antibiotic therapy; Gram-negative bacteraemia; chronic-care patients; antibiotic over-utilisation; point-of-care randomisation
Huttner Angela, Albrich Werner C, Bochud Pierre-Yves, Gayet-Ageron Angèle, Rossel Anne, Dach Elodie von, Harbarth Stephan, Kaiser Laurent (2017), PIRATE project: point-of-care, informatics-based randomised controlled trial for decreasing overuse of antibiotic therapy in Gram-negative bacteraemia, in
BMJ Open, 7(7), e017996-e017996.
von Dach Elodie, Albrich Werner, Brunel Anne-Sophie, Prendki Virginie, Cuvélier Clémence, Flury Domenica, Gayet-Ageron Angèle, Huttner Benedikt, Kohler Philipp, Lemmenmeier Eva, McCallin Shawna, Rossel Anne, Harbarth Stephan, Kaiser Laurent, Bochud Pierre-Yves, Huttner Angela, Effect of C-Reactive Protein-Guided Antibiotic Treatment Duration, 7-Day Treatment, or 14-Day Treatment on 30-Day Clinical Failure Rate in Patients with Uncomplicted Gram-negative Bacteremia, in
JAMA, 323(21).
Our best intentions for the patients of today may be harming the patients of tomorrow. Physicians in Switzerland are cognizant of the current level of resource waste, but are confronted daily by an unfortunate triad: sick individuals in need of immediate help, a relative wealth of diagnostic and therapeutic options, and only a meagre evidence base proving that many of these options are simply unnecessary for the patient at hand. New methods to strengthen this evidence base-efficiently and at low cost-are long overdue, given that traditional randomised controlled trials (RCT) are expensive, time-consuming, and often lack external validity. Uniquely positioned to compare approved treatments or diagnostic techniques toward which there is clinical equipoise, novel point-of-care trials use the electronic health record (EHR) already in place in the majority of healthcare systems to embed pragmatic RCT in the clinical setting, thus creating “learning healthcare systems” to benefit current and future patients. The use of the EHR facilitates participant recruitment and data collection, minimising study overhead and excessive follow-up visits for patients, and maximising generalisability. Clinical outcomes data from “real” patients, also retrievable from the EHR, can be analysed efficiently and fed back to healthcare providers to guide later management. We propose to conduct the first POC randomised controlled trial in Switzerland and thereby build a platform for further low-cost, methodologically rigorous POC trials. As a seminal prototype, and with a focus on conserving an endangered healthcare resource for an aging population, the trial proposed here will assess optimal durations of antibiotic therapy for Gram-negative bacteraemia, a frequent - and frequently life-threatening - infection in patients with chronic conditions. Patients with chronic illnesses rely most on antibiotics and, through no fault of their own, misuse them the most. While health services research clearly aims to optimize the prevention and treatment of illnesses in our aging population, its goal must also be to safeguard the precious, limited resource without which these individuals cannot safely undergo routine cardiovascular and joint-replacement surgeries, chemo- and other immunosuppressive therapy, and for whom common infections and minor injuries could once again become life-threatening.