A multicentre cluster-randomized clinical trial to improve antibiotic use and reduce length of stay in hospitals: comparison of three measurement and feedback methods | Zendy

Marlot C. Kallen | Zendy; Marlies Hulscher | Zendy; B Elzer | Zendy; Suzanne E. Geerlings | Zendy; Paul D. van der Linden | Zendy; Steven Teerenstra | Zendy; Stephanie Natsch | Zendy; Brent C. Opmeer | Zendy; Jan M. Prins | Zendy; Masja Leendertse | Zendy; Nathalie M. Delfos | Zendy; P D Knoester | Zendy; Cees M. Verduin | Zendy; P. van Hattum | Zendy; R M T Ladestein | Zendy; Miranda M. L. van Rijen | Zendy; B. M. de Jongh | Zendy; Peer de Graaf | Zendy; L A Noach | Zendy; R. H. Streefkerk | Zendy; B. Maraha | Zendy; Fleur Snijders | Zendy; Momme Kück | Zendy; H S A Ammerlaan | Zendy; I. T. M. A. Overdevest | Zendy; C.J. Miedema | Zendy; Stuart Sanders | Zendy; Mark van den Hurk | Zendy; F.W. Sebens | Zendy; Wil C. van der Zwet | Zendy; Robin F. J. Benus | Zendy; Dennis Huugen | Zendy; Maurits Arbouw | Zendy; J da Silva-Voorham | Zendy; Sanjay U. C. Sankatsing | Zendy; Akke K. van der Bij | Zendy; J C Dutilh | Zendy; R.J.A. Diepersloot | Zendy; Emile M. Kuck | Zendy; Winnie de Bruijn | Zendy; Damian C. Melles∗ | Zendy; Annelies Verbon | Zendy; Rein Posthuma | Zendy; Gijs W.D. Landman | Zendy; G J Blaauw | Zendy; Maurine A. Leversteinvan Hall | Zendy; Th. A. Ruys | Zendy; J. W. van’t Wout | Zendy; E Roelofsen | Zendy; Arno Müller | Zendy; L B S Gelinck | Zendy; Cees van Nieuwkoop | Zendy; R.W. Brimicombe | Zendy; E.P.M. van Elzakker | Zendy; Erik B. Wilms | Zendy; Patrick Sturm | Zendy; Beatrix J van Dijke | Zendy; O Ponteselli | Zendy; Katalin Pogány | Zendy; D.J. Theunissen | Zendy; Jan G. den Hollander | Zendy; Frank H. van Tiel | Zendy; Dirk Posthouwer | Zendy; M E van Wolfswinkel | Zendy; Rogier van der Zanden | Zendy; Marit G. A. van Vonderen | Zendy; Linda M. Kampschreur | Zendy; E Mooi | Zendy; N Welles | Zendy; P.C.A.M. Buijtels | Zendy; Elsbeth Nagtegaal | Zendy; M E Sanson | Zendy; C. Jaspers | Zendy; J L W Pot | Zendy; Elisabeth H. Gisolf | Zendy; C.M.A. Swanink | Zendy; P. Margreet G. Filius | Zendy; J W Dorigo-Zetsma | Zendy; Inger van Heijl | Zendy; Kristy Vons Mark Hendriks | Zendy; Bhanu Sinha | Zendy; Jerome R. Lo Ten Foe | Zendy; K R Wilting | Zendy; P Nannan Panday | Zendy; S. Nijssen | Zendy; S N Bouwman | Zendy; A Pieffers | Zendy

Open Access

A multicentre cluster-randomized clinical trial to improve antibiotic use and reduce length of stay in hospitals: comparison of three measurement and feedback methods

Author(s) -

Marlot C. Kallen,

Marlies Hulscher,

B Elzer,

Suzanne E. Geerlings,

Paul D. van der Linden,

Steven Teerenstra,

Stephanie Natsch,

Brent C. Opmeer,

Jan M. Prins,

Masja Leendertse,

Nathalie M. Delfos,

P D Knoester,

Cees M. Verduin,

P. van Hattum,

R M T Ladestein,

Miranda M. L. van Rijen,

B. M. de Jongh,

Peer de Graaf,

L A Noach,

R. H. Streefkerk,

B. Maraha,

Fleur Snijders,

Momme Kück,

H S A Ammerlaan,

I. T. M. A. Overdevest,

C.J. Miedema,

Stuart Sanders,

Mark van den Hurk,

F.W. Sebens,

Wil C. van der Zwet,

Robin F. J. Benus,

Dennis Huugen,

Maurits Arbouw,

J da Silva-Voorham,

Sanjay U. C. Sankatsing,

Akke K. van der Bij,

J C Dutilh,

R.J.A. Diepersloot,

Emile M. Kuck,

Winnie de Bruijn,

Damian C. Melles∗,

Annelies Verbon,

Rein Posthuma,

Gijs W.D. Landman,

G J Blaauw,

Maurine A. Leversteinvan Hall,

Th. A. Ruys,

J. W. van’t Wout,

E Roelofsen,

Arno Müller,

L B S Gelinck,

Cees van Nieuwkoop,

R.W. Brimicombe,

E.P.M. van Elzakker,

Erik B. Wilms,

Patrick Sturm,

Beatrix J van Dijke,

O Ponteselli,

Katalin Pogány,

D.J. Theunissen,

Jan G. den Hollander,

Frank H. van Tiel,

Dirk Posthouwer,

M E van Wolfswinkel,

Rogier van der Zanden,

Marit G. A. van Vonderen,

Linda M. Kampschreur,

E Mooi,

N Welles,

P.C.A.M. Buijtels,

Elsbeth Nagtegaal,

M E Sanson,

C. Jaspers,

J L W Pot,

Elisabeth H. Gisolf,

C.M.A. Swanink,

P. Margreet G. Filius,

J W Dorigo-Zetsma,

Inger van Heijl,

Kristy Vons Mark Hendriks,

Bhanu Sinha,

Jerome R. Lo Ten Foe,

K R Wilting,

P Nannan Panday,

S. Nijssen,

S N Bouwman,

A Pieffers

Publication year - 2021

Publication title -

journal of antimicrobial chemotherapy

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 2.124

H-Index - 194

eISSN - 1460-2091

pISSN - 0305-7453

DOI - 10.1093/jac/dkab035

Subject(s) - medicine , antimicrobial stewardship , pharmacy , randomized controlled trial , antibiotic stewardship , emergency medicine , quality management , intervention (counseling) , cluster (spacecraft) , antibiotics , intensive care medicine , family medicine , antibiotic resistance , nursing , operations management , management system , microbiology and biotechnology , economics , biology , computer science , programming language

Background Various metrics of hospital antibiotic use might assist in guiding antimicrobial stewardship (AMS). Objectives To compare patient outcomes in association with three methods to measure and feedback information on hospital antibiotic use when used in developing an AMS intervention. Methods Three methods were randomly allocated to 42 clusters from 21 Dutch hospitals: (1) feedback on quantity of antibiotic use [DDD, days-of-therapy (DOT) from hospital pharmacy data], versus feedback on (2) validated, or (3) non-validated quality indicators from point prevalence studies. Using this feedback together with an implementation tool, stewardship teams systematically developed and performed improvement strategies. The hospital length of stay (LOS) was the primary outcome and secondary outcomes included DOT, ICU stay and hospital mortality. Data were collected before (February–May 2015) and after (February–May 2017) the intervention period. Results The geometric mean hospital LOS decreased from 9.5 days (95% CI 8.9–10.1, 4245 patients) at baseline to 9.0 days (95% CI 8.5–9.6, 4195 patients) after intervention (P < 0.001). No differences in effect on LOS or secondary outcomes were found between methods. Feedback on quality of antibiotic use was used more often to identify improvement targets and was preferred over feedback on quantity of use. Consistent use of the implementation tool seemed to increase effectiveness of the AMS intervention. Conclusions The decrease in LOS versus baseline likely reflects improvement in the quality of antibiotic use with the stewardship intervention. While the outcomes with the three methods were otherwise similar, stewardship teams preferred data on the quality over the quantity of antibiotic use.

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