An Electronic Health Record-Wide Association Study to identify populations at increased risk of E. coli bloodstream infections.

Objectives: Escherichia coli bacteraemias have been under mandatory surveillance in the UK for fifteen years, but cases continue to rise. Systematic searches of all features present within electronic healthcare records (EHRs), described here as an EHR-wide association study (EHR-WAS), could potentially identify under-appreciated factors that could be targeted to reduce infections.

Methods: We used data from Oxfordshire, UK, and an EHR-WAS method developed for use with large-scale COVID-19 data to estimate associations between E.

A pilot protocol for surveillance of infection and antibiotic prescribing in primary healthcare across the globe: Antibiotic Prescribing in Primary Healthcare Point Prevalence Survey (APC-PPS).

Little data is available from the primary healthcare setting in low- and middle-income countries to describe the burden of clinical infections and antibiotic prescribing proportions for those infections. The AWaRe Antibiotic Book provides a framework for assessing antibiotic prescribing in primary healthcare but requires understanding both frequency of clinical infections and their antibiotic prescribing proportions. The Antibiotic Prescribing in Primary Healthcare Point Prevalence Survey (APC-PPS) project is a series of point prevalence surveys conducted at primary healthcare facilities in LMICs to capture the frequency of consultation for different clinical infections and diagnoses and the frequency and type of antibiotic prescribing associated with these infections in primary healthcare facilities.

Nomenclature, definitions, and methodological approaches to estimate the association between antimicrobial treatment and clinical outcomes of drug-resistant bloodstream infections.

Background: Antimicrobial resistance increases the risk of misaligned initial antibiotic treatment (IAT), as susceptibility data are typically delayed. The causal effect on patient outcomes, however, is unclear due to reliance on observational studies with methodological heterogeneity.

Objectives: To describe the terminology and definitions for IAT misalignment and evaluate methods used to analyse its association with mortality and hospital length of stay (LOS) for patients with drug-resistant bloodstream infections (BSIs).

Uncertainty quantification in cost-effectiveness analysis for stochastic-based infectious disease models: Insights from surveillance on lymphatic filariasis.

Cost-effectiveness analyses (CEA) typically involve comparing the effectiveness and costs of one or more interventions compared to the standard of care, in order to determine which intervention should be optimally implemented to maximise population health within the constraints of the healthcare budget. Traditionally, cost-effectiveness evaluations are expressed using incremental cost-effectiveness ratios (ICERs), which are compared with a fixed willingness-to-pay (WTP) threshold. Due to the inherent uncertainty in intervention costs and the overall burden of disease, particularly with regard to diseases in populations that are difficult to study, it becomes important to consider uncertainty quantification while estimating ICERs.

Identification of undetected SARS-CoV-2 infections by clustering of Nucleocapsid antibody trajectories.

During the COVID-19 pandemic, numerous SARS-CoV-2 infections remained undetected. We combined results from routine monthly nose and throat swabs, and self-reported positive swab tests, from a UK household survey, linked to national swab testing programme data from England and Wales, together with Nucleocapsid (N-)antibody trajectories clustered using a longitudinal variation of K-means (N = 185,646) to estimate the number of infections undetected by either approach. Using N-antibody (hypothetical) infections and swab-positivity, we estimated that 7.

Health impact and economic evaluation of the Expanded Program on Immunization in China from 1974 to 2024: a modelling study.

Background: The Expanded Program on Immunization (EPI), initiated by WHO in 1974, is a cornerstone of public health. China's EPI covers more than a sixth of the world's population and includes eight routine vaccines with high coverage rates. This study aimed to estimate health and economic impacts of China's EPI over the past 50 years (1974-2024).

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.

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.

Detecting changes in population trends in infection surveillance using community SARS-CoV-2 prevalence as an exemplar.

Detecting and quantifying changes in the growth rates of infectious diseases is vital to informing public health strategy and can inform policymakers' rationale for implementing or continuing interventions aimed at reducing their impact. Substantial changes in SARS-CoV-2 prevalence with the emergence of variants have provided an opportunity to investigate different methods for doing this. We collected polymerase chain reaction (PCR) results from all participants in the United Kingdom's COVID-19 Infection Survey between August 1, 2020, and June 30, 2022.

Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection.

Objectives: To identify patterns in inflammatory marker and vital sign responses in adult with suspected bloodstream infection (BSI) and define expected trends in normal recovery.

Methods: We included patients ≥16 y from Oxford University Hospitals with a blood culture taken between 1-January-2016 and 28-June-2021. We used linear and latent class mixed models to estimate trajectories in C-reactive protein (CRP), white blood count, heart rate, respiratory rate and temperature and identify CRP response subgroups.

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.