1,721,093 research outputs found
Investigations, actions and learning from an outbreak of SARS-CoV-2 infection among health care workers in the United Kingdom
No full textProcalcitonin as an antibiotic stewardship tool in COVID-19 patients in the intensive care
No full textA service evaluation into the outcomes of periprosthetic joint infections in total hip replacements and total knee replacements
No full textBackground: Total Hip Replacement (THR) and Total Knee Replacement (TKR) are staple procedures for end-stage arthritis and/or trauma in the young and elderly. One serious complication of these procedures is Peri-prosthetic Joint Infection (PJI) which is both equally difficult to diagnose and treat. Treatments vary from antibiotic administration to revision surgery (Debridement Antibiotics and Implant Retention [DAIR], One-stage or Two-stage) or a combination of both.Aims: to evaluate and examine the microbiological and surgical treatment options and outcomes for treating PJIs at the University Hospital Southampton (UHS) compared to existing literature.Methods: patients with PJI infections of THR or TKR were identified from an infection database, referred to microbiology from the Trauma and Orthopaedics department. A total of 124 patient were identified with only 112 patients satisfying the inclusion criteria. A qualitative measure was also enlisted through the Oxford Score (Knee and Hip) used as a secondary outcome measure.Results: 112 patients were included in the study with the mean age being 73 years old at patients’ latest operation. Of these, 38 had infected THR while 74 had infected TKR. 61% of THR were cured after initial treatment procedure while only 47% of TKR were cured. There was no significant different in treatment outcome of giving one intervention, be it surgical or pharmacological (i.e. antibiotics), over multiple. Three patients had an amputation after failed multiple revisions. Out of all the treatment modalities two-stage revision showed the most promising cure of infection with a success-rate of 77% (n=58
Mid-Regional pro-Adrenomedullin (MR-proADM), C-Reactive Protein (CRP) and other biomarkers in the early identification of disease progression in COVID-19 patients in the acute NHS setting
No full textAims: there is a lack of biomarkers validated for assessing clinical deterioration in COVID-19 patients upon presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of C-Reactive Protein, Procalcitonin, Mid-Regional pro-adrenomedullin (MR-proADM) and White Cell Count to support prediction of clinical outcomes.Methods: 135 patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via RT-qPCR were included. Biomarkers from within 24 hours of admission were used to predict disease progression by Cox regression and area under the receiver operating characteristic (AUROC) curves. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, critical care admission and non-invasive ventilation (NIV) use.Results: elevated MR-proADM was shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular, renal and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and non-invasive ventilation.Conclusions: the measurement of MR-proADM and CRP in patients with confirmed COVID-19 infection upon admission shows significant potential to support clinicians in identifying those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions
Prosthetic joint infections, biomarkers and antibiotic stewardship
No full textInfection, microbiology, diagnostics, antibiotic stewardship and infection prevention/control are interweaving matters, one benefit from the other and all advance each other.The complex nature of medical sciences and the advances in medical, surgical, cancer care and technologies currently available, particularly in the western world, means population live longer. However in certain cases, these advances result in increased susceptibility to infection that needs novel diagnostics as well as the provision of excellent antimicrobial and infection prevention programmes to treat, prevent spread as well as limit or prevent the rise of antimicrobial resistance.A good example is joint replacement (Arthroplasty), the majority of which are successful. Not only do they provide pain relief, restore function and independence, but also improve the patients’ quality of life. Prosthetic (or periprosthetic) joint infection (PJI) or arthroplasty associated infections (AAI) which is defined as infection involving the joint prosthesis and adjacent tissue are rare, although the effect on patients and health economy can be detrimental in the era of rising antimicrobial resistance.An accurate diagnosis of PJI remains a challenging clinical problem. Despite aggressive investigations, the distinction between PJI and other causes of joint failure, such as aseptic loosening, can frequently be convoluted even among experts in the field. Chapters one and two of this thesis will review diagnostic tests in PJI including the original application of novel biomarkers in the synovial fluid as well as the application of specific polymerase chain reaction (PCR) technology. Chapter three aims to highlight the issues of antimicrobial resistance through original research into novel strains of methicillin resistant Staphylococcus aureus (MRSA) and a review on hidden resistances associated with S. aureus, an organism that is associated with bone and joint infections including PJI. Finally in chapter four, my aim was to provide further insights through application of biomarkers into antibiotic decision making process and stewardship programmes and specific novel application in antibiotic delivery in PJI.This thesis is the result of research and publication over the past ten years. It is mainly intended for infection specialists, antimicrobial pharmacists and orthopaedic surgeons, aiming to provide professionals with insight to these novel applications and technologies, encourage collaborative work among these multidisciplinary teams, and generating more research questions and future studies
Diagnostics in prosthetic joint infections
No full textProsthetic joint infection (PJI) poses a significant burden on patients, clinicians and the healthcare economy. Although various tests have been established for the diagnosis of PJI, the diagnosis remains challenging. In this review, established and potential future diagnostic tests are presented, some of which could provide stepping stones towards improved diagnosis, identification of aetiological agents and efficacious therapeutic options for the management of PJI
Antibiotic stewardship and early discharge from hospital: impact of a structured approach to antimicrobial management
No full textObjectivesTo assess the impact of an infection team review of patients receiving antibiotics in six hospitals across the UK and to establish the suitability of these patients for continued care in the community.MethodsAn evaluation audit tool was used to assess all patients on antibiotic treatment on acute wards on a given day. Clinical and antibiotic use data were collected by an infection team (doctor, nurse and antibiotic pharmacist). Assessments were made of the requirement for continuing antibiotic treatment, route and duration [including intravenous (iv)/oral switch] and of the suitability of the patients for discharge from hospital and their requirement for community support.ResultsOf 1356 patients reviewed, 429 (32%) were on systemic antibiotics, comprising 165 (38%) on iv ± oral antibiotics and 264 (62%) on oral antibiotics alone. Ninety-nine (23%) patients (including 26 on iv antibiotics) had their antibiotics stopped immediately on clinical grounds. The other 330 (77%) patients (including 139 on iv antibiotics) needed to continue antibiotics, although 47 (34%) could be switched to oral. Eighty-nine (21%) patients were considered eligible for discharge, comprising 10 who would have required outpatient parenteral antibiotic therapy (OPAT), 55 who were suitable for oral outpatient treatment and 24 who had their antibiotics stopped.ConclusionsInfection team review had a significant impact on antimicrobial use, facilitating iv to oral switch and a reduction in the volume of antibiotic use, possibly reducing the risk of healthcare-associated complications and infections. It identified many patients who could potentially have been managed in the community with appropriate resources, saving 481 bed-days. The health economics are reported in a companion paper
Novel negative pressure wound therapy with instillation and the management of diabetic foot infections
No full textPurpose of review The use of negative pressure wound therapy with instillation (NPWTi) in complex or difficult-to-treat acute and chronic wounds has expanded rapidly since the introduction of commercially available NPWTi systems. We summarize the evidence related to NPWTi and particularly focus on the application of this technology in diabetic foot ulcers, diabetic foot infections and postoperative diabetic wounds. Recent findings The benefits of negative pressure wound therapy (NPWT) are well documented in the treatment of complex acute and chronic wounds, including noninfected postoperative diabetic wounds and diabetic foot ulcers. Combining intermittent wound irrigation with NPWT may offer additional benefits compared to NPWT alone, including further reduction of wound bed bioburden, increased granulation tissue formation and provision of wound irrigation in a sealed environment, thus preventing potential cross-contamination events. Recently, available evidence suggests that adjunctive NPWTi may be superior to standard NPWT in the management of diabetic infections following surgical debridement and may promote granulation tissue formation in slow-to-heal wounds. Summary Available evidence relating to the utilization of NPWTi in diabetic foot infections is promising but limited in quality, being derived mostly from case series or small retrospective or prospective studies. In order to confirm or refute the potential benefits of NPWTi in this patient cohort, well designed randomized controlled studies are required that compare NPWTi to NPWT or standard wound care methodologies
The impact of PCR in the management of prosthetic joint infections
No full textAn accurate diagnosis of prosthetic joint infection (PJI) remains a challenging clinical problem and is essential for the success of treatment regardless of the treatment option chosen by patients and surgeons. In recent years, PCR for the diagnosis of PJI has received much attention. Here, we review the impact of common PCR-based techniques on identifying causative organisms, antibiotic management and economics of PJI
Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: an ecological study
No full textBackground: The SARS-CoV-2 variant B.1.1.7 was first identified in December, 2020, in England. We aimed to investigate whether increases in the proportion of infections with this variant are associated with differences in symptoms or disease course, reinfection rates, or transmissibility. Methods: We did an ecological study to examine the association between the regional proportion of infections with the SARS-CoV-2 B.1.1.7 variant and reported symptoms, disease course, rates of reinfection, and transmissibility. Data on types and duration of symptoms were obtained from longitudinal reports from users of the COVID Symptom Study app who reported a positive test for COVID-19 between Sept 28 and Dec 27, 2020 (during which the prevalence of B.1.1.7 increased most notably in parts of the UK). From this dataset, we also estimated the frequency of possible reinfection, defined as the presence of two reported positive tests separated by more than 90 days with a period of reporting no symptoms for more than 7 days before the second positive test. The proportion of SARS-CoV-2 infections with the B.1.1.7 variant across the UK was estimated with use of genomic data from the COVID-19 Genomics UK Consortium and data from Public Health England on spike-gene target failure (a non-specific indicator of the B.1.1.7 variant) in community cases in England. We used linear regression to examine the association between reported symptoms and proportion of B.1.1.7. We assessed the Spearman correlation between the proportion of B.1.1.7 cases and number of reinfections over time, and between the number of positive tests and reinfections. We estimated incidence for B.1.1.7 and previous variants, and compared the effective reproduction number, R
t, for the two incidence estimates. Findings: From Sept 28 to Dec 27, 2020, positive COVID-19 tests were reported by 36 920 COVID Symptom Study app users whose region was known and who reported as healthy on app sign-up. We found no changes in reported symptoms or disease duration associated with B.1.1.7. For the same period, possible reinfections were identified in 249 (0·7% [95% CI 0·6–0·8]) of 36 509 app users who reported a positive swab test before Oct 1, 2020, but there was no evidence that the frequency of reinfections was higher for the B.1.1.7 variant than for pre-existing variants. Reinfection occurrences were more positively correlated with the overall regional rise in cases (Spearman correlation 0·56–0·69 for South East, London, and East of England) than with the regional increase in the proportion of infections with the B.1.1.7 variant (Spearman correlation 0·38–0·56 in the same regions), suggesting B.1.1.7 does not substantially alter the risk of reinfection. We found a multiplicative increase in the R
t of B.1.1.7 by a factor of 1·35 (95% CI 1·02–1·69) relative to pre-existing variants. However, R
t fell below 1 during regional and national lockdowns, even in regions with high proportions of infections with the B.1.1.7 variant. Interpretation: The lack of change in symptoms identified in this study indicates that existing testing and surveillance infrastructure do not need to change specifically for the B.1.1.7 variant. In addition, given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant. Funding: Zoe Global, Department of Health (UK), Wellcome Trust, Engineering and Physical Sciences Research Council (UK), National Institute for Health Research (UK), Medical Research Council (UK), Alzheimer's Society.
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