using nors data to optimise duration of antibiotic therapy...
TRANSCRIPT
“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
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
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
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
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
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
Median
Recommended treatment duration from guideline
IQR
3rd quartile
Outlying values
1st quartile1.5*IQR
Box plot of average treatment duration for all centres
0
50
100
150
200
250
Box plot of average treatment duration JCUH v. all centres
2017 20182017 2018
Duration of treatment for cellulitis
2017 2018
Duration of treatment for osteomyelitis (surgical, non-surgical & DFI)
2017 2018
Duration of treatment for prosthetic joint infection
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
Thank you