{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:07:23Z","timestamp":1784084843579,"version":"3.55.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The objective of this study was to establish how antibiotic prescribing policies at National Health Service (NHS) hospitals match the England Department of Health \u2018Start Smart\u2014Then Focus\u2019 recommendations and relate to Clostridium difficile infection (CDI) rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Antibiotic pharmacists were surveyed regarding recommendations for empirical treatment of common syndromes (\u2018Start Smart\u2019) and antimicrobial prescription reviews (\u2018Focus\u2019) at their hospital trusts. If no response was provided, policy data were sought from trust websites and the MicroGuide app (Horizon Strategic Partners, UK). Empirical treatment recommendations were categorized as broad spectrum (a \u03b2-lactam penicillin\/\u03b2-lactamase inhibitor, cephalosporin, quinolone or carbapenem) or narrow spectrum. CDI rates were gathered from the national mandatory surveillance system.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data were obtained for 105\/145 English acute hospital trusts (72%). \u03b2-Lactam\/\u03b2-lactamase inhibitor combinations were recommended extensively. Only for severe community-acquired pneumonia and pyelonephritis were narrow-spectrum agents recommended first line at a substantial number of trusts [42\/105 (40%) and 50\/105 (48%), respectively]. Policies commonly recommended dual therapy with aminoglycosides and \u03b2-lactams for abdominal sepsis [40\/93 trusts (43%)] and undifferentiated severe sepsis [54\/94 trusts (57%)]. Most policies recommended treating for \u22657 days for most indications. Nearly all policies [100\/105 trusts (95%)] recommended antimicrobial prescription reviews, but only 46\/96 respondents (48%) reported monitoring compliance. Independent predictors of higher CDI rates were recommending a broad-spectrum regimen for community-acquired pneumonia (P\u200a=\u200a0.06) and, counterintuitively, a recommended treatment duration of &amp;lt;48 h for nosocomial pneumonia (P\u200a=\u200a0.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Hospital antibiotic policies in the NHS \u2018Start Smart\u2019 by recommending broad-spectrum antibiotics for empirical therapy, but this may have the unintended potential to increase the use of broad-spectrum antibiotics and risk of CDI unless better mechanisms are in place to improve \u2018Focus\u2019.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dku515","type":"journal-article","created":{"date-parts":[[2014,12,24]],"date-time":"2014-12-24T03:27:05Z","timestamp":1419391625000},"page":"1230-1235","source":"Crossref","is-referenced-by-count":34,"title":["Antibiotic policies in acute English NHS trusts: implementation of \u2018Start Smart\u2014Then Focus\u2019 and relationship with <i>Clostridium difficile<\/i> infection rates"],"prefix":"10.1093","volume":"70","author":[{"given":"Martin J.","family":"Llewelyn","sequence":"first","affiliation":[{"name":"1 \u00a0Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Hand","sequence":"additional","affiliation":[{"name":"2 \u00a0Pharmacy Department, University Hospital Southampton NHS Foundation Trust and Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Hopkins","sequence":"additional","affiliation":[{"name":"3 \u00a0Department of Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Sarah","family":"Walker","sequence":"additional","affiliation":[{"name":"4 \u00a0NIHR Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,12,23]]},"reference":[{"key":"2022020120582513000_DKU515C1","author":"Davies"},{"key":"2022020120582513000_DKU515C2","doi-asserted-by":"crossref","first-page":"2669","DOI":"10.1093\/jac\/dkq367","article-title":"Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals","volume":"65","author":"Cooke","year":"2010","journal-title":"J Antimicrob Chemother"},{"key":"2022020120582513000_DKU515C3","first-page":"CD003543","article-title":"Interventions to improve antibiotic prescribing practices for hospital inpatients","volume":"4","author":"Davey","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2022020120582513000_DKU515C4","doi-asserted-by":"crossref","first-page":"4851","DOI":"10.1128\/AAC.00627-10","article-title":"Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis","volume":"54","author":"Paul","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"key":"2022020120582513000_DKU515C5","author":"Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI)","year":"2011"},{"key":"2022020120582513000_DKU515C6","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.puhe.2014.06.023","article-title":"Antibacterial usage in English NHS hospitals as part of a national Antimicrobial Stewardship Programme","volume":"128","author":"Cooke","year":"2014","journal-title":"Public Health"},{"key":"2022020120582513000_DKU515C7","author":"Department of Health, Department for Environment, Food & Rural Affairs"},{"key":"2022020120582513000_DKU515C8","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00134-012-2769-8","article-title":"Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012","volume":"39","author":"Dellinger","year":"2013","journal-title":"Intensive Care Med"},{"key":"2022020120582513000_DKU515C9","author":"Public Health Wales"},{"key":"2022020120582513000_DKU515C10","first-page":"CD003344","article-title":"Beta lactam antibiotic monotherapy versus beta lactam-aminoglycoside antibiotic combination therapy for sepsis","volume":"1","author":"Paul","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2022020120582513000_DKU515C11","author":"Department of Health"},{"key":"2022020120582513000_DKU515C12","author":"National Audit Office"},{"key":"2022020120582513000_DKU515C13","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1111\/j.1469-0691.2009.03077.x","article-title":"Impact of an intervention to control Clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis","volume":"16","author":"Price","year":"2010","journal-title":"Clin Microbiol Infect"},{"key":"2022020120582513000_DKU515C14","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/2047-2994-1-7","article-title":"Antimicrobial stewardship in Scotland: impact of a national programme","volume":"1","author":"Nathwani","year":"2012","journal-title":"Antimicrob Resist Infect Control"},{"key":"2022020120582513000_DKU515C15","author":"HPA"},{"key":"2022020120582513000_DKU515C16","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1093\/cid\/cit212","article-title":"Understanding the determinants of antimicrobial prescribing within hospitals: the role of \u201cprescribing etiquette\u201d","volume":"57","author":"Chirani","year":"2013","journal-title":"Clin Infect Dis"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/70\/4\/1230\/42355415\/jac_70_4_1230.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/70\/4\/1230\/42355415\/jac_70_4_1230.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T21:03:07Z","timestamp":1643749387000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/70\/4\/1230\/805012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,12,23]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2014,12,23]]},"published-print":{"date-parts":[[2015,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dku515","relation":{},"ISSN":["1460-2091","0305-7453"],"issn-type":[{"value":"1460-2091","type":"electronic"},{"value":"0305-7453","type":"print"}],"subject":[],"published-other":{"date-parts":[[2015,4]]},"published":{"date-parts":[[2014,12,23]]}}}