Baltas Ioannis, Gilchrist Mark, Koutoumanou Eirini, Gibani Malick M, Meiring James E, Otu Akaninyene, Hettle David, Thompson Ameeka, Price James R, Crepet Anna, Atomode Abolaji, Crocker-Buque Timothy, Spinos Dimitrios, Guyver Hudson, Tausan Matija, Somasunderam Donald, Thoburn Maxwell, Chan Cathleen, Umpleby Helen, Sharp Bethany, Chivers Callum, Vaghela Devan Suresh, Shah Ronak J, Foster Jonathan, Hume Amy, Smith Christopher, Asif Ammara, Mermerelis Dimitrios, Reza Mohammad Abbas, Haigh Dominic A, Lamb Thomas, Karatzia Loucia, Bramley Alexandra, Kadam Nikhil, Kavallieros Konstantinos, Garcia-Arias Veronica, Democratis Jane, Waddington Claire S, Moore Luke S P, Aiken Alexander M
Imperial College Healthcare NHS Trust, London, UK.
Institute of Education, University College London, London, UK.
JAC Antimicrob Resist. 2023 Aug 1;5(4):dlad091. doi: 10.1093/jacamr/dlad091. eCollection 2023 Aug.
A novel 'subscription-type' funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model.
An online survey was sent to all infection consultants in NHS acute hospitals in England.
The response rate was 31.2% (235/753). Most consultants agreed the model is a welcome development (69.8%, 164/235), will improve treatment of drug-resistant infections (68.5%, 161/235) and will stimulate research and development of new antimicrobials (57.9%, 136/235). Consultants disagreed that the model would lead to reduced carbapenem use and reported increased use of cefiderocol post-implementation. The presence of an antimicrobial pharmacy team, requirement for preauthorization by infection specialists, antimicrobial stewardship ward rounds and education of infection specialists were considered the most effective antimicrobial stewardship interventions. Under the new model, 42.1% (99/235) of consultants would use these antimicrobials empirically, if risk factors for antimicrobial resistance were present (previous infection, colonization, treatment failure with carbapenems, ward outbreak, recent admission to a high-prevalence setting).Significantly higher insurance and diversity values were given to model antimicrobials compared with established treatments for carbapenem-resistant infections, while meropenem recorded the highest enablement value. Use of both 'subscription-type' model drugs for a wide range of infection sites was reported. Respondents prioritized ceftazidime/avibactam for infections by bacteria producing OXA-48 and KPC and cefiderocol for those producing MBLs and infections with , spp. and .
The 'subscription-type' model was viewed favourably by infection consultants in England.
2022年7月，英国针对头孢他啶/阿维巴坦和头孢地尔推出了一种新型“订阅式”资助模式。我们探讨了感染科顾问对这种脱钩抗菌药物资助模式重要方面的看法。
向英格兰国民保健服务（NHS）急性医院的所有感染科顾问发送了一项在线调查。
回复率为31.2%（235/753）。大多数顾问认为该模式是一项值得欢迎的进展（69.8%，164/235），将改善耐药感染的治疗（68.5%，161/235），并将刺激新型抗菌药物的研发（57.9%，136/235）。顾问们不同意该模式会导致碳青霉烯类药物使用减少，并报告实施后头孢地尔的使用增加。抗菌药物药房团队的存在、感染专科医生的预授权要求、抗菌药物管理病房查房以及感染专科医生的教育被认为是最有效的抗菌药物管理干预措施。在新模式下，如果存在抗菌药物耐药风险因素（既往感染、定植、碳青霉烯类药物治疗失败、病房暴发、近期入住高流行环境），42.1%（99/235）的顾问会经验性使用这些抗菌药物。与碳青霉烯类耐药感染的现有治疗方法相比，模型抗菌药物的保险价值和多样性价值显著更高，而美罗培南的赋能价值最高。报告了两种“订阅式”模式药物在广泛感染部位的使用情况。受访者将头孢他啶/阿维巴坦优先用于产OXA - 48和KPC细菌引起的感染，将头孢地尔优先用于产MBL细菌引起的感染以及由嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌引起的感染。
英国的感染科顾问对“订阅式”模式持积极看法。
