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  1. Article ; Online: Proposed protocol for selection of living kidney donors with diabetes excludes >99% of people with diabetes.

    Gilchrist, Mark / Patel, Kashyap

    Clinical transplantation

    2023  Volume 38, Issue 1, Page(s) e15179

    MeSH term(s) Humans ; Kidney Transplantation ; Diabetes Mellitus ; Kidney ; Living Donors ; Nephrectomy
    Language English
    Publishing date 2023-11-13
    Publishing country Denmark
    Document type Letter ; Research Support, Non-U.S. Gov't
    ZDB-ID 639001-8
    ISSN 1399-0012 ; 0902-0063
    ISSN (online) 1399-0012
    ISSN 0902-0063
    DOI 10.1111/ctr.15179
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  2. Article: Nephrotic syndrome: delays in diagnosis and a cause of pulmonary embolism not to miss.

    Wright, Francesca / Gilchrist, Mark

    British journal of hospital medicine (London, England : 2005)

    2023  Volume 84, Issue 5, Page(s) 1–4

    MeSH term(s) Humans ; Nephrotic Syndrome/complications ; Nephrotic Syndrome/diagnosis ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/etiology
    Language English
    Publishing date 2023-05-22
    Publishing country England
    Document type Journal Article
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2023.0011
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  3. Article ; Online: Assessment of ceftolozane/tazobactam degradation profile and toxicity data in elastomeric devices for continuous infusion via outpatient parenteral antimicrobial therapy (OPAT).

    Gilchrist, Mark / Jamieson, Conor / Drummond, Felicity / Hills, Tim / Seaton, R Andrew / Santillo, Mark

    JAC-antimicrobial resistance

    2023  Volume 5, Issue 2, Page(s) dlad047

    Language English
    Publishing date 2023-04-17
    Publishing country England
    Document type Journal Article
    ISSN 2632-1823
    ISSN (online) 2632-1823
    DOI 10.1093/jacamr/dlad047
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  4. Article ; Online: Accreditation of antimicrobial stewardship programmes: addressing a global need to tackle antimicrobial resistance.

    Sneddon, Jacqueline / Drummond, Felicity / Guise, Tracey / Gilchrist, Mark / Jenkins, David R

    JAC-antimicrobial resistance

    2024  Volume 6, Issue 1, Page(s) dlae007

    Abstract: Accreditation of healthcare services provides quality assurance of hospital practice to support safe and effective care for patients. Accreditation programmes focused on antimicrobial stewardship (AMS) have been developed in high-income countries (HIC) ... ...

    Abstract Accreditation of healthcare services provides quality assurance of hospital practice to support safe and effective care for patients. Accreditation programmes focused on antimicrobial stewardship (AMS) have been developed in high-income countries (HIC) and recently the WHO has developed a toolkit to support AMS practice in low and middle-income (LMIC) countries. BSAC has developed their Global Antimicrobial Stewardship Accreditation Scheme (GAMSAS) for hospitals based on globally applicable standards. GAMSAS aims to support healthcare organizations to build measurable AMS programmes and to support spread of best practice. GAMSAS involves a desktop assessment by BSAC experts followed by a hospital visit to gather further insight into how a hospital's AMS programme operates. A final report of compliance with the GAMSAS standards and a recommendation about accreditation at one of three levels is formally approved at a GAMSAS panel meeting involving well-established global experts in AMS. The BSAC GAMSAS team reflect on progress during the first year and ambitions for future spread.
    Language English
    Publishing date 2024-02-01
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2632-1823
    ISSN (online) 2632-1823
    DOI 10.1093/jacamr/dlae007
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  5. Article ; Online: Personalising intravenous to oral antibiotic switch decision making through fair interpretable machine learning.

    Bolton, William J / Wilson, Richard / Gilchrist, Mark / Georgiou, Pantelis / Holmes, Alison / Rawson, Timothy M

    Nature communications

    2024  Volume 15, Issue 1, Page(s) 506

    Abstract: Antimicrobial resistance (AMR) and healthcare associated infections pose a significant threat globally. One key prevention strategy is to follow antimicrobial stewardship practices, in particular, to maximise targeted oral therapy and reduce the use of ... ...

    Abstract Antimicrobial resistance (AMR) and healthcare associated infections pose a significant threat globally. One key prevention strategy is to follow antimicrobial stewardship practices, in particular, to maximise targeted oral therapy and reduce the use of indwelling vascular devices for intravenous (IV) administration. Appreciating when an individual patient can switch from IV to oral antibiotic treatment is often non-trivial and not standardised. To tackle this problem we created a machine learning model to predict when a patient could switch based on routinely collected clinical parameters. 10,362 unique intensive care unit stays were extracted and two informative feature sets identified. Our best model achieved a mean AUROC of 0.80 (SD 0.01) on the hold-out set while not being biased to individuals protected characteristics. Interpretability methodologies were employed to create clinically useful visual explanations. In summary, our model provides individualised, fair, and interpretable predictions for when a patient could switch from IV-to-oral antibiotic treatment. Prospectively evaluation of safety and efficacy is needed before such technology can be applied clinically.
    MeSH term(s) Humans ; Anti-Bacterial Agents/therapeutic use ; Administration, Intravenous ; Machine Learning ; Administration, Oral ; Decision Making
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2024-01-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2553671-0
    ISSN 2041-1723 ; 2041-1723
    ISSN (online) 2041-1723
    ISSN 2041-1723
    DOI 10.1038/s41467-024-44740-2
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  6. Article: Evaluation of the stability of aciclovir in elastomeric infusion devices used for outpatient parenteral antimicrobial therapy.

    Sime, Fekade Bruck / Wallis, Steven / Jamieson, Conor / Hills, Tim / Gilchrist, Mark / Santillo, Mark / Seaton, R Andrew / Drummond, Felicity / Roberts, Jason

    European journal of hospital pharmacy : science and practice

    2024  

    Abstract: Objectives: To investigate the stability of aciclovir solutions in elastomeric devices used for outpatient parenteral antimicrobial therapy (OPAT).: Methods: Triplicates of two elastomeric devices, Accufuser and Easypump II, were filled with a ... ...

    Abstract Objectives: To investigate the stability of aciclovir solutions in elastomeric devices used for outpatient parenteral antimicrobial therapy (OPAT).
    Methods: Triplicates of two elastomeric devices, Accufuser and Easypump II, were filled with a solution of 200 mg, 2400 mg, and 4500 mg aciclovir in 240 mL 0.9% w/v saline. Devices were stored at room temperature for 14 days, followed by 24 hours storage at 32°C. Assessment using a stability indicating assay, pH and subvisible particle analysis was undertaken at 11 time points throughout the study.
    Results: Aciclovir solution at 200 mg and 2400 mg in 240 mL was stable for 14 days at room temperature (<20°C) and 24 hours of 32°C 'in-use' temperature exposure, remaining above the 95% limit for NHS stability protocols. The high dose was also stable for 14 days at room temperature, but when stored at 32°C there was precipitation of aciclovir within 4 hours in both devices. The precipitate was confirmed as aciclovir and precipitation was not a sign of chemical degradation.
    Conclusions: Aciclovir concentrations above 2400 mg/240 mL are liable to precipitation and cannot be recommended for OPAT services because of heightened risks of nephrotoxicity. Aciclovir solution can be given as a continuous 24-hour infusion for OPAT services at a concentration range of 200-2400 mg in 240 mL in Accufuser and Easypump II elastomeric devices following 14 days storage at room temperature, protected from light.
    Language English
    Publishing date 2024-02-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 2650179-X
    ISSN 2047-9964 ; 2047-9956
    ISSN (online) 2047-9964
    ISSN 2047-9956
    DOI 10.1136/ejhpharm-2023-003784
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  7. Article ; Online: Personalising intravenous to oral antibiotic switch decision making through fair interpretable machine learning

    William J. Bolton / Richard Wilson / Mark Gilchrist / Pantelis Georgiou / Alison Holmes / Timothy M. Rawson

    Nature Communications, Vol 15, Iss 1, Pp 1-

    2024  Volume 13

    Abstract: Abstract Antimicrobial resistance (AMR) and healthcare associated infections pose a significant threat globally. One key prevention strategy is to follow antimicrobial stewardship practices, in particular, to maximise targeted oral therapy and reduce the ...

    Abstract Abstract Antimicrobial resistance (AMR) and healthcare associated infections pose a significant threat globally. One key prevention strategy is to follow antimicrobial stewardship practices, in particular, to maximise targeted oral therapy and reduce the use of indwelling vascular devices for intravenous (IV) administration. Appreciating when an individual patient can switch from IV to oral antibiotic treatment is often non-trivial and not standardised. To tackle this problem we created a machine learning model to predict when a patient could switch based on routinely collected clinical parameters. 10,362 unique intensive care unit stays were extracted and two informative feature sets identified. Our best model achieved a mean AUROC of 0.80 (SD 0.01) on the hold-out set while not being biased to individuals protected characteristics. Interpretability methodologies were employed to create clinically useful visual explanations. In summary, our model provides individualised, fair, and interpretable predictions for when a patient could switch from IV-to-oral antibiotic treatment. Prospectively evaluation of safety and efficacy is needed before such technology can be applied clinically.
    Keywords Science ; Q
    Language English
    Publishing date 2024-01-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: The effect of ciprofloxacin prophylaxis during haematopoietic cell transplantation on infection episodes, exposure to treatment antimicrobials and antimicrobial resistance: a single-centre retrospective cohort study.

    Baltas, Ioannis / Kavallieros, Konstantinos / Konstantinou, Giannis / Koutoumanou, Eirini / Gibani, Malick M / Gilchrist, Mark / Davies, Frances / Pavlu, Jiri

    JAC-antimicrobial resistance

    2024  Volume 6, Issue 1, Page(s) dlae010

    Abstract: Objectives: Fluroquinolone prophylaxis during haematopoietic cell transplantation (HCT) remains contentious. We aimed to determine its effectiveness and association with exposure to treatment antimicrobials and antimicrobial resistance.: Methods: All ...

    Abstract Objectives: Fluroquinolone prophylaxis during haematopoietic cell transplantation (HCT) remains contentious. We aimed to determine its effectiveness and association with exposure to treatment antimicrobials and antimicrobial resistance.
    Methods: All admission episodes for HCT (
    Results: Allo-HCT was performed for 43.3% (173/400) of patients, auto-HCT for 56.7% (227/400). Allo-HCT was associated with an average of 1.01 fewer infection episodes per 100 admission days (95% CI 0.62-1.40,
    Conclusions: Ciprofloxacin prophylaxis in allo-HCT was associated with fewer infection episodes and reduced exposure to treatment antimicrobials. Mortality in auto-HCT remained low. A significant burden of antimicrobial resistance was detected in allo-HCT recipients.
    Language English
    Publishing date 2024-02-01
    Publishing country England
    Document type Journal Article
    ISSN 2632-1823
    ISSN (online) 2632-1823
    DOI 10.1093/jacamr/dlae010
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  9. Article ; Online: The utility of a local multidisciplinary working group to oversee the establishment of rapidly evolving standards of care and to support trial recruitment during the COVID-19 pandemic.

    Satta, Giovanni / Youngstein, Taryn / Lightstone, Liz / Gilchrist, Mark

    Clinical medicine (London, England)

    2021  Volume 21, Issue 3, Page(s) e287–e289

    Abstract: Coronavirus disease 2019 (COVID-19) was first identified in December 2019 in Wuhan, China. The first analyses of cases described high numbers of critically ill patients requiring intensive care admission with significant late inflammatory features. By ... ...

    Abstract Coronavirus disease 2019 (COVID-19) was first identified in December 2019 in Wuhan, China. The first analyses of cases described high numbers of critically ill patients requiring intensive care admission with significant late inflammatory features. By the time the first cases of SARS-CoV-2 infection were diagnosed in the UK, a wide range of drugs were under consideration and it became clear that the input of clinicians covering all organ systems (in particular, infectious diseases, haematology, rheumatology, renal medicine and intensive care) and of expert specialist pharmacists was necessary at the local level. Thus, an expert multidisciplinary (MDT) group within our organisation was convened to offer a standardised approach and robust clinical governance for the treatment of COVID-19 patients admitted to our hospitals and rapidly develop standards of care as evidence evolved. This commentary explores the methods and mechanisms for creating an MDT COVID-19 treatment working group which are applicable to any hospital likely to admit and care for high numbers of COVID-19 patients and demonstrates how the structure and governance of the group allowed for rapid adoption of both dexamethasone and tocilizumab into standard of care as data became available.
    MeSH term(s) Humans ; Pandemics ; SARS-CoV-2 ; Standard of Care ; COVID-19 Drug Treatment
    Language English
    Publishing date 2021-03-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2048646-7
    ISSN 1473-4893 ; 1470-2118
    ISSN (online) 1473-4893
    ISSN 1470-2118
    DOI 10.7861/clinmed.2020-1021
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  10. Article ; Online: Outpatient parenteral antimicrobial therapy (OPAT) versus inpatient care in the UK: a health economic assessment for six key diagnoses.

    Dimitrova, Maria / Gilchrist, Mark / Seaton, R A

    BMJ open

    2021  Volume 11, Issue 9, Page(s) e049733

    Abstract: Objectives: To compare costs associated with different models of outpatient parenteral antimicrobial therapy (OPAT) delivery with costs of inpatient (IP) care across key infection groups managed via OPAT in the UK.: Design: A cost-minimisation design ...

    Abstract Objectives: To compare costs associated with different models of outpatient parenteral antimicrobial therapy (OPAT) delivery with costs of inpatient (IP) care across key infection groups managed via OPAT in the UK.
    Design: A cost-minimisation design was used due to evidence of similarities in patient and treatment outcomes between OPAT and IP care. A bottom-up approach was undertaken for the evaluation of OPAT associated costs. The British Society of Antimicrobial Chemotherapy National Outcomes Registry System was used to determine key infection diagnoses, mean duration of treatment and most frequent antibiotics used.
    Setting: Several OPAT delivery settings were considered and compared with IP care.
    Interventions: OPAT models considered were OP clinic model, nurse home visits, self (or carer)-administration by a bolus intravenous, self-administration by a commercially prefilled elastomeric device, continuous intravenous infusion of piperacillin with tazobactam or flucloxacillin with elastomeric device as OP once daily and, specifically for bone and joint and diabetic foot infections, complex outpatient oral antibiotic therapies.
    Results: Base case and a range of scenario results showed all evaluated OPAT service delivery models to be less costly than IP stay of equivalent duration. The extent of savings varied by OPAT healthcare delivery models. Estimated OPAT costs as a proportion of IP costs were estimated at 0.23-0.53 (skin and soft-tissue infections), 0.34-0.46 (complex urinary tract infections), 0.23-0.51 (orthopaedic infections), 0.24-0.42 (diabetic foot infections) 0.40-0.56 (exacerbations of bronchiectasis) and 0.25-0.42 (intra-abdominal infections). Partial or full complex oral antibiotic therapies in orthopaedic or diabetic foot infections costs were estimated to be 0.13-0.26 of IP costs. Main OPAT costs were associated with staff time and antimicrobial medications.
    Conclusions: OPAT is a cost-effective use of National Health Service resources for the treatment of a range of infections in the UK in patients who can be safely managed in a non-IP setting.
    MeSH term(s) Ambulatory Care ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents ; Cost-Benefit Analysis ; Humans ; Inpatients ; Outpatients ; State Medicine ; United Kingdom
    Chemical Substances Anti-Bacterial Agents ; Anti-Infective Agents
    Language English
    Publishing date 2021-09-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-049733
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