دورية أكاديمية
Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study).
| العنوان: | Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study). |
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| المؤلفون: | Henley J; School of Social Sciences, Cardiff University, Cardiff, UK HenleyJ@cardiff.ac.uk., Brookes-Howell L; Cardiff University Centre for Trials Research, Cardiff, UK., Euden J; College of Biomedical and Life Sciences, Cardiff University Centre for Trials Research, Cardiff, UK., Pallmann P; College of Biomedical and Life Sciences, Cardiff University Centre for Trials Research, Cardiff, UK., Llewelyn M; Brighton and Sussex Medical School, University of Sussex and University Hospitals Sussex NHS Foundation Trust, Brighton, UK., Howard P; School of Healthcare, University of Leeds, Leeds, UK.; Pharmacy, Leeds Teaching Hospitals, Leeds, UK., Powell N; Royal Cornwall Hospitals NHS Trust, Truro, UK., Dark P; Intensive Care Unit, University of Manchester, Salford, UK., Szakmany T; Critical Care Directorate, Aneurin Bevan University Health Board, Newport, UK.; Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff Univeristy, Cardiff, UK., Hellyer TP; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK., Albur M; Microbiology, North Bristol NHS Trust, Bristol, UK., Hamilton R; School of Pharmacy, De Montfort University, Leicester, UK., Prestwich G; Public Patient Representative, Leeds, UK., Ogden M; Faculty of Social Sciences, University of Stirling, Stirling, UK., Maboshe W; Cardiff University Centre for Trials Research, Cardiff, UK., Sandoe J; Department of Microbiology, The General Infirmary at Leeds, Leeds, UK.; Healthcare Associated Infection Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK., Thomas-Jones E; Cardiff University Centre for Trials Research, Cardiff, UK., Carrol E; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK. |
| مؤلفون مشاركون: | PEACH study group (Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients), PEACH consortium (Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients) |
| المصدر: | BMJ open [BMJ Open] 2023 Dec 19; Vol. 13 (12), pp. e077117. Date of Electronic Publication: 2023 Dec 19. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [London] : BMJ Publishing Group Ltd, 2011- |
| مواضيع طبية MeSH: | COVID-19* , Bacterial Infections*/drug therapy, Humans ; Anti-Bacterial Agents/therapeutic use ; Procalcitonin ; Pandemics ; State Medicine ; SARS-CoV-2 ; Hospitals |
| مستخلص: | Objective: To explore and model factors affecting antibiotic prescribing decision-making early in the pandemic. Design: Semistructured qualitative interview study. Setting: National Health Service (NHS) trusts/health boards in England and Wales. Participants: Clinicians from NHS trusts/health boards in England and Wales. Method: Individual semistructured interviews were conducted with clinicians in six NHS trusts/health boards in England and Wales as part of the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients study, a wider study that included statistical analysis of procalcitonin (PCT) use in hospitals during the first wave of the pandemic. Thematic analysis was used to identify key factors influencing antibiotic prescribing decisions for patients with COVID-19 pneumonia during the first wave of the pandemic (March to May 2020), including how much influence PCT test results had on these decisions. Results: During the first wave of the pandemic, recommendations to prescribe antibiotics for patients with COVID-19 pneumonia were based on concerns about secondary bacterial infections. However, as clinicians gained more experience with COVID-19, they reported increasing confidence in their ability to distinguish between symptoms and signs caused by SARS-CoV-2 viral infection alone, and secondary bacterial infections. Antibiotic prescribing decisions were influenced by factors such as clinician experience, confidence, senior support, situational factors and organisational influences. A decision-making model was developed. Conclusion: This study provides insight into the decision-making process around antibiotic prescribing for patients with COVID-19 pneumonia during the first wave of the pandemic. The importance of clinician experience and of senior review of decisions as factors in optimising antibiotic stewardship is highlighted. In addition, situational and organisational factors were identified that could be optimised. The model presented in the study can be used as a tool to aid understanding of the complexity of the decision-making process around antibiotic prescribing and planning antimicrobial stewardship support in the context of a pandemic. Trial Registration Number: ISRCTN66682918. Competing Interests: Competing interests: All authors (with the exception of RH) and members of the PEACH consortium received funding from NIHR COVID Learning and Recovery Call programme (NIHR132254) for the PEACH Study and for the delivery of this manuscript. ET-J, JE, LB-H, PP and WM (main authors) and ST (consortium) all received funding from NIHR-HTA programme for delivery of the PRONTO trial (NIHR17/136/13). EC, ET-J, PP and LB-H received funding from NIHR for the BATCH trial (15/188/42). EC, ET-J and PP received funding from MRC-NIHR EME for contribution to the PRECISE study (NIHR129960). PH received funding from Abbot Laboratories for attending the European Network for Antimicrobial Stewardship in Point of Care. PH has also previously held post as Vice Chancellor for British Society for Antimicrobial Chemotherapy (BSAC) and is currently a committee member. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) |
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| فهرسة مساهمة: | Investigator: M Albur; SE Bond; SM Gerver; S Hopkins; IJ McCullagh; H Parsons; DG Partridge; D Shaw; B Shinkins; S Todd; RM West Keywords: COVID-19; infection control; infectious diseases |
| سلسلة جزيئية: | ISRCTN ISRCTN66682918 |
| المشرفين على المادة: | 0 (Anti-Bacterial Agents) 0 (Procalcitonin) |
| تواريخ الأحداث: | Date Created: 20231219 Date Completed: 20231221 Latest Revision: 20240124 |
| رمز التحديث: | 20240125 |
| DOI: | 10.1136/bmjopen-2023-077117 |
| PMID: | 38114276 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2044-6055 |
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| DOI: | 10.1136/bmjopen-2023-077117 |