Every year, around 100,000 patients in British hospitals develop a bloodstream infection, and up to half of them die. This research programme aims to cut that death rate by identifying the specific, changeable factors that make some patients more likely to die, and by testing whether faster lab diagnostics can save lives. Currently, UK hospitals lack reliable, multi-centre data on why some patients survive and others do not, and no large trial has tested rapid molecular diagnostics—which can identify an infection within eight hours rather than days—in the NHS. The project will track patients with four key pathogens (including MRSA and drug-resistant *E. coli*) to pinpoint modifiable risks, then run a randomised trial of a rapid diagnostic platform. If successful, the findings will feed into a national care bundle and a blended-learning programme for infection specialists across the UK, potentially reducing deaths and cutting the roughly £6,200 cost per episode. This is applied clinical research with a direct, near-term goal: better, faster treatment for a common and deadly hospital complication.
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Aim: To carry out a programme of linked research studies aimed at improving the management of Blood Stream Infection (BSI), and so reducing patient mortality.Background: Infection is a major concern in British hospitals: eight per cent of inpatients have infection; there are around 90-100,000 BSI per annum with a cost of £6,200 per episode in 2000, and the mortality is up to 50%. Healthcare associated research in bacterial infection in the UK is not strong, hence there is a deficiency of information on outcomes in BSI and risk factors for poor outcome. Research conducted elsewhere has been single centre and in different health systems to the NHS, hence its relevance and generalisability to the UK is limited. A number of patient factors related to underlying disease, site and severity of infection are known to impact adversely on outcome. In contrast, timely appropriate antimicrobial chemotherapy and removal of infected prosthetic materials, especially iv lines, are beneficial. Rapid laboratory based Diagnosis (RD), by speeding information flow, has had beneficial effects on antibiotic use in infected patients and may reduce mortality. As no multicentre clinical evaluations of RD have been performed in the UK, it seems the most promising area for improving management of BSI.Research plans: Based on three linked work programmes.(a) Work Package 1 (WP1): To identify modifiable risk factors for death in patients with BSI due to four key pathogens – Methicillin-resistant Staphylococcus aureus (MRSA); Pseudomonas aeruginosa; extended spectrum Blactamase (ESBL) producing E.coli/Klebsiella spp and Candida spp. Additional questions related to speed of response to therapy and length of stay will be addressed. A four centre prospective observational design will be employed.(b) Work Package 2 (WP2): To assess the impact of laboratory based rapid diagnostics on mortality in patients with BSI. Additional questions related to speed of clinical response, antibiotic use, speed of appropriate chemotherapy and length of stay will be addressed. A four centre randomised controlled trial design will be used. The RD will be provided by a molecular platform of multiplex PCR and microarray technology designed to produce high impact laboratory information within 8hrs of commencing laboratory processing of positive specimens.(c) Work Package 3: The information gained in WP1 and WP2 will feed into an educational programme using conventional and blended learning methods. We will engage with professional societies and national quality assurance schemes to inform infection practitioners about our findings. In a blended learning programme, we will use web-based learning tools such as a video-rich expert commentary on BSI, a specifically developed care bundle for BSI and a web-based forum to promote improvements in BSI management. The blended learning programme will be evaluated by telephone interviews, and at the end of the programme be made available to all infection specialists UK wide.Research TeamThe investigators have access through their clinical practice to a large group of patients with BSI and the relevant laboratory support to provide the molecular diagnostic platform. Specialist and reference laboratory involvement ensures expertise for indepth pathogen characterisation and antibiotic evaluation. An international panel of experts will support the team in terms of trial design, execution and analysis. Statistical and informatics experts will ensure appropriate and timely data flow and analysis. Educational expertise will be provided by links to an already funded blended learning programme for Primary Care doctors.Outputs(a) Service Outputs: Within 2-3 years, we will have identified modifiable risk factors associated with poor outcome in four key BSI. These will be included in a BSI care bundle developed for the NHS. This will be modified within 4 years in light of results from the trial of rapid diagnostics. The trial i
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