Impact of a Simple Automated Best Practice Alert (BPA) on Quantity and Quality of In-hospital Antibiotic Use in a Tertiary and Three Secondary Hospitals

Not Applicable

Not yet recruiting

• Conditions: Antibiotic Prescriptions; In-Patient Treatment

• Registration Number: NCT07115966
• Lead Sponsor: Insel Gruppe AG, University Hospital Bern

Brief Summary

The goal of the stepped-wedge cluster-randomized trial is to assess the impact of a n antimicrobial stewardship intervention: a simple, automated BPA that reminds prescribers to reevaluate antibiotic therapy after 72 hours (24 hours for prophylaxis), according to guideline recommendations.

The primary hypothesis is that a simple BPA reduces antibiotic use in terms of quantity (amount, duration) and quality (broadness), measured in days of antibiotic spectrum coverage on a patient level (primary outcome), and on patient and cluster levels, with different metrics used to measure antibiotic use.

The trial will introduce the BPA in a stepwise manner, with all wards using it by the end. It will compare the intervention period to the baseline (pre-intervention) and control periods.

Detailed Description

Not available

Study Timeline

• Status Verified: 2025-08
• Study Start: 2025-08-01
• Study First Submitted: 2025-08-04
• Study First Submitted QC: 2025-08-08
• Last Update Submitted: 2025-08-08
• Study First Posted: 2025-08-11
• Last Update Posted: 2025-08-11
• Primary Completion: 2026-07-31
• Study Completion: 2026-07-31

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 58

Inclusion Criteria

• All inpatient wards with at least 50 PA/year, except those listed in the exclusion criteria

Exclusion Criteria

Ward level:

• Emergency departments
• Outpatient clinics
• Haemato-oncologic stem cell transplant wards, where daily ID visits are performed
• ICU wards, where daily ID visits are performed

Individual patient data for analysis

• Refusal of institutional general consent for further use of patient data

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Primary Outcome Measures

Name	Time	Method
Days of antibiotic spectrum coverage (DASC) per patient admission (PA)	12 months	Overall score of days of antibiotic spectrum coverage per patient admission

Secondary Outcome Measures

Name	Time	Method
Defined daily doses (DDD) per 100 patient days (PD) and per patient admission (PA)	12 months	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.
Antibiotic (AB) days per patient admission (PA)	12 months	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
In hospital mortality	12 months	All cause in hospital mortality
Hospital length of stay (LOS)	12 months
Number of Infectious diseases (ID) consultation per patient admission (PA)	12 months
Inhospital incidence of multi-drug-resistant-organisms (MDRO) detection per100 patient days (PD) or per patient admission (PA)	12 months
Days of treatment (DOT) per 100 patient days (PD) and per patient admission on ward level	12 months	Overall days of treatment (DOT) per 100 patient days (PD) and per patient admission (PA) on ward level
Days of antibiotic spectrum coverage (DASC) per patient antibiotic day (PAD)	12 months	Overall score of antibiotic spectrum coverage per patient antibiotic day
Unplanned readmission within first 30 days after discharge	12 months
In hospital C. difficile infection incidence within hospital stay per patient admission (PA) and per 100 patient days (PD)	12 months
Patient admission to IMC/ICU from studied wards	12 months	Number and proportion of patient admissions to IMC/ICU from studied wards

Trial Locations

Locations (1)

Inselgruppe; 🇨🇭 Bern, Switzerland