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1. Clinical outcomes of teicoplanin use in the OPAT setting

Author

Sarah Logan, Stephen Morris-Jones, Jonathan Underwood, Surjo K. De, Michael Marks, Helena Wickham, Gabriele Pollara, and Hannah Dabrowski

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, medicine.drug_class, 030106 microbiology, Antibiotics, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Outpatients, medicine, Humans, Infusions, Parenteral, Pharmacology (medical), 030212 general & internal medicine, Clinical failure, Adverse effect, Episode of care, biology, business.industry, Teicoplanin, Ceftriaxone, OPAT, Bacterial Infections, General Medicine, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, biology.organism_classification, Anti-Bacterial Agents, 3. Good health, carbohydrates (lipids), Infectious Diseases, Enterococcus, bacteria, business, medicine.drug
Abstract

Teicoplanin possesses several convenient properties for use in the delivery of outpatient parenteral antimicrobial therapy (OPAT) services. However, its use is not widespread and data on its efficacy in the OPAT setting are limited. Here we present a case series of patients undergoing OPAT care being treated by either teicoplanin-based (n = 107) or ceftriaxone-based (n = 191) antibiotic regimens. Clinical failure with teicoplanin occurred in five episodes of care (4.7%) compared with only two episodes of ceftriaxone-based OPAT care (1.0%). Teicoplanin-associated clinical failure was observed in 2 (33.3%) of 6 patients with Enterococcus infections compared with 3 (3.0%) of 101 patients with non-Enterococcus infections. Overall, there were four (2.9%) drug-related adverse events for teicoplanin and four (1.8%) for ceftriaxone, prompting a switch to teicoplanin in three patients. These findings support the continued use of teicoplanin in OPAT as well as its consideration in centres where it is not currently being offered.

Published
2020
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2. Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial

Author

Guy E Thwaites, Matthew Scarborough, Alexander Szubert, Emmanuel Nsutebu, Robert Tilley, Julia Greig, Sarah A Wyllie, Peter Wilson, Cressida Auckland, Janet Cairns, Denise Ward, Pankaj Lal, Achyut Guleri, Neil Jenkins, Julian Sutton, Martin Wiselka, Gonzalez-Ruiz Armando, Clive Graham, Paul R Chadwick, Gavin Barlow, N Claire Gordon, Bernadette Young, Sarah Meisner, Paul McWhinney, David A Price, David Harvey, Deepa Nayar, Dakshika Jeyaratnam, Tim Planche, Jane Minton, Fleur Hudson, Susan Hopkins, John Williams, M Estee Török, Martin J Llewelyn, Jonathan D Edgeworth, A Sarah Walker, Musa Kamfose, Ana de Veciana, Nicola Claire Gordon, Leon Peto, Gemma Pill, Tiphanie Clarke, Laura Watson, Dai Griffiths, Ali Vaughn, Luke Anson, Elian Liu, Sanuki Perera, Lydia Rylance-Knight, Carmen Cantell, Ruth Moroney, Guy Thwaites, Karen Bisnauthsing, Antonio Querol-Rubiera, Charlotte Gibbs, Amita Patel, Carolyn Hemsley, Anna L Goodman, Duncan Wyncoll, Jason Biswas, Jennifer Fitzpatrick, Lizzie Roberts, James Millard, Neil Stone, Angela Cape, Lisa Hurley, Chi Kai Tam, Marie-Claire Hoyle, Kate Maitland, Leona Trainor, Helen Reynolds, Jennifer Harrison, Jim Anson, Joseph Lewis, Jonathan Folb, Lynsey Goodwin, Nicholas Beeching, Sarah Dyas, Helen Winslow, Elizabeth Foote, Paul Roberts, Pavithra Natarajan, Alex Chrdle, Manuel Fenech, Hannah Allsop, Rachel Austin-Hutchison, Louise Barrett, Karen Brookes, Leanne Carwithen, Andrew Conbeer, Richard Cunningham, Charlotte Eglinton, Rosie Fok, Hannah Gott, Shona Hughes, Lewis Jones, Maggie Kalita, Angela King, Linda March, Mike Marner, Tracey Mynes, Aiden Plant, Suzanne Price, Judy Sercombe, Alison Stolton, Mark Wallis, Marie-Claire West, Jackie Westcott, Claire Williams, Rob Wosley, Leona Yabsley, Laura Butland, Julie Sorrell, Tamara Mitchell, Abiola Alli, James Meiring, Boingotlo Masake, Carlene Rowson, Lynne Smart, Laura Makey, Sarah Moll, Jane Cunningham, Kim Ryalls, Kathryn Birchall, Janet Middle, Yvonne Jackson, Diane Swift, Joby Cole, Bala Subramanian, Faith Okhuoya, Maria Edwards, Cheryl Bailey, Rebecca Warren, Gayti Islam, Michael Ankcorn, Sarah Birchall, Paul Jones, John Humphries, Stephen Booth, Cariad Evan, Sarah Wyllie, Andrew Flatt, Lenka Strakova, Maria Hayes, Stacey Valentine, Clare James, Mary Wands, Nicolas Cortes, Nisa Khan, Robert Porter, Zoe Martin, Keith Yip, Helen Preedy, Helen Chesterfield, Tracey Dobson, Colin Walker, Martin Llewelyn, Angela Dunne, Laura Latter, Alison Porges, James Price, John Paul, Laura Behar, Louise Robinson, Amy Murray, Tenessa Sargent, Carrie Ridley, Laura Ortiz-Ruiz de Gordoa, Deborah Gilliam, Carole McPherson, Simon Matthews, Emma Foreman, Rajesh Jarghese, Alisha Beddoe, Sebastien Martin, Sephora Shaw, Dominika Wlazly, Maggie Cole, Abraham Gihawi, Kevin Cole, M Estée Török, Theodore Gouliouris, Luke Bedford, Rebecca B Saunderson, Ilias Mariolis, Rachel Bousfield, Isobel Ramsay, Daniel Greaves, Sani Aliyu, Kim Cox, Lois Mlemba, Lynne Whitehead, Naval Vyse, Mark Bolton, Pauline Lambert, David Chadwick, Kirsty Baillie, Martyn Cain, Richard Bellamy, Jason Wong, Jane Thompson, Helen Vassallo, Agnieszka Skotnicka, Andrea Boyce, Anthony Donnelly, Graham FitzGerald, Victoria Dean, Kristian Warnes, Anna Reyes, Saadia Rahman, Lillian Tsang, Joanne Williams, Stephen Morris-Jones, Elen Witness, Orla Brady, Elizabeth Woodford, Teresa Pettifer, Angela McCadden, Ben Marks, Sophie Collier, Damien Mack, Simon Warren, Colin Brown, Adrian Lyons, Sara Taiyari, Stephen Mepham, Anna Sweeney, Li-An Brown, Alison Potter, Jess Mandiza, Maxine Hough, Sue Williams, Caroline Renton, Fiona Walters, Maria Nadolski, Andree Evans, Polly Tarrant, Katherine Curley, Sophie Whiteley, Julia Halpin, Melanie Hutchings, Shirley Todd, Christop Lohan, Tamika Chapter, Emma Folland, Alaric Colville, Katy Marden, Marina Morgan, Rob Porter, Mel Baxter, Sarah Rippon, Muge Cevik, Judith Chapman, Tim Kemp, Rachel Vincent, Dave Osborne, Tracey Platt, James Calderwood, Bernadette Cook, Caroline Bedford, Leanne Galloway-Browne, Nadine Abberley, Kelly Attack, Joanna Allen, Melanie Harrison, Sarah Stevenson, Carol Brooks, Paula Harlow, Jordan Ewing, Shirley Cooper, Roderick Balancio-Tolentino, Laura O'Neil, Rebecca Tagney, Daniela Shackcloth, James Fellows, Ruth Millett, Jo Studham, Cherrelle de Souza, Geoffrey Howell, Hezron Greaves, Ella Foncel, Rahul Kurup, Jack Briggs, Melody Smith, Cristina Suarez, Giordana Sorrentino, Antonia Scobie, Angela Houston, Fozia Ahmad, Aodhan Breathnach, Rakhee Chahuan, Katie Wilkins, Natalia Waddington, Rashmi Sharma, Peter Flegg, Veenu Kollipara, Mazhar Alam, Andrew Potter, Stacey Donaldson, Charlote Armer, Julie Frudd, Manju Joy, Asha Mathews, Stephen K Glass, Ayodele Ajayi, Amanda Fife, Saba Qaiser, Sharon Sheehan, Sergio Muñoz-Villaverde, Noah Yogo, Ines De Abreu, Gaynor Notcheva, Joanna Flanagan, Cordelia Watson, Efisia Sais, Adetunji Adedayo, Vicky Chu, Georgina Shaw, Michelle A Graver, Rebecca Palmer, Donna Palmer, Senait Haile, Joanne Gordon, Kirandip Mandar, Weronika Szypura, Josephine Marange, Vusumuzi Shabangu, Katy Moore, Jill Lyons, Melinda Munang, Mirriam Sangombe, Ed Moran, Abid Hussain, Adam Lewszuk, Sally Batham, Kate Ellis, Leila Bahadur, Helena White, Manish Pareek, Amandip Sahota, Stephen Coleman, Hilary Pateman, Atul Kotecha, Christopher Sim, Andrew Rosser, Jill Deane, Richard Nendick, Catherine Aldridge, Anne Clarke, Michelle Wood, Adele Marshall, Lynsey Stephenson, Tracy Matheson-Smith, John Sloss, Kathryn Potts, Joanne Malkin, Lemonia Ftika, Veena Raviprakash, Ahalya Malachira, Miranda Kean, Kristine Criste, Kirsty Gladas, Caroline Andrews, Clare Hutchison, Ellen Adams, Janet Andrews, Belinda Romans, Nicola Ridley, Melanie Ekani, Julie Mitchell, Nicola Smith, Tristan Clark, Sarah Glover, Robert Reed, Tat Yam, Holly Burton, Rasha Said, Amy Janvier, Reni Jacob, Chris Smalley, Alison Fair, Susan Lord, Kate Ripalda, Helen Wooldridge, Luis Cotter, Gus Cardoso, Elaine Strachan, Gagan Kaler, Adam Mohamoodally, Emma Lawrence, Zoe Prime, Rachel Abrahams, David Ashley Price, Lesley Rigden, Laura Shewan, Katherine Cullen, Ingrid Emmerson, Karen Martin, Hesther Wilson, Charley Higham, Kathryn Louise Taylor, Edmund Ong, Bijal Patel, Helena Bond, Janine Gradwell, John Widdrington, Sarah Thornthwaite, Scott Prentice, Una Poultney, Hannah Crowther, Helen Fairlamb, Emily Hetherington, Chris Brewer, Suryabrata Banerjee, Clare Hamson, Anna McSkeane, Paula Sharratt, Joanne Thorpe, Sue Kimachia, Helen Wilson, Benjamin Jeffs, Leslie Masters, Jonathan Wilson, Judith Platt, Lisa Burgess, Paul Chadwick, Adam Jeans, Claire Keatley, Amanda Moran, Zoe Swann, Katherine Pagett, Alex Peel, Jason Howard, Kate Maloney, Avril Masdin, Louise Wright, Samantha Crossman, Vicki Lowthorpe, Emma Moore, Peter Moss, Angela Parkin, Adam Wolstencroft, Bev Warner, Clare Tarbotton, Alison Eyre, Anne Anderson, Tina Burdett, Amy Driffill, Ann Sarah Walker, Alex Szubert, Helen Webb, Charlotte Russell, Brooke Jackson, Damilola Otiko, Chiara Borg, Lindsey Masters, Zaheer Islam, Carlos Díaz-Montaña, Debbie Johnson, Apollo - University of Cambridge Repository, and University of St Andrews. School of Medicine

Subjects
0301 basic medicine, Male, Placebo-controlled study, Administration, Oral, Bacteremia, Community-acquired Infections/drug therapy, Administration, intravenous, Rifampin/administration & dosage, law.invention, Randomized controlled trial, law, Treatment Failure, Middle aged, Cross Infection, QR Microbiology, General Medicine, Middle Aged, Staphylococcal Infections, 16. Peace & justice, 3. Good health, Community-Acquired Infections, Staphylococcal infections/drug therapy, Antibiotics, antitubercular/administration & dosage, Cross infection/drug therapy, Administration, Intravenous, Female, Rifampin, medicine.drug, RM, medicine.medical_specialty, Double-blind method, 030106 microbiology, NDAS, Placebo, Staphylococcal infections, Drug Administration Schedule, 03 medical and health sciences, Double-Blind Method, Bacteremia/drug therapy, Internal medicine, medicine, Humans, Adverse effect, Antibiotics, Antitubercular, Aged, Intention-to-treat analysis, business.industry, Administration, oral, Drug administration schedule, medicine.disease, R1, RM Therapeutics. Pharmacology, QR, Treatment failure, Flucloxacillin, business, Rifampicin
Abstract

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants.FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005).INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.FUNDING: UK National Institute for Health Research Health Technology Assessment.

Published
2018

3. A novel approach for evaluating the performance of real time quantitative loop-mediated isothermal amplification-based methods

Author

Judith Stephenson, Helle F. Svenstrup, Stephen Morris-Jones, Carole A. Foy, Jim F. Huggett, Carol E. Donald, C Carder, and Gavin Nixon

Subjects
Isothermal nucleic acid amplification, Loop-mediated isothermal amplification, lcsh:QR1-502, Computational biology, Biology, Biochemistry, Quantitative LAMP, lcsh:Microbiology, NAA, nucleic acid amplification, Structural Biology, Diagnostic model, qLAMP, quantitative loop-mediated amplification, qPCR, quantitative real-time polymerase chain reaction, td, doubling time, Molecular Biology, Diagnostics, lcsh:QH301-705.5, IDT, isothermal doubling time, Molecular biology, Molecular analysis, Tt, threshold time, Real-time polymerase chain reaction, Quantitative Real Time PCR, Quantitative real time PCR, lcsh:Biology (General), MIQE, minimum information for the publication of quantitative real-time PCR experiments, Metric (mathematics), Cq, quantification cycle, Molecular Medicine, Original Article, Standardisation, Quantitative Real-Time Polymerase Chain Reaction, Performance metric
Abstract

Molecular diagnostic measurements are currently underpinned by the polymerase chain reaction (PCR). There are also a number of alternative nucleic acid amplification technologies, which unlike PCR, work at a single temperature. These ‘isothermal’ methods, reportedly offer potential advantages over PCR such as simplicity, speed and resistance to inhibitors and could also be used for quantitative molecular analysis. However there are currently limited mechanisms to evaluate their quantitative performance, which would assist assay development and study comparisons. This study uses a sexually transmitted infection diagnostic model in combination with an adapted metric termed isothermal doubling time (IDT), akin to PCR efficiency, to compare quantitative PCR and quantitative loop-mediated isothermal amplification (qLAMP) assays, and to quantify the impact of matrix interference. The performance metric described here facilitates the comparison of qLAMP assays that could assist assay development and validation activities.

Published
2014
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5. Needles and the damage done: Reasons for admission and financial costs associated with injecting drug use in a Central London Teaching Hospital

Author

Margaret Armstrong, Justin F. Doherty, Philip Gothard, Michael Marks, Emily Pollock, Michael Kidd, Stephen Morris-Jones, and Mahdad Noursadeghi

Subjects
Adult, Male, Microbiology (medical), Drug, medicine.medical_specialty, media_common.quotation_subject, MEDLINE, Teaching hospital, Sepsis, London, Humans, Medicine, Skin Diseases, Infectious, Hospitals, Teaching, Needlestick Injuries, Substance Abuse, Intravenous, Retrospective Studies, media_common, Chi-Square Distribution, business.industry, Soft Tissue Infections, Retrospective cohort study, Length of Stay, Hepatitis B, medicine.disease, Hospitalization, Substance abuse, Pneumonia, Infectious Diseases, Emergency medicine, Female, Medical emergency, business, Chi-squared distribution
Abstract

Summary Objectives To establish the clinical reasons for inpatient admissions among injecting drug users. To determine the frequency of behavioural issues during their care and to estimate the financial implications of injecting drug use to the health service. Methods Retrospective cohort study at University College London Hospital. Clinical, laboratory and financial data were extracted from case notes and electronic records. The cost of each admission was compared to the income received for the period of care. Results 124 injecting drug users required 191 admissions between 2005 and 2009. Skin and soft tissue infections (58%) and pneumonia (18%) were the commonest reasons for admission. Bacteraemia at admission was often not accompanied by an inflammatory response. Exposure to HIV (4%), hepatitis B (49%) and C (84%) was common. Drug misuse (16%) during admission was frequent. The cost to the NHS of treating soft tissue infections in drug users was approximately £77 million per annum. After a median follow-up of 40 months, 10 patients (8%) had died. All deaths were attributable to drug use. Conclusions Bacterial and viral infections are largely responsible for the significant mortality and morbidity of injecting drug users presenting to secondary care. The financial burden to the NHS is substantial.

Published
2013
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6. Fever and weight loss in a patient with HIV

Author

Simon Edwards, Stephen Morris-Jones, Emily Martyn, Ankur Gupta-Wright, Michael Marks, Steven Bandula, and David Moore

Subjects
Male, medicine.medical_specialty, Fever, business.industry, Liver Neoplasms, Human immunodeficiency virus (HIV), HIV Infections, General Medicine, Middle Aged, medicine.disease_cause, Diagnosis, Differential, Weight loss, Internal medicine, Weight Loss, Immunology, medicine, Humans, Differential diagnosis, medicine.symptom, business
Published
2015
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7. Audit of staphylococus aureus bacteraemia (SAB) in a london nhs trust

Author

Stephen Morris-Jones, Anna Pryce, and Anand Sivaramakrishnan

Subjects
Microbiology (medical), medicine.medical_specialty, Hickman line, business.industry, Audit, Functional recovery, Surgery, Metronidazole, Infectious Diseases, Internal medicine, medicine, Ceftriaxone, Hospital discharge, Outpatient clinic, Actinomyces infection, business, medicine.drug
Abstract

s 427 (2) or microscopically proven (1) actinomyces infection. All patients received IV ceftriaxone 4g daily and oral metronidazole 400mg three times daily (in all cases metronidazole was stopped after six weeks). Ceftriaxone was continued for 24 weeks in one patient (16 weeks via OHPAT), 28 weeks in a second patient (20 weeks via OHPAT) and a third patient currently continues on ceftriaxone, having completed eight weeks to date (six weeks via OHPAT). All patients were taught to self-administer their antibiotics via a PICC or Hickman Line, attending the outpatient department once a week only following hospital discharge for medical review. Results: The first two patients made complete clinical, radiological and functional recovery. At the time of writing (March 2008), the third patient had clinically and functionally recovered, with radiological improvement on interval CT brain at eight weeks on continuing therapy. Conclusions: Once-daily parenteral ceftriaxone administered via an OHPAT service can be successfully used to treat selected patients with actinomyces CNS infection. This may reduce hospital duration of stay, costs, and duration of treatment, and facilitate the early rehabilitation needed for a good functional outcome. AUDIT OF STAPHYLOCOCUS AUREUS BACTERAEMIA (SAB) IN A LONDON NHS TRUST Anna Pryce, Anand Sivaramakrishnan, Stephen MorrisJones University College Hospitals NHS Trust, London, United Kingdom

Published
2008
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