old HPRU Publications
Results
- Showing results for:
- Reset all filters
Search results
-
Journal articleLorencatto F, Charani E, Sevdalis N, et al., 2018,
Driving sustainable change in antimicrobial prescribing practice: how can social and behavioural sciences help?
, JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, Vol: 73, Pages: 2613-2624, ISSN: 0305-7453- Author Web Link
- Cite
- Citations: 67
-
Journal articleAylin PP, Bou-Antoun S, Costelloe CE, et al., 2018,
Age-related decline in antibiotic prescribing for uncomplicated respiratory tract infections in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotics in the community: an interrupted time series analysis
, Journal of Antimicrobial Chemotherapy, Vol: 73, Pages: 2883-2892, ISSN: 0305-7453Objectives: To assess the impact of the 2015/16 NHS England Quality Premium (which provided a financial incentive for Clinical Commissioning Groups to reduce antibiotic prescribing in primary care) on antibiotic prescribing by General Practitioners (GPs) for respiratory tract infections (RTIs).Method: Interrupted time series analysis using monthly patient-level consultation and prescribing data obtained from the Clinical Practice Research Datalink (CPRD), between April 2011 and March 2017. The study population comprised patients consulting a GP who were diagnosed with an RTI. We assessed the rate of antibiotic prescribing in patients (both aggregate and stratified by age) with a recorded diagnosis of uncomplicated RTI, before and after the implementation of the Quality Premium.Results: Prescribing rates decreased over the six year study period, with evident seasonality. Notably, there was a 3% drop in the rate of antibiotic prescribing (equating to 14.65 prescriptions per 1,000 RTI consultations) (p<0.05) in April 2015, coinciding with the introduction of the Quality Premium. This reduction was sustained, such that after two years there was a 3% decrease in prescribing relative to that expected had the pre-intervention trend continued. There was also a concurrent 2% relative reduction in the rate of broad-spectrum antibiotic prescribing. Antibiotic prescribing for RTIs diagnosed in children showed the greatest decline with a 6% relative change two years after the intervention. Of the RTI indications studied, the greatest reductions in antibiotic prescribing were seen for patients with sore throats.Conclusions: Community prescribing of antibiotics for RTIs significantly decreased following the introduction of the Quality Premium, with the greatest reduction seen in younger patients.
-
Journal articleAbdolrasouli A, Petrou MA, Park H, et al., 2018,
Surveillance for azole-resistant Aspergillus fumigatus in a centralized diagnostic mycology service, London, United Kingdom, 1998-2017
, Frontiers in Microbiology, Vol: 9, ISSN: 1664-302XBackground/Objectives: Aspergillus fumigatus is the leading cause of invasive aspergillosis. Treatment is hindered by the emergence of resistance to triazole antimycotic agents. Here, we present the prevalence of triazole resistance among clinical isolates at a major centralized medical mycology laboratory in London, United Kingdom, in the period 1998–2017.Methods: A large number (n = 1469) of clinical A. fumigatus isolates from unselected clinical specimens were identified and their susceptibility against three triazoles, amphotericin B and three echinocandin agents was carried out. All isolates were identified phenotypically and antifungal susceptibility testing was carried out by using a standard broth microdilution method.Results: Retrospective surveillance (1998–2011) shows 5/1151 (0.43%) isolates were resistant to at least one of the clinically used triazole antifungal agents. Prospective surveillance (2015–2017) shows 7/356 (2.2%) isolates were resistant to at least one triazole antifungals demonstrating an increase in incidence of triazole-resistant A. fumigatus in our laboratory. Among five isolates collected from 2015 to 2017 and available for molecular testing, three harbored TR34/L98H alteration in the cyp51A gene that are associated with the acquisition of resistance in the non-patient environment.Conclusion: These data show that historically low prevalence of azole resistance may be increasing, warranting further surveillance of susceptible patients.
-
Journal articleJauneikaite E, Kapatai G, Davies F, et al., 2018,
Serial clustering of late onset group B streptococcal infections in the neonatal unit - a genomic re-evaluation of causality
, Clinical Infectious Diseases, Vol: 67, Pages: 854-860, ISSN: 1058-4838Background. Invasive Group B streptococcus (GBS) is a major cause of serious neonatal infection. Current strategies to reduce early onset GBS disease have no impact on late onset disease (LOD). Although GBS is a normal part of the enteric microbiota in healthy term infants, LOD cases arising in the neonatal intensive care unit setting raise questions about mode of acquisition.Methods. Enhanced surveillance for any case of late onset GBS sepsis admitted to a level 3, 24-bed neonatal intensive care unit over a 2 year period was instituted following a cluster of four cases. All late onset GBS isolates were serotyped and genomes sequenced. Rectal screening of neonates for GBS was undertaken weekly. Healthcare workers and parents were not screened.Results. Over 24 months, a total of 12 late onset invasive GBS episodes were identified (incidence 0.6/1000 live births). Genomic analysis revealed that 11/12 GBS isolates (92%) were linked to at least one other LOD isolate. Four isolates from the first cluster were serotype V, resistant to macrolides and lincosamides, providing early evidence of a common source. Sequencing confirmed isolates were indistinguishable, or distinguishable by 1 SNP, from each other, and distinct from contemporary serotype V GBS. Although a common environmental source was not identified, prompt infection prevention interventions were instituted and no further serotype V GBS infections arose. Prospective surveillance identified three further clusters of LOD due to serotypes Ia, Ib, and III, leading to re-evaluation of interventions required for preventing GBS LOD. Conclusion. Acquisition routes for LOD GBS in the neonatal unit are poorly understood; such cases may not necessarily be sporadic. Within this neonatal unit, our data suggest that a single case of LOD GBS sepsis should be considered a potential nosocomial transmission event warranting prompt investigation, heightened infection prevention vigilance and action where required.
-
Conference paperBalinskaite V, Holmes A, Johnson A, et al., 2018,
The Impact of a National Antimicrobial Stewardship Programmes on Antibiotic Prescribing in Primary Care in England: An Interrupted Time Series Analysis
, ISQua, Publisher: OXFORD UNIV PRESS, Pages: 37-38, ISSN: 1353-4505 -
Journal articleCourtenay M, Castro Sanchez EM, Deslandes R, et al., 2018,
Defining antimicrobial stewardship competencies for undergraduate health professional education in the United Kingdom: a study protocol
, Journal of Interprofessional Care, Vol: 32, Pages: 638-640, ISSN: 1356-1820Drug resistant infections have been identified as one of the greatest threats to human health. With the increasing numbers of health professionals from nursing, pharmacy, and the allied health professions (including physiotherapists, podiatrists/chiropodists) involved in medicines management activities, including the prescription of antimicrobials, it is important that they are prepared for this role. This report presents a protocol for a study designed to provide national consensus on antimicrobial stewardship competencies appropriate for undergraduate professional education for these groups. A modified Delphi process will be used in which a panel of Experts comprising members from across England, Scotland and Wales, with expertise in the education and practice of healthcare professionals, antimicrobial prescribing and stewardship, interprofessional education and teamwork, will be invited to take part in two survey rounds to achieve consensus on stewardship competencies appropriate for undergraduate health professional education.
-
Journal articleMookerjee S, Dyakova E, Davies F, et al., 2018,
Evaluating serial screening cultures to detect carbapenemase-producing Enterobacteriaceae following hospital admission
, JOURNAL OF HOSPITAL INFECTION, Vol: 100, Pages: 15-20, ISSN: 0195-6701- Author Web Link
- Cite
- Citations: 6
-
Conference paperBalinskaite V, Holmes A, Johnson A, et al., 2018,
An Assessment of Unintended Consequences in England Following a National Antimicrobial Stewardship Programme: An Interrupted Time Series Analysis
, ISQua, Publisher: OXFORD UNIV PRESS, Pages: 37-37, ISSN: 1353-4505 -
Journal articleLishman H, Costelloe C, Hopkins S, et al., 2018,
Exploring the relationship between primary care antibiotic prescribing for urinary tract infections, Escherichia coli bacteraemia incidence and antibiotic resistance: an ecological study
, International Journal of Antimicrobial Agents, ISSN: 0924-8579 -
Journal articleKnight GM, Costelloe C, Deeny S, et al., 2018,
Quantifying where human acquisition of antibiotic resistance occurs: a mathematical modelling study
, BMC Medicine, Vol: 16, ISSN: 1741-7015BackgroundAntibiotic-resistant bacteria (ARB) are selected by the use of antibiotics. The rational design of interventions to reduce levels of antibiotic resistance requires a greater understanding of how and where ARB are acquired. Our aim was to determine whether acquisition of ARB occurs more often in the community or hospital setting.MethodsWe used a mathematical model of the natural history of ARB to estimate how many ARB were acquired in each of these two environments, as well as to determine key parameters for further investigation. To do this, we explored a range of realistic parameter combinations and considered a case study of parameters for an important subset of resistant strains in England.ResultsIf we consider all people with ARB in the total population (community and hospital), the majority, under most clinically derived parameter combinations, acquired their resistance in the community, despite higher levels of antibiotic use and transmission of ARB in the hospital. However, if we focus on just the hospital population, under most parameter combinations a greater proportion of this population acquired ARB in the hospital.ConclusionsIt is likely that the majority of ARB are being acquired in the community, suggesting that efforts to reduce overall ARB carriage should focus on reducing antibiotic usage and transmission in the community setting. However, our framework highlights the need for better pathogen-specific data on antibiotic exposure, ARB clearance and transmission parameters, as well as the link between carriage of ARB and health impact. This is important to determine whether interventions should target total ARB carriage or hospital-acquired ARB carriage, as the latter often dominated in hospital populations.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.