BTS Clinical Statement on the prevention and management of community-acquired pneumonia in people with learning disability

Legg, Julian; Allen, Jamie-Leigh; Andrew, Morag; Annesley, Charlotte; Chatwin, Michelle; Crawford, Hannah; Elverson, Joanna; Forton, Julian; Oulton, Kate; Renton, Kate; Tavaré, Alison; Tedd, Hilary; Simpson, AJ

doi:10.1136/thorax-2022-219698

Cited by 28 publications

(3 citation statements)

References 236 publications

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“…36 Indeed, the most recent British Thoracic Society guidelines support the use of both enteral and inhaled antibiotics to reduce infection frequency in individuals with learning disabilities suffering from recurrent community-acquired pneumonia. 48 Although early evidence on prophylactic inhaled antibiotic use is promising, it is very weak, limited to two small retrospective cohort studies. 37,47 One of these studies was a retrospective case series of six tracheostomised children, which reported a reduction in antimicrobial use and episodes of LRTI; however, neither finding was statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…Prophylactic antimicrobials have also been investigated in the context of recurrent LRTI 37,47 and persistent bacterial colonization after LRTI 36 . Indeed, the most recent British Thoracic Society guidelines support the use of both enteral and inhaled antibiotics to reduce infection frequency in individuals with learning disabilities suffering from recurrent community‐acquired pneumonia 48 . Although early evidence on prophylactic inhaled antibiotic use is promising, it is very weak, limited to two small retrospective cohort studies 37,47 .…”

Section: Discussionmentioning

confidence: 99%

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A systematic review of antimicrobial therapy in children with tracheostomies

Pearce,

Talks,

Powell

et al. 2023

Pediatric Pulmonology

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Tracheostomies are indicated in children to facilitate long‐term ventilatory support, aid in the management of secretions, or manage upper airway obstruction. Children with tracheostomies often experience ongoing airway complications, of which respiratory tract infections are common. They subsequently receive frequent courses of broad‐spectrum antimicrobials for the prevention or treatment of respiratory tract infections. However, there is little consensus in practice with regard to the indication for treatment/prophylactic antimicrobial use, choice of antimicrobial, route of administration, or duration of treatment between different centers. Routine antibiotic use is associated with adverse effects and an increased risk of antimicrobial resistance. Tracheal cultures are commonly obtained from pediatric tracheostomy patients, with the aim of helping guide antimicrobial therapy choice. However, a positive culture alone is not diagnostic of infection and the role of routine surveillance cultures remains contentious. Inhaled antimicrobial use is also widespread in the management of tracheostomy‐associated infections; this is largely based on the theoretical benefits of higher airway antibiotic concentrations. The role of prophylactic inhaled antimicrobial use for tracheostomy‐associated infections remains largely unproven. This systematic review summarizes the current evidence base for antimicrobial selection, duration, and administration route in pediatric tracheostomy‐associated infections. It also highlights significant variation in practice between centers and the urgent need for further prospective evidence to guide the management of these vulnerable patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A systematic review of antimicrobial therapy in children with tracheostomies

Pearce,

Talks,

Powell

et al. 2023

Pediatric Pulmonology

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“…MI-E may be beneficial to patients with cerebral palsy, but further work is warranted [ 23 ]. More recently, based on clinical experience, and where indicated, MI-E has been recommended in the BTS clinical statement on the prevention and treatment of community acquired pneumonia in individuals with learning disability [ 30 ].…”

Section: Patient Populations and Clinical Benefits Of Mi-e Devicesmentioning

confidence: 99%

Mechanical Insufflation-Exsufflation: Considerations for Improving Clinical Practice

Chatwin

Wakeman

2023

JCM

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The provision of mechanical insufflation-exsufflation (MI-E) devices to enhance cough efficacy is increasing. Typically, MI-E devices are used to augment cough in patients with neuromuscular disorders but also in patients who are weak in an acute care setting. Despite a growing evidence base for the use of these devices, there are barriers to the provision of MI-E, including clinician lack of knowledge and confidence. Enhancing clinician education and confidence is key. Individualized or protocolized approaches can be used to initiate MI-E. Evaluation of MI-E efficacy is critical. One method to evaluate effectiveness of MI-E is the MI-E-assisted cough peak flow (CPF). However, this should always be considered alongside other factors discussed in this review. The purpose of this review is to increase the theoretical understanding of the provision and evaluation of MI-E and provide insight into how this knowledge can be applied into clinical practice. Approaches to initiation and titration can be selected based on the clinical situation, patient diagnosis (including and beyond neuromuscular disorders), and clinician’s confidence.

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BTS on community‐acquired and aspiration pneumonia

Chaplin¹

2023

Prescriber

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I n 2022, the British Thoracic Society (BTS) revived its Clinical Statements initiative. These lengthy documents provide guidance on areas of clinical practice for which a full guideline is either impractical or not feasible but where new information, or a lack of it, means that a statement based on evidence or expert opinion is helpful. 1 The BTS explains: "Clinical Statements are not clinical guidelines, rather they seek to give a 'snapshot in time' of knowledge and best practice in a particular clinical area, and provide a series of good practice points."The most recent BTS Clinical Statements cover two aspects of the management of pneumonia: communityacquired pneumonia in people with learning disability 2 and aspiration pneumonia. 3 Both helpfully include a summary of the main clinical practice points separate from the very detailed text.

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BTS Clinical Statement on the prevention and management of community-acquired pneumonia in people with learning disability

Cited by 28 publications

References 236 publications

A systematic review of antimicrobial therapy in children with tracheostomies

A systematic review of antimicrobial therapy in children with tracheostomies

Mechanical Insufflation-Exsufflation: Considerations for Improving Clinical Practice

BTS on community‐acquired and aspiration pneumonia

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