Multiple peripheral pneumococcal mycotic aneurysms without aortic involvement: A unique case confirmed with the novel use of a molecular diagnostic technique

Mycotic aneurysms confer a high morbidity and mortality. Streptococcus pneumoniae aneurysms usually affect the aorta and are rare, although bacterial cultures from aneurysm tissue may be difficult following prior antimicrobial therapy. We report a unique case of mycotic femoral and popliteal artery aneurysms following pneumococcal pneumonia and meningitis, which were managed by resection, revascularization with autologous vein, and intravenous benzylpenicillin. Although blood and aneurysm sac cultures were negative, arterial wall S pneumoniae DNA was detected by polymerase chain reaction (PCR). Appropriate molecular diagnostic techniques can facilitate diagnosis and direct antimicrobial therapy; an important consideration with increasing antimicrobial resistance

Lipid coated liquid crystal droplets for the on-chip detection of antimicrobial peptides

We describe a novel biosensor based on phospholipid-coated nematic liquid crystal (LC) droplets and demonstrate the detection of Smp43, a model antimicrobial peptide (AMP) from the venom of North African scorpion Scorpio maurus palmatus. Mono-disperse lipid-coated LC droplets of diameter 16.7 ± 0.2 μm were generated using PDMS microfluidic devices with a flow-focusing configuration and were the target for AMPs. The droplets were trapped in a bespoke microfluidic trap structure and were simultaneously treated with Smp43 at gradient concentrations in six different chambers. The disruption of the lipid monolayer by the Smp43 was detected (<6 μM) at concentrations well within its biologically active range, indicated by a dramatic change in the appearance of the droplets associated with the transition from a typical radial configuration to a bipolar configuration, which is readily observed by polarizing microscopy. This suggests the system has feasibility as a drug-discovery screening tool. Further, compared to previously reported LC droplet biosensors, this LC droplet biosensor with a lipid coating is more biologically relevant and its ease of use in detecting membrane-related biological processes and interactions has the potential for development as a reliable, low-cost and disposable point of care diagnostic tool

Co-Developing an Antibiotic Stewardship Tool for Dentistry: Shared Decision-Making for Adults with Toothache or Infection

From MDPI via Jisc Publications RouterHistory: accepted 2021-11-02, pub-electronic 2021-11-04Publication status: PublishedFunder: National Institute for Health Research; Grant(s): DRF-2016-09-148Dentistry is responsible for around 10% of antibiotic prescribing across global healthcare, with up to 80% representing inappropriate use. Facilitating shared decision-making has been shown to optimise antibiotic prescribing (antibiotic stewardship) in primary medical care. Our aim was to co-develop a shared decision-making antibiotic stewardship tool for dentistry. Dentists, patients and other stakeholders prioritised factors to include in the new tool, based on previous research (a systematic review and ethnographic study) about dentists’ decision-making during urgent appointments. Candidate behaviour-change techniques were identified using the Behaviour Change Wheel and selected based on suitability for a shared decision-making approach. A ‘think aloud’ study helped fine-tune the tool design and Crystal Marking ensured clarity of messaging. The resulting paper-based worksheet for use at point-of-care incorporated various behaviour change techniques, such as: ’information about (and salience of) health consequences’, ‘prompts and cues’, ‘restructuring the physical (and social) environment’ and ‘credible sources’. The think aloud study confirmed the tool’s acceptability to dentists and patients, and resulted in the title: ‘Step-by-step guide to fixing your toothache.’ Further testing will be necessary to evaluate its efficacy at safely reducing dental antibiotic prescribing during urgent dental appointments in England and, with translation, to other dental contexts globally

A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UK

Background: Bacterial native vertebral osteomyelitis (NVO) can present diagnostic and therapeutic challenges leading to high levels of morbidity and mortality. To inform strategies aimed at improving outcomes in these patients, data are needed on the current aetiology, diagnostic interventions, management and risk factors for treatment failure. Methods: This was a retrospective, multicentre, observational cohort study of adult patients with bacterial NVO across the UK between 1st January 2015 and 31st December 2016. Infectious Disease Society of America (IDSA) guideline standards were selected and used to audit practice relating to the management of these patients. Results: A total of 286 patients were included from 40 hospitals. An organism was identified in 61% of cases by blood culture or biopsy. Of these, 51% were due to Staphylococcus aureus and 12% were due to Gram-negative bacteria. When performed, biopsy obtained a microbiological diagnosis in 50% of cases. Nearly 10% of patients required admission to an Intensive Care Unit, 20% were re-admitted to hospital, 56% experienced complications and 6% died within 90 days. Higher Charlson comorbidity index (CCI) was significantly associated with treatment failure at one month (p = 0.004). Conclusions: This study identified opportunities to improve UK practice in the investigation and management of bacterial NVO. The range of organisms isolated supports the use of diagnostic biopsy where blood cultures are non-diagnostic, to guide antimicrobial therapy and strive to avoid treatment failure or complications. This study shows a clear need for antibiotic guidelines to reflect the current aetiology of NVO and authors support the creation of a formal registry

A patient with bacteraemia and possible endocarditis caused by a recently-discovered genomospecies of Capnocytophaga: Capnocytophaga genomospecies AHN8471: a case report

<p>Abstract</p> <p>Introduction</p> <p><it>Capnocytophaga </it>are a genus of bacteria that have been found to be the causative organisms in a range of infections, including serious conditions such as bacteraemia, endocarditis and meningitis. This has been especially true amongst those with serious comorbidities and the immunocompromised populations. Although several species are known to cause human disease, historically, laboratories have often not identified isolates to species level due to the unreliable, laborious techniques needed. With the advent of Polymerase Chain Reaction-Restriction Fragment Length Polymorphism Analysis, identification to species level is now frequently possible and desirable, as it may provide clues as to the source of infection and its treatment.</p> <p>Case presentation</p> <p>Here we describe a case of bacteraemia and possible endocarditis in a 64-year-old white British man caused by a newly identified genomospecies of <it>Capnocytophaga </it>in a patient subsequently diagnosed with metastatic adenocarcinoma of the oesophagus. The source of the bacteraemia was presumed to be from the patient's own oral flora.</p> <p>Conclusion</p> <p>Our case further confirms the potential for <it>Capnocytophaga </it>to cause systemic infections, highlights the availability and need for identification of isolates to species level and re-emphasises the difficulty in diagnosing <it>Capnocytophaga </it>infections due to their slow growth in the laboratory.</p

'Antibiotic footprint' as a communication tool to aid reduction of antibiotic consumption-authors' response

We thank Dominic Moran for describing the potential implications of our proposed antibiotic footprint and how the ecological footprint was originally defined.1 The ‘antibiotic footprint’ has been designed as a simple metric focusing on communication with the general public, healthcare professionals and policy makers to aid reduction of antibiotic consumptio

Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: Qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study)

Objective: To explore and model factors affecting antibiotic prescribing decision-making early in the pandemic. Design: Semistructured qualitative interview study. Setting: National Health Service (NHS) trusts/health boards in England and Wales. Participants: Clinicians from NHS trusts/health boards in England and Wales. Method: Individual semistructured interviews were conducted with clinicians in six NHS trusts/health boards in England and Wales as part of the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients study, a wider study that included statistical analysis of procalcitonin (PCT) use in hospitals during the first wave of the pandemic. Thematic analysis was used to identify key factors influencing antibiotic prescribing decisions for patients with COVID-19 pneumonia during the first wave of the pandemic (March to May 2020), including how much influence PCT test results had on these decisions. Results: During the first wave of the pandemic, recommendations to prescribe antibiotics for patients with COVID-19 pneumonia were based on concerns about secondary bacterial infections. However, as clinicians gained more experience with COVID-19, they reported increasing confidence in their ability to distinguish between symptoms and signs caused by SARS-CoV-2 viral infection alone, and secondary bacterial infections. Antibiotic prescribing decisions were influenced by factors such as clinician experience, confidence, senior support, situational factors and organisational influences. A decision-making model was developed. Conclusion: This study provides insight into the decision-making process around antibiotic prescribing for patients with COVID-19 pneumonia during the first wave of the pandemic. The importance of clinician experience and of senior review of decisions as factors in optimising antibiotic stewardship is highlighted. In addition, situational and organisational factors were identified that could be optimised. The model presented in the study can be used as a tool to aid understanding of the complexity of the decision-making process around antibiotic prescribing and planning antimicrobial stewardship support in the context of a pandemic

Procalcitonin evaluation of antibiotic use in COVID-19 hospitalised patients (PEACH): protocol for a retrospective observational study

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is a viral illness, many patients admitted to hospital are prescribed antibiotics, based on concerns that COVID-19 patients may experience secondary bacterial infections, and the assumption that they may respond well to antibiotic therapy. This has led to an increase in antibiotic use for some hospitalised patients at a time when accumulating antibiotic resistance is a major global threat to health. Procalcitonin (PCT) is an inflammatory marker measured in blood samples and widely recommended to help diagnose bacterial infections and guide antibiotic treatment. The PEACH study will compare patient outcomes from English and Welsh hospitals that used PCT testing during the first wave of the COVID-19 pandemic with those from hospitals not using PCT. It will help to determine whether, and how, PCT testing should be used in the NHS in future waves of COVID-19 to protect patients from antibiotic overuse. PEACH is a retrospective observational cohort study using patient-level clinical data from acute hospital Trusts and Health Boards in England and Wales. The primary objective is to measure the difference in antibiotic use between COVID-19 patients who did or did not have PCT testing at the time of diagnosis. Secondary objectives include measuring differences in length of stay, mortality, intensive care unit admission, and resistant bacterial infections between these groups

Oral versus intravenous antibiotics for bone and joint infection

BACKGROUND The management of complex orthopedic infections usually includes a prolonged course of intravenous antibiotic agents. We investigated whether oral antibiotic therapy is noninferior to intravenous antibiotic therapy for this indication. METHODS We enrolled adults who were being treated for bone or joint infection at 26 U.K. centers. Within 7 days after surgery (or, if the infection was being managed without surgery, within 7 days after the start of antibiotic treatment), participants were randomly assigned to receive either intravenous or oral antibiotics to complete the first 6 weeks of therapy. Follow-on oral antibiotics were permitted in both groups. The primary end point was definitive treatment failure within 1 year after randomization. In the analysis of the risk of the primary end point, the noninferiority margin was 7.5 percentage points. RESULTS Among the 1054 participants (527 in each group), end-point data were available for 1015 (96.3%). Treatment failure occurred in 74 of 506 participants (14.6%) in the intravenous group and 67 of 509 participants (13.2%) in the oral group. Missing end-point data (39 participants, 3.7%) were imputed. The intention-to-treat analysis showed a difference in the risk of definitive treatment failure (oral group vs. intravenous group) of −1.4 percentage points (90% confidence interval [CI], −4.9 to 2.2; 95% CI, −5.6 to 2.9), indicating noninferiority. Complete-case, per-protocol, and sensitivity analyses supported this result. The between-group difference in the incidence of serious adverse events was not significant (146 of 527 participants [27.7%] in the intravenous group and 138 of 527 [26.2%] in the oral group; P=0.58). Catheter complications, analyzed as a secondary end point, were more common in the intravenous group (9.4% vs. 1.0%). CONCLUSIONS Oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first 6 weeks for complex orthopedic infection, as assessed by treatment failure at 1 year. (Funded by the National Institute for Health Research; OVIVA Current Controlled Trials number, ISRCTN91566927. opens in new tab.