A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards
Aim: To evaluate general shortcomings and faculty-specific pitfalls as well as to improve antibiotic prescription quality (ABQ) in non-ICU wards, we performed a prospective cluster trial. Methods: An infectious-disease (ID) consulting service performed a prospective investigation consisting of three...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | deu |
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German Medical Science GMS Publishing House
2023-06-01
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| Series: | GMS Hygiene and Infection Control |
| Subjects: | |
| Online Access: | http://www.egms.de/static/en/journals/dgkh/2023-18/dgkh000440.shtml |
| _version_ | 1797770546905088000 |
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| author | Scheithauer, Simone Karasimos, Britta Manamayil, David Häfner, Helga Lewalter, Karl Mischke, Karl Heintz, Bernhard Tacke, Frank Brücken, David Lüring, Christian Heidenhain, Christoph Tewarie, Lachmandath Hilgers, Ralf-Dieter Lemmen, Sebastian W. |
| author_facet | Scheithauer, Simone Karasimos, Britta Manamayil, David Häfner, Helga Lewalter, Karl Mischke, Karl Heintz, Bernhard Tacke, Frank Brücken, David Lüring, Christian Heidenhain, Christoph Tewarie, Lachmandath Hilgers, Ralf-Dieter Lemmen, Sebastian W. |
| author_sort | Scheithauer, Simone |
| collection | DOAJ |
| description | Aim: To evaluate general shortcomings and faculty-specific pitfalls as well as to improve antibiotic prescription quality (ABQ) in non-ICU wards, we performed a prospective cluster trial. Methods: An infectious-disease (ID) consulting service performed a prospective investigation consisting of three 12-week phases with point prevalence evaluation conducted once per week (=36 evaluations in total) at seven non-ICU wards, followed by assessment of sustainability (weeks 37–48). Baseline evaluation (phase 1) defined multifaceted interventions by identifying the main shortcomings. Then, to distinguish intervention from time effects, the interventions were performed in four wards, and the 3 remaining wards served as controls; after assessing effects (phase 2), the same interventions were performed in the remaining wards to test the generalizability of the interventions (phase 3). The prolonged responses after all interventions were then analyzed in phase 4. ABQ was evaluated by at least two ID specialists who assessed the indication for therapy, the adherence to the hospital guidelines for empirical therapy, and the overall antibiotic prescription quality. Results: In phase 1, 406 of 659 (62%) patients cases were adequately treated with antibiotics; the main reason for inappropriate prescription was the lack of an indication (107/253; 42%). The antibiotic prescription quality (ABQ) significantly increased, reaching 86% in all wards after the focused interventions (502/584; nDf=3, ddf=1,697, F=6.9, p=0.0001). In phase 2 the effect was only seen in wards that already participated in interventions (248/347; 71%). No improvement was seen in wards that received interventions only after phase 2 (189/295; 64%). A given indication significantly increased from about 80% to more than 90% (p<.0001). No carryover effects were observed.Discussion: ABQ can be improved significantly by intervention bundles with apparent sustainable effects. |
| first_indexed | 2024-03-12T21:24:46Z |
| format | Article |
| id | doaj.art-806e06ba1ffe4d3bb7e7349327452bff |
| institution | Directory Open Access Journal |
| issn | 2196-5226 |
| language | deu |
| last_indexed | 2024-03-12T21:24:46Z |
| publishDate | 2023-06-01 |
| publisher | German Medical Science GMS Publishing House |
| record_format | Article |
| series | GMS Hygiene and Infection Control |
| spelling | doaj.art-806e06ba1ffe4d3bb7e7349327452bff2023-07-28T09:53:50ZdeuGerman Medical Science GMS Publishing HouseGMS Hygiene and Infection Control2196-52262023-06-0118Doc1410.3205/dgkh000440A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wardsScheithauer, Simone0Karasimos, Britta1Manamayil, David2Häfner, Helga3Lewalter, Karl4Mischke, Karl5Heintz, Bernhard6Tacke, Frank7Brücken, David8Lüring, Christian9Heidenhain, Christoph10Tewarie, Lachmandath11Hilgers, Ralf-Dieter12Lemmen, Sebastian W.13Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University Göttingen, GermanyClinic for Orthopedics and Trauma Surgery, Hospital Düren, Düren, GermanyInfection Control and Infectious Diseases, University Hospital Aachen, Aachen, GermanyInfection Control and Infectious Diseases, University Hospital Aachen, Aachen, GermanyInfection Control and Infectious Diseases, University Hospital Aachen, Aachen, GermanyMedical Clinic 1, Leopoldina Hospital Schweinfurt, Schweinfurt, GermanyClinic for Nephrology, University Hospital Aachen, Aachen, GermanyDepartment of Hepatology and Gastroenterology, Campus Charité Mitte (CCM)/Campus Virchow-Klinikum (CVK, Charité – University Medical Center Berlin, Berlin, GermanyClinic for Traumatology, University Hospital Aachen, Aachen, GermanyClinic for Orthopedics, Clinic Dortmund, Dortmund, GermanyClinic for Visceral Surgery, AGAPLESION MARKUS Krankenhaus Frankfurt, Frankfurt/Main, GermanyClinic for Cardiosurgery, University Hospital Aachen, Aachen, GermanyInstitute for Statistics¸ University Hospital Aachen, Aachen, GermanyInfection Control and Infectious Diseases, University Hospital Aachen, Aachen, GermanyAim: To evaluate general shortcomings and faculty-specific pitfalls as well as to improve antibiotic prescription quality (ABQ) in non-ICU wards, we performed a prospective cluster trial. Methods: An infectious-disease (ID) consulting service performed a prospective investigation consisting of three 12-week phases with point prevalence evaluation conducted once per week (=36 evaluations in total) at seven non-ICU wards, followed by assessment of sustainability (weeks 37–48). Baseline evaluation (phase 1) defined multifaceted interventions by identifying the main shortcomings. Then, to distinguish intervention from time effects, the interventions were performed in four wards, and the 3 remaining wards served as controls; after assessing effects (phase 2), the same interventions were performed in the remaining wards to test the generalizability of the interventions (phase 3). The prolonged responses after all interventions were then analyzed in phase 4. ABQ was evaluated by at least two ID specialists who assessed the indication for therapy, the adherence to the hospital guidelines for empirical therapy, and the overall antibiotic prescription quality. Results: In phase 1, 406 of 659 (62%) patients cases were adequately treated with antibiotics; the main reason for inappropriate prescription was the lack of an indication (107/253; 42%). The antibiotic prescription quality (ABQ) significantly increased, reaching 86% in all wards after the focused interventions (502/584; nDf=3, ddf=1,697, F=6.9, p=0.0001). In phase 2 the effect was only seen in wards that already participated in interventions (248/347; 71%). No improvement was seen in wards that received interventions only after phase 2 (189/295; 64%). A given indication significantly increased from about 80% to more than 90% (p<.0001). No carryover effects were observed.Discussion: ABQ can be improved significantly by intervention bundles with apparent sustainable effects.http://www.egms.de/static/en/journals/dgkh/2023-18/dgkh000440.shtmlantibiotic resistanceantibiotic stewardshipcomplianceselectionsurveillance |
| spellingShingle | Scheithauer, Simone Karasimos, Britta Manamayil, David Häfner, Helga Lewalter, Karl Mischke, Karl Heintz, Bernhard Tacke, Frank Brücken, David Lüring, Christian Heidenhain, Christoph Tewarie, Lachmandath Hilgers, Ralf-Dieter Lemmen, Sebastian W. A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards GMS Hygiene and Infection Control antibiotic resistance antibiotic stewardship compliance selection surveillance |
| title | A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards |
| title_full | A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards |
| title_fullStr | A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards |
| title_full_unstemmed | A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards |
| title_short | A prospective cluster trial to increase antibiotic prescription quality in seven non-ICU wards |
| title_sort | prospective cluster trial to increase antibiotic prescription quality in seven non icu wards |
| topic | antibiotic resistance antibiotic stewardship compliance selection surveillance |
| url | http://www.egms.de/static/en/journals/dgkh/2023-18/dgkh000440.shtml |
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