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Dates: 2014-2019
Funding: NIHR/PHE
Collaborators: Derrick Crook, Nuffield Department of Clinical Medicine, University of Oxford
Information: Sarah Wordsworth

Bacterial infections such as C. difficile can cause severe diarrhoea. Spores of the C. difficile bacteria can be passed in faeces (stools) and can survive for many weeks on objects and surfaces. Because the genetic sequences of the C. difficile bacteria vary greatly, this information can be used to determine where the infections come from. In addition, some bacteria can become “resistant” to an antibiotic, so specific antibiotics no longer stop the infection. Finding out which antibiotics bacteria are resistant to is crucial to ensure that patients do not get ineffective treatment.

This HPRU will focus on improving data linkage across hospitals for infectious diseases such as C. difficile and tuberculosis (TB) to better track infections, using the latest advances in genomic testing technologies such as ‘whole genome sequencing’ (WGS) to analyse the bacteria’s DNA. The HPRU will also explore methods to improve the prescribing of antibiotics in hospitals and primary care. Researchers from several departments at the University of Oxford will work in collaboration with PHE in this HPRU, with Sarah Wordsworth leading the health economics component.

This health economics work will evaluate whether WGS is more cost-effective than current testing approaches in NHS laboratories for a range of infectious diseases. We will also help to assess the benefit and dis-benefit of immediate antibiotic use and consider the best way to incorporate the potential for substantial future harm from increases in microbial resistance into these analyses. Alongside disease modelling experts at PHE, we will construct health economic models for antimicrobial use in hospitals and primary care, and use simulation-based approaches to explore different methods to incorporate future harms. We will also use discrete choice experiments to estimate how much patients and doctors are willing to ‘trade-off’ reduced quality of life in the short-term from delays in symptom resolution, for possible future benefits from reductions in antibiotic use.

It is expected that this programme of research will make an important contribution to informing the prevention and control of healthcare associated infections and antimicrobial resistance.

National Institute for Health Research

The National Institute for Health Research  Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford is one of thirteen HPRUs established in partnership between universities and Public Health England (PHE) that act as centres of excellence in multidisciplinary health protection research in England. The role of the HPRUs is to support PHE in delivering its objectives and functions for the protection of the public’s health in the areas of infection, chemical and radiation threats and hazards, emergency preparedness and response, environmental change and health, health impact of environmental hazards, immunisation and the cross-cutting areas of evaluation of interventions and modelling methodology.