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Title: Lower respiratory tract infection in adults : carriage as a diagnostic, home-based care and vaccine development
Author: Collins, Andrea M.
ISNI:       0000 0004 6496 0561
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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Introduction: Lower Respiratory Tract Infection (LRTI) and pneumonia are leading causes of death in the UK and costly health problems to the NHS. The aetiological pathogen is rarely found making targeted therapy difficult, hospital bed pressures are growing year on year and our current vaccinations are sub-optimal. Key questions: Current UK priorities include 1) Better diagnostics - without knowing the causal pathogen we cannot treat our patients effectively nor determine what pathogen to develop better vaccines against. Could nasal samples from hospitalised patients with LRTI/pneumonia be useful in aetiological diagnosis? 2) Better therapeutics - acute hospital bed pressures and hospital acquired infections rates are increasing. Could hospitalised patients with LRTI/pneumonia be discharged home sooner by support and treatment in the community from an early supported discharge scheme (ESDS)? 3) Better prevention - current pneumonia vaccines are inadequate. Could a new experimental model in humans using live pneumococcal bacteria help us to select from candidate pneumococcal vaccines? Main findings: We found that prior antibiotic treatment meant that nasal sampling in hospitalised patients was not useful. ESDS is safe and reduces the total hospital bed days with high rates of patient and carer/next of kin satisfaction. A large recruitment effort is needed. Using our Experimental Human Pneumococcal Carriage (EHPC) model confirmed that the current pneumococcal vaccine reduces rates of pneumococcal acquisition and carriage density. Implications: A community based study of nasal sampling techniques in patients with LRTI/pneumonia prior to antibiotic therapy may be useful. An ESDS is worthwhile but needs better integration within well-established CCG-funded chronic obstructive pulmonary disease (COPD) schemes to form a 'Respiratory ESDS' and a national multi-site RCT trial. Our robust EHPC model can now be used to test novel candidate vaccines using a smaller sample size and shorter timescales than clinical community studies in order to reduce cost and time to market.
Supervisor: Pleass, R. ; Gordon, S. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral