Abstract
BackgroundRecently we developed and validated generic quality indicators that define ‘appropriate antibiotic use’ in hospitalized adults treated for a (suspected) bacterial infection. Previous studies have shown that with appropriate antibiotic use a reduction of 13% of length of hospital stay can be achieved. Our main objective in this project is to provide hospitals with an antibiotic checklist based on these quality indicators, and to evaluate the introduction of this checklist in terms of (cost-) effectiveness.Methods/DesignThe checklist applies to hospitalized adults with a suspected bacterial infection for whom antibiotic therapy is initiated, at first via the intravenous route. A stepped wedge study design will be used, comparing outcomes before and after introduction of the checklist in nine hospitals in the Netherlands. At least 810 patients will be included in both the control and the intervention group. The primary endpoint is length of hospital stay. Secondary endpoints are appropriate antibiotic use measured by the quality indicators, admission to and duration of intensive care unit stay, readmission within 30 days, mortality, total antibiotic use, and costs associated with implementation and hospital stay. Differences in numerical endpoints between the two periods will be evaluated with mixed linear models; for dichotomous outcomes generalized estimating equation models will be used. A process evaluation will be performed to evaluate the professionals’ compliance with use of the checklist. The key question for the economic evaluation is whether the benefits of the checklist, which include reduced antibiotic use, reduced length of stay and associated costs, justify the costs associated with implementation activities as well as daily use of the checklist.DiscussionIf (cost-) effective, the AB-checklist will provide physicians with a tool to support appropriate antibiotic use in adult hospitalized patients who start with intravenous antibiotics.Trial registrationDutch trial registry: NTR4872
Highlights
We developed and validated generic quality indicators that define ‘appropriate antibiotic use’ in hospitalized adults treated for a bacterial infection
If effective, the AB-checklist will provide physicians with a tool to support appropriate antibiotic use in adult hospitalized patients who start with intravenous antibiotics
This study is set to implement an antibiotic checklist based on the validated generic quality indicators measuring the appropriateness of intravenously initiated antibiotic use in hospitalized adults treated for a suspected bacterial infection, and to analyse the effect of the introduction of the checklist on patient care in terms of shorter duration of intensive care unit (ICU)- and hospital stay, adequate treatment, decreased mortality rates, decreased total antibiotic use and lower costs
Summary
We developed and validated generic quality indicators that define ‘appropriate antibiotic use’ in hospitalized adults treated for a (suspected) bacterial infection. Previous studies have shown that with appropriate antibiotic use a reduction of 13% of length of hospital stay can be achieved. The World Health Organization signalled the emergence of antimicrobial resistance (AMR), along with the Previous studies have shown that appropriate antibiotic use is of great importance to curb antimicrobial resistance, and has a short-term consequence. The van Daalen et al BMC Infectious Diseases (2015) 15:134 evaluation of antibiotic treatment for urinary tract infections in hospitals showed an inverse relationship between the proportion of appropriate antibiotic use in a patient and length of stay (LOS). A similar inverse relationship has been shown between appropriate antibiotic use in treatment of all bacterial infections in the hospital and LOS, with a reduction of 13% in LOS with appropriate use. K-325. 54th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 5 -9, 2014, Washington DC]
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