1
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Sandoe JAT, Ahmed F, Arumugam P, Guleri A, Horner C, Howard P, Perry J, Prendergast BD, Schwiebert R, Steeds RP, Watkin R, Wendler O, Chambers JB. Expert consensus recommendations for the provision of infective endocarditis services: updated guidance from the Joint British Societies. Heart 2023; 109:e2. [PMID: 36898706 PMCID: PMC10423555 DOI: 10.1136/heartjnl-2022-321791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Infective endocarditis (IE) remains a difficult condition to diagnose and treat and is an infection of high consequence for patients, causing long hospital stays, life-changing complications and high mortality. A new multidisciplinary, multiprofessional, British Society for Antimicrobial Chemotherapy (BSAC)-ledWorking Party was convened to undertake a focused systematical review of the literature and to update the previous BSAC guidelines relating delivery of services for patients with IE. A scoping exercise identified new questions concerning optimal delivery of care, and the systematic review identified 16 231 papers of which 20 met the inclusion criteria. Recommendations relating to endocarditis teams, infrastructure and support, endocarditis referral processes, patient follow-up and patient information, and governance are made as well as research recommendations. This is a report of a joint Working Party of the BSAC, British Cardiovascular Society, British Heart Valve Society, British Society of Echocardiography, Society of Cardiothoracic Surgeons of Great Britain and Ireland, British Congenital Cardiac Association and British Infection Association.
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Affiliation(s)
- Jonathan A T Sandoe
- Microbiology department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Fozia Ahmed
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- The University of Manchester, Manchester, UK
| | - Parthiban Arumugam
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Achyut Guleri
- Microbiology department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Carolyne Horner
- Formerly British Society of Antimicrobial Chemotherapy, Birmingham, UK
| | - Philip Howard
- NHS England North East & Yorkshire, Leeds, UK
- University of Leeds, Leeds, UK
| | - John Perry
- Microbiology department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Bernard D Prendergast
- Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Cleveland Clinic, London, UK
| | - Ralph Schwiebert
- Microbiology department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Richard Paul Steeds
- Cardiology department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Watkin
- Cardiology department, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, UK
| | - Olaf Wendler
- Cardiothoracic Surgery, King's College Hospital, King's Health Partners, London, UK
| | - John B Chambers
- Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Arredondo-Alonso S, Blundell-Hunter G, Fu Z, Gladstone RA, Fillol-Salom A, Loraine J, Cloutman-Green E, Johnsen PJ, Samuelsen Ø, Pöntinen AK, Cléon F, Chavez-Bueno S, De la Cruz MA, Ares MA, Vongsouvath M, Chmielarczyk A, Horner C, Klein N, McNally A, Reis JN, Penadés JR, Thomson NR, Corander J, Taylor PW, McCarthy AJ. Evolutionary and functional history of the Escherichia coli K1 capsule. Nat Commun 2023; 14:3294. [PMID: 37322051 PMCID: PMC10272209 DOI: 10.1038/s41467-023-39052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
Escherichia coli is a leading cause of invasive bacterial infections in humans. Capsule polysaccharide has an important role in bacterial pathogenesis, and the K1 capsule has been firmly established as one of the most potent capsule types in E. coli through its association with severe infections. However, little is known about its distribution, evolution and functions across the E. coli phylogeny, which is fundamental to elucidating its role in the expansion of successful lineages. Using systematic surveys of invasive E. coli isolates, we show that the K1-cps locus is present in a quarter of bloodstream infection isolates and has emerged in at least four different extraintestinal pathogenic E. coli (ExPEC) phylogroups independently in the last 500 years. Phenotypic assessment demonstrates that K1 capsule synthesis enhances E. coli survival in human serum independent of genetic background, and that therapeutic targeting of the K1 capsule re-sensitizes E. coli from distinct genetic backgrounds to human serum. Our study highlights that assessing the evolutionary and functional properties of bacterial virulence factors at population levels is important to better monitor and predict the emergence of virulent clones, and to also inform therapies and preventive medicine to effectively control bacterial infections whilst significantly lowering antibiotic usage.
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Affiliation(s)
- Sergio Arredondo-Alonso
- Department of Biostatistics, University of Oslo, 0317, Oslo, Norway
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
| | | | - Zuyi Fu
- Department of Infectious Disease, Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Rebecca A Gladstone
- Department of Biostatistics, University of Oslo, 0317, Oslo, Norway
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
| | - Alfred Fillol-Salom
- Department of Infectious Disease, Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | | | - Elaine Cloutman-Green
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Pål J Johnsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ørjan Samuelsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Anna K Pöntinen
- Department of Biostatistics, University of Oslo, 0317, Oslo, Norway
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - François Cléon
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Susana Chavez-Bueno
- University of Missouri Kansas City, Kansas City, USA
- Division of Infectious Diseases, Children's Mercy Hospital Kansas City, UMKC School of Medicine, Kansas City, USA
| | - Miguel A De la Cruz
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatría, Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Miguel A Ares
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatría, Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Agnieszka Chmielarczyk
- Faculty of Medicine, Chair of Microbiology, Jagiellonian University Medical College, Czysta str. 18, 31-121, Kraków, Poland
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Nigel Klein
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Alan McNally
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Joice N Reis
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Salvador, Brazil
- Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
| | - José R Penadés
- Department of Infectious Disease, Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Nicholas R Thomson
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jukka Corander
- Department of Biostatistics, University of Oslo, 0317, Oslo, Norway.
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK.
- Helsinki Institute of Information Technology, Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland.
| | - Peter W Taylor
- School of Pharmacy, University College London, London, UK.
| | - Alex J McCarthy
- Department of Infectious Disease, Centre for Bacterial Resistance Biology, Imperial College London, London, UK.
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3
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Moineau B, Chaves G, Horner C, Nassif F, Alizadeh-Meghrazi M, Khaykin Y. CARDIOLOGIST EVALUATION OF ELECTROCARDIOGRAM COLLECTED AT THE WAIST WITH TEXTILE ELECTRODES. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.077] [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: 11/02/2022] Open
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Reynolds R, Mushtaq S, Allen MK, Horner C, Longshaw C, Livermore DM. Impact of changed co-amoxiclav susceptibility testing formats on apparent resistance rates for bloodstream Escherichia coli in a long-term surveillance. J Antimicrob Chemother 2022; 77:1206-1208. [PMID: 35045166 DOI: 10.1093/jac/dkab483] [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] [Received: 10/06/2021] [Revised: 11/23/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rosy Reynolds
- Bristol Medical School, University of Bristol, Bristol, UK
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5
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Aliabadi S, Jauneikaite E, Müller-Pebody B, Hope R, Vihta KD, Horner C, Costelloe CE. Exploring temporal trends and risk factors for resistance in Escherichia coli-causing bacteraemia in England between 2013 and 2018: an ecological study. J Antimicrob Chemother 2021; 77:782-792. [PMID: 34921311 DOI: 10.1093/jac/dkab440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Escherichia coli are Gram-negative bacteria associated with an increasing burden of antimicrobial resistance (AMR) in England. OBJECTIVES To create a comprehensive epidemiological picture of E. coli bacteraemia resistance trends and risk factors in England by linking national microbiology data sources and performing a longitudinal analysis of rates. METHODS A retrospective observational study was conducted on all national records for antimicrobial susceptibility testing on E. coli bacteraemia in England from 1 January 2013 to 31 December 2018 from the UK Health Security Agency (UKHSA) and the BSAC Resistance Surveillance Programme (BSAC-RSP). Trends in AMR and MDR were estimated using iterative sequential regression. Logistic regression analyses were performed on UKHSA data to estimate the relationship between risk factors and AMR or MDR in E. coli bacteraemia isolates. RESULTS An increase in resistance rates was observed in community- and hospital-onset bacteraemia for third-generation cephalosporins, co-amoxiclav, gentamicin and ciprofloxacin. Among community-acquired cases, and after adjustment for other factors, patients aged >65 years were more likely to be infected by E. coli isolates resistant to at least one of 11 antibiotics than those aged 18-64 years (OR: 1.21, 95% CI: 1.18-1.25; P < 0.05). In hospital-onset cases, E. coli isolates from those aged 1-17 years were more likely to be resistant than those aged 18-64 years (OR: 1.33, 95% CI: 1.02-1.73; P < 0.05). CONCLUSIONS Antibiotic resistance rates in E. coli-causing bacteraemia increased between 2013 and 2018 in England for key antimicrobial agents. Findings of this study have implications for guiding future policies on a prescribing of antimicrobial agents, for specific patient populations in particular.
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Affiliation(s)
- Shirin Aliabadi
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Elita Jauneikaite
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, UK.,NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, UK
| | - Berit Müller-Pebody
- Division of Healthcare Associated Infections and Antimicrobial Resistance, National Infection Service, UK Health Security Agency, London, UK
| | - Russell Hope
- Division of Healthcare Associated Infections and Antimicrobial Resistance, National Infection Service, UK Health Security Agency, London, UK
| | - Karina-Doris Vihta
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Céire E Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.,Division of Clinical studies, Institute of Cancer Research, London, UK
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6
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Horner C, Mushtaq S, Allen M, Hope R, Gerver S, Longshaw C, Reynolds R, Woodford N, Livermore DM. Replacement of Enterococcus faecalis by Enterococcus faecium as the predominant enterococcus in UK bacteraemias. JAC Antimicrob Resist 2021; 3:dlab185. [PMID: 34909690 PMCID: PMC8664539 DOI: 10.1093/jacamr/dlab185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To review temporal changes in the proportions of different Enterococcus species recorded in two UK bacteraemia surveillance systems. Antibiotic resistance trends were also considered. Methods We reviewed data for enterococci from 2001 to 2019 in: (a) the BSAC Resistance Surveillance Programme, which collected up to 7–10 bloodstream enterococci every year from each of 23–39 hospitals in the UK and Ireland and tested these centrally; and (b) PHE bacteraemia surveillance, using routine results from NHS microbiology laboratories in England. Results BSAC surveillance, based upon 206–255 enterococci each year (4486 in total), indicated that the proportion of Enterococcus faecium rose from 31% (212/692) in the period 2001–3 to 51% (354/696) in the period 2017–19, balanced by corresponding falls in the proportion of Enterococcus faecalis. PHE surveillance provided a larger dataset, with >5000 enterococcus reports per year; although its identifications are less precise, it too indicated a rise in the proportion of E. faecium. BSAC surveillance for E. faecium indicated no consistent trends in resistance to ampicillin (≥86% in all years), vancomycin (annual rates 19%–40%) or high-level resistance to gentamicin (31%–59%). Resistance to vancomycin remained <4% in E. faecalis in all years, whilst high-level resistance to gentamicin fell, perhaps partly reflecting the decline of two initially prevalent gentamicin- and ciprofloxacin-resistant clones. Conclusions Both surveillance systems indicate a growing proportion of E. faecium in enterococcal bloodstream infections. This is important because fewer therapeutic options remain against this frequently multiresistant species than against E. faecalis.
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Affiliation(s)
- Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
- Corresponding author. E-mail:
| | | | - Michael Allen
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
- Merck Sharp & Dohme (UK) Limited, London, UK
| | | | | | - Christopher Longshaw
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
- Shionogi B.V., London, UK
| | - Rosy Reynolds
- Bristol Medical School, University of Bristol, Bristol, UK
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7
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Horner C, Mushtaq S, Allen M, Longshaw C, Reynolds R, Livermore DM. Are resistance rates among bloodstream isolates a good proxy for other infections? Analysis from the BSAC Resistance Surveillance Programme. J Antimicrob Chemother 2021; 76:1822-1831. [PMID: 33822968 DOI: 10.1093/jac/dkab096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Bacteraemia data are often used as a general measure of resistance prevalence but may poorly represent other infection types. We compared resistance prevalence between bloodstream infection (BSI) and lower respiratory tract infection (LRTI) isolates collected by the BSAC Resistance Surveillance Programme. METHODS BSI isolates (n = 8912) were collected during 2014-18 inclusive and LRTI isolates (n = 6280) between October 2013 to September 2018 from participating laboratories in the UK and Ireland, to a fixed annual quota per species group. LRTI isolates, but not BSI, were selected by onset: community for Streptococcus pneumoniae; hospital for Staphylococcus aureus, Pseudomonas aeruginosa and Enterobacterales. MICs were determined centrally by agar dilution; statistical modelling adjusted for ICU location and possible clustering by collection centre. RESULTS Resistance was more prevalent among the LRTI isolates, even after adjusting for a larger proportion of ICU patients. LRTI P. aeruginosa and S. pneumoniae were more often resistant than BSI isolates for most antibiotics, and the proportion of MRSA was higher in LRTI. For S. pneumoniae, the observation reflected different serotype distributions in LRTI and BSI. Relationships between LRTI and resistance were less marked for Enterobacterales, but LRTI E. coli were more often resistant to β-lactams, particularly penicillin/β-lactamase inhibitor combinations, and LRTI K. pneumoniae to piperacillin/tazobactam. For E. cloacae there was a weak association between LRTI, production of AmpC enzymes and cephalosporin resistance. CONCLUSIONS Estimates of resistance prevalence based upon bloodstream isolates underestimate the extent of the problem in respiratory isolates, particularly for P. aeruginosa, S. pneumoniae, S. aureus and, less so, for Enterobacterales.
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Affiliation(s)
- Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Shazad Mushtaq
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, UK
| | - Michael Allen
- British Society for Antimicrobial Chemotherapy, Birmingham, UK.,Merck Sharp & Dohme (UK) Limited, London, UK
| | - Christopher Longshaw
- British Society for Antimicrobial Chemotherapy, Birmingham, UK.,Shionogi B.V, London, UK
| | - Rosy Reynolds
- Bristol Medical School, University of Bristol, Bristol, UK
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Horner C, Cunney R, Demirjian A, Doherty C, Green H, Mathai M, McMaster P, Munro A, Paulus S, Roland D, Patel S. Paediatric Common Infections Pathways: improving antimicrobial stewardship and promoting ambulation for children presenting with common infections to hospitals in the UK and Ireland. JAC Antimicrob Resist 2021; 3:dlab029. [PMID: 34223103 PMCID: PMC8210287 DOI: 10.1093/jacamr/dlab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/15/2021] [Indexed: 12/19/2022] Open
Abstract
Paediatric common infection pathways have been developed in collaboration between the BSAC and national paediatric groups, addressing the management of cellulitis, lymphadenitis/lymph node abscess, pneumonia/pleural empyema, pyelonephritis, tonsillitis/peritonsillar abscess, otitis media/mastoiditis, pre-septal/post-septal (orbital) cellulitis, and meningitis. Guidance for the management of a child presenting with a petechial/purpuric rash and the infant under 3 months of age with fever is also provided. The aim of these pathways is to support the delivery of high-quality infection management in children presenting to a hospital. The pathways focus on diagnostic approaches, including the recognition of red flags suggesting complex or severe infection requiring urgent intervention, approaches to antimicrobial stewardship (AMS) principles and guidance on safe and timely ambulation aligned with good practice of outpatient parenteral antimicrobial therapy (OPAT).
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Affiliation(s)
- Carolyne Horner
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Robert Cunney
- Temple Street Children's University Hospital, Dublin, Ireland
| | | | | | - Helen Green
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Alasdair Munro
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stéphane Paulus
- Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Sanjay Patel
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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9
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Brown NM, Goodman AL, Horner C, Jenkins A, Brown EM. Treatment of methicillin-resistant Staphylococcus aureus (MRSA): updated guidelines from the UK. JAC Antimicrob Resist 2021; 3:dlaa114. [PMID: 34223066 PMCID: PMC8210269 DOI: 10.1093/jacamr/dlaa114] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [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] [Indexed: 12/03/2022] Open
Abstract
These evidence-based guidelines are an updated version of those issued in 2008. They have been produced following a review of the published literature (2007-18) pertaining to the treatment of infections caused by MRSA. The guidelines update, where appropriate, previous recommendations, taking into account changes in the UK epidemiology of MRSA, ongoing national surveillance data and the efficacy of novel anti-staphylococcal agents licensed for use in the UK. Emerging therapies that have not been licensed for use in the UK at the time of the review have also been assessed.
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Affiliation(s)
- Nicholas M Brown
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Corresponding author. E-mail:
| | - Anna L Goodman
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK,MRC Clinical Trials Unit, University College London, London, UK
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Abi Jenkins
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Erwin M Brown
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
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10
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Horner C, Mushtaq S, Livermore DM. Activity of ceftaroline versus ceftobiprole against staphylococci and pneumococci in the UK and Ireland: analysis of BSAC surveillance data. J Antimicrob Chemother 2020; 75:3239-3243. [PMID: 32728710 DOI: 10.1093/jac/dkaa306] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Ceftaroline and ceftobiprole inhibit most MRSA and MDR pneumococci. Few direct comparisons of their activity have been published, but in several years (2008, 2013, 2017 and 2018) both were tested in parallel in the BSAC Resistance Surveillance Programme, giving paired results. These are reviewed. METHODS Isolates included were bloodstream Staphylococcus aureus [n = 1884 (MRSA, n = 234)], bloodstream CoNS (n = 813; 574 methicillin resistant), and bloodstream (n = 852) and respiratory (n = 670) Streptococcus pneumoniae. MICs were determined by BSAC agar dilution and reviewed against EUCAST breakpoints; S. aureus breakpoints were assumed for CoNS. RESULTS Ceftaroline MICs were mostly 2-fold lower than those of ceftobiprole, but, for all groups, MICs of both agents were strongly inter-related. Methicillin-susceptible staphylococci were universally susceptible to both agents; all MRSA were susceptible to ceftobiprole, whereas 10/234 had intermediate/high-dose susceptibility to ceftaroline. Among methicillin-resistant CoNS, 88% were susceptible to both agents, but reduced ceftaroline susceptibility and ceftobiprole resistance were frequent (65%) among methicillin-resistant Staphylococcus haemolyticus. One S. pneumoniae was resistant to both ceftaroline (MIC 0.5 mg/L) and ceftobiprole (MIC 1 mg/L) and seven others were only resistant to ceftobiprole (MIC 1 mg/L); seven of these eight pneumococci belonged to serotype 19A or 19F. No time trend in susceptibility was seen for either cephalosporin. CONCLUSIONS Ceftaroline and ceftobiprole have similarly good activity against staphylococci and pneumococci. Therapeutic choices between these agents should be predicated on other differentiating factors, including licensed indications, clinical experience and need for Gram-negative coverage.
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Affiliation(s)
- Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Shazad Mushtaq
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, UK
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Chapman ALN, Patel S, Horner C, Gilchrist M, Seaton RA. Outpatient parenteral antimicrobial therapy: updated recommendations from the UK. J Antimicrob Chemother 2020; 74:3125-3127. [PMID: 31504575 DOI: 10.1093/jac/dkz343] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) offers safe, effective and patient-centred care for adults and children. The OPAT UK good practice recommendations for adults and children have recently been updated through a process of literature review, expert consensus and extensive stakeholder consultation. Here we discuss the key changes in the updated recommendations in the context of recent developments, including novel antimicrobial agents and delivery devices, the place of oral antimicrobials as an alternative to intravenous therapy, new OPAT service models and the broader antimicrobial stewardship agenda.
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Affiliation(s)
| | - Sanjay Patel
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carolyne Horner
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | | | - R Andrew Seaton
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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12
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Horner C, Mushtaq S, Livermore DM. Potentiation of imipenem by relebactam for Pseudomonas aeruginosa from bacteraemia and respiratory infections. J Antimicrob Chemother 2020; 74:1940-1944. [PMID: 31032858 DOI: 10.1093/jac/dkz133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/22/2019] [Accepted: 03/05/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Imipenem resistance in Pseudomonas aeruginosa most often entails loss of the 'carbapenem-specific' porin OprD; more rarely it reflects acquired carbapenemases. Loss of OprD only confers resistance to imipenem if AmpC β-lactamase is expressed, and we investigated whether this mechanism was overcome by relebactam, a developmental diazabicyclooctane β-lactamase inhibitor. METHODS Consecutive P. aeruginosa isolates causing bacteraemia or hospital-onset lower respiratory tract infections were collected between 2014 and 2016 under the aegis of the BSAC Resistance Surveillance Programme. Imipenem MICs were determined centrally by BSAC agar dilution, with relebactam at a fixed concentration (4 mg/L). RESULTS For most imipenem-susceptible P. aeruginosa (726/759, 95.7%), the MICs of imipenem alone were 0.5-2 mg/L and were decreased 3- to 4-fold by addition of relebactam, as based on geometric means or modes. For most imipenem-resistant P. aeruginosa (82/92, 89%), imipenem MICs were 8-16 mg/L, and were reduced to 1-2 mg/L by relebactam. These patterns applied regardless of whether the isolates were susceptible to penicillins and cephalosporins or had phenotypes suggesting derepressed AmpC or up-regulated efflux. Imipenem MICs for five P. aeruginosa with MBLs remained high (≥16 mg/L) regardless of relebactam. CONCLUSIONS Potentiation of imipenem by relebactam was almost universal, in accordance with the view that endogenous pseudomonal AmpC ordinarily protects against this carbapenem to a small degree. Imipenem MICs were reduced to the current breakpoint, or lower, except for MBL producers. Potentiation was not compromised by derepression of AmpC or up-regulation of efflux.
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Affiliation(s)
- Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
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13
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Mushtaq S, Reynolds R, Gilmore MC, Esho O, Adkin R, García-Romero I, Chaudhry A, Horner C, Bartholomew TL, Valvano MA, Dry M, Murray J, Pichon B, Livermore DM. Inherent colistin resistance in genogroups of the Enterobacter cloacae complex: epidemiological, genetic and biochemical analysis from the BSAC Resistance Surveillance Programme. J Antimicrob Chemother 2020; 75:2452-2461. [DOI: 10.1093/jac/dkaa201] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 01/19/2023] Open
Abstract
AbstractBackgroundPolymyxins have re-entered use against problem Gram-negative bacteria. Resistance rates are uncertain, with estimates confounded by selective testing.MethodsThe BSAC Resistance Surveillance Programme has routinely tested colistin since 2010; we reviewed data up to 2017 for relevant Enterobacterales (n = 10 914). Unexpectedly frequent resistance was seen among the Enterobacter cloacae complex isolates (n = 1749); for these, we investigated relationships to species, genome, carbon source utilization and LPS structure.ResultsAnnual colistin resistance rates among E. cloacae complex isolates were 4.4%–20%, with a rising trend among bloodstream organisms; in contrast, annual rates for Escherichia coli and Klebsiella spp. (including K. aerogenes) generally remained <2%. WGS split the E. cloacae complex isolates into seven genogroup clusters, designated A–G. Among isolates assigned to genogroups A–D, 47/50 sequenced were colistin resistant, and many of those belonging to genogroups A–C identified as E. asburiae. Isolates belonging to genogroups E–G consistently identified as E. cloacae and were rarely (only 3/45 representatives sequenced) colistin resistant. Genogroups F and G, the predominant colistin-susceptible clusters, were metabolically distinct from other clusters, notably regarding utilization or not of l-fucose, formic acid, d-serine, adonitol, myo-inositol, l-lyxose and polysorbates. LPS from resistant organisms grown without colistin pressure lacked substitutions with 4-amino-arabinose or ethanolamine but was more structurally complex, with more molecular species present.ConclusionsColistin resistance is frequent in the E. cloacae complex and increasing among bloodstream isolates. It is associated with: (i) particular genomic and metabolic clusters; (ii) identification as E. asburiae; and (iii) with more complex LPS architectures.
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Affiliation(s)
- Shazad Mushtaq
- Antimicrobial Resistance & Healthcare Associated Infection Reference Unit, Public Health England, Colindale, London
| | - Rosy Reynolds
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
- Department of Medical Microbiology, Southmead Hospital, Bristol, UK
- University of Bristol Medical School (Population Health Sciences), Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Michael C Gilmore
- The Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
- Laboratory for Molecular Infection Medicine Sweden (MIMS), Department of Molecular Biology, Umeå University, Umeå, Sweden
| | - Olubukola Esho
- Department of Medical Microbiology, Norfolk and Norwich University Hospital, Norwich, UK
- Department of Clinical Microbiology and Infection Control, Royal Gwent Hospital, Cardiff Road, Newport, Gwent NP20 2UB, UK
| | - Rachael Adkin
- Antimicrobial Resistance & Healthcare Associated Infection Reference Unit, Public Health England, Colindale, London
| | | | - Aiysha Chaudhry
- Antimicrobial Resistance & Healthcare Associated Infection Reference Unit, Public Health England, Colindale, London
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Toby L Bartholomew
- The Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
- Excerpta Medica BV, 90 Southwark Street, London SE1 0SW, UK
| | - Miguel A Valvano
- The Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
| | - Magdalena Dry
- Quotient Bio Analytical Sciences and HFL Sport Science, LGC Group, Fordham, UK
| | - John Murray
- Quotient Bio Analytical Sciences and HFL Sport Science, LGC Group, Fordham, UK
- Fisher Scientific Ltd, Bishop Meadow Road, Loughborough LE1 5RG, UK
| | - Bruno Pichon
- Antimicrobial Resistance & Healthcare Associated Infection Reference Unit, Public Health England, Colindale, London
| | - David M Livermore
- Antimicrobial Resistance & Healthcare Associated Infection Reference Unit, Public Health England, Colindale, London
- Norwich Medical School, University of East Anglia, Norwich, UK
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14
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Horner C, van Griensven H. The diagnosis of neuropathic pain in musculoskeletal services: an online survey of current UK-based physiotherapy practice. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Aliabadi S, Horner C, Mushtaq S, Livermore D. Resistance trends among Enterobacterales from bacteraemias in the UK and Ireland, 2007 - 2017. Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, United Kingdom
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16
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Turner CE, Holden MTG, Blane B, Horner C, Peacock SJ, Sriskandan S. The Emergence of Successful Streptococcus pyogenes Lineages through Convergent Pathways of Capsule Loss and Recombination Directing High Toxin Expression. mBio 2019; 10:e02521-19. [PMID: 31822586 PMCID: PMC6904876 DOI: 10.1128/mbio.02521-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/29/2019] [Indexed: 12/17/2022] Open
Abstract
Gene transfer and homologous recombination in Streptococcus pyogenes has the potential to trigger the emergence of pandemic lineages, as exemplified by lineages of emm1 and emm89 that emerged in the 1980s and 2000s, respectively. Although near-identical replacement gene transfer events in the nga (NADase) and slo (streptolysin O) loci conferring high expression of these toxins underpinned the success of these lineages, extension to other emm genotype lineages is unreported. The emergent emm89 lineage was characterized by five regions of homologous recombination additional to nga-slo, including complete loss of the hyaluronic acid capsule synthesis locus hasABC, a genetic trait replicated in two other leading emm types and recapitulated by other emm types by inactivating mutations. We hypothesized that other leading genotypes may have undergone similar recombination events. We analyzed a longitudinal data set of genomes from 344 clinical invasive disease isolates representative of locations across England, dating from 2001 to 2011, and an international collection of S. pyogenes genomes representing 54 different genotypes and found frequent evidence of recombination events at the nga-slo locus predicted to confer higher toxin genotype. We identified multiple associations between recombination at this locus and inactivating mutations within hasAB, suggesting convergent evolutionary pathways in successful genotypes. This included common genotypes emm28 and emm87. The combination of no or low capsule and high expression of nga and slo may underpin the success of many emergent S. pyogenes lineages of different genotypes, triggering new pandemics, and could change the way S. pyogenes causes disease.IMPORTANCEStreptococcus pyogenes is a genetically diverse pathogen, with over 200 different genotypes defined by emm typing, but only a minority of these genotypes are responsible for the majority of human infection in high-income countries. Two prevalent genotypes associated with disease rose to international dominance following recombination of a toxin locus that conferred increased expression. Here, we found that recombination of this locus and promoter has occurred in other diverse genotypes, events that may allow these genotypes to expand in the population. We identified an association between the loss of hyaluronic acid capsule synthesis and high toxin expression, which we propose may be associated with an adaptive advantage. As S. pyogenes pathogenesis depends both on capsule and toxin production, new variants with altered expression may result in abrupt changes in the molecular epidemiology of this pathogen in the human population over time.
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Affiliation(s)
- Claire E Turner
- Molecular Biology & Biotechnology, The Florey Institute, University of Sheffield, Sheffield, United Kingdom
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Matthew T G Holden
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Beth Blane
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, United Kingdom
| | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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17
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Cooper C, Horner C, Barlow G, Stryja J, Sandy-Hodgetts K, Guise T, Humphreys H. A survey of practice and opinions on the use of topical antibiotics to prevent surgical site infection: more confusion than consensus. J Antimicrob Chemother 2019; 73:1978-1983. [PMID: 29596598 DOI: 10.1093/jac/dky097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Abstract
Background Surgical site infection (SSI) is one of the most common causes of healthcare-associated infection. Although the use of topical antibiotics to prevent SSI is not recommended by current guidelines, published studies document conflicting results and conclusions. Objectives The objectives of this survey were to: (i) determine the extent of the use of topical antibiotics to prevent SSI in clinical practice; and (ii) gather the opinions of healthcare professionals most likely to be involved in their use. Methods A questionnaire was circulated to members of BSAC and the European Wound Management Association (EWMA). Results The questionnaire received 160 responses from a variety of healthcare professionals around the world. Most respondents (70%) did not have guidelines for the use of topical antibiotics for the prevention of SSI in their institution; if present, local guidance was based on national guidelines (20/31, 65%). Most respondents did not use or recommend topical antibiotics to prevent SSI; of those that did, gentamicin collagen sponges were most commonly used (24/96 responses, 25%). Over half of the surgeons (18/33, 55%) who responded to the survey did not use topical antibiotics for the prevention of SSI but, when used, contaminated surgery (8/33, 24%) was the most commonly stated indication. Conclusions There are diverse opinions and practices among healthcare professionals about the use of topical antibiotics for the prevention of SSI. This considerable, and possibly inappropriate, variation in clinical practice needs to be addressed as part of antibiotic stewardship.
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Affiliation(s)
- Charlotte Cooper
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Jan Stryja
- Podiatric Outpatients' Department, Hospital Podlesi, Trinec, The Czech Republic
| | - Kylie Sandy-Hodgetts
- School of Human Sciences, University of Western Australia, Joondalup Hospital, Joondalup, Australia
| | - Tracey Guise
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Microbiology, Beaumont Hospital, Dublin, Ireland
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18
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Chapman ALN, Patel S, Horner C, Green H, Guleri A, Hedderwick S, Snape S, Statham J, Wilson E, Gilchrist M, Seaton RA. Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK. JAC Antimicrob Resist 2019; 1:dlz026. [PMID: 34222901 PMCID: PMC8209972 DOI: 10.1093/jacamr/dlz026] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) were published in 2012 and 2015 for adult and paediatric patients, respectively. Here we update the initial good practice recommendations in a combined document based on a further review of the OPAT literature and an extensive consultation process. As with the previous good practice recommendations, these updated recommendations are intended to provide pragmatic guidance for new and established OPAT services across a range of settings and to act as a set of quality indicators for service evaluation and quality improvement.
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Affiliation(s)
| | - Sanjay Patel
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carolyne Horner
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Helen Green
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Susan Snape
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Julie Statham
- South Warwickshire NHS Foundation Trust, Warwick, UK
| | | | | | - R Andrew Seaton
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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19
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Russell AH, Horner C, Livermore DM, MacGowan AP. Doxycycline in UK guidelines for hospital-acquired pneumonia: where is the evidence base?—authors’ response. J Antimicrob Chemother 2019; 74:1767. [DOI: 10.1093/jac/dkz105] [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)
- Alicia H Russell
- John Innes Centre, Norwich, UK
- University of East Anglia, Norwich, UK
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
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20
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McNally A, Kallonen T, Connor C, Abudahab K, Aanensen DM, Horner C, Peacock SJ, Parkhill J, Croucher NJ, Corander J. Diversification of Colonization Factors in a Multidrug-Resistant Escherichia coli Lineage Evolving under Negative Frequency-Dependent Selection. mBio 2019; 10:e00644-19. [PMID: 31015329 PMCID: PMC6479005 DOI: 10.1128/mbio.00644-19] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/18/2022] Open
Abstract
Escherichia coli is a major cause of bloodstream and urinary tract infections globally. The wide dissemination of multidrug-resistant (MDR) strains of extraintestinal pathogenic E. coli (ExPEC) poses a rapidly increasing public health burden due to narrowed treatment options and increased risk of failure to clear an infection. Here, we present a detailed population genomic analysis of the ExPEC ST131 clone, in which we seek explanations for its success as an emerging pathogenic strain beyond the acquisition of antimicrobial resistance (AMR) genes. We show evidence for evolution toward separate ecological niches for the main clades of ST131 and differential evolution of anaerobic metabolism, key colonization, and virulence factors. We further demonstrate that negative frequency-dependent selection acting across accessory loci is a major mechanism that has shaped the population evolution of this pathogen.IMPORTANCE Infections with multidrug-resistant (MDR) strains of Escherichia coli are a significant global public health concern. To combat these pathogens, we need a deeper understanding of how they evolved from their background populations. By understanding the processes that underpin their emergence, we can design new strategies to limit evolution of new clones and combat existing clones. By combining population genomics with modelling approaches, we show that dominant MDR clones of E. coli are under the influence of negative frequency-dependent selection, preventing them from rising to fixation in a population. Furthermore, we show that this selection acts on genes involved in anaerobic metabolism, suggesting that this key trait, and the ability to colonize human intestinal tracts, is a key step in the evolution of MDR clones of E. coli.
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Affiliation(s)
- Alan McNally
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom
| | - Teemu Kallonen
- Infection Genomics, Wellcome Sanger Institute, Cambridge, United Kingdom
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Christopher Connor
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom
| | - Khalil Abudahab
- Infection Genomics, Wellcome Sanger Institute, Cambridge, United Kingdom
| | - David M Aanensen
- Infection Genomics, Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Carolyne Horner
- British Society of Antimicrobial Chemotherapy, Birmingham, United Kingdom
| | - Sharon J Peacock
- Infection Genomics, Wellcome Sanger Institute, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julian Parkhill
- Infection Genomics, Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Nicholas J Croucher
- Faculty of Medicine, School of Public Health, Imperial College, London, United Kingdom
| | - Jukka Corander
- Infection Genomics, Wellcome Sanger Institute, Cambridge, United Kingdom
- Department of Biostatistics, University of Oslo, Oslo, Norway
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
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21
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Gouliouris T, Raven KE, Moradigaravand D, Ludden C, Coll F, Blane B, Naydenova P, Horner C, Brown NM, Corander J, Limmathurotsakul D, Parkhill J, Peacock SJ. Detection of vancomycin-resistant Enterococcus faecium hospital-adapted lineages in municipal wastewater treatment plants indicates widespread distribution and release into the environment. Genome Res 2019; 29:626-634. [PMID: 30898881 PMCID: PMC6442392 DOI: 10.1101/gr.232629.117] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 11/22/2017] [Accepted: 02/14/2019] [Indexed: 12/20/2022]
Abstract
Vancomycin-resistant Enterococcus faecium (VREfm) is a leading cause of healthcare-associated infection. Reservoirs of VREfm are largely assumed to be nosocomial although there is a paucity of data on alternative sources. Here, we describe an integrated epidemiological and genomic analysis of E. faecium associated with bloodstream infection and isolated from wastewater. Treated and untreated wastewater from 20 municipal treatment plants in the East of England, United Kingdom was obtained and cultured to isolate E. faecium, ampicillin-resistant E. faecium (AREfm), and VREfm. VREfm was isolated from all 20 treatment plants and was released into the environment by 17/20 plants, the exceptions using terminal ultraviolet light disinfection. Median log10 counts of AREfm and VREfm in untreated wastewater from 10 plants in direct receipt of hospital sewage were significantly higher than 10 plants that were not. We sequenced and compared the genomes of 423 isolates from wastewater with 187 isolates associated with bloodstream infection at five hospitals in the East of England. Among 481 E. faecium isolates belonging to the hospital-adapted clade, we observed genetic intermixing between wastewater and bloodstream infection, with highly related isolates shared between a major teaching hospital in the East of England and 9/20 plants. We detected 28 antibiotic resistance genes in the hospital-adapted clade, of which 23 were represented in bloodstream, hospital sewage, and municipal wastewater isolates. We conclude that our findings are consistent with widespread distribution of hospital-adapted VREfm beyond acute healthcare settings with extensive release of VREfm into the environment in the East of England.
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Affiliation(s)
- Theodore Gouliouris
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.,Public Health England, Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge CB2 0QW, United Kingdom
| | - Kathy E Raven
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | | | - Catherine Ludden
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Francesc Coll
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Beth Blane
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Plamena Naydenova
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham B1 3NJ, United Kingdom
| | - Nicholas M Brown
- Public Health England, Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge CB2 0QW, United Kingdom
| | - Jukka Corander
- Wellcome Sanger Institute, Hinxton, Cambridge CB10 1SA, United Kingdom.,Institute of Basic Medical Sciences, University of Oslo, 0372 Oslo, Norway
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, 10400, Thailand
| | - Julian Parkhill
- Wellcome Sanger Institute, Hinxton, Cambridge CB10 1SA, United Kingdom
| | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.,Wellcome Sanger Institute, Hinxton, Cambridge CB10 1SA, United Kingdom.,London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
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22
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Ludden C, Raven KE, Jamrozy D, Gouliouris T, Blane B, Coll F, de Goffau M, Naydenova P, Horner C, Hernandez-Garcia J, Wood P, Hadjirin N, Radakovic M, Brown NM, Holmes M, Parkhill J, Peacock SJ. One Health Genomic Surveillance of Escherichia coli Demonstrates Distinct Lineages and Mobile Genetic Elements in Isolates from Humans versus Livestock. mBio 2019; 10:e02693-18. [PMID: 30670621 PMCID: PMC6343043 DOI: 10.1128/mbio.02693-18] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 01/22/2023] Open
Abstract
Livestock have been proposed as a reservoir for drug-resistant Escherichia coli that infect humans. We isolated and sequenced 431 E. coli isolates (including 155 extended-spectrum β-lactamase [ESBL]-producing isolates) from cross-sectional surveys of livestock farms and retail meat in the East of England. These were compared with the genomes of 1,517 E. coli bacteria associated with bloodstream infection in the United Kingdom. Phylogenetic core genome comparisons demonstrated that livestock and patient isolates were genetically distinct, suggesting that E. coli causing serious human infection had not directly originated from livestock. In contrast, we observed highly related isolates from the same animal species on different farms. Screening all 1,948 isolates for accessory genes encoding antibiotic resistance revealed 41 different genes present in variable proportions in human and livestock isolates. Overall, we identified a low prevalence of shared antimicrobial resistance genes between livestock and humans based on analysis of mobile genetic elements and long-read sequencing. We conclude that within the confines of our sampling framework, there was limited evidence that antimicrobial-resistant pathogens associated with serious human infection had originated from livestock in our region.IMPORTANCE The increasing prevalence of E. coli bloodstream infections is a serious public health problem. We used genomic epidemiology in a One Health study conducted in the East of England to examine putative sources of E. coli associated with serious human disease. E. coli from 1,517 patients with bloodstream infections were compared with 431 isolates from livestock farms and meat. Livestock-associated and bloodstream isolates were genetically distinct populations based on core genome and accessory genome analyses. Identical antimicrobial resistance genes were found in livestock and human isolates, but there was limited overlap in the mobile elements carrying these genes. Within the limitations of sampling, our findings do not support the idea that E. coli causing invasive disease or their resistance genes are commonly acquired from livestock in our region.
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Affiliation(s)
- Catherine Ludden
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Kathy E Raven
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Dorota Jamrozy
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Theodore Gouliouris
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
- Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Beth Blane
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Francesc Coll
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Marcus de Goffau
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Plamena Naydenova
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, United Kingdom
| | - Juan Hernandez-Garcia
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paul Wood
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - Nazreen Hadjirin
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Milorad Radakovic
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas M Brown
- Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- British Society for Antimicrobial Chemotherapy, Birmingham, United Kingdom
| | - Mark Holmes
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Julian Parkhill
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Sharon J Peacock
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
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Russell AH, Horner C, Livermore DM, MacGowan AP. Doxycycline in UK guidelines for hospital-acquired pneumonia: where is the evidence base? J Antimicrob Chemother 2018; 73:3212-3215. [DOI: 10.1093/jac/dky306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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)
- Alicia H Russell
- John Innes Centre, Norwich, UK
- University of East Anglia, Norwich, UK
| | - Carolyne Horner
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - David M Livermore
- University of East Anglia, Norwich, UK
- Public Health England, London, UK
| | - Alasdair P MacGowan
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
- Southmead Hospital North Bristol NHS Trust, Bristol, UK
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Horner C, Tenenbaum E, Sipp D, Master Z. The use of civil litigation to rein businesses marketing unproven stem cell interventions. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rosello A, Hayward AC, Hopkins S, Horner C, Ironmonger D, Hawkey PM, Deeny SR. Impact of long-term care facility residence on the antibiotic resistance of urinary tract Escherichia coli and Klebsiella. J Antimicrob Chemother 2017; 72:1184-1192. [PMID: 28077671 DOI: 10.1093/jac/dkw555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/24/2016] [Indexed: 11/14/2022] Open
Abstract
Background Long-term care facilities (LTCFs) are thought to be important reservoirs of antimicrobial-resistant (AMR) bacteria; however, there is no routine surveillance of resistance in LTCF residents, or large population-based studies comparing AMR in LTCFs with the community, so the relative burden of AMR in LTCFs remains unknown. Objectives To compare the frequency of antibiotic resistance of urinary tract bacteria from residents of LTCFs for the elderly and adults aged 70 years or older living in the community. Methods Positive urine specimens reported to any diagnostic microbiology laboratory in the West Midlands region (England) from 1 April 2010 to 31 March 2014 collected from individuals aged 70 years or older were analysed. The resistance of Escherichia coli and Klebsiella to trimethoprim, nitrofurantoin, third-generation cephalosporins and ciprofloxacin and the rate of laboratory-confirmed E. coli and Klebsiella urinary tract infection (UTI) were assessed in LTCF residents and in the community. Results LTCF residents had a laboratory-confirmed E. coli and Klebsiella UTI rate of 21 per 100 person years compared with 8 per 100 person years in the elderly living in the community [rate ratio (RR)=2.66, 95% CI = 2.58-2.73] and a higher rate of developing E. coli and Klebsiella UTIs caused by bacteria resistant to trimethoprim (RR = 4.41, 95% CI = 4.25-4.57), nitrofurantoin (RR = 4.38, 95% CI = 3.98-4.83), ciprofloxacin (RR = 5.18, 95% CI = 4.82-5.57) and third-generation cephalosporins (RR = 4.49, 95% CI = 4.08-4.94). Conclusions Residents of LTCFs for the elderly had more than double the rate of E. coli and Klebsiella UTI and more than four times the rate of E. coli and Klebsiella UTI caused by antibiotic-resistant bacteria compared with those living in the community.
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Affiliation(s)
- Alicia Rosello
- Modelling and Economics Unit, National Infection Service, Public Health England, London NW9 5EQ, UK.,Institute of Health Informatics, Farr Institute of Health Informatics Research, UCL, London NW1 2DA, UK
| | - Andrew C Hayward
- Institute of Health Informatics, Farr Institute of Health Informatics Research, UCL, London NW1 2DA, UK
| | - Susan Hopkins
- Department of Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK.,Healthcare Associated Infections Surveillance, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Carolyne Horner
- Regional Laboratory Leeds, Public Health England, Leeds LS1 3EX, UK
| | - Dean Ironmonger
- Field Epidemiology Service, Public Health England, Birmingham B3 2PW, UK
| | - Peter M Hawkey
- Institute of Microbiology & Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Public Health England Public Health Laboratory, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
| | - Sarah R Deeny
- Data analytics, The Health Foundation, London WC2E 9RA, UK.,Modelling and Economics Unit, National Infection Service, Public Health England and Health Protection Research Unit in Modelling Methodology, London NW9 5EQ, UK
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Trepanier P, Mallard K, Meunier D, Pike R, Brown D, Ashby JP, Donaldson H, Awad-El-Kariem FM, Balakrishnan I, Cubbon M, Chadwick PR, Doughton M, Doughton R, Hardiman F, Harvey G, Horner C, Lee J, Lewis J, Loughrey A, Manuel R, Parsons H, Perry JD, Vanstone G, White G, Shetty N, Coia J, Wiuff C, Hopkins KL, Woodford N. Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures. J Antimicrob Chemother 2016; 72:596-603. [DOI: 10.1093/jac/dkw414] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/18/2016] [Accepted: 08/31/2016] [Indexed: 12/25/2022] Open
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Ellington MJ, Findlay J, Hopkins KL, Meunier D, Alvarez-Buylla A, Horner C, McEwan A, Guiver M, McCrae LX, Woodford N, Hawkey P. Multicentre evaluation of a real-time PCR assay to detect genes encoding clinically relevant carbapenemases in cultured bacteria. Int J Antimicrob Agents 2016; 47:151-4. [DOI: 10.1016/j.ijantimicag.2015.11.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 11/20/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
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Nomamiukor BO, Horner C, Kirby A, Hughes GJ. Living conditions are associated with increased antibiotic resistance in community isolates of Escherichia coli. J Antimicrob Chemother 2015; 70:3154-8. [PMID: 26260128 DOI: 10.1093/jac/dkv229] [Citation(s) in RCA: 10] [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: 04/02/2015] [Accepted: 07/04/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The objective of this study was to measure the associations between domains of deprivation and antibiotic resistance of Escherichia coli. METHODS Routine surveillance data for antibiotic susceptibility of E. coli isolates were obtained from urine specimens taken from patients presenting with suspected urinary tract infection in 2010-12 to healthcare practitioners based in the community in Leeds and Bradford. Eight antibiotics were included in the analyses. Postcodes were linked to lower super output areas (average populations of 1500). The 2010 Indices of Deprivation were used as neighbourhood characteristics for each lower super output area. Multilevel logistic regression models were used to estimate the independent effect of structural components on the odds of resistance to each antibiotic. RESULTS With respect to living conditions, residence in the most-deprived areas compared with the least-deprived areas was associated with increased odds of antibiotic resistance for all eight antibiotics analysed. The magnitude of these associations included an OR of 2.04 (95% CI 1.03-3.07) for cefalexin, 2.16 (95% CI 1.16-4.05) for ciprofloxacin, 2.47 (95% CI 1.08-5.66) for nitrofurantoin and 1.33 (95% CI 1.07-1.75) for trimethoprim. CONCLUSIONS Social deprivation in the form of living conditions is associated with increased antibiotic resistance for E. coli. This evidence suggests there is a need for further individual-level studies to explore the potential mechanism for these associations.
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Affiliation(s)
- Brenda O Nomamiukor
- Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Carolyne Horner
- Old Medical School, Leeds General Infirmary, Public Health England - Leeds, Leeds, UK
| | - Andrew Kirby
- Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Gareth J Hughes
- Academic Unit of Public Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Kirby A, Bretsztajn L, Santoni N, Patel H, Burke D, Horner C. Microbiological prediction of surgical site infection risk after colorectal surgery: a feasibility study. J Hosp Infect 2015; 90:271-2. [DOI: 10.1016/j.jhin.2015.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/04/2015] [Indexed: 11/24/2022]
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Klein A, Karrer S, Horner C, Werner A, Heinlin J, Zeman F, Koller M, Landthaler M, Szeimies RM, Gruber M, Graf B, Hansen E, Kerscher C. Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial. Br J Dermatol 2015; 173:192-200. [DOI: 10.1111/bjd.13547] [Citation(s) in RCA: 18] [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] [Accepted: 11/15/2014] [Indexed: 01/02/2023]
Affiliation(s)
- A. Klein
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - S. Karrer
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - C. Horner
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - A. Werner
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - J. Heinlin
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - F. Zeman
- Department of Centre for Clinical Studies; University Hospital Regensburg; Regensburg Germany
| | - M. Koller
- Department of Centre for Clinical Studies; University Hospital Regensburg; Regensburg Germany
| | - M. Landthaler
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - R.-M. Szeimies
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | - M. Gruber
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - B. Graf
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - E. Hansen
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
| | - C. Kerscher
- Department of Anaesthesiology; University Hospital Regensburg; Regensburg Germany
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Harbarth S, Tuan Soh S, Horner C, Wilcox MH. Is reduced susceptibility to disinfectants and antiseptics a risk in healthcare settings? A point/counterpoint review. J Hosp Infect 2014; 87:194-202. [PMID: 24996517 DOI: 10.1016/j.jhin.2014.04.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 04/29/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given the breadth and depth of antiseptic use, it is surprising how few large-scale studies have been undertaken into the consequences of their use, particularly in clinical practice. Depending on your point of view, this may either reflect an assurance that reduced susceptibility to antiseptics, and notably whether this confers cross-resistance to systemically administered antimicrobial agents, is not an issue of concern, or relative ignorance about the potential threat. AIM This point/counterpoint review offers a differentiated perspective and possible answers to the question, 'Should we be worried about reduced susceptibility to disinfectants and antiseptics in healthcare settings?'. METHODS This topic was the subject of a debate by MHW (point) and SH (counterpoint) during the SHEA Spring Conference 2013: Advancing healthcare epidemiology and the role of the environment, held in Atlanta, GA, USA on 4(th) May 2013. This review is a general representation of the main themes presented during the debate, rather than a systematic review of the literature. FINDINGS There are examples of reduced susceptibility to antiseptics in clinical practice; however, to date, there is no strong evidence that reduced susceptibility to antiseptics is a major clinical problem. Given the growing number of potential indications for use of biocidal active ingredients, the potential for emergence of reduced susceptibility remains a concern. CONCLUSIONS Changes in the clinical use of antiseptics should be matched with surveillance studies to understand whether there are unintended microbiological or clinical consequences, including the selection of bacterial strains that can survive exposure to antiseptics.
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Affiliation(s)
- S Harbarth
- Geneva University Hospitals and Medical School, Geneva, Switzerland
| | | | - C Horner
- Leeds Teaching Hospitals and University of Leeds, Leeds, UK
| | - M H Wilcox
- Leeds Teaching Hospitals and University of Leeds, Leeds, UK.
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Horner C, Fawley W, Morris K, Parnell P, Denton M, Wilcox M. Escherichia coli bacteraemia: 2 years of prospective regional surveillance (2010-12). J Antimicrob Chemother 2013; 69:91-100. [DOI: 10.1093/jac/dkt333] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [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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Horner C, Parnell P, Hall D, Kearns A, Heritage J, Wilcox M. Meticillin-resistant Staphylococcus aureus in elderly residents of care homes: colonization rates and molecular epidemiology. J Hosp Infect 2013; 83:212-8. [PMID: 23332564 DOI: 10.1016/j.jhin.2012.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Meticillin-resistant Staphylococcus aureus (MRSA) is a significant cause of mortality and morbidity in healthcare and community settings; however, there is a paucity of large-scale, longitudinal studies monitoring the occurrence of MRSA in the care home setting. AIM To determine the molecular epidemiology of MRSA colonizing elderly residents of care homes. METHODS Residents in 65 care homes in Leeds, UK, were screened for MRSA nasal colonization in four consecutive years (2006-2009). Isolates were characterized using antibiotic susceptibility testing, detection of the Panton-Valentine leucocidin (PVL) locus, accessory gene regulator allotyping, characterization of the staphylococcal cassette chromosome mec element, spa-typing and pulsed-field gel electrophoresis. FINDINGS MRSA was recovered from 888 nasal swabs of 2492 residents and prevalence was similar (19-22%) throughout the study. Resistance to ≥3 antibiotic classes was common (34%), but resistance to only β-lactam agents was rare (3%); no PVL-positive isolates were identified. Most isolates were related to healthcare-associated epidemic-MRSA type 15 (EMRSA-15, ST22-IV); such isolates decreased in prevalence during the study (86-72%; P < 0.0001, χ(2)-test). The remainder belonged to five different multi-locus sequence type clonal complexes (CC). Most notably, CC59 strains increased in prevalence (10-25%; P < 0.0001, χ(2)-test) and were associated with high-level mupirocin resistance. CONCLUSIONS The molecular epidemiology of MRSA in care homes is complex and dynamic. There was a high, consistent prevalence of MRSA nasal colonization, dominated by healthcare-associated strains. Vigilance is recommended; however, as high-level mupirocin resistance was associated with a single clonal group (CC59) that significantly increased in prevalence during the study.
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Affiliation(s)
- C Horner
- Leeds Teaching Hospitals NHS Trust, Department of Microbiology, Old Medical School, Leeds, UK.
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Horner C, Mawer D, Wilcox M. Reduced susceptibility to chlorhexidine in staphylococci: is it increasing and does it matter? J Antimicrob Chemother 2012; 67:2547-59. [DOI: 10.1093/jac/dks284] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Horner C, Wilcox M, Barr B, Hall D, Hodgson G, Parnell P, Tompkins D. The longitudinal prevalence of MRSA in care home residents and the effectiveness of improving infection prevention knowledge and practice on colonisation using a stepped wedge study design. BMJ Open 2012; 2:e000423. [PMID: 22240647 PMCID: PMC3278489 DOI: 10.1136/bmjopen-2011-000423] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To determine the prevalence and health outcomes of meticillin-resistant Staphylococcus aureus (MRSA) colonisation in elderly care home residents. To measure the effectiveness of improving infection prevention knowledge and practice on MRSA prevalence. Setting Care homes for elderly residents in Leeds, UK. Participants Residents able to give informed consent. Design A controlled intervention study, using a stepped wedge design, comprising 65 homes divided into three groups. Baseline MRSA prevalence was determined by screening the nares of residents (n=2492). An intervention based upon staff education and training on hand hygiene was delivered at three different times according to group number. Scores for three assessment methods, an audit of hand hygiene facilities, staff hand hygiene observations and an educational questionnaire, were collected before and after the intervention. After each group of homes received the intervention, all participants were screened for MRSA nasal colonisation. In total, four surveys took place between November 2006 and February 2009. Results MRSA prevalence was 20%, 19%, 22% and 21% in each survey, respectively. There was a significant improvement in scores for all three assessment methods post-intervention (p≤0.001). The intervention was associated with a small but significant increase in MRSA prevalence (p=0.023). MRSA colonisation was associated with previous and subsequent MRSA infection but was not significantly associated with subsequent hospitalisation or mortality. Conclusions The intervention did not result in a decrease in the prevalence of MRSA colonisation in care home residents. Additional measures will be required to reduce endemic MRSA colonisation in care homes.
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Affiliation(s)
- C Horner
- Leeds Teaching Hospitals NHS Trust and University of Leeds, Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds, UK
| | - M Wilcox
- Leeds Teaching Hospitals NHS Trust and University of Leeds, Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds, UK
| | - B Barr
- Division of Public Health, Quadrangle, University of Liverpool, Liverpool, UK
| | - D Hall
- NHS Leeds, Sycamore Lodge, Leeds, UK
| | - G Hodgson
- Leeds Teaching Hospitals NHS Trust, Infection Prevention and Control, Leeds General Infirmary, Leeds, UK
| | - P Parnell
- Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds, UK
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Horner C, Winger AG, Bodamer GW, Kunin R. Potential for Steel Mill Waste Disposal—Electrolytic Treatment of Waste Sulfate Pickle Liquor Using Anion Exchange Membranes. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/ie50546a014] [Citation(s) in RCA: 13] [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: 11/29/2022]
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Jelks K, Berger T, Horner C, Miller MG. alpha-chlorohydrin induced changes in sperm fertilizing ability in the rat: association with diminished sperm ATP levels and motility. Reprod Toxicol 2001; 15:11-20. [PMID: 11137374 DOI: 10.1016/s0890-6238(00)00115-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the present study, alpha-chlorohydrin (ACH) (5, 10, 25, 50 and 75 mg/kg, po) was administered to rats and the effects on sperm ATP levels, sperm motility, and the ability of sperm to bind and penetrate rat oocytes were determined. Groups of rats were killed 5 days and 3 h following treatment. At both time points, sperm from ACH-treated rats (>/=10 mg/kg) had significantly lower levels of ATP when diluted in media containing glucose. No diminution of ATP was seen in sperm diluted in phosphate-buffered saline (PBS). Computer analysis of sperm motility indicated that straight-line velocity (VSL) was the most sensitive parameter to ACH treatment and was significantly decreased in rat sperm three hours after ACH exposure (25 mg/kg). A clear drop in percent penetration (35% vs. 85% in control) of zona-free rat oocytes by rat sperm of both ACH groups was observed at 10 mg/kg. Higher dose levels produced no significant further decrease in percent penetration. Overall, the fertilizing ability of sperm was highly sensitive to ACH doses that caused minor but significant changes in sperm ATP levels and no significant changes in motility. These data are consistent with the spermatozoan's need for an uncompromised energy supply to maintain its ability to bind and penetrate the oocyte.
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Affiliation(s)
- K Jelks
- Department of Environmental Toxicology, University of California-Davis, 95616, Davis, CA, USA
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Horner C. The history and application of acupuncture. Br J Theatre Nurs 1998; 8:33-5. [PMID: 9934044 DOI: 10.1177/175045899800800604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Broin EO, Horner C, Mealy K, Kerin MJ, Gillen P, O'Brien M, Tanner WA. Meralgia paraesthetica following laparoscopic inguinal hernia repair. An anatomical analysis. Surg Endosc 1995; 9:76-8. [PMID: 7725221 DOI: 10.1007/bf00187893] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Entrapment of the lateral cutaneous nerve of the thigh (LCNT) is a recognized complication of laparoscopic hernia repair. In our first 10 patients in a series of 30 laparoscopic herniorrhaphies we encountered two cases of meralgia paraesthetica, leading us to review our surgical technique and analyze the local anatomy in 20 LCNT cadaver dissections. The distances of the LCNT from fixed anatomical points were analyzed and safe margins of mesh placement at laparoscopic herniorrhaphy were defined.
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Affiliation(s)
- E O Broin
- Department of Surgery, Meath Hospital, Dublin, Ireland
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Abstract
That observers tend to agree in their ratings of a target even if they have never interacted with that target has been called consensus at zero acquaintance. The basic finding that consensus is highest for judgments concerning a target's degree of extraversion (EV) and somewhat weaker for judgments of conscientiousness is replicated. Several potential observable cues that might be used by judges when rating targets are examined. The finding that ratings of physical attractiveness correlate with judgments of EV is replicated. In Study 1, rapid body movements and smiling were also found to correlate with EV judgments. The level of consensus declined when initially unacquainted Ss interacted one-on-one (Study 2), but did not decline--and even increased--when Ss interacted in a group (Study 3). Ss judged as extraverted at zero acquaintance were also seen as extraverted after interacting with others.
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Affiliation(s)
- D A Kenny
- Department of Psychology, University of Connecticut, Storrs 06269-1020
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Abstract
That observers tend to agree in their ratings of a target even if they have never interacted with that target has been called consensus at zero acquaintance. The basic finding that consensus is highest for judgments concerning a target's degree of extraversion (EV) and somewhat weaker for judgments of conscientiousness is replicated. Several potential observable cues that might be used by judges when rating targets are examined. The finding that ratings of physical attractiveness correlate with judgments of EV is replicated. In Study 1, rapid body movements and smiling were also found to correlate with EV judgments. The level of consensus declined when initially unacquainted Ss interacted one-on-one (Study 2), but did not decline--and even increased--when Ss interacted in a group (Study 3). Ss judged as extraverted at zero acquaintance were also seen as extraverted after interacting with others.
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Affiliation(s)
- D A Kenny
- Department of Psychology, University of Connecticut, Storrs 06269-1020
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Horner C. "First, do no harm" will guide reform. Interview by Richard L. Clarke. Healthc Financ Manage 1991; 45:18-22. [PMID: 10145469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Horner C. Financing long-term care: options for the future. Bull N Y Acad Med 1988; 64:15-9. [PMID: 3149540 PMCID: PMC1629991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
A comparative study was carried out on a series of 72 ice-skating and 57 roller skating injuries over a sixteen month period. The average patient age was 20.5 years in the ice-skating group and 16.5 years in the roller skating group. Females predominated in both groups accounting for 72% of ice-skaters injured and 77% of roller skaters injured. Ice-skaters sustained more serious injuries than roller skaters as was evident from the significant difference in fracture numbers in the two groups. Ice-skating fractures accounted for 40% of all injuries while roller skating fractures were only 14% of their total injuries. The majority of ice-skating fractures occurred in females. As a result of our study we recommended several preventative measures.
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