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Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries.

Authors :
Hartman EAR
van de Pol AC
Heltveit-Olsen SR
Lindbæk M
Høye S
Lithén SS
Sundvall PD
Sundvall S
Arnljots ES
Gunnarsson R
Kowalczyk A
Godycki-Cwirko M
Platteel TN
Groen WG
Monnier AA
Zuithoff NP
Verheij TJM
Hertogh CMPM
Source :
BMJ (Clinical research ed.) [BMJ] 2023 Feb 22; Vol. 380, pp. e072319. Date of Electronic Publication: 2023 Feb 22.
Publication Year :
2023

Abstract

Objective: To evaluate whether antibiotic prescribing for suspected urinary tract infections in frail older adults can be reduced through a multifaceted antibiotic stewardship intervention.<br />Design: Pragmatic, parallel, cluster randomised controlled trial, with a five month baseline period and a seven month follow-up period.<br />Setting: 38 clusters consisting of one or more general practices (n=43) and older adult care organisations (n=43) in Poland, the Netherlands, Norway, and Sweden, from September 2019 to June 2021.<br />Participants: 1041 frail older adults aged 70 or older (Poland 325, the Netherlands 233, Norway 276, Sweden 207), contributing 411 person years to the follow-up period.<br />Intervention: Healthcare professionals received a multifaceted antibiotic stewardship intervention consisting of a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. A participatory-action-research approach was used for implementation, with sessions for education, evaluation, and local tailoring of the intervention. The control group provided care as usual.<br />Main Outcome Measures: The primary outcome was the number of antibiotic prescriptions for suspected urinary tract infections per person year. Secondary outcomes included the incidence of complications, all cause hospital referrals, all cause hospital admissions, all cause mortality within 21 days after suspected urinary tract infections, and all cause mortality.<br />Results: The numbers of antibiotic prescriptions for suspected urinary tract infections in the follow-up period were 54 prescriptions in 202 person years (0.27 per person year) in the intervention group and 121 prescriptions in 209 person years (0.58 per person year) in the usual care group. Participants in the intervention group had a lower rate of receiving an antibiotic prescription for a suspected urinary tract infection compared with participants in the usual care group, with a rate ratio of 0.42 (95% confidence interval 0.26 to 0.68). No differences between intervention and control group were observed in the incidence of complications (<0.01 v 0.05 per person year), hospital referrals (<0.01 v 0.05), admissions to hospital (0.01 v 0.05), and mortality (0 v 0.01) within 21 days after suspected urinary tract infections, nor in all cause mortality (0.26 v 0.26).<br />Conclusions: Implementation of a multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infections in frail older adults.<br />Trial Registration: ClinicalTrials.gov NCT03970356.<br />Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the Joint Programming Initiative on Antimicrobial Resistance through national funding agencies National Science Centre Poland, ZonMw the Netherlands, the Research Council of Norway, and the Swedish Research Council, and support from the Healthcare Board, Region Västra Götaland for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. SH is head of the Antibiotic Center for Primary Care, which is funded by the Norwegian Directorate of Health, and delivers quality improvement/antibiotic stewardship programmes for nursing homes.<br /> (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Details

Language :
English
ISSN :
1756-1833
Volume :
380
Database :
MEDLINE
Journal :
BMJ (Clinical research ed.)
Publication Type :
Academic Journal
Accession number :
36813284
Full Text :
https://doi.org/10.1136/bmj-2022-072319