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1. Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial

Author

Hartman, Esther A. R., Groen, Wim G., Heltveit-Olsen, Silje Rebekka, Lindbæk, Morten, Høye, Sigurd, Lithén, Sara Sofia, Sundvall, Pär-Daniel, Sundvall, Sofia, Snaebjörnsson Arnljots, Egill, Gunnarsson, Ronny, Kowalczyk, Anna, Godycki-Cwirko, Maciej, van de Pol, Alma C., Platteel, Tamara N., Monnier, Annelie A., Verheij, Theo J. M, and Hertogh, Cees M. P. M.

Published
2024
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2. Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Author

Schwartz, Kevin L., Xu, Alice X. T., Alderson, Sarah, Bjerrum, Lars, Brehaut, Jamie, Brown, Benjamin C., Bucher, Heiner C., De Sutter, An, Francis, Nick, Grimshaw, Jeremy, Gunnarsson, Ronny, Hoye, Sigurd, Ivers, Noah, Lecky, Donna M., Lindbæk, Morten, Linder, Jeffrey A., Little, Paul, Michalsen, Benedikte Olsen, O’Connor, Denise, Pulcini, Celine, Sundvall, Pär-Daniel, Lundgren, Pia Touboul, Verbakel, Jan Y., and Verheij, Theo J.

Published
2023
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3. Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries

Author

Li, Xiao, Bilcke, Joke, van der Velden, Alike W., Bruyndonckx, Robin, Coenen, Samuel, Bongard, Emily, de Paor, Muirrean, Chlabicz, Slawomir, Godycki-Cwirko, Maciek, Francis, Nick, Aabenhus, Rune, Bucher, Heiner C., Colliers, Annelies, De Sutter, An, Garcia-Sangenis, Ana, Glinz, Dominik, Harbin, Nicolay J., Kosiek, Katarzyna, Lindbæk, Morten, Lionis, Christos, Llor, Carl, Mikó-Pauer, Réka, Radzeviciene Jurgute, Ruta, Seifert, Bohumil, Sundvall, Pär-Daniel, Touboul Lundgren, Pia, Tsakountakis, Nikolaos, Verheij, Theo J., Goossens, Herman, Butler, Christopher C., and Beutels, Philippe

Published
2023
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8. Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysis

Author

Kaußner, Yvonne, Röver, Christian, Heinz, Judith, Hummers, Eva, Debray, Thomas P.A., Hay, Alastair D., Heytens, Stefan, Vik, Ingvild, Little, Paul, Moore, Michael, Stuart, Beth, Wagenlehner, Florian, Kronenberg, Andreas, Ferry, Sven, Monsen, Tor, Lindbæk, Morten, Friede, Tim, and Gágyor, Ildikó

Published
2022
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15. Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness:economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries

Author

Li, Xiao, Bilcke, Joke, van der Velden, Alike W., Bruyndonckx, Robin, Coenen, Samuel, Bongard, Emily, de Paor, Muirrean, Chlabicz, Slawomir, Godycki-Cwirko, Maciek, Francis, Nick, Aabenhus, Rune, Bucher, Heiner C., Colliers, Annelies, De Sutter, An, Garcia-Sangenis, Ana, Glinz, Dominik, Harbin, Nicolay J., Kosiek, Katarzyna, Lindbaek, Morten, Lionis, Christos, Llor, Carl, Miko-Pauer, Reka, Jurgute, Ruta Radzeviciene, Seifert, Bohumil, Sundvall, Par-Daniel, Lundgren, Pia Touboul, Tsakountakis, Nikolaos, Verheij, Theo J., Goossens, Herman, Butler, Christopher C., Beutels, Philippe, Francis, Nick/0000-0001-8939-7312, van der velden, alike/0000-0002-9443-2837, Bruyndonckx, Robin/0000-0002-4217-2869, Coenen, Samuel/0000-0002-1238-8052, Li, Xiao, Bilcke, Joke, van der Velden, Alike W., BRUYNDONCKX, Robin, Coenen , Samuel, Bongard, Emily, de Paor, Muirrean, Chlabicz, Slawomir, Godycki-Cwirko, Maciek, Francis, Nick, Aabenhus, Rune, Bucher, Heiner C., Colliers, Annelies, De Sutter, An, Garcia-Sangenis, Ana, Glinz, Dominik, Harbin, Nicolay J., Kosiek, Katarzyna, Lindbaek, Morten, Lionis, Christos, Llor, Carl, Miko-Pauer, Reka, Jurgute, Ruta Radzeviciene, Seifert, Bohumil, Sundvall, Par-Daniel, Lundgren, Pia Touboul, Tsakountakis, Nikolaos, Verheij, Theo J., Goossens, Herman, Butler, Christopher C., Beutels, Philippe, and ALIC4Etrial Investigators

Subjects
Multi-country, Economics, Health Policy, Economics, Econometrics and Finance (miscellaneous), Cost-utility analysis, Productivity losses, Tamiflu, Direct cost, ADULTS, Europe, QALY, Indirect cost, ILI, Human medicine, METAANALYSIS
Abstract

Background Oseltamivir is usually not often prescribed (or reimbursed) for non-high-risk patients consulting for influenza-like-illness (ILI) in primary care in Europe. We aimed to evaluate the cost-effectiveness of adding oseltamivir to usual primary care in adults/adolescents (13 years +) and children with ILI during seasonal influenza epidemics, using data collected in an open-label, multi-season, randomised controlled trial of oseltamivir in 15 European countries. Methods Direct and indirect cost estimates were based on patient reported resource use and official country-specific unit costs. Health-Related Quality of Life was assessed by EQ-5D questionnaires. Costs and quality adjusted life-years (QALY) were bootstrapped (N = 10,000) to estimate incremental cost-effectiveness ratios (ICER), from both the healthcare payers’ and the societal perspectives, with uncertainty expressed through probabilistic sensitivity analysis and expected value for perfect information (EVPI) analysis. Additionally, scenario (self-reported spending), comorbidities subgroup and country-specific analyses were performed. Results The healthcare payers’ expected ICERs of oseltamivir were €22,459 per QALY gained in adults/adolescents and €13,001 in children. From the societal perspective, oseltamivir was cost-saving in adults/adolescents, but the ICER is €8,344 in children. Large uncertainties were observed in subgroups with comorbidities, especially for children. The expected ICERs and extent of decision uncertainty varied between countries (EVPI ranged €1–€35 per patient). Conclusion Adding oseltamivir to primary usual care in Europe is likely to be cost-effective for treating adults/adolescents and children with ILI from the healthcare payers’ perspective (if willingness-to-pay per QALY gained > €22,459) and cost-saving in adults/adolescents from a societal perspective.

Published
2023

18. Best Practice Guidance for Antibiotic Audit and Feedback interventions in Primary Care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial Resistance - Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Author

Schwartz, Kevin L., primary, Xu, Alice X.T., additional, Alderson, Sarah, additional, Bjerrum, Lars, additional, Brehaut, Jamie, additional, Brown, Benjamin C., additional, Bucher, Heiner C., additional, De Sutter, An, additional, Francis, Nick, additional, Grimshaw, Jeremy, additional, Gunnarsson, Ronny, additional, Hoye, Sigurd, additional, Ivers, Noah, additional, Lecky, Donna M., additional, Lindbaek, Morten, additional, Linder, Jeffrey A., additional, Little, Paul, additional, Michalsen, Benedikte Olsen, additional, O’Connor, Denise, additional, Pulcini, Celine, additional, Sundvall, Par-Daniel, additional, Lundgren, Pia Touboul, additional, Verbakel, Jan Y., additional, and Verheij, Theo J., additional

Published
2023
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19. Best practice guidance for antibiotic audit and feedback interventions in primary care:a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Author

Schwartz, Kevin L., Xu, Alice X.T., Alderson, Sarah, Bjerrum, Lars, Brehaut, Jamie, Brown, Benjamin C., Bucher, Heiner C., De Sutter, An, Francis, Nick, Grimshaw, Jeremy, Gunnarsson, Ronny, Hoye, Sigurd, Ivers, Noah, Lecky, Donna M., Lindbæk, Morten, Linder, Jeffrey A., Little, Paul, Michalsen, Benedikte Olsen, O'Connor, Denise, Pulcini, Celine, Sundvall, Pär Daniel, Lundgren, Pia Touboul, Verbakel, Jan Y., Verheij, Theo J., Schwartz, Kevin L., Xu, Alice X.T., Alderson, Sarah, Bjerrum, Lars, Brehaut, Jamie, Brown, Benjamin C., Bucher, Heiner C., De Sutter, An, Francis, Nick, Grimshaw, Jeremy, Gunnarsson, Ronny, Hoye, Sigurd, Ivers, Noah, Lecky, Donna M., Lindbæk, Morten, Linder, Jeffrey A., Little, Paul, Michalsen, Benedikte Olsen, O'Connor, Denise, Pulcini, Celine, Sundvall, Pär Daniel, Lundgren, Pia Touboul, Verbakel, Jan Y., and Verheij, Theo J.

Abstract

Background Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care. Objective To develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance—Primary Care Antibiotic Audit and Feedback Network. Methods We used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement. Results The final set of guidelines include 13 best practice statements in four categories: general considerations (n = 3), selecting feedback recipients (n = 1), data and indicator selection (n = 4), and feedback delivery (n = 5). Conclusion We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care., BACKGROUND: Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care. OBJECTIVE: To develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance-Primary Care Antibiotic Audit and Feedback Network. METHODS: We used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement. RESULTS: The final set of guidelines include 13 best practice statements in four categories: general considerations (n = 3), selecting feedback recipients (n = 1), data and indicator selection (n = 4), and feedback delivery (n = 5). CONCLUSION: We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.

Published
2023

20. Regional and national antimicrobial stewardship activities:a survey from the Joint Programming Initiative on Antimicrobial Resistance - Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Author

Michalsen, Benedikte Olsen, Xu, Alice X.T., Alderson, Sarah L., Bjerrum, Lars, Brehaut, Jamie, Bucher, Heiner C., Clarkson, Janet, Duncan, Eilidh, Grimshaw, Jeremy, Gunnarsson, Ronny, Høye, Sigurd, Ivers, Noah, Lecky, Donna M., Lindbæk, Morten, Llor, Carl, Lundgren, Pia Touboul, O'connor, Denise, Pulcini, Celiné, Ramsay, Craig, Sundvall, Pär Daniel, Verheij, Theo, Schwartz, Kevin L., Michalsen, Benedikte Olsen, Xu, Alice X.T., Alderson, Sarah L., Bjerrum, Lars, Brehaut, Jamie, Bucher, Heiner C., Clarkson, Janet, Duncan, Eilidh, Grimshaw, Jeremy, Gunnarsson, Ronny, Høye, Sigurd, Ivers, Noah, Lecky, Donna M., Lindbæk, Morten, Llor, Carl, Lundgren, Pia Touboul, O'connor, Denise, Pulcini, Celiné, Ramsay, Craig, Sundvall, Pär Daniel, Verheij, Theo, and Schwartz, Kevin L.

Abstract

Expectations of how theory, empirical material, and methods should be dealt with in academic writing has not always been explicitly communicated to students. Due to a heterogeneity in student populations enrolled in higher degree courses worldwide, diversity in academic writing practices has increased. This paper explores academic writing practices among a group of students with professional, vocational backgrounds and close relationships to practical knowledge. Twelve examination papers from fifteen students within a continuing education program at a Danish university have been analysed inspired by Aristotle’s activities of theoria and praxis and Bourdieu’s concept of strategy. In this perspective, the study shows student strategies of how the students seem to retain an affinity to allow a practical approach of social and ethical evaluation when handling theory, empirical material, and methods. The analysis shows that students’ personal preferences are brought into the foreground., Background: Antibiotic overuse and misuse in primary care are common, highlighting the importance of antimicrobial stewardship (AMS) efforts in this setting. Audit and feedback (A&F) interventions can improve professional practice and performance in some settings. Objectives and methods: To leverage the expertise from international members of the Joint Programming Initiative on Antimicrobial Resistance - Primary care Antibiotic Audit and feedback Network (JPIAMR-PAAN). Network members all have experience of designing and delivering A&F interventions to reduce inappropriate antibiotic prescribing in primary care settings. We aim to introduce the network and explore ongoing A&F activities in member regions. An online survey was administered to all network members to collect regional information. Results: Fifteen respondents from 11 countries provided information on A&F activities in their country, and national/regional antibiotic stewardship programmes or policies. Most countries use electronic medical records as the primary data source, antibiotic appropriateness as the main outcome of feedback, and target GPs as the prescribers of interest. Funding sources varied across countries, which could influence the frequency and quality of A&F interventions. Nine out of 11 countries reported having a national antibiotic stewardship programme or policy, which aim to provide systematic support to ongoing AMS efforts and aid sustainability. Conclusions: The survey identified gaps and opportunities for AMS efforts that include A&F across member countries in Europe, Canada and Australia. JPIAMR-PAAN will continue to leverage its members to produce best practice resources and toolkits for antibiotic A&F interventions in primary care settings and identify research priorities.

Published
2023

21. Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries

Author

HAG Infectieziekten, Infection & Immunity, HAG Zorginnovatieonderzoek, Biostatistiek Onderzoek, Other research (not in main researchprogram), Hartman, Esther A.R., van de Pol, Alma C., Heltveit-Olsen, Silje Rebekka, Lindbæk, Morten, Høye, Sigurd, Lithén, Sara Sofia, Sundvall, Pär Daniel, Sundvall, Sofia, Arnljots, Egill Snaebjörnsson, Gunnarsson, Ronny, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Platteel, Tamara N., Groen, Wim G., Monnier, Annelie A., Zuithoff, Nicolaas P., Verheij, Theo J.M., Hertogh, Cees M.P.M., HAG Infectieziekten, Infection & Immunity, HAG Zorginnovatieonderzoek, Biostatistiek Onderzoek, Other research (not in main researchprogram), Hartman, Esther A.R., van de Pol, Alma C., Heltveit-Olsen, Silje Rebekka, Lindbæk, Morten, Høye, Sigurd, Lithén, Sara Sofia, Sundvall, Pär Daniel, Sundvall, Sofia, Arnljots, Egill Snaebjörnsson, Gunnarsson, Ronny, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Platteel, Tamara N., Groen, Wim G., Monnier, Annelie A., Zuithoff, Nicolaas P., Verheij, Theo J.M., and Hertogh, Cees M.P.M.

Published
2023

22. Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries.

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Li, Xiao, Bilcke, Joke, van der Velden, Alike W, Bruyndonckx, Robin, Coenen, Samuel, Bongard, Emily, de Paor, Muirrean, Chlabicz, Slawomir, Godycki-Cwirko, Maciek, Francis, Nick, Aabenhus, Rune, Bucher, Heiner C, Colliers, Annelies, De Sutter, An, Garcia-Sangenis, Ana, Glinz, Dominik, Harbin, Nicolay J, Kosiek, Katarzyna, Lindbæk, Morten, Lionis, Christos, Llor, Carl, Mikó-Pauer, Réka, Radzeviciene Jurgute, Ruta, Seifert, Bohumil, Sundvall, Pär-Daniel, Touboul Lundgren, Pia, Tsakountakis, Nikolaos, Verheij, Theo J, Goossens, Herman, Butler, Christopher C, Beutels, Philippe, ALIC4Etrial investigators, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Li, Xiao, Bilcke, Joke, van der Velden, Alike W, Bruyndonckx, Robin, Coenen, Samuel, Bongard, Emily, de Paor, Muirrean, Chlabicz, Slawomir, Godycki-Cwirko, Maciek, Francis, Nick, Aabenhus, Rune, Bucher, Heiner C, Colliers, Annelies, De Sutter, An, Garcia-Sangenis, Ana, Glinz, Dominik, Harbin, Nicolay J, Kosiek, Katarzyna, Lindbæk, Morten, Lionis, Christos, Llor, Carl, Mikó-Pauer, Réka, Radzeviciene Jurgute, Ruta, Seifert, Bohumil, Sundvall, Pär-Daniel, Touboul Lundgren, Pia, Tsakountakis, Nikolaos, Verheij, Theo J, Goossens, Herman, Butler, Christopher C, Beutels, Philippe, and ALIC4Etrial investigators

Published
2023

25. Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries

Author

Hartman, Esther A R, primary, van de Pol, Alma C, additional, Heltveit-Olsen, Silje Rebekka, additional, Lindbæk, Morten, additional, Høye, Sigurd, additional, Lithén, Sara Sofia, additional, Sundvall, Pär-Daniel, additional, Sundvall, Sofia, additional, Arnljots, Egill Snaebjörnsson, additional, Gunnarsson, Ronny, additional, Kowalczyk, Anna, additional, Godycki-Cwirko, Maciek, additional, Platteel, Tamara N, additional, Groen, Wim G, additional, Monnier, Annelie A, additional, Zuithoff, Nicolaas P, additional, Verheij, Theo J M, additional, and Hertogh, Cees M P M, additional

Published
2023
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28. Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU)

Author

Heltveit-Olsen, Silje Rebekka, primary, Sundvall, Pär-Daniel, additional, Gunnarsson, Ronny, additional, Snaebjörnsson Arnljots, Egill, additional, Kowalczyk, Anna, additional, Godycki-Cwirko, Maciek, additional, Platteel, Tamara N, additional, Koning, Hilde A M, additional, Groen, Wim G, additional, Åhrén, Christina, additional, Grude, Nils, additional, Verheij, Theo J M, additional, Hertogh, Cees M P M, additional, Lindbaek, Morten, additional, and Hoye, Sigurd, additional

Published
2022
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31. Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries.

Author

Li, Xiao, Bilcke, Joke, van der Velden, Alike W., Bruyndonckx, Robin, Coenen, Samuel, Bongard, Emily, de Paor, Muirrean, Chlabicz, Slawomir, Godycki-Cwirko, Maciek, Francis, Nick, Aabenhus, Rune, Bucher, Heiner C., Colliers, Annelies, De Sutter, An, Garcia-Sangenis, Ana, Glinz, Dominik, Harbin, Nicolay J., Kosiek, Katarzyna, Lindbæk, Morten, and Lionis, Christos

Subjects
RANDOMIZED controlled trials, PRIMARY care, QUALITY of life, OSELTAMIVIR, SEASONAL influenza
Abstract

Background: Oseltamivir is usually not often prescribed (or reimbursed) for non-high-risk patients consulting for influenza-like-illness (ILI) in primary care in Europe. We aimed to evaluate the cost-effectiveness of adding oseltamivir to usual primary care in adults/adolescents (13 years +) and children with ILI during seasonal influenza epidemics, using data collected in an open-label, multi-season, randomised controlled trial of oseltamivir in 15 European countries. Methods: Direct and indirect cost estimates were based on patient reported resource use and official country-specific unit costs. Health-Related Quality of Life was assessed by EQ-5D questionnaires. Costs and quality adjusted life-years (QALY) were bootstrapped (N = 10,000) to estimate incremental cost-effectiveness ratios (ICER), from both the healthcare payers' and the societal perspectives, with uncertainty expressed through probabilistic sensitivity analysis and expected value for perfect information (EVPI) analysis. Additionally, scenario (self-reported spending), comorbidities subgroup and country-specific analyses were performed. Results: The healthcare payers' expected ICERs of oseltamivir were €22,459 per QALY gained in adults/adolescents and €13,001 in children. From the societal perspective, oseltamivir was cost-saving in adults/adolescents, but the ICER is €8,344 in children. Large uncertainties were observed in subgroups with comorbidities, especially for children. The expected ICERs and extent of decision uncertainty varied between countries (EVPI ranged €1–€35 per patient). Conclusion: Adding oseltamivir to primary usual care in Europe is likely to be cost-effective for treating adults/adolescents and children with ILI from the healthcare payers' perspective (if willingness-to-pay per QALY gained > €22,459) and cost-saving in adults/adolescents from a societal perspective. [ABSTRACT FROM AUTHOR]

Published
2023
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33. Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: a qualitative study in four European countries

Author

Hartman, Esther A R, primary, Groen, Wim G, additional, Heltveit-Olsen, Silje Rebekka, additional, Lindbæk, Morten, additional, Høye, Sigurd, additional, Sundvall, Pär-Daniel, additional, Skoglund, Ingmarie, additional, Snaebjörnsson Arnljots, Egill, additional, Gunnarsson, Ronny, additional, Kowalczyk, Anna, additional, Godycki-Cwirko, Maciek, additional, Kosiek, Katarzyna, additional, Platteel, Tamara N, additional, van de Pol, Alma C, additional, Verheij, Theo J M, additional, Monnier, Annelie A, additional, and Hertogh, Cees M P M, additional

Published
2022
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36. Diagnostic prediction models for computed tomography-confirmed acute rhinosinusitis and culture-confirmed acute bacterial rhinosinusitis in adults presenting to primary care: an individual participant data meta-analysis

Author

Takada, Toshihiko, Hoogland, Jeroen, Hansen, Jens G., Lindbaek, Morten, Autio, Timo, Alho, Olli-Pekka, Ebell, Mark H., Reitsma, Johannes B., Venekamp, Roderick P., and Epidemiology and Data Science

Abstract

Background Antibiotics are overused in patients with acute rhinosinusitis (ARS) as it is difficult to identify those who benefit from antibiotic treatment. Aim To develop prediction models for computed tomography (CT)-confirmed ARS and cultureconfirmed acute bacterial rhinosinusitis (ABRS) in adults presenting to primary care with symptoms suggestive of ARS. Design and setting This was a systematic review and individual participant data meta-analysis. Method CT-confirmed ARS was defined as the presence of fluid level or total opacification in any maxillary sinuses, whereas culture-confirmed ABRS was defined by culture of fluid from antral puncture. Prediction models were derived using logistic regression modelling. Results Among 426 patients from three studies, 140 patients (32.9 had CT-confirmed ARS. A model consisting of seven variables: previous diagnosis of ARS, preceding upper respiratory tract infection, anosmia, double sickening, purulent nasal discharge on examination, need for antibiotics as judged by a physician, and C-reactive protein (CRP) showed an optimismcorrected c-statistic of 0.73 (95CI] = 0.69 to 0.78) and a calibration slope of 0.99 (95= 0.72 to 1.19). Among 225 patients from two studies, 68 patients (30.2 had culture-confirmed ABRS. A model consisting of three variables: pain in teeth, purulent nasal discharge, and CRP showed an optimism-corrected c-statistic of 0.70 (95CI = 0.63 to 0.77) and a calibration slope of 1.00 (95= 0.66 to 1.52). Clinical utility analysis showed that both models could be useful to rule out the target condition. Conclusion Simple prediction models for CT-confirmed ARS and culture-confirmed ABRS can be useful to safely reduce antibiotic use in adults with ARS in high-prescribing countries.

Published
2022

37. Clinical presentation and disease course in patients with flu-like illness:does microbiological aetiology matter?

Author

Verheij, Theo, Cianci, Daniela, van der Velden, Alike, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Colliers, Annelies, Francis, Nick, Little, Paul, Godycki-Cwirko, Maciek, Llor, Carl, Chlabicz, Slawomir, Lionis, Christos, Sundvall, Pär-Daniel, Bjerrum, Lars, De Sutter, An, Aabenhus, Rune, Jonassen Harbin, Nicolay, Lindbaek, Morten, Glinz, Dominik, Bucher, Heiner, Kovacs, Bernadett, Seifert, Bohumil, Touboul Lundgren, Pia, de Paor, Muireann, Radzeviciene JUrgute, Ruta, Matheeussen, Veerle, Goossens, Herman, Ieven, Margareta, Verheij, Theo, Cianci, Daniela, van der Velden, Alike, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Colliers, Annelies, Francis, Nick, Little, Paul, Godycki-Cwirko, Maciek, Llor, Carl, Chlabicz, Slawomir, Lionis, Christos, Sundvall, Pär-Daniel, Bjerrum, Lars, De Sutter, An, Aabenhus, Rune, Jonassen Harbin, Nicolay, Lindbaek, Morten, Glinz, Dominik, Bucher, Heiner, Kovacs, Bernadett, Seifert, Bohumil, Touboul Lundgren, Pia, de Paor, Muireann, Radzeviciene JUrgute, Ruta, Matheeussen, Veerle, Goossens, Herman, and Ieven, Margareta

Abstract

BACKGROUND: There is little evidence about the relation between aetiology, illness severity and clinical course of respiratory tract infections (RTI) in primary care. Understanding these associations would aid to develop effective management strategies for these infections.AIM: To investigate whether the clinical presentation and illness course differ between RTI in whom a viral pathogen was detected and those in whom a potential bacterial pathogen was found.DESIGN AND SETTING: Post hoc analysis of data from a pragmatic randomised trial on the effects of oseltamivir in patients with influenza-like illness (ILI) in primary care (n=3266) in 15 European countries.METHODS: Patient characteristics, signs and symptoms were registered at baseline. Naso-pharyngeal (adults) or nasal and pharyngeal (children) swabs were taken for PCR analysis. Patients were followed up until 28 days after inclusion. Regression models and Kaplan-Meier curves were used to analyse the relation between aetiology, clinical presentation at baseline and course of disease including complications.RESULTS: Except for a less prominent congested nose (OR 0.55, CI 0.35 - 0.86) and acute cough (OR 0.52, CI 0.27 - 0.65) in ILI patients in whom a possible bacterial pathogen was isolated, there were no clear clinical differences in presentations between those with a possible bacterial aetiology than in those with a viral one. Also the course of disease and complications were not related to aetiology.CONCLUSION: Given the currently available microbiological tests and antimicrobial treatments, and outside pandemics like COVID-19, microbiological testing in primary care patients with ILI seems to have limited value.

Published
2022

38. Clinical prediction of laboratory-confirmed influenza in adults with influenza-like illness in primary care:A randomized controlled trial secondary analysis in 15 European countries

Author

Ouchi, Dan, García-Sangenís, Ana, Moragas, Ana, van der Velden, Alike W, Verheij, Theo J, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Cook, Johanna, Francis, Nick A, Godycki-Cwirko, Maciek, Lundgren, Pia Touboul, Lionis, Christos, Radzeviciene Jurgute, Ruta, Chlabicz, Sławomir, De Sutter, An, Bucher, Heiner C, Seifert, Bohumil, Kovács, Bernadett, de Paor, Muireann, Sundvall, Pär-Daniel, Aabenhus, Rune, Harbin, Nicolay Jonassen, Ieven, Greet, Goossens, Herman, Lindbæk, Morten, Bjerrum, Lars, Llor, Carl, Ouchi, Dan, García-Sangenís, Ana, Moragas, Ana, van der Velden, Alike W, Verheij, Theo J, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Cook, Johanna, Francis, Nick A, Godycki-Cwirko, Maciek, Lundgren, Pia Touboul, Lionis, Christos, Radzeviciene Jurgute, Ruta, Chlabicz, Sławomir, De Sutter, An, Bucher, Heiner C, Seifert, Bohumil, Kovács, Bernadett, de Paor, Muireann, Sundvall, Pär-Daniel, Aabenhus, Rune, Harbin, Nicolay Jonassen, Ieven, Greet, Goossens, Herman, Lindbæk, Morten, Bjerrum, Lars, and Llor, Carl

Abstract

BACKGROUND: Clinical findings do not accurately predict laboratory diagnosis of influenza. Early identification of influenza is considered useful for proper management decisions in primary care.OBJECTIVE: We evaluated the diagnostic value of the presence and the severity of symptoms for the diagnosis of laboratory-confirmed influenza infection among adults presenting with influenza-like illness (ILI) in primary care.METHODS: Secondary analysis of patients with ILI who participated in a clinical trial from 2015 to 2018 in 15 European countries. Patients rated signs and symptoms as absent, minor, moderate, or major problem. A nasopharyngeal swab was taken for microbiological identification of influenza and other microorganisms. Models were generated considering (i) the presence of individual symptoms and (ii) the severity rating of symptoms.RESULTS: A total of 2,639 patients aged 18 or older were included in the analysis. The mean age was 41.8 ± 14.7 years, and 1,099 were men (42.1%). Influenza was microbiologically confirmed in 1,337 patients (51.1%). The area under the curve (AUC) of the model for the presence of any of seven symptoms for detecting influenza was 0.66 (95% confidence interval [CI]: 0.65-0.68), whereas the AUC of the symptom severity model, which included eight variables-cough, fever, muscle aches, sweating and/or chills, moderate to severe overall disease, age, abdominal pain, and sore throat-was 0.70 (95% CI: 0.69-0.72).CONCLUSION: Clinical prediction of microbiologically confirmed influenza in adults with ILI is slightly more accurate when based on patient reported symptom severity than when based on the presence or absence of symptoms.

Published
2022

39. Diagnostic prediction models for CT-confirmed and bacterial rhinosinusitis in primary care: individual participant data meta-analysis

Author

HAG Trombose, Epi Methoden Team 4, Circulatory Health, JC onderzoeksprogramma Methodologie, HAG Onderzoek, Child Health, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Takada, Toshihiko, Hoogland, Jeroen, Hansen, Jens G, Lindbaek, Morten, Autio, Timo, Alho, Olli-Pekka, Ebell, Mark H, Reitsma, Johannes B, Venekamp, Roderick P, HAG Trombose, Epi Methoden Team 4, Circulatory Health, JC onderzoeksprogramma Methodologie, HAG Onderzoek, Child Health, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Takada, Toshihiko, Hoogland, Jeroen, Hansen, Jens G, Lindbaek, Morten, Autio, Timo, Alho, Olli-Pekka, Ebell, Mark H, Reitsma, Johannes B, and Venekamp, Roderick P

Published
2022

40. Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU)

Author

HAG Infectieziekten, Infection & Immunity, UMC Utrecht Holding, Heltveit-Olsen, Silje Rebekka, Sundvall, Pär Daniel, Gunnarsson, Ronny, Snaebjörnsson Arnljots, Egill, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Platteel, Tamara N., Koning, Hilde A.M., Groen, Wim G., Åhrén, Christina, Grude, Nils, Verheij, Theo J.M., Hertogh, Cees M.P.M., Lindbaek, Morten, Hoye, Sigurd, HAG Infectieziekten, Infection & Immunity, UMC Utrecht Holding, Heltveit-Olsen, Silje Rebekka, Sundvall, Pär Daniel, Gunnarsson, Ronny, Snaebjörnsson Arnljots, Egill, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Platteel, Tamara N., Koning, Hilde A.M., Groen, Wim G., Åhrén, Christina, Grude, Nils, Verheij, Theo J.M., Hertogh, Cees M.P.M., Lindbaek, Morten, and Hoye, Sigurd

Published
2022

41. Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: A qualitative study in four European countries

Author

HAG Infectieziekten, Infection & Immunity, Huisartsopleiding, Hartman, Esther A.R., Groen, Wim G., Heltveit-Olsen, Silje Rebekka, Lindbæk, Morten, Høye, Sigurd, Sundvall, Pär Daniel, Skoglund, Ingmarie, Snaebjörnsson Arnljots, Egill, Gunnarsson, Ronny, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Kosiek, Katarzyna, Platteel, Tamara N., Van De Pol, Alma C., Verheij, Theo J.M., Monnier, Annelie A., Hertogh, Cees M.P.M., HAG Infectieziekten, Infection & Immunity, Huisartsopleiding, Hartman, Esther A.R., Groen, Wim G., Heltveit-Olsen, Silje Rebekka, Lindbæk, Morten, Høye, Sigurd, Sundvall, Pär Daniel, Skoglund, Ingmarie, Snaebjörnsson Arnljots, Egill, Gunnarsson, Ronny, Kowalczyk, Anna, Godycki-Cwirko, Maciek, Kosiek, Katarzyna, Platteel, Tamara N., Van De Pol, Alma C., Verheij, Theo J.M., Monnier, Annelie A., and Hertogh, Cees M.P.M.

Published
2022

42. Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data

Author

HAG Infectieziekten, CTM & Statistical consultation, Biostatistiek Onderzoek, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Verheij, Theo, Cianci, Daniela, van der Velden, Alike, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Colliers, Annelies, Francis, Nick, Little, Paul, Godycki-Cwirko, Maciek, Llor, Carl, Chlabicz, Slawomir, Lionis, Christos, Sundvall, Pär-Daniel, Bjerrum, Lars, De Sutter, An, Aabenhus, Rune, Jonassen Harbin, Nicolay, Lindbaek, Morten, Glinz, Dominik, Bucher, Heiner, Kovacs, Bernadett, Seifert, Bohumil, Radzeviciene JUrgute, Ruta, Touboul Lundgren, Pia, de Paor, Muireann, Matheeussen, Veerle, Goossens, Herman, Ieven, Margareta, HAG Infectieziekten, CTM & Statistical consultation, Biostatistiek Onderzoek, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Verheij, Theo, Cianci, Daniela, van der Velden, Alike, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Colliers, Annelies, Francis, Nick, Little, Paul, Godycki-Cwirko, Maciek, Llor, Carl, Chlabicz, Slawomir, Lionis, Christos, Sundvall, Pär-Daniel, Bjerrum, Lars, De Sutter, An, Aabenhus, Rune, Jonassen Harbin, Nicolay, Lindbaek, Morten, Glinz, Dominik, Bucher, Heiner, Kovacs, Bernadett, Seifert, Bohumil, Radzeviciene JUrgute, Ruta, Touboul Lundgren, Pia, de Paor, Muireann, Matheeussen, Veerle, Goossens, Herman, and Ieven, Margareta

Published
2022

43. Clinical prediction of laboratory-confirmed influenza in adults with influenza-like illness in primary care. A randomized controlled trial secondary analysis in 15 European countries

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Ouchi, Dan, García-Sangenís, Ana, Moragas, Ana, van der Velden, Alike W, Verheij, Theo J, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Cook, Johanna, Francis, Nick A, Godycki-Cwirko, Maciek, Lundgren, Pia Touboul, Lionis, Christos, Radzeviciene Jurgute, Ruta, Chlabicz, Sławomir, De Sutter, An, Bucher, Heiner C, Seifert, Bohumil, Kovács, Bernadett, de Paor, Muireann, Sundvall, Pär-Daniel, Aabenhus, Rune, Harbin, Nicolay Jonassen, Ieven, Greet, Goossens, Herman, Lindbæk, Morten, Bjerrum, Lars, Llor, Carl, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Ouchi, Dan, García-Sangenís, Ana, Moragas, Ana, van der Velden, Alike W, Verheij, Theo J, Butler, Christopher C, Bongard, Emily, Coenen, Samuel, Cook, Johanna, Francis, Nick A, Godycki-Cwirko, Maciek, Lundgren, Pia Touboul, Lionis, Christos, Radzeviciene Jurgute, Ruta, Chlabicz, Sławomir, De Sutter, An, Bucher, Heiner C, Seifert, Bohumil, Kovács, Bernadett, de Paor, Muireann, Sundvall, Pär-Daniel, Aabenhus, Rune, Harbin, Nicolay Jonassen, Ieven, Greet, Goossens, Herman, Lindbæk, Morten, Bjerrum, Lars, and Llor, Carl

Published
2022

46. Additional file 1 of The efficacy of pivmecillinam in oral step-down treatment in hospitalised patients with E. coli bacteremic urinary tract infection; a single-arm, uncontrolled treatment study

Author

Hansen, Bjørn Åsheim, Grude, Nils, Lindbæk, Morten, and Stenstad, Tore

Abstract

Additional file 1: Table S1. Number of subjects screened/excluded/included and reason for exclusion. Figure S1. Venn diagram showing variations in self-reported improvement in health status. Table S2. Univariate analysis of various clinical and laboratory parameters vs treatment success. Table S3. Rates of Adverse Events (AE)/Serious Adverse Event (SAE) among patients treated with pivmecillinam 400 mg QID for 1 week (ITT, n = 53).

Published
2022
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49. Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data

Author

Verheij, Theo J, primary, Cianci, Daniela, additional, van der Velden, Alike W, additional, Butler, Christopher C, additional, Bongard, Emily, additional, Coenen, Samuel, additional, Colliers, Annelies, additional, Francis, Nick A, additional, Little, Paul, additional, Godycki-Cwirko, Maciek, additional, Llor, Carl, additional, Chlabicz, Sławomir, additional, Lionis, Christos, additional, Sundvall, Pär-Daniel, additional, Bjerrum, Lars, additional, De Sutter, An, additional, Aabenhus, Rune, additional, Harbin, Nicolay Jonassen, additional, Lindbæk, Morten, additional, Glinz, Dominik, additional, Bucher, Heiner C, additional, Kovács, Bernadett, additional, Seifert, Bohumil, additional, Jurgute, Ruta Radzeviciene, additional, Lundgren, Pia Touboul, additional, de Paor, Muireann, additional, Matheeussen, Veerle, additional, Goossens, Herman, additional, and Ieven, Margareta, additional

Published
2021
Full Text
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