“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