Empiric Antibiotic Treatment Thresholds for Serious Bacterial Infections: A Scenario-based Survey Study
| Autor: | Amol A. Verma, Alex M. Cressman, Derek R. MacFadden, Fahad Razak, Nick Daneman |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty Canada medicine.drug_class 030106 microbiology Antibiotics Clinical Decision-Making Specialty 03 medical and health sciences 0302 clinical medicine Interquartile range Risk Factors Internal medicine Physicians Severity of illness Internal Medicine Medicine Humans 030212 general & internal medicine Antibiotic prophylaxis Practice Patterns Physicians' Genitourinary system business.industry Disease Management Bacterial Infections Antibiotic coverage Anti-Bacterial Agents Regimen Infectious Diseases Health Care Surveys business |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 69(6) |
| ISSN: | 1537-6591 |
| Popis: | Background Physicians face competing demands of maximizing pathogen coverage while minimizing unnecessary use of broad-spectrum antibiotics when managing sepsis. We sought to identify physicians’ perceived likelihood of coverage achieved by their usual empiric antibiotic regimen, along with minimum thresholds of coverage they would be willing to accept when managing these patients. Methods We conducted a scenario-based survey of internal medicine physicians from across Canada using a 2 × 2 factorial design, varied by infection source (undifferentiated vs genitourinary) and severity (mild vs severe) denoted by the Quick Sequential Organ Failure Assessment (qSOFA) score. For each scenario, participants selected their preferred empiric antibiotic regimen, estimated the likelihood of coverage achieved by that regimen, and considered their minimum threshold of coverage. Results We had 238 respondents: 87 (36.6%) residents and 151 attending physicians (63.4%). The perceived likelihood of antibiotic coverage and minimum thresholds of coverage (with interquartile range) for each scenario were as follows: (1) severe undifferentiated, 90% (89.5%–95.0%) and 90% (80%–95%), respectively; (2) mild undifferentiated, 89% (80%–95%) and 80% (70%–89.5%); (3) severe genitourinary, 91% (87.3%–95.0%) and 90% (80.0%–90.0%); and (4) mild genitourinary, 90% (81.8%–91.3%) and 80% (71.8%–90%). Illness severity and infectious disease specialty predicted higher thresholds of coverage whereas less clinical experience and lower self-reported prescribing intensity predicted lower thresholds of coverage. Conclusions Pathogen coverage of 80% and 90% are physician-acceptable thresholds for managing patients with mild and severe sepsis from bacterial infections. These data may inform clinical guidelines and decision-support tools to improve empiric antibiotic prescribing. |
| Databáze: | OpenAIRE |
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