TY - JOUR
T1 - Exploring the views of infection consultants in England on a novel delinked funding model for antimicrobials
T2 - the SMASH study
AU - Baltas, Ioannis
AU - Gilchrist, Mark
AU - Koutoumanou, Eirini
AU - Gibani, Malick M
AU - Meiring, James E
AU - Otu, Akaninyene
AU - Hettle, David
AU - Thompson, Ameeka
AU - Price, James R
AU - Crepet, Anna
AU - Atomode, Abolaji
AU - Crocker-Buque, Timothy
AU - Spinos, Dimitrios
AU - Guyver, Hudson
AU - Tausan, Matija
AU - Somasunderam, Donald
AU - Thoburn, Maxwell
AU - Chan, Cathleen
AU - Umpleby, Helen
AU - Sharp, Bethany
AU - Chivers, Callum
AU - Vaghela, Devan Suresh
AU - Shah, Ronak J
AU - Foster, Jonathan
AU - Hume, Amy
AU - Smith, Christopher
AU - Asif, Ammara
AU - Mermerelis, Dimitrios
AU - Reza, Mohammad Abbas
AU - Haigh, Dominic A
AU - Lamb, Thomas
AU - Karatzia, Loucia
AU - Bramley, Alexandra
AU - Kadam, Nikhil
AU - Kavallieros, Konstantinos
AU - Garcia-Arias, Veronica
AU - Democratis, Jane
AU - Waddington, Claire S
AU - Moore, Luke S P
AU - Aiken, Alexander M
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - OBJECTIVES: A novel 'subscription-type' funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model.METHODS: An online survey was sent to all infection consultants in NHS acute hospitals in England.RESULTS: The response rate was 31.2% (235/753). Most consultants agreed the model is a welcome development (69.8%, 164/235), will improve treatment of drug-resistant infections (68.5%, 161/235) and will stimulate research and development of new antimicrobials (57.9%, 136/235). Consultants disagreed that the model would lead to reduced carbapenem use and reported increased use of cefiderocol post-implementation. The presence of an antimicrobial pharmacy team, requirement for preauthorization by infection specialists, antimicrobial stewardship ward rounds and education of infection specialists were considered the most effective antimicrobial stewardship interventions. Under the new model, 42.1% (99/235) of consultants would use these antimicrobials empirically, if risk factors for antimicrobial resistance were present (previous infection, colonization, treatment failure with carbapenems, ward outbreak, recent admission to a high-prevalence setting).Significantly higher insurance and diversity values were given to model antimicrobials compared with established treatments for carbapenem-resistant infections, while meropenem recorded the highest enablement value. Use of both 'subscription-type' model drugs for a wide range of infection sites was reported. Respondents prioritized ceftazidime/avibactam for infections by bacteria producing OXA-48 and KPC and cefiderocol for those producing MBLs and infections with Stenotrophomonas maltophilia, Acinetobacter spp. and Burkholderia cepacia.CONCLUSIONS: The 'subscription-type' model was viewed favourably by infection consultants in England.
AB - OBJECTIVES: A novel 'subscription-type' funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model.METHODS: An online survey was sent to all infection consultants in NHS acute hospitals in England.RESULTS: The response rate was 31.2% (235/753). Most consultants agreed the model is a welcome development (69.8%, 164/235), will improve treatment of drug-resistant infections (68.5%, 161/235) and will stimulate research and development of new antimicrobials (57.9%, 136/235). Consultants disagreed that the model would lead to reduced carbapenem use and reported increased use of cefiderocol post-implementation. The presence of an antimicrobial pharmacy team, requirement for preauthorization by infection specialists, antimicrobial stewardship ward rounds and education of infection specialists were considered the most effective antimicrobial stewardship interventions. Under the new model, 42.1% (99/235) of consultants would use these antimicrobials empirically, if risk factors for antimicrobial resistance were present (previous infection, colonization, treatment failure with carbapenems, ward outbreak, recent admission to a high-prevalence setting).Significantly higher insurance and diversity values were given to model antimicrobials compared with established treatments for carbapenem-resistant infections, while meropenem recorded the highest enablement value. Use of both 'subscription-type' model drugs for a wide range of infection sites was reported. Respondents prioritized ceftazidime/avibactam for infections by bacteria producing OXA-48 and KPC and cefiderocol for those producing MBLs and infections with Stenotrophomonas maltophilia, Acinetobacter spp. and Burkholderia cepacia.CONCLUSIONS: The 'subscription-type' model was viewed favourably by infection consultants in England.
U2 - 10.1093/jacamr/dlad091
DO - 10.1093/jacamr/dlad091
M3 - Article (Academic Journal)
C2 - 37533762
SN - 2632-1823
VL - 5
JO - JAC-Antimicrobial Resistance
JF - JAC-Antimicrobial Resistance
IS - 4
M1 - dlad091
ER -