Modeling the impact of health care worker masking to reduce nosocomial SARS-CoV-2 transmission under varying adherence, prevalence, and transmission settings.

Objectives: To understand the scenarios where health care worker (HCW) masking is most impactful for preventing nosocomial transmission.

Methods: A mathematical agent-based model of nosocomial spread with masking interventions. Masking adherence, community prevalence, disease transmissibility, masking effectiveness, and proportion of breakroom (unmasked) interactions were varied.

The global economic burden of antibiotic-resistant infections and the potential impact of bacterial vaccines: a modelling study.

Introduction: Antibiotic resistance (ABR) may increase hospital costs, utility loss and mortality risk per patient. Understanding these losses at national, regional and global scales is necessary for efficiently tackling ABR. Our aim is to estimate the global economic burden of antibiotic-resistant infections and the potential for bacterial vaccines to mitigate this burden.

Antimicrobial Resistance (AMR) Development Map: A Conceptual Map and a Tool to Support Economic Evaluation of AMR Interventions.

Introduction: Antimicrobial resistance (AMR) is a complex, inter-sectoral and international problem. Economic evaluation (EE) methods offer systematic, evidence-driven approaches to inform policy decisions about which AMR interventions to fund. EE of AMR interventions is complicated owing to diffuse effects, complex mechanics of the problem and high levels of uncertainty.

The NOSTRA model: Coherent estimation of infection sources in the case of possible nosocomial transmission.

Nosocomial, or hospital-acquired, infections are a key determinant of patient health in healthcare facilities, leading to longer stays and increased mortality. In addition to the direct effects on infected patients, the burden imposed by nosocomial infections impacts both staff and other patients by increasing the load on the healthcare system. The appropriate infection control response may differ depending on whether the infection was acquired in the hospital or the community.

Plasmid conjugation drives within-patient plasmid diversity.

Plasmids are well-known vehicles of antimicrobial resistance (AMR) gene dissemination. Through conjugation, plasmid-encoded AMR genes are spread among neighbouring bacteria, irrespective of their strain or even their species. This process is very concerning from a public health perspective, as plasmid-borne AMR gene outbreaks are often not confined to single species or strains and are therefore more difficult to fully uncover.

Economic Evaluation of Interventions to Reduce Antimicrobial Resistance: A Systematic Literature Review of Methods.

Background And Objective: Economic evaluation of antimicrobial resistance (AMR) interventions is complicated by the multisectoral, inter-temporal and international aspects of the problem, further hindered by a lack of available data and theoretical understanding of the emergence and transmission of AMR. Despite the substantial global focus on the problem, there is a lack of comprehensive economic evaluation literature on AMR policies. The goal of this work is to review the available literature on the economic evaluation of AMR interventions focusing on methods used to quantify the effects on AMR and the associated health consequences and costs.

General practice antibiotic prescriptions attributable to respiratory syncytial virus by age and antibiotic class: an ecological analysis of the English population.

Background: Respiratory syncytial virus (RSV) may contribute to a substantial volume of antibiotic prescriptions in primary care. However, data on the type of antibiotics prescribed for such infections are only available for children <5 years in the UK. Understanding the contribution of RSV to antibiotic prescribing would facilitate predicting the impact of RSV preventative measures on antibiotic use and resistance.

How to: share and reuse data-challenges and solutions from predicting the impact of monoclonal antibodies & vaccines on antimicrobial resistance project.

Background: Data sharing accelerates scientific progress and improves evidence quality. Even though journals and funding institutions require investigators to share data, only a small part of studies made their data publicly available upon publication. The procedures necessary to share retrospective data for reuse in secondary data analysis projects can be cumbersome.

Rapid antibiotic susceptibility testing for urinary tract infections in secondary care in England: a cost-effectiveness analysis.

Objectives: To perform a model-based cost-effectiveness evaluation of a rapid antimicrobial susceptibility test.

Design: A Markov model of a cohort of hospital inpatients with urinary tract infection (with inpatient numbers based on national administrative data from 1 April 2017 to 31 March 2019).

Setting: Urinary tract infections (UTI) in acute National Health Service (NHS) Trusts in England, from the perspective of the NHS Healthcare system, at a national level.

Expert consensus on antimicrobial resistance research priorities to focus development and implementation of antibacterial vaccines and monoclonal antibodies.

To reduce antimicrobial resistance (AMR), pathogen-specific AMR burden data are crucial to guide target selection for research and development of vaccines and monoclonal antibodies (mAbs). We identified knowledge gaps through previously conducted systematic reviews, which informed a Delphi expert consultation on future AMR research priorities and harmonisation strategies to support data-driven decision-making. Consensus (≥80% agreement) on importance and feasibility of research topics was achieved in two rounds, involving 24 of 39 and 19 of 24 invited experts, respectively.

Risk of unintended consequences from lower antibiotic prescribing for respiratory tract infections in primary care.

Objectives: About 60% of antibiotic prescribing in primary care is for respiratory tract infections (RTIs), some of which is likely unnecessary. There is limited evidence on the association between reduced antibiotic prescribing and adverse events. We aimed to identify associations between practice-level prescribing rates for RTIs in general practice, and patient-level adverse outcomes.

Impact of interventions to reduce nosocomial transmission of SARS-CoV-2 in English NHS Trusts: a computational modelling study.

Background: Prior to September 2021, 55,000-90,000 hospital inpatients in England were identified as having a potentially nosocomial SARS-CoV-2 infection. This includes cases that were likely missed due to pauci- or asymptomatic infection. Further, high numbers of healthcare workers (HCWs) are thought to have been infected, and there is evidence that some of these cases may also have been nosocomially linked, with both HCW to HCW and patient to HCW transmission being reported.

Antimicrobial resistance prevalence in bloodstream infection in 29 European countries by age and sex: An observational study.

Background: Antibiotic usage, contact with high transmission healthcare settings as well as changes in immune system function all vary by a patient's age and sex. Yet, most analyses of antimicrobial resistance (AMR) ignore demographic indicators and provide only country-level resistance prevalence values. This study aimed to address this knowledge gap by quantifying how resistance prevalence and incidence of bloodstream infection (BSI) varied by age and sex across bacteria and antibiotics in Europe.

The effectiveness and efficiency of asymptomatic SARS-CoV-2 testing strategies for patient and healthcare workers within acute NHS hospitals during an omicron-like period.

Background: Asymptomatic SARS-CoV-2 testing of hospitalised patients began in April-2020, with twice weekly healthcare worker (HCW) testing introduced in November-2020. Guidance recommending asymptomatic testing was withdrawn in August-2022. Assessing the impact of this decision from data alone is challenging due to concurrent changes in infection prevention and control practices, community transmission rates, and a reduction in ascertainment rate from reduced testing.

Evaluating pooled testing for asymptomatic screening of healthcare workers in hospitals.

Background: There is evidence that during the COVID pandemic, a number of patient and HCW infections were nosocomial. Various measures were put in place to try to reduce these infections including developing asymptomatic PCR (polymerase chain reaction) testing schemes for healthcare workers. Regularly testing all healthcare workers requires many tests while reducing this number by only testing some healthcare workers can result in undetected cases.

Model-based evaluation of admission screening strategies for the detection and control of carbapenemase-producing Enterobacterales in the English hospital setting.

Background: Globally, detections of carbapenemase-producing Enterobacterales (CPE) colonisations and infections are increasing. The spread of these highly resistant bacteria poses a serious threat to public health. However, understanding of CPE transmission and evidence on effectiveness of control measures is severely lacking.

Evaluating the impact of testing strategies for the detection of nosocomial COVID-19 in English hospitals through data-driven modeling.

Introduction: During the first wave of the COVID-19 pandemic 293,204 inpatients in England tested positive for SARS-CoV-2. It is estimated that 1% of these cases were hospital-associated using European centre for disease prevention and control (ECDC) and Public Health England (PHE) definitions. Guidelines for preventing the spread of SARS-CoV-2 in hospitals have developed over time but the effectiveness and efficiency of testing strategies for preventing nosocomial transmission has not been explored.

The burden and dynamics of hospital-acquired SARS-CoV-2 in England.

Hospital-based transmission had a dominant role in Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) epidemics, but large-scale studies of its role in the SARS-CoV-2 pandemic are lacking. Such transmission risks spreading the virus to the most vulnerable individuals and can have wider-scale impacts through hospital-community interactions. Using data from acute hospitals in England, we quantify within-hospital transmission, evaluate likely pathways of spread and factors associated with heightened transmission risk, and explore the wider dynamical consequences.

A systematic review on the excess health risk of antibiotic-resistant bloodstream infections for six key pathogens in Europe.

Background: Antimicrobial resistance is a global threat, which requires novel intervention strategies, for which priority pathogens and settings need to be determined.

Objectives: We evaluated pathogen-specific excess health burden of drug-resistant bloodstream infections (BSIs) in Europe.

Methods: A systematic review and meta-analysis.

Impact of testing on Clostridioides difficile infection in hospitals across Europe: a mathematical model.

Objectives: The prevalence of Clostridioides difficile infection (CDI) has been shown to vary markedly between European countries, both in hospitals and in the community. Determining the true prevalence has proven challenging. Without systematic testing in hospitals, the unchecked transmission of CDI can lead to large outbreaks in more susceptible cohorts.