Diagnostics

Lauren Rash, MD1, Luay Boulahouache2, Nathaniel Giles2, Robert Atmar2, 1Baylor College of Medine, TX, Houston, 2Baylor College of Medicine, Background: Murine typhus, a flea-borne rickettsial disease traditionally found in warm, humid climates, is increasingly reported in non-endemic regions due to factors such as climate change and urbanization. 7 patients were excluded if they were outpatient, had an incomplete chart to review, were diagnosed and cared for outside of Harris Health, had too low of titers to make the diagnosis, or diagnosis was not consistent with murine typhus. Demographics, clinic and admission dates, length of stay, comorbidities and medications, animal exposures, symptoms, vitals, physical exams, labs, imaging, treatment course, illness complications, timing and antibiotic selection, whether infectious disease was consulted, and fever clearance time was documented. Infectious Disease team was consulted 57% of the time with an average day of consult on day 3 and Infectious Disease team consulted resulted in doxycycline being started 100% of the time.

The analysis was undertaken by the National Institute for Health and Care Research (NIHR) funded Applied Research Collaboration Greater Manchester (ARC-GM), the NIHR Manchester HealthTech Research Centre in Emergency and Acute Care and the NIHR Manchester Biomedical Research Centre (BRC), in collaboration with The Northern Care Alliance NHS Foundation Trust and Manchester University NHS Foundation Trust. Study co-author, Professor Paul Dark, is Vice Dean for health and care partnerships at the University of Manchester and Professor of critical care medicine at the Northern Care Alliance NHS Foundation Trust. This will be better for patients, who will experience more limited side effects, and better for health care systems by providing significant cost savings." He added: "Our recent cost effectiveness study that was part of the ADAPT-Sepsis trial also suggests that implementing daily procalcitonin measurement into routine NHS sepsis care would likely be cost effective. "This approach supports the UK's 10-Year Health Plan to tackle antibiotic resistance and could inform future NICE sepsis guidelines, paving the way for routine use of these blood tests in sepsis care."

The multi-country study, funded by the Centers for Disease Control and Prevention (CDC), USA, is being implemented in India at three major hospitals in Maharashtra — BJ Medical College and Sassoon General Hospital (SGH), Pune, Dr DY Patil Medical College Hospital and Research Centre (DPU), Pune, and P D Hinduja Hospital and Medical Research Centre, Mumbai. Dr Randive added: The study is important to help develop future antibiotics and also guide the current therapy for patients." According to health officials, the objective of the project is to strengthen surveillance at selected hospitals and assess the prevalence and patterns of carbapenem resistance. Under the programme, researchers are analysing clinical samples from admitted patients to identify the type of organism causing infection and determine whether it is resistant to carbapenem. Dr Rajesh Karyakarte, principal investigator for BJMC-SGH, said, "Genome sequencing helps us understand which genes are responsible for resistance, whether the infections in different patients are linked, and whether they are coming from the same source or multiple sources." He further said that with very few effective antibiotics left for carbapenem-resistant infections, understanding how resistance is developing and spreading is critical."