Department of Respiratory Sciences, University of Leicester, Leicester, UK
Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
Postgrad Med J. 2021 Dec;97(1154):782-788. doi: 10.1136/postgradmedj-2020-138452. Epub 2020 Oct 2.
The number of different antimicrobial recommendations between hospital trusts for the same indication in England is unknown.
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.
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.
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%).
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.
在英国，针对同一适应症，不同医院信托之间的抗菌药物推荐数量尚不清楚。
我们旨在评估英格兰 7 种常见住院感染的抗菌药物推荐方案在各医院信托之间的异质性，并评估在国家（国家卫生与临床优化研究所，NICE）和国际（世界卫生组织，WHO）抗菌药物指南发布后，推荐方案的变化情况。
从 2017 年 12 月至 2018 年 2 月收集了 MicroGuide 智能手机应用程序上发布的指南，并于 2019 年 12 月至 2020 年 2 月重新评估。评估了以下适应症：社区获得性肺炎（CURB65 评分≥3）、医院获得性肺炎（HAP）、慢性阻塞性肺疾病感染恶化（iCOPD）、蜂窝织炎、单纯性尿路感染（uUTI）、腹腔内感染（IAI）和不明来源的败血症（SUS）。随访时，评估了对 WHO WATCH 抗生素和 NICE 建议的遵守情况。
指南主要来自英格兰。随着适应症的不同，医院之间的抗生素方案变得越来越多样化，顺序如下：uUTI、蜂窝织炎、iCOPD、CAP、HAP、IAI 和 SUS。HAP（59%）、SUS（39%）和 IAI（30%）推荐使用哌拉西林/他唑巴坦方案。2 年后，357 种抗生素方案建议中进行了 107 次修改；使用哌拉西林-他唑巴坦和 WHO WATCH 抗生素的方案总数保持不变。NICE 指南的建议遵守情况如下：iCOPD（100% 符合）、uUTI（98%）、蜂窝织炎（90%）、CAP（43%）和 HAP（27%）。
随着感染的严重程度增加，潜在的细菌病因更加广泛，抗生素推荐方案的异质性也随之增加。尽管 WHO 和 NICE 指南不推荐，但哌拉西林-他唑巴坦仍在抗生素方案中受到青睐。
