Inappropriate PPI prescribing is common in frail older hospitalized patients, and might increase the risk of drug-drug interactions. Polypharmacy and comorbidity were independently associated with inappropriate PPI prescribing in this group.

No abstract

During the first wave of the COVID-19 pandemic in spring, 2020, 22% of infants in the WHO European Region had their vaccination courses interrupted. 3 A drop in vaccination rates of almost 20% during the first UK lockdown was reported in England. 4 However, in Lothian, attendance at childhood immunisation clinics remained stable in the weeks during lockdown (appendix).When the Scottish Vaccination Transformation Programme was designed in 2018, a strong emphasis was placed on the needs of children and adults who require vaccinations. 5 This programme provided the foundation for local adaptations to immunisation efforts by the childhood immunisation team in Lothian during the first wave of the COVID-19 pandemic. Several adaptations had an important role in keeping attendance rates stable.First, vaccinations were delivered via fixed-point clinics at various locations that were accessible by public transport. Children who could not attend clinics owing to shielding could be vaccinated by mobile teams. All vaccinations were delivered with appropriate personal protective equipment in place, in line with guidance at the time.Second, changes were made to how data were collected. All vaccination data are held centrally in the Scottish Immunisation Recall System. Public Health Scotland collects and publishes vaccination uptake data for Scotland. 2 Data published in previous years began with vaccinations completed when children reached 12 months of age. By contrast, during the pandemic, much shorter periods of time were required to monitor immunisation clinic attendance (appendix) and uptake of vaccinations.Third, efforts were made to establish trust and ensure that children and their families felt looked after. All families received a personal reminder via telephone from a trained operator on Methodology.

Xpert MTB/RIF was rapid and accurate in diagnosing pulmonary TB in a low prevalence area. Rapid results will influence infection prevention and control and treatment measures. The excellent NPV obtained suggests further work should be carried out to assess its role in replacing microscopy.

Background An increase in infections with non-tuberculous mycobacteria (NTM) has been noted globally and their incidence has overtaken that of Mycobacterium tuberculosis complex (MTBc) in many countries. Using data from a national reference laboratory, we aimed to determine if this trend was observed in Scotland. Methods We undertook a retrospective review of all NTM isolates received by the Scottish Mycobacteria Reference Laboratory (SMRL) over 9 years from 2011 to 2019 inclusive. Clinical episodes were defined as per 2017 BTS and 2020 ATS/ERS/ESCMID/IDSA NTM guidelines. These rates were compared with Scottish tuberculosis rates over the same period. Results Of 8552 NTM isolates from 4586 patients in 2011 to 2019, 7739 (90.5%) were considered clinically relevant. These represented 2409 episodes of NTM infection, with M. avium, M. intracellulare and M. abscessus complex being most common. 1953 (81.1%) were pulmonary NTM infection episodes from 1470 patients and 456 extra-pulmonary episodes from 370 patients. We estimated a rise in incidence from 3.4 to 6.5 per 100,000 person-years (2011-2019 inclusive) with an increase in NTM incidence over MTBc incidence in Scotland by 2017. Conclusion The incidence of NTM infection in Scotland has overtaken MTBc incidence. NTM infection leads to a costly healthcare burden, possibly as much as UK £1.47 million (US$ and Euro 1.73 million) annually. We recommend standardisation of isolate referral with clinical surveillance and implementation of agreed standards of care delivered through multi-disciplinary teams. This would improve diagnosis and patient management as well as assessment of diagnostics and novel treatments through clinical trials.

Background Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse. Methods A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further. Results Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was −0.19 (95 per cent c.i. −0.39 to −0.12) and − 0.01 (− 0.17 to −0.03) respectively. Conclusion Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, although these require external validation.

This review seeks to inform clinicians how Whole Genome Sequencing could be used to improve GBS detection and antibiotic choices in the routine management of patients. It also describes the role of WGS in the detection and management outbreaks involving GBS.