Management of patients with suspected infectious diarrhoea in hospitals in England

Buchanan, James; Wordsworth, Sarah; O’Connor, Lily; Pike, Graham; Walker, A.S.; Wilcox, Mark H.; Crook, Derrick W.

doi:10.1016/j.jhin.2014.12.021

Cited by 4 publications

(5 citation statements)

References 10 publications

(8 reference statements)

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“…Thus, the model is limited to the initial index episode and does not consider readmissions. Buchanan et al 84 stated that 10% of patients who have been discharged on antibiotics for infectious diarrhoea from hospital before a full course of treatment has been completed will be readmitted within 14 days of discharge. l We have not considered the management of outbreaks, as this was excluded from the scope of work.…”

Section: Health Economic Methods and Resultsmentioning

confidence: 99%

Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis

Freeman

Mistry

Tsertsvadze

et al. 2017

Health Technol Assess

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Background Gastroenteritis is a common, transient disorder usually caused by infection and characterised by the acute onset of diarrhoea. Multiplex gastrointestinal pathogen panel (GPP) tests simultaneously identify common bacterial, viral and parasitic pathogens using molecular testing. By providing test results more rapidly than conventional testing methods, GPP tests might positively influence the treatment and management of patients presenting in hospital or in the community. Objective To systematically review the evidence for GPP tests [xTAG® (Luminex, Toronto, ON, Canada), FilmArray (BioFire Diagnostics, Salt Lake City, UT, USA) and Faecal Pathogens B (AusDiagnostics, Beaconsfield, NSW, Australia)] and to develop a de novo economic model to compare the cost-effectiveness of GPP tests with conventional testing in England and Wales. Data sources Multiple electronic databases including MEDLINE, EMBASE, Web of Science and the Cochrane Database were searched from inception to January 2016 (with supplementary searches of other online resources). Review methods Eligible studies included patients with acute diarrhoea; comparing GPP tests with standard microbiology techniques; and patient, management, test accuracy or cost-effectiveness outcomes. Quality assessment of eligible studies used tailored Quality Assessment of Diagnostic Accuracy Studies-2, Consolidated Health Economic Evaluation Reporting Standards and Philips checklists. The meta-analysis included positive and negative agreement estimated for each pathogen. A de novo decision tree model compared patients managed with GPP testing or comparable coverage with patients managed using conventional tests, within the Public Health England pathway. Economic models included hospital and community management of patients with suspected gastroenteritis. The model estimated costs (in 2014/15 prices) and quality-adjusted life-year losses from a NHS and Personal Social Services perspective. Results Twenty-three studies informed the review of clinical evidence (17 xTAG, four FilmArray, two xTAG and FilmArray, 0 Faecal Pathogens B). No study provided an adequate reference standard with which to compare the test accuracy of GPP with conventional tests. A meta-analysis (of 10 studies) found considerable heterogeneity; however, GPP testing produces a greater number of pathogen-positive findings than conventional testing. It is unclear whether or not these additional ‘positives’ are clinically important. The review identified no robust evidence to inform consequent clinical management of patients. There is considerable uncertainty about the cost-effectiveness of GPP panels used to test for suspected infectious gastroenteritis in hospital and community settings. Uncertainties in the model include length of stay, assumptions about false-positive findings and the costs of tests. Although there is potential for cost-effectiveness in both settings, key modelling assumptions need to be verified and model findings remain tentative. Limitations No test–treat trials were retrieved. The economic model reflects one pattern of care, which will vary across the NHS. Conclusions The systematic review and cost-effectiveness model identify uncertainties about the adoption of GPP tests within the NHS. GPP testing will generally correctly identify pathogens identified by conventional testing; however, these tests also generate considerable additional positive results of uncertain clinical importance. Future work An independent reference standard may not exist to evaluate alternative approaches to testing. A test–treat trial might ascertain whether or not additional GPP ‘positives’ are clinically important or result in overdiagnoses, whether or not earlier diagnosis leads to earlier discharge in patients and what the health consequences of earlier intervention are. Future work might also consider the public health impact of different testing treatments, as test results form the basis for public health surveillance. Study registration This study is registered as PROSPERO CRD2016033320. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Health Economic Methods and Resultsmentioning

confidence: 99%

Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis

Freeman

Mistry

Tsertsvadze

et al. 2017

Health Technol Assess

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“…2 A recent report from English hospitals underlined the weak percentage of stools testing with a targeted pathogen demand (20.2%) and the better infection control practices when the infectious status of diarrhea was confirmed. 8 These data supported the implementation of a laboratory-based nucleic acid amplification test strategy. Our PCR assays are based on a userfriendly platform allowing a random-access PCR-based diagnosis of numerous infectious agents without technical skills requirement.…”

Section: Discussionmentioning

confidence: 75%

“…1,7 Rapid diagnostic tests are recommended to support clinical decision, but stool testing practices vary across facilities. 8 In the present instance the availability of a rapid and sensitive nucleic acid amplification test could limit the risk of cross-transmission.…”

Section: Discussionmentioning

confidence: 98%

Laboratory-based strategy using a new marketed polymerase chain reaction assay to manage diarrheic episodes among patients from rehabilitation and long-term care facilities

Salmona

Jolivet

Duprilot

et al. 2016

American Journal of Infection Control

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Management of Norovirus and Clostridium difficile gastroenteritis is challenging for rehabilitation and long-term care facilities. We evaluated the contribution of a 2-step laboratory-based strategy, including a new ready-to-use Norovirus polymerase chain reaction assay to promote isolation precautions. C difficile and Norovirus were successively identified from 17% and 23% of 52 episodes of diarrhea, respectively, during the winter season, leading to 100% adequate isolation measures. In patient populations with numerous risk factors for diarrhea, a combined laboratory-based approach could improve infection control.

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“…Consequential spread of infectious diarrhoea caused by Clostridium difficile is reported to be a major concern in hospitals. In a 2015 study, 18 the mean number of patients suspected to be infected with these organisms was estimated to be 149.6 ± 173.6 in small hospitals, 75.0 ± 27.8 in medium hospitals and 43.78 ± 37.7 in large hospitals. In order to treat patients with diarrhoea that resulted from Clostridum difficile infection, metronidazole and fidaxomicin were the primary antimicrobial agents used while vancomycin was the secondary drug of choice.…”

Section: Antibiotic Use In Uk Human Medicinementioning

confidence: 99%

“…In order to treat patients with diarrhoea that resulted from Clostridum difficile infection, metronidazole and fidaxomicin were the primary antimicrobial agents used while vancomycin was the secondary drug of choice. 18 One concern that emerged from the study was that with the increasing incidence there was the possible spread of infections due to poor infection control practices. Without adequate infection control, the risk of the emergence of antimicrobial resistant Clostridium difficile increases.…”

Section: Antibiotic Use In Uk Human Medicinementioning

confidence: 99%

Infection control in the UK: an antimicrobial resistance perspective

Henry

Collins

Bird

et al. 2017

Int. j. infect. control

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The spread of healthcare-associated infections has become a matter of global concern. These infections, which were once isolated to hospital settings, have emerged in the community. Reduced infection control practices are a major cause of this rapid spread of infections, which has led to the increase in the occurrence of multi-drug resistant organisms. The state of infection control in the United Kingdom is of extreme importance because of several reported cases of infections caused by these organisms. In addition to antimicrobial usage in human medicine, antimicrobial agents used in agriculture must be considered as major factors in the prevalence of resistant organisms and the implications to the UK. However, this increased occurrence of antimicrobial resistant bacteria and their resulting infections could be reduced with the application of effective policies for antibiotic use in agricultural environments, stringent decontamination and sterilisation techniques and better regulations that encourage the search for, and development of, new and novel drugs.

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Management of patients with suspected infectious diarrhoea in hospitals in England

Cited by 4 publications

References 10 publications

Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis

Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis

Laboratory-based strategy using a new marketed polymerase chain reaction assay to manage diarrheic episodes among patients from rehabilitation and long-term care facilities

Infection control in the UK: an antimicrobial resistance perspective

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