NIHR Oxford Biomedical Research Centre
Enabling translational research through partnership
Antibiotics are often given to hospital patients where there is initially a concern about an infection, but where later it was found that an infection was not present and antibiotics were not needed after all. Antibiotics are then stopped, but where possible it would be better not to start them in ... READ MORE
The use of artificial joint replacements can considerably improve the quality of life of patients suffering from arthritis. Unfortunately, about 1-2% of joint replacements get infected after surgery. Treatment of joint replacement infections can be difficult and usually involves both surgery and ... READ MORE
Blood cultures are a test sent from unwell patients with serious infections that are used to detect if bacteria are present in their blood. Blood taken from patients is taken to a laboratory where any bacteria that are present are grown, or ‘cultured’. These blood cultures help find the cause of ... READ MORE
Antimicrobial resistance (AMR) is a growing global health issue and poses a particular risk to patients with cancer. AMR is where the bacteria and other germs causing infections develop the ability to defeat the medicines made to get rid of them. Many cancer treatments can weaken the body’s ability ... READ MORE
E. coli is a type of bacteria that commonly causes infections. When it gets into a patient’s blood it can cause very severe infections and there is up to around a 20% chance that patients will die despite medical treatment. A vaccine to prevent severe disease caused by E. coli is currently in ... READ MORE
Babies in the first month of life (neonates) are very vulnerable to bacterial infections, which require antibiotics as treatment. Increasingly bacterial infections are harder to treat, a problem known as antibiotic resistance. Some forms of antibiotic resistance occur because bacteria can share ... READ MORE
Antibiotics are key part of treating infections. However, use and over-use of antibiotics leads to bacteria developing antibiotic resistance, where antibiotics no longer work as expected. When antibiotics are given to patients with infections, doctors and other professionals try to balance giving ... READ MORE
Antibiotics are key part of treating and preventing infections. However, use and over-use of antibiotics leads to bacteria developing antibiotic resistance, where antibiotics no longer work for patients as expected. One solution to this problem is developing and using new antibiotics, but ... READ MORE
From a recent audit using clinical observation standards, we have identified that 1 in 4 patients admitted through the Hyperacute Stroke Unit at Oxford University Hospitals deteriorate, and that infection may play an important role in some deteriorations. National monitoring consistently ... READ MORE
Pneumonia can be associated with fluid in the chest – this is called parapneumonic effusion. The fluid can be simple and not infected (simple parapneumonic effusion) or can progress to become infected with bacteria (pleural infection). We know that patients with pleural infection are more likely to ... READ MORE
Clostridioides difficile or C diff is an important type of bacteria that can cause diarrhoea, particularly in people who have taken antibiotics or been in hospital. Most of the time, doctors can successfully treat C diff infections, but they can be serious and even life-threatening in some ... READ MORE
To safely use medical records in research via IORD and other similar research databases, the records are first “de-identified”. This means taking out names, dates of birth, addresses, phone numbers, NHS numbers, etc, so that researchers cannot see information that could be used to identify who the ... READ MORE
Inflammation in the brain, known as encephalitis, is commonly caused by infections. Some people develop severe and debilitating complications following infectious encephalitis. These include death, seizures, and cognitive decline. Unfortunately, we cannot clearly identify those at risk of these ... READ MORE
Enterococcus bacteria are a type of bacteria that live inside our intestines. Sometimes, they can make us sick with infections in different parts of our body, like the bladder, heart, stomach, and blood. In the UK, more and more people have been getting blood infections because of these Enterococcus ... READ MORE
People with blood cancers like leukaemia can easily get sick because their immune systems are not very strong. To treat these diseases, they might get special medicine called chemotherapy. Sometimes, doctors use chemotherapy to try and cure the disease, while in other cases, they use it to make the ... READ MORE
Patients with acute respiratory illnesses commonly present in emergency departments and ambulatory assessment units. Diagnosing prevalent conditions such as respiratory infections or pulmonary embolism, which often cause these symptoms, can be challenging for doctors. Frequently, CT scans are ... READ MORE
Patients with blood conditions receiving treatment for cancer can be at increased risk of infection, especially when their white blood counts are low. Detecting infection early is important for making sure that it is treated effectively in these patients. Often this means that patients at high risk ... READ MORE
When a patient is suspected of having a bacterial infection, antibiotics are often given and at the same time blood, urine and other samples might be collected to try to identify the bacteria causing the infection. Different antibiotics work against different bacteria, and test results, which ... READ MORE
Hospital doctors currently make a decision on when patients are ready to discharge from hospital based on clinical experience, the information that they can read in the patient’s clinical record, and the availability of appropriate support in the community. This project aims to create a tool that ... READ MORE
Antimicrobial resistance is a growing threat to public health worldwide. In hospitals, if antibiotics do not treat severe infections effectively this can lead to more deaths and longer hospital stays. However, prompt adjustments to antibiotic treatments to switch to an antibiotic that works may ... READ MORE
Since 31 March 2022, there has been an increase in cases of children presenting with severe liver disease of unknown cause (termed ‘acute severe hepatitis of unknown etiology’ (ASHep-UE)) across multiple countries including the UK. Most of these have been children aged 1–6 years, leading to hospital ... READ MORE
Underlying haematological malignancy has previously been shown to be a major risk factor for worse outcomes from infection with SARS-CoV-2. There is concern that this same patient group may mount reduced immune responses to the COVID-19 vaccinations, and thus derive less protection from them. In ... READ MORE
Myeloma is a blood cancer that results in a weakened immune system and an increased risk of infection. Myeloma is currently incurable and the most common cause of death in patients living with myeloma, aside from the disease itself, is infection. We know that rates of respiratory infections ... READ MORE
COVID-19 caused by SARS-CoV2, remains a significant cause of hospital attendance, admission and mortality. The clinical presentation of COVID-19 is variable, with most patients experiencing mild self-limiting symptoms, while others progress to respiratory failure. The use of biomarkers early in the ... READ MORE
Since June 2011, every bloodstream infection caused by a bacteria called Escherichia coli (E. coli) has to be reported to the UK Health Security Agency. Monthly counts are published regularly, as well as annual reports describing the overall trend, distribution by age and sex, and geographic ... READ MORE
Longer than necessary antibiotic courses in patients with sepsis (an infection of the blood) may lead to side-effects like C diff diarrhoea, and increase antibiotic resistance. But not switching antibiotics promptly when patients don’t respond or get worse is harmful. In hospital, lots of blood ... READ MORE
The ‘circadian clock’ is an endogenous 24-hour clock recognised in all biology that, along with a seasonal clock (summer/winter), impacts on how environmental challenges are handled, including the outcome of infectious diseases and vaccinations. The COVID-19 pandemic, caused by SARS-CoV-2 ... READ MORE
Using a dataset of 270 critically ill patients with COVID-19 we have identified a set of variables that predict the mortality for patients on the day of admission to the ICU. The use of this practical prediction model should affect clinical decision-making and medical management of COVID-19 ... READ MORE
Respiratory viral pathogens have long been known to be responsible for a large burden of seasonal acute paediatric emergency department presentations. We are investigating the local epidemiology of these viral agents which prompt emergency department presentation. The SARS-CoV-2 pandemic has ... READ MORE
Respiratory viral infections can cause serious illnesses in patients with weakened immune systems, such as those who have undergone a bone marrow transplant, or are undergoing chemotherapy for blood cancers. The Haematology department at Oxford University Hospitals (OUH) routinely tests for these ... READ MORE
COVID-19, caused by SARS-CoV2, is a novel biphasic disease that may be associated with significant morbidity and mortality in the second phase of illness in select groups of infected individuals. There is significant interest in testing the utility of biomarkers in the first phase of illness for ... READ MORE
The ‘circadian clock’ is an inbuilt 24-hour clock recognised in human biology that, along with a seasonal clock (summer/winter), impacts on how environmental challenges are handled, including influencing the outcome of infectious diseases and vaccinations (Borrmann 2020, Sengupta 2021).The COVID-19 ... READ MORE
The inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) affect approximately 1% of the UK population; and 25-30% of these patients are now treated with biological therapies which target the immune system to maintain remission. It has been hypothesized that these ... READ MORE
Most patients diagnosed with Covid-19 acquire their infection in the community. However, it is not known how much Covid-19 in the first wave of the pandemic was acquired in hospital. National data may be informative, but locally available data in Oxford are more detailed, potentially allowing ... READ MORE
The COVID-19 pandemic started in December 2019 and quickly spread around the world. A key challenge in all healthcare settings is to identify patients with possible COVID-19 at presentation, to inform both clinical management and infection prevention and control interventions. Diagnosis relies in ... READ MORE
Oxford University Hospitals (OUH) has conducted a large staff testing programme for Covid-19. Staff were tested using a combination of antibody and PCR tests looking for previous and current infection with the virus that causes Covid-19 (SARS-CoV-2). These results were stored in the electronic ... READ MORE
The Global Research on AntiMicrobial resistance (GRAM) Project is the flagship study of the Oxford GBD (Global Burden of Disease) Group, and aims to provide robust, comprehensive and timely evidence of the burden of antimicrobial resistance (AMR) in 195 countries and territories. The Oxford GBD ... READ MORE
Up to 30% of patients admitted to hospital with COVID (novel coronavirus infection) will require admission to an intensive care unit (ICU) and potentially help with breathing via a ventilator. We will develop statistical and artificial intelligence approaches to predict which patients are most ... READ MORE
The Covid-19 pandemic is having a profound impact on healthcare globally. Whilst the virus is directly devastating for many suffering from severe infection, there are also wider implications. These include potentially lower use of healthcare for other serious conditions with potential adverse ... READ MORE
Around half of all women will suffer from at least one urinary tract infection (UTI) in their lifetime, and it is the most common bacterial infection treated by General Practitioners (GPs). Up to 800,000 women in the UK suffer from frequent UTIs each year. Such ‘recurrent UTI’ causes painful and ... READ MORE
Antibiotics are commonly used to treat infections, but they may also affect how other infections are detected and transmitted. MRSA is a potentially serious healthcare-associated infection. Over the past decade there has been major progress in reducing the number of patients who carry MRSA on their ... READ MORE
Neonatal sepsis is a major cause of death in infants and young children in low-income and middle-income countries. There is increasing concern that rising antimicrobial resistance is reducing the effectiveness of recommended antibiotic treatments. New studies are being set-up to test new approaches ... READ MORE
Antibiotics are mainly old drugs that have been in use for many years. The doses of antibiotics we use to treat infections were mainly worked out using older methods in the 1960s-1980s. Often one fixed dose is used in adults with normal kidney function, and this dose is reduced in adults with poorer ... READ MORE
Increasingly detailed electronic health records are available and being used to try to work out how to improve management and outcomes in hospitals. However, these data are not always recorded accurately, and the impact of this on how they should best be used is unknown. We plan to look at ... READ MORE
Every year, influenza virus causes significant illness globally. Many people are admitted to the John Radcliffe hospital with the virus and tested using molecular test. Currently, we do not use all the information that the test provides. This study aims to use the extra information from the current ... READ MORE
Acute exacerbations of asthma are often triggered by airways infection and a proportion of these infections are due to bacteria. We know that a group of patients with asthma have chronic airways infection with Haemophilus influenzae and this may be related to poor symptom control and more frequent ... READ MORE
Acute kidney injury (AKI) is a sudden reduction in kidney function (commonly caused by infections and other illnesses) and occurs in about one-fifth of patients admitted to hospital. Compared to admissions not complicated by AKI, hospitalisation with AKI has been associated with longer stay and ... READ MORE
Electronic health records (EHR) are increasingly being used to conduct epidemiological research but there is little awareness or guidance regarding appropriate methods to check the validity of using such data when it spans long time periods. Many things which contribute to how and what data is ... READ MORE
There are increasing numbers of reports of micro-organisms that can cause human infections being found in wastewater environments, like sinks, drains and toilets. These could potentially be transmitted to unwell people in hospitals. However, whether this really occurs is unclear. We have sequenced ... READ MORE
Every year influenza (‘flu’) puts a major strain on UK hospitals. Whilst many patients are admitted with influenza, other patients can get it during their hospital stay. This is because it is very easy to transmit, and it is not always obvious who has flu. We are using genetic sequencing to work out ... READ MORE
Across England, the number of bloodstream infections caused by a group of bacteria which include ‘Esherichia coli’ (E. coli) and ‘Klebsiella pneuomoniae’ (K. pneumoniae) has been rising significantly for the last few years. A recent investigation by our group using the IORD database has in addition ... READ MORE
Fever is an important sign of infection and can be used to work out how to manage patients after they arrive at a hospital Emergency Department (ED) (called a “care pathway”). Often, patients with fever need specific tests or may even be admitted to hospital straightaway (for example if sepsis is ... READ MORE
In order to reduce the threat of antimicrobial resistance, a first key step is to understand how much resistance there is. This is typically done by looking at bacteria causing serious infections, particularly bloodstream infections. However, growing bacteria from blood usually requires ... READ MORE
Routinely collected electronic health record data is increasingly being used as a fast and inexpensive way to investigate different diseases. Often these diseases are identified by “diagnostic codes” which are assigned to every admission to hospital, either as the primary code (“the main condition ... READ MORE
Cellulitis is a bacterial infection of the skin and most commonly affects the legs where the affected area becomes red, hot, swollen and painful. Approximately 1000 patients are admitted to Oxford hospitals with cellulitis each year. Cellulitis is treated with antibiotics, given through the vein ... READ MORE
A large number of companies making tests to diagnose infections are aiming to design tests which will be used by GPs in community settings. These rapid tests can give a single result to help doctors decide if an infection is present, or can perform a combination of different tests on a single ... READ MORE
Infections due to one particular family of bacteria called Enterobacteriaceae are increasing in Oxfordshire and worldwide, as are infections resistant to the commonly-used beta-lactam antibiotics (such as co-amoxiclav, sometimes also called augmentin). Treating people with particular types of ... READ MORE
The Sepsis Trust estimates that 44,000 people in the UK die every year from sepsis. However, exactly where these estimates come from, and how reliable they are is unclear. “Sepsis” is generally used to mean an infection of the blood – where bugs get into the blood and cause high temperature, low ... READ MORE
The Sepsis Trust estimates that 44,000 people in the UK die every year from sepsis, and this is currently the focus of much attention in hospitals and the media. “Sepsis” is generally used to mean an infection of the blood – where bugs get into the blood and cause high temperature, low pulse, low ... READ MORE
Patients are usually defined by their clinical symptoms, for example pneumonia as opposed to bronchitis or chronic obstructive pulmonary disease (COPD). However, scientists are starting to work out that sometimes the same underlying problem can lead to different clinical presentations. One example ... READ MORE
The C-reactive protein (CRP) test is used by clinicians in various health care settings. CRP is an acute phase protein released into the blood during an infection or inflammation. There is an increase in the use of CRP test in primary care, accident and emergency departments and outpatient clinics. ... READ MORE
Across England, the number of infections caused by a family of bacteria called Streptococcus have been rising strongly for the last few years. However, the reasons behind these increases are not well understood at the moment. We plan to use the extra information in the IORD database to look at ... READ MORE
Antibiotics are prescribed when sick patients arrive at hospital, before doctors know what kind of bacteria is causing an infection and what antibiotics it might be resistant to. Even when a bacteria is identified as causing an infection, it is labelled as “resistant” (R) or “susceptible” (S) based ... READ MORE
Re-admissions are instances where patients are admitted to hospital within a short period of time after having been sent home from a previous hospital admission. Re-admissions have been thought to reflect poor hospital care, with a potential negative impact on patient health. They are expensive for ... READ MORE
A delayed discharge occurs when a patient remains in hospital after having been declared medically fit to return home from a hospital admission. Patients may remain in hospital for reasons other than medical need due to for example delays in finding appropriate placements for community care, need to ... READ MORE
Recently a fungus called Candida auris, resistant to multiple antifungal treatments, emerged globally. It is related to the family that causes thrush, Candida albicans, but behaves differently, usually infecting or colonizing patients in intensive care facilities. This organism is now colonizing ... READ MORE
In 2008 guidance recommended no longer using antibiotics to prevent people getting infections of the heart after having surgery at their dentists. This was because there was no strong evidence showing this was necessary, and to reduce overall use of antibiotics to avoid increasing antibiotic ... READ MORE
Across England, the number of bloodstream infections caused by a bacteria called ‘Esherichia coli’ (E. coli) have been rising strongly for the last few years. However, the reasons behind these increases are not well understood at the moment. We plan to use the extra information in the IORD database ... READ MORE
Reducing antibiotic use to combat antimicrobial resistance is a priority. We want to know if we can do this safely and without putting patients at undue risk. Antibiotic use was measured over 1 week in an intensive audit of practice in the Acute/General Medicine service at the John Radcliffe. This ... READ MORE
Millions of operations are carried out in the NHS every year. Infection is a rare but important complication that can happen after surgery. Specific operations are routinely monitored every year in every NHS hospital to see how often these post-surgery infections occur. This is very time-consuming ... READ MORE
The numbers of children coming to A&E have steadily increased over the last 5 years, and are continuing to increase. This puts a large burden on NHS staff. However, the reasons behind this increase are not entirely clear. Parents may be bringing children who are less sick because they struggle ... READ MORE
Newborns differ a great deal in terms of their size at birth. In particular, their weight, length and head circumference are determined by how well they have grown in the womb and their age at birth, i.e. premature babies are smaller than babies born at term. We seek to understand whether these ... READ MORE
Antibiotics are medicines that are hugely important in treating many infections, and antibiotic resistance is a major clinical problem. Research has shown that increased use of antibiotics, whether appropriate or inappropriate, seems to be associated with higher numbers of antibiotic-resistant ... READ MORE
Our knowledge of resistance of bacteria, such as E. coli, to antibiotic drugs is incomplete. An understanding of how such resistance is passed on from generation to generation of bacteria is important in helping us to determine which drugs should be given to patients, and in helping us formulate new ... READ MORE
Urinary tract infections comprise around 1% of the 300 million general practice consultations annually in the UK; most of these are acute uncomplicated UTIs (AUUTIs) in women of childbearing age. AUUTIs affect around 50% of women during their lifetime and, by 24 years of age, one-third of women have ... READ MORE
Although relatively rare (under 5%), surgical site infections are the most common complication of planned operations (hospital admissions for what is termed “elective surgery”). Other complications (such as needing to be re-operated on, or even dying) are also rare, but may also be related to ... READ MORE
Urine cultures are the most commonly performed microbiology test at the Oxford University Hospitals but clinical impression is that many of these tests may be unnecessary. IORD provides an opportunity to see if we can answer clinical questions about the value of tests such as urine cultures for ... READ MORE
This project aims to estimate the incidence of C. difficile infection in Oxfordshire, inside and outside hospitals (inpatient, outpatient/day case/A&E, community), over calendar time, analysing the trends to identify potential new strains (as measured by multi-locus sequence type, MLST) ... READ MORE
This project focusses on patients who do not recover straightaway from C. difficile, but in whom either initial treatment for the infection does not work, or in whom the infection comes back (termed “recurrence” of infection). We want to work how often C. difficile recurrence happens, and how long ... READ MORE
Summary of findings: In this project, we looked at the hospital database of all people admitted to hospital, and found that admissions for pneumonia had almost tripled over the space of 15 years, an alarming increase. By looking at different types of data available in IORD, it became clear that ... READ MORE
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See publication: Probabilistic transmission models incorporating sequencing data for healthcare-associated Clostridioides difficile outperform heuristic rules and identify strain-specific differences in transmission ... READ MORE
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Within a hospital, infectious disease can potentially pass from person-to-person through close contact. Without comprehensive data on actual contacts between different patients (contact ‘networks’), it is reasonable to assume that there is an increased chance of transmission of an infection between ... READ MORE
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Summary of findings: Trends in the rates of serious bloodstream infections caused by antibiotic-sensitive microbes were similar between 1998-2007 across 14 hospitals in Europe, but rates of serious bloodstream infections caused by antibiotic-resistant microbes increased much more in hospitals in ... READ MORE
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Summary of findings: In an endemic setting, with well-implemented infection control measures, ward-based contact with other patients with C. difficile diarrhoea cannot account for the majority of new cases – no more than 25% of new cases in Oxfordshire over 2 years could be linked to a previous ... READ MORE
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Summary of findings: Rates of MRSA infection in blood and other sites were falling before intensification of infection-control measures in 2006. This, together with strain-specific changes in MRSA isolation, strongly suggests that incompletely understood biological factors are responsible for the ... READ MORE
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Summary of findings: We found that increases in severity of C. difficile diarrhoea, likely to due to the arrival of the hypervirulent 027 strain in the UK, could have been detected three years early using routine monitoring of neutrophil counts at diagnosis, compared with looking at patient ... READ MORE
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