Patients with HA-BSI had a 3.6 (95% CI, 1.3-10.4) times higher hazard for in-hospital death than noninfected patients. CONCLUSIONS Hospital-acquired bloodstream infection increased the length of stay and mortality of pediatric inpatients. The results of this study provide an evidence base to judge the health and economic impact of programs to prevent and control HA-BSI in children.
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Affiliation(s)
- N Green
- Public Health England, London, United Kingdom Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - A P Johnson
- Public Health England, London, United Kingdom
| | | | | | - S Thelwall
- Public Health England, London, United Kingdom
| | | | - M Sharland
- Pediatric Infectious Diseases Unit, St George's Hospital, London, United Kingdom
| | - M Wolkewitz
- Freiburg Center for Data Analysis and Modeling, Germany
| | - S R Deeny
- Public Health England, London, United Kingdom
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Hagger-Johnson G, Harron K, Gonzalez-Izquierdo A, Cortina-Borja M, Dattani N, Muller-Pebody B, Parslow R, Gilbert R, Goldstein H. Identifying Possible False Matches in Anonymized Hospital Administrative Data without Patient Identifiers. Health Serv Res 2015; 50:1162-78. [PMID: 25523215 PMCID: PMC4545352 DOI: 10.1111/1475-6773.12272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify data linkage errors in the form of possible false matches, where two patients appear to share the same unique identification number. DATA SOURCE Hospital Episode Statistics (HES) in England, United Kingdom. STUDY DESIGN Data on births and re-admissions for infants (April 1, 2011 to March 31, 2012; age 0-1 year) and adolescents (April 1, 2004 to March 31, 2011; age 10-19 years). DATA COLLECTION/EXTRACTION METHODS Hospital records pseudo-anonymized using an algorithm designed to link multiple records belonging to the same person. Six implausible clinical scenarios were considered possible false matches: multiple births sharing HESID, re-admission after death, two birth episodes sharing HESID, simultaneous admission at different hospitals, infant episodes coded as deliveries, and adolescent episodes coded as births. PRINCIPAL FINDINGS Among 507,778 infants, possible false matches were relatively rare (n = 433, 0.1 percent). The most common scenario (simultaneous admission at two hospitals, n = 324) was more likely for infants with missing data, those born preterm, and for Asian infants. Among adolescents, this scenario (n = 320) was more common for males, younger patients, the Mixed ethnic group, and those re-admitted more frequently. CONCLUSIONS Researchers can identify clinically implausible scenarios and patients affected, at the data cleaning stage, to mitigate the impact of possible linkage errors.
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Affiliation(s)
- Gareth Hagger-Johnson
- Address correspondence to Gareth Hagger-Johnson, Ph.D., Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, 30 Guilford Street, London WC1N 1EH, UK;
| | - Katie Harron
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Arturo Gonzalez-Izquierdo
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Mario Cortina-Borja
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Nirupa Dattani
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Berit Muller-Pebody
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Roger Parslow
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Ruth Gilbert
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
| | - Harvey Goldstein
- Katie Harron, Ph.D., is with the Institute of Health Informatics, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Arturo Gonzalez-Izquierdo, Ph.D., is with the Institute of Child Health, Faculty of Pop Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Mario Cortina-Borja, Ph.D., is with the Centre for Maternal and Child Health Research, School of Health Sciences, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Harvey Goldstein, Ph.D., is with the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, Centre of Paediatric Epidemiology and Biostatistics, London, UK
- Nirupa Dattani, Ph.D., is with the City University London, UK
- Berit Muller-Pebody, Ph.D., and Ruth Gilbert, M.D., are with the Public Health England, London, UK
- Roger Parslow, Ph.D., is with the University of Leeds, Leeds, UK
- Harvey Goldstein, Ph.D., is also with the University of Bristol, Bristol, UK
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Okike IO, Johnson AP, Henderson KL, Blackburn RM, Muller-Pebody B, Ladhani SN, Anthony M, Ninis N, Heath PT, Galiza EP, Cameron JC, Smith-Palmer A, McDonald E, Sinka K, Jones L, Cunney R, Borgulya G, Borrow R. Incidence, Etiology, and Outcome of Bacterial Meningitis in Infants Aged <90 Days in the United Kingdom and Republic of Ireland: Prospective, Enhanced, National Population-Based Surveillance. Clin Infect Dis 2014; 59:e150-7. [DOI: 10.1093/cid/ciu514] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Harron K, Wade A, Gilbert R, Muller-Pebody B, Goldstein H. Evaluating bias due to data linkage error in electronic healthcare records. BMC Med Res Methodol 2014; 14:36. [PMID: 24597489 PMCID: PMC4015706 DOI: 10.1186/1471-2288-14-36] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 02/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background Linkage of electronic healthcare records is becoming increasingly important for research purposes. However, linkage error due to mis-recorded or missing identifiers can lead to biased results. We evaluated the impact of linkage error on estimated infection rates using two different methods for classifying links: highest-weight (HW) classification using probabilistic match weights and prior-informed imputation (PII) using match probabilities. Methods A gold-standard dataset was created through deterministic linkage of unique identifiers in admission data from two hospitals and infection data recorded at the hospital laboratories (original data). Unique identifiers were then removed and data were re-linked by date of birth, sex and Soundex using two classification methods: i) HW classification - accepting the candidate record with the highest weight exceeding a threshold and ii) PII–imputing values from a match probability distribution. To evaluate methods for linking data with different error rates, non-random error and different match rates, we generated simulation data. Each set of simulated files was linked using both classification methods. Infection rates in the linked data were compared with those in the gold-standard data. Results In the original gold-standard data, 1496/20924 admissions linked to an infection. In the linked original data, PII provided least biased results: 1481 and 1457 infections (upper/lower thresholds) compared with 1316 and 1287 (HW upper/lower thresholds). In the simulated data, substantial bias (up to 112%) was introduced when linkage error varied by hospital. Bias was also greater when the match rate was low or the identifier error rate was high and in these cases, PII performed better than HW classification at reducing bias due to false-matches. Conclusions This study highlights the importance of evaluating the potential impact of linkage error on results. PII can help incorporate linkage uncertainty into analysis and reduce bias due to linkage error, without requiring identifiers.
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Affiliation(s)
- Katie Harron
- Institute of Child Health, University College London, 30 Guilford Street, London WC1 N 1EH, UK.
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Harron K, Goldstein H, Wade A, Muller-Pebody B, Parslow R, Gilbert R. Linkage, evaluation and analysis of national electronic healthcare data: application to providing enhanced blood-stream infection surveillance in paediatric intensive care. PLoS One 2013; 8:e85278. [PMID: 24376874 PMCID: PMC3869925 DOI: 10.1371/journal.pone.0085278] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/26/2013] [Indexed: 11/30/2022] Open
Abstract
Background Linkage of risk-factor data for blood-stream infection (BSI) in paediatric intensive care (PICU) with bacteraemia surveillance data to monitor risk-adjusted infection rates in PICU is complicated by a lack of unique identifiers and under-ascertainment in the national surveillance system. We linked, evaluated and performed preliminary analyses on these data to provide a practical guide on the steps required to handle linkage of such complex data sources. Methods Data on PICU admissions in England and Wales for 2003-2010 were extracted from the Paediatric Intensive Care Audit Network. Records of all positive isolates from blood cultures taken for children <16 years and captured by the national voluntary laboratory surveillance system for 2003-2010 were extracted from the Public Health England database, LabBase2. “Gold-standard” datasets with unique identifiers were obtained directly from three laboratories, containing microbiology reports that were eligible for submission to LabBase2 (defined as “clinically significant” by laboratory microbiologists). Reports in the gold-standard datasets were compared to those in LabBase2 to estimate ascertainment in LabBase2. Linkage evaluated by comparing results from two classification methods (highest-weight classification of match weights and prior-informed imputation using match probabilities) with linked records in the gold-standard data. BSI rate was estimated as the proportion of admissions associated with at least one BSI. Results Reporting gaps were identified in 548/2596 lab-months of LabBase2. Ascertainment of clinically significant BSI in the remaining months was approximately 80-95%. Prior-informed imputation provided the least biased estimate of BSI rate (5.8% of admissions). Adjusting for ascertainment, the estimated BSI rate was 6.1-7.3%. Conclusion Linkage of PICU admission data with national BSI surveillance provides the opportunity for enhanced surveillance but analyses based on these data need to take account of biases due to ascertainment and linkage error. This study provides a generalisable guide for linkage, evaluation and analysis of complex electronic healthcare data.
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Affiliation(s)
- Katie Harron
- Institute of Child Health, University College London, London, United Kingdom
- * E-mail:
| | - Harvey Goldstein
- Institute of Child Health, University College London, London, United Kingdom
- Graduate School of Education, University of Bristol, Bristol, United Kingdom
| | - Angie Wade
- Institute of Child Health, University College London, London, United Kingdom
| | - Berit Muller-Pebody
- Healthcare Associated Infection and Antimicrobial Resistance Department, Public Health England, London, United Kingdom
| | - Roger Parslow
- Division of Epidemiology, University of Leeds, Leeds, United Kingdom
| | - Ruth Gilbert
- Institute of Child Health, University College London, London, United Kingdom
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Blackburn RM, Henderson KL, Minaji M, Muller-Pebody B, Johnson AP, Sharland M. Exploring the Epidemiology of Hospital-Acquired Bloodstream Infections in Children in England (January 2009-March 2010) by Linkage of National Hospital Admissions and Microbiological Databases. J Pediatric Infect Dis Soc 2012; 1:284-92. [PMID: 26619421 DOI: 10.1093/jpids/pis084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/05/2012] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hospital-acquired bloodstream infection (HA-BSI) requires immediate effective antibiotic treatment. However, there are no published national data for England that describe the pathogen profile and antibiotic resistance rates of HA-BSI in children. METHODS Probabilistic matching methods were used to link national data on microbiologically confirmed BSI to hospital in-patient admissions data for the period of January 2009-March 2010. HA-BSI was defined as a positive blood culture drawn from a child aged 1 month-18 years 2 or more days after admission (and before discharge). RESULTS A total of 8718 episodes of BSI was reported during the study period. Linkage allowed 82% of records to be matched, of which 23% (1734) were HA-BSI, giving a rate of 4.74 per 1000 admissions. The median age of infection was 1 year, and 54% of infections were in males. Methicillin resistance was seen in 83% and 17% of coagulase-negative staphylococci and Staphylococcus aureus, respectively. Penicillin resistance was rare in pyogenic streptococci but more common in viridans streptococci (39%). Among Gram-positive organisms, only 3% were vancomycin-resistant. The overall proportion of Gram-negative bacteria resistant to recommended empirical antibiotics (meropenem or piperacillin/tazobactam) was 5% and 16%, respectively, but <4% of isolates were resistant when either of these drugs were combined with gentamicin. CONCLUSIONS This study provides the first national estimates of the proportion of pediatric BSI that is hospital-acquired and describes the antimicrobial resistance of organisms causing infection. Pediatric HA-BSI remains unacceptably high; interventions must focus on identifying effective means of preventing HA-BSI, fostering antibiotic stewardship, and improving surveillance.
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Affiliation(s)
- Ruth M Blackburn
- Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency
| | - Katherine L Henderson
- Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency
| | - Mehdi Minaji
- Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency
| | - Berit Muller-Pebody
- Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency
| | - Alan P Johnson
- Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency
| | - Mike Sharland
- Paediatric Infectious Diseases Research Unit, St George's Hospital, London, United Kingdom
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Blackburn RM, Muller-Pebody B, Planche T, Johnson A, Hopkins S, Sharland M, Kennea N, Heath PT. Neonatal sepsis--many blood samples, few positive cultures: implications for improving antibiotic prescribing. Arch Dis Child Fetal Neonatal Ed 2012; 97:F487-8. [PMID: 22762988 DOI: 10.1136/archdischild-2012-302261] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- Katie Harron
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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Muller-Pebody B, Johnson AP, Heath PT, Gilbert RE, Henderson KL, Sharland M. Empirical treatment of neonatal sepsis: are the current guidelines adequate? Arch Dis Child Fetal Neonatal Ed 2011; 96:F4-8. [PMID: 20584804 DOI: 10.1136/adc.2009.178483] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To use national laboratory surveillance data to determine whether pathogens responsible for neonatal bacteraemia were sensitive to nationally recommended antibiotic regimens. DESIGN All reports of neonatal bacteraemia received by the Health Protection Agency's voluntary surveillance scheme in England and Wales from January 2006 until March 2008, were extracted from the database. Organisms were ranked by frequency, and proportions susceptible to antimicrobials recommended for empirical treatment of neonatal sepsis were determined. RESULTS There were 1516 reports of bacteraemia for neonates <48 h old (early-onset) and 3482 reports for neonates 2-28 days old (late-onset). For early-onset bacteraemia, group B streptococcus (GBS) was the most frequent pathogen (31%) followed by coagulase-negative staphylococci (CoNS; 22%), non-pyogenic streptococci (9%) and Escherichia coli (9%). For late-onset bacteraemia, CoNS were isolated most frequently (45%), followed by Staphylococcus aureus (13%), Enterobacteriaceae (9%), E coli (7%) and GBS (7%). More than 94% of organisms (early-onset) were susceptible to regimens involving combinations of penicillin with either gentamicin or amoxicillin, amoxicillin combined with cefotaxime or cefotaxime monotherapy. More than 95% of organisms (late-onset) were susceptible to gentamicin with either flucloxacillin or amoxicillin and amoxicillin with cefotaxime, but only 79% were susceptible to cefotaxime monotherapy. CONCLUSIONS Current guidelines for empirical therapy in neonates with sepsis are appropriate. However, gentamicin-based regimens should be used in preference to cefotaxime-based treatments, because of lower levels of susceptibility to cefotaxime and the need to avoid exerting selective pressure for resistance. Surveillance data linked to clinical data should further inform rational antibiotic prescribing in neonatal units.
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Affiliation(s)
- B Muller-Pebody
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, UK.
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Henderson KL, Johnson AP, Muller-Pebody B, Charlett A, Gilbert R, Sharland M. The changing aetiology of paediatric bacteraemia in England and Wales, 1998–2007. J Med Microbiol 2010; 59:213-219. [DOI: 10.1099/jmm.0.015271-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bacteraemia in children is a potentially life-threatening condition. The objective of this study was to determine trends in the aetiology of bacteraemia in children aged 1 month–15 years in England and Wales by collecting data voluntarily reported by National Health Service hospital microbiology laboratories. Over the 10-year period 1998–2007, a total of 51 788 bacteraemia cases involving 105 genera/species of bacteria were reported. Total annual reports of bacteraemia increased from 4125 to 6916, with a mean increase of 6.5 % per year (95 % CI: 1.3–12.1 %). In 2007, just over half the cases were accounted for by four groups of organisms: coagulase-negative staphylococci (28 %), Staphylococcus aureus (10 %), non-pyogenic streptococci (9 %) and Streptococcus pneumoniae (7 %). These organisms along with a further 13 species/genera accounted for 90 % of the cases. The commonest Gram-negative organisms were Neisseria meningitidis and Escherichia coli, which each accounted for 5 % of total bacteraemia reports in 2007. There was a significant decrease in reports of bacteraemia due to the three vaccine-preventable pathogens Haemophilus influenzae, N. meningitidis and Strep. pneumoniae, following the introduction of each vaccine programme or catch-up campaign. This study identified the commonest causes of bacteraemia in children in England and Wales, and highlighted the shifts in trends observed over time.
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Affiliation(s)
- Katherine L. Henderson
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, Health Protection Agency Centre for Infections, London, UK
| | - Alan P. Johnson
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, Health Protection Agency Centre for Infections, London, UK
| | - Berit Muller-Pebody
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, Health Protection Agency Centre for Infections, London, UK
| | - André Charlett
- Department of Statistics, Modelling and Bioinformatics, Health Protection Agency Centre for Infections, London, UK
| | - Ruth Gilbert
- MRC Centre of Epidemiology for Child Health, UCL Institute for Child Health, London, UK
| | - Mike Sharland
- Paediatric Infectious Disease Unit, St George's Hospital Medical School, University of London, London, UK
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Henderson KL, Muller-Pebody B, Blackburn RM, Johnson AP. Reduction in erythromycin resistance in invasive pneumococci from young children in England and Wales. J Antimicrob Chemother 2009; 65:369-70. [DOI: 10.1093/jac/dkp442] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Muller-Pebody B, Lillie M, Johnson AP. Isolation and antimicrobial sensitivities of Kluyvera spp. from humans in England, Wales and Northern Ireland, 2005–2006. Int J Antimicrob Agents 2007; 30:371-2. [PMID: 17669632 DOI: 10.1016/j.ijantimicag.2007.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 06/12/2007] [Accepted: 06/12/2007] [Indexed: 10/23/2022]
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