Browsing by Author "M. Estée Török"

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    Comparison of two chromogenic media for the detection of vancomycin-resistant enterococcal carriage by nursing home residents
    (2016-08-01) Theodore Gouliouris; Beth Blane; Hayley J. Brodrick; Kathy E. Raven; Kirsty E. Ambridge; Angela D. Kidney; Nazreen F. Hadjirin; M. Estée Török; Direk Limmathurotsakul; Sharon J. Peacock; University of Cambridge; Public Health England; Cambridge University Hospitals NHS Foundation Trust; Mahidol University; London School of Hygiene & Tropical Medicine
    © 2016 The Authors We compared ChromID VRE and Brilliance VRE media for the detection of vancomycin-resistant enterococci (VRE). Using a panel of 28 enterococcal isolates, 10 vanA Enterococcus faecium and three vanA Enterococcus faecalis isolates grew as per manufacturers’ instructions whilst growth of two vanC and eight vancomycin-susceptible enterococci was inhibited on both media. Important differences were noted in the selectivity and chromogenic properties of the two media for vanA Enterococcus raffinosus and vanB E. faecium. The two media were further evaluated using 295 stool samples from nursing home residents, 34 of which grew VRE (11.5%). ChromID and Brilliance had comparable sensitivity, which was increased markedly by prolonging incubation to 48 hours (from 29% to 82%, and from 41% to 85%, respectively) and by a pre-enrichment step (to 97% and 100%, respectively). Brilliance VRE agar had higher selectivity at 48 hours, and after pre-enrichment.
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    Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: A nested case-control study
    (2018-06-01) Theodore Gouliouris; Ben Warne; Edward J.P. Cartwright; Luke Bedford; Chathika K. Weerasuriya; Kathy E. Raven; Nick M. Brown; M. Estée Török; Direk Limmathurotsakul; Sharon J. Peacock; Public Health England; London School of Hygiene & Tropical Medicine; University of Cambridge; Cambridge University Hospitals NHS Foundation Trust; Mahidol University
    © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Background: VRE bacteraemia has a high mortality and continues to defy control. Antibiotic risk factors for VRE bacteraemia have not been adequately defined. We aimed to determine the risk factors for VRE bacteraemia focusing on duration of antibiotic exposure. Methods: A retrospective matched nested case-control study was conducted amongst hospitalized patients at Cambridge University Hospitals NHS Foundation Trust (CUH) from 1 January 2006 to 31 December 2012. Cases who developed a first episode of VRE bacteraemia were matched 1:1 to controls by length of stay, year, specialty and ward type. Independent risk factors for VRE bacteraemia were evaluated using conditional logistic regression. Results: Two hundred and thirty-five cases were compared with 220 controls. Duration of exposure to parenteral vancomycin, fluoroquinolones and meropenem was independently associated with VRE bacteraemia. Compared with patients with no exposure to vancomycin, those who received courses of 1-3 days, 4-7 days or.7 days had a stepwise increase in risk of VRE bacteraemia [conditional OR (cOR) 1.2 (95% CI 0.4-3.8), 3.8 (95% CI 1.2-11.7) and 6.6 (95% CI 1.9-22.8), respectively]. Other risk factors were: presence of a central venous catheter (CVC) [cOR 8.7 (95% CI 2.6-29.5)]; neutropenia [cOR 15.5 (95% CI 4.2-57.0)]; hypoalbuminaemia [cOR 8.5 (95% CI 2.4-29.5)]; malignancy [cOR 4.4 (95% CI 1.6-12.0)]; gastrointestinal disease [cOR 12.4 (95% CI 4.2-36.8)]; and hepatobiliary disease [cOR 7.9 (95% CI 2.1-29.9)]. Conclusions: Longer exposure to vancomycin, fluoroquinolones or meropenemwas associated with VRE bacteraemia. Antimicrobial stewardship interventions targeting high-risk antibiotics are required to complement infection control procedures against VRE bacteraemia.
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    Impact of infectious diseases consultation on the management of Staphylococcus aureus bacteraemia in children
    (2014-01-01) Rebecca B. Saunderson; Theodore Gouliouris; Edward J. Cartwright; Emma J. Nickerson; Sani H. Aliyu; D. Roddy O'Donnell; Wilf Kelsall; D. Limmathurotsakul; Sharon J. Peacock; M. Estée Török; University of Cambridge; Cambridge University Hospitals NHS Foundation Trust; Public Health England; Mahidol University; Wellcome Trust Sanger Institute
    Objectives: Infectious diseases consultation (IDC) in adults with Staphylococcus aureus bacteraemia (SAB) has been shown to improve management and outcome. The aim of this study was to evaluate the impact of IDC on the management of SAB in children. Study design: Observational cohort study of children with SAB. Setting: Cambridge University Hospitals National Health Service (NHS) Foundation Trust, a large acute NHS Trust in the UK. Participants: All children with SAB admitted to the Cambridge University Hospitals NHS Foundation Trust between 16 July 2006 and 31 December 2012. Methods: Children with SAB between 2006 and 31 October 2009 were managed by routine clinical care (pre-IDC group) and data were collected retrospectively by case notes review. An IDC service for SAB was introduced in November 2009. All children with SAB were reviewed regularly and data were collected prospectively (IDC group) until 31 December 2012. Baseline characteristics, quality metrics and outcome were compared between the pre-IDC group and IDC group. Results: There were 66 episodes of SAB in 63 children - 28 patients (30 episodes) in the pre-IDC group, and 35 patients (36 episodes) in the IDC group. The median age was 3.4 years (IQR 0.2-10.7 years). Patients in the IDC group were more likely to have echocardiography performed, a removable focus of infection identified and to receive a longer course of intravenous antimicrobial therapy. There were no differences in total duration of antibiotic therapy, duration of hospital admission or outcome at 30 or 90 days following onset of SAB. Conclusions: IDC resulted in improvements in the investigation and management of SAB in children.
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    Valacyclovir for herpes simplex encephalitis
    (2011-07-01) Thomas Pouplin; Julie Nguyen Pouplin; Pham Van Toi; Niklas Lindegardh; H. Rogier Van Doorn; Tran Tinh Hien; Jeremy Farrar; M. Estée Török; Tran Thi Hong Chau; UCL; Cambridge University Hospitals NHS Foundation Trust; Mahidol University
    The recommended treatment for herpes simplex encephalitis (HSE) remains intravenous acyclovir. In resource-poor countries, however, intravenous formulations are usually unavailable or unaffordable. We report the penetration of acyclovir into the cerebrospinal fluid (CSF) in patients with HSE, treated with the oral prodrug valacyclovir at 1,000 mg three times daily. The oral therapy achieved adequate acyclovir concentrations in the CSF and may be an acceptable early treatment for suspected HSE in resource-limited settings. Copyright © 2011, American Society for Microbiology. All Rights Reserved.
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    Zero tolerance for healthcare-associated MRSA bacteraemia: Is it realistic?
    (2014-01-01) M. Estée Török; Simon R. Harris; Edward J.P. Cartwright; Kathy E. Raven; Nicholas M. Brown; Michael E.D. Allison; Daniel Greaves; Michael A. Quail; Direk Limmathurotsakul; Matthew T.G. Holden; Julian Parkhill; Sharon J. Peacock; University of Cambridge; Cambridge University Hospitals NHS Foundation Trust; Public Health England; Wellcome Trust Sanger Institute; Mahidol University
    Background: The term 'zero tolerance' has recently been applied to healthcare-associated infections, implying that such events are always preventable. This may not be the case for healthcare-associated infections such as methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Methods:We combined information froman epidemiological investigation and bacterialwhole-genome sequencing to evaluate a cluster of five MRSA bacteraemia episodes in four patients in a specialist hepatology unit. Results: The five MRSA bacteraemia isolates were highly related bymultilocus sequence type (ST) (four isolates were ST22 and one isolate was a single-locus variant, ST2046). Whole-genome sequencing demonstrated unequivocally that the bacteraemia cases were unrelated. Placing the MRSA bacteraemia isolates within a local and global phylogenetic tree of MRSA ST22 genomes demonstrated that the five bacteraemia isolates were highly diverse. This was consistent with the acquisition and importation of MRSA from the wider referral network. Analysis of MRSA carriage and disease in patients within the hepatology service demonstrated a higher risk of both initial MRSA acquisition compared with the nephrology service and a higher risk of progression from MRSA carriage to bacteraemia, compared with patients in nephrology or geriatric services. A root cause analysis failed to reveal any mechanism by which three of five MRSA bacteraemia episodes could have been prevented. Conclusions: This study illustrates the complex nature of MRSA carriage and bacteraemia in patients in a specialized hepatology unit. Despite numerous ongoing interventions to preventMRSA bacteraemia in healthcare settings, these are unlikely to result in a zero incidence in referral centres that treat highly complex patients. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.