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If it ain’t broke don’t fix it: Lack of review of antimicrobials in ‘well’ patients – time for a CRP change

Amanda Hill, Eloise Hamon, Melanie Nana, Sian Price, Noel Craine and Brendan Healy
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DOI: https://doi.org/10.7861/fhj.2019-0042
Future Healthc J March 2021
Amanda Hill
AGreat Western Hospital, Swindon, UK
Roles: core medical trainee
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  • For correspondence: amanda.hill.25@live.com
Eloise Hamon
BCardiff University, Cardiff, UK
Roles: medical student
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Melanie Nana
CWales Deanery, Nantgarw, UK
Roles: specialty registrar in diabetes and endocrinology
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Sian Price
DPrincess of Wales Hospital, Bridgend, UK
Roles: specialist antimicrobial pharmacist
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Noel Craine
EPublic Health Wales Communicable Disease Surveillance Centre, Cardiff, UK
Roles: research scientist
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Brendan Healy
FPublic Health Wales, Cardiff, UK
Roles: consultant in microbiology and infectious diseases
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    Fig 1.

    Guidance on antimicrobial use as recommended by NICE,3 Start smart then focus4 and Surviving Sepsis UK.5 IV - = intravenous; NICE = National Institute for Health and Care Excellence; PO = per oral.

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    Fig 2.

    48-hour review antibiotic stickers. a) Site 1. b) Site 2.

Tables

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    Table 1.

    Logistic regression univariate analysis of the likelihood of 48-hour review depending on category of C-reactive protein test result

    Category48-hour review, n/total nOdds ratio95% confidence intervalp value
    CRP >100 mg/L37/531n/an/a
    CRP 21–100 mg/L23/520.340.15–0.760.009
    CRP ≤20 mg/L13/260.430.16–1.140.089
    No CRP test1/80.060.07–0.540.012
    Total74/139n/an/an/a
    • CRP = C-reactive protein.

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    Table 2.

    Comparison of C-reactive protein value against a 48 hour antibiotic review at sites 1 and 2 pre- and post-intervention

    CategorySite 1 pre-intervention 48-hour review, n/total nSite 1 post-intervention 48-hour review, n/total nImprovement, %Site 2 pre-intervention 48-hour review, n/total nSite 2 post-intervention 48-hour review, n/total nImprovement, %
    CRP >100 mg/L14/2010/121323/334/510
    CRP 21–100 mg/L9/239/123614/299/1227
    CRP ≤20 mg/L4/92/2569/171/2–3
    No CRP test0/10/0n/a1/71/186
    Total27/5321/263047/8615/2020
    • CRP = C-reactive protein.

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If it ain’t broke don’t fix it: Lack of review of antimicrobials in ‘well’ patients – time for a CRP change
Amanda Hill, Eloise Hamon, Melanie Nana, Sian Price, Noel Craine, Brendan Healy
Future Healthc J Mar 2021, 8 (1) e92-e95; DOI: 10.7861/fhj.2019-0042

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If it ain’t broke don’t fix it: Lack of review of antimicrobials in ‘well’ patients – time for a CRP change
Amanda Hill, Eloise Hamon, Melanie Nana, Sian Price, Noel Craine, Brendan Healy
Future Healthc J Mar 2021, 8 (1) e92-e95; DOI: 10.7861/fhj.2019-0042
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