Hospital Wide Roll-Out of Antimicrobial Stewardship
17. november 2014 opdateret af: Sunnybrook Health Sciences Centre
Hospital Wide Roll-Out of Antimicrobial Stewardship: A Stepped Wedge Randomized Controlled Trial
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.
Studieoversigt
Status
Afsluttet
Betingelser
Undersøgelsestype
Interventionel
Tilmelding (Faktiske)
19220
Fase
- Ikke anvendelig
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
-
-
Ontario
-
Toronto, Ontario, Canada, M4N 3M5
- Sunnybrook Health Sciences Centre
-
-
Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
- Barn
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
All patients admitted to the medical/surgical services will be included in statistical analysis of program evaluation. The inclusion/exclusion criteria below, just define who receives the antibiotic stewardship intervention on each service.
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
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Sundhedstjenesteforskning
- Tildeling: Randomiseret
- Interventionel model: Crossover opgave
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: Antibiotic stewardship intervention
Audit-and-feedback intervention to prescribers of patients receiving 3rd or 10th day of targeted broadspectrum antimicrobial
|
See primary outcome for list of targeted drugs.
See citations for previous publications describing the intervention.
|
|
Ingen indgriben: Control
The pre-intervention period will serve as the control period on each medical and surgical service.
The cross-over is uni-directional from control to intervention; all services receive the intervention by the end of the study.
This is a stepped wedge design.
The order of roll-out is randomized.
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Days of antibiotic therapy (DOTs) of targeted broadspectrum agents per patient days (PDs)
Tidsramme: patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
|
|
patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Days of antibiotic therapy of any antibiotic agent(DOTs)per patient days (PDs)
Tidsramme: 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)
|
patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
|
|
Costs of antibiotic therapy ($) per patient day
Tidsramme: patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
|
Based on acquisition costs for each agent.
|
patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
|
|
Hospital-acquired Clostridium difficile infection.
Tidsramme: 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.
|
patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
|
|
Antibiotic susceptibility of gram negative bacterial isolates
Tidsramme: patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
|
patients will be followed until discharge from hospital (expected median 7 days for those on antibiotics)
|
Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Nick Daneman, Sunnybrook Health Sciences Centre
Publikationer og nyttige links
Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.
Generelle publikationer
- Elligsen M, Walker SA, Simor A, Daneman N. Prospective audit and feedback of antimicrobial stewardship in critical care: program implementation, experience, and challenges. Can J Hosp Pharm. 2012 Jan;65(1):31-6. doi: 10.4212/cjhp.v65i1.1101. No abstract available.
- Elligsen M, Walker SA, Pinto R, Simor A, Mubareka S, Rachlis A, Allen V, Daneman N. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis. Infect Control Hosp Epidemiol. 2012 Apr;33(4):354-61. doi: 10.1086/664757.
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart
1. april 2010
Primær færdiggørelse (Faktiske)
1. april 2012
Studieafslutning (Faktiske)
1. april 2012
Datoer for studieregistrering
Først indsendt
13. april 2012
Først indsendt, der opfyldte QC-kriterier
26. april 2012
Først opslået (Skøn)
30. april 2012
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
19. november 2014
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
17. november 2014
Sidst verificeret
1. november 2014
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- 416-2009
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .
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