Adherence to Guidelines for Antibiotic Use in Respiratory Infections at Hospitals

Not Applicable

Completed

• Conditions: Pneumonia; Chronic Bronchitis; COPD

• Registration Number: NCT00129883
• Lead Sponsor: Radboud University Medical Center

Brief Summary

The purpose of this study is to test a strategy to improve the quality of antibiotic use in lower respiratory tract infections (LRTIs) at hospitals. Therefore, a multifaceted intervention strategy is compared to a control strategy and the effectiveness and feasibility of the intervention is assessed.

Detailed Description

Improving processes of care in patients with hospital LRTI has been related to better patient outcome. Inappropriate use of antibiotics has contributed to the emergence and spread of drug-resistant micro organisms and increased treatment costs. International guidelines provide recommendations for the initial evaluation and management of LRTI, including advice on judicious antibiotic therapy. Nonetheless, studies have demonstrated a wide variability in adherence to these guidelines.

To implement key recommendations in clinical practice, various strategies have been used, with mixed results. Perhaps the most important aspect of choosing a potentially effective intervention is that the choice of intervention should be based upon assessment of potential barriers in the target group. Many intervention studies are flawed by failing to control for secular trends.

The investigators performed a cluster randomised controlled trial, to study the effect of a multifaceted intervention strategy on the quality of antibiotic use for LRTI. Their intervention was tailored to the areas most in need for improvement and took perceived barriers in the target group into consideration at the individual hospital level.

Study Timeline

• Status Verified: 2002-08
• Study Start: 2002-09
• Study Completion: 2005-04
• Study First Submitted: 2005-08-11
• Study First Submitted QC: 2005-08-11
• Study First Posted: 2005-08-12
• Last Update Submitted: 2005-09-26
• Last Update Posted: 2005-09-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 2000

Inclusion Criteria

• Patients admitted to a respiratory care or internal medicine ward with community-acquired pneumonia or acute exacerbation of chronic bronchitis or chronic obstructive pulmonary disease (COPD)

Exclusion Criteria

• Recent (< 30 days) admission for LRTI
• Patients with underlying immunodeficiency (HIV infection, neutropenia, treatment with immunomodulating drugs, active hematological malignancies, anatomical or functional asplenia and hypogammaglobulinemia)
• Patients already on treatment with antibiotics for another culture proven infection at the time of admission
• Patients from nursing homes
• Patients who had been transferred to another hospital or ICU and patients who had died within 24 hours of admission
• Patients with very poor prognosis (life expectancy < 2 weeks on admission).

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
adherence to key quality indicators for antibiotic use in lower respiratory tract infections (indicators were developed from current [inter]national guideline recommendations and a systematic review of the literature)

Secondary Outcome Measures

Name	Time	Method
cost
process evaluation: how well was the intervention performed
length of hospital stay
in-hospital mortality
Intensive Care Unit (ICU)-transfer
30 day re-admission rate

Trial Locations

Locations (6)

Gelre Ziekenhuizen; 🇳🇱 Apeldoorn, Netherlands

Bernhoven Ziekenhuis; 🇳🇱 Veghel, Netherlands

Ziekenhuis Gelderse Vallei; 🇳🇱 Ede, Netherlands

Maxima Medisch Centrum; 🇳🇱 Veldhoven, Netherlands

Vie Curi Medisch Centrum; 🇳🇱 Venlo, Netherlands

Deventer Ziekenhuis; 🇳🇱 Deventer, Netherlands