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Exploring the views of infection consultants in England on a novel delinked funding model for antimicrobials: the SMASH study

Lookup NU author(s): Jonathan Foster

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 2023 The Author(s). Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.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.


Publication metadata

Author(s): Baltas I, Gilchrist M, Koutoumanou E, Gibani MM, Meiring JE, Otu A, Hettle D, Thompson A, Price JR, Crepet A, Atomode A, Crocker-Buque T, Spinos D, Guyver H, Tausan M, Somasunderam D, Thoburn M, Chan C, Umpleby H, Sharp B, Chivers C, Vaghela DS, Shah RJ, Foster J, Hume A, Smith C, Asif A, Mermerelis D, Reza MA, Haigh DA, Lamb T, Karatzia L, Bramley A, Kadam N, Kavallieros K, Garcia-Arias V, Democratis J, Waddington CS, Moore LSP, Aiken AM

Publication type: Article

Publication status: Published

Journal: JAC-Antimicrobial Resistance

Year: 2023

Volume: 5

Issue: 4

Print publication date: 01/08/2023

Online publication date: 01/08/2023

Acceptance date: 10/07/2023

Date deposited: 20/09/2023

ISSN (electronic): 2632-1823

Publisher: Oxford University Press

URL: https://doi.org/10.1093/jacamr/dlad091

DOI: 10.1093/jacamr/dlad091

Data Access Statement: Appendices I and II, Figure S1 and Tables S1 to S3 are available as Supplementary data at JAC-AMR Online.


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Funding

Funder referenceFunder name
Shionogi B.V.

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