bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 12 month follow-up looking at improvements to adult inpatient gentamicin prescribing and the role of the antimicrobial pharmacist
Authors: Hinchliffe Rachael 
Published: March 2020

Background
Audits at Mid Yorkshire NHS Trust have identified inappropriate prescribing of gentamicin. Antimicrobial stewardship (AMS) interventions in hospital have increased adherence to antimicrobial prescribing policies2.

Methods
Pre-intervention data were collected by the antimicrobial pharmacist in January 2018. Interventions were then completed and included: oral presentations, targeted reviews and teaching sessions. Inappropriate indications or doses received routine AMS intervention. Following interventions a second audit was completed in May 2018 to measure improvements in prescribing. A second intervention was the introduction of a 5 day review service of prescribed gentamicin and a third audit was completed in August 2019 to demonstrate a sustained improvement.

Results
In total, 25 patients were audited in January 2018, 24 patients in May 2018 and 29 patients in August 2019. The three groups were similar for age, sex and reason for admission. The proportion of patients receiving an appropriate initial dose of gentamicin increased from 13/25 patients (54%) to 19/24 patients (79%) and again to 27/29 patients (93%). The proportion of patients that had the subsequent dose of gentamicin prescribed appropriately increased from 9/25 patients (36%) to 20/24 patients (83%) and again to 29/29 patients (100%).

Conclusions
This project demonstrated a sustained improvement in gentamicin prescribing following a series of pharmacist-led education and training sessions, one to one training, presentations at governance group meetings and the introduction of a 5 day pharmacist review service. The sample was limited to those patients who had levels taken.
Experience of adopting a standardised nomogram for gentamicin monitoring- an audit
Authors: Brookfield Charlotte , Clark Rebecca , Reddy Suganya 
Published: March 2020

Background:
Gentamicin, an aminoglycoside antibiotic, requires therapeutic drug monitoring to decrease the risk of nephrotoxicity and ototoxicity. We audited compliance with our dosing and monitoring guidelines since adoption of the Barnes-Jewish Nomogram for once daily 5mg/kg dosing in September 2018.

Methods:
We retrospectively reviewed 62 patients who received 171 gentamicin doses with 173 accompanying levels taken between 1/11/18 and 31/1/19.

Results:
The audit demonstrated overall poor adherence to guidelines. Only 50% of patients received the correctly calculated dose. 40% of gentamicin levels were taken between 6-14 hours resulting in a large number of uninterpretable levels requiring additional actions e.g. repeat levels. 50% of follow up doses were given in the correct time frame. For patients with normal renal function twice weekly monitoring is recommended. In all cases (n=35) where this applied levels were monitored more frequently that indicated. U&Es were regularly monitored for all patients and we did not identify any acute kidney injury.

Conclusion:
The Barnes-Jewish nomogram was adopted to provide a standardised evidence based monitoring system for gentamicin. However our audit demonstrates the guidance was not well executed clinically. There appeared to be a lack of appreciation and responsibility for monitoring and interpretation of levels. This resulted in erratic sampling, unnecessary levels, and delayed doses. As a result of this audit we intend to adopt a simpler trough level system based on the gentamicin SPC. Our audit demonstrates the need to evaluate service improvement implementations since theoretical benefits do not always translate in to clinical practice
Tayside TB Pathway: A Quality Improvement Project
Authors: Wilson Aline , Jordan Rose 
Published: March 2020

Aims:
The aim of this project was to look at our local practice of identifying and managing patients with mycobacterium tuberculosis (MTB) and non pulmonary NTM. In Tayside, the care of patients with MTB is shared between the Infectious Diseases physicians and the Respiratory physicians. We aim to improve communication and identify any issues with continuity of care and create solutions to standardise the care our patients receive.

Methods:
We performed an initial audit of patients that were currently receiving or had recently completed treatment for MTB and non pulmonary NTM. We collected data from 26 patients between January 2017 - July 2018.

Results:
Some of the results are as follows: Out of the 26 patients, only 14 (53.8%) of those had a documented start date of treatment on the initial clinic letter. 92.3% had a documented treatment regime on clinic letter. 88.4% (23 out of 26 patients) had a documented diagnosis (specifying site) on clinic letter. Only 46% had a complete BBV screen, 35% had an incomplete BBV screen and 19% had none.

Outcome:
After performing the initial audit and assessing the areas of improvement, we were able to create our “Tayside TB Pathway”. The idea behind this was to create a more cohesive and streamlined approach to TB care whilst involving all members of the MDT. The pathway was created to be straightforward and allow us to have a “centralised hub” to oversee the important steps involved in the management and prompt these to be performed where needed.
Early laboratory markers may reflect the severity of pyogenic liver abscess infection: Retrospective cohort study
Authors: Husain Ahmed , Mohd Mahmoud , Elmekaty Eman , Mulla Abdalrazig El , Adam Mohammad , Al-Khal Abdullatif , Maslamani Muna Al 
Published: March 2020

Background:
Liver abscess carries significant morbidity and mortality rate due to its complications. We aimed to identify laboratory markers associated with septic shock related to pyogenic liver abscess.

Methods:
The study was conducted at Hamad General Hospital, a tertiary hospital in Qatar. Data were collected retrospectively. All patients diagnosed with pyogenic liver abscess between 2013 and 2017 were included. Liver abscess was diagnosed based on clinical presentation and radiological finding with or without microbiological evidence. Septic shock defined as the need of vasopressors to maintain mean arterial pressure > 60 mmHg. Data has been collected on admission time. Descriptive data were presented in mean ± SD and percentages. Normally distributed data were analyzed by T-test otherwise Mann–Whitney was used.Fisher Exact test was used for categorical data. The level of significance was set at P<0.05.

Results:
Pyogenic liver abscess has been identified in 78 patients. 89.9% were males. 48.7% of the patients were diabetic. Nine patients (11.5%) developed septic shock. Patients who developed septic shock had higher procalcitonin level (Hazard ratio [HR] 1.025, 95% CI 1.006-1.044, p0.009) but lower level of hemoglobin (HR 0.744, 95% CI 0.581-0.952, P. 0.019), protein(HR 0.867, 95% CI 0.779-0.966, p 0.009) and platelet (HR 0.994, 95% CI 0.988-1.000, p 0.035)

Conclusion:
Measurement of baseline procalcitonin, hemoglobin, protein, and platelet in pyogenic liver abscess may provide early information about the severity of the infection and the need for early aggressive management. However, a larger sample size is needed to achieve more statistical significance.
CPE in Beaumont Hospital – Trying to understand an increasing and challenging pathogen
Authors: Skelly Emma , Foley Margaret , Skally Mairead , Reilly Aoife , Humphreys Hilary , Fitzpatrick Fidelma 
Published: March 2020

Background
The prevention and control of carbapenemase-producing Enterobacteriales (CPE) cross-infection is increasingly difficult worldwide. Patients exposed to a CPE positive patient in our institution are informed, offered CPE screening and their clinical records flagged on our hospital information system since mid-2017 as recommended nationally. However, no assessment of the numbers of CPE contacts has been performed prior to this.

Objective / Aims
To retrospectively identify and quantify CPE contacts patients in Beaumont Hospital between 2011 and mid-2017.

Methods
Patients with an exposure to CPE positive patients while an inpatient were identified retrospectively. Each CPE contact was evaluated for: number of CPE screens taken, mortality, existing multidrug resistant colonisation, duration of CPE exposure, recurrent hospitalisation after CPE exposure and CPE colonisation within this group.

Results
Twenty-eight CPE positive patients were identified from January 2011 – May 2017. This included 22 OXA-48, six KPC and four NDM patients; two patients had OXA 48 and NDM genes. A total of 237 patients were identified as CPE contacts of whom 124 (52.7%) had 190 CPE screens. Four CPE contact patients were identified as CPE positive (all OXA-48), however, only three (1.2%) were associated with exposure to one of the 28 CPE positive patients.

Conclusions
The identification of potential CPE contacts and subsequent CPE positive patients is essential to prevent further cross-transmission. Of the CPE contacts screened, only three CPE positive patients were associated with exposure to the index patients, which may indicate good adherence with infection control precautions or low sensitivity of culture-based screening.
A tricky trochanter
Authors: McGuire Emma , Charambous Alexander , Gulati Vivek , Boyd Aileen , Woods Kate 
Published: March 2020

A 24-year-old previously well female presented with a discharging thigh abscess after travel to Ghana. She reported malaise but was otherwise systemically well. Further history revealed 2 years of intermittent left thigh pain, which had been attributed to a large trochanteric bursa identified on ultrasound in 2017. On examination she was afebrile with a deep, undermined ulcer discharging pus in the left antero-lateral thigh. Femoral X-ray was unremarkable.
She underwent surgical debridement and intra-operatively infection was found to track to the greater trochanter. Tissue specimens grew Gemella morbillorum, Klebsiella pneumoniae, Enterobacter cloacae, Streptococcus anginosus and mixed anaerobes. She responded well to 4 weeks of ciprofloxacin, metronidazole and amoxicillin. Histological examination of the ulcer edge revealed non-necrotising granulomata (Ziehl-Neelsen stain negative).Mycobacterium tuberculosis(MTB) was subsequently isolated on mycobacterial culture from the same site. MRI demonstrated osteomyelitis of the greater trochanter with a 2cm intramedullary abscess and an adjacent soft tissue collection. Macroscopically caseous material was found on further debridement and tissue samples were AAFB smear negative but MTB complex was detected by PCR and culture of intra-medullary bone.
This case demonstrates that bacteria and mycobacteria may be co-pathogens, and that M. tuberculosis bone infection may present with no systemic symptoms. It is a reminder of the importance of cross-sectional imaging and mycobacterial culture in deep soft tissue infections with a long or unusual history.
Analysis of outpatient and home parenteral intravenous antibiotic therapy (OHPAT) cases at the Newcastle upon Tyne Hospitals NHS Foundation Trust from April 2017 to June 2019
Authors: Pinedo Joshua , Schwab Uli 
Published: March 2020

Introduction and Methods
Newcastle’s OHPAT service has been operating since 2011, providing intravenous antimicrobials on outpatient basis for deep seated infections (DSI) and skin and soft tissue infections (SSTI); either provided at the OHPAT service in hospital (H-OPAT), delivered to the patient’s home (C-OPAT) or self-administered by an instructed patient (S-OPAT). The service aims to reduce admissions and inpatient bed days. Data from a prospective database was analysed to determine bed days saved, admissions avoided, location and success rate of treatment and adverse outcomes.

Results
292 patients (174 male, 118 female) median age 54 (range 17– 97) April 2017-June 2019. 148 patients with SSTI and 143 DSI. 140 patients previously treated as inpatients. 141 admissions avoided; 3540 bed days saved; 267 patients treated with H-OPAT; 21 C-OPAT; 4 S-OPAT. High cure rate of 100% in SSTI and 97% in DSI (3 re-admissions, 1 self-discharge). Low complication rate with no death, MSSA/other bacteraemia or CDT-associated diarrhoea. Low complication rate of 0.7%: rash in 1 patient (on ceftriaxone) and line blockage in 1 patient.

Conclusion
The aim of the OHPAT service is equality of effectiveness and safety compared to inpatient care. This has been achieved in the ongoing low rate of complications and adverse outcomes. The service treated a wide range of DSI which contribute a larger proportion of bed days for much fewer cases than SSTI. Significant numbers of hospital stays were avoided or shortened. OHPAT has been able provide complex regimes with home delivered and self-administered dosing.
Comedones and carbapenems: hydradenitis suppurativa in the OPAT clinic
Authors: Rogers Benedict , Harman Karen , White Helena 
Published: March 2020

Background
Hydradenitis suppurativa (HS) is a chronic inflammatory skin disease. The UK prevalence is estimated at between 1-4%. There is an approximate 3:1 female: male preponderance and it is associated with smoking, obesity, type 2 diabetes mellitus. The pathogenesis of HS is poorly understood. Clinical features vary in extent and the axillae, inguinal and anogenital areas are typically affected. It has a significant impact on quality of life, with high rates of depression amongst sufferers.
Current UK treatment guidelines focus on lifestyle interventions, as well as targeted use of oral antibiotics, however microbiological sampling is usually not helpful. Where these are unsuccessful anti-TNF agents and surgical intervention may be indicated. Despite their absence from these guidelines, there is growing evidence to support the role of intravenous (IV) antibiotics in treating HS. It is not known whether the treatment response seen with IV antibiotics is due to their antibacterial or an anti-inflammatory effect. We present a series of HS patients managed under the OPAT team at University Hospitals of Leicester.
Cases
To date 8 patients have completed treatment (7F/1M). All received at least 6 weeks of therapy with IV ertapenem (+/- teicoplanin). Significant improvement in both clinical signs and symptoms was achieved in all cases. However, disease relapse was seen in three cases after cessation of IVs, requiring additional courses of treatment. Antibiotics were well tolerated with one adverse drug reaction secondary to teicoplanin.

Conclusion
Intravenous antibiotics are an effective adjunctive treatment in selected cases of hidradenitis suppurativa.
Online continuous medical education: Diagnosing fungal infections from a distance
Authors: Corzo-leon Dora E. , Rivera-Martinez Norma E. 
Published: March 2020

Background
Increasing global incidence of serious fungal infections (SFI) requires increasing access to high quality medical mycology education to improve their identification and decrease associated mortality.

Methods
An online course was developed by two infectious diseases (ID) specialists. The course aimed to improve diagnosis of SFI and was delivered from April-June 2019. The course consisted of 9 online interactive sessions every week. Sessions were streamed by a hospital in Mexico and local participants gather there every week. Other participants connected independently online. Participants took one exam at the start and another after the course was completed. Feedback was collected during the course. A final evaluation of the impact on diagnosis will be collected in October 2019.

Results
A total of 137 people registered for the course. Registrants were from four different countries, Mexico (126, 92%), Ecuador (9, 6.6%), Australia (1, 0.7%) and Bolivia (1, 0.7%). Mexican participants connected from 15 of the 32 regions (47%) in Mexico and 45 (33%) attended the course at host hospital. Most participants were physicians (76%), 54 were ID specialists and 19 were ID residents. Sixty participants (60/137, 44%) completed the course, with greater completion by those attending in person (33/45, 73%) compared with online attendance (27/92, 29%). The exams results improved 30% after the course. Clinical urgent calls limited attendance.

Conclusions
This online course allowed a broad geographical participation. Learning as group lead to better completion rates. Recorded sessions will be available on demand and may allow the completion of the course.
Teicoplanin therapeutic drug monitoring (TDM) – excessive or essential?
Authors: Boyd Aileen , Brasa Carmen Cabeza 
Published: March 2020

Background:
Teicoplanin is a glycopeptide antibiotic which is frequently used in preference to vancomycin because it does not require such regular TDM as the association between concentration and toxicity has not been fully established. TDM is however, recommended to help optimise therapy in some patients. In our hospital there was an observation of frequent sub-therapeutic levels which prompted an audit of TDM results.

Methods:
Retrospective review of TDM results August 2015- March 2017 at Homerton Hospital with analysis of dose, renal function, patients’ weight and type of infection.

Results:
We analysed 54 samples from 33 patients. The most common dose was 600 mg OD which equated to a mean dose of 8.68 mg/Kg with under-dosing in all weight groups but with lowest levels in the group between 110-120 Kg. A 24hr dosing regimen was the most common and other dosing regimens (48hrly or 72hrly) more frequently associated with sub-therapeutic levels.
Overall, the mean level was 27.8 +/- 11.9 mg/L but 41% (n=22) of levels were sub-therapeutic for the type of infection treated including 4 patients with bacteraemia, 7 patients with bone and joint infections (n=10 samples) and 3 patients (n=6 samples) with prosthetic joint infections. There was only one patient with teicoplanin levels >60 mg/L who was on treatment for a streptococcal endocarditis. She did not report any side effects.

Conclusion:
The current dosing regimen recommended by the BNF frequently results in sub-therapeutic levels. TDM is essential in managing complex infections to ensure therapeutic levels are achieved.
Prevalence of MRSA colonisation amongst patients undergoing elective orthopaedic implant surgery at North Bristol NHS Trust
Authors: Nye Clemency , Webb Jason , Hammond Fiona , Darley Elizabeth 
Published: March 2020

Introduction:
National guidelines recommend MRSA screening of all patients before elective orthopaedic implant procedures (EOIP) as a measure to reduce risk of MRSA surgical site infection (SSI). With low prevalence of MRSA in UK currently, this universal approach of screening all EOIP patients may be unnecessary.
Objectives
To determine MRSA colonisation rate of EOIP patients pre surgery and number of MRSA-positive patients developing surgical site infection (SSI) within 30 days.

Methods:
North Bristol NHS Trust is the largest Orthopaedic unit in Southwest England. It performs over 6000 elective Orthopaedic operations annually, including 2000 hip and knee joint replacements. All major elective cases are reviewed in a pre-operative assessment clinic where MRSA screening, amongst other tests, is performed.
The pathology IT system was interrogated to identify data on patients screened for MRSA in the orthopaedic pre-assessment clinic from 1st January to 31st March 2019. Routinely collected SSI data was reviewed for details of any SSI in these patients.

Results:
439 patients were screened in the pre-operative clinic. 4/439 patients (0.9%) had positive screens. Applying national MRSA screening criteria, 2/4 patients had recognised risk factors for MRSA colonisation (including one patient previously MRSA colonised), and 2/4 did not. All 4 patients were decolonised pre-surgery and none developed SSI. No patient developed MRSA SSI.
Conclusions:
Approximately 1%, of patients attending for EOIP are colonised with MRSA in this Trust. No patient developed MRSA SSI in the 3month period. There may be potential to rationalise the approach to MRSA screening in EOIP patients.
The trend in HIV internet search activity over a 5-year period and the impact of AIDS awareness day
Authors: Carter Emma 
Published: March 2020

Background
Worldwide there are an estimated 36.9 million people with HIV of which 25% do not know their status. The following study assesses the effect of AIDS awareness day on internet search activity for HIV, and analyses other causes of spikes in internet search activity.
Methods
Google trends was used to examine search trends for HIV, over the past 5 years. These were correlated with ‘’AIDS’ awareness day’’ to assess the effect of this campaign on public interest. Search trends for the United Kingdom were also analysed. Repeated measures ANOVA and Tukey post-hoc analyses were performed to assess for significant differences in activity.

Results
There are increased levels of search activity for HIV in the two weeks surrounding AIDS awareness day on a worldwide level consistently over a 5-year period (p<0.0001). However, in the United Kingdom there is no significant increase compared to the rest of the year. The event corresponding to the largest spike in HIV search activity was the announcement by Charlie Sheen of his HIV status. A spike in search activity was also seen in the United Kingdom corresponding with the MP Lloyd Russell-Moyle announcing his HIV-positive status, this was higher than observed on AIDS awareness day in the UK 2 days later.
Conclusions
On a worldwide level AIDS awareness week is achieving it’s aims of increasing public interest in HIV. However, in the United Kingdom, the announcement by public figures of their HIV-positive status appears to have a greater effect on stimulating public interest.