bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study of the clinical and microbiological profile of patients with endocarditis and cancer – A case series from Tertiary care cancer hospital in Western India
Authors: Vaidya Viplov , Dhir Aruna Alahari , Sawant Sheela , Daddi Anuprita , Mehrotra Kush 
Published: March 2020

Background:
Endocarditis is rare and can be life-threatening in patients with cancer. We sought to evaluate the clinical and microbiological profile of patients of cancer who developed endocarditis.

Methods:
We retrospectively analyzed transthoracic echocardiograms done in our hospital along with the clinical data stored in computerized medical records between 2016-2018. Infective Endocarditis was diagnosed by using modified Duke criteria. Patients with valvular verrucae and sterile blood cultures were considered to have culture-negative endocarditis.

Results:
There were 10 patients of cancer who were diagnosed with endocarditis. All patients had developed endocarditis after the diagnosis of cancer. 5(50%) patients had hematological malignancy. The aortic valve was involved in 5 (50%) patients. Blood cultures were sterile in 7(70%) patients. Out of the 3 patients with positive blood cultures, 2 were positive for Klebsiella pneumoniae and 1 grew Candida tropicalis.
5 (50%) patients had concurrent pneumonia. The most common intravenous antibiotics given were cefoperazone plus sulbactam, teicoplanin, and meropenem, while most common antifungals given were caspofungin and voriconazole. The patient with Candidemia underwent surgical removal of vegetation as advised by a cardiologist. Histopathological examination and staining of the excised vegetation of this patient revealed Cryptococcus species. 6 (60%) patients developed congestive cardiac failure. 4(40%) died within 4 weeks of diagnosis of endocarditis, out of which 3 were culture-negative endocarditis.

Conclusions:
In our case series, none of the blood cultures grew gram-positive bacteria and an increased proportion of culture-negative endocarditis was noted. The mortality is high in patients of cancer with endocarditis.
Role of Climatic factors influencing Dengue incidence in central India: A model for Dengue prediction
Authors: Nigam Rishi Kumar 
Published: March 2020

Introduction:
Dengue is caused an arbovirus and transmitted by Aedes mosquito. The mosquito lifecycle is influenced by various climatic factors This study was carried out to examine whether the climatic factors data can be used to predict yearly dengue cases .

Methods:
Monthly reported dengue cases and climate data for the years 2012–2016 were obtained from the Chief Medical and Health officer,Bhopal and Meteorological Department , respectively. One-way analysis of variance was used to analyse whether the climatic parameters differed significantly among seasons. Four models were developed using negative binomial generalized linear model analysis. Monthly rainfall, temperature, were used as independent variables, and the number of dengue cases reported monthly was used as the dependent variable. The first model consider data from the same month, while the other three models involved incorporating data with a lag phase of 1, 2, and 3 months, respectively.

Results:
Climatic factors, rainfall and maximum temperature were significantly correlated with monthly dengue cases. The greatest number of cases was reported during the post-monsoon period. Temperature, rainfall, and humidity varied significantly across the pre-monsoon, monsoon, and post-monsoon periods. The best correlation between these climatic factors and dengue occurrence was at a time lag of 2 months.
Conclusions:
The climate had a major effect on the occurrence of dengue infection in Bhopal city of central India. Though the prediction model had some limitations in predicting dengue cases, it could forecast possible outbreak two months in advance with considerable accuracy, and can act as early warning system.
Utilising data held within ePACT2 to monitor and influence antimicrobial prescribing within secondary care outpatient clinics
Authors: Hamilton Ryan Ashley , Grant Allister 
Published: March 2020

Background
Assurance and intervention is needed around antimicrobial prescribing in secondary care outpatient settings, which has increased by 21% in 5-years. Use of NHS FP10 prescriptions impedes timely monitoring of prescribing. This project aimed to develop an efficient method for monitoring and reporting outpatient prescribing on FP10 forms.
Methods
A Microsoft Excel spreadsheet was developed to allow direct importing of antimicrobial prescribing data from ePACT2, which then automatically updates charts of prescribing activity using VLookup formulae and pivot charts. Reports were developed in Microsoft Word that directly pull updated charts from the spreadsheet described.

Results
The method allows rapid calculation and collation of DDDs and creates charts for assessing monthly antimicrobial prescribing trends. The reports highlight areas for review and action, which have driven engagement in antimicrobial stewardship across the organisation. Unexpectedly, these reports heightened nurses’ awareness of antimicrobial stewardship (AMS), who now seek reassurance on, and challenge, antimicrobial prescribing at the time of prescribing. The process takes less than 20-minutes on average (versus 3-hours previously), freeing up antimicrobial pharmacists’ time to interrogate prescribing trends and undertake clinical duties. This method also allows potentially inappropriate prescriptions to be identified and pulled from NHS BSA sooner, so that individual prescribers and teams can be targeted for intervention and reflection.

Conclusion
This method allows efficient reporting of antimicrobial prescribing, enables stewardship teams to focus interventions on prescribers and teams, and drives engagement in antimicrobial stewardship. This method could be adapted by other organisations to monitor and interrogate antimicrobial prescribing.
Predicting Cotrimoxazole-Associated Acute Kidney Injury and Hyperkalaemia
Authors: Rajput Jaikishan , Moore Luke , Mughal Nabeela , Marvin Vanessa , Hughes Stephen 
Published: March 2020

Background:
Increasing antimicrobial resistance has renewed interest in older, infrequently used antimicrobials. Cotrimoxazole shows future promise; however, acute kidney injury (AKI) and hyperkalaemia are potential complications. Recognising risk factors for cotrimoxazole-associated AKI and hyperkalaemia, and quantifying the impact, are required for safe use against future antimicrobial resistance.

Method:
A single-centre retrospective observational study using electronic-healthcare records of patients prescribed cotrimoxazole was conducted. Patient risk factors were identified, and serum creatinine and potassium levels were analysed over the subsequent 21-days from prescription. Univariate and multiple logistic regression analyses were performed. The project was registered locally with the clinical governance team as service evaluation [Ref: CSS033].

Results:
Of 214 patients, 42 (20%) developed AKI and 33 (15.4%) developed hyperkalaemia. Low baseline eGFR (<60mls/min/1,73m2, OR = 7.78, 95%CI 3.57-16.13, p<0.0001) and pre-existing cardiac disorders (OR = 2.40, 95%CI 1.17-4.82, p=0.011) significantly predicted AKI. Early serum creatinine increases within 2-4 days of therapy predicted future AKI (OR = 3.65, 95%CI 1.73-7.41, p = 0.001). A low baseline eGFR also significantly predicted future hyperkalaemia (<60mls/min/1.73m2, OR = 6.80, 95%CI 3.09-15.06, p<0.0001). Low-dose cotrimoxazole (<1920mg/day) was associated with lower AKI and hyperkalaemia risk (p = 0.007 and 0.019, respectively).

Conclusions:
Cotrimoxazole-associated AKI and hyperkalaemia is frequent and dose-dependant. Renal function and pre-existing cardiac disorders should be carefully evaluated before prescribing cotrimoxazole. Serum creatinine should be monitored in the first 2-4 days of treatment to identify susceptible patients, and low-doses considered if AKI or hyperkalaemia is suspected.
Optimising the diagnosis of UTI in patients with mixed growth bacteriuria
Authors: Folaranmi Tolulope , Kirby Andrew , Harley Clare , Jolly Jim , Freeman Jane 
Published: March 2020

Background: Leeds Teaching Hospitals NHS Trust (LTHT) Microbiology department report urine cultures with >1 isolate as ‘mixed growth’ (MG). The clinical significance of this remains controversial. We aimed to describe MG and explore how clinicians interpret MG reports.
Methods: Urine culture data (2018) were retrospectively collected from the LTHT laboratory information system. Urine cultures reported as MG from a one-week period in 2019 underwent further laboratory analysis. Semi-structured interviews of eight NHS clinicians were explored for emergent themes around MG using framework analysis. Clinicians were also provided with data in existing MG report formats and alternative reports including organism identities and sensitivities; and clinician propensity to diagnose/treat urinary tract infection (UTI) was noted.
Results: Of 115664 cultured specimens, 12% were MG with rates highest in patients >65yrs (19.3%, n=41760) and <1yr old (18.7%, n=2727). Of 459 isolates from 200 MG cultures, Enterococcus species (30.1%) and E. coli (27.5%) were most frequently isolated and the most frequent organism combination (24%). 65.5% of cultures contained 2 organisms, with 82.5% having at least one Enterobacteriales. Many clinicians believed MG statements represented detection of many commensal bacteria which did not represent infection. When given alternative reports including organism identities/sensitivities, (cf. report of MG only), more were likely to diagnose and treat a UTI
Conclusions: MG in urines is common. Most MGs include Enterobacteriales, an important cause of UTI. Reporting two species as MG only can be misleading, resulting in failure to treat clinically apparent infections.
A retrospective study to evaluate the epidemiology, standard of care, outcomes and resource utilization in patients with confirmed or suspected infection by a carbapenem resistant Gram-negative organism in the UK – the CARBAR study - Epidemiology of Gram negative organisms
Authors: Goldenberg Simon , Dodgson Andrew , Barlow Gavin , Parcell Benjamin , Jones Lim , Albur Mahableshwar , Wilson Peter , Hussain Abid , Enoch David A. , Marek Aleksandra , Saunders Luke , Lopes Sara , Manisero Davide , Longshaw Christopher , Tone Keiko 
Published: March 2020

Background:
Antimicrobial resistance is a global threat with potentially devastating consequences and significant costs to society. Carbapenems are customarily reserved for difficult-to-treat Gram-negative (GN) infections, but resistance is increasing; hence WHO classified carbapenem-resistant (CR) strains of Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), and Enterobacteriaceae as critical priority.
CR-GN infections have few effective treatment options, with variable outcomes and scarce clinical trial evidence. In this analysis, we describe the epidemiology of patients infected with CR-GN organisms.

Methods:
Retrospective chart review from 10 sites in UK. Adult patients admitted to hospital between April 2017-March 2018 were included if they had a confirmed GN bacterial infection and/or positive screening isolate for CR-GN bacteria colonisation. Data collection included microbiological results and patient demographics.

Results:
36,078 patients were included, representing 42,310 GN isolates, of which 3,063 (7%) were CR-GN. Mean age was 59.9 years; 60.2% were female.
The most prevalent GN species were E. coli representing 51.8% of all isolates, followed by P. aeruginosa (12.0%), and K. pneumoniae (8.7%).
Within CR-GN isolates CRPA represented 26.6%, E. coli 21.5%, and other bacteria 51.9% (including CRAB and Stenotrophomonas maltophilia).

Conclusion:
GN isolates are frequent across the UK, and 7% are CR-GN, representing a small important segment of this population. Understanding the real-world prevalence of GN and particularly CR-GN infections, where there is the highest unmet need, can help optimise antimicrobial stewardship and infection control programmes and ultimately improve overall patient’s and healthcare system’s outcomes, which is the focus of this study’s next phase.
Electronic medicine dispensing cabinet usage reporting as a tool for hospital antimicrobial stewardship
Authors: Duguid Anne , Romanes David , James Edward 
Published: March 2020

Multi disciplinary antimicrobial ward rounds have been demonstrated to be effective in promoting good antimicrobial stewardship (AMS) within hospitals. The ability to review patients’ current antibiotic treatment and intervene in a timely fashion is essential in this process. Hospital Electronic Prescribing and Medicines Administration (HEPMA), where available, is an invaluable aid in this but, for many Health Boards, its introduction is still a long time in the future.
In the absence of HEPMA, other surrogates can be used, such as pharmacy stock software, to identify patients requiring AMS review e.g. for use of “alert” antibiotics. These systems would not, however, provide patient-level information from stock issues to ward areas.
This study investigated the potential of ward electronic medicine dispensing cabinets to provide patient-level data on alert antibiotic use in a hospital where HEPMA was not in use. Daily reports on “alert” antibiotic issues were sent via automated message to the Consultant Microbiologist and Antimicrobial Pharmacist. Patients’ antibiotic use was then reviewed and documented using ICNET software.
Data from AMS ward rounds over a period prior to and after the introduction of electronic cabinet reporting were analysed. A 50% increase in the identification of alert antibiotic issues was seen after the introduction of electronic cabinet reporting. Over a one month period, time for AMS intervention was reduced by an average of 8h (range 3.5-28.5h) with the use of cabinet reporting.
Electronic cabinet reporting has been shown to be a useful tool for facilitating good antimicrobial stewardship in a general hospital.
A lateral flow strip in combination with microfluidic device and polymerase chain amplification for rapid and visual detection of lymphatic filarial infection
Authors: Phuakrod Achinya , Sripumkhai Witsaroot , Jeamsaksiri Wutthinan , Pattamang Pattaraluck , Foongladda Suporn , Sarasombath Patsharaporn , Wongkamchai Sirichit 
Published: March 2020

Background:
Lymphatic filariasis (LF) is a neglected tropical disease caused by the filarial nematode parasites which is transmitted by the bites of infective mosquitoes. The diagnosis of LF traditionally relies on the detection of circulating microfilariae (mf) using Giemsa-stained thick blood smears which has several limitations.

Materials and methods:
In the present study, we developed a lateral flow (LF) strip to be used in combination with a novel microfluidic device and polymerase chain reaction (PCR) for a rapid and visual detection of lymphatic filariae, Brugia malayi/ Wuchereria bancrofti infection in human blood samples.

Results:
The assay targets B. malayi HhaI gene and W. bancrofti Ssp gene. Prior to perform the assay, no DNA product clean up step required, thus, it can shorten time and reduce cost. The LF strip can detect as low as 10 pg of DNA product and no cross-reactivity with DNA of other parasites such as Gnathostoma spinigerum, cysticercisis soliumnor with DNA of other filariae i.e. Brugia pahangi, Dirofilaria immitis andD. repens.

Conclusions:
The developed LF strip shows high sensitivity and specificity, in combination with a novel microfluidic device and PCR, can be used as an alternative tool for the diagnosis of lymphatic filariasis.
Outcomes of an admission avoidance scheme for diabetic foot infections via OPAT
Authors: Atack Kelly , Waterhouse Annabelle 
Published: March 2020

Background
The 2019 National Diabetes Foot Care Audit shows 2.7% of patients with a diabetic foot ulcer underwent major amputation within six months and 14% died within twelve months. Our OPAT service treats such patients referred from inpatient wards and via the limb salvage clinic as an admission avoidance scheme. A review compared outcomes between these referrals and the national data.

Methods
The OPAT database identified patients referred via an inpatient ward and the clinic. Each patient was then reviewed for each of the following criteria:
1. Was the patient alive and ulcer free at 12 weeks?
2. Had the patient had a major amputation within six months?
3. Was the patient still alive after 12 months?

Results
100 patients were reviewed; 50 referred by inpatient wards and 50 referred by the clinic as admission avoidance patients.
In both categories, 94% of patients were alive after twelve weeks, with 12% being ulcer-free in the inpatient category compared with 18% in the admission avoidance group. 6% had a major amputation within six months in the inpatient group, compared with none in the admission avoidance group. 16% of patients in the inpatient group had died within 12 months of treatment, compared with 10% of admission avoidance patients.

Discussion
OPAT patients receiving treatment for diabetic foot infections have similar outcomes to those in the national audit. No extra harm is being done to those referred to OPAT without hospital admission.
Intravenous drug use causing Enterococcus Faecalis bacteraemia, mycotic pulmonary artery aneurysm and suspected Mucormycosis
Authors: Cobb Katherine , Callaby Helen , Rae Nikolas 
Published: March 2020

Background
33 year old previously fit and well lady with a history of previous drug use presented generally unwell with shortness of breath and cough.
Methods
Initial investigations demonstrated marked inflammatory response with bilateral pneumonia on chest xray. She was initially treated for severe community acquired pneumonia. On day 3 of admission blood cultures isolated Enterococcus faecalis, which was later also isolated in sputum.

Results
Transthoracic echo demonstrated no evidence of vegetations to suggest endocarditis. Despite appropriate antibiotic switch inflammatory markers increased, and a groin abscess was suspected on clinical examination leading to CT angiogram in addition to CT thorax. Imaging demonstrated left ileofemoral DVT and a large pulmonary artery aneurysm with multiple cavitating pulmonary lesions. Following discussion with cardiothoracics the patient was transferred to a cardiothoracic centre for left lower lobectomy and lingulectomy. Histopathological perioperative samples showed branching fungal hyphae within multiple blood vessels, although 18s PCR returned as negative. The patient had a good clinical response with IV Amoxicillin and antifungal therapy - Oral Posaconazole was used as she suffered an adverse reaction to liposomal Amphotericin B.
Discussion
Final impression was of mycotic pulmonary artery aneurysm caused by Enterococcus faecalis with suspected mucormycosis as result of intravenous drug use. This case highlights the increased risk of mucormycosis in people who inject drugs.
Vancomycin continuous infusion - review of use on our adult intensive care unit and establishing therapeutic loading dose
Authors: Chamurally Sheiba , Remmington Chris , Cheong Jamie 
Published: March 2020

Background
Reviewing compliance to our Trust guidelines on AICU led us to investigate whether the loading dose prior to continuous infusion was sufficient to achieve therapeutic levels at first measurement.
Methods
Retrospective data was pulled (January 2011 - June 2017) from a data interrogation system (SAS Enterprise Guide) which linked patients receiving continuous infusion vancomycin at a concentration of 500mg/50ml. This was presented into Excel spreadsheets, additional headings added for data interpretation, then manipulated into pivot tables to determine objectives.

Results
In 82 courses of vancomycin continuous infusions in 70 patients, 53 received correct loading doses. 31 courses had continuous infusion started within 2 hours of loading dose finishing. 13 courses started at the correct rate. 12/13 courses had vancomycin levels taken. Only one course reached therapeutic range at the first level taken (19.5mg/kg). Of the remaining 11 courses which were out of range, 7 were titrated appropriately – 6 became therapeutic, one remained out of range and was stopped. 3 were not titrated correctly and remained out of range or not titrated at all.

Conclusion
16% (13/82) of all continuous vancomycin infusions on AICU complied with guidelines. Only one patient who received the highest weight-based loading dose of 19.5mg/kg reached therapeutic range at the first level monitored, suggesting that doses of ≥20mg/kg at loading are required.
A large-scale pragmatic automated audit of the appropriateness of antibiotics initiated for presumed community-acquired pneumonia using a novel algorithmic approach
Authors: Bow Alexander , Lilley Jessica , Santos Reem , Murphy Michael , Bedford Luke , Sander Clare , Gouliouris Theodore 
Published: March 2020

Background
Audit is a fundamental part of antimicrobial stewardship, but this has traditionally been labour-intensive. The advent of fully electronic records (EPIC) at Cambridge University Hospitals (CUH) presents novel opportunities for large-scale automated data analyses and feedback. We developed and validated an algorithm to audit the appropriateness of prescriptions initiated for presumed community-acquired pneumonia (CAP).
Methods
We developed an algorithm that extracts prescription and clinical data from EPIC, calculates CURB-65 scores, and assesses the appropriateness of antibiotics with an indication of CAP against Trust guidelines based on predefined rules. Clinical data included age, gender, blood results, vital signs, NEWS-2 score, MRSA status, penicillin allergy and pregnancy status. Prescriptions were limited to 48 hours from admission. The accuracy of the algorithm was validated in a representative sample of 30 patients.
We present data on all prescriptions initiated for CAP admitted to CUH between September 2018 and June 2019.

Results
On validation, the algorithm calculated the CURB-65 score with an accuracy of 97% and correctly categorised antibiotic appropriateness in 98.5% of cases. Only 15% of patients had a CURB-65 score documented in the notes.
The algorithm evaluated 4,307 prescriptions in 2,198 patients. Appropriateness was significantly better in CURB-65 scores of 2-5 (83.7%) versus 0-1 (33.5%) largely due to over-prescription of co-amoxiclav in the latter.

Conclusion
This algorithm enables large-scale analysis of prescriptions initiated for CAP with high accuracy automating the audit cycle. An automatically calculated CURB-65 score has the potential to reduce over-prescribing of co-amoxiclav and should be evaluated in the future.