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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
19,220
See primary outcome for list of targeted drugs. See citations for previous publications describing the intervention.
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
Days of antibiotic therapy (DOTs) of targeted broadspectrum agents per patient days (PDs)
* 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)
Time frame: patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
Days of antibiotic therapy of any antibiotic agent(DOTs)per patient days (PDs)
-Definition as per primary outcome, but can include any antibiotic (not just those broadspectrum agents targeted by the intervention)
Time frame: patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
Costs of antibiotic therapy ($) per patient day
Based on acquisition costs for each agent.
Time frame: patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
Hospital-acquired Clostridium difficile infection.
Cases of Clostridium difficile infection deemed to have been acquired during the current hospital stay by prospective Infection Prevention \& Control surveillance team.
Time frame: patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
Antibiotic susceptibility of gram negative bacterial isolates
Time frame: patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
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