Mark Woodhead

Central Manchester University Hospitals NHS Foundation Trust, Manchester, England, United Kingdom

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Publications (66)438.82 Total impact

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    ABSTRACT: A matched-propensity analysis of national data from the British Thoracic Society community-acquired pneumonia audit was conducted (n=13 725). Overall, time to first antibiotic (TFA) was ≤4 h in 63%. Adjusted 30-day inpatient (IP) mortality was lower for adults with TFA ≤4 h compared with TFA >4 h (adjusted OR 0.84, 95% CI 0.74 to 0.94; p=0.003). Increasing TFA was associated with greater OR of 30-day IP mortality (p value for trend=0.001), but no TFA threshold was evident. Although we found an association between TFA and mortality, we cannot say whether this is causal or whether TFA might just be a quality measure for overall or other processes of care.
    Thorax 11/2015; DOI:10.1136/thoraxjnl-2015-207513 · 8.29 Impact Factor
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    ABSTRACT: C21 CONFLICT OR PEACEFUL CO-EXISTENCE? THE BACTERIAL LUNG MICROBIOME AND HOST IMMUNITY / Poster Discussion Session / Tuesday, May 19/9:30 AM-11:30 AM / Mile High Ballroom 1 A-B (Lower Level) Colorado Convention Center The Genus Haemophilus Was Dominant In A Cohort With Community Acquired Pneumonia And Low Species Diversity Was Related To Age And Prior Pulmonary Disease D. G. Wootton1, M. J. Cox2, G. L. Hickey3, O. Eneje4, J. Court4, 5, L. Macfarlane4, S. Wilks4, M. Woodhead6, W. O. Cookson2, M. F. Moffatt2, P. J. Diggle3, S. B. Gordon4 University of Liverpool, Liverpool, United Kingdom, 2Imperial College London, 6LY, United Kingdom, University of Liverpool, 7BE, United Kingdom, 4Liverpool School of Tropical Medicine, 5QA, United Kingdom, 5, 6Central Manchester University Hospitals NHS Foundation Trust, 9WM, United Kingdom Corresponding author's email: Rationale The causative organism(s) responsible for the syndrome of community acquired pneumonia (CAP) are frequently not defined. Culture-independent techniques offer the possibility of new insights into the range and interactions of pathogens in CAP. Here we explored the bacteria present in sputum from patients with CAP by 16SrRNA gene sequencing. Methods Between February 2011 and March 2013, and as part of a prospective observational cohort study, CAP admissions were recruited within 24 hours of admission at two hospitals in Liverpool. Eligibility criteria were:- Aged ≥ 16yrs; Treatment for CAP (British Thoracic Society in-hospital definition) Exclusion Criteria were:- Admission within the last 14 days; Bronchiectasis or cystic fibrosis; Immunocompromised Self-expectorated sputum was frozen at -80oC in sealed, gamma irradiated pots with no prior processing. DNA was extracted using FastDNATM extraction kits and a bead-beater. Pooled, barcoded products from quadruplicate PCRs of the V3-5 region of the 16SrRNA gene were sequenced using the Roche 454FLX platform. Compositional analysis of relationships between individual taxa and clinical variables was performed using the R package ALDeX2. Bacterial species diversity was explored with the R package Phyloseq. Results 169 subjects provided 86 acute sputum samples of which 76 were analysed (44.7% women, median age 68.5yrs (IQR 49 – 76), median CURB65 score 2 (IQR 0-2.25), median pro-calcitonin 0.73 ng/ml (IQR 0.18-4.30), median length of stay 5 days (IQR 2.75 – 7.25)). Although several individual bacterial operational taxonomic units (OTUs) appeared to be associated with clinical parameters none were significant after correction for multiple testing (Benjamini-Hochberg method). Following rarefaction to 549 reads and removal of singletons, 774 OTUs were identified across all sputum samples; median per-sample was 43 (IQR 23-62). Multiple-regression revealed age (P=0.014) and underlying pulmonary disease (P=0.006) were independently associated with the diversity (Shannon) of bacterial species in a subject’s sputum. Haemophilus_617 was the most abundant OTU in these samples (Figure). Image.png Conclusions In this cohort of patients with CAP, increasing age and underlying pulmonary disease were associated with lower bacterial species diversity. These are well documented risk factors for CAP and are associated with worse outcomes. In culture-based studies pneumococcus is the most commonly implicated bacterial pathogen in CAP. In this study streptococcal OTUs were amongst the most abundant but Haemophilus_617 was twice as abundant. This raises the possibility that bacteria of the genus Haemophilus may be more important than has previously been thought in the context of CAP. This abstract is funded by: This work was supported by a Doctoral Research Fellowship awarded to D.Wootton by the UK National Institute of Health Research (NIHR) and by the Wellcome Trust. Am J Respir Crit Care Med 191;2015:A3954 Internet address: Online Abstracts Issue
    American Thoracic Society Conference, Denver, USA; 05/2015
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    ABSTRACT: There are no completed randomised trials of the use of corticosteroids in patients with severe influenza infection. Corticosteroid use in influenza is widespread, non-systematic and marked by controversy. A recent meta-analysis of observational studies of adjuvant corticosteroids in influenza found an association with increased mortality but there were important concerns regarding the risks of bias. To (1) evaluate whether or not low-dose corticosteroids given as an adjunct to standard treatment is beneficial in patients who are hospitalised with severe pandemic influenza and (2) develop an 'off-the-shelf' clinical trial that is ready to be activated in a future pandemic. Multicentre, pragmatic, blinded, randomised placebo-controlled trial. Thirty to 40 hospitals in the UK. Adults (≥ 16 years) admitted to hospital with an influenza-like illness during a pandemic. Five-day course of dexamethasone (Dexsol®, Rosemont Pharmaceuticals Ltd) 6 mg daily, started within 24 hours of admission. Admission to Intensive Care Unit, or death, within 30 days of admission to hospital. This trial has not yet been activated. It is currently set up with full ethics and regulatory approvals in place, ready for rapid activation at the onset of the next pandemic. Hurdles to setting up a pandemic trial include planning for pandemic-level pressures on UK NHS resources and co-enrolment of patients to multiple pandemic studies, ensuring adequate geographical distribution of participating sites, maintaining long-term low-level engagement with site investigators, addressing future trial-specific training needs of local investigators and resilience planning in trial management. Identified threats to trial delivery include changes to research capabilities or policies during the hibernation phase, lack of staff resources during a pandemic and the influence of media at the time of a pandemic. A mismatch in the approach to informed consent required by current regulations to that preferred by patients and the public was identified. This study demonstrates that advance set-up of a trial to be conducted during a pandemic, with full regulatory approvals in place, is possible. Regular review during the hibernation phase will be required. This study serves as a model for the development of other 'off-the-shelf' trials as part of preparedness planning for public health emergencies. Current Controlled Trials ISRCTN72331452. European Union Drug Regulating Authorities Clinical Trials number: 2013-001051-12. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 16. See the NIHR Journals Library website for further project information.
    Health technology assessment (Winchester, England) 02/2015; 19(16):1-78. DOI:10.3310/hta19160 · 5.03 Impact Factor
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    ABSTRACT: Objective To determine the association between 30-day inpatient mortality and route of admission to hospital, for adults with community acquired pneumonia (CAP). Methods We studied 16 313 adults included in the British Thoracic Society (BTS) national CAP audit dataset. Comparisons were made between adults admitted via emergency departments (ED) with non-ED routes of admission, with regard to 30-day inpatient mortality. Secondary outcome measures were adherence to national CAP guidelines (time to first chest X-ray ≤4 h from admission; time to first antibiotic dose ≤4 h from admission; antibiotic choice; and antibiotic route of administration) by route of admission. Results Of adults hospitalised with CAP, 75.6% were admitted via ED; these adults had a greater prevalence of comorbid illness and higher disease severity in comparison with non-ED admissions. Adjusted 30-day inpatient mortality was similar for ED versus non-ED route of admission (OR 1.10, 95% CI 0.96 to 1.25). Admissions via ED were associated with faster processes of care (time to chest X-ray ≤4 h, adjusted OR 3.39, 95% CI 2.79 to 4.12; time to first antibiotic ≤4 h, adjusted OR 1.62, 95% CI 1.42 to 1.84) and greater use of intravenous antibiotics regardless of disease severity (adjusted OR 1.58, 95% CI 1.43 to 1.74). Conclusions Adults with CAP admitted via EDs have more comorbid illness and greater disease severity compared to those admitted via non-ED routes. Following adjustment for these differences, 30-day inpatient mortality was not associated with route of admission.
    Emergency Medicine Journal 12/2014; 32(1). DOI:10.1136/emermed-2013-203494 · 1.84 Impact Factor
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    Giovanni Sotgiu · Mark Woodhead ·

    European Respiratory Journal 07/2014; 44(1):5-7. DOI:10.1183/09031936.00081714 · 7.64 Impact Factor
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    D. G. Wootton · P. J. Diggle · M. Woodhead · S. B. Gordon ·
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    ABSTRACT: D. G. Wootton , P. J. Diggle , M. Woodhead , S. B. Gordon Liverpool School of Tropical Medicine, Liverpool, United Kingdom, , University of Liverpool, Institute of Infection and Global Health, Liverpool, United Kingdom, Manchester Royal Infirmary, Manchester, United Kingdom Corresponding author's email: Rationale Despite evidence of excess long term morbidity and mortality, little is known about the factors that affect rates of recovery from community acquired pneumonia (CAP). One mechanism that may account for differential resolution of inflammation and associated symptoms is efferocytosis. This process of removing apoptotic host cells is a vital component of recovery from acute inflammation and is impaired in a number of inflammatory lung conditions. We measured efferocytosis in patients recovering from CAP and looked for factors that influenced this process. Methods As part of a prospective observational cohort study, between February 2011 and 31 March 2013, at two hospitals in Liverpool (UK), st admissions were recruited within 24 hours of admission. Eligibility criteria were: · Aged ≥ 16 · Treatment for CAP (British Thoracic Society in hospital definition). Exclusion Criteria were:-· Admission within the last 14 days · Bronchiectasis or cystic fibrosis · Immunocompromised One month following admission, subjects were invited to re-visit for bronchoscopy and bronchoalveolar lavage (BAL). Saline was instilled into the middle lobe and alveolar macrophages were separated and cultured. Simultaneously, whole blood was taken from the subject and neutrophils were separated, stained green and allowed to become apoptotic by culture for 20 hours. The neutrophils were added to the macrophages and co-cultured for 90 minutes. Efferocytosis was then measured using flow cytometry. Results 169 subjects (48% women, mean age 64y-range 16-94y) were recruited. 22 volunteered to undergo research bronchoscopy (36% women, mean age 48 – range 22-82y). Multiple regression analysis of these 22 subjects revealed smoking (p<0.001) and prior statin use (p<0.001) as having significant associations with efferocytosis. The analysis used a linear mixed effects model to account for inter-subject and intra-subject efferocytosis assay variation. Inter-subject and intra-subject (assay) variation accounted for 84.3% and 15.7%, respectively of the variation in the data. efferocytosis mean and statin.jpg Conclusions These experiments demonstrate that, in patients recovering from CAP, there is a statistically significant association between smoking, prior statin use and the capacity of alveolar macrophages to carry out efferocytosis. These observations have not been made previously in patients recovering from pneumonia. However, previous studies have shown that the reduced capacity for efferocytosis in alveolar macrophages from subjects with COPD can be increased by exposure to statins. Ours was a small study but the data support the epidemiological association between statin use and improved outcomes following CAP and suggest efferocytosis is one possible mechanism to explain this. This abstract is funded by: This work was supported by a Doctoral Research Fellowship awarded to Dr D.G. Wootton by National Instituteof Health Research (NIHR)UK. Am J Respir Crit Care Med 189;2014:A5237 Internet address: Online Abstracts Issue
    American Thoracic Society Meeting, San Diego, USA; 05/2014
  • Mark Woodhead ·

    European Respiratory Journal 02/2014; 43(2):331-3. DOI:10.1183/09031936.00145313 · 7.64 Impact Factor
  • Zaid Al-Nakeeb · Vandana Gupta · Christine Bell · Mark Woodhead ·
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    ABSTRACT: Tuberculosis (TB) incidence is rising globally, with drug resistance becoming increasingly problematic. Microbiological confirmation ensures correct anti-tuberculous chemotherapy. We retrospectively analysed all TB cases diagnosed in Central Manchester in 2009 investigating how often we are not achieving microbiological diagnosis, factors influencing this and whether opportunities to obtain microbiological samples are missed. 128/156 (82%) cases had samples sent for microbiology. Factors affecting this included disease site, with ocular disease least likely to be sampled (p < 0.0001), and patient age (with children less likely to be sampled p = 0.002). Ethnicity did not affect sampling (n.s.). Overall, 92/156 (59%) cases were culture positive. Negative culture was related to specimen type (p < 0.0001) and patient age (p = 0.019), with children significantly less likely to have a positive culture. Ethnicity and disease site did not affect culture results. There was a trend towards culture positivity being more common in pulmonary (75%) than non-pulmonary (46%) disease (n.s.). In only 7 (4%), could samples have been sent where they were originally absent (3) or further samples obtained where the cultures proved to be negative (4). Despite an overall culture positive rate of 59%, opportunities to achieve microbiological confirmation are seldom missed. In our centre, which is typical of UK practice, this lack of capacity to increase microbiological confirmation, particularly in an era of increasing importance of extra-pulmonary TB, is concerning. Improvements in sample acquisition and laboratory methods are urgently required.
    Respiratory medicine 10/2013; 107(12). DOI:10.1016/j.rmed.2013.09.016 · 3.09 Impact Factor
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    Waseem Asrar Khan · Mark Woodhead ·
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    ABSTRACT: This article is a non-systematic review of selected recent publications in community-acquired pneumonia, including a comparison of various guidelines. Risk stratification of patients has recently been advanced by the addition of several useful biomarkers. The issue of single versus dual antibiotic treatment remains controversial and awaits a conclusive randomized controlled trial. However, in the meantime, there is a working consensus that more severe patients should receive dual therapy.
    F1000 Prime Reports 10/2013; 5:43. DOI:10.12703/P5-43
  • Mark Woodhead ·

    Thorax 09/2013; 68(11). DOI:10.1136/thoraxjnl-2013-204060 · 8.29 Impact Factor
  • Philip A J Crosbie · Mark Woodhead ·

    Thorax 05/2013; 68(10). DOI:10.1136/thoraxjnl-2013-203766 · 8.29 Impact Factor
  • Mark Woodhead · Ruth Wiggans ·

    Expert Review of Respiratory Medicine 02/2013; 7(1):5-7. DOI:10.1586/ers.12.79
  • Chamira Rodrigo · Tricia M McKeever · Mark Woodhead · Wei Shen Lim ·
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    ABSTRACT: The benefits of β-lactam/macrolide combination therapy over β-lactam therapy alone for the treatment of hospitalised community-acquired pneumonia (CAP) in relation to pneumonia severity are uncertain. We studied 5240 adults hospitalised with CAP from 72 secondary care trusts across England and Wales. The overall 30-day inpatient (IP) death rate was 24.4%. Combination therapy was prescribed in 3239 (61.8%) patients. In a multivariable model, combination therapy was significantly associated with lower 30-day IP death rate in patients with moderate-severity CAP (adjusted OR 0.54, 95% CI 0.41 to 0.72) and high-severity CAP (adjusted OR 0.76, 95% CI 0.60 to 0.96) but not low-severity CAP.
    Thorax 10/2012; 68(5). DOI:10.1136/thoraxjnl-2012-202296 · 8.29 Impact Factor
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    Wei Shen Lim · Mark Woodhead ·

    Thorax 09/2012; 67(9):832-833. DOI:10.1136/thoraxjnl-2011-200980 · 8.29 Impact Factor
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    ABSTRACT: Patients with Chronic Obstructive Pulmonary Disease (COPD) are at higher risk of developing Community-Acquired Pneumonia (CAP) than patients in the general population. However, no studies have been performed in general practice assessing longitudinal incidence rates for CAP in COPD patients or risk factors for pneumonia onset. A cohort of COPD patients aged ≥ 45 years, was identified in the General Research Practice Database (GPRD) between 1996 and 2005, and annual and 10-year incidence rates of CAP evaluated. A nested case-control analysis was performed, comparing descriptors in COPD patients with and without CAP using conditional logistic regression generating odds ratios (OR) and 95% confidence intervals (CI). The COPD cohort consisted of 40,414 adults. During the observation period, 3149 patients (8%) experienced CAP, producing an incidence rate of 22.4 (95% CI 21.7-23.2) per 1000 person years. 92% of patients with pneumonia diagnosis had suffered only one episode. Multivariate modelling of pneumonia descriptors in COPD indicate that age over 65 years was significantly associated with increased risk of CAP. Other independent risk factors associated with CAP were co-morbidities including congestive heart failure (OR 1.4, 95% CI 1.2-1.6), and dementia (OR 2.6, 95%CI 1.9-3.). Prior severe COPD exacerbations requiring hospitalization (OR 2.7, 95% CI 2.3-3.2) and severe COPD requiring home oxygen or nebulised therapy (OR 1.4, 95% CI 1.1-1.6) were also significantly associated with risk of CAP. COPD patients presenting in general practice with specific co-morbidities, severe COPD, and age >65 years are at increased risk of CAP.
    Respiratory medicine 05/2012; 106(8):1124-33. DOI:10.1016/j.rmed.2012.04.008 · 3.09 Impact Factor
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    Paul A Marsden · Mark Woodhead ·

    Primary care respiratory journal: journal of the General Practice Airways Group 03/2012; 21(1):11-3. DOI:10.4104/pcrj.2012.00018 · 2.50 Impact Factor
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    ABSTRACT: Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases. Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of > 100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan. Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman's rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (χ2 = 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control. TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.Please see related article:
    BMC Public Health 11/2011; 11(1):896. DOI:10.1186/1471-2458-11-896 · 2.26 Impact Factor
  • Wei Shen Lim · Mark Woodhead ·
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    ABSTRACT: The updated British Thoracic Society (BTS) Guidelines for the management of community acquired pneumonia (CAP) in adults was published in October 2009. In conjunction with the Guidelines, the first national BTS audit of adult CAP was conducted. An audit tool was developed as part of the Guidelines. Members of the BTS were invited to participate in the audit capturing data relating to acutely ill adults admitted to hospitals in the U.K. and treated for CAP within the period 1 December 2009 and 31 January 2010. Data entry using the web-based audit tool closed in May 2010. Of 2749 submissions from 64 institutions; 8 were excluded due to inconsistent data. The mean age of patients was 71 years (range 16-105 years). The CURB65 score was 0 to 1 in 40% of patients, 2 in 30% and 3 to 5 in 30%. Five hundred and three (18.3%) patients died in hospital within 30 days, 101 (20.1%) within 1 day of admission. Initial empirical antibiotics were in accordance with local CAP guidelines in 1478 (55.5%) patients and were administered intravenously in 712 (65%), 603 (74%) and 743 (90%) patients with CURB65 scores 0 to 1, 2 and 3 to 5 respectively. Within 4 hours of admission, a chest x-ray was obtained in 83% of patients and the first dose of antibiotics was administered in 58%. The burden of CAP is high. Efforts should be directed at improving adherence to local CAP guidelines and specific processes of care.
    Thorax 06/2011; 66(6):548-9. DOI:10.1136/thoraxjnl-2011-200081 · 8.29 Impact Factor
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    Nita Sehgal · Mark Woodhead ·

    Thorax 03/2011; 66(3):187-8. DOI:10.1136/thx.2010.157404 · 8.29 Impact Factor
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    Vandana Gupta · Mark Woodhead ·

    Primary care respiratory journal: journal of the General Practice Airways Group 12/2010; 19(4):301-3. DOI:10.4104/pcrj.2010.00055 · 2.50 Impact Factor

Publication Stats

2k Citations
438.82 Total Impact Points


  • 2012-2015
    • Central Manchester University Hospitals NHS Foundation Trust
      Manchester, England, United Kingdom
  • 2009-2014
    • The University of Manchester
      • Respiratory Medicine Research Group
      Manchester, England, United Kingdom
  • 2011
    • British Thoracic Society
      United Kingdom
  • 1991
    • St George's, University of London
      Londinium, England, United Kingdom
  • 1989
    • Saint James School Of Medicine
      Παρκ Ριτζ, Illinois, United States
  • 1986
    • Nottingham University Hospitals NHS Trust
      Nottigham, England, United Kingdom