using nors data to optimise duration of antibiotic therapy...
TRANSCRIPT
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“Other than tuberculosis …. for every bacterial infection for which trials have
compared short-course with longer course antibiotic therapy, short-course
therapy has been just as effective…”
Spellberg, JAMA Intern Med. 2016;176(9):1254-1255
Using NORS data to optimise duration of antibiotic therapy in OPAT
John WilliamsConsultant ID Physician, South Tees Hospitals NHS Trust
William DobellMedical Student, Newcastle University
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Why Reduce Antibiotic Usage?
Pros ConsReduced Cost Treatment FailureAnti-Microbial ResistanceReduced risk of AdverseEffects
“Antibiotics should be used for the shortest duration possible that gives an appropriate
clinical outcome.”
- Public Health England, 2015
“We will reduce inappropriate antibiotic prescribing by 50%, with the aim of being a
world leader in reducing prescribing by 2020.”
- HM Government, 2016
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Guidelines
Primary Infective Diagnosis Duration of Treatment
Guidelines Source
Psoas Abscess - No None
Pelvic Abscess - No None
Vertebral Osteomyelitis with metalwork No Peer Reviewed Journal
Vascular Graft Infection No Peer Reviewed Journal
Respiratory Tract Infection – Other Variable No ESCMID
Osteomyelitis – non-surgical 2-4 weeks No Peer Reviewed Journal
Endocarditis Variable No BMJ Best Practice
Osteomyelitis – Surgical 6-8 weeks No Peer Reviewed Journal
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GuidelinesPrimary Infective Diagnosis Duration of
TreatmentGuidelines Source
Epidural Abscess 6-12 weeks Yes BMJ Best Practice
Line Related Infection 7-14 days Yes ESCMID
Non-Tuberculous Mycobacteria >12 months Yes British Thoracic Society
Empyema >3 weeks Yes BMJ Best Practice
Cerebral Abscess >6 weeks Yes BMJ Best Practice
Intra-abdominal abscess >4 days Yes BMJ Best Practice
Bacterial Meningitis Variable Yes BMJ Best Practice
Malignant Otitis Externa 6 weeks Yes Peer Reviewed Journal
Hepatic Abscess 4-6 weeks Yes BMJ Best Practice
Vertebral Osteomyelitis – No Metalwork 6 weeks Yes BSAC
Septic Arthritis 2 weeks Yes BSAC
Prosthetic Hip Infection 2-6 weeks Yes IDSA
Diabetic Foot Infection without osteomyelitis 10-14 days Yes NICE
Surgical Site Infection 5-7 days Yes WHO
Bacteraemia 7-10 days Yes IDSA
Prosthetic Knee Infection 2-6 weeks Yes IDSA
Skin & Soft Tissue Infection 7-14 days Yes IDSA
Diabetic Foot Infection with Osteomyelitis 6 weeks Yes NICE
Bronchiectasis 10-14 days Yes British Thoracic Society
Cellulitis 3-4 days Yes CREST
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Methods• NORS 2017 data accessed January 2018
•Mean Length of Treatment (LoT) derived for each Primary Infective Diagnosis (PID) (total treatment days/number of episodes)
• Data cleaned• Suspected erroneous data excluded
•NORS 2018 data accessed August 2018
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Analysis
•Min, median, max and IQR duration of treatment were calculated for each PID
•Results >3 SD from median highlighted as ‘Outlying Values’• defined as <Q1-(1.5*IQR) or >Q3+(1.5*IQR)
•National data examined for outliers & against guidelines (where extant)
•Local data compared with all national centres
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Median
Recommended treatment duration from guideline
IQR
3rd quartile
Outlying values
1st quartile1.5*IQR
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Box plot of average treatment duration for all centres
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0
50
100
150
200
250
Box plot of average treatment duration JCUH v. all centres
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2017 20182017 2018
Duration of treatment for cellulitis
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2017 2018
Duration of treatment for osteomyelitis (surgical, non-surgical & DFI)
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2017 2018
Duration of treatment for prosthetic joint infection
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Conclusions• Accurate data entry is important
•NORS data doesn’t include treatment Abx prior to OPAT or subsequent oral Abx
•Measuring local LoT & benchmarking against national data helped us reduce LoT for cellulitis & orthopaedic infection
•Unable to assess if reducing average LoT has affected outcomes
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Thank you