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Randomized Controlled Trial
. 2018 Sep 10:7:109.
doi: 10.1186/s13756-018-0400-7. eCollection 2018.

The effect of antibiotic stewardship interventions with stakeholder involvement in hospital settings: a multicentre, cluster randomized controlled intervention study

Jannicke Slettli Wathne  1   2   3 , Lars Kåre Selland Kleppe  4 , Stig Harthug  1   2 , Hege Salvesen Blix  5 , Roy M Nilsen  6 , Esmita Charani  7 ; Bergen Intervention Teams; Ingrid Smith  8
Collaborators, Affiliations
Randomized Controlled Trial

The effect of antibiotic stewardship interventions with stakeholder involvement in hospital settings: a multicentre, cluster randomized controlled intervention study

Jannicke Slettli Wathne et al. Antimicrob Resist Infect Control. .

Abstract

Background: There is limited evidence from multicenter, randomized controlled studies to inform planning and implementation of antibiotic stewardship interventions in hospitals.

Methods: A cluster randomized, controlled, intervention study was performed in selected specialities (infectious diseases, pulmonary medicine and gastroenterology) at three emergency care hospitals in Western Norway. Interventions applied were audit with feedback and academic detailing. Implementation strategies included co-design of interventions with stakeholders in local intervention teams and prescribers setting local targets for change in antibiotic prescribing behaviour. Primary outcome measures were adherence to national guidelines, use of broad-spectrum antibiotics and change in locally defined targets of change in prescribing behaviour. Secondary outcome measures were length of stay, 30-day readmission, in-hospital- and 30-day mortality.

Results: One thousand eight hundred two patients receiving antibiotic treatment were included. Adherence to guidelines had an absolute increase from 60 to 66% for all intervention wards (p = 0.04). Effects differed across specialties and pulmonary intervention wards achieved a 14% absolute increase in adherence (p = 0.003), while no change was observed for other specialties. A pulmonary ward targeting increased use of penicillin G 2 mill IU × 4 for pneumonia and COPD exacerbations had an intended increase of 30% for this prescribing behaviour (p < 0.001).

Conclusions: Pulmonary wards had a higher increase in adherence, independent of applied intervention. The effect of antibiotic stewardship interventions is dependent on how and in which context they are implemented. Additional effects of interventions are seen when stakeholders discuss ward prescribing behaviour and agree on specific targets for changes in prescribing practice.

Keywords: Academic detailing; Antibiotic stewardship; Audit with feedback; Goal setting; Hospital; Intervention; cRCT.

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Conflict of interest statement

The study was conducted in accordance with the Declaration of Helsinki, national and institutional standards [27]. The study was approved by the Data Protection Officer (2013/9352) and the Western Regional Committee for Medical and Health Research Ethics approved the waiver of informed consent (2013/1305). All patients received written information about the study, with opportunity to withdraw from the study. The study was not registered in a clinical trial database as randomization was conducted at cluster level only, with primary aim of investigating the effect of interventions on ward prescribing behaviour. Individual patient treatment was at the discretion of the treating physician.Not applicableJ.S.W received a 3-month grant in patient safety research for preparation of the manuscript, but the funder has not played any role in the design, execution, analysis or reporting of the research. Competing interests for other authors: None to declare.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Use of broad-spectrum antibiotics at intervention wards and per specialty intervention wards compared to control wards
See this image and copyright information in PMC

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