さまよう薬剤師のブログ

感染症治療を考える素材を提供します。最近は意思決定への応用が関心領域。双子と0歳の育児奮闘中。I have Ph.D. but less sense a ID pharmacist (ICPS). Another face is an investor.

Impact of Implementing Antibiotic Stewardship Programs in 15 Small Hospitals: A Cluster-Randomized Intervention

CDIに報告された、小規模病院ASPの Cluster-Randomized Intervention

 

www.ncbi.nlm.nih.gov

感想

  •  Program 3 はハードル高いが、ベースラインと比べ、プロセスアウトカムが改善。
  • クリニカルアウトカムに差なしは残念。
  • ID Telephone Hotlineの数値比較は新しい。良いかどうかはおいといて。

 

note

  • Program 1 hospitals were provided basic antibiotic stewardship education and tools, access to an infectious disease hotline, and antibiotic utilization data.
  • Program 2 hospitals received those interventions plus advanced education, audit and feedback for select antibiotics, and locally controlled antibiotic restrictions.
  • Program 3 hospitals received program 2 interventions plus audit and feedback on the majority of antibiotics, and an infectious diseases-trained clinician approved restricted antibiotics and reviewed microbiology results.
  • No statistically significant differences in mortality, 30-day readmission, and hospital length of stay were observed in any of the programs between the 1-year baseline and intervention periods.
  • The incidence of C. difficile in the study hospitals during the baseline and intervention periods was low and model convergence was not obtained.
  • The ID hotline recorded 1,006 calls for case discussions during the 15-month intervention (median 62 case discussions/month; range 48 – 83). Of these, 83% were received Monday through Friday. Call duration was 5 to 15 minutes for 48% of calls and ≤5 minutes for 47% of the calls. The rate of hotline use varied by program: 1.6 calls/1000DP for Program 1, 13 calls/1000DP for Program 2, and 10 calls/1000DP for Program 3.

 

Abstract

BACKGROUND:

 

Studies on the implementation of antibiotic stewardship programs (ASPs) in small hospitals are limited. Accreditation organizations now require all hospitals to have ASPs.

METHODS:

 

The objective of this cluster-randomized intervention was to assess the effectiveness of implementing ASPs in Intermountain Healthcare's 15 small hospitals. Each hospital was randomized to 1 of 3 ASPs of escalating intensity. Program 1 hospitals were provided basic antibiotic stewardship education and tools, access to an infectious disease hotline, and antibiotic utilization data. Program 2 hospitals received those interventions plus advanced education, audit and feedback for select antibiotics, and locally controlled antibiotic restrictions. Program 3 hospitals received program 2 interventions plus audit and feedback on the majority of antibiotics, and an infectious diseases-trained clinician approved restricted antibiotics and reviewed microbiology results. Changes in total and broad-spectrum antibiotic use within programs (intervention versus baseline) and the difference between programs in the magnitude of change in antibiotic use (eg, program 3 vs 1) were evaluated with mixed models.

RESULTS:

 

Program 3 hospitals showed reductions in total (rate ratio, 0.89; confidence interval, .80-.99) and broad-spectrum (0.76; .63-.91) antibiotic use when the intervention period was compared with the baseline period. Program 1 and 2 hospitals did not experience a reduction in antibiotic use. Comparison of the magnitude of effects between programs showed a similar trend favoring program 3, but this was not statistically significant.

CONCLUSIONS:

 

Only the most intensive ASP intervention was associated with reduction in total and broad-spectrum antibiotic use when compared with baseline.

CLINICAL TRIALS REGISTRATION:

NCT03245879.

 

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