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Article ; Online: Coronavirus disease 2019 (COVID-19) impact on central-line-associated bloodstream infections (CLABSI): a systematic review.

Satta, Giovanni / Rawson, Timothy M / Moore, Luke S P

Infection prevention in practice

2023 Volume 5, Issue 4, Page(s) 100313

Abstract: Introduction: Central line-associated bloodstream infections (CLABSI) are an important clinical and public health issue, impacted by the purported increase in healthcare-associated infections (including CLABSI) during the COVID-19 pandemic. This review ... ...

Abstract	Introduction: Central line-associated bloodstream infections (CLABSI) are an important clinical and public health issue, impacted by the purported increase in healthcare-associated infections (including CLABSI) during the COVID-19 pandemic. This review evaluates the impact of COVID-19 on CLABSI at a global level, to determine risk factors, effective preventive measures and microbiological epidemiology. Methods: A systematic literature review was performed using a PECO framework, with COVID-19 infection as the exposure measure and CLABSI rates as the main outcome of interest, pre- and during the pandemic. Results: Overall, most studies (17 of Conclusion: The COVID-19 pandemic significantly impacted CLABSI incidence/rates. Observations from the different studies highlight significant gaps in healthcare associated infections (HCAI) knowledge and practice during the pandemic, and the importance of identifying preventive measures effective in reducing CLABSI, essential to health system resilience for future pandemics. Central to this are changes to CLABSI surveillance, as reporting is not mandatory in many healthcare systems. An audit tool combined with regular assessments of the compliance with infection control measures and line care bundles also remains an essential step in the prevention of CLABSI.
Language	English
Publishing date	2023-10-13
Publishing country	England
Document type	Journal Article ; Review
ISSN	2590-0889
ISSN (online)	2590-0889
DOI	10.1016/j.infpip.2023.100313
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Article ; Online: Understanding how diagnostics influence antimicrobial decision-making is key to successful clinical trial design.

Rawson, Timothy M / Moore, Luke S P

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

2023 Volume 29, Issue 6, Page(s) 666–669

MeSH term(s)	Humans ; Clinical Trials as Topic ; Anti-Infective Agents/pharmacology ; Anti-Infective Agents/therapeutic use ; Multiplex Polymerase Chain Reaction ; Decision Making ; Clinical Decision-Making
Chemical Substances	Anti-Infective Agents
Language	English
Publishing date	2023-03-12
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	1328418-6
ISSN	1469-0691 ; 1470-9465 ; 1198-743X
ISSN (online)	1469-0691
ISSN	1470-9465 ; 1198-743X
DOI	10.1016/j.cmi.2023.03.010
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Zs.A 4541: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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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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Article ; Online: A low-volume LC/MS method for highly sensitive monitoring of phenoxymethylpenicillin, benzylpenicillin, and probenecid in human serum.

Riezk, Alaa / Wilson, Richard C / Cass, Anthony E G / Holmes, Alison H / Rawson, Timothy M

Analytical methods : advancing methods and applications

2024 Volume 16, Issue 4, Page(s) 558–565

Abstract: ... ...

Abstract	Background
MeSH term(s)	Humans ; Penicillin V ; Probenecid/pharmacology ; Tandem Mass Spectrometry/methods ; Anti-Bacterial Agents/pharmacology ; Penicillin G
Chemical Substances	Penicillin V (Z61I075U2W) ; Probenecid (PO572Z7917) ; Anti-Bacterial Agents ; Penicillin G (Q42T66VG0C)
Language	English
Publishing date	2024-01-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2515210-5
ISSN	1759-9679 ; 1759-9660
ISSN (online)	1759-9679
ISSN	1759-9660
DOI	10.1039/d3ay01816d
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Article ; Online: Can precision antibiotic prescribing help prevent the spread of carbapenem-resistant organisms in the hospital setting?

Vasikasin, Vasin / Rawson, Timothy M / Holmes, Alison H / Otter, Jonathan

JAC-antimicrobial resistance

2023 Volume 5, Issue 2, Page(s) dlad036

Abstract: The emergence of carbapenem-resistant organisms (CROs) is a significant global threat. Reduction of carbapenem consumption can decrease CROs. In the global endemic era of ESBL-producing bacteria, carbapenems are considered the treatment of choice, ... ...

Abstract	The emergence of carbapenem-resistant organisms (CROs) is a significant global threat. Reduction of carbapenem consumption can decrease CROs. In the global endemic era of ESBL-producing bacteria, carbapenems are considered the treatment of choice, leading to challenge in limiting carbapenem use. This review describes the role of precision prescribing for prevention of CROs. This involves improving antibiotic selection, dosing and shortening duration. The effect of different antibiotics, dosing and duration on CRO development are explored. Available options for precision prescribing, gaps in the scientific evidence, and areas for future research are also presented.
Language	English
Publishing date	2023-03-29
Publishing country	England
Document type	Journal Article ; Review
ISSN	2632-1823
ISSN (online)	2632-1823
DOI	10.1093/jacamr/dlad036
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Article ; Online: UK standards for microbiology investigations of ear infection (SMI B1) are inadequate for the recovery of fungal pathogens and laboratory diagnosis of otomycosis: A real-life prospective evaluation.

Rawson, Timothy M / Fatania, Nita / Abdolrasouli, Alireza

Mycoses

2022 Volume 65, Issue 4, Page(s) 490–495

Abstract: Background: We evaluated the recovery of fungal pathogens from clinical external ear samples from patients with otitis externa (OE) using the UK national Standard Microbiology Investigations of ear infection (SMI B1).: Method: The UK SMI B1 protocol ... ...

Abstract	Background: We evaluated the recovery of fungal pathogens from clinical external ear samples from patients with otitis externa (OE) using the UK national Standard Microbiology Investigations of ear infection (SMI B1). Method: The UK SMI B1 protocol including a single Sabouraud dextrose agar with chloramphenicol (SABC) incubated at 37°C for 48 hours was compared with a standard fungal-specific culture method using two SABC agar plates incubated at 28 and 37°C for 2 weeks with an extra Candida chromogenic agar incubated at 37°C for 5 days. This real-life evaluation was undertaken on ear samples from patients with OE from January 2020 to December 2020. Results: Altogether, 304 individual patient ear swabs were prospectively examined. The positivity rate of UK standard was 14% (42/304) versus 26% (79/304) for the fungal-specific protocol (p < .05). The standard protocol identified seven compared with 17 species using the fungal-specific protocol. A total of 93 fungal isolates were recovered; nine different yeasts and eight filamentous fungal species. Candida parapsilosis (38/304; 13%), C. albicans (10/304; 3%) and C. orthopsilosis (6/304; 2%) were common yeast species. Aspergillus niger complex (16/304; 5%) was the most common mould, followed by A. fumigatus complex (3/304; 1%). Many less common and emerging yeasts and moulds were only isolated from samples cultured using a fungal-specific protocol. Conclusion: Our results suggest that the UK SMI B1 media and procedures are inadequate to detect all fungal agents causing otomycosis. Fungal-specific culture protocols increase the recovery rate and diversity of fungal pathogens isolated from external ear samples.
MeSH term(s)	Candida albicans ; Clinical Laboratory Techniques ; Humans ; Otitis Externa/diagnosis ; Otomycosis/diagnosis ; Otomycosis/microbiology ; United Kingdom
Language	English
Publishing date	2022-01-31
Publishing country	Germany
Document type	Journal Article
ZDB-ID	392487-7
ISSN	1439-0507 ; 0933-7407
ISSN (online)	1439-0507
ISSN	0933-7407
DOI	10.1111/myc.13423
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bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
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Article: Management of Bacterial and Fungal Infections in the ICU: Diagnosis, Treatment, and Prevention Recommendations.

Rawson, Timothy M / Antcliffe, David B / Wilson, Richard C / Abdolrasouli, Alireza / Moore, Luke S P

Infection and drug resistance

2023 Volume 16, Page(s) 2709–2726

Abstract: Bacterial and fungal infections are common issues for patients in the intensive care unit (ICU). Large, multinational point prevalence surveys have identified that up to 50% of ICU patients have a diagnosis of bacterial or fungal infection at any one ... ...

Abstract	Bacterial and fungal infections are common issues for patients in the intensive care unit (ICU). Large, multinational point prevalence surveys have identified that up to 50% of ICU patients have a diagnosis of bacterial or fungal infection at any one time. Infection in the ICU is associated with its own challenges. Causative organisms often harbour intrinsic and acquired mechanisms of drug-resistance, making empiric and targeted antimicrobial selection challenging. Infection in the ICU is associated with worse clinical outcomes for patients. We review the epidemiology of bacterial and fungal infection in the ICU. We discuss risk factors for acquisition, approaches to diagnosis and management, and common strategies for the prevention of infection.
Language	English
Publishing date	2023-05-04
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2494856-1
ISSN	1178-6973
ISSN	1178-6973
DOI	10.2147/IDR.S390946
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Article ; Online: Towards optimizing carbapenem selection in stewardship strategies: a prospective propensity score-matched study of ertapenem versus class 2 carbapenems for empirical treatment of third-generation cephalosporin-resistant Enterobacterales bacteraemia.

Vasikasin, Vasin / Panuvatvanich, Bawornnan / Rawson, Timothy M / Holmes, Alison H / Nasomsong, Worapong

The Journal of antimicrobial chemotherapy

2023 Volume 78, Issue 7, Page(s) 1748–1756

Abstract: Background: Third-generation cephalosporin-resistant Enterobacterales (3GCRE) are increasing in prevalence, leading to greater carbapenem consumption. Selecting ertapenem has been proposed as a strategy to reduce carbapenem resistance development. ... ...

Abstract	Background: Third-generation cephalosporin-resistant Enterobacterales (3GCRE) are increasing in prevalence, leading to greater carbapenem consumption. Selecting ertapenem has been proposed as a strategy to reduce carbapenem resistance development. However, there are limited data for the efficacy of empirical ertapenem for 3GCRE bacteraemia. Objectives: To compare the efficacy of empirical ertapenem and class 2 carbapenems for the treatment of 3GCRE bacteraemia. Methods: A prospective non-inferiority observational cohort study was performed from May 2019 to December 2021. Adult patients with monomicrobial 3GCRE bacteraemia receiving carbapenems within 24 h were included at two hospitals in Thailand. Propensity scores were used to control for confounding, and sensitivity analyses were performed in several subgroups. The primary outcome was 30 day mortality. This study is registered with clinicaltrials.gov (NCT03925402). Results: Empirical carbapenems were prescribed in 427/1032 (41%) patients with 3GCRE bacteraemia, of whom 221 received ertapenem and 206 received class 2 carbapenems. One-to-one propensity score matching resulted in 94 pairs. Escherichia coli was identified in 151 (80%) of cases. All patients had underlying comorbidities. Septic shock and respiratory failure were the presenting syndromes in 46 (24%) and 33 (18%) patients, respectively. The overall 30 day mortality rate was 26/188 (13.8%). Ertapenem was non-inferior to class 2 carbapenems in 30 day mortality (12.8% versus 14.9%; mean difference -0.02; 95% CI: -0.12 to 0.08). Sensitivity analyses were consistent regardless of aetiological pathogens, septic shock, source of infection, nosocomial acquisition, lactate levels or albumin levels. Conclusions: Ertapenem may be of comparable efficacy to class 2 carbapenems in the empirical treatment of 3GCRE bacteraemia.
MeSH term(s)	Adult ; Humans ; Ertapenem/therapeutic use ; Carbapenems/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Propensity Score ; Shock, Septic/drug therapy ; Prospective Studies ; Bacteremia/drug therapy ; Escherichia coli ; Cephalosporins
Chemical Substances	Ertapenem (G32F6EID2H) ; Carbapenems ; Anti-Bacterial Agents ; Cephalosporins
Language	English
Publishing date	2023-05-30
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	191709-2
ISSN	1460-2091 ; 0305-7453
ISSN (online)	1460-2091
ISSN	0305-7453
DOI	10.1093/jac/dkad165
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Zs.A 1197: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 124: Show issues

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Article ; Online: Understanding the role of bacterial and fungal infection in COVID-19.

Rawson, Timothy M / Wilson, Richard C / Holmes, Alison

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

2020 Volume 27, Issue 1, Page(s) 9–11

MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antifungal Agents/therapeutic use ; Antimicrobial Stewardship ; Bacterial Infections/drug therapy ; Bacterial Infections/epidemiology ; COVID-19/drug therapy ; COVID-19/epidemiology ; Coinfection/drug therapy ; Cross Infection/drug therapy ; Cross Infection/epidemiology ; Cross Infection/microbiology ; Humans ; Mycoses/drug therapy ; Mycoses/epidemiology ; SARS-CoV-2/drug effects ; Superinfection/drug therapy
Chemical Substances	Anti-Bacterial Agents ; Antifungal Agents
Keywords	covid19
Language	English
Publishing date	2020-10-09
Publishing country	England
Document type	Journal Article
ZDB-ID	1328418-6
ISSN	1469-0691 ; 1470-9465 ; 1198-743X
ISSN (online)	1469-0691
ISSN	1470-9465 ; 1198-743X
DOI	10.1016/j.cmi.2020.09.025
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Zs.A 4541: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Haematological and hepatic adverse effects of ceftriaxone in ambulatory care: a dual-centre retrospective observational analysis of standard vs high dose.

Mistry, Rakhee / Rawson, Timothy M / Troise, Oliver / Mughal, Nabeela / Moore, Luke S P / Hughes, Stephen

BMC infectious diseases

2022 Volume 22, Issue 1, Page(s) 959

Abstract: Background: European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoint criteria for methicillin-susceptible Staphylococcus aureus (MSSA) treatment with ceftriaxone are based upon high dose (4 g/day) rather than standard dose (2 g/day) ...

Abstract	Background: European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoint criteria for methicillin-susceptible Staphylococcus aureus (MSSA) treatment with ceftriaxone are based upon high dose (4 g/day) rather than standard dose (2 g/day) posology. This is particularly relevant for invasive infections, and for patients managed via Outpatient Parenteral Antimicrobial Therapy (OPAT), but may result in increased drug toxicity. We quantified the incidence of neutropenia, thrombocytopenia and raised liver enzymes between standard and high dose ceftriaxone in adult patients. Method: Adult outpatients prescribed ≥ 7 days of ceftriaxone therapy were identified, and clinical, pharmacological, and laboratory parameters extracted from electronic health records between May 2021 and December 2021. Incidence and median time to haematological and hepto-toxicity were analysed. Univariate odds ratios were calculated for neutrophil count and ALT levels with 95% confidence level and Chi squared/Fisher's exact test used to identify statistical significance. Results: Incidence of neutropenia was comparable between both groups; 8/47 (17%) in the 2 g group vs 6/39 (15.4%) in the 4 g group (OR 0.89 (95% CI 0.26-2.63), p > 0.999). Median time to neutropenia was 12 and 17 days in the 2 g and 4 g groups respectively. Thrombocytopenia was observed in 0/47 in the 2 g group compared with 3/39 (7.7%) in the 4 g group (p 0.089). Median time to thrombocytopenia was 7 days in the 4 g group. Elevated liver enzymes did not clearly correlate with ceftriaxone dosing; present in 5/47 (10.6%) and 2/39 (5.1%) for 2 g and 4 g respectively (OR 0.45 (95% CI 0.87-2.36), p 0.448). Treatment cessation due to any adverse effect was similar between both groups 2/47 (4.3%) for 2 g and 3/39 (7.7%) for 4 g (OR 1.86 (95% CI 0.36-10.92), p 0.655). Conclusions: Increased adverse effects with 4 g (over 2 g) daily dosing of ceftriaxone was not observed in an OPAT population. However absolute development of haematological and liver dyscrasias was appreciable-monitoring of liver function and full blood count in patients receiving prolonged ceftriaxone is indicated irrespective of dosing.
Language	English
Publishing date	2022-12-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-022-07925-y
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