Hospital Wide Roll-Out of Antimicrobial Stewardship: A Stepped Wedge Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Bacterial Infections
- Sponsor
- Sunnybrook Health Sciences Centre
- Enrollment
- 19220
- Locations
- 1
- Primary Endpoint
- Days of antibiotic therapy (DOTs) of targeted broadspectrum agents per patient days (PDs)
- Status
- Completed
- Last Updated
- 11 years ago
Overview
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.
Investigators
Eligibility Criteria
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
Outcomes
Primary Outcomes
Days of antibiotic therapy (DOTs) of targeted broadspectrum agents per patient days (PDs)
Time Frame: 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 Outcomes
- 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))
- 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))
- Costs of antibiotic therapy ($) per patient day(patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics))