Exemplar Studies Roundtable Discussion

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Exemplar Studies Roundtable Discussion

• Charis Marwick
• Clinical Lead / Chair IIP User Group
• c.z.marwick_at_dundee.ac.uk
• charismarwick_at_nhs.net

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Outline

• Brief introduction to first sixteen studies
• Four work streams
• Describe two first phase studies
• Clinical / research questions
• Three studies for roundtable discussion
• Aims of roundtable discussion
• Concluding remarks

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• Risk factors work stream
• Risk factors S. aureus and E. coli bacteraemia
  one-off study
• Routine analysis risk factors for common
  bacteraemia
• Technical work stream
• Addition of local datasets e.g. ICNet, HEPMA, HMUD

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Interventions work stream

• Primary care prescribing and HA CDI
• Primary care prescribing and other HAI
• UTI primary care prescribing and AMR
• Other primary care prescribing and AMR
• High risk antibiotic prescribing and outcomes
  from emerging resistant pathogens

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Outcomes work stream

• Validation of IIP for SSI surveillance
• Mortality associated with SSI, SAB, CDI, HAI
• MRSA and CDI deaths routine reporting
• 30 day mortality after blood culture
• SAPG evaluation antibiotic policy
• Standardised 30 day blood culture mortality
• SPSP evaluation sepsis collaborative
• Consequences of antibiotic policy changes
• Intended and unintended (secondary care)
• Surgical prophylaxis change
• AKI in Lanarkshire then across Scotland

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Risk factors S. aureus and E. coli bacteraemia

• What risk markers are associated with adverse
  outcomes of S. aureus bacteraemia (MSSA or MRSA)
  or E. coli bacteraemia in Scotland?
• What are the differences in risk markers between
• Patients with these bacteraemia compared to
  hospitalised patients without bacteraemia?
• Patients with MSSA compared to MRSA bacteraemia?
• Patients with community onset bacteraemia
  compared to those with hospital onset?

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UTI primary care prescribing and AMR

1. What is the epidemiology of UTI prescribing?
2. What proportion get subsequent different
   antimicrobials?
3. What proportion are subsequently hospitalised and
   why?
4. What are the differences in subsequent
   antimicrobial resistance by initial antibiotic
   prescribed?
5. What factors are associated with antimicrobial
   resistance at patient, antibiotic use and
   practice levels?
6. Is antimicrobial resistance and treatment failure
   associated with increased risk of hospital
   admission and death?

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Studies for roundtable discussion

• Impact of primary care antimicrobial prescribing
  (other than UTI) on antimicrobial resistance
• Validation of IIP for surgical site infection
  surveillance
• Intended and unintended consequences of changes
  in secondary care antibiotic policies

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Aims of discussion

• What do clinicians (you) want this study to do?
• What questions should be answered?
• What difference could the results make to patient
  care?
• Please start with study assigned to your table
• 30 minutes for discussion