Mike Sharland

Publications (60)181.39 Total impact

• Article: A systematic review of strategies for reporting of neonatal hospital-acquired bloodstream infections.

  Laura Folgori, Julia Bielicki, Mike Sharland
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  ABSTRACT: OBJECTIVE: To examine the reporting of hospital-acquired bloodstream infection (HABSI) and central line-associated BSI (CLABSI) rates in neonatal intensive care units (NICUs). DESIGN: Systematic review of evidence published after 2000 reporting HABSI cumulative incidence, crude HABSI and/or CLABSI rate and total patient-days and/or central line-days for single NICU. SETTING: Inpatient. PATIENTS: Neonates admitted to NICU. MAIN OUTCOME MEASURES: To consider the reporting of and relationship between cumulative incidence of BSI and HABSI and/or CLABSI rates. RESULTS: 18 studies fulfilled inclusion criteria. There was a wide variability in reporting of HABSI indicators and risk-adjustment strategies with reported crude HABSI and/or CLABSI rates showing an approximately sevenfold variation between centres. Information about NICU size and level of care was not always available. Many studies provided insufficient information about case mix, such as surgical care provision and prematurity. The proportion of total patient-days that were central venous catheters (CVC)-days ranged from 11.7% to 85.4%. Only six studies reported HABSI and CLABSI incidence. Comparing HABSI and CLABSI ranking, we found a relationship between rates. CONCLUSIONS: We found significant variability in HABSI rate reporting. Although there appears to be an association between CLABSI and HABSI rates, non-CVC-related BSIs are likely to be highly relevant in some NICUs. If confirmed, and given CLABSI rates are more challenging to collect, it may be more appropriate to use HABSI rates for monitoring NICU healthcare-associated infection (HAI) in some settings. A European network of NICUs using a standardised methodology is required to determine the feasibility and reliability of different risk-adjusted measured of HAI rates.
  Archives of Disease in Childhood - Fetal and Neonatal Edition 05/2013; · 3.05 Impact Factor
• Article: Rifampicin pharmacokinetics in extreme prematurity to treat congenital tuberculosis.

  Kirsty Le Doare, Nathaniel Barber, Katja Doerholt, Mike Sharland
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  ABSTRACT: Little evidence is available on the pharmacokinetics of antituberculous medication in premature infants. We report rifampicin (RMP) pharmacokinetics in an extremely premature, low-birthweight female infant born to a mother with known miliary tuberculosis. Intravenous RMP, isoniazid (INH), ciprofloxacin and amikacin were used, as the enteral route was not possible. Area under the curve calculations revealed low average RMP concentrations at doses of 5-10 mg/kg. We review the literature with regard to the dosing regimen and therapeutic drug levels of RMP and INH in premature infants and discuss issues of management. Evidence from this case suggests 10 mg/kg/day is the minimum dose required.
  Case Reports 01/2013; 2013.
• Article: The epidemiology of neonatal and pediatric candidemia in England and wales, 2000-2009.

  Clarissa Oeser, Theresa Lamagni, Paul T Heath, Mike Sharland, Shamez Ladhani
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  ABSTRACT: : There are few population-based studies on the epidemiology of neonatal and pediatric invasive Candida infections, despite their significant clinical impact on patients. This study aimed to describe the epidemiology of pediatric candidemia in England and Wales during a 10-year period as a means of quantifying the changing burden of infection and identifying emerging trends. : National Health Service hospital microbiology laboratories in England and Wales routinely report clinically significant invasive infections electronically to the Health Protection Agency. Records of all positive blood cultures for Candida species in children aged <15 years between 2000 and 2009 inclusive were extracted for analysis. : During 2000 to 2009, 1473 childhood candidemia cases were reported in England and Wales (annual incidence, 1.52/100,000 person-years), with the highest rate in <1 year olds (n = 706; 11.0/100,000), followed by 1-4 year olds (n = 440; 1.77/100,000), 5-9 year olds (n = 168; 0.53/100,000) and 10-14 year olds (n = 159; 0.47/100,000). Incidence increased from 1.04 per 100,000 in 2000 to 2.09 per 100,000 in 2007 (P < 0.001) before falling to 1.53 per 100,000 in 2009 (P < 0.001). Candida species was reported in 89.6% (1320/1473) cases, with Candida albicans and Candida parapsilosis accounting for most infections in all age groups. There were no significant differences in species distribution by season or year of study and the proportion of non-albicans cases did not increase with time. : Pediatric candidemia rates are beginning to fall in England and Wales. C. albicans continues to account for most Candida bloodstream infections in all age groups with no evidence of increases in non-albicans species.
  The Pediatric Infectious Disease Journal 01/2013; 32(1):23-6. · 3.58 Impact Factor
• Article: Significantly increasing hospital admissions for acute throat infections among children in England: is this related to tonsillectomy rates?

  Elizabeth Koshy, Joanna Murray, Alex Bottle, Paul Aylin, Mike Sharland, Azeem Majeed, Sonia Saxena
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  ABSTRACT: OBJECTIVE: To examine trends in hospital admissions for acute throat infection (ATI) and peritonsillar abscess (PTA) alongside tonsillectomy trends in children. DESIGN: We analysed Hospital Episode Statistics data to calculate annual age-standardised and age-sex specific rates for ATI, PTA and tonsillectomies in children aged 0-17 years who were admitted to hospital in England between 1 April 1999 and 31 March 2010. RESULTS: Age-standardised admission rates for ATI increased by 76% from 107.3 (95% CI 105.3 to 109.2) to 188.4 (95% CI 185.9 to 191.0) admissions per 100 000 children. Median length of stay for ATI admissions decreased from 1 to 0 days. Admission rates for PTA remained stable at between 9.6 (95% CI 9.0 to 10.2) and 8.7 (95% CI 8.1 to 9.2) per 100 000 children in 1999/2000 and 2009/2010, respectively. Age-standardised tonsillectomy rates declined from 367.4 (95% CI 363.8 to 371.0) to 278.0 (95% CI 274.9 to 281.1) per 100 000 children between 1999/2000 and 2000/2001, respectively, increased to 322.4 (95% CI 319.0 to 325.7) in 2002/2003 and then gradually declined again to 293.6 (95% CI 290.4 to 296.8) in 2009/2010. CONCLUSIONS: ATI admission rates have increased substantially in the past decade, but the majority of children are discharged after a short stay. PTA admission rates have remained stable. This suggests the severity of throat infection has not increased. Tonsillectomy rates in England have been declining overall but do not appear to be associated with this increasing trend in ATI admissions. The increase most likely reflects changes in primary care and hospital service provision.
  Archives of Disease in Childhood 10/2012; · 2.88 Impact Factor
• Article: Neonatal sepsis - many blood samples, few positive cultures: implications for improving antibiotic prescribing.

  Ruth M Blackburn, Berit Muller-Pebody, Tim Planche, Alan Johnson, Susan Hopkins, Mike Sharland, Nigel Kennea, Paul T Heath
  Archives of Disease in Childhood - Fetal and Neonatal Edition 07/2012; 97(6):487-8. · 3.05 Impact Factor
• Article: Primary care of children: the unique role of GPs.

  Sonia Saxena, Nick Francis, Mike Sharland
  British Journal of General Practice 07/2012; 62(600):340-1. · 1.83 Impact Factor
• Article: Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart--Then Focus.

  Diane Ashiru-Oredope, Mike Sharland, Esmita Charani, Cliodna McNulty, Jonathan Cooke
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  ABSTRACT: There has been dramatic change in antibiotic use in English hospitals. Data from 2004 and 2009 show that the focus on reducing fluoroquinolone and second- and third-generation cephalosporin use seems to have been heeded in NHS secondary care, and has been associated with a substantial decline in hospital Clostridium difficile rates. However, there has been a substantial increase in use of co-amoxiclav, carbapenems and piperacillin/tazobactam. In primary care, antibiotic prescribing fell markedly from 1995 to 2000, but has since risen steadily to levels seen in the early 1990s. There remains a 2-fold variation in antimicrobial prescribing among English General Practices. In 2010, the NHS Atlas of Variation documented a 3-fold variation in the prescription of quinolones and an 18-fold variation in cephalosporins by Primary Care Trusts across England. There is a clear need to improve antimicrobial prescribing. This paper describes the development of new antimicrobial stewardship programmes for primary care and hospitals by the Department of Health's Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection: Antimicrobial Stewardship in Primary Care Initiative. The secondary care programme promotes the rapid prescription of the right antibiotic at the right dose at the right time, followed by active review for all patients still on antibiotics 48 h after admission. The five options available are to stop, switch to oral, continue and review again, change (if possible to a narrower spectrum) or move to outpatient parenteral antibiotic therapy. A range of audit and outcome tools has been developed, but to maintain optimal antimicrobial usage, monitoring of local and national quantitative and qualitative data on prescribing and consumption is required, linked to the development of key performance indicators in primary, secondary and tertiary care.
  Journal of Antimicrobial Chemotherapy 07/2012; 67 Suppl 1:i51-63. · 5.07 Impact Factor
• Article: Comparing neonatal and paediatric antibiotic prescribing between hospitals: a new algorithm to help international benchmarking.

  Alessandro Porta, Yingfen Hsia, Katja Doerholt, Nikos Spyridis, Julia Bielicki, Esse Menson, Maria Tsolia, Susanna Esposito, Ian C K Wong, Mike Sharland
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  ABSTRACT: The WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) methodology is a standardized method of comparing antimicrobial use. The ATC/DDD is defined as the average maintenance daily dose of a drug used in a 70 kg adult, ignoring the considerable differences in body weight of neonates and children. The aim of this study was to develop a new standardized way of comparing rates of antimicrobial prescribing between European children's hospitals. This pilot study at four European children's hospitals (in the UK, Greece and Italy) collected data including demographics, antibiotic use, dosing and indication in children and neonates over a 14 day period. A total of 1217 antibiotic prescriptions were issued with 47 different antibiotics used. Approximately half of all children and a third of all neonates received antibiotics, with wide variation between centres in the type and dose of antibiotic used. We propose a new pragmatic three-step algorithm. The first step includes a simple comparison of the proportion of hospitalized children on antibiotics by weight bands and the number of antimicrobials that account for 90% of total DDD drug usage (DU90%). The second step is a comparison of the dosing used (mg/kg/day). The third step is to compare overall drug exposure using DDD/100 bed days for standardized weight bands between centres. This novel method has the potential to be a useful tool to provide antibiotic use comparator data and requires validation in a large prospective point prevalence study.
  Journal of Antimicrobial Chemotherapy 02/2012; 67(5):1278-86. · 5.07 Impact Factor
• Article: Using antibiotics responsibly: right drug, right time, right dose, right duration.

  Matthew Dryden, Alan P Johnson, Diane Ashiru-Oredope, Mike Sharland
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  ABSTRACT: Everyone prescribing antibiotics should consider both their clinical and public health responsibilities. The objective should be to provide optimal patient care while at the same time seeking to minimize selective pressure that may result in the emergence and spread of antibiotic resistance. To this end, in 2008 the European Centre for Disease Control initiated the annual European Antibiotic Awareness Day (EAAD) to take place on 18 November, when Europe-wide activities are undertaken to highlight the critical importance of prudent antibiotic prescribing. This year activities in England will focus on the optimal management of infections in secondary care, and will have two inter-related aims. The first is to improve the quality of the initial decision to prescribe an antibiotic (including making an informed choice of empirical drug and dose) in particular ensuring rapid prescribing and administration in presumed sepsis. This is deliberately combined with a second focus on the critical importance of formally reviewing antibiotic therapy at 48 h, based on the patient's clinical response and the availability of microbiology test results. This should lead to a clear decision to stop, switch to oral, switch to outpatient antibiotic therapy (OPAT) or change antibiotic, if possible to a narrower spectrum. The EAAD campaign in England will highlight the need to 'Start Smart-Then Focus'. The aim is that patients receiving antibiotics should receive the right drug at the right time at the right dose for the right duration.
  Journal of Antimicrobial Chemotherapy 09/2011; 66(11):2441-3. · 5.07 Impact Factor
• Article: Measuring antibiotic prescribing in hospitalised children in resource-poor countries: A systematic review.

  Adam Irwin, Mike Sharland
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  ABSTRACT: Antibiotic resistance represents a significant threat to global health. Widespread exposure to antibiotics drives the development of antibiotic resistance. Little is known about the exposure to antibiotics of hospitalised children, particularly in resource-poor countries where the burden of infectious disease is highest. The review sought to identify original research quantifying antibiotic use in hospitalised children in resource countries. The methods used were: A systematic search of the MEDLINE, CINAHL, EMBASE, LILACS and African Index Medicus databases. Eighteen papers were identified and the methodology varied considerably. Only seven used a recognised defined daily dose (DDD) methodology. The studies reveal a high exposure of hospitalised children to antibiotics. With the exception of data from China, the studies were limited by their design. Limited evidence of the variation in drug, dose and total exposure to antibiotic use in hospitalised children in resource-poor countries exists. An international network of surveillance of both antimicrobial prescribing and resistance using a simple standardised methodology in this context remains an important goal. A simplified paediatric version of the adult DDD methodology is required to allow international comparison between populations.
  Journal of Paediatrics and Child Health 06/2011; · 1.28 Impact Factor
• Article: The Contribution of Infections to Neonatal Deaths in England and Wales

  Sarita J. Depani, Shamez Ladhani, Paul T. Heath, Theresa L. Lamagni, Alan P. Johnson, Richard G. Pebody, Mary E. Ramsay, Mike Sharland
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  ABSTRACT: This study used anonymized death certificate data to determine the contribution of specific infections to neonatal deaths in England and Wales between 2003 and 2005. Infection was recorded in 11% of deaths, with two-thirds occurring in premature neonates. Group B Streptococcus was indicated in 32% of death certificates that specified a bacterial infection and in 11% of all infection-related deaths.
  The Pediatric Infectious Disease Journal 03/2011; 30(4):345-347. · 3.58 Impact Factor
• Article: Ganciclovir treatment in children: evidence of subtherapeutic levels.

  Suzanne Luck, Andrew Lovering, Paul Griffiths, Mike Sharland
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  ABSTRACT: Ganciclovir (GCV) is used to treat babies and older children with cytomegalovirus-related disease. Treatment courses are generally derived from adult studies and there are few data relating to the pharmacokinetics of GCV in children. In adults, low trough GCV levels have been associated with treatment failure and virological resistance. Data regarding suitable drug levels for use in therapeutic drug monitoring (TDM) in the paediatric age group do not currently exist. In this study, anonymised data for all GCV levels sent to the UK Antibiotic Reference Laboratory from 1 November 1999 to 31 March 2007 were reviewed and analysed by age group. In total, 339 specimens were received from 129 patients; 192 specimens were from patients aged <18 years. There were significantly more trough GCV levels <0.5 mg/L in those aged <6 months and 6-12 months compared with adults (64.8% and 53.9%, respectively, vs. 15.9%; P<0.001). Those aged 5-18 years also had significantly more trough samples with levels <0.5 mg/L (80.0% vs. 15.9%; P<0.001). There was a significant difference between median peak GCV levels in those aged <6 months and adults (4.8 mg/L vs. 5.7 mg/L, respectively; P=0.047). In conclusion, GCV levels associated with treatment failure and considered subtherapeutic in adult patients were observed more often in specimens from paediatric patients. These lower levels may have implications for dosing in the paediatric age group, particularly during periods of rapid change in renal function such as the neonatal period. Clinicians should be aware of the relatively low drug exposure noted in this study and consider TDM and increasing drug dose where virological response is poor.
  International journal of antimicrobial agents 02/2011; 37(5):445-8. · 3.03 Impact Factor
• Article: Dosing of oral penicillins in children: is big child=half an adult, small child=half a big child, baby=half a small child still the best we can do?

  Umar Ahmed, Nikos Spyridis, Ian C K Wong, Mike Sharland, Paul F Long
  BMJ (Clinical research ed.). 01/2011; 343:d7803.
• Article: Antiviral therapy of CMV disease in children.

  Mike Sharland, Suzanne Luck, Paul Griffiths, Mark Cotton
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  ABSTRACT: Cytomegalovirus (CMV) remains an important cause of morbidity and mortality in infants and children. The main burden of disease occurs in congenital infection, postnatal infection in premature infants and in older immunocompromised children (now predominantly following transplantation) in developed countries. In lower income countries, CMV is a major co-pathogen in human immunodeficiency virus [HIV]-infected infants. Antiviral treatment options remain very limited. The guanosine analogue ganciclovir (GCV) was first used in children over 20 years ago, but the optimal dose, duration and route of administration remain poorly evidence based. In particular there are very limited data in premature infants and older children. Direct comparison studies between the intravenous ganciclovir and the oral valyl-ester valganciclovir (VGCV) have not been performed. CMV disease is important, but not very common and there remains a need to identify useful surrogate markers of successful antiviral therapy to facilitate clinical trials. Cidofovir and foscarnet have very significant toxicity. No other anti-CMV agent has successfully completed phase III studies. There remain few other antiviral agents effective against CMV on the horizon. This chapter reviews the current clinical spectrum of CMV disease in childhood and the evidence base for both GCV and VGCV use in clinical practice. It also discusses the antiviral studies currently being performed and those that need to be performed.
  Advances in experimental medicine and biology 01/2011; 697:243-60. · 1.09 Impact Factor
• Article: Response to Gandhi et al., Management of congenital cytomegalovirus infection.

  Suzanne Luck, Paul D Griffiths, Mike Sharland
  Acta Paediatrica 10/2010; 99(10):1445. · 2.07 Impact Factor
• Article: Improving antibiotic prescribing in neonatal units: time to act.

  Alison Bedford Russell, Mike Sharland, Paul T Heath
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  ABSTRACT: Antibiotics are increasingly prescribed in the peripartum period, for both maternal and fetal indications. Their effective use can be life-saving, however, injudicious use drives antibiotic resistance and contributes to the development of abnormal faecal flora and subsequent immune dysregulation. Neonatal units are a high risk area for the selection and transmission of multi-resistant organisms. Very few new antibiotics with activity against Gram-negative bacteria are under development, and no significantly new Gram-negative antibiotics will be available in the next decade. This review seeks to summarise current practice, and suggests restrictive antibiotic strategies based on epidemiological data from recently published UK neonatal infection surveillance studies.
  Archives of Disease in Childhood - Fetal and Neonatal Edition 10/2010; 97(2):F141-6. · 3.05 Impact Factor
• Article: High neonatal concentrations of raltegravir following transplacental transfer in HIV-1 positive pregnant women.

  Denise A McKeown, Melanie Rosenvinge, Sheila Donaghy, Mike Sharland, David W Holt, Ian Cormack, Phillip Hay, S Tariq Sadiq
  AIDS (London, England) 09/2010; 24(15):2416-8. · 4.91 Impact Factor
• Article: Impact of the seven-valent pneumococcal conjugate vaccination (PCV7) programme on childhood hospital admissions for bacterial pneumonia and empyema in England: national time-trends study, 1997-2008.

  Elizabeth Koshy, Joanna Murray, Alex Bottle, Mike Sharland, Sonia Saxena
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  ABSTRACT: Childhood bacterial pneumonia and empyema rates have reportedly increased in recent years in Europe. In September 2006 the seven-valent pneumococcal conjugate vaccination (PCV7) was introduced to the childhood national immunisation programme in England following a successful PCV7 campaign in the USA. The aim of this study was to report national time trends in hospital admissions for childhood bacterial pneumonia and empyema in England before and after the introduction of PCV7. A population-based time-trend analysis of Hospital Episode Statistics data of children aged <15 years admitted to all NHS hospitals in England, with a primary diagnosis of bacterial pneumonia and empyema from 1997 to 2008 was performed. Annual crude and age-sex standardised hospital admission rates for bacterial pneumonia and empyema were calculated. Admission rates for bacterial pneumonia and empyema increased from 1997 to 2006, then declined to 2008. Bacterial pneumonia rates decreased to 1079 (95% CI 1059 to 1099) per million children and empyema rates decreased to 14 (95% CI 11 to 16) per million children. The RR for bacterial pneumonia admissions was 1.19 (95% CI 1.16 to 1.22) in 2006 compared with 2004 and 0.81 (95% CI 0.79 to 0.83) in 2008 compared with 2006. For empyema, the corresponding RRs were 1.77 (95% CI 1.38 to 2.28) in 2006 compared with 2004 and 0.78 (95% CI 0.62 to 0.98) in 2008 compared with 2006. Childhood bacterial pneumonia and empyema admission rates were increasing prior to 2006 and decreased by 19% and 22% respectively between 2006 and 2008, following the introduction of the PCV7 pneumococcal conjugate vaccination to the national childhood immunisation programme.
  Thorax 09/2010; 65(9):770-4. · 6.84 Impact Factor
• Source

  Available from: Nicola Principi

  Article: Off-label antibiotic use in children in three European countries.

  Alessandro Porta, Susanna Esposito, Esse Menson, Nikos Spyridis, Maria Tsolia, Mike Sharland, Nicola Principi
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  ABSTRACT: Antibiotics are the drugs most frequently prescribed for children, and most of them lack patent protection. The aim of this study was to evaluate off-label antibiotic use in three European countries. Data relating to all patients admitted to the neonatal intensive care units (NICUs) and paediatric wards of the participating centres were collected by the same investigator over a 2-week survey period between February and May 2009. The data included age, date of birth, weight, relevant medical history and diagnosis, together with details of all of the antibiotics prescribed (compound, route of administration, dose, and indication for use). The study involved 616 children (110 admitted to NICUs: 62 in the UK, 38 in Italy and 10 in Greece; 506 admitted to general paediatric wards: 265 in the UK, 94 in Italy and 147 in Greece). A total of 1,244 antibiotic prescriptions were issued (290 in NICUs and 954 in paediatric wards). The results showed that off-label antibiotic use is very common among European paediatric patients, with generally only slight, but sometimes significant differences between countries. However, this use relates almost exclusively to doses and indications, and rarely to age. The only antibiotics found to be used off-label in an age-related manner in paediatric clinical practice are meropenem for neonates and quinolones or linezolid for older children, which represent priorities for future studies. European-wide educational programmes are urgently needed to meet the objectives of improving paediatricians' working knowledge of the recommendations surrounding licensed antibiotics-use in children, and of reducing uncontrolled patterns of prescribing.
  European Journal of Clinical Pharmacology 09/2010; 66(9):919-27. · 2.85 Impact Factor
• Source

  Available from: Sonia Saxena

  Article: Risk-benefit analysis of restricting antimicrobial prescribing in children: what do we really know?

  Tamara Keith, Sonia Saxena, Joanna Murray, Mike Sharland
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  ABSTRACT: Most childhood respiratory infections including acute otitis media (AOM), sore throat, upper respiratory tract infections (URTIs) and sinusitis are self-limiting illnesses. Yet, despite extensive guidance discouraging routine use of antibiotics to limit side-effects and combat antimicrobial resistance, antibiotic prescribing for these conditions remains high in many developed countries, fuelled by the fear of rare but serious bacterial complications including mastoiditis, quinsy, pneumonia and brain abscess. This review summarizes evidence for the role of antibiotics in preventing serious complications of URTIs in children. From a key observational study reporting antibiotic use in children, the calculated excess risk of suppurative complications of respiratory tract infections in children who did not receive an antibiotic was 3.8 per 10 000. Despite extensive searches of the literature, no data were found to assess the affect of antibiotics upon the risk of brain abscess after sinusitis in children. New information from observational studies suggests antibiotics show little benefit in preventing complications of mastoiditis following AOM, quinsy following sore throat and pneumonia following URTI/bronchitis. Further research should focus on stratifying the key risk factors for such complications and optimizing long-term monitoring strategies to detect any future changes in the risk-benefit analysis for antibiotic prescription.
  Current Opinion in Infectious Diseases 04/2010; 23(3):242-8. · 4.93 Impact Factor