Moore Luke S P, Baltas Ioannis, Amos James, Cooray Mineli, Hughes Stephen, Freeman Rachel, Ashfield Tom
Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Imperial College London, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, London, UK.
JAC Antimicrob Resist. 2024 Apr 16;6(2):dlae058. doi: 10.1093/jacamr/dlae058. eCollection 2024 Apr.
To address antimicrobial resistance, antimicrobial stewardship (AMS) principles must be implemented and adhered to. Clinical decision aids such as the MicroGuide app are an important part of these efforts. We sought to evaluate the consistency of core AMS information and the diversity of classification thresholds for healthcare-associated pneumonia (HAP) in the MicroGuide app.
Guidelines in the MicroGuide app were extracted and analysed for content related to AMS and HAP. Guidelines were characterized according to HAP naming classification; community-acquired pneumonia (CAP) classifications were analysed to serve as a comparator group.
In total, 115 trusts (119 hospitals) were included. Nearly all hospitals had developed MicroGuide sections on AMS ( = 112/119, 94%) and sepsis management ( = 117/119, 98%). Other AMS sections were outpatient parenteral antimicrobial therapy (47%), antifungal stewardship (70%), critical care (23%) and IV to oral switch therapy (83%). Only 9% of hospitals included guidance on the maximum six key AMS sections identified. HAP definitions varied widely across hospitals with some classifying by time to onset and some classifying by severity or complexity. The largest proportion of HAP guidelines based classification on severity/complexity ( = 69/119, 58%). By contrast, definitions in CAP guidelines were uniform.
The high heterogeneity in HAP classification identified suggests inconsistency of practice in identifying thresholds for HAP in the UK. This complicates HAP management and AMS practices. To address HAP in alignment with AMS principles, a comprehensive strategy that prioritizes uniform clinical definitions and thresholds should be developed.
为应对抗菌药物耐药性问题，必须实施并坚持抗菌药物管理（AMS）原则。诸如MicroGuide应用程序之类的临床决策辅助工具是这些努力的重要组成部分。我们试图评估MicroGuide应用程序中核心AMS信息的一致性以及医疗相关肺炎（HAP）分类阈值的多样性。
提取并分析MicroGuide应用程序中的指南，以获取与AMS和HAP相关的内容。根据HAP命名分类对指南进行特征描述；分析社区获得性肺炎（CAP）分类以作为对照。
总共纳入了115个信托机构（119家医院）。几乎所有医院都制定了关于AMS（112/119，94%）和脓毒症管理（117/119，98%）的MicroGuide章节。其他AMS章节包括门诊胃肠外抗菌治疗（47%）、抗真菌管理（70%）、重症监护（23%）和静脉转口服治疗（83%）。只有9%的医院纳入了关于确定的六个关键AMS章节的指南。不同医院的HAP定义差异很大，一些按发病时间分类，一些按严重程度或复杂性分类。基于严重程度/复杂性进行分类的HAP指南比例最大（69/119，58%）。相比之下，CAP指南中的定义是统一的。
所发现的HAP分类中的高度异质性表明，英国在确定HAP阈值方面的实践存在不一致。这使HAP管理和AMS实践变得复杂。为了按照AMS原则应对HAP，应制定一项优先考虑统一临床定义和阈值的综合策略。
