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NIHR Signal C-reactive protein is not useful in diagnosing late-onset infection in newborns
The blood level of C-reactive protein (CRP), a marker indicating inflammation in the body, is not accurate enough alone to diagnose late-onset infection in newborn infants. Late-onset neonatal infection, occurring more than three days after birth, is potentially serious and is relatively common. Tests measuring the blood level of CRP are widely used by physicians to guide their decision on whether or not to start antibiotic treatment for suspected infection. This NIHR-funded review found 20 st...
NIHR Signal Antimicrobial stewardship programmes reduce antibiotic use in long-term care homes
Antimicrobial stewardship programmes have been found to reduce antibiotic use in long-term care residences by 14% when pooling evidence across a range of study types and interventions. Antimicrobial resistance is a public health threat, and overuse of antimicrobials is one of the main causes. Antimicrobial stewardship programmes are a government strategy to support the appropriate prescribing of antimicrobials within the NHS. There has been little evidence for their use or effectiveness in lon...
NIHR Signal Decontamination of the mouth or digestive tract was not linked to reductions in drug-resistant bloodstream infections in the intensive care unit
Decontamination strategies to remove potentially harmful bacteria from the mouth, throat and gut of critically ill patients don’t reduce the risk of intensive care unit-acquired bloodstream infections or deaths from bacteria that were resistant to antibiotics. The study was carried out in 13 intensive care units across Europe, including the UK, with moderate to high levels of antibiotic resistance (extended resistance in more than 5% of all bloodstream infections). This fills an important ...
NIHR Signal Several antibiotics appear effective against early-stage Lyme disease
Most cases of Lyme disease, which is an infection carried by ticks, can be easily managed if treated early using antibiotics, with choice of antibiotic agent having little bearing on success. This network meta-analysis suggests that when symptoms of the disease are confined to a localised skin infection, treatment failures are relatively infrequent, only 2% at 12 months. Effective antibiotics include penicillin V, doxycycline, azithromycin, cefuroxime, amoxicillin and ceftriaxone plus doxycycli...
NIHR Signal Steroids rapidly reduce children’s croup symptoms and shorten hospital stays
Corticosteroids reduce symptoms of croup in children within two hours and continue to do so for at least 24 hours. They also cut the amount of time children spend in hospital by 15 hours and reduce return visits or readmissions from about 20% to 10%. This Cochrane review assessed the effectiveness of corticosteroids such as dexamethasone and budesonide compared with placebo. It updates a previous review which concluded that corticosteroids reduce symptoms of croup at six hours. The review also...
NIHR Signal Joint infection after hip replacement is linked to some risk factors that could be modified
Ten years of National Joint Registry data show that many factors may increase the risk of joint infection following hip replacement. Less than 1 in 1,000 people on average needed revision surgery for infection per year. Several modifiable patient factors increased risk, such as obesity and diabetes. Using ceramic components, and approaching surgery from the back rather than the side of the hip, may slightly reduce infection risk. This NIHR-funded study analysed registry data for 623,253 hip re...
NIHR Signal Tools for GPs can help reduce unnecessary antibiotic prescribing
Interventions to reduce inappropriate antibiotic prescribing for upper respiratory tract infections are most effective when they provide a negotiation tool to support patient interaction. These interventions are more likely to be rejected if they are perceived as interfering with individual clinical judgment or damaging patient relationships. Upper respiratory tract infections often resolve themselves within a few days, without the need for antibiotics, yet antibiotics are often prescribed. Thi...
NIHR Signal Ethanol locks in catheters for dialysis may prevent sepsis
In patients with tunnelled central venous catheters used for dialysis, ethanol locks may reduce catheter-related bloodstream infections when compared with other locks, mainly saline. There was no increase in the risk of catheter blockage with ethanol locks in this study. Long-term catheters carry a risk of bloodstream infection. ‘Locks’ are the small amount of fluid left inside a long intravenous catheter between uses to reduce the risk of blockage with clotted blood and ideally als...
NIHR Signal High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis
A randomised controlled trial of 1,472 infants with bronchiolitis found that more children improved when started on high-flow oxygen therapy than with standard oxygen therapy. Those who failed to improve on standard therapy were switched to high flow oxygen. Most then improved - overall, similar numbers were transferred to intensive care. There was also no difference between the groups in the proportion of infants needing intubation, length of time on oxygen therapy or days spent in hospital. ...
NIHR Signal Daily low-dose antibiotics halve urinary tract infections in people who self-catheterise
People who perform clean intermittent self-catheterisation can reduce symptomatic urinary tract infections from two per year to one by taking daily low-dose antibiotics. This NIHR-funded trial randomised 404 adults in the UK who perform the procedure for a variety of reasons to either daily oral low-dose antibiotics or no prophylaxis. All had a recent history of urinary tract infection. Although prophylactic antibiotics halved infection rates, it increased antimicrobial resistance compared wit...
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