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  • Journal article
    Gea-Caballero V, Castro Sanchez EM, Diaz-Herrera MA, Sarabia-Cobo C, Juarez-Vela R, Zabaleta del Olmo Eet al., 2019,

    Motivations, beliefs and expectations of Spanish nurses planning migration for economic reasons: a cross-sectional, web-based survey

    , Journal of Nursing Scholarship, Vol: 51, Pages: 178-186, ISSN: 1527-6546

    Purpose of the article: Migration of nurses is not a new or recent event. During the last few decades, nursing migration flows have been a constant trend worldwide. The main objective of this study was to explore the motivations, beliefs, and expectations that Spanish nurses had when considering migration to another country in the near future.Design: Cross-sectional, internet survey of Spanish nurses planning migration for professional reasons.Methods: Ad hoc,web-based questionnaire following NEXT study guidelines.Findings: 172 nurses responded. 50% participants intended to emigrate in the following six monthsand had chosen the United Kingdom as destination. The most important drivers of migration were unemployment or precarious employment, and professional development. 58% of participants were very afraid of experiencing discrimination orrejection. Conclusions: This first study conducted in Spain directly exploring determinants of nurse migration highlighted globalization-driven factors and specific acculturation fears. Clinical relevance: Employment uncertainty and professional development remain key push’ drivers for migration of Spanish nurses. Discrimination or rejection due to migrancy were concerns for 60% of participants.
  • Journal article
    Ming D, Rawson T, Sangkaew S, Rodriguez-Manzano J, Georgiou P, Holmes Aet al., 2019,

    Connectivity of rapid-testing diagnostics and surveillance of infectious diseases

    , Bulletin of the World Health Organization, Vol: 97, Pages: 242-244, ISSN: 0042-9686

    The World Health Organization (WHO) developed the ASSURED criteria to describe the ideal characteristics for point-of-care testing in low-resource settings: affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free and deliverable.1 These standards describe. Over the last decade, widespread adoption of point-of-care testing has led to significant changes in clinical decision-making processes. The development of compact molecular diagnostics, such as the GeneXpert® platform, have enabled short turnaround times and allowed profiling of antimicrobial resistance. Although modern assays have increased operational requirements, many devices are robust and can be operated within communities with minimal training. These new generation of rapid tests have bypassed barriers to care and enabled treatment to take place independently from central facilities. Here we describe the importance of connectivity, the automatic capture and sharing of patient healthcare data from testing, in the adoption and roll-out of rapid testing.
  • Journal article
    Phillips CJ, Gilchrist M, Cooke FJ, Franklin BD, Enoch DA, Murphy ME, Santos R, Brannigan ET, Holmes AHet al., 2019,

    Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts

    , BMJ Open, Vol: 9, ISSN: 2044-6055

    OBJECTIVE: To investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context. SETTING: Data were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017. DESIGN: Cohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report. PARTICIPANTS: Inpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs. RESULTS: A total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495; 33.1%), UTI (407; 27.2%), HAP (330; 22%) and SSTI (265; 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52; 21.7%), side effect (27; 11.3%) and no documentation (161; 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517; 87.6%) versus no allergy (1731 of 2128; 81.3%) (OR 0.52 (95% CI 0.37 to 0.73) p<0.001). Guideline-adherence for CAP was higher if penicillin allergy (151 of 163; 92.6%) versus no allergy (582 of 810; 71.9%) (OR 0.20 (95% CI 0.10 to 0.37) p<0.001). There was no difference in adherence between those with and without penicillin allergy for UTI, HAP or SSTI treatment. CONCLUSIONS: A relatively high proportion of patients had a penicillin allergy and two thirds of these had no description of their allergy, which has important implications for patient safety. Patients with penicillin allergy treated for CAP
  • Journal article
    Gharbi M, Lishman H, Goudie R, Molokhia M, Johnson A, Holmes A, Aylin Pet al., 2019,

    Antibiotic management of urinary tract infection in the elderly in primary care and its association with bloodstream infections and all-cause mortality: a population-based cohort study

    , BMJ, Vol: 365, ISSN: 0959-8138

    OBJECTIVETo evaluate the association between severe adverse outcomes and the antibiotic treatment for urinary tract infection (UTI) diagnosed in elderly adults in primary care. DESIGNA retrospective population-based cohort study.SETTINGClinical Practice Research Datalink (2007-2015) primary care records linked to Hospital Episode Statistics and death records in England.PARTICIPANTSPatients aged≥65 years presenting to a General Practitioner (GP) with at least one diagnosis of suspected or confirmed lower UTI from November 2007 to May 2015.MAIN OUTCOME MEASURESBloodstream infection (BSI), hospital admission and all-cause mortality within 60 days following the index UTI diagnosis.RESULTSAmong 312,896 UTI episodes (157,264 unique patients), 7% did not have a record of having been prescribed antibiotics and 6% showed a delay in antibiotic prescribing. 1,539 episodes of BSI were recorded within 60 days following the initial UTI. The rate of BSI was significantly higher among those patients who were not prescribed an antibiotic (2. 9%) and those patients recorded as returning to the GP within 7 days of the initial consultation for an antibiotic prescription (2.2%), compared with those given a prescription for an antibiotic at the initial consultation (0.2%) (p=0.001). After adjustment for covariates, patients were significantly more likely to experience a BSI in the ‘deferred antibiotics’ and ‘no antibiotics’ groups compared with the ‘immediate antibiotics’ group (aOR=7.12 [95% CI 6.22 to 8.14] and aOR=8.08 [95% CI 7.12 to 9.16]).The Number Needed to Harm (NNH) for occurrence of BSI was lower (greater risk) for the ‘no antibiotics’ group (NNH=37) than for the ‘deferred antibiotics’ group (NNH=51), relative to the ‘immediate antibiotics’ group. The rate of hospital admissions was approximately double among cases with ‘no antibiotics’ (27%) and ‘deferred antibiotics’ (27%) comp
  • Journal article
    Charani E, Castro-Sanchez E, Bradley S, Nathwani D, Holmes A, Davey Pet al., 2019,

    Implementation of antibiotic stewardship in different settings - results of an international survey

    , Antimicrobial Resistance and Infection Control, Vol: 8, ISSN: 2047-2994

    BackgroundAntibiotic stewardship interventions are being implemented across different healthcare settings. We report the findings of a global survey of healthcare professionals on the implementation of antibiotic stewardship programmes.MethodsLearners of a Massive Online Open Course (MOOC) on antibiotic stewardship were invited to complete an online survey on the core available organisational resources for stewardship. The categorical variables were analysed using chi-squared test, and Likert questions were analysed using an ordinal regression model. The p-values were considered as two-tailed. Significance was set at p-value of < 0.05.ResultsThe response rate was 55% (505/920), from 53 countries. The responders were 36% (182) doctors, 26% (130) pharmacists, 18% (89) nurses and 20% (104) other (researchers, students and members of the public). Post-graduate training in infection management and stewardship was reported by 56% of doctors compared with 43% (OR 0.59, 95%CI 0.35–1.00) nurses and 35% (OR 0.39, 95%CI 0.24–0.62) of pharmacists. Hospitals were significantly (83% in teaching hospitals, 79% in regional hospitals, p = < 0.01) more likely to have antibiotic policies, when compared to primary care. A surveillance mechanism for antibiotic consumption was reported in 58% (104/178) of teaching hospitals and 62% (98/159) of regional hospitals. Antimicrobial resistance, patient needs, policy, peer influence and specialty level culture and practices were deemed important determinants for decision-making.ConclusionPostgraduate training and support in antibiotic prescribing remains low amongst nurses and pharmacists. Whilst antibiotic policies and committees are established in most institutions, surveillance of antibiotic use is not. The impact of specialty level culture, and peer influence appears to be important factors of antibiotic prescribing.
  • Journal article
    Rodriguez-Manzano J, Moniri A, Malpartida-Cardenas K, Dronavalli J, Davies F, Holmes A, Georgiou Pet al., 2019,

    Simultaneous single-channel multiplexing and quantification of carbapenem-resistant genes using multidimensional standard curves

    , Analytical Chemistry, Vol: 91, Pages: 2013-2020, ISSN: 0003-2700

    Multiplexing and quantification of nucleic acids, both have, in their own right, significant and extensive use in biomedical related fields. Currently, the ability to detect several nucleic acid targets in a single-reaction scales linearly with the number of targets; an expensive and time-consuming feat. Here, we propose a new methodology based on multidimensional standard curves that extends the use of real-time PCR data obtained by common qPCR instruments. By applying this novel method-ology, we achieve simultaneous single-channel multiplexing and enhanced quantification of multiple targets using only real-time amplification data. This is obtained without the need of fluorescent probes, agarose gels, melting curves or sequencing analysis. Given the importance and demand for tackling challenges in antimicrobial resistance, the proposed method is ap-plied to four of the most prominent carbapenem-resistant genes: blaOXA-48, blaNDM, blaVIM and blaKPC, which account for 97% of the UK's reported carbapenemase-producing Enterobacteriaceae.
  • Journal article
    Legeay C, Hue R, Berton C, Cormier H, Chenouard R, Corvec S, Birgand Get al., 2019,

    Control strategy for carbapenemase-producing Enterobacteriaceae in nursing homes: perspectives inspired from three outbreaks

    , Journal of Hospital Infection, Vol: 10, Pages: 183-187, ISSN: 0195-6701

    Three outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) in three nursing homes in western France were retrospectively assessed. In all, ten cases of colonization or infection with CPE were detected upon admission in neighbouring hospitals. Antibiotic consumption or high frailty was infrequent among them. Nursing homes should be included in a regional strategy to limit CPE spread.
  • Journal article
    Blandy O, Honeyford K, Gharbi M, Thomas A, Ramzan F, Ellington MJ, Hope R, Holmes A, Johnson AP, Aylin P, Woodford N, Sriskandan Set al., 2019,

    Factors that impact on the burden of Escherichia coli bacteraemia: multivariable regression analysis of 2011-2015 data from West London

    , Journal of Hospital Infection, Vol: 101, Pages: 120-128, ISSN: 0195-6701

    BackgroundThe incidence of Escherichia coli bacteraemia in England is increasing amid concern regarding the roles of antimicrobial resistance and nosocomial acquisition on burden of disease.AimTo determine the relative contributions of hospital-onset E. coli blood stream infection and specific E. coli antimicrobial resistance patterns to the burden and severity of E. coli bacteremia in West London.MethodsPatient and antimicrobial susceptibility data were collected for all cases of E. coli bacteraemia between 2011 and 2015. Multivariable logistic regression was used to determine the association between the category of infection (hospital or community-onset) and length of stay, intensive care unit admission, and 30-day all-cause mortality.FindingsE. coli bacteraemia incidence increased by 76% during the study period, predominantly due to community-onset cases. Resistance to quinolones, third-generation cephalosporins, and aminoglycosides also increased over the study period, occurring in both community- and hospital-onset cases. Hospital-onset and non-susceptibility to either quinolones or third-generation cephalosporins were significant risk factors for prolonged length of stay, as was older age. Rates of mortality were 7% and 12% at 7 and 30 days, respectively. Older age, a higher comorbidity score, and bacteraemia caused by strains resistant to three antibiotic classes were all significant risk factors for mortality at 30 days.ConclusionMultidrug resistance, increased age, and comorbidities were the main drivers of adverse outcome. The rise in E. coli bacteraemia was predominantly driven by community-onset infections, and initiatives to prevent community-onset cases should be a major focus to reduce the quantitative burden of E. coli infection.
  • Journal article
    Otter JA, Galtelly TJ, Davies F, Hitchcock J, Gilchrist MJ, Dyakova E, Mookerjee S, Holmes AH, Brannigan ETet al., 2019,

    Planning to halve Gram-negative bloodstream infection: getting to grips with healthcare-associated <i>Escherichia coli</i> bloodstream infection sources

    , JOURNAL OF HOSPITAL INFECTION, Vol: 101, Pages: 129-133, ISSN: 0195-6701
  • Journal article
    Charani E, Smith I, Skodvin B, Perozziello A, Lucet JC, Lescure FX, Brigand G, Poda A, Ahmad R, Singh S, Holmes AHet al., 2019,

    Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries – a qualitative study

    , PLoS ONE, Vol: 14, ISSN: 1932-6203

    BackgroundMost of the evidence on antimicrobial stewardship programmes (ASP) to help sustain the effectiveness of antimicrobials is generated in high income countries. We report a study investigating implementation of ASP in secondary care across low-, middle- and high-income countries. The objective of this study was to map the key contextual, including cultural, drivers of the development and implementation of ASP across different resource settings.Materials and methodsHealthcare professionals responsible for implementing ASP in hospitals in England, France, Norway, India, and Burkina Faso were invited to participate in face-to face interviews. Field notes from observations, documentary evidence, and interview transcripts were analysed using grounded theory approach. The key emerging categories were analysed iteratively using constant comparison, initial coding, going back the field for further data collection, and focused coding. Theoretical sampling was applied until the categories were saturated. Cross-validation and triangulation of the findings were achieved through the multiple data sources.Results54 participants from 24 hospitals (England 9 participants/4 hospitals; Norway 13 participants/4 hospitals; France 9 participants/7 hospitals; India 13 participants/ 7 hospitals; Burkina Faso 8 participants/2 hospitals) were interviewed. Across Norway, France and England there was consistency in ASP structures. In India and Burkina Faso there were country level heterogeneity in ASP. State support for ASP was perceived as essential in countries where it is lacking (India, Burkina Faso), and where it was present, it was perceived as a barrier (England, France). Professional boundaries are one of the key cultural determinants dictating involvement in initiatives with doctors recognised as leaders in ASP. Nurse and pharmacist involvement was limited to England. The surgical specialty was identified as most difficult to engage with in each country. Despite challenges, on

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