Bacterial Infections
Conditions
Keywords
Antibiotic stewardship., Clostridium difficile infection., Antibiotic resistance.
Brief summary
Dramatic increases in antibiotic utilization in hospitals continue to drive antibiotic resistance among hospital-acquired pathogens. However, 30-50% of the antibiotic use in hospitals is unnecessary or inappropriate. The Infectious Diseases Society of America has published guidelines stating that all hospitals should develop an institutional program to enhance antimicrobial stewardship. At Sunnybrook Health Sciences Centre, an antibiotic stewardship audit-and-feedback intervention for all patients reaching their third or tenth day of broadspectrum antibiotic use in intensive care, resulted in a reduction of antibiotic use, antibiotic costs, and Clostridium difficile infections in the intensive care unit. The investigators hypothesize that this intervention will result in similar benefits outside of the intensive care unit, and so expanded the intervention to non-ICU medical and surgical wards. To increase the rigor of our program evaluation, the roll-out was conducted in a stepped-wedge randomized controlled design.
Interventions
OTHERAntibiotic stewardship audit-and-feedback to prescribers of patients receiving 3rd or 10th day of targeted broadspectrum antibiotics
See primary outcome for list of targeted drugs. See citations for previous publications describing the intervention.
Sponsors
Ontario Ministry of Health and Long Term Care
Sunnybrook Health Sciences Centre
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
All patients admitted to the medical/surgical services will be included in statistical analysis of program evaluation. The inclusion/
Exclusion criteria
below, just define who receives the antibiotic stewardship intervention on each service. Inclusion Criteria: * admitted to one of these services: general internal medicine, cardiology, nephrology, orthopedic surgery, neurosurgery, general surgery or trauma surgery * receiving 3rd or 10th day of treatment with one of the following antibiotics: * ceftriaxone, ceftazidime, piperacillin-tazobactam, ciprofloxacin, levofloxacin, meropenem, ertapenem, vancomycin
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Days of antibiotic therapy (DOTs) of targeted broadspectrum agents per patient days (PDs) | patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics) | * Targeted broadspectrum antibiotics include third generation cephalosporins (ceftriaxone, ceftazidime), beta-lactam beta-lactamase inhibitors (piperacillin-tazobactam), fluoroquinolones (ciprofloxacin, levofloxacin), carbapenems (ertapenem and meropenem), and glycopeptides (vancomycin) * DOTs are defined as the number of unique antibiotic agents prescribed each day (regardless of dose) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Days of antibiotic therapy of any antibiotic agent(DOTs)per patient days (PDs) | patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics) | -Definition as per primary outcome, but can include any antibiotic (not just those broadspectrum agents targeted by the intervention) |
| Costs of antibiotic therapy ($) per patient day | patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics) | Based on acquisition costs for each agent. |
| Hospital-acquired Clostridium difficile infection. | patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics) | Cases of Clostridium difficile infection deemed to have been acquired during the current hospital stay by prospective Infection Prevention & Control surveillance team. |
| Antibiotic susceptibility of gram negative bacterial isolates | patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics) | — |
Countries
Canada
Outcome results
None listed