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Implementation of routine audit and feedback on the use of protected anti-Gram-negative antibiotics: a multicenter, randomized trial using segmented regression analysis of interrupted time series

English title Implementation of routine audit and feedback on the use of protected anti-Gram-negative antibiotics: a multicenter, randomized trial using segmented regression analysis of interrupted time series
Applicant Senn Laurence
Number 167192
Funding scheme NRP 72 Antimicrobial Resistance
Research institution Unité d'hygiène hospitalière SMPH, département de médecine Centre Hospitalier Universitaire Vaudois
Institution of higher education University of Lausanne - LA
Main discipline Infectious Diseases
Start/End 01.03.2017 - 31.03.2021
Approved amount 287'230.00
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All Disciplines (2)

Discipline
Infectious Diseases
Medical Microbiology

Keywords (8)

Anti-bacterial Agents/therapeutic use; Hospitals; Medical audit; Multicenter Study; Interrupted Time Series Analysis; Drug Resistance, Multiple, Bacterial; Drug Utilization/statistics & numerical data

Lay Summary (German)

Lead
Wir testen in neun Spitälern, ob Ärztinnen und Ärzte gezielter Antibiotika einsetzen, wenn Infektiologinnen und Infektiologen ihre Verschreibungspraxis regelmässig auswerten und ihnen dazu ein Feedback geben.
Lay summary

Werden Antibiotika unsachgemäss verschrieben, kann dies die Entstehung von Resistenzen begünstigen. Wir wollen deshalb die verschreibende Ärzteschaft für einen verantwortungsvollen Umgang mit diesen Medikamenten sensibilisieren. Dazu entwickeln wir ein Programm, in welchem Infektiologinnen und Infektiologen Schulungen anbieten. Zudem überprüfen sie wöchentlich die Verschreibungspraxis der Ärztinnen und Ärzte und diskutieren diese mit ihnen. Wir führen diese Intervention in verschiedenen Abteilungen an neun Spitälern der französischen Schweiz durch. Die Abteilungen teilen wir nach Zufallsprinzip in zwei Gruppen: In einer findet unsere Intervention statt, in der anderen nicht. So können wir die Wirkung unseres Programms überprüfen.

Hintergrund
Gezielte Massnahmen für einen verbesserten Umgang mit Antibiotika, sogenannte Stewardship Programme, haben sich in vielen Ländern bewährt. In der Schweiz gibt es dazu jedoch noch wenig Erfahrung.

Ziel
Unser Ziel ist es, ein einfach umzusetzendes, praxisnahes Instrument zu entwickeln, das die Qualität der Antibiotikaverschreibung im Spitalalltag verbessert.

Bedeutung
Bestätigt sich die Wirkung unseres Programms, kann es auf weitere Spitäler in der ganzen Schweiz ausgeweitet werden. Unser Projekt bietet die Möglichkeit, ein "Antiobiotic Stewardship"-Netzwerk zu schaffen, in dem verschiedene Spitäler gemeinsam den verantwortungsvollen Umgang mit Antibiotika fördern.


Direct link to Lay Summary Last update: 05.12.2017

Lay Summary (French)

Lead
Nous examinons dans neuf hôpitaux si une évaluation des prescriptions suivie d’un feedback direct par un spécialiste en infectiologie permet une utilisation plus appropriée de certains antibiotiques.
Lay summary

Les prescriptions inadéquates d’antibiotiques peuvent favoriser le développement de résistances aux antibiotiques. Par conséquent, nous voulons sensibiliser les médecins prescripteurs à l’usage responsable des antibiotiques. Nous mettons au point un programme dans lequel des spécialistes en infectiologie dispensent des formations et examinent chaque semaine la conformité des prescriptions des médecins en leur faisant part de leurs réflexions. Nous menons cette intervention dans différents services de neuf hôpitaux de Suisse romande. Nous répartissons ces services en deux groupes de façon aléatoire et intervenons dans l’un d’entre eux uniquement, ce qui nous permet d’évaluer l’impact de notre programme.

Contexte
Les mesures ciblées en vue de mieux utiliser les antibiotiques ("stewardship programs") ont fait leurs preuves dans de nombreux pays. La Suisse dispose pour sa part de peu d’expérience dans ce domaine.

Objectif
Notre objectif est d’élaborer un programme axé sur la pratique et facile à mettre en œuvre afin d’améliorer la qualité de la prescription des antibiotiques en milieu hospitalier.

Importance
Si l’efficacité de notre programme est confirmée, celui-ci pourra être étendu à d’autres hôpitaux dans toute la Suisse. Ce projet représente une opportunité de créer un réseau d’antibiotic stewardship qui permettra à différents hôpitaux d’agir en concertation pour promouvoir l’usage responsable des antibiotiques.

Direct link to Lay Summary Last update: 05.12.2017

Lay Summary (English)

Lead
We are carrying out a study in nine hospitals to determine whether doctors use antibiotics more specifically if infectious diseases specialists evaluate their prescribing habits regularly and provide them with feedback.
Lay summary

Culture du feedback et bon usage des antibiotiques dans les hôpitaux

Feedback culture and the rational use of antibiotics in the hospital setting

Inappropriate prescribing of antibiotics can promote the development of resistance. We want to make prescribing doctors more aware of the need to use these medicines responsibly. To this end, we are developing a programme in which training is provided by infectious diseases specialists. They also review the doctors’ prescribing habits on a weekly basis and discuss their findings with them. We are performing this intervention in a number of departments at nine hospitals in the French-speaking part of Switzerland. We have divided the departments randomly into two groups: the intervention takes place in one group, but not in the other. This allows us to check the efficacy of our programme.

Background
Targeted measures, known as stewardship programmes, have been used successfully in many countries to improve the way antibiotics are used. There is little experience of this in Switzerland, however.

Aim
Our aim is to develop a practical, easy-to-use programme that will improve the quality of antibiotic prescribing in the everyday hospital setting.

Relevance
If our programme proves to be effective, it can be extended to other hospitals throughout Switzerland. Our project provides an opportunity to create an antibiotic stewardship network in which various hospitals work together to promote the responsible use of antibiotics.

Direct link to Lay Summary Last update: 05.12.2017

Responsible applicant and co-applicants

Employees

Name Institute

Project partner

Collaboration

Group / person Country
Types of collaboration
Pr Chuard Christian, Hôpital Fribourgeois Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Pr Marchetti Oscar, Ensemble hospitalier de la Côte, Hôpital de Morges Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Dr Nicolas Widmer, Pharmacie des Hôpitaux de l’Est Lémanique, Vevey Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Dr Christin Laurent, Groupement hospitalier de l'Ouest lausannois, hôpital de Nyon Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Pr Cometta Alain, Etablissements hospitaliers du Nord vaudois Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Pr Troillet Nicolas, Hôpital du Valais Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Dre Catherine Hänni, Hôpital fribourgeois, Hôpital cantonal, Pharmacie Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Dr Nicolas Schaad, Pharmacie Interhospitalière de la Côte Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Dr Clerc Olivier, Hôpital Neuchâtelois Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Dr Renaud Pichon, Pharmacie des Hôpitaux du Nord Vaudois et de la Broye Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Dr Stéphane Gloor, Hôpital neuchâtelois, Service de Pharmacie Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Dr Bellini Cristina, Hôpital Riviera Chablais Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Dr Johnny Beney, Dre Vera Jordan-von Gunten, Institut Central des Hôpitaux Valaisans, Pharmacie Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
GSASA congrès 2021 Talk given at a conference IMPACT OF WEEKLY CLINICAL AUDITS AND FEEDBACK ON CONSUMPTION OF PROTECTED ANTI-GRAM NEGATIVE ANTIBIOTICS IN 8 HOSPITALS OF THE FRENCH-SPEAKING PART OF SWITZERLAND 10.11.2021 Lugano, Switzerland Pluess-Suard Catherine;
5th International conference on prevention and infection control (ICPIC) Talk given at a conference APPROPRIATENESS OF PROTECTED ANTI GRAM-NEGATIVE ANTIBIOTICS IN EIGHT SWISS HOSPITALS: PRELIMINARY RESULTS OF THE NRP72 PROJECT “OPA STUDY” 10.09.2019 Geneva, Switzerland Chuard Christian; Pluess-Suard Catherine; Senn Laurence; Troillet Nicolas;
SSM annual congress Talk given at a conference Optimised use of antibiotics in acute care hospitals: a multicenter cluster randomized trial 28.08.2018 Lausanne, Switzerland Senn Laurence;


Communication with the public

Communication Title Media Place Year
Media relations: radio, television Antibiotiques, la fin du miracle L'Illustré Western Switzerland 2019
Media relations: print media, online media Résistance aux antibiotiques: un logiciel d'alerte fait ses preuves en Valais H+ Hospital Forum Competence German-speaking Switzerland Western Switzerland Rhaeto-Romanic Switzerland Italian-speaking Switzerland 2019
Media relations: radio, television Emission Couleurs locales: le bon usage des antibiotiques RTS TV Western Switzerland 2018
Media relations: radio, television Emission CQFD: étude OPA RTS radio Western Switzerland 2018
New media (web, blogs, podcasts, news feeds etc.) site web OPA Western Switzerland 2018

Abstract

In the context of increasing antibiotic resistance in Switzerland, we set up in 2015 an intercantonal antibiotic stewardship working group including infectious diseases physicians of 9 acute care hospitals located in 5 cantons of the French part of Switzerland. The project proposed by our group is a multicenter antibiotic stewardship intervention which consists of a weekly clinical audit and multifaceted feedback strategies targeting prescriptions of “protected” anti-Gram-negative antibiotics. This will be the first opportunity in Switzerland to study a multicenter intervention on the use of anti-Gram-negative antibiotics regularly prescribed in Swiss hospitals which deserve a protective prescription policy.The primary goal of the study is to evaluate the impact of the intervention on reducing the use of “protected” anti-Gram-negative antibiotics. In addition, we will assess the appropriateness of prescriptions of “protected” antibiotics and whether new microbiological rapid tests to detect antibiotic resistance may offer opportunities for antibiotic stewardship actions. We plan to conduct a prospective, multicenter, randomized, quasi-experimental study using a segmented interrupted time series (ITS) regression analysis.We expect to show that our intervention will reduce the use of “protected” antibiotics. By using antibiotics more appropriately, we guess an impact on antimicrobial resistance. The study will be an opportunity to set up local antibiotic stewardship programs by involving the local stakeholders in Swiss acute care hospitals. It is of upmost importance that many Swiss hospitals can share antibacterial stewardship programs feasible in daily practice in various hospital settings. Our approach may also offer perspectives for future antibiotic stewardship campaigns to raise general awareness on appropriate antimicrobial use. The development of a communication strategy will allow a visibility beyond the participating hospitals.
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