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Journal articleAlividza V, Mariano V, Ahmad R, et al., 2018,
Investigating the impact of poverty on colonization and infection with drug-resistant organisms in humans: a systematic review
, Infectious Diseases of Poverty, Vol: 7, ISSN: 2049-9957BackgroundPoverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics. Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and antimicrobial resistance. Investigating such relationship would strengthen antimicrobial stewardship interventions.MethodsA systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Ovid, MEDLINE, EMBASE, Scopus, CINAHL, PsychINFO, EBSCO, HMIC, and Web of Science databases were searched in October 2016. Prospective and retrospective studies reporting on income or non-income dimensions of poverty and their influence on colonisation or infection with antimicrobial-resistant organisms were retrieved. Study quality was assessed with the Integrated quality criteria for review of multiple study designs (ICROMS) tool.ResultsNineteen articles were reviewed. Crowding and homelessness were associated with antimicrobial resistance in community and hospital patients. In high-income countries, low income was associated with Streptococcus pneumoniae and Acinetobacter baumannii resistance and a seven-fold higher infection rate. In low-income countries the findings on this relation were contradictory. Lack of education was linked to resistant S. pneumoniae and Escherichia coli. Two papers explored the relation between water and sanitation and antimicrobial resistance in low-income settings.ConclusionsDespite methodological limitations, the results suggest that addressing social determinants of poverty worldwide remains a crucial yet neglected step towards preventing antimicrobial resistance.
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Journal articleKnight GM, Dyakova E, Mookerjee S, et al., 2018,
Fast and expensive (PCR) or cheap and slow (culture)? A mathematical modelling study to explore screening for carbapenem resistance in UK hospitals
, BMC Medicine, Vol: 16, ISSN: 1741-7015BackgroundEnterobacteriaceae are a common cause of hospital infections. Carbapenems are a clinically effective treatment of such infections. However, resistance is on the rise. In particular, carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are increasingly common. In order to limit spread in clinical settings, screening and isolation is being recommended, but many different screening methods are available. We aimed to compare the impact and costs of three algorithms for detecting CP-CRE carriage.MethodsWe developed an individual-based simulation model to compare three screening algorithms using data from a UK National Health Service (NHS) trust. The first algorithm, “Direct PCR”, was highly sensitive/specific and quick (half a day), but expensive. The second, “Culture + PCR”, was relatively sensitive/specific but slower, requiring 2.5 days. A third algorithm, “PHE”, repeated the “Culture + PCR” three times with an additional PCR. Scenario analysis was used to compare several levels of CP-CRE prevalence and coverage of screening, different specialities as well as isolation strategies. Our outcomes were (1) days that a patient with CP-CRE was not detected and hence not isolated (“days at risk”), (2) isolation bed days, (3) total costs and (4) mean cost per CP-CRE risk day averted per year. We also explored limited isolation bed day capacity.ResultsWe found that although a Direct PCR algorithm would reduce the number of CP-CRE days at risk, the mean cost per CP-CRE risk day averted per year was substantially higher than for a Culture + PCR algorithm. For example, in our model of an intensive care unit, during a year with a 1.6% CP-CRE prevalence and 63% screening coverage, there were 508 (standard deviation 15), 642 (14) and 655 (14) days at risk under screening algorithms Direct PCR, Culture + PCR and PHE respectively, with mean costs per risk day averted of £192, £61 and
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Journal articleRodriguez-Manzano J, Ying Chia P, Wen Yeo T, et al., 2018,
Improving Dengue diagnostics and management through innovative technology
, Current Infectious Disease Reports, Vol: 20, ISSN: 1534-3146Purpose of Review:Dengue continues to be a major global public health threat. Symptomatic infections can cause a spectrum of disease ranging from a mild febrile illness to severe and potentially life-threatening manifestations. Management relies on supportive treatment with careful fluid replacement. The purpose of this review is to define the unmet needs and challenges in current dengue diagnostics and patient monitoring and outline potential novel technologies to address these needs.Recent Findings:There have been recent advances in molecular and point-of-care (POC) diagnostics as well as technologies including wireless communication, low-power microelectronics, and wearable sensors that have opened up new possibilities for management, clinical monitoring, and real-time surveillance of dengue.Summary:Novel platforms utilizing innovative technologies for POC dengue diagnostics and wearable patient monitors have the potential to revolutionize dengue surveillance, outbreak response, and management at population and individual levels. Validation studies of these technologies are urgently required in dengue-endemic areas.
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Journal articleAbbara A, Rawson T, Karah N, et al., 2018,
Antimicrobial resistance in the context of the Syrian conflict: drivers before and after the onset of conflict and key recommendations
, International Journal of Infectious Diseases, Vol: 73, Pages: 1-6, ISSN: 1201-9712Current evidence describing antimicrobial resistance (AMR) in the context of the Syrian conflict is of poor quality and sparse in nature. This paper explores and reports the major drivers of AMR that were present in Syria pre-conflict and those that have emerged since its onset in March 2011. Drivers that existed before the conflict included a lack of enforcement of existing legislation to regulate over-the-counter antibiotics and notification of communicable diseases. This contributed to a number of drivers of AMR after the onset of conflict, and these were also compounded by the exodus of trained staff, the increase in overcrowding and unsanitary conditions, the increase in injuries, and economic sanctions limiting the availability of required laboratory medical materials and equipment. Addressing AMR in this context requires pragmatic, multifaceted action at the local, regional, and international levels to detect and manage potentially high rates of multidrug-resistant infections. Priorities are (1) the development of a competent surveillance system for hospital-acquired infections, (2) antimicrobial stewardship, and (3) the creation of cost-effective and implementable infection control policies. However, it is only by addressing the conflict and immediate cessation of the targeting of health facilities that the rehabilitation of the health system, which is key to addressing AMR in this context, can progress.
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Journal articleRodriguez-Manzano J, Chia PY, Yeo TW, et al., 2018,
Improving Dengue Diagnostics and Management Through Innovative Technology (vol 20, 25, 2018)
, CURRENT INFECTIOUS DISEASE REPORTS, Vol: 20, ISSN: 1523-3847 -
Journal articleTaylor E, Sriskandan S, Woodford N, et al., 2018,
High prevalence of 16S rRNA methyltransferases among carbapenemase-producing Enterobacteriaceae in the UK & Ireland
, International Journal of Antimicrobial Agents, Vol: 52, Pages: 278-282, ISSN: 0924-8579The emergence of 16S rRNA methyltransferases (16S RMTases) worldwide is a growing concern due to their ability to confer high-level resistance (MICs >256 mg/L) to all clinically-relevant aminoglycosides. As the occurrence of 16S RMTases in the United Kingdom has not been investigated to date, we screened 806 Enterobacteriaceae isolates displaying high-level aminoglycoside resistance (amikacin, gentamicin and tobramycin MICs ≥64, ≥32 and ≥32 mg/L, respectively) for 16S RMTases either by analysing whole-genome sequence (WGS) data (which were available for 449 isolates) or by PCR. A total of 94.5% (762/806) pan-aminoglycoside resistant Enterobacteriaceae were positive for one or more 16S RMTase genes; armA was the most common (340, 44.6%) followed by rmtC (146, 19.2%), rmtF (137, 18.0%), rmtB (87, 11.4%) and various two gene combinations (52, 6.8%). Most (93.4%; 712/762) 16S RMTase producers also carried acquired carbapenemase genes, with blaNDM the most common (592/712; 83.1%). Additionally, high-risk bacterial clones associated with blaNDM were identified in the subset of isolates with WGS data. These included E. coli sequence types (STs) 405 [21.8%, 19/87], 167 [20.7%, 18/87] 410 [12.6%, 11/87] and K. pneumoniae STs 14 [35.6%, 112/315], 231 [15.6%, 49/315] and 147 [10.5%, 33/315]. These accounted for 4.2% [15/358], 5.0% [18/358], 3.1% [11/358], 28.2% [101/358], 3.1% [11/358] and 7.0% [25/358] blaNDM-producing isolates, respectively. This study shows that 16S RMTases occur in the UK & Ireland and carbapenemases are particularly prevalent in 16S RMTase-producing Enterobacteriaceae. This association poses a risk to the treatment of multidrug-resistant Gram-negative infections in the clinical setting.
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Journal articleCastro Sanchez EM, Bennasar-Veny M, Smith M, et al., 2018,
European Commission Guidelines for the prudent use of antimicrobials in human health: a missed opportunity to embrace nursing participation in stewardship
, Clinical Microbiology and Infection, Vol: 24, Pages: 914-915, ISSN: 1198-743XOur letter highlights the shortcomings of recent EU Commission Guidelines for the prudent use of antimicrobials in human health in terms of the contribution of nurses towards stewardship. Such contribution has been advocated much more progressively in recent documents, which have also expanded the domains of the contribution to include domains other than clinical.
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Journal articleBlanco-Mavillard I, Bennasar-Veny M, De Pedro-Gómez J, et al., 2018,
Implementation of a knowledge mobilization model to prevent peripheral venous catheter-related adverse events. PREBACP study: A multicenter cluster randomized trial protocol
, Implementation Science, Vol: 13, ISSN: 1748-5908BackgroundPeripheral venous catheters are the most commonly used invasive devices in hospitals worldwide. Patients can experience multiple adverse events during the insertion, maintenance, and management of these devices. Health professionals aim to resolve the challenges of care variability in the use of peripheral venous catheter through adherence to clinical practice guidelines. The aim of this cluster-randomized controlled trial is to determine the efficacy of a multimodal intervention on incidence of adverse events associated with the use of peripheral venous catheters in adult hospital patients. Additional aims are to analyze the fidelity of nurses and the relationship between contextual factors on the use of best available and the outcomes of the intervention.MethodsFive public hospitals in the Spanish National Health System, with diverse profiles, including one university hospital and four second-level hospitals, will be included. In total, 20 hospitalization wards will be randomized for this study by ward to one of two groups. Those in the first group receive an intervention that lasts 12 months implementing evidence-based practice in healthcare related to peripheral catheters through a multimodal strategy, which will contain updated and poster protocols insertion, maintenance and removal of peripheral venous catheters, technologies applied to e-learning, feedback on the results, user and family information related to peripheral catheter, and facilitation of the best evidence by face-to-face training session. Primary outcome measures: Incidence of adverse events associated with the use of peripheral venous catheters is measured by assessing hospital records. Secondary outcome measures: Nurses’ adherence to clinical practice guidelines, clinical outcomes, and the cost of implementing the multimodal intervention.DiscussionClinical implementation is a complex, multifaceted phenomenon which requires a deep understanding of decision-making, knowledge mobil
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Journal articleCastro Sanchez EM, Iwami M, Ahmad R, et al., 2018,
Articulating citizen participation in national antimicrobial resistance plans: a comparison of European countries
, European Journal of Public Health, ISSN: 1101-1262BackgroundNational action plans determine country responses to anti-microbial resistance (AMR). These plans include interventions aimed at citizens. As the language used in documents could persuade certain behaviours, we sought to assess the positioning and implied responsibilities of citizens in current European AMR plans. This understanding could lead to improved policies and interventions.MethodsReview and comparison of national action plans for AMR (NAP-AMR) obtained from the European Centre for Disease Prevention and Control (plans from 28 European Union and four European Economic Area/European Free Trade Association countries), supplemented by European experts (June–September 2016). To capture geographical diversity, 11 countries were purposively sampled for content and discourse analyses using frameworks of lay participation in healthcare organization, delivery and decision-making.ResultsCountries were at different stages of NAP-AMR development (60% completed, 25% in-process, 9% no plan). The volume allocated to citizen roles in the plans ranged from 0.3 to 18%. The term ‘citizen’ was used by three countries, trailing behind ‘patients’ and ‘public’ (9/11), ‘general population’ (6/11) and ‘consumers’ (6/11). Increased citizen awareness about AMR was pursued by ∼2/3 plans. Supporting interventions included awareness campaigns (11/11), training/education (7/11) or materials during clinical encounters (4/11). Prevention of infection transmission or self-care behaviours were much less emphasized. Personal/individual and social/collective role perspectives seemed more frequently stimulated in Nordic countries.ConclusionCitizen roles in AMR plans are not fully articulated. Documents could employ direct language to emphasise social or collective responsibilities in optimal antibiotic use.
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Journal articlePuaar SJ, Franklin BD, 2018,
Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital
, BMJ QUALITY & SAFETY, Vol: 27, Pages: 529-538, ISSN: 2044-5415- Author Web Link
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