Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea.

BACKGROUND: The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM: To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS: A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS: Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION: HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.

OPAT for cellulitis: its benefits and the factors that predispose to longer treatment.

This retrospective study investigated the demographics and treatment outcomes of patients with cellulitis receiving outpatient parenteral antibiotic therapy (OPAT) between 2010 and 2014 in Cambridge University Hospitals. The rate of treatment failure (as indicated by the readmission to hospital) was low, at 5.5%. Risk factors associated with a longer duration of OPAT treatment included: immunosuppression, peripheral vascular disease, obesity, lymphoedema, previous cellulitis and diabetes.

Investigation of outbreaks of highly pathogenic H5N1 avian influenza in waterfowl and wild birds in Hong Kong in late 2002.

Outbreaks of highly pathogenic H5N1 avian influenza have occurred in Hong Kong in chickens and other gallinaceous poultry in 1997, 2001, twice in 2002 and 2003. High mortality rates were seen in gallinaceous birds but not in domestic or wild waterfowl or other wild birds until late 2002 when highly pathogenic H5N1 avian influenza occurred in waterfowl (geese, ducks and swans), captive Greater Flamingo (Phoenicopterus ruber) and other wild birds (Little Egret Egretta garzetta) at two waterfowl parks and from two dead wild Grey Heron (Ardea cinerea) and a Black-headed Gull (Larus ridibundus) in Hong Kong. H5N1 avian influenza virus was also isolated from a dead feral pigeon (Columba livia) and a dead tree sparrow (Passer montanus) during the second outbreak. The first waterfowl outbreak was controlled by immediate strict quarantine and depopulation 1 week before the second outbreak commenced. Control measures implemented for the second outbreak included strict isolation, culling, increased sanitation and vaccination. Outbreaks in gallinaceous birds occurred in some live poultry markets concurrently with the second waterfowl outbreak, and infection on a chicken farm was detected 1 week after the second waterfowl park outbreak was detected, on the same day the second grey heron case was detected. Subsequent virus surveillance showed the outbreaks had been contained.

Incidence of perforated and bleeding peptic ulcers before and after the introduction of H2-receptor antagonists.

The incidence of perforated and bleeding peptic ulcer requiring emergency surgery was studied in a defined population before and after the introduction of histamine H2-blockers. The incidence of these ulcer complications was unchanged from 1974 to 1984 with an incidence of ulcer perforation from 4 to 10/100,000 per year and of bleeding ulcer from 5 to 10/100,000, indicating that the H2-blockers have not changed the incidence of severe ulcer complications.

Effect of a somatostatin analogue, SMS 201-995, on 133Xe clearance from colonic mucosa in unanesthetized man.

The effect of intravenous bolus injection of the somatostatin analogue SMS 201-995 on mucosal and submucosal blood flow was studied with the local 133Xe clearance technique in eight subjects. Mucosal and submucosal blood flow decreased by 33% after injection of SMS 201-995. These observations suggest that SMS 201-995, like somatostatin, inhibits splanchnic blood flow.

Effect of somatostatin on 133Xe clearance from colonic mucosa before and after local nervous blockade in unanaesthetized man.

The effect of intravenous somatostatin bolus on mucosal and submucosal blood flow in six patients with colostomies was studied with the local 133Xe clearance technique. Mucosal and submucosal blood flow decreased by 28% after somatostatin injection. After induction of local nervous blockade by infiltrating the labelled area of the mucosal membrane with lidocaine the reduction in blood flow caused by somatostatin was abolished. These observations suggest that the vasoconstrictor effect of somatostatin is mediated by neurogenic mechanisms.