Hospital Wide Roll-Out of Antimicrobial Stewardship

Not Applicable

Completed

• Conditions: Bacterial Infections
• Interventions: Other: Antibiotic stewardship audit-and-feedback to prescribers of patients receiving 3rd or 10th day of targeted broadspectrum antibiotics

• Registration Number: NCT01587937
• Lead Sponsor: Sunnybrook Health Sciences Centre

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.

Detailed Description

Not available

Study Timeline

• Study Start: 2010-04
• Primary Completion: 2012-04
• Study Completion: 2012-04
• Study First Submitted: 2012-04-13
• Study First Submitted QC: 2012-04-26
• Study First Posted: 2012-04-30
• Status Verified: 2014-11
• Last Update Submitted: 2014-11-17
• Last Update Posted: 2014-11-19

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 19220

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

Exclusion Criteria

• patient being followed by the infectious diseases consult service

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Antibiotic stewardship intervention	Antibiotic stewardship audit-and-feedback to prescribers of patients receiving 3rd or 10th day of targeted broadspectrum antibiotics	Audit-and-feedback intervention to prescribers of patients receiving 3rd or 10th day of targeted broadspectrum antimicrobial

Primary Outcome Measures

Name	Time	Method
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 Outcome Measures

Name	Time	Method
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)
Antibiotic susceptibility of gram negative bacterial isolates	patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
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.
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.

Trial Locations

Locations (1)

Sunnybrook Health Sciences Centre; 🇨🇦 Toronto, Ontario, Canada