The goal of the stepped-wedge cluster-randomized trial is to assess the impact of an antimicrobial stewardship intervention: a simple, automated Best Practice Alert (BPA) that reminds prescribers to reevaluate antibiotic therapy after 72 hours (or 24 hours for prophylaxis), in accordance with guideline recommendations. The primary hypothesis is that this simple BPA reduces antibiotic use in terms of quantity (amount and duration) and quality (spectrum breadth), measured by days of antibiotic spectrum coverage at the patient level (primary outcome), as well as at both patient and cluster levels using various metrics of antibiotic use. The trial will introduce the BPA in a stepwise manner, with all wards implementing it by the end. It will compare the intervention period to the baseline (pre-intervention) and control periods.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
58
The antimicrobial stewardship intervention encourages prescribers by a simple alert to follow guidelines for reviewing antimicrobial prescriptions after a set timeframe for potential de-escalation to targeted therapy or discontinuation of the antibiotics, as recommended by national and international guidelines. An automated simple BPA will trigger after an antibiotic prescription with therapeutic indication (72 hours) or surgical prophylaxis (24 hours, reminding prescribers to reassess treatment for possible de-escalation, adaption to targeted therapy, or cessation. If ignored, the prescription remains unchanged, but the alert will continue until addressed. Prescribers must select reasons for not changing the prescription, such as pending microbiology results. The control group corresponds to the inpatient wards not yet receiving the BPA, where antibiotics are managed according to "standard-of-care".
Inselgruppe
Bern, Switzerland
Days of antibiotic spectrum coverage (DASC) per patient admission (PA)
Overall score of days of antibiotic spectrum coverage per patient admission. The score is composed of the breadth of the bacterial spectrum covered by the administered antibiotic (according to Kakiuchi 2022 - the broader the antibiotic spectrum, the higher the score), summed over the number of days the antibiotic is given. Accordingly, there are no maximum or minimum values
Time frame: 12 months
Days of antibiotic spectrum coverage (DASC) per patient antibiotic day (PAD)
Overall score of antibiotic spectrum coverage per patient antibiotic day. The score is composed of the breadth of the bacterial spectrum covered by the administered antibiotic (according to Kakiuchi 2022 - the broader the antibiotic spectrum, the higher the score), summed over the number of days the antibiotic is given. Accordingly, there are no maximum or minimum values.
Time frame: 12 months
Days of treatment (DOT) per 100 patient days (PD) and per patient admission on ward level
Overall days of treatment (DOT) per 100 patient days (PD) and per patient admission (PA) on ward level
Time frame: 12 months
Defined daily doses (DDD) per 100 patient days (PD) and per patient admission (PA)
Overall defined daily doses) per 100 patient days (PD) and per patient admission (PA) on ward level. Standard metrics recommended by WHO for international benchmarking.
Time frame: 12 months
Antibiotic (AB) days per patient admission (PA)
No of days an AB per PA gives the proportion of days antibiotics have been applicated, irrespective of single, double, triple combinations, in relation to total PA
Time frame: 12 months
In hospital mortality
All cause in hospital mortality
Time frame: 12 months
Hospital length of stay (LOS)
Time frame: 12 months
Unplanned readmission within first 30 days after discharge
Time frame: 12 months
Patient admission to IMC/ICU from studied wards
Number and proportion of patient admissions to IMC/ICU from studied wards
Time frame: 12 months
Number of Infectious diseases (ID) consultation per patient admission (PA)
Time frame: 12 months
In hospital C. difficile infection incidence within hospital stay per patient admission (PA) and per 100 patient days (PD)
Time frame: 12 months
Inhospital incidence of multi-drug-resistant-organisms (MDRO) detection per100 patient days (PD) or per patient admission (PA)
Time frame: 12 months
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