Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, UK Health Security Agency, London, UK.
NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK.
BMJ Open. 2023 Jul 7;13(7):e068299. doi: 10.1136/bmjopen-2022-068299.
This rapid review aimed to assess and collate intravenous-to-oral switch (IVOS) criteria from the literature to achieve safe and effective antimicrobial IVOS in the hospital inpatient adult population.
The rapid review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
OVID Embase and Medline databases.
Articles of adult populations published globally between 2017 and 2021 were included.
An Excel spreadsheet was designed with specific column headings. IVOS criteria from UK hospital IVOS policies informed the framework synthesis.
IVOS criteria from 45/164 (27%) local IVOS policies were categorised into a five-section framework: (1) timing of IV antimicrobial review, (2) clinical signs and symptoms, (3) infection markers, (4) enteral route and (5) infection exclusions. The literature search identified 477 papers, of which 16 were included. The most common timing for review was 48-72 hours from initiation of intravenous antimicrobial (n=5, 30%). Nine studies (56%) stated clinical signs and symptoms must be improving. Temperature was the most frequently mentioned infection marker (n=14, 88%). Endocarditis had the highest mention as an infection exclusion (n=12, 75%). Overall, 33 IVOS criteria were identified to go forward into the Delphi process.
Through the rapid review, 33 IVOS criteria were collated and presented within five distinct and comprehensive sections. The literature highlighted the possibility of reviewing IVOS before 48-72 hours and of presenting heart rate, blood pressure and respiratory rate as a combination early warning score criterion. The criteria identified can serve as a starting point of IVOS criteria review for any institution globally, as no country or region limits were applied. Further research is required to achieve consensus on IVOS criteria from healthcare professionals that manage patients with infections.
CRD42022320343.
本快速综述旨在评估和整理文献中的静脉-口服转换（IVOS）标准，以实现医院住院成年患者人群中安全有效的抗菌 IVOS。
快速综述遵循系统评价和荟萃分析的首选报告项目声明。
OVID Embase 和 Medline 数据库。
纳入 2017 年至 2021 年期间在全球发表的成年人群体的文章。
设计了一个带有特定列标题的 Excel 电子表格。英国医院 IVOS 政策中的 IVOS 标准为框架综合提供了信息。
将 45/164（27%）个本地 IVOS 政策中的 IVOS 标准分为五个部分框架：（1）IV 抗菌药物审查的时间，（2）临床症状和体征，（3）感染标志物，（4）肠内途径和（5）感染排除。文献检索确定了 477 篇论文，其中 16 篇被纳入。审查最常见的时间是从开始静脉内抗菌药物治疗后 48-72 小时（n=5，30%）。有 9 项研究（56%）指出临床症状和体征必须改善。体温是最常提到的感染标志物（n=14，88%）。作为感染排除标准，心内膜炎被提及最多（n=12，75%）。总体而言，确定了 33 个 IVOS 标准进入 Delphi 过程。
通过快速综述，整理并呈现了 33 个 IVOS 标准，分为五个明确和全面的部分。文献强调了在 48-72 小时之前审查 IVOS 的可能性，并提出将心率、血压和呼吸率作为早期预警评分标准的组合。确定的标准可以作为任何全球机构的 IVOS 标准审查的起点，因为没有应用任何国家或地区的限制。需要进一步研究以在管理感染患者的医疗保健专业人员中就 IVOS 标准达成共识。
PROSPERO 注册号：CRD42022320343。
