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 admissions requiring intensive care, and in some cases … Read more
IORD – Ongoing approved projects and project outputs
Identifying “at-risk” populations for E. coli bacteraemias
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 distribution by NHS trust. Having a system in place … Read more
Defining normal response to culture-positive and culture-negative sepsis
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 tests are done routinely and patient status is regularly monitored, … Read more
Analysis of 5 year trends in respiratory virus infections of haematology inpatients at Oxford University Hospitals
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 viruses if patients are admitted with symptoms suggestive of infection like breathlessness or … Read more
An epidemiological review of paediatric respiratory viruses in acute hospital presentations with respiratory symptoms
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 highlighted the need to understand the process of virus propagation within the community. Greater understanding … Read more
Global Research on AntiMicrobial resistance (GRAM) Project
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 Group is a partnership between the Big Data Institute (BDI) … Read more
The microbiological features associated with greater risk of recurrent UTI
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 distressing symptoms, difficulty in managing … Read more
Clinical implications of sputum bacterial pathogens in asthma
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 exacerbations. Our aim is to look at the frequency … Read more
Can we estimate resistance in bloodstream infections from resistance in other types of specimen?
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 sophisticated machines which heat samples of blood in special nutrients. These machines are … Read more
What diagnostic codes are used in inpatient admission records for patients who have bacteraemia?
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 treated or investigated during the relevant episode of healthcare”) or as … Read more
Determinants of antibiotic treatment duration and outcomes in cellulitis
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 (intravenously) at first and then switched to tablets (orally). Doctors … Read more
Contribution of “sepsis” to mortality in Oxfordshire
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 pulse, low blood … Read more
Outcomes following “sepsis” in Oxfordshire
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 blood … Read more
Contribution of inflammation to infectious and supposedly non-infectious respiratory conditions leading to inpatient admission
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 is when the body reacts to something, called inflammation. A particular kind of … Read more
Changes in the incidence and importance of endocarditis as a diagnosis code in Oxfordshire hospitals
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 resistance in future. However, in 2015, a group looked at … Read more
Do birth characteristics influence susceptibility to childhood infections?
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 differences at birth … Read more
Can we identify surgical site infections using routine electronic health record data?
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 as it is done in person by an infection … Read more
Using secondary data sources to investigate incidence and severity of respiratory infections
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 there wasn’t a simple explanation … Read more