Hospital prescribing algorithm shows promise, UK study finds
An algorithm designed to augment antibiotic prescribing in secondary care provided appropriate recommendations that were narrower in spectrum than current clinical practice, UK researchers reported in Clinical Infectious Diseases.
The Case-Based Reasoning (CBR) algorithm was developed using locally sourced data and designed for use in general medical and surgical settings at three London hospitals, with implementation and integration into the hospitals' clinical decision support systems starting in July 2017.
To evaluate the impact of the CBR algorithm on antibiotic prescribing, a team led by researchers with the UK's National Institute for Health Research examined two patient populations—patients with confirmed Escherichia coli bloodstream infections and general ward patients with a range of potential infections—and compared prescribing recommendations made by the CBR algorithm with those made by physicians in clinical practice.
Prescribing recommendations were evaluated using the Antimicrobial Spectrum Index (ASI) and the World Health Organization Essential Medicine List Access, Watch, Reserve classification system. The appropriateness of a prescription was defined as the spectrum of the prescription covering the antibiotic susceptibility profile of the known or most-likely organism.
A total of 224 patients (145 E coli patients and 79 general ward patients) were included in the study. Comparison of prescribing showed that 90% (202 of 224) CBR recommendations were appropriate, compared with 83% (186/224) of physician recommendations (odds ratio, 1.24; 95% confidence interval [CI], 0.392 to 3.936; P = 0.71), with similar results found in the specific analysis of E coli and general ward patients.
The CBR algorithm was associated with a significantly narrower spectrum of antibiotic prescribing, with a median ASI of 6 compared with 8 for physician prescribing. CBR recommendations were also more likely to be classified as Access class antibiotics (110/224, 49%) compared with physician prescriptions (79/224, 35%).
"A CBR algorithm provided antimicrobial recommendations that were in line with physician decisions, but also shifted recommendations towards narrower spectrum antimicrobial prescribing," the authors concluded. "Future work is now underway to explore the impact of integration of CBR with other methods for optimisation of antimicrobial prescribing, including dose optimisation platforms and patient-facing applications."
Apr 4 Clin Infect Dis abstract
HPV vaccines not linked to infertility in younger women
A study published late last week in Vaccine found no link between human papillomavirus (HPV) vaccination and infertility in women 20 to 33 years old.
The researchers, from the University of Wisconsin in Madison, said that the results should reassure clinicians and the public that HPV vaccines are safe and effective. They noted that a small number of case reports and media stories have raised concerns about a link between HPV vaccines and infertility, although this was refuted in a large cohort study published in Pediatrics in 2018.
Using 2013 to 2016 National Health and Nutrition Examination Surveys, the investigators analyzed the data of 1,114 women 20 to 33 years old. Women of other ages were excluded because the surveys did not ask those younger than 20 if they had been pregnant, and women older than 33 would not have been offered the HPV vaccine because it was unavailable until 2006.
They created two logistic regression models stratified by marital history. The first model evaluated the likelihood of infertility in women who had never been pregnant or were pregnant before vaccination. The second model included all women 20 to 33 years old who reported that they were infertile for any 12-month period, to account for potential delayed and/or nondurable post-vaccine infertility.
Overall, 8.1% reported infertility. In the first model, women who were or had been married and had been vaccinated against HPV were less likely than others to report infertility (odds ratio, 0.04; 95% confidence interval, 0.01 to 0.57). No other association between HPV vaccination and infertility was identified.
"These results provide further evidence of HPV vaccine safety and should give providers confidence in recommending HPV vaccination," the authors wrote. "Further research should explore protective effects of HPV vaccines on female and male fertility."
HPV is a common sexually transmitted disease linked to cervical, anal, vulvar, vaginal, and nose and throat cancers in women and anal, penile, and nose and throat cancers in men. HPV vaccines have been recommended for teens and young adults for the last 10 years in the United States to prevent these cancers. Studies have shown that the nine-strain HPV vaccine is 96% effective at preventing infections.
Apr 3 Vaccine study
Aug 31, 2018, Pediatrics study
