Recommended antimicrobial therapy for common inpatient infections: a comparative review of guidelines across 51 hospital trusts in England

dc.cclicenceN/Aen
dc.contributor.authorPan, Daniel
dc.contributor.authorHills, George
dc.contributor.authorHamilton, Ryan A.
dc.contributor.authorNash, Tamsin
dc.contributor.authorHine, Thomas
dc.contributor.authorWhitehorn, Sarah
dc.contributor.authorBarlow, Gavin
dc.date.acceptance2020-08-30
dc.date.accessioned2020-11-19T09:58:31Z
dc.date.available2020-11-19T09:58:31Z
dc.date.issued2020-10-02
dc.descriptionThe file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.en
dc.description.abstractBackground 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.en
dc.funderNo external funderen
dc.identifier.citationPan, D., Hills, G., Hamilton, A.R., Nash, T., Hine, T., Whitehorn, S., Barlow, G.(2020) Recommended antimicrobial therapy for common inpatient infections: a comparative review of guidelines across 51 hospital trusts in England. Postgraduate Medical Journal, 97, pp. 782-788en
dc.identifier.doihttps://doi.org/10.1136/postgradmedj-2020-138452
dc.identifier.issn0032-5473
dc.identifier.urihttps://dora.dmu.ac.uk/handle/2086/20480
dc.language.isoenen
dc.peerreviewedYesen
dc.publisherBMJen
dc.subjectAntibioticsen
dc.subjectAntimicrobialen
dc.subjectPrescribingen
dc.subjectGuidelinesen
dc.subjectInfectionen
dc.titleRecommended antimicrobial therapy for common inpatient infections: a comparative review of guidelines across 51 hospital trusts in Englanden
dc.typeArticleen

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