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Inequality of timely Clostridioidies difficile infection testing, treatment and management in hospitalised and community patients

   Faculty of Medicine and Health

  , Dr Kerrie Davies, ,  Tuesday, October 10, 2023  Funded PhD Project (UK Students Only)

About the Project

As part of the National Institute for Health Research funded, Leeds Biomedical Research Centre (BRC), one PhD scholarship is available for UK fee rated applicants only. This scholarship will be based within the AMR and Infection theme and through partnership with the Oxford University NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infection.

Clostridioidies difficile infection (CDI) is the leading cause of hospital associated diarrhoea in the western world, but there is increasing recognition of cases within the community setting. Although current diagnostic and treatment guidelines include some information on community cases, this is based on weak evidence. Inequalities potentially exist for CDI patients both in hospitals and the community. We know that diarrhoea sampling and CDI testing practices vary widely across institutions. A recent European study of CDI also found that 50% of cases in the community were never tested for the infection by their original healthcare provider; lack of suspicion is largely based on the assumption that CDI is a hospital associated infection. In addition to lack of testing for the infection in the community, availability of treatment may also be an issue. Patient feedback has highlighted delays in getting appropriate treatment in the community; many community pharmacies do not stock the required antibiotics, with additional delays caused by weekends. 

This project will examine in detail the potential inequalities between hospital and community CDI patients.

Work package 1: A survey will be used to gather information from both community and hospital-based UK clinicians on current guidelines and practices, with regard to propensity to test, time to test, time to treatment, access to treatment (e.g. availability of drugs in the community)

Work package 2: Data will be gathered from hospital(s) and community practices on time from patient presentation to test, time to diagnosis, time to treatment, treatment given, continuation or start of concomitant antibiotics, and when were (hospitalised) patients isolated?

Work package 3: Will examine what factors influence the results found in work package 2. This will be qualitative research using focus group of both patients and clinicians.


The successful candidate will be based with the Healthcare Associated Infections (HCAI) research group within the School of Medicine at the University of Leeds. The HCAI research group is world-leading in the area of CDI, with previous studies influencing the current UK, European, US and Australasian diagnostic guidelines and continues to research CDI diagnosis, treatment, epidemiology, pathogenesis and relation to the gut microbiota using our innovative in vitro gut models. The group is also a part of the Leeds NIHR BRC and leads the AMR and Infection theme. The HCAI research group has members from Leeds Teaching Hospitals NHS Trust, The University of Leeds and UKHSA, ensuring that the candidate will benefit from a broad range of knowledge and support. The candidate will also benefit from expert biostatistical supervisory input and guidance from Prof Robert West, who has a considerable track record in the analysis of large, existing data sets for health research.


Leeds Teaching Hospitals NHS Trust (LTHT) in partnership with the University of Leeds (UoL) has been awarded a National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre (BRC) with funding of £20million for five years. This exciting investment in translational medicine represents a threefold increase in our previous funding and provides a unique opportunity to drive research which makes a difference to the health and wealth of the United Kingdom, but also to our local community. Building on our existing strength in musculoskeletal disease and engagement with patients and the public who are at the heart of all our activities, the new NIHR Leeds BRC now includes research in surgical technologies, haematology (with the University of York), cardiometabolic disease, pathology, and antimicrobial resistance.

The HCAI research group is currently based at the Old Medical School at Leeds General Infirmary but travel to the main University campus and St James’s campus may be required; a shuttle bus service runs between sites. The group will move to the St James campus in 2023.


Applicants to this scholarship should normally hold a first degree equivalent to at least a UK upper second class honours degree, or suitable postgraduate degree in a health-related subject. You will be enthusiastic, organised and motivated with experience in, or knowledge of healthcare services. Importantly, you will be committed to fully engaging with a wider multi-disciplinary team to conduct high-quality research that is of value to the NHS.

Candidates whose first language is not English must provide evidence that their English language is sufficient to meet the specific demands of their study, the Faculty minimum requirements are:

  • British Council IELTS - score of 6.5 overall, with no element less than 6.0
  • TOEFL iBT - overall score of 92 with the listening and reading element no less than 21, writing element no less than 22 and the speaking element no less than 23.

How to Apply:

To apply for this scholarship opportunity applicants should complete an online application form and attach the following documentation to support their application. 

  • a full academic CV
  • degree certificate and transcripts of marks
  • Evidence that you meet the University's minimum English language requirements (if applicable)

To help us identify that you are applying for this scholarship project please ensure you provide the following information on your application form;

  • Select PhD in Medicine as your programme of study
  • Give the full project title and name the supervisors listed in this advert
  • For source of funding please state you are applying for a University Scholarship in association with the NIHR

If English is not your first language, you must provide evidence that you meet the University's minimum English language requirements.

Any enquiries relating to the project and/or candidate suitability should be directed to;

Dr Kerrie Davies e. or Dr Jane Freeman e.

Any queries regarding the application process should be directed to;

Faculty Admissions Team e.  

Funding Notes

This scholarship is sponsored by the University of Leeds and will attract an annual tax-free stipend of £18,622 each year for up to 3 years subject to satisfactory progress. Academic fees will also be paid at the UK fee rate. Due to limited funding we can only consider applicants for this position who are eligible for UK fee status.


Viprey VF, Davis GL, Benson AD, Ewin D, Spittal W, Vernon JJ, Rupnik M, Banz , Allantaz F, Cleuziat P; COMBACTE-CDI National Coordinators ; Wilcox MH, Davies KA; COMBACTE-CDI consortium 8; Members of the COMBACTE-CDI National coordinators. A point-prevalence study on community and inpatient Clostridioides difficile infections (CDI): results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI), July to November 2018.Euro Surveill. 2022 Jun; 27 (26): 2100704. doi: 10.2807/1560-7917.ES.2022.27.26.2100704.
Viprey, Virginie F. and Davis, Georgina L. and Benson, Anthony D. and Ewin, Duncan and Spittal, William and Vernon, Jon and Rupnik, Maja and Banz, Alice and Allantaz, Florence and Cleuziat, Philippe and Coordinators, COMBACTE- CDI National and Wilcox, Mark H. and Davies, Kerrie and Group, COMBACTE-CDI Consortium, Key Differences in Diagnosis and Patient Populations between Community and In-Patient Clostridioides Difficile Infections (CDI): Results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI). Available at SSRN: or

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