المؤلفون: Piyasena, C, Galu, S, Yoshida, R, Thakkar, D, O'Sullivan, J, Longley, C, Evans, K, Sweeney, S, Kendall, G, Ben-Sasi, K, Richards, J, Harris, C, Jagodzinski, J, Demirjian, A, Lamagni, T, Le Doare, K, Heath, PT, Battersby, C, Neonatal Trainee-Led Research and Improvement Projects (NeoTRIPs

الوصف: OBJECTIVE: We sought to compare the incidence of early-onset sepsis (EOS) in infants ≥34 weeks' gestation identified >24 hours after birth, in hospitals using the Kaiser Permanente Sepsis Risk Calculator (SRC) with hospitals using the National Institute for Health and Care Excellence (NICE) guidance. DESIGN AND SETTING: Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units colocated with maternity services across London (10 using SRC, 16 using NICE). PARTICIPANTS: All live births ≥34 weeks' gestation between September 2020 and August 2021. OUTCOME MEASURES: EOS was defined as isolation of a bacterial pathogen in the blood or cerebrospinal fluid (CSF) culture from birth to 7 days of age. We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures. RESULTS: Of 99 683 live births, 42 952 (43%) were born in SRC hospitals and 56 731 (57%) in NICE hospitals. The overall incidence of EOS (<72 hours) was 0.64/1000 live births. The incidence of EOS identified >24 hours was 2.3/100 000 (n=1) for SRC vs 7.1/100 000 (n=4) for NICE (OR 0.5, 95% CI (0.1 to 2.7)). This corresponded to (1/20) 5% (SRC) vs (4/45) 8.9% (NICE) of EOS cases (χ=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4.4/1000 (n=187) for SRC vs 2.9/1000 (n=158) for NICE (OR 1.5, 95% CI (1.2 to 1.9)). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals vs 8428 (15%) in NICE hospitals. CONCLUSION: There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life.

وصف الملف: application/pdf

العلاقة: https://openaccess.sgul.ac.uk/id/eprint/115575/1/2023%20BMJ%20Open%20Pan%20London%20EOS%20plus%20supplemental.pdfTest; Piyasena, C; Galu, S; Yoshida, R; Thakkar, D; O'Sullivan, J; Longley, C; Evans, K; Sweeney, S; Kendall, G; Ben-Sasi, K; et al. Piyasena, C; Galu, S; Yoshida, R; Thakkar, D; O'Sullivan, J; Longley, C; Evans, K; Sweeney, S; Kendall, G; Ben-Sasi, K; Richards, J; Harris, C; Jagodzinski, J; Demirjian, A; Lamagni, T; Le Doare, K; Heath, PT; Battersby, C; Neonatal Trainee-Led Research and Improvement Projects (NeoTRIPs (2023) Comparison of diagnoses of early-onset sepsis associated with use of Sepsis Risk Calculator versus NICE CG149: a prospective, population-wide cohort study in London, UK, 2020-2021. BMJ Open, 13 (7). e072708. ISSN 2044-6055 https://doi.org/10.1136/bmjopen-2023-072708Test SGUL Authors: Le Doare, Kirsty Heath, Paul Trafford

الإتاحة: https://doi.org/10.1136/bmjopen-2023-072708Test
https://openaccess.sgul.ac.uk/id/eprint/115575Test/
https://openaccess.sgul.ac.uk/id/eprint/115575/1/2023%20BMJ%20Open%20Pan%20London%20EOS%20plus%20supplemental.pdfTest

المؤلفون: Li, H.K., Zhi, X., Vieira, A., Whitwell, H.J., Schricker, A., Jauneikaite, E., Li, H., Yosef, A., Andrew, I., Game, L., Turner, C.E., Lamagni, T., Coelho, J., Sriskandan, S.

الوصف: Streptococcus pyogenes genotype emm1 is a successful, globally distributed epidemic clone that is regarded as inherently virulent. An emm1 sublineage, M1UK, that produces increased levels of SpeA toxin was associated with increased scarlet fever and invasive infections in England in 2015/2016. Defined by 27 SNPs in the core genome, M1UK is now dominant in England. To more fully characterize M1UK, we undertook comparative transcriptomic and proteomic analyses of M1UK and contemporary non-M1UKemm1 strains (M1global). Just seven genes were differentially expressed by M1UK compared with contemporary M1global strains. In addition to speA, five genes in the operon that includes glycerol dehydrogenase were upregulated in M1UK (gldA, mipB/talC, pflD, and phosphotransferase system IIC and IIB components), while aquaporin (glpF2) was downregulated. M1UK strains have a stop codon in gldA. Deletion of gldA in M1global abrogated glycerol dehydrogenase activity, and recapitulated upregulation of gene expression within the operon that includes gldA, consistent with a feedback effect. Phylogenetic analysis identified two intermediate emm1 sublineages in England comprising 13/27 (M113SNPs) and 23/27 SNPs (M123SNPs), respectively, that had failed to expand in the population. Proteomic analysis of invasive strains from the four phylogenetic emm1 groups highlighted sublineage-specific changes in carbohydrate metabolism, protein synthesis and protein processing; upregulation of SpeA was not observed in chemically defined medium. In rich broth, however, expression of SpeA was upregulated ~10-fold in both M123SNPs and M1UK sublineages, compared with M113SNPs and M1global. We conclude that stepwise accumulation of SNPs led to the emergence of M1UK. While increased expression of SpeA is a key indicator of M1UK and undoubtedly important, M1UK strains have outcompeted M123SNPs and other emm types that produce similar or more superantigen toxin. We speculate that an accumulation of adaptive SNPs has contributed to a wider fitness advantage ...

وصف الملف: text

العلاقة: https://eprints.whiterose.ac.uk/201083/1/Characterization%20of%20emergent%20toxigenic%20M1subUKsub%20iStreptococcus%20pyogenesi%20and%20associated%20sublineages.pdfTest; Li, H.K. orcid.org/0000-0002-8149-5943 , Zhi, X. orcid.org/0000-0003-0811-913X , Vieira, A. orcid.org/0000-0003-4384-6746 et al. (11 more authors) (2023) Characterization of emergent toxigenic M1UK Streptococcus pyogenes and associated sublineages. Microbial Genomics, 9 (4). 000994. ISSN 2057-5858

الإتاحة: https://eprints.whiterose.ac.uk/201083Test/
https://eprints.whiterose.ac.uk/201083/1/Characterization%20of%20emergent%20toxigenic%20M1subUKsub%20iStreptococcus%20pyogenesi%20and%20associated%20sublineages.pdfTest

المؤلفون: Lamagni, T, Guy, RL, Sriskandan, S, Decraene, V, Brown, CS

المصدر: e766

جغرافية الموضوع: England

العلاقة: The Lancet Microbe; http://hdl.handle.net/10044/1/105396Test

الإتاحة: https://doi.org/10.1016/S2666-5247Test(23)00186-6
http://hdl.handle.net/10044/1/105396Test

المؤلفون: Li, H-K, Zhi, X, Vieira, A, Whitwell, HJ, Schricker, A, Jauneikaite, E, Li, H, Yosef, A, Andrew, I, Game, L, Turner, CE, Lamagni, T, Coelho, J, Sriskandan, S

المصدر: 15 ; 1

الوصف: Streptococcus pyogenes genotype emm1 is a successful, globally distributed epidemic clone that is regarded as inherently virulent. An emm1 sublineage, M1UK, that produces increased levels of SpeA toxin was associated with increased scarlet fever and invasive infections in England in 2015/2016. Defined by 27 SNPs in the core genome, M1UK is now dominant in England. To more fully characterize M1UK, we undertook comparative transcriptomic and proteomic analyses of M1UK and contemporary non-M1UKemm1 strains (M1global). Just seven genes were differentially expressed by M1UK compared with contemporary M1global strains. In addition to speA, five genes in the operon that includes glycerol dehydrogenase were upregulated in M1UK (gldA, mipB/talC, pflD, and phosphotransferase system IIC and IIB components), while aquaporin (glpF2) was downregulated. M1UK strains have a stop codon in gldA. Deletion of gldA in M1global abrogated glycerol dehydrogenase activity, and recapitulated upregulation of gene expression within the operon that includes gldA, consistent with a feedback effect. Phylogenetic analysis identified two intermediate emm1 sublineages in England comprising 13/27 (M113SNPs) and 23/27 SNPs (M123SNPs), respectively, that had failed to expand in the population. Proteomic analysis of invasive strains from the four phylogenetic emm1 groups highlighted sublineage-specific changes in carbohydrate metabolism, protein synthesis and protein processing; upregulation of SpeA was not observed in chemically defined medium. In rich broth, however, expression of SpeA was upregulated ~10-fold in both M123SNPs and M1UK sublineages, compared with M113SNPs and M1global. We conclude that stepwise accumulation of SNPs led to the emergence of M1UK. While increased expression of SpeA is a key indicator of M1UK and undoubtedly important, M1UK strains have outcompeted M123SNPs and other emm types that produce similar or more superantigen toxin. We speculate that an accumulation of adaptive SNPs has contributed to a wider fitness advantage ...

العلاقة: Microbial Genomics; http://hdl.handle.net/10044/1/103489Test

الإتاحة: https://doi.org/10.1099/mgen.0.000994Test
http://hdl.handle.net/10044/1/103489Test

المؤلفون: McGuire, E, Li, A, Collin, S, Decraene, V, Cook, M, Padfield, S, Sriskandan, S, Van Beneden, C, Lamagni, T, Brown, CS

المصدر: 19 ; 1

الوصف: Background: Public health guidance recommending isolation of individuals with group A streptococcal (GAS) infection or carriage for 12–24 h from antibiotic initiation to prevent onward transmission requires a strong evidence base. Aim: To estimate the pooled proportion of individuals who remain GAS culture-positive at set intervals after initiation of antibiotics through a systematic literature review (PROSPERO CRD42021290364) and meta-analysis. Methods: We searched Ovid MEDLINE (1946–), EMBASE (1974–) and Cochrane library. We included interventional or observational studies with ≥ 10 participants reporting rates of GAS throat culture positivity during antibiotic treatment for culture-confirmed GAS pharyngitis, scarlet fever and asymptomatic pharyngeal GAS carriage. We did not apply age, language or geographical restrictions. Results: Of 5,058 unique records, 43 were included (37 randomised controlled studies, three non-randomised controlled trials and three before-and-after studies). The proportion of individuals remaining culture-positive on day 1, day 2 and days 3–9 were 6.9% (95% CI: 2.7–16.8%), 5.4% (95% CI: 2.1–13.3%) and 2.6% (95% CI: 1.6–4.2%). For penicillins and cephalosporins, day 1 positivity was 6.5% (95% CI: 2.5–16.1%) and 1.6% (95% CI: 0.04–42.9%), respectively. Overall, for 9.1% (95% CI: 7.3–11.3), throat swabs collected after completion of therapy were GAS culture-positive. Only six studies had low risk of bias. Conclusions: Our review provides evidence that antibiotics for pharyngeal GAS achieve a high rate of culture conversion within 24 h but highlights the need for further research given methodological limitations of published studies and imprecision of pooled estimates. Further evidence is needed for non-beta-lactam antibiotics and asymptomatic individuals.

العلاقة: Eurosurveillance; http://hdl.handle.net/10044/1/103185Test

الإتاحة: https://doi.org/10.2807/1560-7917.ES.2023.28.15.2200573Test
http://hdl.handle.net/10044/1/103185Test

المؤلفون: Tanner, J., Brierley Jones, L., Rochon, M., Westwood, N., Wloch, C., Vaja, R., Rogers, L., Dearling, J., Wilson, K., Magboo, R., Aujla, H., Page, S., Whiting, P., Murphy, G., Brown, C., Lamagni, T., Harrington, P.

المصدر: Journal of Hospital Infection ; volume 141, page 112-118 ; ISSN 0195-6701

مصطلحات موضوعية: Infectious Diseases, Microbiology (medical), General Medicine

الإتاحة: https://doi.org/10.1016/j.jhin.2023.08.023Test
https://api.elsevier.com/content/article/PII:S0195670123002967?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0195670123002967?httpAccept=text/plainTest

المؤلفون: Sherwood, E, Vergnano, S, Kakuchi, I, Bruce, MG, Chaurasia, S, David, S, Dramowski, A, Georges, S, Guy, R, Lamagni, T, Levy-Bruhl, D, Lyytikäinen, O, Naus, M, Okaro, JO, Oppegaard, O, Vestrheim, DF, Zulz, T, Steer, AC, Van Beneden, CA, Seale, AC

الوصف: BACKGROUND: The incidence of invasive disease caused by group A streptococcus (GAS) has increased in multiple countries in the past 15 years. However, despite these reports, to the best of our knowledge, no systematic reviews and combined estimates of the incidence of invasive GAS have been done in key high-risk groups. To address this, we estimated the incidence of invasive GAS disease, including death and disability outcomes, among two high-risk groups-namely, pregnant women and children younger than 5 years. METHODS: We did a systematic review and meta-analyses on invasive GAS outcomes, including incidence, case fatality risks, and neurodevelopmental impairment risk, among pregnant women, neonates (younger than 28 days), infants (younger than 1 year), and children (younger than 5 years) worldwide and by income region. We searched several databases for articles published from Jan 1, 2000, to June 3, 2020, for publications that reported invasive GAS outcomes, and we sought unpublished data from an investigator group of collaborators. We included studies with data on invasive GAS cases, defined as laboratory isolation of Streptococcus pyogenes from any normally sterile site, or isolation of S pyogenes from a non-sterile site in a patient with necrotising fasciitis or streptococcal toxic shock syndrome. For inclusion in pooled incidence estimates, studies had to report a population denominator, and for inclusion in pooled estimates of case fatality risk, studies had to report aggregate data on the outcome of interest and the total number of cases included as a denominator. We excluded studies focusing on groups at very high risk (eg, only preterm infants). We assessed heterogeneity with I2. FINDINGS: Of the 950 published articles and 29 unpublished datasets identified, 20 studies (seven unpublished; 3829 cases of invasive GAS) from 12 countries provided sufficient data to be included in pooled estimates of outcomes. We did not identify studies reporting invasive GAS incidence among pregnant women in low-income ...

العلاقة: pii: S1473-3099(21)00672-1; Sherwood, E., Vergnano, S., Kakuchi, I., Bruce, M. G., Chaurasia, S., David, S., Dramowski, A., Georges, S., Guy, R., Lamagni, T., Levy-Bruhl, D., Lyytikäinen, O., Naus, M., Okaro, J. O., Oppegaard, O., Vestrheim, D. F., Zulz, T., Steer, A. C., Van Beneden, C. A. & Seale, A. C. (2022). Invasive group A streptococcal disease in pregnant women and young children: a systematic review and meta-analysis. Lancet Infect Dis, 22 (7), pp.1076-1088. https://doi.org/10.1016/S1473-3099Test(21)00672-1.; http://hdl.handle.net/11343/309221Test

الإتاحة: https://doi.org/10.1016/S1473-3099Test(21)00672-1
http://hdl.handle.net/11343/309221Test

المؤلفون: Miller, KM, Van Beneden, C, McDonald, M, Hla, TK, Wong, W, Pedgrift, H, Kaslow, DC, Cherian, T, Carapetis, JR, Scheel, A, Seale, A, Bowen, AC, Moore, HC, Lamagni, T, Rodriguez-Iturbe, B

الوصف: Acute poststreptococcal glomerulonephritis (APSGN) is an immune complex-induced glomerulonephritis that develops as a sequela of streptococcal infections. This article provides guidelines for the surveillance of APSGN due to group A Streptococcus (Strep A). The primary objectives of APSGN surveillance are to monitor trends in age- and sex-specific incidence, describe the demographic and clinical characteristics of patients with APSGN, document accompanying risk factors, then monitor trends in frequency of complications, illness duration, hospitalization rates, and mortality. This document provides surveillance case definitions for APSGN, including clinical and subclinical APSGN based on clinical and laboratory evidence. It also details case classifications that can be used to differentiate between confirmed and probable cases, and it discusses the current investigations used to provide evidence of antecedent Strep A infection. The type of surveillance recommended depends on the burden of APSGN in the community and the objectives of surveillance. Strategies for minimal surveillance and enhanced surveillance of APSGN are provided. Furthermore, a discussion covers the surveillance population and additional APSGN-specific surveillance considerations such as contact testing, active follow up of cases and contacts, frequency of reporting, surveillance visits, period of surveillance, and community engagement. Finally, the document presents core data elements to be collected on case report forms, along with guidance for documenting the course and severity of APSGN.

العلاقة: pii: ofac346; Miller, K. M., Van Beneden, C., McDonald, M., Hla, T. K., Wong, W., Pedgrift, H., Kaslow, D. C., Cherian, T., Carapetis, J. R., Scheel, A., Seale, A., Bowen, A. C., Moore, H. C., Lamagni, T. & Rodriguez-Iturbe, B. (2022). Standardization of Epidemiological Surveillance of Acute Poststreptococcal Glomerulonephritis. Open Forum Infect Dis, 9 (Suppl 1), pp.S57-S64. https://doi.org/10.1093/ofid/ofac346Test.; http://hdl.handle.net/11343/334485Test

الإتاحة: https://doi.org/10.1093/ofid/ofac346Test
http://hdl.handle.net/11343/334485Test

المؤلفون: Naylor, NR, Evans, S, Pouwels, KB, Troughton, R, Lamagni, T, Muller-Pebody, B, Knight, GW, Atun, R, Robotham, JV

الوصف: Antimicrobial resistance (AMR) may negatively impact surgery patients through reducing the efficacy of treatment of surgical site infections, also known as the ‘primary effects’ of AMR. Previous estimates of the burden of AMR have largely ignored the potential ‘secondary effects’, such as changes in surgical care pathways due to AMR, such as different infection prevention procedures or reduced access to surgical procedures altogether, with literature providing limited quantifications of this potential burden. Former conceptual models and approaches for quantifying such impacts are available, though they are often high-level and difficult to utilise in practice. We therefore expand on this earlier work to incorporate heterogeneity in antimicrobial usage, AMR, and causative organisms, providing a detailed decision-tree-Markov-hybrid conceptual model to estimate the burden of AMR on surgery patients. We collate available data sources in England and describe how routinely collected data could be used to parameterise such a model, providing a useful repository of data systems for future health economic evaluations. The wealth of national-level data available for England provides a case study in describing how current surveillance and administrative data capture systems could be used in the estimation of transition probability and cost parameters. However, it is recommended that such data are utilised in combination with expert opinion (for scope and scenario definitions) to robustly estimate both the primary and secondary effects of AMR over time. Though we focus on England, this discussion is useful in other settings with established and/or developing infectious diseases surveillance systems that feed into AMR National Action Plans.

العلاقة: https://ora.ox.ac.uk/objects/uuid:fed86e6b-9c11-4275-8769-731503a9bb89Test; https://doi.org/10.3389/fpubh.2022.803943Test

الإتاحة: https://doi.org/10.3389/fpubh.2022.803943Test
https://ora.ox.ac.uk/objects/uuid:fed86e6b-9c11-4275-8769-731503a9bb89Test

المؤلفون: Cordery, R, Reeves, L, Zhou, J, Rowan, A, Watber, P, Rosadas, C, Crone, M, Storch, M, Freemont, P, Mosscrop, L, Cowley, A, Zelent, G, Bisset, K, Le Blond, H, Regmi, S, Buckingham, C, Junaideen, R, Abdulla, N, Eliahoo, J, Mindlin, M, Lamagni, T, Barclay, W, Taylor, GP, Sriskandan, S

الوصف: BACKGROUND: Assessing transmission of SARS-CoV-2 by children in schools is of crucial importance to inform public health action. We assessed frequency of acquisition of SARS-CoV-2 by contacts of pupils with COVID-19 in schools and households, and quantified SARS-CoV-2 shedding into air and onto fomites in both settings. METHODS: We did a prospective cohort and environmental sampling study in London, UK in eight schools. Schools reporting new cases of SARS-CoV-2 infection to local health protection teams were invited to take part if a child index case had been attending school in the 48 h before a positive SARS-CoV-2 PCR test. At the time of the study, PCR testing was available to symptomatic individuals only. Children aged 2-14 years (extended to <18 years in November, 2020) with a new nose or throat swab SARS-CoV-2 positive PCR from an accredited laboratory were included. Incidents involving exposure to at least one index pupil with COVID-19 were identified (the prevailing variants were original, α, and δ). Weekly PCR testing for SARS-CoV-2 was done on immediate classroom contacts (the so-called bubble), non-bubble school contacts, and household contacts of index pupils. Testing was supported by genome sequencing and on-surface and air samples from school and home environments. FINDINGS: Between October, 2020, and July, 2021 from the eight schools included, secondary transmission of SARS-CoV-2 was not detected in 28 bubble contacts, representing ten bubble classes (participation rate 8·8% [IQR 4·6-15·3]). Across eight non-bubble classes, 3 (2%) of 62 pupils tested positive, but these were unrelated to the original index case (participation rate 22·5% [9·7-32·3]). All three were asymptomatic and tested positive in one setting on the same day. In contrast, secondary transmission to previously negative household contacts from infected index pupils was found in six (17%) of 35 household contacts rising to 13 (28%) of 47 household contacts when considering all potential infections in household contacts. ...

وصف الملف: application/pdf

العلاقة: https://openaccess.sgul.ac.uk/id/eprint/114744/1/1-s2.0-S2666524722001240-main.pdfTest; https://openaccess.sgul.ac.uk/id/eprint/114744/6/1-s2.0-S2666524722001240-mmc1.pdfTest; Cordery, R; Reeves, L; Zhou, J; Rowan, A; Watber, P; Rosadas, C; Crone, M; Storch, M; Freemont, P; Mosscrop, L; et al. Cordery, R; Reeves, L; Zhou, J; Rowan, A; Watber, P; Rosadas, C; Crone, M; Storch, M; Freemont, P; Mosscrop, L; Cowley, A; Zelent, G; Bisset, K; Le Blond, H; Regmi, S; Buckingham, C; Junaideen, R; Abdulla, N; Eliahoo, J; Mindlin, M; Lamagni, T; Barclay, W; Taylor, GP; Sriskandan, S (2022) Transmission of SARS-CoV-2 by children to contacts in schools and households: a prospective cohort and environmental sampling study in London. Lancet Microbe, 3 (11). e814-e823. ISSN 2666-5247 https://doi.org/10.1016/S2666-5247Test(22)00124-0 SGUL Authors: Mindlin, Miranda Juliet

الإتاحة: https://doi.org/10.1016/S2666-5247Test(22)00124-0
https://openaccess.sgul.ac.uk/id/eprint/114744Test/
https://openaccess.sgul.ac.uk/id/eprint/114744/1/1-s2.0-S2666524722001240-main.pdfTest
https://openaccess.sgul.ac.uk/id/eprint/114744/6/1-s2.0-S2666524722001240-mmc1.pdfTest