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Journal articleBryce A, Hay AD, Lane IF, et al., 2016,
Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis
, British Medical Journal, Vol: 352, ISSN: 1468-5833Objectives To systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous antibiotics prescribed in primary care and resistance.Design and data analysis Systematic review and meta-analysis. Pooled percentage prevalence of resistance to the most commonly used antibiotics in children in primary care, stratified by the OECD (Organisation for Economic Co-operation and Development) status of the study country. Random effects meta-analysis was used to quantify the association between previous exposure to antibiotics in primary care and resistance.Data sources Observational and experimental studies identified through Medline, Embase, Cochrane, and ISI Web of Knowledge databases, searched for articles published up to October 2015.Eligibility criteria for selecting studies Studies were eligible if they investigated and reported resistance in community acquired urinary tract infection in children and young people aged 0-17. Electronic searches with MeSH terms and text words identified 3115 papers. Two independent reviewers assessed study quality and performed data extraction.Results 58 observational studies investigated 77 783 E coli isolates in urine. In studies from OECD countries, the pooled prevalence of resistance was 53.4% (95% confidence interval 46.0% to 60.8%) for ampicillin, 23.6% (13.9% to 32.3%) for trimethoprim, 8.2% (7.9% to 9.6%) for co-amoxiclav, and 2.1% (0.8 to 4.4%) for ciprofloxacin; nitrofurantoin was the lowest at 1.3% (0.8% to 1.7%). Resistance in studies in countries outside the OECD was significantly higher: 79.8% (73.0% to 87.7%) for ampicillin, 60.3% (40.9% to 79.0%) for co-amoxiclav, 26.8% (11.1% to 43.0%) for ciprofloxacin, and 17.0% (9.8% to 24.2%) for nitrofurantoin. There was evidence that bacterial isolates from the urinary tract from individual children who had received previous
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Journal articleCastro Sanchez EM, Drumright LN, Gharbi, et al., 2016,
Mapping antimicrobial stewardship in undergraduate medical, dental, pharmacy, nursing and veterinary education in the United Kingdom
, PLOS One, Vol: 11, ISSN: 1932-6203ObjectivesTo investigate the teaching of antimicrobial stewardship (AS) in undergraduate healthcare educational degree programmes in the United Kingdom (UK).Participants and MethodsCross-sectional survey of undergraduate programmes in human and veterinary medicine, dentistry, pharmacy and nursing in the UK. The main outcome measures included prevalence of AS teaching; stewardship principles taught; estimated hours apportioned; mode of content delivery and teaching strategies; evaluation methodologies; and frequency of multidisciplinary learning.Results80% (112/140) of programmes responded adequately. The majority of programmes teach AS principles (88/109, 80.7%). ‘Adopting necessary infection prevention and control precautions’ was the most frequently taught principle (83/88, 94.3%), followed by 'timely collection of microbiological samples for microscopy, culture and sensitivity’ (73/88, 82.9%) and ‘minimisation of unnecessary antimicrobial prescribing’ (72/88, 81.8%). The ‘use of intravenous administration only to patients who are severely ill, or unable to tolerate oral treatment’ was reported in ~50% of courses. Only 32/88 (36.3%) programmes included all recommended principles.DiscussionAntimicrobial stewardship principles are included in most undergraduate healthcare and veterinary degree programmes in the UK. However, future professionals responsible for using antimicrobials receive disparate education. Education may be boosted by standardisation and strengthening of less frequently discussed principles.
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Journal articleRawson TM, Moore LSP, Hatcher JC, et al., 2016,
Plasmid-mediated colistin resistance mechanisms: is it time to revise our approach to selective digestive decontamination?
, LANCET INFECTIOUS DISEASES, Vol: 16, Pages: 149-150, ISSN: 1473-3099- Author Web Link
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- Citations: 7
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Journal articleYates TA, Khan PY, Knight GM, et al., 2016,
The transmission of Mycobacterium tuberculosis in high burden settings
, LANCET INFECTIOUS DISEASES, Vol: 16, Pages: 227-238, ISSN: 1473-3099- Author Web Link
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- Citations: 103
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Journal articleArdal C, Outterson K, Hoffman SJ, et al., 2016,
International cooperation to improve access to and sustain effectiveness of antimicrobials
, LANCET, Vol: 387, Pages: 296-307, ISSN: 0140-6736 -
Journal articleCastro Sanchez E, Chang PW, Vila-Candel R, et al., 2016,
Health literacy and infectious diseases: why does it matter?
, International Journal of Infectious Diseases, Vol: 43, Pages: 103-110, ISSN: 1878-3511OBJECTIVES: Multifactorial interventions are crucial to arrest the threat posed by infectious diseases. Public involvement requires adequate information, but determinants such as health literacy can impact on the effective use of such knowledge. The influence of health literacy on infectious diseases is examined in this paper. METHODS: Databases were searched from January 1999 through July 2015 seeking studies reporting on health literacy and infections such tuberculosis, malaria or influenza, or infection-related behaviours such as vaccination or hand hygiene. HIV was excluded as comprehensive reviews had already been published. RESULTS: Studies were found on antibiotic knowledge and use, adoption of influenza and MMR immunisations, screening for sexually transmitted and viral hepatitis infections. There was a lack of investigations on areas such as tuberculosis, malaria, hand hygiene or diarrhoeal diseases. CONCLUSIONS: Limited or insufficient health literacy was associated with reduced adoption of protective behaviours such as immunisation, or inadequate understanding of antibiotics, although the relation was not consistent. Large gaps remain related to infectious diseases with high clinical and societal impact such as tuberculosis or malaria.
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Journal articleMoore LSP, Owens DS, Jepson A, et al., 2016,
Waterborne Elizabethkingia meningoseptica in adult critical care
, Emerging Infectious Diseases, Vol: 22, Pages: 9-17, ISSN: 1080-6059Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E. meningoseptica acquisition (n = 13) to have an attributable morbidity rate of 54% (systemic inflammatory response syndrome >2, rising C-reactive protein, new radiographic changes), suggesting that E. meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-source–associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates across a wider London hospital network suggests this outbreak, and possibly other recently reported outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging pathogen.
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Journal articleOtter JA, Mutters NT, Tacconelli E, et al., 2015,
Controversies in guidelines for the control of multidrug-resistant Gram-negative bacteria in EU countries
, CLINICAL MICROBIOLOGY AND INFECTION, Vol: 21, Pages: 1057-1066, ISSN: 1198-743X- Author Web Link
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- Citations: 51
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Journal articlePalmer WL, Bottle A, Aylin PP, 2015,
The association between day of delivery and obstetric outcomes: an observational study
, The BMJ, Vol: 351, ISSN: 0959-8138Objective To examine the association between day of delivery and measures of quality and safety of maternity services and, in particular, compare weekend with weekday performance.Design We examined outcomes for maternal and neonatal records within the nationwide administrative dataset for English hospitals by day of the week. Groups were defined by day of admission (for maternal indicators) or delivery (for neonatal indicators) rather than by day of complication. We used logistic regression to adjust for case-mix factors including gestational age, birth-weight, and maternal age. We also investigated staffing factors using multi-level models to evaluate the association between outcomes and level of consultant presence. Setting English National Health Service public hospitals.Participants 1,332,835 deliveries and 1,349,599 births between 1 April 2010 and 31 March 2012. Main outcome measures The primary outcomes were perinatal mortality and – for both neonate and mother – infections, emergency readmissions and injuries.Results Performance across four of the seven measures was significantly worse for women admitted, and babies born, at weekends. In particular, the perinatal mortality rate was 7.3 per 1,000 babies delivered at weekends, 0.9 per 1,000 higher than at weekdays (adjusted odds ratio [AOR] 1.07; 95% confidence interval 1.02 to 1.13). We did not identify a consistent association between outcomes and staffing, although trusts who complied with recommended levels of consultant presence had a perineal tear rate of 3.0% compared with 3.3% for non-compliant services (AOR 1.21; 1.00 to 1.45).Conclusion The study suggests an association between day of delivery and aspects of performance, and some outcomes appear worse for both women admitted, and babies born, at the weekend. The results would suggest approximately 770 perinatal deaths and 470 maternal infections per year above what might be expected if performance was consistent across women admitted, and
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Journal articleHolmes AH, Moore LSP, Sundsfjord A, et al., 2015,
Understanding the mechanisms and drivers of antimicrobial resistance
, Lancet, Vol: 387, Pages: 176-187, ISSN: 1474-547XTo combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is affected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Strategies to reduce antimicrobial resistance by removing antimicrobial selective pressure alone rely upon resistance imparting a fitness cost, an effect not always apparent. Minimising resistance should therefore be considered comprehensively, by resistance mechanism, microorganism, antimicrobial drug, host, and context; parallel to new drug discovery, broad ranging, multidisciplinary research is needed across these five levels, interlinked across the health-care, agriculture, and environment sectors. Intelligent, integrated approaches, mindful of potential unintended results, are needed to ensure sustained, worldwide access to effective antimicrobials.
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