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

Ioannis Baltas; Mark Gilchrist; Eirini Koutoumanou; Malick M Gibani; James E Meiring; Akaninyene Otu; David Hettle; Ameeka Thompson; James R Price; Anna Crepet; Abolaji Atomode; Timothy Crocker-Buque; Dimitrios Spinos; Hudson Guyver; Matija Tausan; Donald Somasunderam; Maxwell Thoburn; Cathleen Chan; Helen Umpleby; Bethany Sharp; Callum Chivers; Devan Suresh Vaghela; Ronak J Shah; Jonathan Foster; Amy Hume; Christopher Smith; Ammara Asif; Dimitrios Mermerelis; Mohammad Abbas Reza; Dominic A Haigh; Thomas Lamb; Loucia Karatzia; Alexandra Bramley; Nikhil Kadam; Konstantinos Kavallieros; Veronica Garcia-Arias; Jane Democratis; Claire S Waddington; Luke S P Moore; Alexander M Aiken

doi:10.1093/jacamr/dlad091

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

JAC Antimicrob Resist. 2023 Aug 1;5(4):dlad091. doi: 10.1093/jacamr/dlad091. eCollection 2023 Aug.

Authors

Ioannis Baltas^{1

2}, Mark Gilchrist^{1

3}, Eirini Koutoumanou⁴, Malick M Gibani³, James E Meiring⁵, Akaninyene Otu⁶, David Hettle⁷, Ameeka Thompson⁷, James R Price^{8

9}, Anna Crepet⁹, Abolaji Atomode¹⁰, Timothy Crocker-Buque¹¹, Dimitrios Spinos¹², Hudson Guyver¹³, Matija Tausan¹⁴, Donald Somasunderam¹⁵, Maxwell Thoburn¹⁶, Cathleen Chan¹⁶, Helen Umpleby¹⁷, Bethany Sharp¹⁸, Callum Chivers¹⁸, Devan Suresh Vaghela¹⁹, Ronak J Shah¹, Jonathan Foster²⁰, Amy Hume²⁰, Christopher Smith³, Ammara Asif²¹, Dimitrios Mermerelis²², Mohammad Abbas Reza²³, Dominic A Haigh²⁴, Thomas Lamb^{25

26}, Loucia Karatzia²⁷, Alexandra Bramley²⁸, Nikhil Kadam²⁹, Konstantinos Kavallieros³⁰, Veronica Garcia-Arias¹⁷, Jane Democratis³¹, Claire S Waddington¹, Luke S P Moore^{1

14

32}, Alexander M Aiken³³

Affiliations

¹ Imperial College Healthcare NHS Trust, London, UK.
² Institute of Education, University College London, London, UK.
³ Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK.
⁴ Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK.
⁵ Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
⁶ Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁷ Department of Infection Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
⁸ Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
⁹ University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
¹⁰ Liverpool University NHS Foundation Trust, Liverpool, UK.
¹¹ Department of Microbiology, Royal Free London NHS Foundation Trust, London, UK.
¹² Department of ENT, Head and Neck Surgery, Gloucester Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
¹³ James Paget University Hospitals NHS Foundation Trust, Norfolk, UK.
¹⁴ Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
¹⁵ Bart's Health NHS Trust, London, UK.
¹⁶ University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁷ Hampshire Hospitals NHS Foundation Trust, Hampshire, UK.
¹⁸ Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁹ Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
²⁰ Directorate of Pharmacy, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
²¹ Hull University Teaching Hospitals NHS Trust, Hull, UK.
²² Maidstone and Tunbridge Wells NHS Trust, Kent, UK.
²³ Northwest Anglia NHS Foundation Trust, Peterborough, UK.
²⁴ Manchester University NHS Foundation Trust, Manchester, UK.
²⁵ Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
²⁶ Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic.
²⁷ Oxford University Hospitals NHS Trust, Oxford, UK.
²⁸ St George's University Hospitals NHS Foundation Trust, London, UK.
²⁹ Mid and South Essex NHS Trust, Westcliff-on-Sea, UK.
³⁰ Faculty of Medicine, Imperial College London, London, UK.
³¹ Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK.
³² Imperial College London, NIHR Health Protection Research Unit on Healthcare Associated Infections and Antimicrobial Resistance, London, UK.
³³ Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.

Abstract

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.