Martin J Llewelyn1, Kieran Hand2, Susan Hopkins3, A Sarah Walker4. 1. Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE, UK m.j.llewelyn@bsms.ac.uk. 2. Pharmacy Department, University Hospital Southampton NHS Foundation Trust and Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. 3. Department of Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK. 4. NIHR Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
Abstract
OBJECTIVES: The objective of this study was to establish how antibiotic prescribing policies at National Health Service (NHS) hospitals match the England Department of Health 'Start Smart-Then Focus' recommendations and relate to Clostridium difficile infection (CDI) rates. METHODS: Antibiotic pharmacists were surveyed regarding recommendations for empirical treatment of common syndromes ('Start Smart') and antimicrobial prescription reviews ('Focus') at their hospital trusts. If no response was provided, policy data were sought from trust websites and the MicroGuide app (Horizon Strategic Partners, UK). Empirical treatment recommendations were categorized as broad spectrum (a β-lactam penicillin/β-lactamase inhibitor, cephalosporin, quinolone or carbapenem) or narrow spectrum. CDI rates were gathered from the national mandatory surveillance system. RESULTS: Data were obtained for 105/145 English acute hospital trusts (72%). β-Lactam/β-lactamase inhibitor combinations were recommended extensively. Only for severe community-acquired pneumonia and pyelonephritis were narrow-spectrum agents recommended first line at a substantial number of trusts [42/105 (40%) and 50/105 (48%), respectively]. Policies commonly recommended dual therapy with aminoglycosides and β-lactams for abdominal sepsis [40/93 trusts (43%)] and undifferentiated severe sepsis [54/94 trusts (57%)]. Most policies recommended treating for ≥ 7 days for most indications. Nearly all policies [100/105 trusts (95%)] recommended antimicrobial prescription reviews, but only 46/96 respondents (48%) reported monitoring compliance. Independent predictors of higher CDI rates were recommending a broad-spectrum regimen for community-acquired pneumonia (P=0.06) and, counterintuitively, a recommended treatment duration of <48 h for nosocomial pneumonia (P=0.01). CONCLUSIONS: Hospital antibiotic policies in the NHS 'Start Smart' by recommending broad-spectrum antibiotics for empirical therapy, but this may have the unintended potential to increase the use of broad-spectrum antibiotics and risk of CDI unless better mechanisms are in place to improve 'Focus'.
OBJECTIVES: The objective of this study was to establish how antibiotic prescribing policies at National Health Service (NHS) hospitals match the England Department of Health 'Start Smart-Then Focus' recommendations and relate to Clostridium difficileinfection (CDI) rates. METHODS: Antibiotic pharmacists were surveyed regarding recommendations for empirical treatment of common syndromes ('Start Smart') and antimicrobial prescription reviews ('Focus') at their hospital trusts. If no response was provided, policy data were sought from trust websites and the MicroGuide app (Horizon Strategic Partners, UK). Empirical treatment recommendations were categorized as broad spectrum (a β-lactam penicillin/β-lactamase inhibitor, cephalosporin, quinolone or carbapenem) or narrow spectrum. CDI rates were gathered from the national mandatory surveillance system. RESULTS: Data were obtained for 105/145 English acute hospital trusts (72%). β-Lactam/β-lactamase inhibitor combinations were recommended extensively. Only for severe community-acquired pneumonia and pyelonephritis were narrow-spectrum agents recommended first line at a substantial number of trusts [42/105 (40%) and 50/105 (48%), respectively]. Policies commonly recommended dual therapy with aminoglycosides and β-lactams for abdominal sepsis [40/93 trusts (43%)] and undifferentiated severe sepsis [54/94 trusts (57%)]. Most policies recommended treating for ≥ 7 days for most indications. Nearly all policies [100/105 trusts (95%)] recommended antimicrobial prescription reviews, but only 46/96 respondents (48%) reported monitoring compliance. Independent predictors of higher CDI rates were recommending a broad-spectrum regimen for community-acquired pneumonia (P=0.06) and, counterintuitively, a recommended treatment duration of <48 h for nosocomial pneumonia (P=0.01). CONCLUSIONS: Hospital antibiotic policies in the NHS 'Start Smart' by recommending broad-spectrum antibiotics for empirical therapy, but this may have the unintended potential to increase the use of broad-spectrum antibiotics and risk of CDI unless better mechanisms are in place to improve 'Focus'.
Authors: Alice Ledda; James R Price; Kevin Cole; Martin J Llewelyn; Angela M Kearns; Derrick W Crook; John Paul; Xavier Didelot Journal: J Antimicrob Chemother Date: 2017-05-01 Impact factor: 5.790
Authors: Karina-Doris Vihta; Nicole Stoesser; Martin J Llewelyn; T Phuong Quan; Tim Davies; Nicola J Fawcett; Laura Dunn; Katie Jeffery; Chris C Butler; Gail Hayward; Monique Andersson; Marcus Morgan; Sarah Oakley; Amy Mason; Susan Hopkins; David H Wyllie; Derrick W Crook; Mark H Wilcox; Alan P Johnson; Tim E A Peto; A Sarah Walker Journal: Lancet Infect Dis Date: 2018-08-17 Impact factor: 25.071
Authors: Igho J Onakpoya; A Sarah Walker; Pui S Tan; Elizabeth A Spencer; Oghenekome A Gbinigie; Johanna Cook; Martin J Llewelyn; Christopher C Butler Journal: PLoS One Date: 2018-03-28 Impact factor: 3.240
Authors: Annelie A Monnier; Barry I Eisenstein; Marlies E Hulscher; Inge C Gyssens Journal: J Antimicrob Chemother Date: 2018-06-01 Impact factor: 5.790
Authors: M Santillo; K Sivyer; A Krusche; F Mowbray; N Jones; T E A Peto; A S Walker; M J Llewelyn; L Yardley Journal: J Antimicrob Chemother Date: 2019-11-01 Impact factor: 5.790
Authors: Ann Sarah Walker; Eric Budgell; Magda Laskawiec-Szkonter; Katy Sivyer; Sarah Wordsworth; Jack Quaddy; Marta Santillo; Adele Krusche; Laurence S J Roope; Nicole Bright; Fiona Mowbray; Nicola Jones; Kieran Hand; Najib Rahman; Melissa Dobson; Emma Hedley; Derrick Crook; Mike Sharland; Chris Roseveare; F D Richard Hobbs; Chris Butler; Louella Vaughan; Susan Hopkins; Lucy Yardley; Timothy E A Peto; Martin J Llewelyn Journal: Trials Date: 2019-07-11 Impact factor: 2.279
Authors: T Phuong Quan; Nicola J Fawcett; John M Wrightson; John Finney; David Wyllie; Katie Jeffery; Nicola Jones; Brian Shine; Lorraine Clarke; Derrick Crook; A Sarah Walker; Timothy E A Peto Journal: Thorax Date: 2016-02-17 Impact factor: 9.139