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de Graaf H, Sukhtankar P, Arch B, Ahmad N, Lees A, Bennett A, Spowart C, Hickey H, Jeanes A, Armon K, Riordan A, Herberg J, Hackett S, Gamble C, Shingadia D, Pallett A, Clarke SC, Henman P, Emonts M, Sharland M, Finn A, Pollard AJ, Powell C, Marsh P, Ballinger C, Williamson PR, Clarke NM, Faust SN. Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study. Health Technol Assess 2018; 21:1-164. [PMID: 28862129 DOI: 10.3310/hta21480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is little current consensus regarding the route or duration of antibiotic treatment for acute osteomyelitis (OM) and septic arthritis (SA) in children. OBJECTIVE To assess the overall feasibility and inform the design of a future randomised controlled trial (RCT) to reduce the duration of intravenous (i.v.) antibiotic use in paediatric OM and SA. DESIGN (1) A prospective service evaluation (cohort study) to determine the current disease spectrum and UK clinical practice in paediatric OM/SA; (2) a prospective cohort substudy to assess the use of targeted polymerase chain reaction (PCR) in diagnosing paediatric OM/SA; (3) a qualitative study to explore families' views and experiences of OM/SA; and (4) the development of a core outcome set via a systematic review of literature, Delphi clinician survey and stakeholder consensus meeting. SETTING Forty-four UK secondary and tertiary UK centres (service evaluation). PARTICIPANTS Children with OM/SA. INTERVENTIONS PCR diagnostics were compared with culture as standard of care. Semistructured interviews were used in the qualitative study. RESULTS Data were obtained on 313 cases of OM/SA, of which 218 (61.2%) were defined as simple disease and 95 (26.7%) were defined as complex disease. The epidemiology of paediatric OM/SA in this study was consistent with existing European data. Children who met oral switch criteria less than 7 days from starting i.v. antibiotics were less likely to experience treatment failure (9.6%) than children who met oral switch criteria after 7 days of i.v. therapy (16.1% when switch was between 1 and 2 weeks; 18.2% when switch was > 2 weeks). In 24 out of 32 simple cases (75%) and 8 out of 12 complex cases (67%) in which the targeted PCR was used, a pathogen was detected. The qualitative study demonstrated the importance to parents and children of consideration of short- and long-term outcomes meaningful to families themselves. The consensus meeting agreed on the following outcomes: rehospitalisation or recurrence of symptoms while on oral antibiotics, recurrence of infection, disability at follow-up, symptom free at 1 year, limb shortening or deformity, chronic OM or arthritis, amputation or fasciotomy, death, need for paediatric intensive care, and line infection. Oral switch criteria were identified, including resolution of fever for ≥ 48 hours, tolerating oral food and medicines, and pain improvement. LIMITATIONS Data were collected in a 6-month period, which might not have been representative, and follow-up data for long-term complications are limited. CONCLUSIONS A future RCT would need to recruit from all tertiary and most secondary UK hospitals. Clinicians have implemented early oral switch for selected patients with simple disease without formal clinical trial evidence of safety. However, the current criteria by which decisions to make the oral switch are made are not clearly established or evidence based. FUTURE WORK A RCT in simple OM and SA comparing shorter- or longer-course i.v. therapy is feasible in children randomised after oral switch criteria are met after 7 days of i.v. therapy, excluding children meeting oral switch criteria in the first week of i.v. therapy. This study design meets clinician preferences and addresses parental concerns not to randomise prior to oral switch criteria being met. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Hans de Graaf
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Priya Sukhtankar
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Barbara Arch
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Nusreen Ahmad
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Public Health England, Southampton, UK
| | - Amanda Lees
- Health and Wellbeing Research and Development Group, University of Winchester, Winchester, UK
| | - Abigail Bennett
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Catherine Spowart
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Helen Hickey
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Annmarie Jeanes
- Radiology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate Armon
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Andrew Riordan
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jethro Herberg
- Section of Paediatrics, Imperial College London, St Mary's Campus, London, UK
| | - Scott Hackett
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carrol Gamble
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Delane Shingadia
- Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Ann Pallett
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stuart C Clarke
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Philip Henman
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Marieke Emonts
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Mike Sharland
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Adam Finn
- Bristol Children's Vaccine Centre, School of Clinical Sciences, University of Bristol, Bristol, UK.,Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, UK
| | - Andrew J Pollard
- Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Colin Powell
- School of Medicine, University of Cardiff, Cardiff, UK.,Department of Paediatrics, University Hospital of Wales, Cardiff, UK
| | - Peter Marsh
- Public Health England, South East Public Health England Regional Laboratory, Southampton, UK
| | - Claire Ballinger
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Paula R Williamson
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Nicholas Mp Clarke
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Orthopaedics, University of Southampton, Southampton, UK
| | - Saul N Faust
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Willis C, Morley R, Westbury J, Greenwood M, Pallett A. Evaluation of ATP bioluminescence swabbing as a monitoring and training tool for effective hospital cleaning. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1469044607083604] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effective cleaning in hospitals is an important aspect of infection control of pathogens such as methicillin resistant Staphylococcus aureus (MRSA). There is a need for simple, rapid methods of assessing cleanliness in order to effectively audit cleaning programmes and to educate staff. The aim of this study was to evaluate the use of adenosine triphosphate (ATP) bioluminescence swabs for assessing cleanliness in hospitals. Sites (n=108) in three hospital wards, including floors, patient equipment and clinical workstations were examined by visual assessment, microbiological swabbing and ATP bioluminescence swabbing. Overall, ATP swabbing detected a similar number of undesirably high results compared to microbiological swabbing, but visual assessment gave significantly fewer unsatisfactory results. Highest median contamination levels (both ATP and microbiological) were obtained from floor sites under patient beds, and the lowest levels from patient equipment. It was concluded that ATP bioluminescence swabbing, while not directly equivalent to microbiological swabbing, was a useful tool for monitoring cleanliness. In addition, because of its ability to produce on-the-spot results, it proved useful during education sessions with ward staff and cleaning staff, as a novel way of demonstrating the importance of cleaning.
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Affiliation(s)
- C. Willis
- Wessex Environmental Microbiology Services, Health Protection Agency, Southampton, Hampshire SO16 6YO
| | - R. Morley
- Wessex Environmental Microbiology Services, Health Protection Agency, Southampton, Hampshire SO16 6YO
| | - J. Westbury
- Infection Control Department, Southampton General Hospital, Southampton, Hampshire SO16 6YD
| | - M. Greenwood
- Wessex Environmental Microbiology Services, Health Protection Agency, Southampton, Hampshire SO16 6YO
| | - A. Pallett
- Infection Control Department, Southampton General Hospital, Southampton, Hampshire SO16 6YD
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Dabbas N, Chand M, Pallett A, Royle GT, Sainsbury R. Have the organisms that cause breast abscess changed with time?--Implications for appropriate antibiotic usage in primary and secondary care. Breast J 2010; 16:412-5. [PMID: 20443790 DOI: 10.1111/j.1524-4741.2010.00923.x] [Citation(s) in RCA: 10] [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] [Indexed: 11/29/2022]
Abstract
Many patients with breast abscess are managed in primary care. Knowledge of current trends in the bacteriology is valuable in informing antibiotic choices. This study reviews bacterial cultures of a large series of breast abscesses to determine whether there has been a change in the causative organisms during the era of increasing methicillin-resistant Staphylococcus aureus (MRSA). Analysis was undertaken of all breast abscesses treated in a single unit over 2003 - 2006, including abscess type, bacterial culture, antibiotic sensitivity and resistance patterns. One hundred and ninety cultures were obtained (32.8% lactational abscess, 67.2% nonlactational). 83% yielded organisms. Staphylococcus aureus was the commonest organism isolated (51.3%). Of these, 8.6% were MRSA. Other common organisms included mixed anaerobes (13.7%), and anaerobic cocci (6.3%). Lactational abscesses were significantly more likely to be caused by S. aureus (p < 0.05). Methicillin-resistant Staphylococcus aureus rates were not statistically different between lactational and nonlactational abscess groups. Appropriate antibiotic choices are of great importance in the community management of breast abscess. Ideally, microbial cultures should be obtained to institute targeted therapy but we recommend the continued use of flucloxacillin with or without metronidazole (or amoxicillin-clavulanate as a single preparation) as initial empirical therapy.
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Affiliation(s)
- Natalie Dabbas
- Breast Surgery Unit, Southampton General Hospital, Southampton, UK.
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