Richard Slack

Omeprazole as a risk factor for campylobacter gastroenteritis: case-control study.

Gastric acid protects against enteric infections,1 and patients who have had gastric surgery or are taking H2antagonists are more susceptible to salmonella infection.2 3 Antibiotic treatment also increases the risk of infection.3 It is not known whether these factors are also associated with campylobacter infection, for which statutory notifications now exceed those for salmonella.4 We conducted a case-control study to assess whether gastric antisecretory drugs, antibiotics, and abdominal surgery are associated with campylobacter infection. Between January 1992 and August 1994, 243 notified cases of campylobacter infection, confirmed by faecal culture, were identified in people aged 45 and over in two of the local district councils within Nottingham Health Authority. Thirty two cases were excluded (non-resident (four), general practitioner declined (19), patient died and notes unobtainable (six), and notes unobtainable at general practice (three)), leaving 211 (123 women). The …

Changing carriage rate of Neisseria meningitidis among university students during the first week of term: cross sectional study.

Abstract Objective: To determine the rates of, and risk factors for, meningococcal carriage and acquisition among university students. Design: Repeated cross sectional study. Participants: 2507 students in their first year at university. Main outcome measures: Prevalence of carriage of meningococci and risk factors for carriage and acquisition of meningococci. Results: Carriage rates for meningoccoci increased rapidly in the first week of term from 6.9% on day 1, to 11.2% on day 2, to 19.0% on day 3, and to 23.1% on day 4. The average carriage rate during the first week of term in October among students living in catered halls was 13.9%. By November this had risen to 31.0% and in December it had reached 34.2%. Independent associations for acquisition of meningococci in the autumn term were frequency of visits to a hall bar (5-7 visits: odds ratio 2.7, 95% confidence interval 1.5 to 4.8), active smoking (1.6, 1.0 to 2.6), being male (1.6, 1.2 to 2.2), visits to night clubs (1.3, 1.0 to 1.6), and intimate kissing (1.4, 1.0 to 1.8). Lower rates of acquisition were found in female only halls (0.5, 0.3 to 0.9). The most commonly acquired meningococcal strain was C2a P1.5 (P1.2), which has been implicated in clusters of invasive meningococcal disease at other UK universities. Conclusions: Carriage rates of meningococci among university students increase rapidly in the first week of term, with further increases during the term. The rapid rate of acquisition may explain the increased risk of invasive meningococcal disease and the timing of cases and outbreaks in university students.

Diabetes mellitus, anti-secretory drugs and other risk factors for campylobacter gastro-enteritis in adults: a case-control study

The epidemiology of notified cases of campylobacter gastroenteritis in adults in Nottingham Health District was investigated using a case-control study with a postal questionnaire to ascertain data on risk factors. Over a 14-month period 531 cases (a 73% response rate of all laboratory confirmed cases) and 512 controls replied. Conditional logistic regression analysis was used to determine independent associations with infection. These included foreign travel (odds ratio (OR) 3.4; 95% confidence intervals (CI) 2.0-5.7), diabetes mellitus (OR 4.1, CI 1.1-17), medication with omeprazole (OR 3.5, CI 1.1-12) and H2 and H2 antagonists (OR 3.7, CI 1.3-15), contact with puppies (OR 11.3, CI 1.2-105), eating chicken (OR 1.4, CI 1.1-1.8) and drinking milk from bottles with tops damaged by a bird (OR 3.3, CI 1.0-11). Preparing main meals (OR 0.9, CI 0.8-1.0) and drinking delivered milk (OR 0.6, CI 0.4-0.9) were associated with a reduced risk of campylobacter infection. Foreign travel was reported in 25% of cases and another 15% had significant associations with other risk factors. The majority of cases, 60%, remained unexplained, indicating the need for further evolution of sporadic cases.

Nottingham Staphylococcus aureus population study: prevalence of MRSA among elderly people in the community

The spread of methicillin resistant Staphylococcus aureus (MRSA) has caused problems in most hospitals in the United Kingdom in the past decade.1 The extent to which the community serves as a reservoir for MRSA is unknown despite the growing recognition of MRSA as a community pathogen in various countries.2 We investigated the prevalence of nasal carriage of MRSA in a sample of people aged 65 and over who live in their own homes and represent the elderly population in the Greater Nottingham Health District, where MRSA is endemic in hospitals.3 We used electoral ward level statistics from 1991 to combine the catchment areas of seven large general practices and provide a study population of which the demographic composition (age, sex, social class, ethnicity, and proportion of elderly people living alone) was representative of the Nottingham Health District, which in most respects is …

Hospital Networks and the Dispersal of Hospital-Acquired Pathogens by Patient Transfer

Hospital-acquired infections (HAI) are often seen as preventable incidents that result from unsafe practices or poor hospital hygiene. This however ignores the fact that transmissibility is not only a property of the causative organisms but also of the hosts who can translocate bacteria when moving between hospitals. In an epidemiological sense, hospitals become connected through the patients they share. We here postulate that the degree of hospital connectedness crucially influences the rates of infections caused by hospital-acquired bacteria. To test this hypothesis, we mapped the movement of patients based on the UK-NHS Hospital Episode Statistics and observed that the proportion of patients admitted to a hospital after a recent episode in another hospital correlates with the hospital-specific incidence rate of MRSA bacteraemia as recorded by mandatory reporting. We observed a positive correlation between hospital connectedness and MRSA bacteraemia incidence rate that is significant for all financial years since 2001 except for 2008–09. All years combined, this correlation is positive and significantly different from zero (partial correlation coefficient r = 0.33 (0.28 to 0.38)). When comparing the referral pattern for English hospitals with referral patterns observed in the Netherlands, we predict that English hospitals more likely see a swifter and more sustained spread of HAIs. Our results indicate that hospitals cannot be viewed as individual units but rather should be viewed as connected elements of larger modular networks. Our findings stress the importance of cooperative effects that will have a bearing on the planning of health care systems, patient management and hospital infection control.

Seven-week interval between acquisition of a meningococcus and the onset of invasive disease. A case report

Invasive meningococcal disease (IMD) is thought to occur within a few days of pharyngeal acquisition of Neisseria meningitidis. During a longitudinal study of carriage and acquisition among 2453 first-year undergraduates we identified a male student from whom N. lactamica was isolated in October 1997 followed by N. meningitidis in December 1997. In mid-January 1998 this student suffered a mild episode of IMD (meningitis) during which N. meningitidis was isolated from his CSF. The meningococcus carried in December 1997 was phenotypically and genotypically indistinguishable from the invading organism, suggesting the possibility that the organism may have been carried for 7 weeks prior to the onset of invasive disease. Further studies are needed to assess more accurately the range of asymptomatic carriage prior to disease onset.

A bacteriological survey of amputation wound sepsis

A retrospective survey of 100 lower limb amputations performed for ischaemia were analysed to assess the influence of preoperative bacterial isolates and the use of prophylactic antibiotics on wound sepsis. Forty-eight per cent had previously undergone a vascular procedure to attempt limb salvage and 17% were diabetics. Benzylpenicillin was given preoperatively and continued for 5 days; diabetics received metronidazole in addition. A total of 51 isolates were obtained from 30 patients preoperatively; Staphylococcus aureus and Enterobacteriaceae each accounted for over 25%. Postoperatively, 74 isolates (20 multiple) were obtained with an overall sepsis rate of 40%. Those patients with a positive preoperative culture were significantly more likely to develop wound sepsis. There was no significant difference in wound sepsis rates for diabetics. In view of the range of organisms causing postoperative infection, we recommend prophylaxis with a broad spectrum antibiotic for amputations.

Sexually transmitted infections in teenagers.

Prevention of sexually transmitted infection in teenagers is a high priority. The introduction of non-invasive methods for diagnostic testing of Chlamydia trachomatis and Neisseria gonorrhoeae has enabled screening for these sexually transmitted micro-organisms in a range of community-based settings among populations at high risk, such as teenagers, who do not readily access existing sexual health services.

Francis William O’Grady

Francis William O’Grady had a distinguished career as a medical microbiologist and later as chief scientist at the Department of Health. He was an international authority on antimicrobial chemotherapy and urinary and airborne infections. After pathology training at the Bland Sutton Institute, Middlesex Hospital, he did national service in the Royal Army Medical Corps and then joined the Territorial Army, which started a long affiliation to the army and the award of the …

Malcolm John Lewis

After training and hospital jobs in Bristol, Malcolm John Lewis joined the Lister Institute with Bruce Stocker to work on bacterial genetics. He then joined the Public Health Laboratory Service (PHLS) as a trainee bacteriologist, where he worked at the Central Laboratory, Colindale, under the supervision of E S Anderson. There he was involved in seminal work on the spread of bacterial plasmids in …