Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study
Abstract Background Widespread inappropriate use of antimicrobial substances drives resistance development worldwide. In long-term care facilities (LTCF), antibiotics are among the most frequently prescribed medications. More than one third of antimicrobial agents prescribed in LTCFs are for urinary...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13756-024-01397-2 |
| _version_ | 1797199194664992768 |
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| author | Elisabeth König Lisa Kriegl Christian Pux Michael Uhlmann Walter Schippinger Alexander Avian Robert Krause Ines Zollner-Schwetz |
| author_facet | Elisabeth König Lisa Kriegl Christian Pux Michael Uhlmann Walter Schippinger Alexander Avian Robert Krause Ines Zollner-Schwetz |
| author_sort | Elisabeth König |
| collection | DOAJ |
| description | Abstract Background Widespread inappropriate use of antimicrobial substances drives resistance development worldwide. In long-term care facilities (LTCF), antibiotics are among the most frequently prescribed medications. More than one third of antimicrobial agents prescribed in LTCFs are for urinary tract infections (UTI). We aimed to increase the number of appropriate antimicrobial treatments for UTIs in LTCFs using a multi-faceted antimicrobial stewardship intervention. Methods We performed a non-randomized cluster-controlled intervention study. Four LTCFs of the Geriatric Health Centers Graz were the intervention group, four LTCFs served as control group. The main components of the intervention were: voluntary continuing medical education for primary care physicians, distribution of a written guideline, implementation of the project homepage to distribute guidelines and videos and onsite training for nursing staff. Local nursing staff recorded data on UTI episodes in an online case report platform. Two blinded reviewers assessed whether treatments were adequate. Results 326 UTI episodes were recorded, 161 in the intervention group and 165 in the control group. During the intervention period, risk ratio for inadequate indication for treatment was 0.41 (95% CI 0.19–0.90), p = 0.025. In theintervention group, the proportion of adequate antibiotic choices increased from 42.1% in the pre-intervention period, to 45.9% during the intervention and to 51% in the post-intervention period (absolute increase of 8.9%). In the control group, the proportion was 36.4%, 33.3% and 33.3%, respectively. The numerical difference between intervention group and control group in the post-intervention period was 17.7% (difference did not reach statistical significance). There were no significant differences between the control group and intervention group in the safety outcomes (proportion of clinical failure, number of hospital admissions due to UTI and adverse events due to antimicrobial treatment). Conclusions An antimicrobial stewardship program consisting of practice guidelines, local and web-based education for nursing staff and general practitioners resulted in a significant increase in adequate treatments (in terms of decision to treat the UTI) during the intervention period. However, this difference was not maintained in the post-intervention phase. Continued efforts to improve the quality of prescriptions further are necessary. Trial registration The trial was registered at ClinicalTrials.gov NCT04798365. |
| first_indexed | 2024-04-24T07:11:53Z |
| format | Article |
| id | doaj.art-6cef5861623b4401a53ec5ef16dfa6c5 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-04-24T07:11:53Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-6cef5861623b4401a53ec5ef16dfa6c52024-04-21T11:30:48ZengBMCAntimicrobial Resistance and Infection Control2047-29942024-04-011311810.1186/s13756-024-01397-2Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention studyElisabeth König0Lisa Kriegl1Christian Pux2Michael Uhlmann3Walter Schippinger4Alexander Avian5Robert Krause6Ines Zollner-Schwetz7Division of Infectious Diseases, Department of Internal Medicine, Medical University of GrazDivision of Infectious Diseases, Department of Internal Medicine, Medical University of GrazGeriatric Health Centers of the City of GrazGeriatric Health Centers of the City of GrazGeriatric Health Centers of the City of GrazInstitute of Medical Informatics, Statistics and Documentation, Medical University of GrazDivision of Infectious Diseases, Department of Internal Medicine, Medical University of GrazDivision of Infectious Diseases, Department of Internal Medicine, Medical University of GrazAbstract Background Widespread inappropriate use of antimicrobial substances drives resistance development worldwide. In long-term care facilities (LTCF), antibiotics are among the most frequently prescribed medications. More than one third of antimicrobial agents prescribed in LTCFs are for urinary tract infections (UTI). We aimed to increase the number of appropriate antimicrobial treatments for UTIs in LTCFs using a multi-faceted antimicrobial stewardship intervention. Methods We performed a non-randomized cluster-controlled intervention study. Four LTCFs of the Geriatric Health Centers Graz were the intervention group, four LTCFs served as control group. The main components of the intervention were: voluntary continuing medical education for primary care physicians, distribution of a written guideline, implementation of the project homepage to distribute guidelines and videos and onsite training for nursing staff. Local nursing staff recorded data on UTI episodes in an online case report platform. Two blinded reviewers assessed whether treatments were adequate. Results 326 UTI episodes were recorded, 161 in the intervention group and 165 in the control group. During the intervention period, risk ratio for inadequate indication for treatment was 0.41 (95% CI 0.19–0.90), p = 0.025. In theintervention group, the proportion of adequate antibiotic choices increased from 42.1% in the pre-intervention period, to 45.9% during the intervention and to 51% in the post-intervention period (absolute increase of 8.9%). In the control group, the proportion was 36.4%, 33.3% and 33.3%, respectively. The numerical difference between intervention group and control group in the post-intervention period was 17.7% (difference did not reach statistical significance). There were no significant differences between the control group and intervention group in the safety outcomes (proportion of clinical failure, number of hospital admissions due to UTI and adverse events due to antimicrobial treatment). Conclusions An antimicrobial stewardship program consisting of practice guidelines, local and web-based education for nursing staff and general practitioners resulted in a significant increase in adequate treatments (in terms of decision to treat the UTI) during the intervention period. However, this difference was not maintained in the post-intervention phase. Continued efforts to improve the quality of prescriptions further are necessary. Trial registration The trial was registered at ClinicalTrials.gov NCT04798365.https://doi.org/10.1186/s13756-024-01397-2Nursing homeHealthcare associated infectionAntibiotic stewardshipUrinary tract infections |
| spellingShingle | Elisabeth König Lisa Kriegl Christian Pux Michael Uhlmann Walter Schippinger Alexander Avian Robert Krause Ines Zollner-Schwetz Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study Antimicrobial Resistance and Infection Control Nursing home Healthcare associated infection Antibiotic stewardship Urinary tract infections |
| title | Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study |
| title_full | Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study |
| title_fullStr | Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study |
| title_full_unstemmed | Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study |
| title_short | Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study |
| title_sort | implementation of an antimicrobial stewardship program for urinary tract infections in long term care facilities a cluster controlled intervention study |
| topic | Nursing home Healthcare associated infection Antibiotic stewardship Urinary tract infections |
| url | https://doi.org/10.1186/s13756-024-01397-2 |
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