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Recommended antimicrobial therapy for common inpatient infections: a comparative review of guidelines across 51 hospital trusts in England.
Pan, Daniel; Hills, George; Hamilton, Ashley Ryan; Nash, Tamsin; Hine, Thomas; Whitehorn, Sarah; Barlow, Gavin.
Afiliación
  • Pan D; Department of Respiratory Sciences, University of Leicester, Leicester, UK Daniel.pan@nhs.net.
  • Hills G; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
  • Hamilton AR; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
  • Nash T; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
  • Hine T; Leicester School of Pharmacy, De Montfort University, UK, Leicester.
  • Whitehorn S; Hull York Medical School, John Hughlings Jackson Building, York, UK.
  • Barlow G; Hull York Medical School, John Hughlings Jackson Building, York, UK.
Postgrad Med J ; 97(1154): 782-788, 2021 Dec.
Article en En | MEDLINE | ID: mdl-33008956
BACKGROUND: The number of different antimicrobial recommendations between hospital trusts for the same indication in England is unknown. AIM: We aimed to evaluate the heterogeneity of antimicrobial recommendations for seven common inpatient infections across hospital trusts in England and evaluate changes to recommendations following introduction of national (National Institute for Healthcare and Excellence, NICE) and international (WHO) antimicrobial guidelines. METHODS: Guidelines published on the MicroGuide smartphone application were collected from December 2017 to February 2018 and re-evaluated between December 2019 and February 2020. The following indications were assessed: community-acquired pneumonia (CAP) CURB65 score ≥3, hospital-acquired pneumonia (HAP), infective exacerbation of chronic obstructive pulmonary disease (iCOPD), cellulitis, uncomplicated urinary tract infection (uUTI), intra-abdominal infection (IAI) and sepsis of unknown source (SUS). On follow-up, compliance against WHO WATCH antibiotic and NICE recommendations was evaluated. RESULTS: Guidelines were obtained predominantly from England. Antibiotic regimens between hospitals became increasingly diverse across indications in the following order: uUTI, cellulitis, iCOPD, CAP, HAP, IAI and SUS. A piperacillin/tazobactam-based regimen was recommended in HAP (59%), SUS (39%) and IAI (30%). After 2 years, 107 changes were made to 357 antibiotic regimen recommendations; the overall number of regimens using piperacillin-tazobactam and WHO WATCH antibiotics remained similar. Compliance of recommendations with NICE guidelines as follows: iCOPD (100% adherent), uUTI (98%), cellulitis (90%), CAP (43%) and HAP (27%). CONCLUSION: The heterogeneity of antibiotic recommendations increased as the indicated infection was more severe, with broader underlying bacterial causes. Piperacillin-tazobactam remains favoured in antibiotic regimens, despite not recommended in WHO and NICE guidance.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infección Hospitalaria / Guías como Asunto / Pacientes Internos / Antibacterianos Tipo de estudio: Guideline Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Postgrad Med J Año: 2021 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infección Hospitalaria / Guías como Asunto / Pacientes Internos / Antibacterianos Tipo de estudio: Guideline Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Postgrad Med J Año: 2021 Tipo del documento: Article Pais de publicación: Reino Unido