bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of compliance to SEPSIS 6 criteria in Emergency Department admissions
Authors: Carvalho Lara Silva de , Sivaramakrishnan Anand , Bharathan Binutha , Patel Kirta 
Published: March 2020

INTRODUCTION
The timely diagnosis of sepsis is the essential first step that activates life-saving pathways. The aim of our study was to assess the accuracy of the ‘sepsis flag’ assigned to patients presenting to our hospital’s Emergency Department (ED).
METHOD
A retrospective two week review (18/03/19 to 25/03/19 and 07/05/19 to14/05/19) was performed in a District General Hospital in London, assessing the medical records of all adult patients assigned a sepsis flag in ED (n=21), in order to assess if SEPSIS 6 criteria were met. For comparison, patients admitted to ED with gram negative bacteraemias (n=8) in the same period were reviewed to check if they were included in the SEPSIS 6 group.
RESULTS
Ten out of twenty one patients with a ‘sepsis flag’ fulfilled criteria. Six other patients had one criterion (T>38oC) for sepsis. Blood cultures were sent in all patients. Four out of ten patients were administered IV antibiotics within one hour. During this period, none of the eight patients admitted with gram negative bacteraemias were assigned a ‘sepsis flag’, despite five of them meeting SEPSIS 6 criteria (two or more criteria) and having evidence of infection. However, the majority (7/8) received IV antibiotics within one hour.
CONCLUSION
Our review highlights the difficulties in the diagnosis of sepsis and the limitations of the SEPSIS 6 criteria for detection of septic patients in triage. However, we have demonstrated that the vast majority of patients had appropriate investigations and prompt antibiotic treatment, irrespective of the ‘sepsis flag’.
Lessons learned from a mandatory Irish Carbapenemase producing Enterobacterales (CPE) contact communication programme at University of Limerick Hospitals Group (ULHG)
Authors: Slevin Barbara , Waldron Ruth , Power Lorraine , Kennedy Sarah , Farah Bushra , Woods Sara , Moloney Alison , Monahan Regina , Powell James , Woodland Edel , Burke Paul , O'Connell Nuala 
Published: March 2020

Background: ULHG first detected CPE in 2009. A decision was made at the outset to flag CPE contacts on the surveillance software system (ICNet) rather than write to discharged contacts. CPE was declared a national public health emergency, October 2017. In September 2018, the Irish CPE Expert Group mandated that all hospitals write to CPE contacts, as per open disclosure policy, to inform them of their status. Screening was also offered. An eligible contact was defined as one who did not have 4 negative screens since exposure.
Methods: An ICNet search was conducted to detect all CPE contacts, cross-checking with the national death registry before delineating the number of CPE screens tested via the Laboratory Information System. Processes were put in place to address queries from patients; a generic helpline and a recorded telephone line for clinical concerns or complaints. Screening packs were developed. National template letters were posted to patients, their GPs and consultants.
Results: 2016 CPE contacts were identified from Feb 2009 to Sept 2018. 422 patients contacted the generic helpline; 347 requested call-back from the CPE nursing expert. 115 requested testing packs with 103 delisted as contacts. Patients voiced many concerns including anger for the untimely notification, upset at the potential risk of CPE acquisition and criticism regarding the letter content.
Conclusions: The decision to inform patients is appropriate but it must be timely with access to understandable information and support from a suitably trained professional. The communication programme continues prospectively in the setting of CPE endemicity.
Developing a national indicator of intravenous antibiotic use to support timely review of antibiotics in Scottish hospitals
Authors: Malcolm William , Baxter Linsey , McNicol Megan , Sneddon Jacqueline 
Published: March 2020

Background
To address increasing antibiotic use in acute hospitals, the Scottish Antimicrobial Prescribing Group developed a quality improvement (QI) initiative to support reliable review of patients started on intravenous (IV) antibiotics within 72 hours. This will reduce unnecessary continuation of antibiotics, ensure personalised treatment and appropriate IV to oral switch with associated benefits for patients of reduced risk of device related infections and potential for earlier discharge from hospital.
Methods
Using data obtained from the Hospital Medicines Utilisation Database, a national database of secondary care medicines use in Scotland, we examined trends in IV antibiotic use between 2013 and 2017. We then projected the current trend forward to 2021 to inform development of national indicator to optimise IV antibiotic use.

Results
In 2017, IV antibiotics accounted for 32.9% of all antibiotic use in Scottish hospitals. Annual IV antibiotic use (defined daily doses per 1000 population per day) increased by 20.5% between 2013 and 2017. We estimated a further projected increase of 12.5% between 2018 and 2021. To measure the impact of our QI initiative SAPG agreed to employ a national indicator with a target that ‘use of IV antibiotics in hospitals will be no higher in 2021 than it was in 2018’.

Conclusion
This national indicator will evaluate progress with achieving reliable and timely review of IV antibiotic therapy to reduce hospital antibiotic use and contribute to reduction in total antibiotic use in humans which is a key ambition of the UK AMR National Action Plan.
An audit of antimicrobial usage in perioperative period of adult patients undergoing appendectomy
Authors: Modan Huriyah , Hughes Stephen 
Published: March 2020

Introduction
Antimicrobials are prescribed at appropriate dose and in a timely fashion, to reduce post-operative infections in adult patients undergoing appendectomy. It is desirable to establish the shortest and most effective prophylaxis. To assess this, we reviewed a sample of adult patients that have appendectomy procedure completed at the CWFT to assess antimicrobial prescribing in line with local prescribing guidelines.

Method
We undertook a retrospective observational study at a central London teaching hospital to investigate antimicrobial prescribing in adult patients undergoing appendectomy between Jan2019 and Jun2019.
Results.
A total of 173 patients [median age 31year] were analysed; 7 and 167 had undergone an elective and urgent appendectomy respectively. 163/173 [94.2%] received antimicrobials peri-operatively. Compliance with local guidelines was 40.5%; a lack of aminoglycoside in combination with beta-lactam was common (58%). 126/173(72.8%) patients received antimicrobials on discharge, median 7.0 days total antimicrobials. Readmission rates within 30 days of surgery were 6.4% but unrelated to antimicrobial prescribing (p=0.8). Enterobacteriaceae was the most commonly identified pathogen (n=45), with high co-amoxiclav resistance reported (31%).
Conclusions
Combination co-amoxiclav plus aminoglycoside is advised peri-operatively for appendectomies yet adherence is poor. Despite local co-amoxiclav resistance, aminoglycosides are often omitted. The number of patients treated with post-op antimicrobials and the duration of therapy is greater than comparable published studies. Lack of standard definitions for complicated appendectomies makes it difficult to identify patients that do benefit from post-operative antimicrobials thus overprescribing occurs. Agreement on the optimum duration of treatment also is unclear and results in likely excessive prescribing.
Demographics of new diagnoses of leprosy in the UK over 23 years: a retrospective study of cases at the Hospital for Tropical Diseases, London
Authors: McIntosh Amy , Checkley Anna , McBride Angela , Walker Steve , Lockwood Diana 
Published: March 2020

BACKGROUND: Leprosy is rare in the UK, but migration from endemic countries results in new diagnoses annually. Early recognition, diagnosis and treatment can prevent harmful stigma and disability.
METHODS: We conducted retrospective analysis from a database of new cases of leprosy seen at the Hospital for Tropical Diseases, London from 1995 to 2018. We aimed to identify typical demographics of patients presenting with leprosy and identify causes and consequences of delayed diagnosis.
RESULTS: 157 cases were included. A large proportion were male (67.5%) with a median age of 34 years. Most were non-UK born and migrated in adulthood. 41.3% of cases were acquired in India, Sri Lanka or Bangladesh. Borderline tuberculoid (43.9%) was the most common type, followed by lepromatous leprosy (33.8%). The mean time between arrival in the UK and symptom onset was 5.87 years (SD 10.33). It took over 5 years for 12.8% of patients to be diagnosed. 93.6% of patients completed multidrug treatment following diagnosis.
CONCLUSION: Male predominance and age at diagnosis reflects global epidemiology of leprosy. Patterns of acquisition reflect trends in UK migration from endemic countries. The typical patient presenting to the clinician is a young male who has migrated as an adult and developed symptoms in the years surrounding migration. Many patients may have developed disability before treatment commences as the time to diagnosis can be prolonged. Once diagnosed in the UK, treatment is of high quality, readily available, and effective: earlier recognition by clinicians can prevent disability and reduce the risk of transmission.
In vitro activity of fosfomycin, and synergy in combination, against Gram negative bloodstream infection isolates in a UK hospital
Authors: Suich Joseph , Mawer Damian , Woude Marian Van der , Wearmouth Deborah , Eyre Alison , Burns Phillipa , Smeets Ton , Barlow Gavin 
Published: March 2020

Background:Fosfomycin has retained activity against many multi-drug resistant (MDR) Gram-negatives, and may be useful against extended spectrum beta-lactamase (ESBL) producing and carbapenem-resistant Enterobacteriaceae. There are few data from the UK on the susceptibility of invasive Gram-negative isolates to fosfomycin, especially in the era of increasing use of oral fosfomycin for UTIs.
Materials/methods:
1. We evaluated, in 100 consecutive Gram-negative bloodstream infections (BSI), the in-vitro activity of fosfomycin. Disc diffusion and MIC test strip methods applying revised EUCAST guidelines for fosfomycin were used.
2. A secondary objective was testing for synergy in combination with 10 further antibiotics. Isolates were selected if:
a) Fosfomycin resistant
b) AMP-C/ESBL/carbapenemase producers (or carbapenem resistant)
c) ‘MDR’: defined as ‘resistance to ≥3 classes of antibiotics’ (based on prior routine sensitivity testing).
For eligible isolates, MICs were determined individually, and subsequently in combination using the MTS ‘cross’ synergy method.
Results:96/100 isolates were susceptible to fosfomycin by MIC test strip. 30/100 isolates were eligible for synergy testing. Synergy was most commonly detected between fosfomycin and piperacillin/tazobactam (32.1%), ceftazidime/avibactam (30%), and temocillin (28.5%). An additive effect was most commonly detected with aztreonam (85.7%) and meropenem (82.1%), but 100% indifference was found with tigecycline. No antagonism was identified.
Conclusions:Synergistic or additive effects were detected for beta-lactam/fosfomycin combinations in a high proportion of isolates; >80% for all suggesting such combinations should be preferred when using fosfomycin combination therapy. Agents with a different site of antibiotic action, were more likely to result in indifference.
A retrospective audit of microbiological sampling for spondylodiscitis at the Royal Devon and Exeter Hospital (RD&E)
Authors: Powell Matthew , Morgan Marina 
Published: March 2020

Introduction
Spondylodiscitis is an increasingly diagnosed condition with significant morbidity and mortality. A key aspect of management is a protracted course of targeted antimicrobial therapy, ideally tailored to the organisms isolated from appropriate microbiological specimens in accordance with Infectious Diseases Society of America (IDSA) guidelines (2015). When consulted regarding possible discitis, we routinely recommend blood cultures and disc biopsy, particularly if blood cultures are negative.

Method
We undertook a retrospective audit of patients presenting over 6 years with a radiological diagnosis of discitis with the primary objective of determining the proportion of patients who had appropriate microbiological investigation either via blood culture or biopsy.

Results
42 patients met the inclusion criteria. Blood cultures were positive with organisms likely to be the causative agent in 50% of patients. Of the 50% of patients with negative blood cultures, 57% went on to have a successful spinal biopsy. Biopsies proved positive in 75% of cases. 8 patients with negative blood cultures did not progress to biopsy at the time of diagnosis and four suffered some degree of harm. One of these patients failed empirical anti-staphylococcal therapy and later required spinal stabilization due to destruction of the spinal disc was proven to have pseudomonas infection at the time of the corrective surgery.

Conclusion
19% of patients with discitis did not have appropriate disc sampling prior to commencement of antibiotic therapy. 50% of these suffered some degree of harm. This strengthens the case for recommending appropriate sampling prior to initiation of therapy, unless absolutely contraindicated.
The Reliability of C-Reactive Protein Levels in Predicting Dengue Severity: A Systematic Review
Authors: Salud Vincci Monique , Reyes Francis Andrew , Ricohermoso Jaymelyn , Rubion Lou Erika , Roman Arthur Dessi 
Published: March 2020

Background
Clinical manifestations of dengue vary from mild febrile illnesses to shock and organ failure. However, severe symptoms may not be clinically evident immediately, making it difficult for early detection of patients at risk for poor outcomes. Several biomarkers, particularly C-reactive protein (CRP), were revealed to be highly predictive of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). This systematic review aims to determine a relationship between CRP levels and the probability of developing DHF/DSS.
Methods
Multiple electronic databases were searched for English literature from January 2007 to August 2017. Four reviewers independently extracted data from eligible studies using the standardized critical appraisal tool from JBI-MAStARI. Articles that scored six and above were included.

Results
Three cohort and two cross-sectional studies were reviewed. Sample sizes ranged from 70 to 235 participants. The cohort studies measured CRP levels at point of diagnosis, but were re-measured at different time points in the subjects’ admission. However, regardless of the time difference, they all showed that increased CRP levels exhibited a trend towards development of DSS/DHF. The studies also identified a possible “golden period” for measuring CRP levels that can accurately predict development of DHF/DSS. The cross-sectional studies also saw a similar trend, but have measured this in median values of the CRP levels.

Conclusion
This systematic review showed that increased CRP levels appeared to have a trend towards a higher probability of developing DHF/DSS. A larger population and more studies are needed to further establish a statistically significant relationship.
Haemophagocytic lymphohistiocytosis secondary to disseminated adenovirus infection twenty-five years post heart-lung transplant
Authors: Vathenen Ramu , Rokadiya Sakib , Lambourne Jonathan 
Published: March 2020

Disseminated adenovirus infection is recognised in transplant patients, often occurring early and associated with a high mortality rate. Treatment options are poorly understood and potentially toxic. Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyper-inflammatory response.
A 75-year-old ex-banker presented following a fall, with a 2-week history of fevers, cough and high stoma output after a recent cruise. Past medical history included heart-lung transplant (25 years previously), diverticular disease and diabetes mellitus. Initially, he was febrile and tachycardic and blood tests showed an acute kidney injury (AKI), transaminitis and pancytopenia. Chest radiograph and urinalysis were unremarkable. Initial treatment was with co-amoxiclav and intravenous fluids for neutropenic sepsis. Computerised tomography of thorax and abdomen showed moderate splenomegaly with no lymphadenopathy or pneumonitis.
After 48 hours, he remained febrile with worsening renal and hepatic function. Nasopharyngeal swabs returned positive for adenovirus. Blood cultures were negative with undetectable serum cytomegalovirus (CMV) and Epstein-Barr virus (EBV) DNA.
On day 4 he developed fulminant multi-organ failure. Further investigations were suggestive of HLH. Cidofovir/Brincidofovir were discussed as potential treatments but were difficult to obtain with concern regarding toxicity. On day 6, intravenous immunoglobulins for HLH was commenced. On day 8 he died. Adenovirus was later isolated from urine, stool and serum samples.
Early diagnosis and treatment for infection in immunosuppressed patients is crucial. The 25-year interval between transplant and disseminated adenovirus infection in this case is unprecedented. Difficulty in obtaining adenovirus treatment combined with their toxicity and uncertainty of effectiveness prevented their immediate use in this patient.
Appropriateness of meropenem prescriptions at a large district general hospital, East of England, UK
Authors: Sharma Abhishek , Dhungana Drishya , Vaghela Tejal , Kandil Hala 
Published: March 2020

Introduction
Meropenem is a broad spectrum antibiotic used to treat a variety of bacterial infections. There are no clear standards nationally for the use of meropenem. The purpose of this study is to audit the appropriateness of Meropenem prescription at West Hertfordshire NHS trust
METHODOLOGY
Patients started on meropenem were identified via the hospital pharmacy in the period from 1st January 2019 to 31st March 2019. Patients’ clinical notes, drug charts and blood tests were reviewed. Appropriateness of meropenem prescription was judged based on the following: indication, penicillin allergy and its nature, pathogen antibiogram, microbiologists approval, indications for escalation and duration of treatment
RESULTS
forty-eight patients were identified during the study period. The main indications were hospital-acquired/community-acquired pneumonia and UTI. Penicillin allergy was documented in 31%, the nature of allergy was intolerance in 13% and not known in 20%. Of note, in 42% of these, treatment was not pathogen guided. In 45.5% of non-penicillin allergic patients, escalation to meropenem were neither supported by antibiogram nor by microbiologists. The main driver was raised inflammatory markers (62.5%). Of the 37 patients who completed their treatment during the study period, 21.6% had > 7 days with only 50% recommended by Microbiologists.
CONCLUSION:
In third of the patients, meropenem use was driven by penicillin allergy, however the nature of allergy did not justify its use in many of these cases. Lack of microbiology approval, failure to de-escalate and long courses of meropenem were additional areas identified to target in our antimicrobial stewardship programme
Antimicrobial Efficacy Study using a light disinfection device for Health Care-Associated Infections
Authors: AIN Qurat UL , YEUNG King Lun 
Published: March 2020

Multidrug-resistant organisms (MDROs) are a global challenge especially in long-term care facilities (LTCFs). Older people are more vulnerable to infection due to the senescence of their immune system, resulting in more frequent and longer hospitalization increased cost of care, hence greater workload. Even in the strict hospital environment, less than half of the environmental surfaces sampled were not properly cleaned and this poses a significant risk of disease transmission.
In this study, new light-based surface disinfection technology can complement existing hospital practices to address an important public health problem. Its strategy is based on high-intensity narrow-wavelength (Hi-NW) light sources for surface decontamination of microorganisms commonly found in health care environments using synergic effects of blue LEDs at 405 & 470 nm and UV LED at 278nm, which were not previously investigated together.
A retrospective review of MDRO records has been conducted throughout the study period. Organisms were identified using special agar media and treatment with Hi-NW prototype was tested in the LTCF surfaces.
The prototype results show 99.9% & 88.9% bactericidal rate against MDROs for 5minutes and 2 minutes exposure time on flat surfaces, respectively. Work is still in progress for the 30-second cycle exposure of prototype.
This discovery will support the use of the device as a high material compatibility technology with hospital items, or in other common areas, such as public areas and homes, where frequently touched surfaces play an important role in disease transmission. There is an utmost need for this tool to prevent the proliferation of MDROs
TWIRLS, an automated topic-wise inference method based on massive literature, suggests a possible mechanism via ACE2 for the pathological changes in the human host after coronavirus infection
Authors: Ji Xiaoyang , Zhang Chunming , Zhai Yubo , Zhang Zhonghai , Zhang Chunli , Xue Yiqing , Tan Guangming , Niu Gang 
Published: March 2020

AbstractFaced with the current large-scale public health emergency, collecting, sorting, and analyzing biomedical information related to the “coronavirus” should be done as quickly as possible to gain a global perspective, which is a basic requirement for strengthening epidemic control capacity. However, for human researchers studying the viruses and the hosts, the vast amount of information available cannot be processed effectively and in a timely manner, particularly when the scientific understanding may be limited, which can further lower the information processing efficiency. We present TWIRLS, a method that can automatically acquire, organize, and classify information. Additionally, independent functional data sources can be added to build an inference system using a machine-based approach, which can provide relevant knowledge to help human researchers quickly establish subject cognition and to make more effective decisions. TWIRLS can automatically analyze more than three million words in more than 14,000 literature articles in only 4 hours. Combining with generalized gene interaction databases creates a data interface that can help researchers to further analyze the information. Using the TWIRLS system, we found that an important regulatory factor angiotensin-converting enzyme 2 (ACE2) may be involved in the host pathological changes on binding to the coronavirus after infection. After triggering functional changes in ACE2/AT2R, an imbalance in the steady-state cytokine regulatory axis involving the Renin-Angiotensin System and IP-10 leads to a cytokine storm.